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Rashes in Rheumatology at #ACR23
Which disease entity are these palms pathognomonic for?
@RheumNow https://t.co/NmT1LTzWmm
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Therapeutic Ladder for Discoid Lupus:
1. Strict🌞protection, smoking avoidance
2. Antimalarials
3. Topicals/intralesional corticosteroids, topical CNI
4. Oral steroids, retinoids, MTX, MMF
5. Thalidomide, lenalidomide
6. IVIG, JAKi, Belimumab... BUT also Anifrolumab!… https://t.co/xSw0s12Uvk https://t.co/stIJ944d9A
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR23 Abstr# 2485 Belimumab therapy in RCT was associated with increased risk of psychiatric events inc suicidality vs PBO. When compared with standard immunosuppressant, real-world data using emulated trial design showed no increased risk @RheumNow https://t.co/Vqhc5yRsSA
Md Yuzaiful Md Yusof ( View Tweet)
Complements & HCQ? (Prof Petri et al)
Significant ⬆️ in C3 (p=0.022) & C4 (p=0.003) levels with HCQ whole blood levels >50 ng/mL
Increasing blood levels of HCQ significantly assocd w/⬆️prob of achieving normal C4
Improving C3,C4; addtl benefit of HCQ?
#ACR23 ABST2327 @RheumNow https://t.co/5ucpXq9ngb
sheila ( View Tweet)
HCQ discontinuation in SLE? Why?!
In this retro cohort of 42 pts
Reasons:
Retinal toxicity (57%)
Self-discontinuation (17%)
Factors strongly assoc'd w/ flares 1 yr after discontinuation - mean C3 and +dsDNA at index visit.
#ACR23 ABST2343 @RheumNow https://t.co/BCO9N4gSkX
sheila ( View Tweet)
A#2427 #ACR23 @RheumNow
PR3+ cell abundance higher in prolif LN, more than membranous. Mostly in tuberulointerstitium
Density of PR3+ higher in glomueruli of prolif LN
Correlates with activity, not chronicity
Urinary PR3 predict renal fxn loss at 3y
@jhrheumatology @andreafava https://t.co/vvC8lgZgWO
Eric Dein ( View Tweet)
#ACR23 Abstr#2270 What are the causes of discordance btw #SLE patients and physicians pertaining to disease activity? Survey data from Global COVAD: 45% rate of discordance! Could be related to fatigue levels, pain, poor mental being & impaired physical function @RheumNow https://t.co/kVzGRJm2R8
Md Yuzaiful Md Yusof ( View Tweet)
Great research by @andreafava on urinary biomarkers for lupus nephritis A#0850 #ACR23
IL-17 and other biomarkers can predict renal fxn loss - better than proteinuria!
Article on @RheumNow https://t.co/DeiWFKzNxC
Eric Dein ( View Tweet)
#ACR23 Abstr#2334 Can we achieve #SLE DORIS remission with current therapy? Post-hoc analyses of 3 x RCTs + LTE over 4 years showed anifrolumab therapy was associated with more frequent and sustained remission vs PBO during the 4-year period. Good for long-term outcomes @RheumNow https://t.co/eq02yChTZr
Md Yuzaiful Md Yusof ( View Tweet)
Rashes in Rheumatology at #ACR23
Name the rash? @Rheumnow https://t.co/uFjXEOHczZ
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Review of rashes in SLE at #ACR23 by Dr. Katherine Shaw, MD
⭐️Important to recognize rashes of lupus b/c heterogeneity of cutaneous lupus erythematosus subtypes influences response to treatment.
@RheumNow https://t.co/u7dwDe9kbt
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
⭐️Important to recognize rashes of lupus b/c heterogeneity of cutaneous lupus erythematosus subtypes influences response to treatment.
🚩Phase II trial of Iberdomide in SLE:
➡️ not associated w/ statistically significant improvement in CLASI-A when including ALL CLE subtypes… https://t.co/LHNqKMALzU https://t.co/K73sXjFTHM
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR23 Late-Breaking Abstr#L13 CAR-T is in CT but not RCT yet. Preliminary results from open label (N=3 #SLE of YTB323 (rapcabtagene autocel CD19 directed with preserved T cell stemness) showed favourable CAR T expansion, B cell depletion, early efficacy & safety @RheumNow https://t.co/UQUOfDbFJe
Md Yuzaiful Md Yusof ( View Tweet)
A#2316 #ACR23 @RheumNow
91 SLE pts w COVID v 182 SLE wo COVID ifn
11 SLE/COVID: serious disease
1 death, 7 severe compl
W/in 90d, 15% mild/mod SLE flare 2% severe SLE flare
Flare rate 17.6% higher than no COVID ifn 5% p=0.001
High HV ifn (2% v 1%)
dsDNA/C3 changes not signif diff https://t.co/dxGJNNWuFy
Eric Dein ( View Tweet)
A#2313 #ACR23 @RheumNow
Utilization of inpt palliative care incr from 2016-2020 in SLE admits from 1.8% 2016 to 2.6% 2020
Pall care use incr: older pt, comorbid index, teaching, large hosps
Lower use: age <35 yo, Black & Hispanic race
Need to address racial disparities in utiliz https://t.co/wQ8NOhm9lK https://t.co/3tJgt4MMDf
Eric Dein ( View Tweet)
@EricFMorand SPOCS Study: A#2263 @ACR23
826 pts - 71% high IFN gene sig
Mean SLEDAI-2K lower with low IFNGS
6mo: pts reports 1+ flare 19% high IFNGS, 16% low. Both grps 6.7% LLDAS, but remission 4% low/1.7% high
In 36 mo, <10% LLDAS, <10% remission
@earlyARA @RheumNow https://t.co/z5v4TBVuDG
Eric Dein ( View Tweet)
Post hoc analysis of Ph2 AURA-LV & Ph3 AURORA1
⬆️VOC-treated pts achieved CRR at 1yr vs. control arm (41.0% vs. 21.9%; OR 2.48, p< 0.0001) and PRR at 1yr (OR 2.3, p< 0.0001)
Similar safety profiles
VOC: Additional tx option for LN pts w/ UPCR >/=2g/g
#ACR23 ABST2326 @RheumNow https://t.co/9z1n3s7umU
sheila ( View Tweet)
A#2297 #ACR23 @RheumNow
Baseline IFNα predicts complete response at 2 yrs in LN
HIgh IFNα: incr risk of 2+ renal flare
Increase of 1 unit of IFNα incr risk of 2+ flares by 35% & risk of decr GFR
IFNα cutoff 0.6 for 2+ flare, 1.3 for progr to eGFR <15
AUC 0.6 (weak predictor) https://t.co/FKeDJVNyYj
Eric Dein ( View Tweet)
HCQ improves complements
A#2327 #ACR23 @RheumNow
Petri @jhrheumatology @andreafava
Pts w/ low complement & low HCQ levels
In pts who increased HCQ WB level >50 ng/mL, incr in mean C3 (p=0.02) v HCQ that did not incr
More nml C4 levels (p=.003) and incr mean C4 (p=.004) on HCQ https://t.co/J7PIuaRTO8
Eric Dein ( View Tweet)
HCQ Discontinuation
A#2343 #ACR23 @RheumNow
42 pts d/c HCQ
19% flared in past yr before d/c
D/c reasons: retina tox 57%, self-dc 17%, other eye issue 12%
26% flare in yr after d/c - strongest ass for flare: mean C3, dsDNA+ at index visit https://t.co/d4TqneS46u
Eric Dein ( View Tweet)