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Dr. Jack Cush reviews the news and journal reports from the past week - including a few contrary reports on infection, seropositivity and plasmapheresis.
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Dr. Jack Cush has advice for Caesar and the superstitious, and covers pregnancy, platelets, dialysis and vaccinations in Lupus.
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While it is believed that autoimmunity follows autoantibody positivity, a Danish study shows the incidence of polyautoimmunity to be similar in rheumatoid arthritis (RA) patients who are either anticyclic citrullinated peptide antibody (ACPA)–positive or ACPA–negative.
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According to the National Health Interview Survey (NHIS), in 2022, the prevalence of diagnosed arthritis in adults was 18.9% (women 21.5%, more than men 16.1%). These numbers are down since the CDC's MMWR report of 2019–2021, where is was estimated 21.2% of U.S.
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In patients with clinically stable systemic lupus erythematosus (SLE) and lupus nephritis, the withdrawal of mycophenolate mofetil was not significantly inferior to mycophenolate maintenance, but MMF withdrawal had numerically more reactivations, while MMF maintenance had more infections.
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Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Are these associations with infection, biomarkers and weather real or imaginary? Linked or luck? Causal or casual? You decide....
Article
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.
Article
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.
Dr. John Cush
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Series of Chronic Cutaneous Lupus responding to anifrolumab. 6 pts (4 DLE, 2 CCLE) betw 37-66 yrs old w/ Dz duration 10.5 yrs, 4 w/ SLE, all refractory to multiple therapies Rx w/ ANIF w/ Skin benefit. 1 developed herpes, 1 had worsening of nephritis https://t.co/6imLq3TDMu https://t.co/BMoIQhRtYs
Dr. John Cush
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91 #SLE pts w/ no baseline synovitis, underwent Ultrasound exams. 10 yrs later, 31 had clinical progression of arthritis. Pts w/ progression, 75% had baseline subclinical synovitis on US vs without progression 77% did NOT have an abnormal US at baseline https://t.co/MN9wkNgsQV https://t.co/ozgvjFI531
Dr. John Cush
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SLE & remission on hemodyalysis (HD)? Cohort of 137 pts starting HD & the # off SLE Rx increased w/ time: 67% (HD start), 76.0% (1st Yr), 83% at 3 yrs (less w/ younger). Lupes flares most in 1st yr of HD; @12 mos 52% minor and 12% had severe flares. https://t.co/8N7CJWkIUY https://t.co/48eOclzrJH
Dr. John Cush
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Chinese SLE registry study of 350 SLE-TP (low plts) pts - 55% were aPL Ab+ (who had lower Plts @baseline (61K vs 76k). aPL+ SLE-TP pts w/ higher relapse rate (58% vs. 44%, P=0.009) & lower complete response rate. > more aPLs--> increased relapse rates https://t.co/Mb2YhsniVJ https://t.co/92QRWICcB4
Dr. John Cush
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Vaccinations NOT linked to SLE risk. 17 studies (45 million) w/ F/U up to 2 yrs. No signif SLE risk:
- all vaccinations (OR=1.1; CI 0.86–1.5)
- HBV vax (OR=2.11; 1.11-4)
- HPV (OR=1.4; 0.88–2.3)
- Flu (OR=0.96; 0.82–1.1)
- COVID (OR=0.44; 0.18–1.2) https://t.co/YpxSYL97DM https://t.co/hsytm9UpDC
Dr. John Cush
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Japanese study of 96 #SLE pregnancies: 59 in remission @ conception. Remission had fewer adverse preg outcomes (OR 0.27) vs those w/ activity. No difference in APO based on serologies, but Pred ≥7.5/d us had signif. more APO. (OR 3) https://t.co/BvOeiSERN9 https://t.co/ePh1dqdJvS
Dr. John Cush
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Can Mycophenolate be Stopped in Stable SLE?
https://t.co/8oQx0cqDr3 https://t.co/mlt2Qqj8wm
Dr. John Cush
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Review of autoimmune Dz & adverse preg outcomes: Incr risk of:
- Miscarriage w/ Sjögrens (RR 8.85) & SLE (OR 4.9)
- Preeclampsia w/ SLE (OR 3.2)
- IUGR w/ scleroderma (OR 3.2) & celiac (OR 1.71)
- Preterm birth w/ SLE (OR 2.79).
https://t.co/bll2x2aS9Z https://t.co/Eg0sVBcPmR
Dr. John Cush
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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
Dr. John Cush
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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
Dr. John Cush
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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
Dr. Rachel Tate
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Anticardiolipin ab are the most frequent aPL in SLE. Dr. M. Petri #RWCS24 @RWCSmtg @RheumNow https://t.co/cCxhctLTGf
