March 2024, Amsterdam
Liebe Kolleginnen und Kollegen
Im Special Report finden Sie jetzt den zweiten Teil von Kurzbotschaften über Neuerkenntnisse in Publikationen über die letzten 12 Monate. Die Aufstellung ist für den raschen Leser konzipiert, für weitere Ausführungen verweise ich auf die jeweiligen Quellenpublikationen.
Viel Vergnügen
Prof. Dr. med. Beat Michel
Osteoporosis (G. Adami)
Glucocorticoid-Induced Osteoporosis
Very low-dose of GCs have been associated with higher fracture risk and bone loss
Screen everyone >=2.5 mg/day of prednisone
Adami et al, Arthritis Rheum 2023; 75(10):1762
Treat most of them
Humphrey et al, Arthritis Care Res 2023; 75(12):2405
Small Vessel Vasculitis (B. Terrier)
EULAR Treatment Recommendations for GPA/MPA
Induction of remission (organ-/life-threatening disease): GC + rituximab or cyclophosphamide
Rituximab is preferred in relapsing and non-life-threatening disease
Alternatives to rituximab: methotrexate or mycophenolate
Maintenance after remission for 24-48 months
Hellmich et al, Ann Rheum Dis 2024;83:30
Avacopan provides benefit in health-related quality
Strand et al, Lancet 2023;5:e451
Geetha et al, Ann Rheum Dis 2024;83:223
zur Studie
Large Vessel Vasculitis (C. Dejaco)
Pathogenesis of GCA
Senescent fibroblasts might trigger inflammation in GCA via IL-6 dependent pathways
Veroutis D et al, Ann Rheum Dis 2024; 83(3):342
Diagnosis
Ultrasound of temporal arteries first imaging test
PET: alternative, also for assessment of cranial arteries
Dejaco C et al, Ann Rheum Dis 2023: doi:10.1136/ard-2023-22443
14% of GCA pts have involvement of intracranial arteries
Guggenberger KV et al, Rheumatology 2024: Keae010
GCA and PMR
PMR and GCA are part of a disease spectrum
Dejaco C et al, Ann Rheum Dis 2024;83(1):48
Subclinical GCA is linked with a higher relapse rate in PMR
DeMiguel et al, Ann Rheum Dis 2024;83:335
Treatment of PMR
IL-6R blockade effective for PMR; Sarilumab approved by FDA
Spiera R et al, N Engl J Med 2023;389(14):1263
Promising data for Tofacitinib and Rituximab
Ma X et al, PLoS Med 2023;20(6):e1004249
Bolhuis TE et al, Lancet Rheumatol 2023;5(4):e208
zur Studie
Possible effects also for abatacept
Saraux A et al, Lancet Rheumatol 2023;5(12):e728
Treatment of GCA
GC treatment duration can be shortened in pts treated with tocilizumab
Unizony S et al, Lancet Rheumatol 2023;5:e736
Muratore F et al, Rheumatology 2023;kead215
zur Studie
Treatment of Takayasu arteritis
TNFi and Tocilizumab first line biologics in TA
Misra DP et al, Autoimmun Rev 2023;22(3):103275
Tocilizumab i.v. may be more efficient for relapses than s.c.
