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“50% of pts with lupus nephritis are asymptomatic . You have to have a degree of kidney damage before you have proteinuria. Proteinuria does not correlate with intrarenal activity.” – Dr. A Fava #RNL2024 @rheumnow https://t.co/9aHmLG6VjA
TheDaoIndex KDAO2011 ( View Tweet)
ICYMI @eular_org 2023 SLE Treatment guidelines https://t.co/BkGhwQtSor @rheumnow #RNL2024 https://t.co/troJ9D6AGm
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TheDaoIndex KDAO2011 ( View Tweet)
Dr. Kahlenberg reviews the cycle of lupus. #RNL2024 @RheumNow @Kahlenberglab
Genetic > environmental > immune system activation > immunocomplexes > clinical disease https://t.co/Q7T9QpbFlm
Dr. Rachel Tate uptoTate ( View Tweet)
Don’t forget: complement activation by Abs form immune complexes resulting tissue destruction in different organs. - Dr. M Kahlenberg may use AVISE CTD to help determine if pts are in a flare @rheumnow #RNL2024 https://t.co/wdwtq1G3Sn
TheDaoIndex KDAO2011 ( View Tweet)
Clinical Pearl!
Lupus flare mimics with Dr. Kahlenberg
- FM
- Stress
- Infection
- Lack of sleep
- Iron deficiency
- Vitamin D deficiency
- Celiac or other concomitant inflammatory disease
- thyroid issues
@Kahlenberglab @RheumNow #RNL2024 https://t.co/4vEjmwTd3D
Dr. Rachel Tate uptoTate ( View Tweet)
Type I IFNs are a unique lupus feature.
- Increase class switching
- Repress TREGs
- Drive rash development
- DCs and B cells are more active
Look at the signature graph on the R hand side of the screen.
Dr. Kahlenberg #RNL2024 @RheumNow @Kahlenberglab https://t.co/zmClt9h3FW
Dr. Rachel Tate uptoTate ( View Tweet)
Pro tip from Dr. Kahlenberg with regard to B cell activation: Belimumab takes a long time to work because it doesn't deal with ab secreting cells, it just blocks making new ones. #RNL2024 @RheumNow @Kahlenberglab https://t.co/gFwPeEdGF6
Dr. Rachel Tate uptoTate ( View Tweet)
Would a wholistic B cell therapy, such as CAR-T, be more effective in Lupus?
We know B cell activation is important but belimumab may work better for short-lived B cells and RTX doesn't deplete most plasma cells.
CAR-T, targeting CD19, depletes all B cells. More research is… https://t.co/mPzKIfUC8p https://t.co/cGnI3dggqZ
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Dr. Rachel Tate uptoTate ( View Tweet)
The EULAR 2023 lupus flare guidelines (broken down here by renal and non-renal involvement) as reviewed by Dr. Kahlenberg. Remember to talk to patients about diet, adherence to treatment, skin protection, infection risk, vaccinations, blood glucose control, etc. #RNL2024… https://t.co/jUb04AFiA4 https://t.co/lATaUO75DA
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Dr. Rachel Tate uptoTate ( View Tweet)
Protips: Plasmablasts are made after B cell activation, making dsDNAAb & NMDA Ab that bind complement forming IC’s. A drug targeting plasmablast may be a better target. Belimumab may work better for short-lived B cell problems. – Dr. M Kahlenberg @rheumnow #RNL2024 https://t.co/vj6sRn4f7c
TheDaoIndex KDAO2011 ( View Tweet)
BAFF levels are high in patients lupus and allow for survival of autoreactive B cells. – Dr. M Kahlenberg on contributors to #SLE flares. #belimumab blocks BAFF but takes a long time to work, consider adding something faster active like steroids. @rheumnow #RNL2024 https://t.co/QGTcAgqjSN
TheDaoIndex KDAO2011 ( View Tweet)
T cells are important in SLE flares (but are not the only player) - Dr. M Kahlenberg @rheumnow #RNL2024 https://t.co/xFeYrKHnGi
TheDaoIndex KDAO2011 ( View Tweet)
Treatment of SLE. EULAR guidelines via @Kahlenberglab @RheumNow #RNL2024 https://t.co/a5lWfRLuh3
Richard Conway RichardPAConway ( View Tweet)
Triggers for SLE flare by @Kahlenberglab . Here in Ireland, it is so often UV light (oh its not warm enough for sunblock, its cloudy, I was only out for 20 minutes, etc). We must get our messaging better @RheumNow #RNL2024 https://t.co/0T1oJH8MqJ
Richard Conway RichardPAConway ( View Tweet)
Mimics of SLE flare by @Kahlenberglab . They are many, common, and crucial @RheumNow #RNL2024 https://t.co/P7b72T9GS6
Richard Conway RichardPAConway ( View Tweet)
Type 1 IFNs are a unique feature that impacts disease – Dr. M Kahlenberg noted innate immune cells & tissue are triggered by UV light, microorganisms, causing changes to the immune system: DC’s and B cells are more active, represses Tregs, drive skin disease. #RNL2024 @rheumnow https://t.co/fXnPIFN6VA
TheDaoIndex KDAO2011 ( View Tweet)
“Flares require a trigger!” – Dr. M Kahlenberg on #SLE flares #RNL2024 @rheumnow https://t.co/rqAnAOfJZP
TheDaoIndex KDAO2011 ( View Tweet)
Is it a lupus flare or a mimic? Fibromyalgia, stress, infection, poor sleep, hypothyroidism, vitamin deficiencies can contribute to pain and fatigue in a patient. – Dr. M Kahlenberg #RNL2024 @rheumnow https://t.co/pLuqyy8gHm
TheDaoIndex KDAO2011 ( View Tweet)
Lupus has many flavors. If we are better able to sort them, we might be more better at finding effective treatments. @rheumnow #RNL2024 @DrDavidKarp https://t.co/rklqnA8Ur6
TheDaoIndex KDAO2011 ( View Tweet)
"SLE affects women in the prime of their life, 25% of pts go to the ER, up to 50% will have lupus nephritis; it is a deadly and costly disease.” - @DrDavidKarp on why we would be focusing on identifying preclinical SLE and preventing the disease #RNL2024 @rheumnow https://t.co/SIZ5ZBwu94
TheDaoIndex KDAO2011 ( View Tweet)