Thread by @GuyKatzMD

Still can't get over how good the #RheumMadness scouting reports are.

Common themes:
✅Most teams are convinced they will win their first round match-up (🤔)
✅Everyone is worried about AAV/SLE teams

Are we being blinded by the bright and shiny AAV/SLE trials?

I say yes.

🧵

First, let's acknowledge that these trials (BLISS-LN, TULIP, PEXIVAS, ADVOCATE) are amazing and definitely worthy competitors. But clinical trials aren't new in #Rheumatology and the other teams offer so much to our field.

IgG4-RD Classification Criteria:

✅Disease many in our field don't understand
✅Describe common + rare manifestations
✅Emphasize IgG4-RD 🆚 mimickers

Think it's too rare to win? We don't even know prevalence (likely under-recognized)!

Hence the criteria...

RP Subtypes:

Sure, it's rare, but now we know that:
✅Many don't have classic phenotype
✅Prolonged delay in diagnosis common

In a disease where diagnostic delay can be devastating, understanding these phenotypes is 🗝️

Anti-CD38 in Refractory SLE:

✅Treating sickest of sick patients (🆚 BLISS-LN)
✅Drug already available for use for other indications (🆚 anifrolumab, avacopan)

It's hard to study such sick patients in large trials, but maybe they care about wins like this > large trials?

VEXAS:

✅New disease!
✅Substantial morbidity/mortality
✅MDS + vasculitis + RP + Sweet, etc. (🤯)
✅Incredible gene-driven discovery likely to be replicated to find other diseases
✅Probably way more common than we realized

We'll be talking about this one for a while...

SEMIRA:

✅Tapering off steroids entirely works 🆚 maintaining low-dose
✅Tapering group exposed to less steroid than avacopan group in ADVOCATE!

Talk about day-to-day applicability...

Harms of short term steroids:

‼️Steroids are our worst enemy
‼️We use them so much we can forget that even small amounts are toxic
✅Important wake-up call to use less steroids

Sure, no rheum pts in the study. But their pts were healthier, so numbers for rheum may be worse...

UK Frost for Frozen Shoulder:

✅Exceedingly common, debilitating, and long-lasting
✅Conservative treatments work as well as procedures

Let's acknowledge that we see a lot of this. This is important.

PT vs GC injection for knee OA:

✅As common as it gets
✅Steroids are not benign (see above)
✅High quality data guiding day-to-day decisions

PRIME cells for RA:

✅Credit where it's due: they followed 4 pts for years and analyzed labs WEEKLY
✅Immediate implications for understanding of pathophysiology
✅Potential for future therapeutics

This is beautiful science for the prototypical disease of rheumatology.

Synovial B cells & therapy response in RA (R4RA):

✅Do we advance this team to thank the patients who had synovial biopsies for the good of science?
✅Any step towards precision medicine is a huge win.

FAST Study:

✅Gout: most common inflammatory arthritis
✅Debunks an important safety concern
✅I've learned to never underestimate gout

ACR Gout Guidelines:

✅Relevant to rheum, primary care, and many other specialists
✅Address important controversies (let's end the treat-to-target debate)
✅I just love that ice is conditionally recommended.

Again, gout never ceases to amaze.

So to summarize:

✅Clinical trials in AAV and SLE are great
✅There have been incredible advances in our field outside of these
✅Blue Ribbon Panelists know all of this and have final say

Read the Scouting Reports:
sites.duke.edu/rheummadness/b…

No time to read? Listen to the book-on-tape Podcast version courtesy of @DavidLeverenz and @LisaCriscione:
rheummadness.buzzsprout.com/1465681/817554…

Haven't submitted your #RheumMadness bracket yet? You have until 3/26 at 11:59pm EST!

sites.duke.edu/rheummadness/c…

@AkiUdupa @didemsayginmd @jeffsparks @kristenyoung @EBRheum @TKTarrant @Nephro_Sparks