Blog entry by Meguid El Nahas

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by Meguid El Nahas - Wednesday, 15 February 2012, 10:42 PM
Anyone in the world

Questions and answers put to Prof Glassock following his talk on the Management of Vasculitis:

 

Prof Salah Naga: Is there a role for CNIs in the management of ANCA associated systemic vasculitis?

Prof Glassock: CNIs do not seem to be very effective in the management of AASV. They certainly dont feature in the recognised effective therapeutic approaches.

Prof Sabry Gohar:  Is there a role for Infliximab in AASV?

Prof Glassock: No role and many reports of significant side effects including a high rate of infectious complications.

Prof Adel Afifi: IN the face of an increase in sCr, when would you rebiopsy?

Prof Glassock: Rebiopsying should be considered in the face of clinical, biochemical (CRP) or immunological (Autoantibodies) signs of disease activity.

Prof Afifi: How do you treat relapses?

Prof Glassock: I treat relapses of AASV with rituximab to avoid the toxicity of repeat courses of cyclophosphamide.

Prof Essam Nooreldin: How do you prevent hemorrhagic cystitis?

Prof Glassock: In more than 30 years of practice, I did not see a single case of hemorrhagic cystitis.

I tend to prescribe the cyclophosphamide to be taken at 9am

along with 4 glasses of water and I encourage th epatient to drink more water at bedtime (another 4 glasses).

Prof El Nahas: Do you think that Plasma exchange is beneficial outdside the indication for lung hemmorhage?

Prof Glassock: Whilst the MEPEX study showed some benfit at 12 months, follow up study over more than 3 years failed to show any advantage of plasma exchange of ESRD or death and was associated with increased toxicity/side effects (Walsh and Jayne, Personal Communication).

 

 

 

 

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