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Cognitive Impairment: The Hidden Burden in Lupus Care
Suppose you have a patient with lupus returning for follow-up. Their joint symptoms are well controlled. The kidneys—managed with a combination of biologic DMARD and mycophenolate—show no signs of active urinary sediment or protein. Yet, during the routine visit, your patient brings up fatigue and difficulty remembering things. How do you address this? Several studies presented at ACR24 focused on cognitive impairment in lupus.
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In Vivo CAR T Cell Therapy.
A single intralymphatic injection of VivoVec™ particles:
- Generates functional CAR T cells in vivo
- Achieves complete B cell depletion in NHPs without lymphodepletion
- Demonstrates potential for an off-the-shelf solution for autoimmune disease… https://t.co/5DTzRvZjbY https://t.co/DvTOqnhn1V
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In Vivo CAR T Cell Therapy.
A single intralymphatic injection of VivoVec™ particles:
- Generates functional CAR T cells in vivo
- Achieves complete B cell depletion in NHPs without lymphodepletion
- Demonstrates potential for an off-the-shelf solution for autoimmune disease… https://t.co/5DTzRvZjbY https://t.co/DvTOqnhn1V
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
🚨 New SLE treatment update! 🚨 Dapirolizumab pegol (DZP), novel CD40L inhibitor, for moderate-to-severe lupus. Phase 3 trial, DZP reduced disease activity, helped taper steroids, and achieved a higher BICLA Safe and generally well tolerated! #ACR24 #L16 @rheumnow https://t.co/lFrKjz4CZ1
Bella Mehta bella_mehta ( View Tweet)
Severe thrombocytopenia (TP) is rare but linked to major organ involvement and poor prognosis in #SLE. Data from the RISE registry shows TP in 9.3% of SLE patients, with higher prevalence in males, African-Americans+ those with multiple comorbidities.
#ACR24 @RheumNow abst#2680
Bella Mehta bella_mehta ( View Tweet)
In prelim analysis of this controlled clinical trial, SLE pts w/ active dse who weres given addtl NAC for 3 mos had significantly reduced dse activity.
Mechanism? NAC reduces rapamycin (mTOR) activation.
Common AEs: nausea, vomiting
@RheumNow #ACR24 abs2677 https://t.co/E4w2Qd7RwP
sheila RHEUMarampa ( View Tweet)
PHOENYCS GO, RCT of dapirplizumab, novel CD40Li in SLE
Met primary endpoint (NNT~6 for BICLA) & numerical improvements in many other endpts
1 MI & 1 death from infection over 213 pts
Encouraging for sure! Second phase 3 being launched
#ACR24 @RheumNow Abstr#L16 #ACRbest https://t.co/QwDMKjhFvb
Mike Putman EBRheum ( View Tweet)
ACR 2024 - Day 3 Report
Highlights from Day 3 at ACR24 included the plenary session presentation on Nipocalimab (previously reviewed), but the big highlight was the Lupus Nephritis guideline recommendations.
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It is NO LONGER a ACCEPTABLE
To NOT consider
#MMF or #Cyclo + another proven #Rx
Added to
#HCQ and #tapering /limiting #glucocorticoids
RCTs in #lupus #nephritis support this
? Is which to add
#belimumab
#CNI #volclosporin
#obinutuzimab
#ACR #ACRbest @RheumNow @ACRheum https://t.co/a7WMFfCyXl
Janet Pope Janetbirdope ( View Tweet)
Pathophysiological pathways in neuropsychiatric SLE. 2 components:
-Ischaemic
-Inflammatory
Zahi Touma @RheumNow #ACR24 https://t.co/wwlSSSpOIU
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Subsets of lupus arthritis. Kenneth Kalunian @RheumNow #ACR24 https://t.co/ZmHui126zr
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Study by Maria Dall'Era et al. compared voclosporin-based triple immunosuppressive therapy with high-dose GC in active lupus nephritis.
- Fewer adverse events in the voclosporin group, despite a higher incidence of specific issues like decreased GFR and hypertension.
- 25%… https://t.co/ToRu2rdErC https://t.co/uUXzNNuLDb
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Study by Maria Dall'Era et al. compared voclosporin-based triple immunosuppressive therapy with high-dose GC in active lupus nephritis.
- Fewer adverse events in the voclosporin group, despite a higher incidence of specific issues like decreased GFR and hypertension.
- 25%… https://t.co/ToRu2rdErC https://t.co/uUXzNNuLDb
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Loiseau et al. 4700 pSS, 47000 comparators. pSS associated with increased risk of every CV/VTE outcome. Did not have that in my priors! @RheumNow #ACR24 Abstr#2631 https://t.co/QKemUhbcG8 https://t.co/twpjdS2L63
Richard Conway RichardPAConway ( View Tweet)
Loiseau et al. 4700 pSS, 47000 comparators. pSS associated with increased risk of every CV/VTE outcome. Did not have that in my priors! @RheumNow #ACR24 Abstr#2631 https://t.co/QKemUhbcG8 https://t.co/twpjdS2L63
Richard Conway RichardPAConway ( View Tweet)
A re-evaluation of lupus arthritis. Old dogma is RA is erosive and SLE non-erosive. With better imaging, lupus arthritis can be erosive. Vivianne Malstrom. @RheumNow #ACR24 https://t.co/JEqVPLGNfu
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Did you know?
#Lupus arthritis have clinical and US classifications.
On MRI, findings will show:
- periarticular hyperplastic tissue
- capsular swelling
- edematous tenosynovitis
@RheumNow #ACR24 @rheumarhyme @theactiverheum https://t.co/EoKh2Q3V9Z
sheila RHEUMarampa ( View Tweet)
Dr. CStone et al. assessed nailfold dermoscopy in distinguishing DM from SLE
Almost all DM pts had nailfold changes in at least 1 digit vs. SLE
& majority of DM pts had nailfold changes in all 10 digits
Dermoscopy is a simple alternative to capillaroscopy
@rheumNow #ACR24 ab2404 https://t.co/6tEXAlX7lt
sheila RHEUMarampa ( View Tweet)
Neuropsychiatric manifestations in SLE.
Susanne Benseler MD @RheumNow #ACR24 https://t.co/subiykC5Q4
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Neuroimaging is done to support the diagnosis of CNS #lupus but only 75% reveal abnormal brain MRI.
📌 It is more useful in pts with local deficits than diffuse.
📌 poorly correlated with cognitive dysfunction & psych phenotypes.
@Rheumnow #ACR24 @rheumarhyme @theactiverheum https://t.co/HjNbVBaOHv
sheila RHEUMarampa ( View Tweet)