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Taking AI Out of AutoImmunity: Predicting disease before it develops
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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Abstract 1873: The impact of urbanization on lupus nephritis mortality is complex.
Race/ethnicity + income modify the effects
- Income ≥$50k + living in suburbs associated with lower odds of mortality due to LN in racial/ethnic minorities
@RheumNow #ACR24
Akhil Sood MD AkhilSoodMD ( View Tweet)
Quote of the day. “Time is kidney” Maria Dall’Era MD, UCSF at the ACR SLE guidelines for management of lupus nephritis @RheumNow #ACR24 https://t.co/rz9AhPS2cl
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Important study in SLE: out of 590 pts with pericarditis, 20% had recurrence w/in 1 year
Higher in early dx, younger pts, higher dx activity, & pred exposure
Is prednisone risk confounding by indication? Or causative?
#ACR24 @RheumNow @andreafava Abstr#2372 https://t.co/Seyi4F6weY
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Mike Putman EBRheum ( View Tweet)
Depressing finding re:glucocorticoid discontinuation in SLE
No improvement over decades in rate of GC discontinuation; if anything, we start more GC than ever
@AliDuarteMD help me out here; why haven't we made more progress?
#ACR24 @RheumNow Abstr#2421 https://t.co/uzZATKPWVC
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Mike Putman EBRheum ( View Tweet)
Why is there female predominance in #SLE - the extra X chromosome in females (XX) may not be inactivated properly- usually maintained by the long non-coding RNA #Xist
#ACR24 abst#2599 @RheumNow https://t.co/C9Qj5zSnpN
Bella Mehta bella_mehta ( View Tweet)
Updated ACR guidelines on management of lupus nephritis (LN). Consider early biopsy. Focus on triple therapy in LN. From the panel discussion, Tacrolimus can be an alternative to CNI (Voclosporin) where there is no access to this. Manage comorbidities such as CV risk, bone… https://t.co/4R02YnRXDP https://t.co/3J7YcF5ucQ
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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Applying the guidelines to Cases- Dr M Dall’Era for a pt wit extrarenal lupus and active LN. #ACR24 @rheumnow https://t.co/lvOUWjEdEz
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TheDaoIndex KDAO2011 ( View Tweet)
The updated 2024 ACR Guideline for Dx and Tx of #lupus nephritis is here!
Dr. Lisa Samaritano discusses the key recommendations 👇
For all pts: screen for LN, give HCQ and RAAS for pts with ⬆️ proteinuria
GCs in pts w/ LN class III/IV &/or V.
@Rheumnow #ACR24 @rheumarhyme https://t.co/wLVRGktR59
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sheila RHEUMarampa ( View Tweet)
The overview for #lupus nephritis tx.
Triple therapy is preferred as first line due to:
1. RCTs (BLISS-LN & AURORA 1) showing improved outcomes w/ triple txs
2. Nephron loss happens with ongoing LN - time is kidney!
@RheumNow #ACR24 https://t.co/IQo3q3O1pt
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sheila RHEUMarampa ( View Tweet)
Recommend "Triple Therapy" = Glucocorticoids + two other agents
Practically, that means MMF + belimumumab OR CNI for most pts
For the CYC afficionados, the lower-dose EUROLUPUS protocol is preferred
#ACR24 @RheumNow https://t.co/0gRISXSw0c
Mike Putman EBRheum ( View Tweet)
Applying the #ACR24 #LupusNephritis: Case 2 by Dr M Dall’Era @RheumNow https://t.co/A7i103uHZT
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TheDaoIndex KDAO2011 ( View Tweet)
Interesting! Study of pts w/ ANA(-) & dsDNA(+). 1 in 5 dx with APLS! Have others seen that?
I have been disgregarding this pattern, though some of that is related to my in-house assay (seems overly-sensitive) & my bias against overdiagnosis
#ACR24 @RheumNow Abstr#2391 https://t.co/FWgCjEwPDK
Mike Putman EBRheum ( View Tweet)
Abstract 1876: Developed a machine learning model w/ #SDoH covariates to accurately identify patients with SLE and ESRD in NIH All of US dataset
@RheumNow #ACR24 https://t.co/TLDSiBZZPs
Akhil Sood MD AkhilSoodMD ( View Tweet)
Provocative study suggests SLE has changed. Big picture: less physical manifestations, more serologic
@andreafava why isn't this just more-testing & more-sensitive testing shifting the phenotype of who we diagnose?
#ACR24 @RheumNow Abstr#2413 https://t.co/o2e9TFMsUp
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Mike Putman EBRheum ( View Tweet)
Lots of data on TYKs including much supporting efficacy in interferon inhibition
Can we really call interferon signalling a "central" pathway in SLE?
Inhibiting it has been modestly successful, at best, and mostly for skin dx
#ACR24 @RheumNow Abstr#2434 https://t.co/Q94FQz3gzO
Mike Putman EBRheum ( View Tweet)
Class V #Lupus Nephritis usually takes longer to treat. Stay the course if no contraindications and taper steroids! - Dr A Askanase #ACR24 LN Guidelines @RheumNow https://t.co/4BBuAWi2da
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TheDaoIndex KDAO2011 ( View Tweet)
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
Mike Putman EBRheum ( View Tweet)
Dr. @karen_kc123 discusses the results of the VITAL study.
- Long term use of Vit D3 2000IU was safe and decreased the incidence of all autoimmune dses by 22%.
- It took a while to work but the effect dissipates once discontinued.
@RheumNow #ACR24
@rheumarhyme https://t.co/mnwRsdZ06N
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sheila RHEUMarampa ( View Tweet)
#ACR24 Guidelines #LupusNephritis for refractory dz @RheumNow https://t.co/LlSixkggKK
TheDaoIndex KDAO2011 ( View Tweet)
