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ICYMI: What are the Early Stages of Lupus?
Incomplete lupus? Undifferentiated connective tissue disease? Pre-clinical autoimmune disease? During the lupus pod at RheumNow Live 2024, Dr. David Karp discussed the spectrum of autoimmune disease and the confusing terminology that is used with the complex world of early autoimmune disease. He cautioned against the traditional use of phrases such as incomplete lupus or undifferentiated connective tissue disease, which are heterogeneous and poorly defined.
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Rheum Chapter Notes (4.26.2024)
Dr. Jack Cush reviews this past week’s news and journal articles from RheumNow.com.
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Predicting Infection in Lupus Nephritis
Machine learning (ML) models were applied to 3 cohorts of lupus nephritis (LN) patients and established algorithms to predict co-infection in LN.
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With the FDA's approval of its 50th biosimilar - they have published "A Milestone in Facilitating the Development of Safe and Effective Biosimilars". Since biosimialrs were approved in 2015, they saved the health care system $23.6 billion. https://t.co/7GPJ5XLGnr https://t.co/6Qw7DttmjT
Dr. John Cush RheumNow ( View Tweet)
Venous thromboembolic event Risk study in 1854 SLE pts vs controls (12,107) from 1985–2015 in W Australia. VTE affected 12.8% SLE pts; 6 fold higher than controls (RR 6.6). Risk factors: aPL(aHR 4.24), serositis (2.7), nephritis (1.75), low Plts (1.65) https://t.co/efUUQzTNzK https://t.co/XXXXTbQOCn
Dr. John Cush RheumNow ( View Tweet)
JAMA review of ILD; that affects 650,000 in USA, leading to 25,000-30,000 deaths/YR. Types reviewed. Key Symptoms: dyspnea and cough, w/ chest CT being diagnostic tool. Antifibrotic & immunomodulatory may slow disease progression. https://t.co/tE7kHgUE02 https://t.co/V7Htoct3VP
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Dr. John Cush RheumNow ( View Tweet)
Is Colchicine Rx a problem? Retrospective study of UK Clinical Practice registry, 13945 gout initiated allopurinol with colchicine (64yrs; 78% male). 26% on 1+ meds interacting w/ colchicine. Diarrhea & MI more freq w/ comorbidities & more severe CKD https://t.co/ZkhpzaTjjI https://t.co/e3BO813b30
Dr. John Cush RheumNow ( View Tweet)
'Drug Rediscovery for Rare Immune Mediated Inflammatory Diseases’ - a 6 center consortium will study if JAKi (filgotinib) is effective and safe in 3 rare disorders -- Behcets, inflammatory myositis & IgG4 related disease. https://t.co/UyZM4VNSY2 https://t.co/D2D1tdygS4
Dr. John Cush RheumNow ( View Tweet)
Articular Findings Sarcoidosis:
- Acute arthritis: Lg Jt Oligoarthritis; Loffgrens syndrome (hilar LN, arthritis, E. nodosum)
- Acute > Chronic arthritis
- Chronic arthritis: tenosynovitis, oligo- &polyarthritis, dactylitis, erosions or Jaccouds arthritis
Dr. John Cush RheumNow ( View Tweet)
Hyperpigmentation from Hydroxychloroquine. From 316 HCQ pts, 26% got hyperpigmentation; delayed onset of 12 mos (6–30mos) after median cum. dose of 108 g. Seen on face (602%), Legs (36%) & hands (20%). Daily sun exposure decrease in the incidence (P=0.02) https://t.co/6B6Z0suXB4
Dr. John Cush RheumNow ( View Tweet)
Predicting CKD Outcomes in Lupus Nephritis
An observational cohort study suggests that proteinuria levels in lupus nephritis (LN) patients did not predict their histologic class.
https://t.co/SCsuYuXgw4 https://t.co/bHB9ggf20H
Dr. John Cush RheumNow ( View Tweet)
1/3 of lupus nephritis patient classified as ""complete responders"" continued to accrue progressive renal damage despite resolution of proteinuria over 1 year.
Dr. @andreafava reviews GFR trajectories after renal bx at #RNL2024 @RheumNow https://t.co/mqwhfIFQsL
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Dr. John Cush RheumNow ( View Tweet)
#RNL2024
@DrDavidKarp
Incomplete lupus is heterogeneous term
""Stage 2"" pre-classification stage as ILE/UCTD
Stage 1: non-specific antibodies, dysregulation
2: incomplete features
3: classified, multi-system disease
4: irreversible tissue damage https://t.co/lmorwojG49
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Dr. John Cush RheumNow ( View Tweet)
Urine proteomics in lupus nephritis
IL-16 and CD163 are urinary biomarkers most correlated w/ histologic activity
Myeloid & degranulation sign ass w histo activity -> PR3+cells abundant in LN
@andreafava #RNL2024 @RheumNow https://t.co/YpoMiupOlQ
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Dr. John Cush RheumNow ( View Tweet)
Venous thromboembolic event Risk study in 1854 SLE pts vs controls (12,107) from 1985–2015 in W Australia. VTE affected 12.8% SLE pts; 6 fold higher than controls (RR 6.6). Risk factors: aPL(aHR 4.24), serositis (2.7), nephritis (1.75), low Plts (1.65) https://t.co/KNInhNkjmQ https://t.co/jT3cTemxMD
Dr. John Cush RheumNow ( View Tweet)
Our final TNR for the month of April will take place on 4/30 at 6:30pm ET.
Mastering SLE
Rethinking Pre-Clinical Disease in Lupus - David Karp, MD
Biology and Rx of Lupus Flares - Michelle Kahlenberg, MD
Current/Future Biomarkers in SLE - Andrea Fava, MD
https://t.co/IoRDAaAJbo https://t.co/C7HpKvehXX
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Dr. John Cush RheumNow ( View Tweet)
Prospective look at 25 280 older adults (mean 74yrs) w/ incident fracture, shows impact of multimorbidity by Charlson Comorbid Index (CCI). If CCI =2-3, Incr risk of subseq Fx (16-25%) & death (HR ~2); If CCI=4+, Fx Risk ^33-48%, death HR~4. https://t.co/6wnhFNiSXH https://t.co/Xy2y0ANDRd
Dr. John Cush RheumNow ( View Tweet)
Prevalence of MSK presentations in practice = 21.1%, based on UK practice cohort. Most common: pain in LS spine (18%) & knee (17%). Re-presentations of existing Dx made up 74% all MSK consultations. Steroid injx given to 1/3 of knee consults https://t.co/nTioq1lCEB https://t.co/ecm8Kxz2cu
Dr. John Cush RheumNow ( View Tweet)
JAMA review of ILD; that affects 650,000 in USA, leading to 25,000-30,000 deaths/YR. Types reviewed. Key Symptoms: dyspnea and cough, w/ chest CT being diagnostic tool. Antifibrotic & immunomodulatory may slow disease progression. https://t.co/xegChTUysM https://t.co/6GMJCqjoBx
Links:
Dr. John Cush RheumNow ( View Tweet)
Is Colchicine Rx a problem? Retrospective study of UK Clinical Practice registry, 13945 gout initiated allopurinol with colchicine (64yrs; 78% male). 26% on 1+ meds interacting w/ colchicine. Diarrhea & MI more freq w/ comorbidities & more severe CKD https://t.co/Y2boo9gcg2 https://t.co/aqUGMooXto
Dr. John Cush RheumNow ( View Tweet)