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Type 2 SLE: Insights from a Biopsychosocial Framework

Jennifer L. Rogers, MD

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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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/WXnuViSLbe
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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
Dr. John Cush Tweet
RheumNow
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
Dr. John Cush Tweet
RheumNow
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 Tweet
RheumNow

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 Tweet
RheumNow
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
Dr. John Cush Tweet
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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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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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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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