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Immunosuppression Increasing (2.23.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past 2 weeks on RheumNow.com; but begins with a discussion of what constitutes "immunosuppression" and how it applies to our patients.

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CD19 CAR T-Cell Therapy in Autoimmune Disease

Jack Cush, MD

The NEJM has published the results of CD19 B cell depletion (by CAR-T cell therapy) in autoimmune disease patients, demonstrating it to be feasible, safe, and efficacious.

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RNL24

What are the Early Stages of Lupus?

Eric Dein, MD

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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pregnancy,birth,preterm,baby

Autoimmune disease and pregnancy

EurekAlert!

 For many aspiring mothers with autoimmune disease, pregnancy can be daunting and full of unknowns. In some cases, those suffering from specific autoimmune conditions have chosen to forego pregnancy altogether due to concerns about their disease treatments and adverse pregnancy outcomes.

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Rheumatoid,RA,nodules,damage

SeXXist Reason for More Women with Autoimmune Disease

EurekAlert!

Somewhere between 24 and 50 million Americans have an autoimmune disease, a condition in which the immune system attacks our own tissues. As many as 4 out of 5 of those people are women.

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Norway study 1558 chart-reviewed SLE cases; 797 were new-onset SLE from 1999 to 2017. During this period the annual SLE incidence rates fell; mostly pronounced in women 50-59 yrs (fell 3.4 to 1.1 per 100K) - paralleled by 74% reduction menopausal HRT https://t.co/zYkXAnEcOI https://t.co/oaz9t65zZy

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Dr. John Cush RheumNow ( View Tweet)
Week 52 outcomes of 180 lupus nephritis pts (IV, VI, III) from AMP academic centers (rx w/ standard of care) showed 22% complete resp,  22% partial resp, 42% non-responder& 14% undetermined. 8/180 (4.4%) had CR sustained Wk 12 to 52; 10% PR. An unmet need! https://t.co/MJklf0Xhih https://t.co/w6a1fLKmoF

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Dr. John Cush RheumNow ( View Tweet)
What are the Early Stages of Lupus? Incomplete lupus? Undifferentiated connective tissue disease? Pre-clinical autoimmune disease? https://t.co/kl1ePmQ5zf https://t.co/5MgIt4QyJV

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Dr. John Cush RheumNow ( View Tweet)
Anticardiolipin ab are the most frequent aPL in SLE. Dr. M. Petri #RWCS24 @RWCSmtg @RheumNow https://t.co/cCxhctLTGf

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Dr. Rachel Tate uptoTate ( View Tweet)
Dr. Petri reviews the 2023 ACR/APS Classification Criteria at #RWCS24 @RheumNow @RWCSmtg https://t.co/FWGsFk02Dn

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Dr. Rachel Tate uptoTate ( View Tweet)
85 Chinese SLE pts study of Dz activity & depression/ anxiety assessed by PHQ-9 & GAD-7. Good correlation betw SLEDAI-2K & SLE-DAS (r=0.76);also w/ mod-high activity (r=0.79), but less w/ mild Dz/remission (r=0.45). Anxiety/Depresion did not affect scores https://t.co/eyhgiYxf3P https://t.co/5LHg3HO21v

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Dr. John Cush RheumNow ( View Tweet)
Full read overview of SJOGRENS SYNDROME, which can be Primary SS or Secondary (15% in SLE, 20% RA, & 30% systemic sclerosis). SS Organ involvement: - CNS 2-17% - Renal <=10% - ILD 10-20% -MSK 45-56% https://t.co/RElOFfP2xr https://t.co/aJI041VCuE

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Dr. John Cush RheumNow ( View Tweet)
Danish registries study shows maternal Autoimmune Dzs (all) were assoc w/ incr risk of childhood cancers (OR=1.25, 95% CI 1.06, 1.47), acute lymphoblastic leukemia (OR =1.52), Burkitt lymphoma (OR=2.6) & CNS tumors (OR=1.45); same seen for RA mothers https://t.co/HQO972ch9R https://t.co/dDEJUo8unq

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Dr. John Cush RheumNow ( View Tweet)
Microbiome study of 16 SLE pts (44 fecal samples) shows that blooms of Ruminococcus gnavus pathobiont was assoc w/ lupus flares and may be the drivers of clinical of relapsing lupus disease https://t.co/Sj3dLesZpL https://t.co/7cu0X7jPM9

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Dr. John Cush RheumNow ( View Tweet)
FDA Safety Warning: denosumab now has a Boxed Warning for risk of severe hypocalcemia in CKD pts taking Prolia (usually seen 2-10 wks post injx). Pts may or may not be symptomatic. CKD pts should have Ca and Creatinine monitored. https://t.co/UMYxjWz9n4 https://t.co/AG5wzBrY1Y

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Dr. John Cush RheumNow ( View Tweet)
The ultimate treatment goal in LN is long term preservation of kidney function. Summary of part 3 of @andreafava brilliant talk. #RNL2024 @RheumNow https://t.co/vwiAbWEmRh

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Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Very insightful talk on Vasculitis and pregnancy by Catherine Sims. Pregnancy compatible medications. Remission state. Checking antibodies ; risk of transmission, pregnancy and fetal morbidity. #RNL2024 @RheumNow https://t.co/81NAN1ulO5

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Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Urine biomarkers ( IL-16, CD163,CD206), parallel internal activity in lupus nephritis and and its decline at 3 months , best predict 1 year response . Future is great for lupus nephritis , cant wait to start using them. Great work @andreafava #RNL2024 @RheumNow https://t.co/VIFMytHFyD

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Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Urine proteomics in lupus nephritis. Summary of part one of his amazing talk. @andreafava #RNL2024 @RheumNow https://t.co/h8Eda0ZWVE

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Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Neutrophil signature in proliferative lupus nephritis. @andreafava #RNL2024 @RheumNow https://t.co/tNFIhohSvP

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Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
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