Diagnosing Neuropsychiatric SLE (5.23.2025)
Dr. Jack Cush reviews the news and journal reports from RheumNow.com - including views on the vagus nerve, NPSLE and CAR-T mania.
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Why DORIS or LLDAS #remission
🤔
⬇️mortality
⬇️damage
⬆️QoL
Dr Nikpour at On Rheum Assoc
Shows Remission > LLDAS
no pred ✅ best
@RheumNow https://t.co/tFcPrkd5Vd
Links:
Janet Pope @Janetbirdope( View Tweet )
Why DORIS or LLDAS #remission
🤔
⬇️mortality
⬇️damage
⬆️QoL
Dr Nikpour at On Rheum Assoc
Shows Remission > LLDAS
no pred ✅ best
@RheumNow https://t.co/uuwnvjJr3R
Links:
Janet Pope @Janetbirdope( View Tweet )
Does ADDING an #immunesuppressive
To
#belimumab in #SLE give more benefit?
❎
NO
#RWE from Spain suggests no added improvement adding IS to Belimumab
Should you switch Rx then? 🤷♀️
@RheumNow #LUPUS2025 poster110
#ClinicalPearl https://t.co/C3ydArMx7x
Links:
Janet Pope @Janetbirdope( View Tweet )
Why follow antiDNA and complements in
#lupus #nephritis #LN
#LUPUS2025 panel said
To detect flare
?to consider after 3 to 5 yrs of remission to taper Rx
?but not for early response to Rx
Just info from the panel with my opinion salted in
@RheumNow https://t.co/bFUfN0PsFF
Links:
Janet Pope @Janetbirdope( View Tweet )
deep thoughts in #lupus
Is ‘better’ the enemy of #remission?
Is a complete renal response <50% at the end of contemporary #triple #therapy
Something to celebrate?
▶️Yes better than old #SoC but a bit sobering
We need RCTs that radically change paradigm
#LUPUS2025 @RheumNow
Janet Pope @Janetbirdope( View Tweet )
Who does worse with #SLE
#nature vs #nurture
South American #lupus #registries
⬆️ activity
⬆️damage
⬇️age
⬇️SES
⬆️SLE #antibodies
#Gladel registry and others vs Europe
Environment >genetics 🤔
#LUPUS2025 #45poster @RheumNow
@gponsestel https://t.co/XjiXHAMuGm
Links:
Janet Pope @Janetbirdope( View Tweet )
#Proteinuria that persists in #LN
#lupus #nephritis even w mild proteinuria
👇
Worse outcomes
Just like all CKD
Take home
Aim for None or minimal in #SLE
<150 protein
#voclosporin >> PBO (SoC)
1/2 Voclosporin had deep response at least once > PBO
#LUPUS2025 @RheumNow https://t.co/CBUzyBatBh
Links:
Janet Pope @Janetbirdope( View Tweet )
Moving Targets in Lupus and Lupus Trials
In the 1990s, lupus treatment development became a major focus, but progress was slow. Belimumab was eventually approved by recognizing that trials could only show small differences from placebo, requiring 867 patients globally to https://t.co/xrj8r1iNxr
Dr. John Cush @RheumNow( View Tweet )
If vagus nerve stimulation improves RA; then what if vagotomy? Danish study of vagotomy (1977-1995). 6070 vagotomy matched w/ 60,699 comparators. Truncal vagotomy was assoc w/ signif incr RA incidence (OR 2.62), but not superselective vagotomy (OR 1.05). NO diff in incident OA https://t.co/Rs1EyrQd57
Dr. John Cush @RheumNow( View Tweet )
No Cancer Recurrence with Biologic DMARDs in RA
A prospective Danish rheumatoid arthritis (RA) registry study look at the risk of recurrence when a biological disease-modifying antirheumatic drugs (bDMARDs) was ued in patients with a a prior solid cancer (in remission) and found no increased
Tocilizumab vs. Methotrexate in Rheumatoid Arthritis
A large randomized rheumatoid arthritis (RA) clinical trial compared subcutaneous tocilizumab (TCZ) vs oral methotrexate (MTX) vs. the combination of subcutaneous TCZ and MTX, and showed that TCZ was superior to MTX, either given as TCZ monotherapy or in combination with MTX.
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Moving Targets in Lupus and Lupus Trials
Clinical trial data quality is a moving target. Lupus is also a moving target. Can we address the moving target of lupus pathology with the moving targets of quality clinical trials and scientific treatment selection?
