0:03
Hi, my name is Al Kim. I'm in Orlando, Florida for the 2026 ACR Convergence Conference and we're covering some more topics within lupus.
0:13
This one is about poster abstracts that have been revealing the gaps in outcomes, not the gaps in terms of the clinical outcomes that we report in clinical trials, but the outcomes that the patients really care about, the patient-reported outcomes.
0:27
So it's interesting because the immunology we've been having has never been better and we've had more approved drugs in lupus than before, but again the patients are not necessarily feeling any better.
0:37
So let's start with cardiovascular risk.
0:40
Abstract 0922 looked at coronary artery calcification in patients with lupus whom where the ACC/AHA PREVENT calculator actually predicted them to be low risk.
0:52
So these are low-risk patients using the PREVENT calculator, but they had their calcium score checked.
1:00
Guess what? They were highly discordant.
1:02
The majority of these patients had high calcium scores despite the fact that the PREVENT calculator dictated that — or told them — that they should be low risk.
1:10
I think this is a really interesting lesson about tools that are developed for the general population that are applied in disease-specific populations such as lupus.
1:18
And you're starting to see some discordances there.
1:21
Then let's look at the kidney. Let's focus on abstracts 1864 and 1865.
1:29
The first one is transplant access amongst patients with ESKD kidney disease and patients with lupus.
1:34
And the second one is graft failure in those recipients compared to other immune-mediated diseases.
1:40
One of them is about getting people in the door.
1:44
The other one is what happens after you do.
1:47
And the story for both is bleak. We spent 15 years optimizing induction therapies for lupus nephritis.
1:52
But these two abstracts are about patients for whom that optimization did not work, and that population has not and will not go away.
2:00
Then there's abstract 0924. This is the one that I was most interested in, because they looked at longitudinal cognitive performance and tried to understand risk factors for the greatest cognitive impairment.
2:14
Guess what that risk factor was? It was actually anxiety — not disease activity, not damage, not glucocorticoid exposure — anxiety.
2:22
So sure, you know, this is just an association.
2:27
So the overread is going to be about direction and causality, but it's also the only variable on the list that we actually can modify, and most of us aren't screening for it.
2:37
So you put these together and a pattern shows up.
2:40
Every one of these risk instruments was built somewhere else and imported.
2:44
We keep losing kidneys, cognition, potentially jobs, while the serologies improve.
2:49
And the reason we are surprised every time is because we're using these borrowed instruments.
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