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Maintain Vigilance for CV Risk Postpartum in Autoimmune Diseases
Pregnant women with autoimmune rheumatic diseases (ARDs) and antiphospholipid syndrome (APS) face significantly increased risks of cardiovascular events (CVEs). This increased risk is often attributed to ARDs, its medications or comorbidities associated with it.
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Vasculitis in SLE
A#1443 @RheumNow #ACR23
804 SLE pts, 74% black, 9.5% h/o vasculitis
45% visceral vasculitis, 43% cutanous, 8% both
Pts w vasculitis: younger age of SLE dx- 27 v 31y
Risks: other SARD, renal dx, neuro dx, low compl
Trend to higher mortality 21 to 14% (no signif)
Eric Dein ( View Tweet)
Fate of ANA+/UCTD
A#1449 #ACR23 @RheumNow
207 asymptomatic ANA+ or UCTD followed
- <10% progress to SARD, 90% did not
Progression to SLE (11 pt), Sjo (5), SSc (3), RA (1)
Progressors to SLE: arthritis (91%), low compl (45%), alopecia (36%), ulcers (27%) - milder manifestations
Eric Dein ( View Tweet)
SGLT2 inhibitors compared to DPP4i may be better at reducing risk for MACE & renal progression in patients with SLE/LN and diabetes. SGLT2i risk for MACE (HR 0.69, 95% CI 0.48-0.99), and renal progression (HR 0.71, 95% CI 0.51-0.98). abst# 1579 #ACRbest #ACR23 @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
#ACR23 Abstr#1512 Can we improve trial design of Bcell depletion in #SLE? Feasibility RCT of RTX in organ specific MSK showed: a) feasible to use ultrasound & clinical as endpoints, b) new tool LAMDA is responsive, c)potential worsening before later improvement with RTX @RheumNow https://t.co/YmbUOWVdWS
Md Yuzaiful Md Yusof ( View Tweet)
Do you discuss HPV vax & cervical CA screening w/SLE & RA pts?
In this study, more women w/SLE discussed cervical CA screening w/their rheums(33.3% vs. 11.4% p<0.01) & more likely to have persistent abn paps on ffup
Similar HPV vax status for both grps
#ACR23 ABST1356 @RheumNow https://t.co/Vbu8hbZ1uh
sheila ( View Tweet)
#ACR23 Abstr#1509 SLR & Meta-Analysis of RCTs in lupus nephritis (N=16 studies):
-CNI (VOC/TAC/CyA) alone (OR 1.4) or combined MMF (OR 2.1) was assoc with CR vs SOC (MMF/Cyclo)
-Less GI AEs & cytopenia in CNI
Assuring data esp when cost is a hurdle for VOC @RheumNow #ACRBest https://t.co/9ScakIdXBN
Md Yuzaiful Md Yusof ( View Tweet)
#ACR23 Abstr#1479 In N=66 patients with #SLE, 29% had high risk HPV infection. Associated with lupus disease duration. In 2nd screening ~1yr after, multiple infections occurred in 15%, about similar vs women with HIV. Call to promote HPV vaccination in SLE 💉 @RheumNow https://t.co/UGIrCwu32x
Md Yuzaiful Md Yusof ( View Tweet)
#ACR23 Abstr#1579 More data on the role of SGLT2-i in #SLE. Data from EHR using propensity match scoring showed the use of SGLT2-i vs DPP4-i (for nonSLE indication) was associated with reduced risk of MACE (HR:0.69)and poor renal outcomes inc. ESRD (HR:0.71) @RheumNow https://t.co/7k0o3m18AN
Md Yuzaiful Md Yusof ( View Tweet)
In their cohort, Dr. Jorge reports that SLE pts who used SGLT2i had⬇️risk of MACE(HR 0.69 [95% CI 0.48-0.99]) & renal progression(HR 0.71 [95% CI 0.51-0.98]) vs DPP4 use
Risk of MACE also⬇️in LN subgrp
🧐💊A potential role of SGLT2i for SLE/LN?
#ACR23 ABST1579 @RheumNow #ACRbest https://t.co/Dod8DqRvLo
sheila ( View Tweet)
#ACR23 @RheumNow
SGLT2 inhibitors help CV & renal outcomes, but SLE pts excluded @AprilJorgeMD
ComparedSGLT2 to DPP4 inhibs, real world observation emulation study in SLE pts with T2DM
Lower incidence of MACE & renal progression
Subgroup w LN - risk reduction 10.2 MACE/100 py https://t.co/JpJ0yWNQBe
Eric Dein ( View Tweet)
Excellent start to Plenary II
Should we borrow SGLT2i and DPP4i use from endocrine?
SLE pts who initiated SGLT2 or DPP4: lower risk of MACE and renal progression
@RheumNow #ACR23 Abs#1579 https://t.co/RsaWuetyft
Robert B Chao, MD ( View Tweet)
Glucocorticoids-free zone in SLE?
For over 70 years, glucocorticoids, (GC) have been a part of standard therapy in SLE. They are classically used to not only induce remission or treat an acute flare, but also as maintenance therapy. #ACR23
https://t.co/sfRhNj6OpZ https://t.co/k6VoG5lKO7
Dr. John Cush RheumNow ( View Tweet)
Patients with autoimmnue diseases have a high maternal and fetal complication rate!
Abst 1003 #ACR23 @RheumNow https://t.co/pnvvBUN2JG
Bella Mehta bella_mehta ( View Tweet)
Pt w/ refractory SCLE, wants to get pregnant. Dr. Petri's approach is: counsel patient and review meds (e.g PPI's can induce SCLE). She also asks: Where's your hat and sunblock? Get HCQ blood levels b/f starting anifrolumab or belimumab #ACR23 @rheumnow #MeetExpert
TheDaoIndex KDAO2011 ( View Tweet)
Difficult SLE skin dse?
Dr. Mosca reminds us to engage pts in the treatment process including adherence to preventive measures & lifestyle mods (sun protection, smoking)
Other considerations:
+ antimalarials
early use of newer tx? - Anifrolumab
#ACR23 @RheumNow https://t.co/kz8YfcBB2d
sheila ( View Tweet)
When to use #belimumab and when to use #voclosporin? Dr. Dall'Era does the following:
Belimumab: GFR<45, low proteinuria, extrarenal dz, pt factors
Voclosporin: GFR>45 w/o sig chronicity, high level proteinuria (3+g/), pt preference for oral
#ACR23 #MeetExpert @rheumnow https://t.co/0SXRBtChfk
TheDaoIndex KDAO2011 ( View Tweet)
"Get rid of partial response. Why would you want to see an oncologist who say I can get risk part of your cancer? Wouldn't you want to get rid of the whole cancer!" - Dr. M Petri on how we should view lupus nephritis #ACR23 @rheumnow #MeetExpert
TheDaoIndex KDAO2011 ( View Tweet)
Proof of concept for cCAR BCMA CD19 - safely eliminated all autoabs, reset B cell/humoral immune system, & delivered long-term, med-free remission in 1 dose in LN and SLE. More studies needed! #ACR Abs 1493 @rheumnow https://t.co/sT68cN3TKe
Dr. Rachel Tate ( View Tweet)
UTSW Dallas study: Health literacy may be essential limiting factor for families w/ children w/ SLE. Other critical barriers to patient care include food security and living costs such as transportation, housing, and utilities. #ACR23 Abs #1029 https://t.co/jtnIgLZQfC @rheumnow https://t.co/A1zr8quSdd
Dr. Rachel Tate ( View Tweet)