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Meet the professorProf Lars Klareskog
• Current smoking – most important determinant for bad response – more so for TNFi
• Increased physical activity – less severe disease
• Obese – 50% less response
• Always include occupational and leisure activity to estimate true disability
Roadmap for vasculitis
Prof P Bacon
• Descriptions of vasculitis• Diagnostic criteria• Definition of disease – standard nomenclature
• Future – focus on pathogenesis and biomarkers• Management recommendations – EULAR • DCVAS 2017 criteria for AA, SV and PAN – weighted
criteria
Immunosuppression in TA – when and how?
Prof D Danda
• Early diagnosis; treat-to-target – better outcome• Challenges - biomarkers, imaging, assessment• Steroid – 0.5mg/kg/day; slow tapering• AZA better than MTX• MMF – comparable to AZA; better safety profile• TCZ, TNFi, UST, RTX• High dose steroid – TCZ – slow tapering – MMF
maintenance• Steroid + MMF – good option; ITAS monitoring helps
Management of AAV
Prof S Rajeswari
• Importance of testing ANCAs, biopsies• Induction: CYC, RTX• Severe renal – plasma exchange + MP; DAH – IPX + GC• Limited disease – MTX• Maintenance – AZA, MTX, MMF (refractory – higher
relapse)• Prophylaxis; Comorbidities; Vaccinations• Future targets – B cell survival factors, Eculizumab (C5a),
Mepolizumab (IL-5)
When to stop immunosuppression in lupus?
Prof D Karp
• Remission – 1.8 yrs median (3% high dis act)• HCQ – reduced flares, increased survival• Prednisone – major cause of organ damage • ALMS – induction with MMF vs CYC equal;
Maintenance – MMF better than AZA • Reducing MMF – significant risk for flare if
tapered before 18 months
Treatment of NPSLE
Dr D Chellapandian
• Primary prevention – anti-malarials, statins• Non-pharmacological intervention• Pharmacological – AED, dopamine agonists, NSAIDs• Inflammatory - CS, CYC, AZA, MMF (not effective as first line
agent), MTX – intra-thecal (rare), RTX, IVIG, IPX, HSCT• Ischemic – low dose Aspirin, anticoagulation• Future – Belimumab, Tabalumab, Sifalimumab,
Rontalizumab, newer OAC - DTIs• Targets - disruption of BBB, targeting cytokines involved,
TWEAK, Eculizumab
Refractory cutaneous lupus
Prof R Saigal
• Definition – acute, subacute, chronic• CLASI • Therapeutics – Tacrolimus (0.1% & 0.03%), Pimecrolimus
(1%), R-salbutamol• Photoprotection• Steroid topical therapies• Refractory CLE – intra-lesional triamcinolone, HCQ, MTX,
Dapsone, Thalidomide, AZA, Lenalidomide, RTX, BEL
Abstract presentations
• Low dose vs high dose CYC in LN– Short term outcome equal in both
• NMR based metabolomics - distinct signature in LN– Improvement of aerobic oxidation as evidenced by
decrease in glucose levels and normalisation of dyslipidemia
• Monocyte, macrophage related biomarkers in LN – uMCP-1 and sCD163 levels higher in renal disease;
correlate with SLEDAI
• Pro-inflammatory cytokines in SLE– IL6, TNF-α good reliable markers of disease activity– Good correlation with major organ involvement in
SLE
• Comparison of PRP vs steroids in OA knee– PRP - sustained improvement up to 24 weeks– Safe and cost effective
WIN – Sjogren’s
Dr P Sandhya
• ACR/EULAR classification criteria for pSS – 5 criteria; weighted score; score ≥ 4; OSS – 5
• Minor salivary gland biopsy in pSS – NPP of FS<3 – 98%• Anti-TRIM38, antibodies against carbamylated
proteins, anti-muscuarinic 3 receptor• Pathogenesis – EBV, IFN expression correlates with key
phenotypic features, Baminercept trial, RBMS3 gene, epigenetics – hypomethylation of IFN regulated genes,
• Salivary microbiome
Disease modification in SS – is it possible?
Dr S Upadhyaya
• Fatigue – exercise and self care; HCQ• MSK – HCQ followed by MTX, CS• Sicca sympoms – RTX• TNFi not to be used to treat sicca
Abstract presentations
• Serum angiogenic markers of inflammation in early RA by PDUS
• MHA HLA DQ6.1 increases RA risk in Indians irrespective of shared epitope
• Cytokine levels may assist in identifying RA patients achieving remission
• Direct LPS recognition and activation of CD8+ T cells via TLR4 in patients with RA
• Assessment of hand arterial flow patterns from proximal to distal arterial segments in RA
• PET CT in assessing treatment response in DMARDs in RA
Mechanism of action of csDMARDs
Dr S Kumar
• SSZ, MTX, LEF, HCQ, Gold• Mode and scope of action still being determined• Pleotropic modes of action• HCQ and LEF – synergestic action with MTX• MTX – immunomodulatory effect by adenosine• LEF – antiproliferative
HCQ and eye: a blind spot
Dr SJ Gupta
• SAE – thrombocytopenia, agranulocytosis, mental disorders, myopathy
• Mechanism of retinal toxicity – increase pH of RPE lysozomes – impairs RPE cell function
• Bull’s eye maculopathy• SD OCT, mfERG, FAF, 10-2 automated visual field• AAO recommendation for screening of HCQ
retinopathy – actual body weight ≤5mg/kg
Cs& biologic DMARDs in perioperative setting
Brg Narayanan
• CS – Hydrocortisone• MTX – stop one week prior to surgery• TNFi – ACR - withhold ≥1 wk before surgery; BSR –
withhold 3-5 half times of drug • RTX – no association between complication and
length of time of infusion• Withhold drugs for 1.5 times the dosing interval
and restart after wound healing
Evaluation of bone health in AIRDDr Nisha N
• Risk of vertebral fractures in AS – high• Hip fractures not high in AS• DEXA limitations in AS – hip BMD, cannot assess bone
microarchitecture and strength• HRpQCT • Treatment with biologic drugs associated with decrease in
bone loss in RA• TNFi agents show preservation or increase in spine and hip
BMD
Osteoporosis : Therapeutic advances
Dr Pande I
• How to choose between various bone agents – 1st line oral BP, HRT, severe OP – teriparatide, CKD - Denosumab
• How to assess and monitor response – 3 mth follow-up - bone markers
• How long to treat – drug holiday – ON jaw; atypical fractures
• Treatment failure – fracture after Rx for 1 yr
WIN – detection of autoantibodies
Prof Stoecker W
• Automated washing of IIF slides• Euroimmun microchip ANA • Euro-pattern microscope – automated ANA
pattern reader• Autoimmune myositis, systemic sclerosis, DM,
PBC
Lupus anticoagulant - Lab
Dr Kamath V
• Common errors occurring in labs with LAC test• Phospholipid platform – tenase complex +
prothrombinase complex• Two APTTs needed – screening &
confirmation; mixing studies• International sensitivity index = 1 / sensitivity• International normalized ratio