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Beyond the Needle: Redefining the Assessment of Lupus Nephritis

Akhil Sood, MD

Lupus nephritis is one of the most silent and severe manifestations of SLE. When not captured early, patients are at high risk of progressing to end-stage renal disease, which would require dialysis or transplantation. Renal biopsy remains the gold standard for diagnosis and disease classification. However, the procedure is invasive and very painful. Non-invasive measures are critical for early detection and continuous monitoring.

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back, LBP, spine, AS

Difficult to Manage Axial Spondyloarthritis

Adela Castro, MD

Studies show that patients with difficult-to-manage axSpA have a higher disease activity; however, the lack of a consensus definition led researchers and clinicians to utilize their own proposed definition, resulting in variability of the characteristics of non-responders.

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US.knee_.jpg

Improving the Value of Musculoskeletal Ultrasound in Rheumatology Care

Jiha Lee, MD

Unlike traditional imaging techniques, MSUS can be easily used at the point-of-care and offers high-resolution images of joints, tendons, and soft tissues, facilitating the early detection of inflammation and structural damage. On Saturday, November 16th at the ACR Convergence 2024, Dr. Veena Ranganath, Dr. Gurjit Kaeley, and Dr. Catherine Bakewell will present the “Proposed ACR Guidance for Use of Musculoskeletal Ultrasound in Rheumatoid and Psoriatic Arthritis.” This is the first update in a decade since the 2012 ACR guidance on the reasonable use of MSUS in rheumatology clinical practice.

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New agent on the block: Bimekizumab IL-17A/F inhibitor Promising clinical data in SpA - what about imaging findings? Dramatic reductions in MRI activity at SI joints seen in BKZ pt, esp when compared to trajectory of PBO pt before cross-over @RheumNow #ACR24 Abst #1757 https://t.co/ACLJx5XkyN

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Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Reason for consult: aortitis- evaluate for systemic causes Abstract 1638: Kmetova et al highlight the promising clinical utility of calprotectin as a marker for clinically isolated aortitis @RheumNow #ACR24 https://t.co/2qPaAqWswG

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Akhil Sood MD AkhilSoodMD ( View Tweet)
The 3-4-5 rule for positive MRI in axSpA remains. The MRI lesion cut-offs demonstrated high performance across different features of axSpA (PsO, AAU,IBD). Deep fat and deep sclerosis high specificity for axSpA. #Abst0821 #ACR24 @RheumNow https://t.co/4JM5MHrB8z

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Adela Castro AdelaCastro222 ( View Tweet)
🫁RP-ILD a/w high morbidity and mortality How to Predict RP-ILD Development? ➡️AutoAb: anti-MDA5, anti-ARS, anti-Ro52 ➡️Biomarkers: CRP, LD, Ferritin, KL-6 ➡️CT: Lower consolidation/GGO #ACR24 @RheumNow https://t.co/OIrHfVTZcM

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Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
In the @ACRheum MSK Ultrasound Guidance: In difficult-to-treat RA, MSUS can distinguish symptoms of active synovitis from other sources of pain. (consensus: mod) CURRENTLY do you often use ultrasound when RA gets difficult to treat, and synovitis isn't obvious? #ACR24 @RheumNow

David Liew drdavidliew ( View Tweet)

One situation I've seen MSK ultrasound have impact ++ in the real-world is showing patients their own RA disease activity. Arthritis might be the invisible disease sometimes, but seeing it in full Doppler colour on screen means a lot to many. #ACR24 MSK USS Guidance @RheumNow https://t.co/wd9s6FAfp4

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David Liew drdavidliew ( View Tweet)
"Do not fear RPF." - John Stone Retroperitoneal fibrosis certainly feels challenging at times, and radiologic features might stay even after functional improvement but we've come a long way (although, despite B cell depletion, there's plenty more to do) #ACR24 16S26 @RheumNow https://t.co/2Y3buXrAFY

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David Liew drdavidliew ( View Tweet)
171 SSc pts w/ hand Xrays and US found 20% w/ Joint involvement. Active Synovitis & tenosynovitis predicted by CRP>10mg/L (p = 0.013), fibrotic tenosynovitis on US (p = 0.005), anti-RNA polymerase III antibodies (p = 0.043) https://t.co/DZrM5aQpJ7 https://t.co/CkGP6H8J6x

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Dr. John Cush RheumNow ( View Tweet)
Prof @WalterMaks et al reports the validation of data-driven quantitative MRI cutoffs for a +SIJ MRI perform highly in pts with established axSpA. - Deep fat lesions & sclerosis: high specificity for #axSpA @RheumNow #ACR24 abs821 https://t.co/sSAtTt1GGV

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sheila RHEUMarampa ( View Tweet)
Not just the presence but higher levels of biomarkers predict RA-ILD progression. #ACR24 @RheumNow ABST#0804 https://t.co/5jhBjXDUeY

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Jiha Lee JihaRheum ( View Tweet)
Does alcohol consumption affect radiographic progression in axSpA? Canadian cohort study over 6 years found greater radiographic progression among alcohol consumers. Still a lot of confounding factors to fully establish an association. Abst#0822 #ACR24 @RheumNow https://t.co/GG0rXq3kjC

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Adela Castro AdelaCastro222 ( View Tweet)
The use of ultrasound in clinically suspect arthralgia can complement MRI early diagnosis of RA. Abstr#228 Gupta A @RheumNow #ACR24 https://t.co/rpVqZKeMXE

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
More evidence: persistence of imaging abnormalities is probably NOT an adequate metric of LVV tx failure Boiardi et al - 87% TAK/LV-GCA pt w persistent dz on imaging despite clinical remission, TAK>GCA PET avidity more persistent in GCA @RheumNow #ACR24 Abstract 1617

Brian Jaros, MD Dr_Brian_MD ( View Tweet)

Dr. Catherine Bakewell @CatherineB27 shares the preliminary ACR guidelines on ultrasound imaging in psoriatic arthritis covering 4 domains, detailed PICOs covering the early phase, diagnosis, assessment covering the domains of PsA @RheumNow #ACR24 https://t.co/DoHE1rsSGf

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#0322🔬 Myocarditis in Myositis(IIM) 📊 26% new IIM pt had myocarditis (ESC,Lake Louise) 💥 Anti-Ku most common MSA 💥Myocarditis a/w ⬆️heart failure, arrhythmia (43 v 6%;p=0.02) 🎯 Myocarditis🟰poor outcomes 🎯Cardiac MRI🟰earlier detection #ACR24 @RheumNow @JuliePaikMD https://t.co/yz0f2ozFVL

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Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
171 SSc pts w/ hand Xrays and US found 20% w/ Joint involvement. Active Synovitis & tenosynovitis predicted by CRP>10mg/L (p = 0.013), fibrotic tenosynovitis on US (p = 0.005), anti-RNA polymerase III antibodies (p = 0.043) https://t.co/OIornA9sAA https://t.co/yXyX5k2yqD

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Dr. John Cush RheumNow ( View Tweet)
Serial MRI study of SI & lumbar (LS) joints in 24 early axSpA (Sxs < 5.5yrs) over 3 yrs, showed: - SIJ developed bone marrow edema, sclerosis & erosion. - LS: fat lesions decreased & erosions increased. - Facet joint inflammation (in t0) significantly influenced yr 3. LS bony… https://t.co/COlFAXVE1x https://t.co/4Xs9ngJN4w
Dr. John Cush RheumNow ( View Tweet)
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