Mekinian A et al, RMD Open 2023;9(2):e002830
Axial Spondyloarthritis (U. Kiltz)
Pathophysiology
HLA-B27 status affects composition of faecal microbiota
Genetics, disease activity and smoking influence microbiota
Microbiota composition may predict response to TNFi
Vallier M et al, RMD Open 2023;9:e002794
Berland M et al, Arthritis Rheum 2023;75:41
zur Studie
Strong impact of disease activity and physical function on global functioning and health
Redeker I et al, RMD Open 2023; doi:10.1136/rmopen-2023-003587
Obesity is frequent, associated with lower socioeconomic status
Micheroli R et al, J Rheumatol 2023; doi:10.3899/jrheuma.2023-0137
Lower diagnostic specificity of structural MRI markers in females
Ulas ST et al, RMD Open 2023; doi:10.1136/rmopen-2023-003252
Treatment
Combi with NSAIDs not superior over TNFi monotherapy in retarding radiographic progression in r-axSpA
Proft F et al, Ann Rheum Dis 2024; doi:10.1136/ard-2023-224699
Treatment response impaired in 2nd/3rd TNFi (loss of efficacy)
Linde L et al, Rheumatol 2023; doi:10.1093/rheumatology/kead494
Remission in 1/3 of axSpA pts treated with TNFi is realistic
Ornbjerg LM et al, J Rheumatol 2023; 50:1009
Upadacitinib: rapid and good clinical improvements in bDMARD inadequate responders
Navarro-Compan V et al, Rheumatol Ther 2023;10:679
Eosinophilic Diseases (C. Ponte)
EGPA (Eosinophilic granulomatosis with polyangiitis)
ANCA, usually MPO, detectable in 25-40% associated with different frequency of clinical manifestations
Fjolek J et al, Front Med (Lausanne) 2023;10:1145257
ANCA-pos pts: more vasculitis, glomerulonephritis, peripheral neuropathy, purpura
ANCA-neg pts: more cardiac involvement, gastroenteritis
Emmi G et al, Nat Rev Rheumatol 2023; 19:378
Treatment
Treatment based on disease severity:
Remission induction
- Severe disease: high-dose GC and cyclophosphamide (alternative: rituximab (RTX))
- Non-severe disease: GC (+ mepolizumab if relapsing/refractory)
Remission maintenance
- Severe disease: GC + RTX and/or mepolizumab and/or MTX and/or azathioprine
- Non-severe disease: GC + mepolizumab
Hellmich et al, Ann Rheum Dis 2024;83:30
Emmi G et al, Nat Rev Rheumatol 2023; 19:378
zur Studie
Myositis (A. Notarnicola)
Subgroups
Autoantibody-defined subgroups have associations with HLA class I and II
Leclair V et al, EBioMedicine 2023; 96:104804
Checkpoint inhibitor-induced myositis: 3 groups show overexpression of IL6 pathway, suggesting treatment potential for tocilizumab
Pinal-Fernandez et al, Ann Rheum Dis 2023;82(6):829
Scleromyositis is a new subgroup with its hallmarks far beyond an overlap of myositis and systemic sclerosis
Giannini M et al, Front Immunol 2023; 13:974078
Treatment
CD19 CAR-T cell therapy can induce drug-free remission in autoimmune disease in resistant pts including B-cell depleting antibodies
Müller F et al, Lancet 2023;401(10379):815
Taubmann J et al, Rheumatology 2024; 63:e12
zur Studie
SLE & APS (M.Aringer)
New ACR/EULAR APS criteria
IgM autoantibodies essentially irrelevant
Most obstetrical events not sufficient for classification
New criteria:
- Microvascular disease clearly defined
- Libman Sacks endocarditis
- Thrombocytopenia
Barbhaiya M et al, Ann Rheum Dis 2023;82:125
zur Studie2023 Update EULAR recommendations SLE
Hydroxychloroquine (HCQ) recommended to all patients, target dose 5 mg/kg (but individualized based on risk of flare and retinal toxicity)
Glucocorticoids (GC) if needed, to be reduced to a maintenance dose of <=5 mg/d if possible
In pts in need for higher doses of GC and resistant to HCQ: add MTX, azathioprine or mycophenolate and/or biological agents (belimumab or anifrolumab)
Active lupus nephritis: iv cyclophosphamide (CYC) or mycophenolate (MYC) and GC; combination with belimumab (either with CyC or MYC) or calcineurin inhibitors (vaclosporin or tacrolimus, combined with MYC)
Treatment of lupus nephritis to be continued for at least 3 years
Vaccinations incl. COVID-19 should be performed
Fanouriakis A et al, Ann Rheum Dis 2024;83:15
zur StudieTreatment
Hydroxychloroquine: Data suggest better effect with higher doses, but non-adherence worst
Garg S et al, Arthritis Care Res 2024;76:24
Londono Jimenez A et al, Arthritis Care Res 2023; 75:1673
zur Studie
Anifrolumab: achievement of EULAR goals (remission, GC tapering); indications for efficacy on lupus nephritis
Morand EF et al, Ann Rheum Dis 2023;82:639
Bruce IN et al, Rheumatology 2023;62:1526
Jayne D et al, Lupus Sc Med 2023;10:e000910
zur Studie
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