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ICYMI: What are the Early Stages of Lupus?

Eric Dein, MD Apr 29, 2024

Incomplete lupus? Undifferentiated connective tissue disease? Pre-clinical autoimmune disease? During the lupus pod at RheumNow Live 2024, Dr. David Karp discussed the spectrum of autoimmune disease and the confusing terminology that is used with the complex world of early autoimmune disease. He cautioned against the traditional use of phrases such as incomplete lupus or undifferentiated connective tissue disease, which are heterogeneous and poorly defined.

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Rheum Chapter Notes (4.26.2024)

Jack Cush, MD Apr 26, 2024

Dr. Jack Cush reviews this past week’s news and journal articles from RheumNow.com.

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Predicting Infection in Lupus Nephritis

Jack Cush, MD Apr 25, 2024

Machine learning (ML) models were applied to 3 cohorts of lupus nephritis (LN) patients and established algorithms to predict co-infection in LN.

In 530 #GCA pts, relapses seen in 46%; but severe relapse (ischemi/aortic events) in 3%. Severe GCA relapse pts more likely to be younger at Dx(P=0.02), w/ more limb claudication(< 0.0001), fewer GCA-related cranial Sxs (<0.0001); but not higher mortality https://t.co/qyUpepmryA https://t.co/MJ9kAKl62r

Frequency and characteristics of severe relapses in giant cell arteritis

With the FDA's approval of its 50th biosimilar - they have published "A Milestone in Facilitating the Development of Safe and Effective Biosimilars". Since biosimialrs were approved in 2015, they saved the health care system $23.6 billion. https://t.co/7GPJ5XLGnr https://t.co/6Qw7DttmjT

A Milestone in Facilitating the Development of Biosimilars

Venous thromboembolic event Risk study in 1854 SLE pts vs controls (12,107) from 1985–2015 in W Australia. VTE affected 12.8% SLE pts; 6 fold higher than controls (RR 6.6). Risk factors: aPL(aHR 4.24), serositis (2.7), nephritis (1.75), low Plts (1.65) https://t.co/efUUQzTNzK https://t.co/XXXXTbQOCn

Long-term incidence, risk factors and complications for venous thromboembolism …

JAMA review of ILD; that affects 650,000 in USA, leading to 25,000-30,000 deaths/YR. Types reviewed. Key Symptoms: dyspnea and cough, w/ chest CT being diagnostic tool. Antifibrotic & immunomodulatory may slow disease progression. https://t.co/tE7kHgUE02 https://t.co/V7Htoct3VP

Interstitial Lung Disease

Is Colchicine Rx a problem? Retrospective study of UK Clinical Practice registry, 13945 gout initiated allopurinol with colchicine (64yrs; 78% male). 26% on 1+ meds interacting w/ colchicine. Diarrhea & MI more freq w/ comorbidities & more severe CKD https://t.co/ZkhpzaTjjI https://t.co/e3BO813b30

Prognostic factors for colchicine prophylaxis-related adverse events when initi…

'Drug Rediscovery for Rare Immune Mediated Inflammatory Diseases’ - a 6 center consortium will study if JAKi (filgotinib) is effective and safe in 3 rare disorders -- Behcets, inflammatory myositis & IgG4 related disease. https://t.co/UyZM4VNSY2 https://t.co/D2D1tdygS4

Existing drugs studied in patients with rare immune diseases

Articular Findings Sarcoidosis: - Acute arthritis: Lg Jt Oligoarthritis; Loffgrens syndrome (hilar LN, arthritis, E. nodosum) - Acute > Chronic arthritis - Chronic arthritis: tenosynovitis, oligo- &polyarthritis, dactylitis, erosions or Jaccouds arthritis

Hyperpigmentation from Hydroxychloroquine. From 316 HCQ pts, 26% got hyperpigmentation; delayed onset of 12 mos (6–30mos) after median cum. dose of 108 g. Seen on face (602%), Legs (36%) & hands (20%). Daily sun exposure decrease in the incidence (P=0.02) https://t.co/6B6Z0suXB4

Hydroxychloroquine-induced pigmentation in rheumatic diseases: prevalence, clin…

Predicting CKD Outcomes in Lupus Nephritis An observational cohort study suggests that proteinuria levels in lupus nephritis (LN) patients did not predict their histologic class. https://t.co/SCsuYuXgw4 https://t.co/bHB9ggf20H

Predicting CKD Outcomes in Lupus Nephritis | RheumNow

1/3 of lupus nephritis patient classified as ""complete responders"" continued to accrue progressive renal damage despite resolution of proteinuria over 1 year. Dr. @andreafava reviews GFR trajectories after renal bx at #RNL2024 @RheumNow https://t.co/mqwhfIFQsL

https://buff.ly/3xSICHa

#RNL2024 @DrDavidKarp Incomplete lupus is heterogeneous term ""Stage 2"" pre-classification stage as ILE/UCTD Stage 1: non-specific antibodies, dysregulation 2: incomplete features 3: classified, multi-system disease 4: irreversible tissue damage https://t.co/lmorwojG49

https://buff.ly/4aNqFID

Urine proteomics in lupus nephritis IL-16 and CD163 are urinary biomarkers most correlated w/ histologic activity Myeloid & degranulation sign ass w histo activity -> PR3+cells abundant in LN @andreafava #RNL2024 @RheumNow https://t.co/YpoMiupOlQ

https://buff.ly/4aWvwra

Long-term incidence, risk factors and complications for venous thromboembolism …

Our final TNR for the month of April will take place on 4/30 at 6:30pm ET. Mastering SLE Rethinking Pre-Clinical Disease in Lupus - David Karp, MD Biology and Rx of Lupus Flares - Michelle Kahlenberg, MD Current/Future Biomarkers in SLE - Andrea Fava, MD https://t.co/IoRDAaAJbo https://t.co/C7HpKvehXX

RheumNow.com

Prospective look at 25 280 older adults (mean 74yrs) w/ incident fracture, shows impact of multimorbidity by Charlson Comorbid Index (CCI). If CCI =2-3, Incr risk of subseq Fx (16-25%) & death (HR ~2); If CCI=4+, Fx Risk ^33-48%, death HR~4. https://t.co/6wnhFNiSXH https://t.co/Xy2y0ANDRd

Health Perceptions, Multimorbidity, and New Fractures and Mortality After a Fra…

Prevalence of MSK presentations in practice = 21.1%, based on UK practice cohort. Most common: pain in LS spine (18%) & knee (17%). Re-presentations of existing Dx made up 74% all MSK consultations. Steroid injx given to 1/3 of knee consults https://t.co/nTioq1lCEB https://t.co/ecm8Kxz2cu

The prevalence of musculoskeletal presentations in general practice: an epidemi…

Interstitial Lung Disease

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ICYMI: What are the Early Stages of Lupus?

Rheum Chapter Notes (4.26.2024)

Predicting Infection in Lupus Nephritis

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