#EULAR2022
What is New (WIN)
MSK Manifestations in COVID 19 patients
🦠 MSK Pain in COVID can have an Osteometabolic profile
🦠 Mech for autoimmunity include
🔸Molecular mimicry
🔸Cryptic antigen presentation
🔸Epitope spreading
🦠APLs, ACAs and ANAs have been positive
#EULAR2022
What is New (WIN)
MSK Manifestations in COVID 19 patients
🦠Inflammation in COVID is similar to MAS
🔸Has ⬆️Ferritin, ⬆️IL1,IL6 ⬆️ INF signature
(Though usually not as high as in MAS)
#EULAR2022
What is New (WIN)
MSK Manifestations in COVID 19 patients
🦠TCZ, JAKi, IL1 and anti-INF-Gamma Rx has utility in Rx
#EULAR2022
What is New (WIN)
MSK Manifestations in COVID 19 patients
🦠 Mortality is ⬆️ with
⬆️ Disease activity
⬆️ Steroid dose (>10mg/day) and RTX
⬆️ age,
⬆️comorbidities and prior Lung disease
#EULAR2022
What is New (WIN)
MSK Manifestations in COVID 19 patients
🦠Long covid mimics ageing with endothelial and adipose dysfunction
🦠Has similarities with FMS
#EULAR2022
What is New (WIN)
MSK Manifestations in COVID 19 patients
🦠 vaccine theoretically can lead to immune activation via TLR 7n9 and lead to flare or new immune event
🦠 cutaneous vasculitis most common menifestation
#EULAR2022
What is New (WIN)
MSK Manifestations in COVID 19 patients
🦠DMARDs and their Role in Vaccine efficacy
#EULAR2022
What is New (WIN)
MSK Manifestations in COVID 19 patients
Summary Slide
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#EULAR2022
Pain in rheumatic and musculoskeletal diseases
😩Pathophysiology of pain in patients with RMDs is not always Nociceptive and can be nociplastic
😩Differentiation between inflammation-related and unrelated pain is important
#EULAR2022
Pain in rheumatic and musculoskeletal diseases
😩Pain can be Nociceptive, Neuropathic and Nociplastic
😩Or can be primary/Secondary
😩Pain sensitisation, processing and response are important for proper assimilation of pain
#EULAR2022
😩No standard method to measure central pain
😩FMS can be present in upto 50% of patients
😩Asso with Higher disease activity and higher biologic use/change
😩A no. of central mechanisms contribute to pain
#EULAR2022
What is New (WIN)
Osteoarthritis – evolving treatments
This talk is a must-watch on-demand - highly recommended
🗝Proposed NICE-UK guidelines for
#EULAR2022
🗝Most trials have tried correcting catabolic pathway
🗝 Most trials in OA have failed
🗝Cartilage though sparsely cellular/vascular exquisitely sensitive to injury
🗝 Max polymorphism in OA is found in the Anabolic pathway
#EULAR2022
What is New (WIN)
Osteoarthritis – evolving treatments
🗝Shear stress leads to damage while compression leads to regeneration
🗝Has been utilized in Joint distraction showing good results
#EULAR2022
Rheumatology across boundaries
The eye in rheumatic diseases
🧿The Pathophysiology of Uveitis is poorly understood
🧿 Uveitis is thought to be due to enthesitis of ciliary body attachment
🧿TH17 and TH1 are major mediators of inflammation
#EULAR2022
Rheumatology across boundaries
The eye in rheumatic diseases
🧿 Most common extra-articular feature
🧿 HLA-B27+vity, Recurrent uveitis and IBP 🚩 for rheumatology referral
#EULAR2022
Rheumatology across boundaries
The eye in rheumatic diseases
🧿 Non-Anterior non infectious Uveitis has a no of causes 👉🏻 makes studying the disease difficult
🧿 Sarcoid, Behcet's other imp causes
🧿 Topical Rx 1st for Anterior Uveitis
🧿 Systemic 1st for NIU
#EULAR2022
How To Treat (HOT)
Anti-phospholipid syndrome
#EULAR2022
How To Treat (HOT)
Anti-phospholipid syndrome
🩸Primary Thromboprophylaxis
🩸Aspirin is recommended but might not be sufficient
🩸VKA use is asso. ⬆️ Bleeding risk (Risk>Benefit)
#EULAR2022
How To Treat (HOT)
Anti-phospholipid syndrome
🩸Secondary Prophylaxis
🩸INR: 2-3 for venous thrombosis (Controversial)
🩸Is not effective in preventing arterial events though
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IBD management for Rheumatologist
🔎The options have been increasing over the years
🔎Remission rates have still not crossed 30-40% Ballpark
#EULAR2022
IBD management for Rheumatologist
🔎Target of therapy is
♦️Clinical remission in short term
♦️Histological remission in medium-term
♦️Disease Modification in Long
🔎Histological activity better marker of future Flare
#EULAR2022
IBD management for Rheumatologist
🔎Very Few Head to head trial to decide biologic of choice
🔎 Vedoli>Adali but Ustki=Adali
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New treatment strategies and approaches to young adults with inflammatory myositis
Treatment options available their doses in IIM
#EULAR2022
New treatment strategies and approaches to young adults with inflammatory myositis
♦️MTX+GC>>MTX+CIC>GC alone
#EULAR2022
New treatment strategies and approaches to young adults with inflammatory myositis
🪩RIM trial
♦️Better response in JDM
♦️Antibody positive (Mi2,Jo1 +ve ) performed better than Ab negetive