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The Decade Ahead: Predicting Long-Term Proteinuria Risk in SLE
The ACR Convergence 2025 in Chicago opens with engaging topics curated for the global rheumatologist. As a clinician, I always look forward to sessions that provide updates and practical key points that I can bring home and apply to my practice.
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If We Can’t Prevent RA, Can We at Least Prevent Difficult-to-Treat RA?
Two new studies presented this year tackle a key question: can our initial treatment choices influence who ends up in the difficult-to-treat category?
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The Long View of Diagnostic Delay in Axial Spondyloarthritis
Axial spondyloarthritis (axSpA) remains a diagnostic challenge, particularly in its early stages before structural sacroiliitis is visible on imaging.
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#1727
360k+ postmenopausal women w osteoporosis: >1/3 untreated patients were at v high fracture risk, yet few received recommended anabolic or antiresorptive therapy.
Even among treated women at very high risk, >50% were still on oral bisphosphonates
@RheumNow #ACR25 https://t.co/9S66tAU68P
Mrinalini Dey DrMiniDey ( View Tweet)
“I never thought I’d live to old age with MCTD, now I plan for it.”
This patient’s journey highlights the power of evolving therapies, resilience, and lifestyle adaptation to age well with chronic autoimmune disease.
Patient perspectives abstract #PP04
@rheumnow #ACR25
Jiha Lee JihaRheum ( View Tweet)
#ClinicalPearl
Pts w #SpA ex #PsA May have
👇
#sicca #dry #eyes #dry mouth
Inflamed gallbladder without calculi
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Can be associated w #autoimmune disease
#POTS can be initial presentation of #SjD
IgA vasculitis—May have #cancer
#Secrets & #Pearls #ACR25 @RheumNow @ACRheum https://t.co/4SAqVYjnrD
Janet Pope Janetbirdope ( View Tweet)
Excited (and a little nervous!) to be presenting on a topic I’m very passionate about- social determinants of health & shared decision making, alongside some fantastic speakers & chairs.
Join us in room W184D, 10:00-11:30
Looking forward to a lively discussion!
#ACR25 @RheumNow https://t.co/FsDDrjisR3
Mrinalini Dey DrMiniDey ( View Tweet)
Passive transfer of Ab can occur w #IVIg
#Ab can occur from IVIg passive transfer incl HepB
IVIg - if pt has #cryoglobulins
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Can precipitate severe #cryo flare
#ClinicalPearl
Secrets & Pearls session
#ACR25 @RheumNow @ACRheum https://t.co/tTaSuVy1yQ
Janet Pope Janetbirdope ( View Tweet)
#1726 IA from immune checkpoint inhibitors (ICI) is a distinct autoimmune entity: T cell-driven but not antibody-mediated
irAE arthritis shows hyperactive, cytotoxic CD8+ T cells & metabolic reprogramming, unlike RA. IL-6, IL-12 & IFNα fuel this process. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
#ClinicalPearl
#seroneg #arthritis often has
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#involvement of
1st toe IP joint
Look at the feet 🦶
@RheumNow @ACRheum #ACR25
#28T08
Session secrets &pearls Tues https://t.co/EfqkLsTKmt
Janet Pope Janetbirdope ( View Tweet)
Overview of the use of SARD-ILD by @drdavidliew covering the challenges, professionalism, explainability and interpretability. Think of using and validating AI in the same way we train our residents. The human interface still needed @RheumNow #ACR25 https://t.co/TYKud057ag
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#1725 Functional NOTCH4 variants contribute to vasculopathy & fibrosis in SSc, particularly in African-American patients
NOTCH4 hyperactivation disrupts angiogenesis & drives EndoMT; inhibition (including with FDA-approved Nirogacestat) restores vascular repair @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
#1724 MAIT cells central in RA pathogenesis. These innate-like T cells accumulate in synovial fluid, driving fibroblast activation, cytokine release & joint damage. Blocking MAIT activation or deleting MR1 reduces arthritis in mice- a potential new target in RA. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
The Power of Gamma Delta T Cell for Autoimmunity https://t.co/wIMu5r7b3D
More on T Cell engagers , this time with gama delta T cell ( tiny but mighty ). Kate Roslin talks about advantages of this protocol. (No cytokines thus less toxicity).
@Yuz6Yusof
@RheumNow
#ACR25
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Pooled data fr diff SLE cohorts by Dr SGarg et al were evaluated to determine an upper threshold tx range of HCQ
750-1150 ng/mL: safe & effective HCQ levels
>1150ng/mL-supratx, no added tx benefit
CKD st >/=3: 2x ⬆️odds of toxic hcq levels
#ACR25 @RheumNow Abs1722 #ACRBest https://t.co/RFx1VO0bov
Links:
sheila RHEUMarampa ( View Tweet)
#1723 Why is systemic autoimmunity more common in females?
Loss of X-chromosome inactivation maintenance in B cells (not T cells) amplifies interferon-driven disease, with increased autoantibodies, inflammation and renal injury. Key mechanistic advance. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
3rd plenary session!
#1722 Defining safe HCQ levels in SLE: whole-blood 750-1150ng/mL= therapeutic range; >1150ng/mL ➡️ ~2× toxicity risk; <750ng/mL ➡️ higher flare risk
CKD ≥3 increases odds of supratherapeutic levels
New era of precision monitoring in SLE?
@RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Plenary 3, HCQ blood levels in SLE
HCQ level > 1150: 1.9x risk of HCQ toxicity
HCQ level < 750: 1.4x risk of active SLE
HCQ dose < 5mg/kg: 1.9x risk active SLE
My take home? Blindly reducing dose to <5mg/kg is BAD; use levels instead!
@RheumNow #ACRBest #ACR25 Abstr1722 https://t.co/UCBPAKAyon
Links:
Mike Putman EBRheum ( View Tweet)
Late-Breaking Trials in axSpA and PsA https://t.co/Fw8wiAPLoN
The amazing @Janetbirdope discussing head to head trials in Axial SpA and PsA with primary failure to TNF.
To switch to another TNF or IL17?
IL17 for my PsA patient for sure.
@RheumNow
#ACR25
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
#ACR25 Please find my video interview with Dr Kate Rochlin on a novel Bi-specific T-cell engager (BiTE) in development which binds to pan-gamma delta T-cell instead of CD3 to minimise risk of cytokine release syndrome side effect. Abstr#1535 @RheumNow
https://t.co/MOmUm41cyA https://t.co/TgIUGgWGw5
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
