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Shifting the Management Paradigm for SLE and Lupus Nephritis
The paradigm for treating patients with systemic lupus erythematosus (SLE) is rapidly shifting and our patients will surely benefit with improved outcomes.
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No Cancer Recurrence with Biologic DMARDs in RA
A prospective Danish rheumatoid arthritis (RA) registry study look at the risk of recurrence when a biological disease-modifying antirheumatic drugs (bDMARDs) was ued in patients with a a prior solid cancer (in remission) and found no increased cancer
Tocilizumab vs. Methotrexate in Rheumatoid Arthritis
A large randomized rheumatoid arthritis (RA) clinical trial compared subcutaneous tocilizumab (TCZ) vs oral methotrexate (MTX) vs. the combination of subcutaneous TCZ and MTX, and showed that TCZ was superior to MTX, either given as TCZ monotherapy or in combination with MTX.
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Tocilizumab vs. Methotrexate in Rheumatoid Arthritis
A large randomized rheumatoid arthritis (RA) clinical trial compared subcutaneous tocilizumab (TCZ) vs oral methotrexate (MTX) vs. the combination of subcutaneous TCZ and MTX, and showed that TCZ was superior to MTX, either https://t.co/AS8MJaujIE
Dr. John Cush RheumNow ( View Tweet)
Why follow antiDNA and complements in
#lupus #nephritis #LN
#LUPUS2025 panel said
To detect flare
?to consider after 3 to 5 yrs of remission to taper Rx
?but not for early response to Rx
Just info from the panel with my opinion salted in
@RheumNow https://t.co/bFUfN0PsFF
Links:
Janet Pope Janetbirdope ( View Tweet)
deep thoughts in #lupus
Is ‘better’ the enemy of #remission?
Is a complete renal response <50% at the end of contemporary #triple #therapy
Something to celebrate?
▶️Yes better than old #SoC but a bit sobering
We need RCTs that radically change paradigm
#LUPUS2025 @RheumNow
Janet Pope Janetbirdope ( View Tweet)
‘Oranges & green vegetables’
⬆️
#diarrhea in #MMF said Ana Malvar
bad #LN outcomes if #nonadherent
Good relationship with#HCP helps
#adherence
✅education to help deal with side effects
pts need to know
Why this Rx
?how long
S|E Rx
#ClinicalPearl
#LUPUS2025
@RheumNow https://t.co/RnFGwJSl1F
Janet Pope Janetbirdope ( View Tweet)
do’s & don’t #Lupus #nephritis
❎
Don’t sequential monotherapy
▶️ use #MMF + #biologic or #CNI
✅
Do a #biopsy
➡️ need to know
#dx
#px
Do target LOW proteinuria
Do treat comorbidities
Lipids
HTN
Fluids
BMI
?mood
No #NSAIDs
Do limit #pred
#SGLT2i
@RheumNow #LUPUS2025 https://t.co/D0vHQXYTvZ
Links:
Janet Pope Janetbirdope ( View Tweet)
‘It’s #Lupus, it’s all in your head!’
➡️ Some patients with #SLE have heard this from others
At #LUPUS2025 in a packed session on #CNS lupus
#Dx is tricky
40% of #neuropsychiatric lupus have NEGATIVE #brain #MRI
👇r/o
infarct/bleed
Infection
Rx #steroids
@RheumNow https://t.co/yU1olg0uZU
Links:
Janet Pope Janetbirdope ( View Tweet)
‘To screen or not’?
For
#CHB #congenital #heart #block
Great debate #LUPUS2025
In #pregnant women with #SLE
In + #Ro #SSA &/or #La #SSB mothers
CHB Rx - #flourinated #steroids
To
⬇️#fetal #mortality ❎no benefit
⬇️#cardiomyopathy ❎
⬇️#pacemaker ❎
@RheumNow
??🤷♀️ https://t.co/xauDzfNBsC
Janet Pope Janetbirdope ( View Tweet)
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
Janet Pope Janetbirdope ( View Tweet)
#Proteinuria that persists in #LN
#lupus #nephritis even w mild proteinuria
👇
Worse outcomes
Just like all CKD
Take home
Aim for None or minimal in #SLE
<150 protein
#voclosporin >> PBO (SoC)
1/2 Voclosporin had deep response at least once > PBO
#LUPUS2025 @RheumNow https://t.co/CBUzyBatBh
Links:
Janet Pope Janetbirdope ( View Tweet)
Any ‘toll’ in #toll #like #receptors 7,8 in #SLE
Cutaneous #lupus
In #systemic or #cutaneous wk16
Rx
PBO
V
#enpatoran
No obvious dose response - all 3 dose >PBO
Safe so far improves IFN
No toll to pay! 👍
But need Ph3 data
#LUPUS2025 @EricFMorand @RheumNow https://t.co/2DDztlVsUm
Links:
Janet Pope Janetbirdope ( View Tweet)
Systematic review and meta-analysis confirms modest efficacy of infliximab for pulmonary sarcoidosis and promising but limited evidence for adalimumab, tofacitinib and efzofitimob in specific sarcoid manifestations. https://t.co/XaqSiAVQTa https://t.co/DTGbIiPT3a
Dr. John Cush RheumNow ( View Tweet)
Moving Targets in Lupus and Lupus Trials
In the 1990s, lupus treatment development became a major focus, but progress was slow. Belimumab was eventually approved by recognizing that trials could only show small differences from placebo, requiring 867 patients globally to https://t.co/xrj8r1iNxr
Dr. John Cush RheumNow ( View Tweet)
If vagus nerve stimulation improves RA; then what if vagotomy? Danish study of vagotomy (1977-1995). 6070 vagotomy matched w/ 60,699 comparators. Truncal vagotomy was assoc w/ signif incr RA incidence (OR 2.62), but not superselective vagotomy (OR 1.05). NO diff in incident OA https://t.co/Rs1EyrQd57
Dr. John Cush RheumNow ( View Tweet)
Infusion/injxn-reactions (IRRs) w/ biologics studied in 1,832 RA pts - IRRs seen in 9.7% & were signif more common w/ being younger (OR1.79), secondary Sjögren's (OR 2.17), prior leflunomide (OR 1.5); but less common w/ Abatacept (OR 0.26) & tocilizumab (OR 0.42), golimumab (OR https://t.co/IaHajITWri
Dr. John Cush RheumNow ( View Tweet)
QD Clinic - Tackling Lupus Pregnancies
Managing Lupus Pregnancy - pre-pregnancy, labs & safe drugs
https://t.co/rtDVCCVqnD https://t.co/IRi1qYYqAA
Dr. John Cush RheumNow ( View Tweet)
Panacea of Prednisone & Cannabis (5.16.2025)
Dr. Jack Cush reviews the news, journal and regulatory reports from this week on RheumNow. Interesting trends and results with prednisone in lupus, cannabis in RA and opioid deaths too!
https://t.co/QDtxItYSco https://t.co/s4nYmMe3vs
Dr. John Cush RheumNow ( View Tweet)
Pregnancy planning, contraception and safe drugs in Pregancy.
Featuring Dr. Megan Clowse, Durham NC
https://t.co/sZuq475VJv https://t.co/HZv9FuviaR
Dr. John Cush RheumNow ( View Tweet)
