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Cognitive Impairment: The Hidden Burden in Lupus Care
Suppose you have a patient with lupus returning for follow-up. Their joint symptoms are well controlled. The kidneys—managed with a combination of biologic DMARD and mycophenolate—show no signs of active urinary sediment or protein. Yet, during the routine visit, your patient brings up fatigue and difficulty remembering things. How do you address this? Several studies presented at ACR24 focused on cognitive impairment in lupus.
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ACR 2024 - Day 3 Report
Highlights from Day 3 at ACR24 included the plenary session presentation on Nipocalimab (previously reviewed), but the big highlight was the Lupus Nephritis guideline recommendations.
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GLP-1 Agonists Show Promise in Slowing Kidney Disease in Lupus Nephritis
A retrospective cohort study presented at #ACR24 explores the benefits of GLP-1Ras in reducing the risk of end-stage renal disease (ESRD) for patients with lupus nephritis. Drawing on data from the TrinetX global research database, the study examines how GLP-1Ras may reduce ESRD progression in a population where 10-20% progress to ESRD within five years, even with immunosuppressive therapies.
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PHOENYCS GO, RCT of dapirplizumab, novel CD40Li in SLE
Met primary endpoint (NNT~6 for BICLA) & numerical improvements in many other endpts
1 MI & 1 death from infection over 213 pts
Encouraging for sure! Second phase 3 being launched
#ACR24 @RheumNow Abstr#L16 #ACRbest https://t.co/QwDMKjhFvb
Links:
Mike Putman EBRheum ( View Tweet)
It is NO LONGER a ACCEPTABLE
To NOT consider
#MMF or #Cyclo + another proven #Rx
Added to
#HCQ and #tapering /limiting #glucocorticoids
RCTs in #lupus #nephritis support this
? Is which to add
#belimumab
#CNI #volclosporin
#obinutuzimab
#ACR #ACRbest @RheumNow @ACRheum https://t.co/a7WMFfCyXl
Janet Pope Janetbirdope ( View Tweet)
Pathophysiological pathways in neuropsychiatric SLE. 2 components:
-Ischaemic
-Inflammatory
Zahi Touma @RheumNow #ACR24 https://t.co/wwlSSSpOIU
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Subsets of lupus arthritis. Kenneth Kalunian @RheumNow #ACR24 https://t.co/ZmHui126zr
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Study by Maria Dall'Era et al. compared voclosporin-based triple immunosuppressive therapy with high-dose GC in active lupus nephritis.
- Fewer adverse events in the voclosporin group, despite a higher incidence of specific issues like decreased GFR and hypertension.
- 25%… https://t.co/ToRu2rdErC https://t.co/uUXzNNuLDb
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Loiseau et al. 4700 pSS, 47000 comparators. pSS associated with increased risk of every CV/VTE outcome. Did not have that in my priors! @RheumNow #ACR24 Abstr#2631 https://t.co/QKemUhbcG8 https://t.co/twpjdS2L63
Links:
Richard Conway RichardPAConway ( View Tweet)
A re-evaluation of lupus arthritis. Old dogma is RA is erosive and SLE non-erosive. With better imaging, lupus arthritis can be erosive. Vivianne Malstrom. @RheumNow #ACR24 https://t.co/JEqVPLGNfu
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Did you know?
#Lupus arthritis have clinical and US classifications.
On MRI, findings will show:
- periarticular hyperplastic tissue
- capsular swelling
- edematous tenosynovitis
@RheumNow #ACR24 @rheumarhyme @theactiverheum https://t.co/EoKh2Q3V9Z
Links:
sheila RHEUMarampa ( View Tweet)
Dr. CStone et al. assessed nailfold dermoscopy in distinguishing DM from SLE
Almost all DM pts had nailfold changes in at least 1 digit vs. SLE
& majority of DM pts had nailfold changes in all 10 digits
Dermoscopy is a simple alternative to capillaroscopy
@rheumNow #ACR24 ab2404 https://t.co/6tEXAlX7lt
sheila RHEUMarampa ( View Tweet)
Neuropsychiatric manifestations in SLE.
Susanne Benseler MD @RheumNow #ACR24 https://t.co/subiykC5Q4
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Neuroimaging is done to support the diagnosis of CNS #lupus but only 75% reveal abnormal brain MRI.
📌 It is more useful in pts with local deficits than diffuse.
📌 poorly correlated with cognitive dysfunction & psych phenotypes.
@Rheumnow #ACR24 @rheumarhyme @theactiverheum https://t.co/HjNbVBaOHv
sheila RHEUMarampa ( View Tweet)
The different NPSLE syndromes 👇
Highlighted in yellow are the most common manifestations. 🧠
- Cognitive dysfunction
- Mood disorder
- Anxiety disorder
@RheumNow #ACR24 https://t.co/1I7OVPT6DK
sheila RHEUMarampa ( View Tweet)
Diagnostic work up for neuropsychiatric SLE. Zahi Touma MD @RheumNow #ACR24 https://t.co/zLX1QHCaSu
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Dr @ZahiTouma discusses the attribution rules for the NPSLE syndromes
Attribute to #SLE if
- onset of NP is near the SLE dx
- absence of concurrent nonSLE factors
- ⬇️ frequency of NP events in the gen pop'n
- diagnostic tools favor NPSLE
@RheumNow #ACR24 https://t.co/e1xBK4Xzsw
sheila RHEUMarampa ( View Tweet)
Very informative slide describing the 2 NPSLE pathogenetic pathways & their differences in mediators, mechanisms and NP events.
@RheumNow #ACR24
@rheumarhyme @theactiverheum https://t.co/D3XFDqxMBq
sheila RHEUMarampa ( View Tweet)
Study on #SLE and ESRD using machine learning:
Developed model to identify patients with SLE and ESRD
Used NIH 'All of Us' dataset
XGBoost outperformed Random Forest
SDOH data improved model precision #ACR24 @rheumnow #MachineLearning abst#1876 https://t.co/PQ7u4Pj5OH
Bella Mehta bella_mehta ( View Tweet)
Disease specific chatbots might be primetime - investigators from NYC made the a #LupusCoach chatbot - patients indicated high levels of satisfaction and were excited about it.
@rheumnow abst#2160 #ACR24
Bella Mehta bella_mehta ( View Tweet)
