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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. They are a valuable 'friend' if used wisely, and can become a 'foe' if used excessively.
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#ACR23 Please find my preview article on selected #SLE abstracts to be presented at year’s conference - towards Glucocorticoid-Free zone in lupus @RheumNow
https://t.co/1kM7LWc64V https://t.co/WK9X7UpsNi
Md Yuzaiful Md Yusof ( View Tweet)
In their study, Dr Deng et al identified TRAF5 as susceptible gene for SLE-PAH
✳️TRAF5 deficiency activates BMP/TGFB signaling w/⬆️PAEC apoptosis
✳️TRAF5 overexpression attenuated PAH sxs in mice
TRAF5 as potential BM for dx/novel tx target in SLE-PAH?
#ACR23 ABST0723 @RheumNow https://t.co/WT9vQo8y8s
sheila ( View Tweet)
In this real world EHR-based SLE cohort, AJorge: BEL was assoc w/⬇️risk of damage prog vs. MMF (HR 0.74 [95% CI 0.67-0.83) but no diff bet BEL vs. MTX/AZA at 3yrs
Further prospective studies req'd?
BEL remains an option for non-renal SLE tx.
#ACR23 ABST0606 @RheumNow https://t.co/KabBeXKpvk
sheila ( View Tweet)
Did you know?
👉APOL1 variants are protective against trypanosomiasis.
👉Despite reassuring renal biopsies, SLE pts with #APOL1 variants had:
⬆️progression to ESRD, ⬆️atherosclerosis, ⬆️osteonecrosis (likely related to endothel dysfnx) #ACR23 @ashira_md @RheumNow #DuboisLecture https://t.co/w1lnGMPFAQ
TheDaoIndex KDAO2011 ( View Tweet)
CV events in women w/ ARDs pregnancies:
-2.0% of 19,340 pregnant ARDs
Adjusted relative risk:
-4 fold in ARD
-15 fold in primary APS
-6 fold in SLE
-SLE + APS 18 fold
25-30% occur in early post partum!
Need for continued vigilance after delivery
@RheumNow #ACR23 ABST0722 https://t.co/hLeN61WBnB
Aurelie Najm ( View Tweet)
CVE’s higher in pregnant pts with SLE + APS, primary APS and Lupus nephritis especially in the postpartum period. Rheums need to be involved with their patients’ care during pregnancy! Abstr#0722 #ACr23 @rheumnow https://t.co/P6sbJtd6xW
TheDaoIndex KDAO2011 ( View Tweet)
Always great to see UCSD represent at #ACR23!
Pregnant women with rheumatic diseases and antiphospholipid syndrome higher a HIGHER risk for acute cardiovascular events
30% of events occurred postpartum
@RheumNow Abs#0722 https://t.co/CqZedfOlBC
Robert B Chao, MD ( View Tweet)
#ACR23 Real-world multicentre study showed steroid-sparing effect of Belimumab in #SLE. At 2 years, proportion of patients on =>10mg/d decreased from 52% to 3%. 18% and 13% achieved LLDAS and DORIS remission. Support its use esp. in those relying on glucocorticoids @RheumNow https://t.co/ad5XH3pmYc
Md Yuzaiful Md Yusof ( View Tweet)
Plenary 1 #ACR23
CVE in ARD/APS is a significant risk factor during pregnancies and the risk stays even after delivery for a significant amount of time. California based administrative data study! abst#722 @RheumNow https://t.co/HawhS4Gqko
Bella Mehta bella_mehta ( View Tweet)
Should all of active moms with #SLE receive DVT prophylaxis post partum? High rates of VTE in #ARDs post partum #0722 #ACRbest #ACR23 @RheumNow @ACRheum Likely data driven by #SLE and maybe #RA and not all #autoimmune #rheumatic #disease. Large pop’n data from California https://t.co/sGJa5N6HUj
Janet Pope ( View Tweet)
Plenary talk by Dhital etc al, shows increased risk of acute CV events in pregnant rheumatic, SLE, APS pts, esp if nephritis or APL+. #ACR23 Abstract 0722 https://t.co/pG0PqzVtIU
Dr. John Cush RheumNow ( View Tweet)
Deucravacitinib (TYK2) data has been surprisngly good in SLE
Strong rationale in PsA as well; I liked this poster & the focus on pain scores / patient QOL
Probably my #1 draft pick for "drugs I'm buying right now"
@RheumNow #ACR23 Abstr0508 https://t.co/FHNvgUrYxp
Mike Putman EBRheum ( View Tweet)
Tired of getting referrals for symptomatic patients with 1/80+ ANAs antibodies?
This new risk model for systemic AID is very welcome!
Variables: age, female, higher ANA titer, higher platelet count, disease-specific autoantibody & billing code count.
#ACR23 @Rheumnow ABST0131 https://t.co/q8rYjjtZ89
Aurelie Najm ( View Tweet)
Year in Review: Dr. P Seo
Dr. Seo gave a moment of silence to Baricitinib use in SLE given studies showing it is not efficacious for SLE
#ACR23 @RheumNow https://t.co/8GKUlfJdbe
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Thinking beyond immunosuppression for SLE Nephritis management:
SGLT-2i
GLP-1RA
ERAs
@RheumNow #ACR23 https://t.co/RdmKnm08YY
Robert B Chao, MD ( View Tweet)
Does knowing ischemic stroke subtypes among SLE patients matter?
This study by Hopia et al 👉54% of ischemic strokes in 56 SLE pts were APS/aPL & cardioembolic origin (accdg to TOAST) & +assoc with STAT4 gene.
#ACR23 ABST0579 @RheumNow https://t.co/Ut8QPpQNQp
sheila ( View Tweet)
SLE pts with +aCL IgG/IgM and LA had higher risk of developing atherosclerotic CVD accdg to this prospective study by Ding et al.
. . .
🧐Again, SLE pts have ⬆️CV risk so always risk stratify and intervene early.
#ACR23 ABST0552 @RheumNow https://t.co/QhttQZzp8G
sheila ( View Tweet)
This study by Munoz-Grajales et al show that the analyte S100A8/A9 (highest AUC) was able to differentiate between SLE pts with cognitive impairment and those without.
. . .
Interesting findings.
More data needed to confirm and explain why it is so.
#ACR23 ABST0558 @RheumNow https://t.co/LcF6s2qgNr
sheila ( View Tweet)
Acute pregnancy-related CV event risk found to be highest in pts w/ SLE+ APS, followed by primary APS, and SLE w/ LN. Most importantly, 25-30% of events happen post-partum! Monitor these pts carefully! #ACR23 Plenary 0722 #ACRbest https://t.co/yD5VFJ2SXh @rheumnow https://t.co/PDvzbs19fR
Dr. Rachel Tate ( View Tweet)