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Why Childhood SLE is More Severe than Adult SLE
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About 10 to 20% of all lupus patients are children, and the criteria to make the diagnosis of lupus are the same in pediatrics and adults. Why is pediatric lupus often more severe than adult-onset disease?
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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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Steroids prevention of #congenital #heart #block in +Ro
Mom
#DM #HTN #wt⬆️
Fetus
?no diff #cardiomyopathy
?learning &behavioural changes
Debate re screen #CHB
Most CHB are kids w CHB as mom is unknown to be +Ro
Angst w screening
High titre Ro Impt
@RheumNow #LUPUS2025
Janet Pope Janetbirdope ( View Tweet)
Do you routinely recommend SLE +Ro/La pregnant Pts to have routine screening for #congenital #heart #block
#LUPUS2025 @RheumNow
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)
Systemic sclerosis is a vasular disorder! Microvascular dysfunction, Endotheliopathy, & reduced vascular reserve account for most findings. Good review w/ literature references in Arthritis Research & Therapy. https://t.co/ULfwBy7ECb https://t.co/QnpImUrA7q
Dr. John Cush RheumNow ( View Tweet)
Is Lupus Just a B Cell Disorder?
https://t.co/0kwxE6KLeI https://t.co/pORHkg9HY6
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)
Assessing neuropsychiatric SLE by 3-T, 3D contrast-enhanced vessel wall imaging. 47 w/ NPSLE vs 42 without (just SLE) showed the NPSLE had 2 fold more 1ntracranial contrast-enhanced vessel wall imaging (CE-VWI) w/ AUC 0.78 for CE-VWLs, & sensitivity 60% , specificity 87%.
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)
Neutrophil alkaline phosphatase (NAP) elevated in active AOSD. 141 AOSD compared to Bcell lymphoma, SLE, aPL & controls. NAP pos. correl w/ Systemic Dz activity score (R=0.71), & 0.59 for CRP/ANC/ferritin. NAP scores higher in pre-MAS, but lower w/ MAS (w/lower WBC). NAP responds https://t.co/YbYPaJUEbz
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)
Emerging therapies targeting the NLRP3-inflammasome (active in Autoinflammatory Dz, Gout, neurodegenerative Dz/Alzheimers). Currently no FDA approved drugs, but many in trials. eg, Oxidized DNA (DAMP) activates NLRP3 & may be blocked by repurposed glycosylase inhibitors to reduce https://t.co/CJv50LVKhy
Dr. John Cush RheumNow ( View Tweet)
CAR-T and cellular depletion therapies gone wild! Currently there are over 85 different therapeutic candidates aiming to reset the immune system in >380 clinical trials. Review article looks at indications, targets, modalities & outlook. https://t.co/yleR4B48IY https://t.co/WwSPzIPomk
Dr. John Cush RheumNow ( View Tweet)
Lupus Clinical Slides: Set 1
https://t.co/zFQqHfl8Ch https://t.co/MBzsixwhQc
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)
