Shifting the Management Paradigm for SLE and Lupus Nephritis
The paradigm for treating patients with systemic lupus erythematosus (SLE) is rapidly shifting and our patients will surely benefit with improved outcomes.
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Treat to target 🎯 #SLE #recommendations
Considerations are nuanced and Impt
Lowest clinical disease activity is goal
Try for remission
🎯 Get patients off #glucocorticoids
If not ⬇️low dose #prednisone
@RheumNow #LUPUS2025 https://t.co/HlBeh2FLxP
Links:
Janet Pope @Janetbirdope( View Tweet )
controversy re
👇
Monitoring for +Ro pregnant re
#congenital #heart #block
87% Y
echo is possibly too late
No ideas if flourinated #steroids work
But many thing we should do something
Guidelines differ on recommendations
Would fetal home HR be better
#LUPUS2025 @RheumNow https://t.co/MY0oPjLnGs
Janet Pope @Janetbirdope( View Tweet )
‘It’s #Lupus, it’s all in your head!’
➡️ Some patients with #SLE have heard this from others
At #LUPUS2025 in a packed session on #CNS lupus
#Dx is tricky
40% of #neuropsychiatric lupus have NEGATIVE #brain #MRI
👇r/o
infarct/bleed
Infection
Rx #steroids
@RheumNow https://t.co/yU1olg0uZU
Links:
Janet Pope @Janetbirdope( View Tweet )
‘To screen or not’?
For
#CHB #congenital #heart #block
Great debate #LUPUS2025
In #pregnant women with #SLE
In + #Ro #SSA &/or #La #SSB mothers
CHB Rx - #flourinated #steroids
To
⬇️#fetal #mortality ❎no benefit
⬇️#cardiomyopathy ❎
⬇️#pacemaker ❎
@RheumNow
??🤷♀️ https://t.co/xauDzfNBsC
Janet Pope @Janetbirdope( View Tweet )
Vitiligo affects up to 2% of people globally; more in blacks & hispanics than whites & more common in women > men. The prevalence has increased over time. Oral corticosteroids are most frequently prescribed, followed by other immunosuppressive drugs https://t.co/wNh6z3lKg1 https://t.co/hQo9sNn4kg
Dr. John Cush @RheumNow( View Tweet )
MTX works in pulmonary Sarcoid! NEJM reports Open label RCT of 138 un-Rx pulm. Sarcoid pts w/ either MTX or placebo. After 24 wks MTX was noninferior to PBO w/ mean change in FVC (-6.7 vs -6.1). AE: more Wt gain, insomnia w/ pred & more Nausea fatigue LFTs w/ MTX https://t.co/8XMCM2DitR
Dr. John Cush @RheumNow( View Tweet )
Steroids in Lupus Nephritis: No Free Lunch
Today I'm here to talk with you about steroids in lupus nephritis. The impetus for this is the 2024 ACR guideline for the management of lupus nephritis.
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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 )
Panacea of Prednisone & Cannabis (5.16.2025)
Dr. Jack Cush reviews the news, journal and regulatory reports from this week on RheumNow.com. Interesting trends and results with prednisone in lupus, cannabis in RA and opioid deaths too!
