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Diagnosing Neuropsychiatric SLE (5.23.2025)
Dr. Jack Cush reviews the news and journal reports from RheumNow.com - including views on the vagus nerve, NPSLE and CAR-T mania.
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Treat to target 🎯 #SLE #recommendations
Considerations are nuanced and Impt
Lowest clinical disease activity is goal
Try for remission
🎯 Get patients off #glucocorticoids
If not ⬇️low dose #prednisone
@RheumNow #LUPUS2025 https://t.co/HlBeh2FLxP
Links:
Janet Pope Janetbirdope ( View Tweet)
Lupus QD Clinic - Rhupus
dsDNA+ SLE Plus CCP+ RA = Rhupus
https://t.co/lyV7fgd1vp https://t.co/Ptw0dmyqCj
Dr. John Cush RheumNow ( View Tweet)
Lupus in an empty house
The full house immunofluorescence pattern is the classic histopathologic finding of lupus and lupus nephritis. Glomerular deposits staining for IgG, IgA, IgM, C3 and C1q can help confirm a suspected diagnosis of systemic lupus erythematosus (SLE). This https://t.co/Zcywc5r9q9
Dr. John Cush RheumNow ( View Tweet)
Lupus Unlocked: Pregnancy & SLE
📅 May 27, 2025
6:00 PM CT | 7:00 PM ET | 4PM PT
Join us for our final Lupus Unlocked webinar this month on pregnancy and SLE. In this webinar, panelists will discuss issues such as congenital heart block, lupus nephritis treatment, teratogenic https://t.co/gouTN7uzCo
Dr. John Cush RheumNow ( View Tweet)
Unmet needs in #lupus are many
👇
Timely #diagnosis
Morbidity - CV, metabolic, OP, mental health
Premature mortality - CAD, active #SLE, infection
Issues w pregnancy
#steroid side effects
⬇️QoL
With partnerships we can ✅
Pts
HCPs
researchers
Pharma
Gov’t
#LUPUS2025
@RheumNow https://t.co/9T9rIrM1hV
Janet Pope Janetbirdope ( View Tweet)
IL2 low dose in #SLE
seems to + alter immune regulation
Multiple targets to explore in #lupus
Unravelling pathophysiology in SLE
CD40L
TLR7,8
#rapamycin type drugs
CAR-T w novel CARS
Etc
#LUPUS2025
@RheumNow https://t.co/jeycgg4ZhT
Links:
Janet Pope Janetbirdope ( View Tweet)
>200 genes 🧬 implicated in #SLE
Complex indeed!
And
▶️ 7 clusters of signalling pathways
So we have to have many Rx options
Ab patterns vary
LN flares can have v diff pathways between Pts
#LUPUS2025 @RheumNow
Unravelling #LUPUS2026 https://t.co/LEKN363194
Links:
Janet Pope Janetbirdope ( View Tweet)
We are not (yet) in #SLE
Getting
👇
Correct drug
In right pt
At right time
At correct individual dose
Even more problematic is in a renal bx - 2 glomeruli beside each other have v different cytokine expressions
Unravelling #LUPUS2025
@RheumNow https://t.co/yGBvhFkPKY
Links:
Janet Pope Janetbirdope ( View Tweet)
Here’s who flares in #SLE
least to most
Persistently neg antiDNA
Persistently + antiDNA
conversion of neg to + antiDNA
So are we over ordering antibodies in 1st 2 groups 🤷♀️
Unravelling #LUPUS2025
@RheumNow https://t.co/1Feau7f199
Janet Pope Janetbirdope ( View Tweet)
controversy re
👇
Monitoring for +Ro pregnant re
#congenital #heart #block
87% Y
echo is possibly too late
No ideas if flourinated #steroids work
But many thing we should do something
Guidelines differ on recommendations
Would fetal home HR be better
#LUPUS2025 @RheumNow https://t.co/MY0oPjLnGs
Janet Pope Janetbirdope ( View Tweet)
An excellent presentation from Dr Pankti Mehta @PanktiMehta24
Re #Jaccoud’s
With
#IFN signature
if #erosive IA - often + CCP / RF
Vs
nonerosive often +RNP
@RheumNow #LUPUS2025 https://t.co/y6z4KbhCdy
Janet Pope Janetbirdope ( View Tweet)
The ANA pattern I hate
#DFS
Why
Dense fine speckled should R/O #SLE
But mimicking patterns that MAY Have #lupus
AC-2 pattern mimickers ex AC-4
Machine learning models to help
▶️improved accuracy
Fast saving hrs
#Artificial #intelligence
May Choi #LUPUS2025 @RheumNow https://t.co/9tk80ZOAWg
Janet Pope Janetbirdope ( View Tweet)
T2T in #SLE
Lots of #rheumatologists do NOT do a validated measure so #DORIS remission may be over estimated
But great algorithm for #lupus #Rx
@RheumNow
#LUPUS2025 https://t.co/mGoopRtK2F
Janet Pope Janetbirdope ( View Tweet)
Monitoring for #HCQ #retinal #toxicity
2 tests beyond visual fields are better than 1
OCT
Etc
But suggestion if low risk to do only every 5 yrs
I don’t agree as risk ⬆️ w disease duration
We do
Annual fields
and either
OCT or retinal photography
#LUPUS2025
@RheumNow https://t.co/TdPJ47jYEL
Links:
Janet Pope Janetbirdope ( View Tweet)
Subclinical #arthritis in #SLE
Do we look for it?
Should we care?
Certainly seems to exist on #MRI hands
More changes of course if tender joints
Not sure of clinical relevance
Optical imaging and POCUS was compared
#LUPUS2025 @RheumNow
ANCA Askanase presents
Janet Pope Janetbirdope ( View Tweet)
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 https://t.co/T7G96cAlE6
Dr. John Cush RheumNow ( View Tweet)
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)
