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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 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
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
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
sheila RHEUMarampa ( View Tweet)
#ACR24 Guidelines #LupusNephritis for refractory dz @RheumNow https://t.co/LlSixkggKK
TheDaoIndex KDAO2011 ( View Tweet)
In earlier studies of Vit D, there were conflicting evidence as to whether it reduced or increased the risk of RA and #SLE
@RheumNow #ACR24 @rheumarhyme https://t.co/PvjjmhHaOd
sheila RHEUMarampa ( 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)
We know most preexisting autoimmune disease is very mangaeable when checkpoint inhibitors are needed.
So great to see that, in the VA, autoimmune disease pts largely haven't missed out on potentially lifesaving cancer immunotherapy.
Keep on reassuring!
#ACR24 ABST1985 @RheumNow https://t.co/ApOACBLi4K
David Liew drdavidliew ( View Tweet)
Abst#1493 complete renal response (< 0.5 g/g w/< 10 mg/day pred); renal remission (UPCR < 0.3 g/g w/< 5 mg/day pred). 60 LN pts followed 3 yrs: 40% CRR & 19% RR. Pts not in CRR/RR had⬇️eGFR w/more decline in eGFR over time. No difference b/t CRR/ RR @rheumnow #ACRbest #ACR24
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
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
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
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
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
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
What a result!!!
Crowed split 49% against and 51% for MCTD as a unique disease entity
Given pre-debate poll of >70% for MCTD, looks like an overall win for the “NOT” group
Fantastic session from all the presenters
@RheumNow #ACR24 https://t.co/GgTVQ1VNWP
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
The anti-MCTD group strikes back
Of cohort of over 1,000 RNP+ pt, only 17 clinically diagnosed with MCTD
Majority of patients, despite potential overlap, treated for other primary rheum dz
@RheumNow #ACR24 https://t.co/vkQ6UPs34y
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Interesting comparative effectivness study, TOFA vs calcineurin inhibitors in MDA5-dermato
Expansion of prior publication @NEJM that used historical controls: https://t.co/AzA8ybCqYH
Encouraging data for JAKs in this disease; need proper trials
#ACR24 @RheumNow Abstr#1736 https://t.co/BHVMZLu6Ip
Mike Putman EBRheum ( View Tweet)