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Type 2 SLE: Insights from a Biopsychosocial Framework
Many of the common symptoms of lupus - fatigue, nociplastic pain, brain fog - can be invisible and difficult to measure, and can often co-occur with impaired sleep, depression and anxiety. These symptoms have led to a well described discordance between physician and patient perception of lupus activity and flares, and this discordance can impact communication, trust, medication adherence, and ultimately outcomes. We developed the Type 1 and Type 2 model many years ago as a means to bridge this gap.
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Methotrexate Fails in Knee Osteoarthritis
We'll be blunt: methotrexate flopped in a randomized placebo-controlled trial among patients with osteoarthritis (OA) of the knee.
https://t.co/Y9elFXTkhN https://t.co/oqDDVPGbh7
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135 pts w/ neurologic autoimmune dz (MS, GBS, myasthenia gravis) who had cancer & Rx w/ checkpoint inhibitors (ICI) showed exacerbations in SOME - 18% of MS pts, but 67%of MG, latter often w/ hospitalization (50%) or death (17%). GBS faired well w/ ICI Rx. https://t.co/RksC6QXce0 https://t.co/HbwYDVrIAt
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In 2019 there was an estimated 273,000 coccidioidomycosis cases in the USA; 23,000 hospitalizations and 900 coccidioidomycosis-associated deaths. Mostly from endemic states California & Arizona. https://t.co/JXPs8B4Dwb https://t.co/90e1TYxGoW
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Psychological Bulletin has published that invalidating (gaslighting) pts Sxs can have harmful consequences. Includes pts dx w/ Ehlers-Danlos, endometriosis, fibromyalgia, ME/CFS, POTS, Gulf War, IBS, long Covid, multiple chemical sensitivity, SLE, and vulvodynia.
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Sacroiliitis is a rare adverse reaction of isotretinoin. Review of 67 pts finds median age 21 yrs, onset median 2.5 mos (0-24) post isotretinoin. Sxs: LBP 70%) & hip pain 45%. Dx by MRI (73%) w BME. Full recovery 81% isoretinoin D/C & NSAIDs (< 10% biologics)
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Review of ARF & Post-streptococcal reactive arthritis (PSRA) following Group A strept infxn. Early Dx & Rx of Strept can prevent ARF & PSRA. PSRA is a sterile arthritis, bimodal age onset, lower extrem arthritis, usually resolves without lasting sequelae https://t.co/ld208yf0Zk
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Global incidence of alopecia areata increased betw 1990 - 2021; from 20.43 million (19.77-21.09 million) in 1990 to 30.89 million in 2021 ( range of 29.95-31.82 million) - highest in USA 550/100,000. High in N.America, S.America, Southeast Asia, Australia. Lowestin Africa, Middle https://t.co/d3WA3CRFRC
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Save the date! RheumNow will be at EULAR '25 June 11-14. https://t.co/J0dq4PWf6q
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CMAJ reminds us that w/ parvovirus B19 infection, Arthropathy seen in ~60% of adolescents & adults, but the classic “slapped cheek rash” is uncommon. Symmetric, polyarticular inflamm arthralgias/itis affects PIPs, MCPS mostly. Sxs resolve w/in 3 wks. ~20% can last mos-yrs https://t.co/2SuL5igcnz
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Environmental and Geographic Risks for SLE
Dr. Karen Costenbader, a rheumatologist at the Brigham and Women's Hospital and a Professor of Medicine at Harvard Medical School in Boston, discusses environmental and geographic risks for systemic lupus.
https://t.co/UDMgB8f0WZ https://t.co/ec5S5wGr9C
Dr. John Cush RheumNow ( View Tweet)
Psychological Bulletin has published that invalidating (gaslighting) pts Sxs can have harmful consequences. Includes pts dx w/ Ehlers-Danlos, endometriosis, fibromyalgia, ME/CFS, POTS, Gulf War, IBS, long Covid, multiple chemical sensitivity, SLE, and vulvodynia.
Dr. John Cush RheumNow ( View Tweet)
Sacroiliitis is a rare adverse reaction of isotretinoin. Review of 67 pts finds median age 21 yrs, onset median 2.5 mos (0-24) post isotretinoin. Sxs: LBP 70%) & hip pain 45%. Dx by MRI (73%) w BME. Full recovery 81% isoretinoin D/C & NSAIDs (< 10% biologics)
Dr. John Cush RheumNow ( View Tweet)
Review of ARF & Post-streptococcal reactive arthritis (PSRA) following Group A strept infxn. Early Dx & Rx of Strept can prevent ARF & PSRA. PSRA is a sterile arthritis, bimodal age onset, lower extrem arthritis, usually resolves without lasting sequelae https://t.co/ld208yf0Zk
Links:
Dr. John Cush RheumNow ( View Tweet)
MMWR: 1994 the U.S. Vaccines for Children program has covered the cost of vaccines for US children. Since 1994 routine child vaccinations will have prevented ~508 million illness, 32 million hospitalizations, & 1,129,000 deaths,; direct savings of $540 billion & societal savings https://t.co/CBUojpR3Q8
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Lupus Unlocked: Survey Responses
https://t.co/LQs7VKT6lq https://t.co/F7yqQvSvvZ
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Valves Gone Wild in SLE
Lupus valvulitis is a rare cardiac manifestation of active systemic lupus erythematosus (SLE) and is defined by inflammation of one or more cardiac valves. It is often associated with Libman-Sacks endocarditis (LSE), which is characterized by the https://t.co/XcC2POFDRd
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Lupus QD Clinic - All Swells that Ends Well
Workup and management of SLE with periorbital edema, HA and seizures
Featuring Dr. Sheila Reyes, The Philippines
https://t.co/DrelXfe76Z https://t.co/dntYllhjWj
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A retrospective VEXAS cohort study of 59 pts receiving 71 targeted Rx - 98%male, mean 71 yrs & 46% had myelodysplastic syndr. Treatments included tocilizumab(19), anakinra (13), azacitidine(13), baricitinib (11), & pred only (10). Best responses w/ azacitidine & tocilizumab https://t.co/jqDmKinPDt
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Turkish study of 1263 primary care referrals to rheumatology found 35.7% with inflammatory rheumatic Dz (IRD), 17.7% osteoarthritis, and 11.2% regional pain syndromes. Another German study showed low risk of IRD if CRP <5 https://t.co/v5qYb7c7jP https://t.co/iq4NfcC3cH https://t.co/RQan6rQi8a
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