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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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Unmet needs in #lupus are many
👇
Timely #diagnosis
Morbidity - CV, metabolic, OP, mental health
Premature mortality - CAD, active #SLE, infection
Issues w pregnancy
#steroid side effects
⬇️QoL
With partnerships we can ✅
Pts
HCPs
researchers
Pharma
Gov’t
#LUPUS2025
@RheumNow https://t.co/9T9rIrM1hV
Janet Pope Janetbirdope ( View Tweet)
IL2 low dose in #SLE
seems to + alter immune regulation
Multiple targets to explore in #lupus
Unravelling pathophysiology in SLE
CD40L
TLR7,8
#rapamycin type drugs
CAR-T w novel CARS
Etc
#LUPUS2025
@RheumNow https://t.co/jeycgg4ZhT
Links:
Janet Pope Janetbirdope ( View Tweet)
>200 genes 🧬 implicated in #SLE
Complex indeed!
And
▶️ 7 clusters of signalling pathways
So we have to have many Rx options
Ab patterns vary
LN flares can have v diff pathways between Pts
#LUPUS2025 @RheumNow
Unravelling #LUPUS2026 https://t.co/LEKN363194
Links:
Janet Pope Janetbirdope ( View Tweet)
We are not (yet) in #SLE
Getting
👇
Correct drug
In right pt
At right time
At correct individual dose
Even more problematic is in a renal bx - 2 glomeruli beside each other have v different cytokine expressions
Unravelling #LUPUS2025
@RheumNow https://t.co/yGBvhFkPKY
Links:
Janet Pope Janetbirdope ( View Tweet)
Here’s who flares in #SLE
least to most
Persistently neg antiDNA
Persistently + antiDNA
conversion of neg to + antiDNA
So are we over ordering antibodies in 1st 2 groups 🤷♀️
Unravelling #LUPUS2025
@RheumNow https://t.co/1Feau7f199
Janet Pope Janetbirdope ( View Tweet)
controversy re
👇
Monitoring for +Ro pregnant re
#congenital #heart #block
87% Y
echo is possibly too late
No ideas if flourinated #steroids work
But many thing we should do something
Guidelines differ on recommendations
Would fetal home HR be better
#LUPUS2025 @RheumNow https://t.co/MY0oPjLnGs
Janet Pope Janetbirdope ( View Tweet)
An excellent presentation from Dr Pankti Mehta @PanktiMehta24
Re #Jaccoud’s
With
#IFN signature
if #erosive IA - often + CCP / RF
Vs
nonerosive often +RNP
@RheumNow #LUPUS2025 https://t.co/y6z4KbhCdy
Janet Pope Janetbirdope ( View Tweet)
The ANA pattern I hate
#DFS
Why
Dense fine speckled should R/O #SLE
But mimicking patterns that MAY Have #lupus
AC-2 pattern mimickers ex AC-4
Machine learning models to help
▶️improved accuracy
Fast saving hrs
#Artificial #intelligence
May Choi #LUPUS2025 @RheumNow https://t.co/9tk80ZOAWg
Janet Pope Janetbirdope ( View Tweet)
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)
