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Written byFan Zhihua
The American College of Rheumatology Annual Meeting (ACR) and the European Union Against Rheumatology (EULAR) are two major international academic conferences
in rheumatology every year.
In 2022, the "Medical Rheumatology and Immunology Channel" not only reported the interesting and innovative conference content of the two conferences in real time, but also carefully invited the youth members of the Rheumatology Branch of the Chinese Medical Association to sort out and explain
.
On the occasion of leaving the old and welcoming the new, the "Rheumatology and Immunology Channel of the Medical Community" specially inventoried some of the heavy contents of ACR and EULAR in 2022, and reviewed and learned with you~
Practice guidelines for anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).
Since 2016, the academic community has made great strides in AAV research, and at the EULAR 2022 Annual Conference, Professor Bernhard Hellmich of Germany shared the 2022 AAV guidelines
on behalf of the EULAR working group.
This guideline update includes evidence from 124 studies, and the level of agreement (LoA) recommended by the guideline is from 0 to 10 to represent "completely disagree" to "fully agree", and the early sharing of this guideline will be classified
by "update", "revision" and "retention".
Guidelines state that high-quality antigen-specific testing is recommended as the mainstay of testing for patients with signs and/or symptoms suspected of AAV, along with anti-protease 3 (PR3) and antimyeloperoxidase antibodies (MPO).
In addition, the guidelines have been revised
on glucocorticoid use of GPA/MPA, induction of remission with EGPA, treatment of relapsed or refractory EGPA, and maintenance of remission in EGPA.
Latest! ANCA-related vasculitis guidelines are focused, and it is enough to collect this one
02Vitamin
D and rheumatic immunology
Vitamin D is a fat-soluble vitamin that promotes the body's absorption of calcium and phosphorus, affects calcium salts and bone renewal, etc.
, in serum, the main form of vitamin D is 25-hydroxyvitamin D
.
And there is growing evidence that vitamin D plays a role
in innate immune responses.
So, what role does vitamin D play in rheumatic immune diseases that are closely related to immunity?
Many scholars have conducted in-depth research on the topic of vitamin D and rheumatism, and shared the following latest progress at the EULAR 2022 Annual Conference:
Low 25-hydroxyvitamin D levels and VDR (FokI) gene polymorphisms are independent risk factors
for osteoporosis in postmenopausal rheumatoid arthritis (RA) patients.
Vitamin D deficiency is associated with RA activity, and this association is independent
of age, daily glucocorticoid dose, and course of illness.
In addition, studies have found that vitamin D tends to reduce the relative risk of RA, PMR and psoriasis, and has a greater
impact on patients with normal BMI.
Indeed, vitamin D not only plays an important role in the regulation of the immune system, but studies have also found that vitamin D plays an important role
in the regulation of immune responses induced by drugs such as methotrexate (MTX) or bDMARDs.
How important vitamin D is for rheumatism patients, read this article to know it all!
Febuxostat vs Allopurinol, who is the final winner in the uric acid lowering field?
In the field of gout, the urate-lowering drugs febuxostat and allopurinol have always attracted the attention
of doctors and patients.
Febuxostat or Allopurinol? What are their cardiovascular risks? Is long-term use of urate-lowering drugs related to kidney function? The medical community's rheumatology and immunity channel searched the summary of the study in EULAR 2022, and these questions have been answered~
A large cohort study based on the Korean population showed similar cardiovascular safety among febuxostat and allopurinol users, but relatively lower
all-cause mortality in the febuxostat group.
Prospective studies have shown that the ability of patients with gout to achieve target serum uric acid levels when taking febuxostat is independent of renal function
.
Even in patients with CKD C4, the blood uric acid compliance rate after taking febuxostat treatment still exceeds 80%.
Regardless of renal function, febuxostat is relatively well tolerated and effective
.
Regarding febuxostat, the 2 most concerned questions for gout patients, EULAR said so.
.
.
use of immunosuppressants, how to kill a thousand enemies and minimize self-damage?
