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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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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.
A multicentre observational study of patients with biopsy-proven LN; either proliferative (PLN) or membranous (MLN) lupus nephritis were compared regarding clinical and laboratory presentation and long-term outcomes. The primary outcome was progression to chronic kidney disease (CKD).
'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
Links:
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
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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/Y2boo9gcg2 https://t.co/aqUGMooXto
Dr. John Cush RheumNow ( View Tweet)
Self Acupressure in Knee Osteoarthritis
A clinical trial has shown that self-administered acupressure (SAA) is effective in relieving knee osteoarthritis (KOA) patients.
https://t.co/jwP25u7J0b https://t.co/PH3aOoJaDu
Dr. John Cush RheumNow ( View Tweet)
ICYMI: How do you manage enthesitis?
https://t.co/8cuKz1Ddpb https://t.co/3KMKQCVDSN
Dr. John Cush RheumNow ( View Tweet)
50 active RA pts RCT Rx w. either low dose IL-2(n=26), IL-2+TCZ (9) or control (15). All improved clinically by DAS28-ESR, but IL-2 Rx pts had signif proliferation of Tregs, w. decr inTh1, Th2, & Th17 cells. TREG #s correlated w/ ESR drop (r=0.54) https://t.co/1tF63FuXzx https://t.co/M5TWsa6zI4
Dr. John Cush RheumNow ( View Tweet)
Single center retrospective 173 pts w/ CTD-ILD - 34% Sjogren’s, 30 RA, 25 systemic sclerosis, 6 UCTD, 3% idiopathic inflam myositis, 1,2% MCTD, 0.6% SLE. NSIP most common (60%) inSS & SSc; UIP more common in RA. 6 died, mostly infection https://t.co/IL2tnVDtoQ https://t.co/Ada49Qv5XL
Dr. John Cush RheumNow ( View Tweet)