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Infection or Disease Flare: What Tools Can Help Differentiate?
Differentiation between a flare of disease and infection in patients with autoinflammatory (AI) conditions, where fever is the hallmark, can be extremely difficult. Few studies have evaluated potential differentiators; and having such tools would meet a huge unmet need.
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Small but important study of LN Class III, IV, and/or V with 6/18 pts considered complete responders by UProt (<500mg/g) continued to⬇️in renal fxn over 5 yrs. Bottom line: even dramatic ⬇️UProt does not tell the whole story.
https://t.co/51x4DlXkJC
#ACR21 Abst#1284 @RheumNow
Pedro Castillo _Castillo_Pedro ( View Tweet)
Infxn risk of 1st year on rituximab for mod to severe SLE vs standard-of-care
🔹Most common SoC Rx: MMF, Aza, and/or cyclophosphamide
🔹🚫significant diff
🔹RTX pts = ⬆️dz duration, ⬆️# of prior meds, ⬇️maintenance steroid dose
https://t.co/AYQFXqlubl
#ACR21 Abst1288 @RheumNow
Pedro Castillo _Castillo_Pedro ( View Tweet)
SLE: Belimumab + standard rx significantly⬇️risk of severe flares vs placebo.
Greatest in those with:
🔹+dsDNA
🔹low C3 or C4
🔹SLICC/ACR Damage index of 0 (argument for early treatment!)
https://t.co/UcGXEklqwJ
#ACR21 Abst#1295
@RheumNow
Pedro Castillo _Castillo_Pedro ( View Tweet)
Dr. Petri on SLE, Vit D, and BMD
~1k pts, 92% fem, 42% Black, 48% White
Freq. of osteoporosis:
💠M ~ F
💠Black ~ White
💠⬆️in smokers
Lumbar BMDs showed:
💠Vit D level w/Paradoxical effect
💠Rec goal of 40ng/mL in SLE
https://t.co/kBylQAwqhD
#ACR21 Abst#1265 #ACRBest @RheumNow
Pedro Castillo _Castillo_Pedro ( View Tweet)
#ACR21 #Abstr1462 More case against Low dose Hydroxychloroquine as could ⬆️ risk of #lupus flares. Adjusted risk as below:
Weight =>80kg, <400mg/d dose (OR 8.3)
Weight <80kg, <300mg/d dose (OR 2.6) @RheumNow https://t.co/bTRMJDoSoI https://t.co/yzopiO3Kbo
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Post hoc analysis of BLISS-LN 🦋
Pts who didn't receive steroid pulses at induction 👇
🔸⬆ PERR & CRR responders, ⬇mean daily pred doses, more pts had ave daily pred <=5mg or <=7.5mg for both BEL & PBO
🔸BEL grp ⬇ flares/kidney-related death
@RheumNow #ACR21 #ACRBest abs1461 https://t.co/ev0LK7d6oL
sheila RHEUMarampa ( View Tweet)
Dr. Furie asked Dr. Touma what he was doing in 1976? Dr. Touma said, "I was not even in school, yet." Dr. Furie noted that in 1976, the first study was published on methylprednisolone pulse for lupus nephritis in 7 patients. #ACR21 @rheumnow Link below https://t.co/Oe9xmH7Tzg https://t.co/xslAHYNXej
TheDaoIndex KDAO2011 ( View Tweet)
#ACR21
#SLE #COVID19
Use of Telemedicine for follow-up of SLE in COVID19
Wait times lower for telemedicine
Patient satisfaction higher in telemedicine group
More hospitalization, higher switch to in person follow up in telemedicine https://t.co/Y21Vki1uDP
Dr. Laura Lewandowski LauraLewMad11 ( View Tweet)
#ACR21
#SLE
SLE – Treatment: New Agents, Old Agents
Pooled data from 2 phase 3 trials (TULIP 1 and 2)
⏬LLDAS is an attainable T2T endpoint in adult SLE trials
⏬Anifrolumab treatment associated with earlier and more sustained LLDAS in adult SLE https://t.co/bxGlVsJOZC
Dr. Laura Lewandowski LauraLewMad11 ( View Tweet)
👉HCQ dose < 400 mg/d are assc with SLE flare. Lower doses of HCQ may decrease risk of retinopathy. 👉For >80 kg (176 lbs), any dose < 400 mg/day is assc with increased odds of flare
(HCQ blood levels not measured)
Abst#1462 #ACR21 @rheumnow https://t.co/5tx3kruT8W
TheDaoIndex KDAO2011 ( View Tweet)
Trauma associates with subsequent increased flares of SLE. Abstr#1446 #ACR21 @RheumNow https://t.co/QeNXOjHAjn
Richard Conway RichardPAConway ( View Tweet)
#volcosporin good ~lupus nephritis added to #MMF but underbelly - side effects like but ?less than #cyclosporin. #FDA update - ⬆️hypertension and nephrotoxicity, infection #ACR21 @RheumNow https://t.co/w5nLLSTlrB
Janet Pope Janetbirdope ( View Tweet)
BAFF & APRIL support B cell development, diff, survival.
ALPN-303: Antagonist of both BAFF & APRIL
💠⬇️B cell fxn & Ab production,⬇️Plasma cells
💠⬇️UProt, dsDNA, renal immune complexes (mouse model)
💠Pending human studies
https://t.co/kzVpUDuNWs
#ACR21 Abst#1429 @RheumNow
Pedro Castillo _Castillo_Pedro ( View Tweet)
Are you using less #rituximab in #SLE during #COVID #ACR21 @RheumNow #Lupus hub
Janet Pope Janetbirdope ( View Tweet)
"Baseline and routine EKGS are NOT required for SLE patients just because they are on HCQ!" - Dr. HM Belmont. "The drug has been demonized due to its use in COVID patients. We don't need to hold HCQ for EMR alerts (e.g, with cipro, SSRIs, etc)." Abstr#1743 #ACR21 @rheumnow https://t.co/5Bxavo6dRg
TheDaoIndex KDAO2011 ( View Tweet)
#PJP prophylaxis debate at #lupus hub if on #prednisone + immune suppression. #SLE has ⤴️septra side effects. Don’t know right answer. NNT v NNH is unknown. I don’t use it in #SLE. @RheumNow #ACR21 8M212
Janet Pope Janetbirdope ( View Tweet)
#SLE study hub re #Lupus nephritis rocks. #Rituximab ⬇️antiDNA but then rebound ⤴️. Thus design of adding #belimumab to Rituximab=Less flares. Love the Hubs. #ACR21 @RheumNow https://t.co/MAhxJdmkWO 10.7326/M21-2078 #ACRBest https://t.co/qWPk5x1ZtM
Janet Pope Janetbirdope ( View Tweet)
#ACR21 Ab#1029 - Great poster by Dr. Guttmann, IRAD in Summit NJ:
▶️2019 EULAR/ACR SLE criteria vs to 1997 ACR & SLICC
⭐️64% SLE pts: all 3 criteria. 10% only SLICC, 3% '97 ACR, 2% EULAR/ACR
⭐️Simliar gender, racial disparities to prior criteria
@Rheumnow https://t.co/QzG78HJgw5 https://t.co/eyuYhj4Acf
Links:
Eric Dein ericdeinmd ( View Tweet)
#ACR21 Abst#1029 @Rheumnow https://t.co/QzG78HJgw5
What is your preferred SLE classification criteria?
Links:
Eric Dein ericdeinmd ( View Tweet)
