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Taking AI Out of AutoImmunity: Predicting disease before it develops

Akhil Sood, MD Nov 18, 2024

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.

Applying the guidelines to Cases- Dr M Dall’Era for a pt wit extrarenal lupus and active LN. #ACR24 @rheumnow https://t.co/lvOUWjEdEz

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

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

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

https://x.com/EBRheum/status/1858535181373563219/photo/1

Applying the #ACR24 #LupusNephritis: Case 2 by Dr M Dall’Era @RheumNow https://t.co/A7i103uHZT

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

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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

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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

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

https://x.com/EBRheum/status/1858540166723359064/photo/1

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

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

https://x.com/EBRheum/status/1858526074323501472/photo/1

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

#ACR24 Guidelines #LupusNephritis for refractory dz @RheumNow https://t.co/LlSixkggKK

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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

https://x.com/RHEUMarampa/status/1858516500765712635/photo/1

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

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

https://x.com/drdavidliew/status/1858505689443991661/photo/1

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

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

Beyond the Needle: Redefining the Assessment of Lupus Nephritis | RheumNow

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

https://x.com/drdavidliew/status/1858459070023479790/photo/1

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Taking AI Out of AutoImmunity: Predicting disease before it develops

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