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Cognitive Impairment: The Hidden Burden in Lupus Care
Suppose you have a patient with lupus returning for follow-up. Their joint symptoms are well controlled. The kidneys—managed with a combination of biologic DMARD and mycophenolate—show no signs of active urinary sediment or protein. Yet, during the routine visit, your patient brings up fatigue and difficulty remembering things. How do you address this? Several studies presented at ACR24 focused on cognitive impairment in lupus.
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Cognitive Impairment: The Hidden Burden in Lupus Care
Suppose you have a patient with SLE returning for follow-up. Their joint symptoms are well controlled. The kidneys—managed with a combination of biologic DMARD and mycophenolate—show no signs of active urinary sediment or… https://t.co/W8RO5aOaxj https://t.co/EF9P93hdPB
Dr. John Cush RheumNow ( View Tweet)
axSpA: Moving the needle in time to diagnosis
The journey to axial spondyloarthritis (axSpA) diagnosis is often prolonged and challenging. Understanding the factors contributing to the delays is important to improve the clinical, psychological, social and economic outcomes.… https://t.co/wnwtj8jj0q https://t.co/Pds2uxVfJV
Dr. John Cush RheumNow ( View Tweet)
If your pt with #rheumatoid #arthritis is
#exhausted - there is a reason
#Meta-analysis of 70000 RA Pts
#Insomnia is ⬆️4X vs gen population
Due to
▶️#pain
▶️#inflammation
▶️#depression
🤷♀️
#ACR24 @RheumNow @ACRheum abst#0480
Janet Pope Janetbirdope ( View Tweet)
Pathophysiological pathways in neuropsychiatric SLE. 2 components:
-Ischaemic
-Inflammatory
Zahi Touma @RheumNow #ACR24 https://t.co/wwlSSSpOIU
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
How often do you ask about #fatigue, #depression & #anxiety in pts with RMDs?
Study of >1000 pts found anxiety symptoms in 1/3 pts and significant association between fatigue & anxiety and depression
Highlights importance of regular review of MH symptoms
Ab2657 #ACR24 @RheumNow https://t.co/0zMOMybrCI
Mrinalini Dey DrMiniDey ( View Tweet)
Neuropsychiatric manifestations in SLE.
Susanne Benseler MD @RheumNow #ACR24 https://t.co/subiykC5Q4
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Neuroimaging is done to support the diagnosis of CNS #lupus but only 75% reveal abnormal brain MRI.
📌 It is more useful in pts with local deficits than diffuse.
📌 poorly correlated with cognitive dysfunction & psych phenotypes.
@Rheumnow #ACR24 @rheumarhyme @theactiverheum https://t.co/HjNbVBaOHv
sheila RHEUMarampa ( View Tweet)
The different NPSLE syndromes 👇
Highlighted in yellow are the most common manifestations. 🧠
- Cognitive dysfunction
- Mood disorder
- Anxiety disorder
@RheumNow #ACR24 https://t.co/1I7OVPT6DK
sheila RHEUMarampa ( View Tweet)
Diagnostic work up for neuropsychiatric SLE. Zahi Touma MD @RheumNow #ACR24 https://t.co/zLX1QHCaSu
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Mental health, sex, and comorbidities are key factors in determining recalcitrant psoriatic arthritis (PsA).
Key findings:
- 21.7% of patients required ≥4 biologic/targeted synthetic DMARDs.
- Female patients and those with depression were more likely to be recalcitrant.
- No… https://t.co/I9YYoRnLwh https://t.co/VtnPceVLOZ
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
ANA neg, but ENA pos
should we care about that result?
PPV 5.5% here
(similar to 6% prev @EricFMorand: https://t.co/Hyaued3rw2)
and how many really needed the serology? Anxiety?
Surely pos ENA w neg ANA might be more hassle than help. So what to do?⬇️
#ACR24 ABST1930 @RheumNow https://t.co/rE7RmgOGey
Links:
David Liew drdavidliew ( View Tweet)
Would be helpful for us (and pts) to better understand rimmunotherapy agent specific risk on subsequent GCA/PMR
AFTRER propensity matching of >7k pt on combo nivolumab/ipilimumab compared to pembrolizumab:
- PMR RR 3.8x N/I vs. P
- no diff in GCA risk
@RheumNow #ACR24 https://t.co/IF4Gh7Cumd
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Study on SLE treatments:
Compared adverse events of anifrolumab vs. belimumab
Similar risks for mortality, sepsis, herpes zoster, dialysis, MACE, PE/VTE, COVID-19, URI, pneumonia, and mental illness #ACR24 @RheumNow abst#1527
Bella Mehta bella_mehta ( View Tweet)
What is the impact of social connections on lupus?
Abstract #1503: In an NYC SLE cohort, greater social integration and support correlated with less pain, depression, disability, and frailty, while loneliness was linked to worse outcomes.
@RheumNow #ACR24 #SDoH https://t.co/5OCCExee06
Akhil Sood MD AkhilSoodMD ( View Tweet)
❔Can rheum drugs have beneficial effects on cognition?
💊Possible benefits with MTX and TNFis but certainly an active area of research and more studies needed
#ACR24 @RheumNow https://t.co/lCnIRLwNjK
Mrinalini Dey DrMiniDey ( View Tweet)
Harkins @DrTrishHarkins et al. People with PMR exhibit an accelerated physical aging phenotype at baseline. High rates of frailty (41%), pre-frailty (28%), cognitive impairment (74%!), sarcopenia (23%), osteoporosis (21%) @RheumNow #ACR24 Abstr#0740 https://t.co/4ZT8VtGi1W https://t.co/xBQ5CLlb5A
Links:
Richard Conway RichardPAConway ( View Tweet)
Characteristics of difficult-to-treat AS accdg to a retrospective study by @DaoudAnsaam @mmagrey1 et al
⬆️ BMI
+ comorbidities: HTN, CKD, depression
+ EAMs: IBD, Pso, iridocyclitis
+ HLA-B27
Interesting real world data.
@RheumNow #ACR24 abs573 https://t.co/GlE4tFpsSz
sheila RHEUMarampa ( View Tweet)
Are you pts using cannabis?
In Canada - 20% reported using w/in past 2 years
Use for pain, sleep, anxiety
78% noted efficacy
Compare to another study said 57% stopped due to inefficacy, 28% AEs - very diff result
70% did not tell their doc
16S18 @BharatKumarMD
#ACR24 @RheumNow https://t.co/6NAECW5MJK
Links:
Eric Dein ericdeinmd ( View Tweet)
How to take cannabis?
Do NOT rec inhaled
- makes drug level go up high/fast, benefit for rec use but not for medicinal
- bronchitis, ?oral cancer
Other risks: psychosis - risk in youth, memory loss (poor studies), dependence, respiratory if inhaled
Clauw 16S18 #ACR24
@RheumNow https://t.co/coYNl7VOT3
Eric Dein ericdeinmd ( View Tweet)
