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Diagnosing Neuropsychiatric SLE (5.23.2025)
Dr. Jack Cush reviews the news and journal reports from RheumNow.com - including views on the vagus nerve, NPSLE and CAR-T mania.
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T2T in #SLE
Lots of #rheumatologists do NOT do a validated measure so #DORIS remission may be over estimated
But great algorithm for #lupus #Rx
@RheumNow
#LUPUS2025 https://t.co/mGoopRtK2F
Janet Pope Janetbirdope ( View Tweet)
Monitoring for #HCQ #retinal #toxicity
2 tests beyond visual fields are better than 1
OCT
Etc
But suggestion if low risk to do only every 5 yrs
I don’t agree as risk ⬆️ w disease duration
We do
Annual fields
and either
OCT or retinal photography
#LUPUS2025
@RheumNow https://t.co/TdPJ47jYEL
Links:
Janet Pope Janetbirdope ( View Tweet)
Subclinical #arthritis in #SLE
Do we look for it?
Should we care?
Certainly seems to exist on #MRI hands
More changes of course if tender joints
Not sure of clinical relevance
Optical imaging and POCUS was compared
#LUPUS2025 @RheumNow
ANCA Askanase presents
Janet Pope Janetbirdope ( View Tweet)
Why follow antiDNA and complements in
#lupus #nephritis #LN
#LUPUS2025 panel said
To detect flare
?to consider after 3 to 5 yrs of remission to taper Rx
?but not for early response to Rx
Just info from the panel with my opinion salted in
@RheumNow https://t.co/bFUfN0PsFF
Links:
Janet Pope Janetbirdope ( View Tweet)
deep thoughts in #lupus
Is ‘better’ the enemy of #remission?
Is a complete renal response <50% at the end of contemporary #triple #therapy
Something to celebrate?
▶️Yes better than old #SoC but a bit sobering
We need RCTs that radically change paradigm
#LUPUS2025 @RheumNow
Janet Pope Janetbirdope ( View Tweet)
Who with +ANA will become #SLE
Mostly similar cytokine signature
But ⬆️IFN and
more innate immune changes
👇
In those who developed #lupus
? prediction & Prevention model in +#ANA people 🤷♀️
yr in review E Vital’s paper
#LUPUS2025 @RheumNow @ZahiTouma https://t.co/khpqRlH8Nk
Janet Pope Janetbirdope ( View Tweet)
‘Oranges & green vegetables’
⬆️
#diarrhea in #MMF said Ana Malvar
bad #LN outcomes if #nonadherent
Good relationship with#HCP helps
#adherence
✅education to help deal with side effects
pts need to know
Why this Rx
?how long
S|E Rx
#ClinicalPearl
#LUPUS2025
@RheumNow https://t.co/RnFGwJSl1F
Janet Pope Janetbirdope ( View Tweet)
Who does worse with #SLE
#nature vs #nurture
South American #lupus #registries
⬆️ activity
⬆️damage
⬇️age
⬇️SES
⬆️SLE #antibodies
#Gladel registry and others vs Europe
Environment >genetics 🤔
#LUPUS2025 #45poster @RheumNow
@gponsestel https://t.co/XjiXHAMuGm
Links:
Janet Pope Janetbirdope ( View Tweet)
do’s & don’t #Lupus #nephritis
❎
Don’t sequential monotherapy
▶️ use #MMF + #biologic or #CNI
✅
Do a #biopsy
➡️ need to know
#dx
#px
Do target LOW proteinuria
Do treat comorbidities
Lipids
HTN
Fluids
BMI
?mood
No #NSAIDs
Do limit #pred
#SGLT2i
@RheumNow #LUPUS2025 https://t.co/D0vHQXYTvZ
Links:
Janet Pope Janetbirdope ( View Tweet)
Impt predictors of
#neuropsychiatric #SLE
#LUPUS2025 @RheumNow
No major predictors
But if explanation of other conditions ex
Past #cvA
#ischemic events
Doesn’t have to have
➡️Active systemic ##Lupus
➡️ ?ribosomalP
+Abs described in #CNS lupus
A real headache! https://t.co/iuWfB454EN
Janet Pope Janetbirdope ( View Tweet)
‘It’s #Lupus, it’s all in your head!’
➡️ Some patients with #SLE have heard this from others
At #LUPUS2025 in a packed session on #CNS lupus
#Dx is tricky
40% of #neuropsychiatric lupus have NEGATIVE #brain #MRI
👇r/o
infarct/bleed
Infection
Rx #steroids
@RheumNow https://t.co/yU1olg0uZU
Links:
Janet Pope Janetbirdope ( View Tweet)
Steroids prevention of #congenital #heart #block in +Ro
Mom
#DM #HTN #wt⬆️
Fetus
?no diff #cardiomyopathy
?learning &behavioural changes
Debate re screen #CHB
Most CHB are kids w CHB as mom is unknown to be +Ro
Angst w screening
High titre Ro Impt
@RheumNow #LUPUS2025
Janet Pope Janetbirdope ( View Tweet)
Do you routinely recommend SLE +Ro/La pregnant Pts to have routine screening for #congenital #heart #block
#LUPUS2025 @RheumNow
Janet Pope Janetbirdope ( View Tweet)
‘To screen or not’?
For
#CHB #congenital #heart #block
Great debate #LUPUS2025
In #pregnant women with #SLE
In + #Ro #SSA &/or #La #SSB mothers
CHB Rx - #flourinated #steroids
To
⬇️#fetal #mortality ❎no benefit
⬇️#cardiomyopathy ❎
⬇️#pacemaker ❎
@RheumNow
??🤷♀️ https://t.co/xauDzfNBsC
Janet Pope Janetbirdope ( View Tweet)
Level up 🆙
#hydroxychloroquine #levels in #SLE
When
to determine adherence - too low
To see if levels are supratherapeutic
Who
SLE Pts who have risks for #HCQ toxicity#CKD, liver dx, age, overdosing
Why
Safety
Adherence
@RheumNow #LUPUS2025 https://t.co/l8FPcqmTki
Janet Pope Janetbirdope ( View Tweet)
#Proteinuria that persists in #LN
#lupus #nephritis even w mild proteinuria
👇
Worse outcomes
Just like all CKD
Take home
Aim for None or minimal in #SLE
<150 protein
#voclosporin >> PBO (SoC)
1/2 Voclosporin had deep response at least once > PBO
#LUPUS2025 @RheumNow https://t.co/CBUzyBatBh
Links:
Janet Pope Janetbirdope ( View Tweet)
Any ‘toll’ in #toll #like #receptors 7,8 in #SLE
Cutaneous #lupus
In #systemic or #cutaneous wk16
Rx
PBO
V
#enpatoran
No obvious dose response - all 3 dose >PBO
Safe so far improves IFN
No toll to pay! 👍
But need Ph3 data
#LUPUS2025 @EricFMorand @RheumNow https://t.co/2DDztlVsUm
Links:
Janet Pope Janetbirdope ( View Tweet)
Is Lupus Just a B Cell Disorder?
https://t.co/0kwxE6KLeI https://t.co/pORHkg9HY6
Dr. John Cush RheumNow ( View Tweet)