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SLE trends: pulse methylprednisolone followed by low dose steroids is rec by various guidelines. Risk factors for SLE flare after GC withdrawal: high Dz activity, active serology, younger age, shorter remission duration, faster tapering strategy, shorter duration/cessation of https://t.co/g6LaTijOpA
Dr. John Cush @RheumNow( View Tweet )
#2 most downloaded paper in 2024 on Journal of Clinical Medicine was “IgA Vasculitis (Henoch–Schönlein Purpura): An Update on Treatment” - Steroids are 1st line Rx, esp in adults w/ severe IgAV; other Rx include calcineurin inhibitors, MMF, RTX , https://t.co/F5jogxkoGr
Dr. John Cush @RheumNow( View Tweet )
Lupus in an empty house
The full house immunofluorescence pattern is the classic histopathologic finding of lupus and lupus nephritis. Glomerular deposits staining for IgG, IgA, IgM, C3 and C1q can help confirm a suspected diagnosis of SLE. But what about patients with negative immunofluorescence and no proliferative
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Betw 2005 -2021, there was a substantial increase in HCQ use, but only modest steroid (GC) reductions. Swedish cohort study of 3891 SLE pts - over 5 yrs GC decr from 68% - 54% to 46%. HCQ increased by 29% over 5 years. https://t.co/6LZVMt9zy7 https://t.co/WunjnBBTW9
Dr. John Cush @RheumNow( View Tweet )
Betw 2005 -2021, there was a substantial increase in HCQ use, but only modest steroid (GC) reductions. Swedish cohort study of 3891 SLE pts - over 5 yrs GC decr from 68% - 54% to 46%. HCQ increased by 29% over 5 years. https://t.co/sI7JWq3AGk https://t.co/RBUMcl8uGz
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/04CjTkCqMJ
Links:
Dr. John Cush @RheumNow( View Tweet )
Comparing EULAR (2025) and ACR (2020) Guidelines on Safety of Lupus Medications in Pregnancy
Attendees at the 2025 RheumaPreg meeting were excited to discuss the newly released EULAR recommendations for use of antirheumatic drugs in reproduction, pregnancy, and lactation. Table 1 summarizes the major recommendations from EULAR (2025) and the American College of Rheumatology (2020)
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Vitamin D Headlines (5.9.2025)
Dr. Jack Cush reviews the news, journal reports and lupus highlights from the past week on RheumNow.com. Triple positivity, the gut and CRPS, and hope for better outcomes with Vitamin D therapy.
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Stable SLE - Should you Withdraw Immunosuppressant or Glucocorticoids?
An open-label, single-centre, randomized controlled trial tested whether immunosuppressant (IS) withdrawal is noninferior to glucocorticoid (GC) withdrawal in SLE patients and found that IS withdrawal is https://t.co/T8Fu83GScH
Dr. John Cush @RheumNow( View Tweet )
Glucocorticoids in SLE: how to start, how to follow, how to stop
More than 70 years after their first use in rheumatology by Philip Hench, glucocorticoids (GCs) continue to be one of the main weapons to fight systemic lupus erythematosus (SLE). No other available medication https://t.co/H6N0N3BhhU
Dr. John Cush @RheumNow( View Tweet )
Retrospective Medicare Claims data study of RA pts w/ metastatic non-small cell lung cancer who recv Rx w/ immune checkpoint inhibitor; found that ICI- Rx RA had the same survival as non-RA pts, and sterid use was not associated with worse survival https://t.co/JLlCfrRwvN https://t.co/DNEM32yocL
Dr. John Cush @RheumNow( View Tweet )
Stable SLE - Should you Withdraw Immunosuppressant or Glucocorticoids?
An open-label, single-centre, randomized controlled trial tested whether immunosuppressant (IS) withdrawal is noninferior to glucocorticoid (GC) withdrawal in systemic lupus erythematosus (SLE) patients and found that IS withdrawal is noninferior to GC withdrawal in SLE patients in long-
Retrospective Medicare Claims data study of RA pts w/ metastatic non-small cell lung cancer who recv Rx w/ immune checkpoint inhibitor; found that ICI- Rx RA had the same survival as non-RA pts, and sterid use was not associated with worse survival https://t.co/JLlCfrRwvN https://t.co/zeqeYt5ZHq
Dr. John Cush @RheumNow( View Tweet )
Keys to Mastery (5.2.2025)
Dr. Jack Cush reviews the news, articles and drug approvals from the past week on RheumNow.com. This podcast marks the beginning of our Lupus Campaign called "Lupus Unlocked: Keys to Mastery". This month's campaign on Lupus is sponsored by Aurinia.
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EULAR Guidelines on Reproductive Health
MedPage Today
Rheumatology patients considering or actually having babies can safely take most of the medications currently used to treat their conditions, according to an updated guideline from the European Alliance of Associations for Rheumatology (EULAR).
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How would you manage a patient with Overlap (anti-synthetase) syndrome, ILD, polyarthritis and myositis?
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