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Assessing and Treating CV Risk Increases in Systemic Lupus
We’ve recognized the increased risk of cardiovascular disease (CVD) in SLE for almost half a century since Urowitz et al. first described a bimodal pattern of mortality in lupus patients in 1976. Numerous subsequent studies have confirmed this, with estimates of increased risk ranging from 2-10-fold compared to the general population. Most striking is the risk in young patients; in their landmark study, Manzi et al. found that women with SLE in the 35–44-year age group had an almost 50-fold increased risk of myocardial infarction compared to age-matched women without SLE.
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Lupus in an empty house
The full house immunofluorescence pattern is the classic histopathologic finding of lupus and lupus nephritis. Glomerular deposits staining for IgG, IgA, IgM, C3 and C1q can help confirm a suspected diagnosis of SLE. This full house pattern is not specific for lupus, as is also seen in endocarditis, HIV, hepatitis C, syphilis, portosystemic shunt, and post-streptococcal glomerulonephritis. But what about patients with negative immunofluorescence and no proliferative or membranous features?
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Smoking & Autoantibodies in Rheumatoid Arthritis
Investigators from the Netherlands have published their findings that smoking is a risk factor in rheumatoid arthritis (RA), led by the induction of local autoimmune responses at mucosal sites (in the lungs) and exemplified by RA-specific autoantibodies.
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Deep remission in SLE – what is it, and can we achieve it?
Recent reports on small numbers of lupus patients treated with CAR-T cells directed against CD19+ B lymphocytes have generated considerable excitement, not so much because the initial response to this therapy was favorable, but because after follow-up durations of two years or longer the patients were reported to have an ongoing clinical remission without the need for further treatment and in the absence of most autoantibodies. This state has been referred to in terms such as “immunological remission” or “resetting the immune system”, suggesting that an important and potentially permanent change had occurred. Perhaps we can call it a Deep Remission, for now. So what is this Deep Remission?
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