In the past two decades, people have gradually proved through evidence-based medicine that immune disorders are prevalent in rheumatic diseases, so researchers have begun to intervene in the immune system, hoping to develop new rheumatic disease treatments - immunosuppressive therapy is a product
of this background.
However, the intervention model has also brought many unavoidable adverse reactions, coupled with the significant heterogeneity of rheumatic diseases, how to avoid or reduce the adverse reactions of immunosuppressive therapy as much as possible to improve the benefits of different patients is an important issue
plaguing the rheumatology immunology community around the world.
The two abstracts presented in EULAR 2022 discuss the issue of immunosuppressants, not only discussing the adverse effects of immunosuppressants, but also showing that stopping targeted monotherapy is unlikely to maintain disease control
.
For clinical practice, it is particularly important
to control the occurrence of adverse reactions related to immunosuppressants.
Attempts to improve the situation by reducing drug discontinuation have focused on the definition of disease steady, hoping to establish a balance between the lowest disease activity and the highest quality of life for patients, the so-called standard treatment
.
If and only if the disease control meets the definition of standard treatment, the reduction of immunosuppressants can be based on evidence, and the adverse reactions of immunosuppressants can be anchored and the appropriate treatment of "the right medicine" can be made, thereby improving the current survival and long-term prognosis
of patients.
How to deal with adverse effects of immunosuppressants? And how to reduce the amount?
ACR's first guide on integrated management interventions for RA
In 2022
At the ACR Annual Meeting, ACR has developed new clinical practice guidelines for diet, exercise, rehabilitation, and other adjunctive interventions for patients with RA, with final publication expected in spring
2023.
The guidelines strongly recommend consistent exercise
.
Continuous participation in one or more exercises, including aerobic exercise, water exercise, resistance exercise, and mind-body exercise (e.
g.
, yoga, tai chi, qigong),
is recommended.
In terms of diet, guidelines conditionally recommend adherence to a Mediterranean-style diet, opposition to a formally defined diet other than the Mediterranean diet, following established dietary recommendations, and not using dietary supplements
.
06Subclinical
rheumatoid arthritis, should drug intervention be required?
Subclinical rheumatoid arthritis (subclinical RA) refers to a state in which patients are autoantibody positive and subclinical synovitis precedes the occurrence of clinical arthritis, and is increasingly common
in rheumatological practice.
However, in practice, there is no conclusive view on how to manage it, and whether initiation of condition-modifying antirheumatic drugs (DMARDs) in this state can prevent the development of
RA.
2022
ACR invited speakers to debate pharmacological interventions for subclinical RA, with proponents arguing that doing so could reduce the burden of disease later onward; The opponent believes that in the absence of therapeutic guidance markers and a clear definition of subclinical RA, preventive treatment is not wise, and current clinical trials have shown that it can only be delayed but not truly prevented, and corresponding arguments
are put forward based on medical practice in the United States.
This is also of practical guiding significance
for the clinical practice of RA in China.
This type of rheumatoid arthritis, can it be good without medicine?
07When
a rheumatologist encounters discoloration of the fingers and toes, how to grasp the essence of differential diagnosis?
It is often associated with peripheral vascular disease, mostly caused by non-rheumatism, so clinical attention should be paid to differential diagnosis
.
Although vasculitis is not a common cause of ischemia, it must be carefully differentiated during diagnosis
.
The 2022 ACR Annual Meeting details how to make differential diagnosis
based on discolored fingers (toes) starting from the most common digital ischemia of vasculopathy and vasculitis.
Macrovasculitis can be adequately excluded by CTA; Patients should also undergo a clinical evaluation for evidence of small vessel vasculitis; Clinical diagnosis of polyarteritis nodosa and rheumatoid vasculitis is relatively difficult because biopsy diagnosis is often unconfirmable, and it is important to distinguish endocarditis (which can present with many of the confounding symptoms of mesovasculitis when looking for evidence of vascular involvement in other systems).
When a rheumatologist encounters discoloration of the fingers and toes, how to grasp the essence of differential diagnosis?
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