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Outcomes in lupus nephritis are akin to the glass half full. Serial monotherapy is out, as the percentage who achieved a complete renal response was very low and some went to end stage kidney disease (ESKD). Solutions?
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The ACR has released its 2025 Systemic Lupus Erythematosus (SLE) treatment guidelines and consensus-based good practice statements, applicable to children and adults with SLE.
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Dr. Jack Cush reviews the news, journal and regulatory reports from this week on RheumNow.com. Interesting trends and results with prednisone in lupus, cannabis in RA and opioid deaths too!
Dr. John Cush
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Turkish study of 1263 primary care referrals to rheumatology found 35.7% with inflammatory rheumatic Dz (IRD), 17.7% osteoarthritis, and 11.2% regional pain syndromes. Another German study showed low risk of IRD if CRP <5 https://t.co/v5qYb7c7jP https://t.co/iq4NfcC3cH https://t.co/RQan6rQi8a
Dr. John Cush
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Genetic Link to CPPD
In a first-of-its-kind genome-wide association study (GWAS) researchers have discovered two genes, RNF144B and ENPP1, that cause calcium pyrophosphate deposition (CPPD) disease in Americans of European and African descent.
https://t.co/YSR6rEYzjG https://t.co/L7JyoxQp3K
Dr. John Cush
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JAMA CME review of Immune Thrombotic Thrombocytopenic Purpura (iTTP) - thrombotic microangiopathy w/ hemolytic anemia (MAHA) & thrombocytopenia. iTTP incidence is 2-6 per million. Caused by Abs to ADAMTS13), w/ low ADAMTS13 activity vWF multimers bind platelets https://t.co/kwKXUciBd1
Dr. John Cush
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Annals of Internal Medicine has published a CME review of LYME DISEASE. Most Lyme is Dx by onset of the erythema migrans rashes,. Lyme Ab testing is of low sensitivity at onset but more sensitive w/ time & CNS, CV complications. or Mono- or oligoarticular arthritis https://t.co/NfL0dabeGe
Dr. John Cush
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SLE, Antiphospholipid Antibodies, and the Placenta
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 https://t.co/z0BOT3xsuQ
Dr. John Cush
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Lupus in an empty house
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 systemic lupus erythematosus (SLE). This https://t.co/Zcywc5r9q9
Janet Pope
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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
Janet Pope
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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
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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
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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
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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
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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
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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
Dr. John Cush
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Is Lupus Just a B Cell Disorder?
https://t.co/0kwxE6KLeI https://t.co/pORHkg9HY6
Dr. John Cush
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Assessing neuropsychiatric SLE by 3-T, 3D contrast-enhanced vessel wall imaging. 47 w/ NPSLE vs 42 without (just SLE) showed the NPSLE had 2 fold more 1ntracranial contrast-enhanced vessel wall imaging (CE-VWI) w/ AUC 0.78 for CE-VWLs, & sensitivity 60% , specificity 87%.
Dr. John Cush
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Neutrophil alkaline phosphatase (NAP) elevated in active AOSD. 141 AOSD compared to Bcell lymphoma, SLE, aPL & controls. NAP pos. correl w/ Systemic Dz activity score (R=0.71), & 0.59 for CRP/ANC/ferritin. NAP scores higher in pre-MAS, but lower w/ MAS (w/lower WBC). NAP responds https://t.co/YbYPaJUEbz
Dr. John Cush
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Lupus in an empty house
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 systemic lupus erythematosus (SLE). This https://t.co/DQWwRJmdqM
