Richard Conway
@richardpaconway
Rheumatologist @stjamesdublin , Associate Professor @tcddublin , Acute Medicine, Vasculitis, ILD, @rheum_covid CASC
ID: 847882911135223809
31-03-2017 18:46:53
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Dr Charles-Schoeman gives us an overview of DM treatment options with a focus on JAKi. Agree, have seen very refractory patients benefit hugely from JAKi use. Dr. John Cush #RNL2025
Dr Charles-Schoeman describes dermatomyositis as a vascular disease. Which explains some of these initially strange things we see, with CPK and inflammatory markers not always fitting with the clinical picture Dr. John Cush #RNL2025
Importance of not over-relying on lab tests. We can test for what we can test for, but this is not comprehensive. For me in clinical practice - Postive antibodies can confirm diagnosis of DM but negative cannot exclude it. Dr. John Cush #RNL2025
Prof van der Heijde. Continuous (vs on-demand) NSAID use prevents structural damage in AxSpA, but only in those with elevated CRP. (Note there has been another negative studies of NSAIDs in this regard) Dr. John Cush #RNL2025
Another way of looking at the NSAID question. TNFi+NSAID vs TNFi alone. Results not statistically significant but there seems there might be some effect. Is it real and is it clinically meaningful though? Dr. John Cush #RNL2025
Dr Cather on hidradenitis suppurativa. I see a fair bit of HS, but didn't appreciate it was this common. Dr. John Cush #RNL2025
Dr Cather treatment options in HS. The last 2 obviously in rheumatology's wheelhouse Dr. John Cush #RNL2025
Really like this old school slide from Michael Wechsler. EGPA is a tiny fraction of lung conditions with eosinophilia. While also often under-diagnosed when present, I frequently see cases diagnosed as EGPA which clearly aren't. Dr. John Cush #RNL2025
Dr Wechsler's version of one of my key EGPA pearls. It has a sequential triphasic pattern. Allowing for the occasions were it can happen quickly or the patient may not remember the earlier phases, if you don't see this pattern question the diagnosis! Dr. John Cush #RNL2025
Dr Wechsler on EGPA management. Eosinophils do hate those steroids! That "But..." is crucial Dr. John Cush #RNL2025
Why we can't just use steroids for EGPA (and most things in rheumatology) Dr. John Cush #RNL2025
Potential to consider monotherapy in EGPA for certain patients. Even then not convinced this is the best approach Dr. John Cush #RNL2025
Mepolizumab in EGPA. I mean the graph is convincing but mepo for EGPA does remind me a bit of nintedanib for ILD Dr. John Cush #RNL2025
Dr Rhee Rennie Rhee tackles the thorny issue of extracranial screening in GCA. I think this is a reasonable approach. Dr. John Cush #RNL2025
Dr Rhee Rennie Rhee summarises her current approach to imaging in LVV Dr. John Cush #RNL2025
Dr Rhee Rennie Rhee mimics of medium/large vessel vasculitis. Increase in cross-sectional imaging use has increased the number of these we get referred. Segmental arterial mediolysis also pops up a fair bit. Dr. John Cush #RNL2025
Most important aspect of #PMR is 👇 Getting #diagnosis ✅ Richard Conway #RNL2025 Dr. John Cush Think of mimickers If it does t fit in #dx - don’t make it fit Proximal only, bilat and should be upper arms and hip girdle ⬆️ESR and or ⬆️CRP Usu💯 % better ~72H at 15mg/d pred
Richard Conway #RNL2025 Dr. John Cush RCT for PMR - MTX does not help SAPHYR trial - NEJM - Sarilumab showed sustained remission at W52 for relapse (28 v 10%) PMR-SPARE- TCZ for new-onset Single dose of RTX? Not as impressive as IL-6 data JAKi? BACHELOR- Bari, EAST PMR - Tofa
