#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
😩FMS co-exists with other RMDs
😩The newer classification is more exclusive
😩 ⬆️ sensitivity or ⬇️ inhibitory control of pain can happen
😩 The concept of fibromyalgianess is new and interesting
😩Pharmacological management is available and can be effective
#EULAR2022
Pain in rheumatic and musculoskeletal diseases
😩Nociplastic pain in RA
😩In 20-30% pts
😩Older
😩⬆️ pain scores / DAS28s
😩Worse Physical functions
😩Mental health issues
😩⬆️ Comorbidities
😩More freq Rx changes
😩Poor Response to bDMARDs
#EULAR2022
Pain in rheumatic and musculoskeletal diseases
😩Management requires effective screening and holistic multidimensional, multimodal management
😩Education
😩Physical Activity + wt. ⬇️
😩Psychosocial interventions
😩Occupational therapy
😩Sleep Rx
😩Pain control meds
#EULAR2022
Pain in rheumatic and musculoskeletal diseases
Conclusions of understanding Nociceptive pain in RA and SpA
Don't Stigmatize Fibromyalgia
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#ACR22#ACR2022
12S129. Purple Peripheries: Vasculopathy VS Vasculitis
Philip Seo is awesome as always
The most common cause is Cardiovascular followed by Rheumatic
More commonly vasculopathy than Vasculitis
#ACR22#ACR2022
12S129. Purple Peripheries: Vasculopathy VS Vasculitis
Algorithm for Digital ischemia in Rheum
Mx for Gangrene in SSc
#ACR22#ACR2022
12S129. Purple Peripheries: Vasculopathy VS Vasculitis
Large and Small vessel rarely cause Digital gangrene
#ACR2022#ACR22
12S130. Rheumatology Secrets and Pearls
Dr John Stone, at his best
🎯RA may present with asymmetric arthritis
🎯AAV might present with migratory oligoarthritis, which is steroid responsive
🎯Only a quarter of RA patients go into remission during pregnancy
#ACR2022#ACR22
12S130. Rheumatology Secrets and Pearls
🎯Following trends is more important in pregnancy that stat values (ESR/Complements)
🎯Proteinuria⬆️ creat ⬇️ due to ⬆️ GFR and maternal Blood volume in pregnancy
#ACR2022#ACR22
12S130. Rheumatology Secrets and Pearls
🎯Puffy fingers may be the first sign of SSc in RNApolIII SSc and No Raynaud's - May present with SRC
🎯ACEi are best kept reserved for SRC
#ACR2022#ACR22
12S130. Rheumatology Secrets and Pearls
Jason Kolfenbach, with his wonderful pearls 1. Vasculitis Pearls
🦪For Steroids ➡️ Less is more
🦪Be very careful in stopping Rx in AAV pts
🦪Don't give up on PLEX in suspected AAV Anti-GBM may have ANCA positivity.
#ACR2022#ACR22
12S130. Rheumatology Secrets and Pearls
🦪Not all Skin thickening = SSc
🦪Lipodermatosclerosis (with inverse 🍾 sign)
🦪Thyroid disease important mimics
🦪PPI can cause diarrhoea
🦪FVC/DLCO ratio can help diagnose ILD/PAH
#ACR2022#ACR22
12S130. Rheumatology Secrets and Pearls
🦪30% SLE pts have APS
🦪DLE uncommonly progresses to SLE
🦪PPIs, NSAIDs, Anti-HTN meds commonly cause SCLE
#ACR2022#ACR22
12S102. Year in Review 👌🏻
1st to be discussed was the Gloria Trial
Glucocorticoids effective but safety an issue
#ACR2022#ACR22
12S102. Year in Review 👌🏻
Next to the most discussed study of the year
Oral surveillance trial
The CV risk is higher in those with ASCVD - NNH 16😳
#ACR2022#ACR22
12S102. Year in Review 👌🏻
Next to the Proderm Study
Cost, thromboembolism a concern in the first positive phase 3 RCT in myositis
#EULAR2022
What is New (WIN)
IgG4
🔆IgG4 is a multi-organ Disease
🔆usually >50
🔆M:F - 3:1
🔆CD4+ cytotoxic cell implicated
🔆 Classification criteria known
#EULAR2022
What is New (WIN)
IgG4
🔆➕ve correlation with smoking (IgG4 retroperitoneal fibrosis)
🔆 blue Collar Jobs have ⬆️IgG4 (pancreato biliary)
🔆d/t toxic exposures 👉🏻 asbestosis, mineral dust
#EULAR2022
What is New (WIN)
IgG4
🔆Role of AutoAb suspected
🔆Anti-IL1RA👉🏻Mediates Inflammation and fibrosis
🔆Anti-Annexin A11👉🏻 damage biliary bicarbonate umbrella