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Taking a closer look: B-Cell depletion beyond the blood
Following the landmark case series by the Erlangen group, multiple cellular therapies have entered the race—each with unique targets, constructs, and mechanisms. Yet, a fundamental question remains: How deep is the B-cell depletion? In clinical practice, peripheral blood counts often serve as our surrogate for depletion. But these may only tell part of the story.
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ACR 2025 Rheumatology Round Up
Drs. Jack Cush & Arthur Kavanaugh, two of rheumatology’s most trusted voices, provide a breakdown of the latest breakthroughs and hottest topics in rheumatology from the 2025 ACR Convergence meeting in Chicago.
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Cellular Biomarkers of Rheumatoid Arthritis
Dr. Jeffrey Sparks reports on four abstracts at #ACR25.
https://t.co/ZO259DXIcW https://t.co/HOpgiXfYvM
Dr. John Cush RheumNow ( View Tweet)
B Cell Depletion: Check the Lymph Node
Dr. Akhil Sood reports on abstract 2695 (B-cell depletion and lymphoid follicle disruption upon different B-cell depleting agents) presented at #ACR25.
https://t.co/BjgIC3Kng0 https://t.co/flfyLZYW8q
Dr. John Cush RheumNow ( View Tweet)
This and other reports on palindromic rheumatism show that PR is a pre-clinical RA state, both having same predictive factors for progression to RA! https://t.co/jfpraGfe72
Dr. John Cush RheumNow ( View Tweet)
@Janetbirdope’s #ACR25 pearls remind us:
Order ANA only when clinical suspicion exists
Never repeat a positive ANA
ENA only if ANA+
❌ Ignore dsDNA if ANA– (except anti-Ro52)
Stop serial dsDNA/C3/C4 if stable
Smart lab use saves patients anxiety and systems money.
#SLE https://t.co/Mu3EefcIx0
Romatolog Nurullah_Akkoc ( View Tweet)
#Urinary #biomarkers #lupus #nephritis
#Tenascin C -suggests repair, fibrosis, progress of #LN
#IL16, #CD163, & more for LN activity
Sometime a biomarker may replace repeat #kidney #biopsies?
#AMP group #Accelerated #Medicines #Program
#ACR24 @ACRheum @RheumNow abst#851
Janet Pope Janetbirdope ( View Tweet)
Will #PAD4 levels predict pts w #CCP positive #arthralgia who will develop #RA?
Leeds study - 79 at risk pts
PAD4 levels may predicting #rheumatoid #arthritis development
#ACR25 @RheumNow @ACRheum abst#832 https://t.co/dnAA6z3NJQ
Janet Pope Janetbirdope ( View Tweet)
When should you order a renal bx in suspected #LN?
Active urinary sediment
Used to be #UPCR 500g/g or more
Abst#772 looked at UPCR 250g/g to 499
71% + LN and half needed Rx
esp if
Low C3,C4
Black race
Petri, Baltimore #lupus #cohort
#ACR25 @ACRheum @RheumNow
Janet Pope Janetbirdope ( View Tweet)
Abstract 2694: Neutrophil:Lymphocyte ratio (NLR)- a practical step towards clinical monitoring of interferon?
Log₂NLR significantly correlated with all three IFN signatures across patients with SLE, systemic sclerosis, rheumatoid arthritis, and myositis
@RheumNow #ACR25 https://t.co/ujaOQGvAUV
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
#2661 In >5000 veterans with RA-ILD, 8 distinct FVC trajectories were identified. >1/2showed a progressive decline (≥0.7%/yr). These progressive patterns predicted higher mortality & respiratory hospitalisations, underscoring major disease heterogeneity. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Sooner May Still Be Too Late: Kidney Biopsies in SLE
#ACR25 kicked off with Plenary Session by Michelle Petri (Abstract 0772: Redefining When to Biopsy the Kidney in Patients with SLE. As part of a collaboration with the Accelerating Medicines Partnership, Petri and colleagues https://t.co/bU09vpcDew
Dr. John Cush RheumNow ( View Tweet)
Inflammation skews lipid levels in RA: the “lipid paradox”
Using data from CERTAIN and VARA, inflammation (hsCRP)-adjusted TC & LDL better predicted ASCVD events than standard lipids.
Are we missing RA pts who need statins?
@RheumNow #ACR25 A#2681
Jiha Lee JihaRheum ( View Tweet)
#2681 Tackling the “lipid paradox” in RA: inflammation-adjusted TC & LDL (using hsCRP correction) improved ASCVD risk prediction and flagged more high-risk patients than standard lipids. A smarter way to guide statin use in RA. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Abst 2694:
Post-hoc analysis of Phase 2 PAISLEY SLE trial examined impact of deucravacitinib on renal dysfunction
🔹 Plasma proteins a/w ↑ BILAG renal score and ↓ UPCR --> reduced by WK 32
🔹 Biomarkers inversely related to eGFR were reduced with deucra vs PBO
@RheumNow #ACR25 https://t.co/6CvmQ9lCfS
Links:
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Lots of interest in MRI for GCA diagnosis... but what about monitoring?
Case series of 14 pts: MRI identified relapse prior to symptoms or inflammatory markers in 2 cases, including those on TCZ, which hides them
More available in US context, noninvasive, & more structures https://t.co/pnrI9SEpll
Mike Putman EBRheum ( View Tweet)
In early axSpA vs non-axSpA CBP, 2 year spinal x-ray progression was minimal in both groups. But on MRI, fat lesions increased significantly in axSpA (0.16 units/yr vs –0.02), with 15% having ≥3 lesions at 2 year vs 1% in non-axSpA. Fat lesions may signal early structural https://t.co/zvgU1Gt0po
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
New biomarkers in axSpA. In early axSpA (DESIR cohort), higher baseline Phospholipid transfer protein (PLTP) activity was linked to sacroiliac radiographic progression over 5 years. Lower zonulin and lipopolysaccharides (LPS) levels also associated with progression. Highlights https://t.co/1uBtR4QA97
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Fukui et al. CorEvitas study. 12076 RA patients. Propensity score matching. Kidney dysfunction (eGFR<60) reduced chance of CDAI remission (HR 0.71) or remission/LDA (HR 0.88) @RheumNow #ACR25 Abstr#2640 https://t.co/uvTjOQlGD7
Richard Conway RichardPAConway ( View Tweet)
Useful clinical pearls by @Janetbirdope on ANA testing @RheumNow #ACR25 #ACRBest https://t.co/1FMv5nIWNe
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
