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RheumThoughts: Changing the Conversation with Patients: Lupus

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Jack Cush, MD

| Apr 05, 2023 5:46 pm

While I believe that this "type 2" (chronic achy) lupus is largely due to secondary FM and is seen in up to half of SLE patients, I believe there is the possibility that FM like manifestations may be part of systemic lupus. I back this up with our mRNA studies of lupus vs ANA+ consults vs FM w/ ANA+ that showed a significant number (5-10%) of ANA+ FM pts had an "immune signature" identical to the active SLE patient. Moreover, many of us have given HCQ to such pts for achy complaints and seen improvement. Is that from the immune benefits of HCQ or is HCQ capable of changing pain thresholds (A. Kavanaugh showed that in a small study done at UT Southwestern nearly 30 years ago). I believe this concept deserves more stringent translational studies!

Gwenesta B Melton

| Apr 10, 2023 10:31 pm

This is compelling to assess the patient for type one and type two manifestations of Lupus. Alternative strategies are important for these symptoms and is indeed helpful to note using your strategies to help the patient.

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Dr. Megan Clowse is an Associate Professor of Medicine in the Division of Rheumatology and Immunology.  Her clinical research focuses on the management of rheumatic diseases in pregnancy. She has cared for over 600 pregnancies in women with rheumatic disease, collecting information on these pregnancies initially in the Duke Autoimmunity in Pregnancy Registry and Repository, and now the MADRA (Maternal Autoimmune Disease Research Alliance) registry and repository.  She served on the Core Leadership Team for the inaugural American College of Rheumatology's Reproductive Health Guidelines, published January 2020.  Dr. Clowse created, a website dedicated to improving lupus pregnancy planning and management for patients and rheumatologists.