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Taking AI Out of AutoImmunity: Predicting disease before it develops

Akhil Sood, MD

the predictive value of a positive ANA test—especially in the absence of other clinical symptoms—remains a challenge. A positive test often leads to further testing, yet it does not necessarily indicate whether a patient truly has an underlying autoimmune disease. The development of AI and machine learning algorithms presents an opportunity to interpret autoantibody tests and predict autoimmune diseases. Here are three studies looking at this issue.

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Cool study investigating differences in nailfold capillaroscopy, jives w/my clinical experience Compared to SLE, pts with DM 🔼nailfold changes, 🔼 loop dilation, 🔼hemorrhages #ACR24 @rheumnow Abstr#2404 https://t.co/8N7KNRZet8

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Mike Putman EBRheum ( View Tweet)
The precise mechanism of action of GIOP is not known. Decrease in osteocyte LCN is observed. Abstr#2528 @RheumNow #ACR24 https://t.co/fazUUy03fQ

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Abst#2413 SLE Cohort of > 2900 pts over 50 yrs - Prevalence of proteinuria at the time of SLE dx has not changed over the decades. Prevalence of proteinuria also did not change at 5 and 10 yrs after dx. Earlier use of HCQ has not led to a ⬇️in lupus nephritis. @RheumNow #ACRbest

TheDaoIndex KDAO2011 ( View Tweet)

Renal biopsies, while painful, remain the gold standard for diagnosing and classifying lupus nephritis. But what if there are less-invasive methods? In this article, I highlight key abstracts exploring innovative approaches. https://t.co/ZInKmVS2Gn @RheumNow #ACR24

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Akhil Sood MD AkhilSoodMD ( View Tweet)

Can you build systems that stop that ANA neg ENA pos anxiety? Plus $$? Lehigh Valley, Allentown, PA: lab would run ENA+dsDNA automatically, but only when ANA >1:80 (i.e. leave the ENA order to the lab) first voluntary, then compulsory it's possible! #ACR24 ABST1931 @RheumNow https://t.co/UQjWwve7DV

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David Liew drdavidliew ( View Tweet)
ANA neg, but ENA pos should we care about that result? PPV 5.5% here (similar to 6% prev @EricFMorand: https://t.co/Hyaued3rw2) and how many really needed the serology? Anxiety? Surely pos ENA w neg ANA might be more hassle than help. So what to do?⬇️ #ACR24 ABST1930 @RheumNow https://t.co/rE7RmgOGey

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David Liew drdavidliew ( View Tweet)

VERY exciting SLE update from Fava et al. Machine learning used to generate urinary protein panel predictive of intra-renal inflammation BETTER than serum biomarkers C3, C4, dsDNA Also monitoring tool for renal response. Outstanding. @RheumNow #ACRbest #ACR24 https://t.co/YXgKrSU4UQ

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Brian Jaros, MD Dr_Brian_MD ( View Tweet)
SURPASS trial of bio naïve axSpA at risk of radiographic progression: 1. Presence of syndesmophytes 2. Higher CRP levels 3. Higher ASDAS 4. Higher spinal MRI BME scores Were predictors of spinal progression independent of ttnt Abst#1759 #ACR24 @RheumNow https://t.co/QC9FMPufPY

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Adela Castro AdelaCastro222 ( View Tweet)
Dr. BDinneen et al reported predictors that can help screen axSpA pts w/o traditional CV RFs for carotid doppler utz: - shorter dse duration - no family hx of IHD - HLAB27+ - ⬆️ dBP, WHratio, ferritin, TC, LDL and TC:HDL ratio Small size, more data reqd @RheumNow #ACR24 abs1440 https://t.co/3pZxFmutJz

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sheila RHEUMarampa ( View Tweet)
A study showed the sex differences in serum proteomic profiles of males and females with PsA. Key findings: -Identified 741 unique proteins in male PsA patients vs. controls vs. 31 in females. - Several sex-specific pathways, including immune cell functions and cytokine… https://t.co/erC599Zbuj

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)

A#1692 Single cell RNA-seq identifies double-negative-2 (DN2) B-cell population ass w progressive SSc-ILD IgD- CD27- cluster is highest risk CD21 low B cells are distinct subset associated with sclerosis, pHTN DN2 B cells as potential biomarkers for SSc-ILD @RheumNow #ACR24 https://t.co/IbnOGS8C3t

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Eric Dein ericdeinmd ( View Tweet)
A#1691 Biomarkers for Rx response SSc ILD? 92 SSc-ILD pts, 19 had progressive pulm fibrosis (PPF) KL-6 - incr in PPF, decr in those w/o PPF CXCL-4 decr across cohort - non-signif trend for more w/o PPF Specifically in MMF: CRP, KL6, CXCL4 are predictive #ACR24 @RheumNow https://t.co/9fG6atcLmK

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Eric Dein ericdeinmd ( View Tweet)
Abstract 1686: Urinary proteomics reveals potential markers (MMP-13, M-CSF receptor, CD163, ALCAM, FOLR2) and pathways (neutrophil degranulation, ECM, tissue remodeling) involved in lupus nephritis Class II. @RheumNow #ACR24 https://t.co/kufd2zl9yc

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Akhil Sood MD AkhilSoodMD ( View Tweet)
Is there a less invasive approach to evaluate lupus nephritis? Abstract 1683 highlights the potential role of 68Ga-FAPI PET imaging in evaluating for lupus nephritis. FAPI uptake ↑ in pts with lupus nephritis vs HC. Correlated with IFN -α and IFN-γ pathways. @RheumNow #ACR24

Akhil Sood MD AkhilSoodMD ( View Tweet)

Will my patient with lupus nephritis respond well to induction therapy? Abstract 1685: Aundhia et al demonstrate the promising utility of RAIL to predict complete renal response in patients with lupus nephritis (Class III or IV +/- V) @RheumNow #ACR24 https://t.co/JBldrrwUhN

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Akhil Sood MD AkhilSoodMD ( View Tweet)
#1330 🔬F-Calprotectin in Early RA ➡️ New-onset RA pts(n=104) had ⬆️ F-calprotectin vs controls(n=50)(71 v. 17µg/g; p<0.001) 🔑Higher F-calprotectin linked to ⬆️ DAS28 & NSAID use ⬇️levels @ 6 months Rx ❓Role of subclinical gut inflammation in early RA #ACR24 @RheumNow

Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)

Is cognitive impairment in SLE driven by cell exhaustion or aging? Abstract 1514 shows that SLE patients with cognitive impairment had higher levels of CD8+ (cell exhaustion) and lower levels of cell senescence markers. @RheumNow #ACR24 https://t.co/SzxTQt3oNY

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Akhil Sood MD AkhilSoodMD ( View Tweet)
#1350 🔬 Microbiome & RA: Impact on Disease Activity & Vascular Function ➡️ Salivary microbiome a/w arterial stiffness (AIx)(p 0.019) ➡️ Stool microbiome a/w DAS28-CRP(p 0.027) 🔴Key taxa👇identified for each; no common taxa for both disease activity & AIx. #ACR24 @RheumNow https://t.co/54Sumzzd27

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Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Navigating Positive ANA: Leveraging AI for better triage Abstract 1526: Markus et al. developed a machine learning model to predict progression to SLE, utilizing diagnoses, meds, procedures, and labs collected 2 years before and 5 years after +ANA. @RheumNow #ACR24 https://t.co/2zzSH8Pb0e

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Akhil Sood MD AkhilSoodMD ( View Tweet)
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