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SLE, Antiphospholipid Antibodies, and the Placenta

Catherine Sims, MD

It is well established that women with SLE are at increased risk for adverse pregnancy outcomes, including preeclampsia, preterm birth, and pregnancy loss. However, the pathophysiologic mechanisms driving these complications are not yet fully understood. In this article, we explore several proposed pathways where the immune system and placenta interface, summarized in Figure 1, that may enhance our understanding of these risks.

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DPGN, lupus, nephritis, GN, glomerulonephritis, biopsy, kidney

Lupus Nephritis 2024 Guidelines

Jack Cush, MD

The ACR has published evidence-based and expert guidance for the screening, treatment, and management of lupus nephritis (LN). These are the same guidelines presented at ACR Convergence 2024. 

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Assessing and Treating CV Risk Increases in Systemic Lupus

Maureen A. McMahon, MD

We’ve recognized the increased risk of cardiovascular disease (CVD) in SLE for almost half a century since Urowitz et al. first described a bimodal pattern of mortality in lupus patients in 1976. Numerous subsequent studies have confirmed this, with estimates of increased risk ranging from 2-10-fold compared to the general population. Most striking is the risk in young patients; in their landmark study, Manzi et al. found that women with SLE in the 35–44-year age group had an almost 50-fold increased risk of myocardial infarction compared to age-matched women without SLE.

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Lupus in an empty house

Eric Dein, MD

The full house immunofluorescence pattern is the classic histopathologic finding of lupus and lupus nephritis. Glomerular deposits staining for IgG, IgA, IgM, C3 and C1q can help confirm a suspected diagnosis of SLE. But what about patients with negative immunofluorescence and no proliferative or membranous features?

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Deep remission in SLE – what is it, and can we achieve it? Recent reports on lupus patients treated with CAR-T cells targeting CD19+ B lymphocytes have sparked excitement. This is due to the patients experiencing ongoing clinical remission without further treatment after two https://t.co/rdBkIhfWWd
Dr. John Cush RheumNow ( View Tweet)
Lupus QD Clinic - SLE Get Ready Young SLE patient wants to get pregnant; but first she needs to get ready! Features Dr. Jack Cush https://t.co/988jrHmdUs https://t.co/qVrBU2lvI5

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SLE trends: pulse methylprednisolone followed by low dose steroids is rec by various guidelines. Risk factors for SLE flare after GC withdrawal: high Dz activity, active serology, younger age, shorter remission duration, faster tapering strategy, shorter duration/cessation of https://t.co/g6LaTijOpA
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Retrospective cohort study 112 biopsy-proven Lupus nephritis pts (65% class IV; F/U 8.3 yrs). (64.3%), alone or in combination. Renal damage incr betw 5 & 10 yrs F/U. 13.4% progressed to renal function impairment, and 11.6% to ESRD. Early Dx & Rx of LN, esp w/ highproteinuria, https://t.co/N1BL9Bri3M
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Refractory Renal SLE How to manage class III/IV lupus glomerulonephritis when you run out of options, by Dr. Jack Cush. https://t.co/syOVCEozfA https://t.co/UOY8MkZeX2

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Lessons Learned from a Lupus Registry: Two sides of one coin? It's Dr. Janet Pope reporting at RheumNow on our special lupus edition. I'd like to talk about lessons learned from a Canadian lupus registry. Is it two sides of one coin? https://t.co/IxMZhA1uht https://t.co/PJixCj8d6g

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Dr. John Cush RheumNow ( View Tweet)
QD Clinic - Refractory Renal SLE How to manage class III/IV lupus glomerulonephritis when you run out of options Features Dr. Jack Cush. https://t.co/8CQm8GZ213 https://t.co/lJKvcpIq60

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QOL survey of on 5222 lupus pts (94% F; 56% both CLE/SLE; 40% w/ SLE. QOL concerns on social activities (60%), mental health (38%). CLE had increased therapeutic hesitancy and less likely to believe in the efficacy of biologics than SLE or both. https://t.co/BOUXUSmmcM https://t.co/62Z1aFsbbv

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Comparing EULAR (2025) and ACR (2020) Guidelines on Safety of Lupus Medications in Pregnancy Attendees at the 2025 RheumaPreg meeting were excited to discuss the newly released EULAR recommendations for use of antirheumatic drugs in reproduction, pregnancy, and lactation. https://t.co/DSYPaElRij

Dr. John Cush RheumNow ( View Tweet)
Retrospective cohort study 112 biopsy-proven Lupus nephritis pts (65% class IV; F/U 8.3 yrs). (64.3%), alone or in combination. Renal damage incr betw 5 & 10 yrs F/U. 13.4% progressed to renal function impairment, and 11.6% to ESRD. Early Dx & Rx of LN, esp w/ highproteinuria, https://t.co/yHzN1Hczb4
Dr. John Cush RheumNow ( View Tweet)
QOL survey of on 5222 lupus pts (94% F; 56% both CLE/SLE; 40% w/ SLE. QOL concerns on social activities (60%), mental health (38%). CLE had increased therapeutic hesitancy and less likely to believe in the efficacy of biologics than SLE or both. https://t.co/BOUXUSmmcM https://t.co/zrzEsDDqVn

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Full read overview of Discoid Lupus. https://t.co/G6lXWTRSFn https://t.co/yjVsDg0D5d

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Betw 2005 -2021, there was a substantial increase in HCQ use, but only modest steroid (GC) reductions. Swedish cohort study of 3891 SLE pts - over 5 yrs GC decr from 68% - 54% to 46%. HCQ increased by 29% over 5 years. https://t.co/6LZVMt9zy7 https://t.co/WunjnBBTW9

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Telitacicept, recombinant fusion protein targeting BLyS & APRIL, studied in 41 Chinese SLE pts (added to standard Rx) showed mean improvements in SLEDAI-2K (10.0 to 6.25 @12 wks & 4.2 @24 wks;p<.001), daily prednisone (21 mg to 9.8mg) & proteinuria (2.8 gr to 1.3 gr/day) https://t.co/xtPMSZBoWg
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Vitamin D Headlines (5.9.2025) Dr. Jack Cush reviews the news, journal reports and lupus highlights from the past week on RheumNow. Triple positivity, the gut and CRPS, and hope for better outcomes with Vitamin D therapy. https://t.co/i9OJrYR59T https://t.co/PQ3fAR5teR

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Telemedicine and Lupus https://t.co/RgfgnMGsZw https://t.co/uQEYLlrlB5

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