SSc-ILD-an overview by Chris Denton
This was a Masterclass in SSc-ILD
🧵Alert 2/n
🫁ILD is associated with a poorer outcome
🫁 Dyspnea in SSc could be multifactorial
🫁 Tissue Oxygen delivery is also ⬇️ Significantly

#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

#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
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
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😳

#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
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
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
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
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
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
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
Contrasts in pathomechanisms and treatment targets between adult and paediatric inflammatory myositis
👁‍🗨 Awesome class on IIM pathogenesis
👁‍🗨The MSA and Phenotype Slide is 👌🏻👌🏻 #EULAR2022
Contrasts in pathomechanisms and treatment targets between adult and paediatric inflammatory myositis
👁‍🗨Summary of Mechanisms
👁‍🗨DM/JDM👉🏻 CD4 and TH17 mediated
👁‍🗨 Both Inflammatory and non inflammatory factors contribute

#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
How to treat (HOT)
Difficult to treat RA
Definition: #EULAR2022
How to treat (HOT)
Difficult to treat RA
🟣 FMS is asso with more severe RA
🟣 Pts with D2T RA have higher comorbidity burden
🟣 Obesity is also a mediator of non Response

#EULAR2022
Apples AND/OR oranges? Differentiating common and uncommon arthritides
Enthesitis can be seen in Upto 40% patients with PsA
Enthesitis is associated with
♦️⬆️Disease activity
♦️Synovitis & dactylitis
♦️⬆️Radiographic Damage
♦️ Poor functional Status #EULAR2022
Apples AND/OR oranges? Differentiating common and uncommon arthritides
♦️Fibromyalgia can be seen in 25% of PsA pts
♦️ Asso with
♦️ ⬆️ Disease activity
♦️ Poor Response to Rx 👉🏻 Change of Rx