Practical Advice for Managing SARDs in the Current Treatment Landscape


Closing out their discussion, experts highlight practical advice for caring for patients with SARDs in the current treatment landscape.


W. Hayes Wilson, MD: It’s important for us to understand that we treat the whole patient, and we treat the whole patient in the circumstances that surround us. And the circumstance that surrounds us now is COVID-19. Sometimes, it brings families closer together because they’re sheltering in place, and that helps with their support group. But sometimes, it’s the opposite. Sometimes, an older parent can’t be around their kids because their kids are sick, or their kids have little kids who are sick. And they don’t have the support. It’s good to keep all those factors in mind when we’re prescribing things. Sometimes an infusion is better, and sometimes a self-injection, for instance, like a repository corticotropin injection, might be easier than coming in to get an infusion. And in some ways, it may be more effective. We have to take into account all the factors with our patients, their support systems, their ability to come in and get treatment, their ability to get the monitoring that they need. All those are important things. Any comments you want to make on that?

Kostas N. Botsoglou, MD: I totally agree. I tell my patients if you want black and white, then this is not the specialty for you. We are many shades of gray, and our decisions are individualized and based on our best opinion.

W. Hayes Wilson, MD: I like to say, that absence of evidence is not evidence of absence. Just because you’re paranoid, doesn’t mean that people are out to get you. My professor used to say, “I don’t know what he’s got, but he’s got something.” And sometimes what we have to do is use the information available and go with it. I had a patient who had a bad inflammatory myopathy, early in the pandemic. I wanted to get a muscle biopsy on her, and there were no elective procedures, so I couldn’t do it. I had to go ahead and treat her. And now, doing the muscle biopsy isn’t going to be that helpful because we’re pretty far along. I’m having some trouble tapering her off of her oral prednisone. And I’ve found that repository corticotropin is a good way to help taper because of its effect on melanocortin type 2 receptors in the adrenal cortex. It’s sort of helping the adrenal cortex to work, and to wake up and do its job, so you can give fewer oral steroids.

Kostas N. Botsoglou, MD: It has both, like you mentioned, direct and indirect properties. The percentage of engagement with the adrenal cortex is minimal. That’s the other special sauce, as you might want to call it.

W. Hayes Wilson, MD: Yes. Well, we’ve covered a lot of ground today about treatment options for systemic lupus erythematosus and idiopathic inflammatory myopathies. What advice would you have for community physicians treating rare systemic autoimmune rheumatic diseases?

Kostas N. Botsoglou, MD: Don’t be afraid to say, “I don’t know.” These are rare conditions, and even we’re not seeing them every day. But a good physical history, there are some serologies that are available, that anyone can order, and try to connect the dots with other subspecialties. If it doesn’t make sense, and if they’re having multiple organs involved, and you can’t quite tie a diagnosis, rheumatologists might be the missing link.

W. Hayes Wilson, MD: I like that, the rheumatologist might be the missing link. That sounds great. I say exactly the same thing, that we’re here to help. Please use us as a resource. And we want to work with you and help you to work with things that are rare. I completely agree that common things are common, and not much of what we do is. And certainly, since we don’t have necessarily a light switch that says on and off for our diseases, it takes a lot of clinical judgment, and it takes a lot of working with the patient, following the patient. And sometimes it evolves over time. We might think it’s one thing, and it turns out that it’s something else. I completely agree with everything you have to say. And I think that’s great advice for community physicians. Do you have any final comments before I make closing remarks?

Kostas N. Botsoglou, MD: I look forward to the good old days, where we can all get together in person, and not have to socially distance ourselves and not worry about unvaccinated individuals. And I wish everyone health and the very best.

W. Hayes Wilson, MD: Well, this has been delightful, and I’ve really enjoyed talking with you. I hope we get to do this again sometime. I want to thank all those out there who are watching this HCPLive® Peers and Perspectives. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming programs and other great content right in your inbox.

Transcript edited for clarity.

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