ACR Convergence 2025 will be kicking off with a Plenary Session by Michelle Petri (Abstract 0772: Redefining When to Biopsy the Kidney in Patients with SLE), which is a great place to kick off our coverage of the meeting. As part of a collaboration with the Accelerating Medicines Partnership, Petri and colleagues have given data to what many of us have long suspected: a biopsy threshold of 0.5g/d of proteinuria may be too high.
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We know that pre-RA is a definition that stands under a large umbrella, ranging from asymptomatic individuals with ACPA positivity to individuals with symptomatic pre-clinical synovitis. How can we predict the transition from the at-risk state to clinical RA outside the realm of clinical, conventional serological (RF/anti-CCP) or imaging (US/MRI synovitis) biomarkers?
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Can Steroids Be Stopped in Lupus Nephritis?
MedPage Today
Patients with lupus nephritis were more likely to get off chronic corticosteroid treatment, and stay off, when certain factors were in place, researchers said.
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The clinical features and genetic abnormalities of neuropsychiatric systemic lupus erythematosus shows that NPSLE often means more severe lupus and more organ involvement beyond the central nervous system.
Akhil Sood MD, MS
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Abstract #0607: The age at diagnosis of SLE is rising in US based cohort📈
Those diagnosed ≥30 yrs were:
⬆️ More likely to have oral ulcers, hematologic features, +ANA
⬇️ Less likely to have malar rash or proteinuria
@RheumNow #ACR25 https://t.co/pMPVLg1xTZ
Antoni Chan MD (Prof)
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In a nationally representative NHANES sample, inflammatory back pain (IBP) was not associated with HLA-B27 positivity or elevated CRP, regardless of IBP criteria used (e.g., Berlin 8a: OR 0.88, p=0.876). IBP alone may be insufficient for identifying axSpA-related immunogenetic or https://t.co/82NjVU171z
Aurelie Najm
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What can we learn from longitudinal peripheral blood multi-omic profiling in at-risk individuals?
50 RA converters vs. non converters from StopRA study
Decision tree showing highest risk for conversion to clinical RA in Individuals w/
-CCP3 ≥108 units
-T peripheral helpers https://t.co/jw53EB6tI6
#0774
Multi-omic profiling of anti-CCP3+ “at-risk” individuals reveals Tph & cytotoxic CD8+ expansions, altered gene/chromatin profiles and predictive model (AUC 0.77) for RA conversion
PTPN22 locus accessibility & Tph ≥ 2.45% identify highest risk. @RheumNow #ACR25 https://t.co/JDSMkdmoGv
Aurelie Najm
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A new marker for stratification of ILD in dermatomyositis: Anti MDA5 antibodies!
Japanese study
MDA5 (201-300) positivity associated w/
Lower 6-month progression-free survival (43% vs. 74%)
Lower 5-year survival rates (34% vs. 66%)
Validation in other populations awaited https://t.co/IBiYyATer4
#0773 Anti-MDA5 epitope mapping identifies key regions (aa 201-300, 601-700) linked to treatment resistance & poor prognosis in DM-ILD and even IIPs.
Epitope-specific antibodies could refine risk stratification & guide therapy in ILD beyond autoimmune disease. @RheumNow #ACR25 https://t.co/moRffVGZPn
#ACR25 Abstr#0772. Should we be worried of #SLE patients with low uPCR 0.25-0.49? Kidney biopsy in N=28 + poor prognostic (Non-White, active serology or active sediment)
- 71% had LN (No class IV or Mixed)
- 46% actionable LN
Cost-effectiveness data needed.
#ACRBest @RheumNow https://t.co/Bt3fuA3aJh
Antoni Chan MD (Prof)
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AI-enhanced MRI integrating STIR and T1-weighted MRI with BME data reflecting both inflammatory and structural changes, enabling the AI model to predict clinical diagnoses of axSpA with accuracy of 82%. Successfully identified axSpA patients who did not meet the ASAS criteria for https://t.co/dLlGj0ZFpj
Plenary session at #ACR25!
#0772 When should we biopsy in SLE?
In pts with uPCR 0.25-0.49 g/g + LN predictors, 69% already had LN (many Class III/V). Low C3/C4 were most important factors.
0.5 g/g cutoff may delay diagnosis and treatment. Time to rethink thresholds? @RheumNow
Brian Jaros, MD
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Early, low level proteinuria is a harbinger in SLE. ~50% with elevated UPCR but <0.5 had actionable LN on early bx.
Risk factor = low c3/c4
Urine biomarkers promising
#ACRBest #ACR25 @RheumNow https://t.co/WuNPKeqeid
Aurelie Najm
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What's new in the Pre-RA world?
Slowly unraveling mechanisms and biology associated to transition from CCP+ asymptomatic pre-RA state to clinical RA
Here is my summary of a few abstracts presented at #ACR25 proposing biomarkers beyond the realm of clinical and classical
Brian Jaros, MD
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From Dr. Petri at Plenary - even small amounts of proteinuria are a PROBLEM. Reduction of microalbuminuria by even 10% improves mortality! #ACR25 @RheumNow https://t.co/hjmH26vXIb
5–10% of axSpA [ts jave comorbid IBD. Southern Swedish study 152 (r- & nr-) axSpA pts found elevated fecal calprotectin (≥ 50 mg/kg) & this was assoc. w/ more damage w/ higher mSASSS values for all axSpA (adj OR 2.2) & in r-axSpA (adj OR 2.9) https://t.co/Hi1lE4so1r https://t.co/YYCGYYasfL
Study from Czech ATTRA registry of 8,543 RA pts 641 (7.5%) met criteria for D2T-RA & 1,825 achieved remission (21%). D2T-RA predicted by machine learning models (accuracy 0.606–0.747, AUC 0.656–0.832). Predictors included CDAI, DAS28-ESR, TJC, HAQ, CRP, steroids https://t.co/PqgKzKhM6h
SAIL-RA: Finding ILD in Early RA
Cohort study of early rheumatoid arthritis (RA) patients finds that interstitial lung disease (ILD) begins early in the course of RA, with certain factors enhancing this risk.
https://t.co/nI0YuYd3YS https://t.co/YR3Gg1kr59
Retrospective study of 423 seropositiv RA pts (SPRA) finds 21% with baseline ILD; over 10 yrs 31% had ILD. High monocyte counts signif higher in RA-ILD; whereas RF, CCP did not predict. Age & ILD predicted mortality - not monocytes, RF or CCP https://t.co/8H4wqZI3WQ https://t.co/dK9iHwj3cz