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Periprosthetic femoral Fx (PPFF): metanalysis of 36 studies found PPFF risk factors: Uncemented stems (OR 3.36), major teaching hosp (2.0), female (1.6), obesity (1.4), Hi comorbidity(1.4), RA (1.89), (1.67), revised THR (2.6). OA = protective (0.51) https://t.co/y2BpH8LUb6 https://t.co/hX2lcjI4Kg
Dr. John Cush @RheumNow( View Tweet )
Assessing and Treating CV Risk Increases in Systemic Lupus
For nearly 50 years, the heightened CVD risk in SLE patients has been acknowledged since Urowitz et al.'s 1976 study on lupus mortality. Research consistently shows SLE patients have a 2-10 times higher CVD risk than https://t.co/P1AdxHkiQi
Dr. John Cush @RheumNow( View Tweet )
Biologics in Pregnancy Patients With Autoimmune Disease
A large cohort, claims data study shows that among pregnant women receiving biologic therapies for autoimmune conditions, 72% continued their biologics pregnancy, more so among inflammatory bowel disease (IBD) patients than those with rheumatoid arthritis (RA), psoriasis (PsO) or psoriatic
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Emulation trials in SLE: Real or Fake?
Recently a landmark paper was published in A&R studying the results of an emulation trial. My colleagues and I were able to write an editorial on this paper and describe emulation trials.
https://t.co/0ulYG5xz0J https://t.co/y2jo2SSH83
Dr. John Cush @RheumNow( View Tweet )
SLE Perspectives: Past, Present, Future
https://t.co/ggYmVvEtZx https://t.co/VriDjAEcl5
Dr. John Cush @RheumNow( View Tweet )
Risk Factors for Knee Osteoarthritis
New research from the University of Sydney reveals that obesity, having a knee injury and occupational risks such as shift work and lifting heavy loads are primary causes of knee osteoarthritis.
https://t.co/Kc686Zc8Xa https://t.co/ANyiE2pIxo
Dr. John Cush @RheumNow( View Tweet )
New Steroid Rules in Lupus? Let’s Talk.
Dr. Michelle Petri breaks down the latest strategies to minimize steroid exposure while managing disease activity in lupus patients.
💡 Smarter steroid use = better outcomes.
👉 Watch now on RheumNow:
https://t.co/vbjrXAlixz
#Lupus https://t.co/TN5EkZhbef
Links:
Dr. John Cush @RheumNow( View Tweet )
Clinical Impacts of the Pre Lupus State on Pregnancy Outcomes
Dr. Catherine Sims talks with Dr. Jessica English at the RheumaPreg 2025 meeting in Vienna, Austria.
https://t.co/T8ZYQtDNmZ https://t.co/PmVRFVlABd
Dr. John Cush @RheumNow( View Tweet )
3-year, RCT of Mediteranean diet vs usual care in 924 older adults w/ metabolic syndrome & BMI > 27. Med. diet shows signif wt loss (3.4% vs 0.4%), w/ improved BMD (by DEXA) at year 3, especially in women. https://t.co/mllx6l1QnM https://t.co/CulO1Sschf
Dr. John Cush @RheumNow( View Tweet )
SLE, Antiphospholipid Antibodies, and the Placenta
It is well established that women with SLE are at increased risk for adverse pregnancy outcomes, including preeclampsia, preterm birth, and pregnancy loss. However, the pathophysiologic mechanisms driving these complications are not yet fully understood. In this article, we explore several
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Retrospective cohort study 112 biopsy-proven Lupus nephritis pts (65% class IV; F/U 8.3 yrs). (64.3%), alone or in combination. Renal damage incr betw 5 & 10 yrs F/U. 13.4% progressed to renal function impairment, and 11.6% to ESRD. Early Dx & Rx of LN, esp w/ highproteinuria, https://t.co/N1BL9Bri3M
Dr. John Cush @RheumNow( View Tweet )
Lessons Learned from a Lupus Registry: Two sides of one coin?
It's Dr. Janet Pope reporting at RheumNow on our special lupus edition. I'd like to talk about lessons learned from a Canadian lupus registry. Is it two sides of one coin?
https://t.co/IxMZhA1uht https://t.co/PJixCj8d6g
Dr. John Cush @RheumNow( View Tweet )
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