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Jun 6 • 10 tweets • 9 min read
#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
#EULAR2022
What is New (WIN)
IgG4
Role of Gut microbiota suspected
🔆 changes similar to PSC
🔆⬇️Blautia, ⬇️ Eubacterium seen in IgG4-SC
#EULAR2022
What is New (WIN)
IgG4
🔆Cluster analysis divides IgG4 in 4 Clusters
🔆Head and Neck MC in females and asians
🔆Mikulicz 👉🏻 ⬆️⬆️IgG4 levels
🔆 Renal Inv asso with ⬆️ pancreato biliary, RPF, ⬇️C3, Multisystem inv
#EULAR2022
What is New (WIN)
IgG4
Newer biomarkers being developed
🔆Plasmablast appear promising (But costly)
Acc to Machine learning
🔆IgG4 level
🔆Age
🔆Ig
🔆sIL-2R
Important variables
#EULAR2022
What is New (WIN)
IgG4
🔆Initial Rx with IS might be better
🔆50% flare by 2-3 yrs with RTX Induction
🔆Obinutuzumab in RTX resistant/Failure
#EULAR2022
What is New (WIN)
IgG4
🔆Tocilizumab 🔥>> CYC
🔆Abatacept ❌
#EULAR2022
What is New (WIN)
IgG4
🔆⬆️ malignancy risk with IgG4
🔆Lung Ca⬆️
🔆Pancreas Ca ⬆️
🔆Lymphoma ⬆️
🔆but not Gastric Ca
🔆Most diagnosed with the 1st year of IgG4 diagnosis
#EULAR2022
What is New (WIN)
IgG4
Summary
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More from @ERheumat

EnvisionRheumat Profile picture
Jun 6
#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
Read 7 tweets
EnvisionRheumat Profile picture
Jun 5
#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
Read 6 tweets
EnvisionRheumat Profile picture
Jun 4
#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 ImageImageImageImage
#EULAR2022
Rheumatology across boundaries
The eye in rheumatic diseases
🧿 Most common extra-articular feature
🧿 HLA-B27+vity, Recurrent uveitis and IBP 🚩 for rheumatology referral ImageImageImage
#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 ImageImageImage
Read 6 tweets
EnvisionRheumat Profile picture
Jun 4
#EULAR2022
How To Treat (HOT)
Anti-phospholipid syndrome Image
#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) ImageImageImageImage
#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 ImageImageImageImage
Read 7 tweets
EnvisionRheumat Profile picture
Jun 4
#EULAR2022
IBD management for Rheumatologist
🔎The options have been increasing over the years
🔎Remission rates have still not crossed 30-40% Ballpark ImageImageImage
#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 ImageImageImage
#EULAR2022
IBD management for Rheumatologist
🔎Very Few Head to head trial to decide biologic of choice
🔎 Vedoli>Adali but Ustki=Adali ImageImageImage
Read 7 tweets
EnvisionRheumat Profile picture
Jun 4
#EULAR2022
New treatment strategies and approaches to young adults with inflammatory myositis
Treatment options available their doses in IIM Image
#EULAR2022
New treatment strategies and approaches to young adults with inflammatory myositis
♦️MTX+GC>>MTX+CIC>GC alone ImageImage
#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 ImageImage
Read 8 tweets

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