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class="jsx-286612495 py-3 text-sm text-gray-500 text-left"><i class="jsx-286612495">December 8th 2022</i></span><div class="jsx-286612495 w-full h-fit mb-4"><p class="jsx-286612495 text-[18px] font-bold text-[#000000] text-left line-clamp-3 text-hidden">LN Treatment Landscape Overview</p></div></div></div></a><a target="" style="scroll-snap-align:center;text-decoration:none" class="jsx-2915913710 sm:w-[280px] xs:w-[240px] w-[65%] h-auto flex flex-col space-y-3 flex-none select-none no-underline" href="/view/dr-liz-lightstone-on-race-and-sociodemographic-implications-in-lupus-nephritis"><div class="jsx-2915913710 w-full h-full flex flex-col overflow-hidden relative bg-white text-center"><div class="jsx-2915913710 relative w-full shadow-md shadow-grey-800 aspect-video"><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:absolute;top:0;left:0;bottom:0;right:0"><img alt="" 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"/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 17th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/initial-presentation-of-lupus-nephritis">Initial Presentation of Lupus Nephritis</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/initial-presentation-of-lupus-nephritis"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Medical experts illustrate characteristics in the presentation of lupus nephritis.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/overview-of-systemic-lupus-erythematosus-sle-and-lupus-nephritis-ln-"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/88cf83a33b222ff7414f54939a3511bcbd5b29bd-1920x1080.jpg?fit=crop&auto=format" alt="Overview of Systemic Lupus Erythematosus (SLE) and Lupus Nephritis (LN)" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 17th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/overview-of-systemic-lupus-erythematosus-sle-and-lupus-nephritis-ln-">Overview of Systemic Lupus Erythematosus (SLE) and Lupus Nephritis (LN)</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/overview-of-systemic-lupus-erythematosus-sle-and-lupus-nephritis-ln-"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Alvin Wells, MD, PhD, opens a discussion surrounding systemic lupus erythematosus (SLE) and lupus nephritis (LN).</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/data-suggest-cle-incidence-has-not-changed-significantly-in-40-years"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/c35546307a088c0e2f20d068e083d4e6664da6a0-1200x960.jpg?fit=crop&auto=format" alt="Image of Mayo Clinic" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 15th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/data-suggest-cle-incidence-has-not-changed-significantly-in-40-years">Data Suggest CLE Incidence Has Not Changed Significantly in 40 Years</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/data-suggest-cle-incidence-has-not-changed-significantly-in-40-years"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Authors also found that the mortality rate of people with cutaneous lupus erythematosus (CLE) are generally similar to that of the general population. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/dr-liz-lightstone-on-emerging-treatment-options-unmet-needs-in-lupus-nephritis"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a7bea4d8aacc8ac09d9d8dd36f6deb7c4938ad4b-800x420.png?fit=crop&auto=format" alt="Dr Liz Lightstone on Emerging Treatment Options, Unmet Needs in Lupus Nephritis" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 11th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/dr-liz-lightstone-on-emerging-treatment-options-unmet-needs-in-lupus-nephritis">Dr Liz Lightstone on Emerging Treatment Options, Unmet Needs in Lupus Nephritis</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/matthew-gavidia">Matthew Gavidia</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/dr-liz-lightstone-on-emerging-treatment-options-unmet-needs-in-lupus-nephritis"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Liz Lightstone, MBBS, PhD, FRCP, professor of renal medicine for the faculty of medicine, Imperial College London, discussed recently approved therapeutic options for patients with lupus nephritis and what unmet needs persist in the management of the disease.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/sle-prevalence-varies-across-low--and-middle-income-countries"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a8d6e11ba5dea4e216ca7cb09f1c616bd3db9dd1-1200x800.jpg?fit=crop&auto=format" alt="Image of a lot of people" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 5th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/sle-prevalence-varies-across-low--and-middle-income-countries">SLE Prevalence Varies Across Low- and Middle-Income Countries</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/sle-prevalence-varies-across-low--and-middle-income-countries"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Colombia and Brazil had the highest prevalence and incidence of systemic lupus erythematosus (SLE), a new investigation found.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/genetic-susceptibility-to-sle-may-protect-against-severe-covid-19"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/af04406227d4f3afff99d0e571e5403118fa8f24-1200x712.jpg?fit=crop&auto=format" alt="Image of SARS-CoV-2" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 3rd 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/genetic-susceptibility-to-sle-may-protect-against-severe-covid-19">Genetic Susceptibility to SLE May Protect Against Severe COVID-19</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/genetic-susceptibility-to-sle-may-protect-against-severe-covid-19"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new report found interesting links between genetic factors associated with COVID-19 severity and autoimmune disease among persons who have systemic lupus erythematosus (SLE).</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-7"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/with-systemic-lupus-erythematosus-finding-a-cause-is-no-simple-task"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a6c0ef9727891a14eed1a4eee038b81b8f1aa946-800x600.jpg?fit=crop&auto=format" alt="Graphic of a person on top of a question mark" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 29th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/with-systemic-lupus-erythematosus-finding-a-cause-is-no-simple-task">With Systemic Lupus Erythematosus, Finding a Cause Is No Simple Task</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/with-systemic-lupus-erythematosus-finding-a-cause-is-no-simple-task"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Existing evidence suggests genetics, environmental factors, and exposure to specific chemicals—such as those in cigarettes—can all increase a person’s risk of systemic lupus erythematosus.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/long-term-childhood-lupus-nephritis-outcomes-appear-to-be-improving"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/4d7be11c0d6c73f035ff772b45ecbb64ead7f54e-1200x798.jpg?fit=crop&auto=format" alt="Image of silhoutted children child" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 25th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/long-term-childhood-lupus-nephritis-outcomes-appear-to-be-improving">Long-term Childhood Lupus Nephritis Outcomes Appear to Be Improving</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/long-term-childhood-lupus-nephritis-outcomes-appear-to-be-improving"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">These new study data are based on 20 years of follow-up in 92 Chinese children with lupus nephritis.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/racial-disparities-correlate-with-covid-19-outcomes-in-people-with-sle"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/90d2e1887e95e0451b1c6b92df7b00e12fb9d0c8-1200x960.jpg?fit=crop&auto=format" alt="Image of patients of many races" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 22nd 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/racial-disparities-correlate-with-covid-19-outcomes-in-people-with-sle">Racial Disparities Correlate With COVID-19 Outcomes in People With SLE</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/racial-disparities-correlate-with-covid-19-outcomes-in-people-with-sle"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Blacks and Hispanics with systemic lupus erythematosus (SLE) are more than twice as likely to have severe outcomes from COVID-19 compared with White patients with SLE, a new study has found.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/sle-rates-vary-worldwide-and-require-further-study-study-emphasizes"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/1fcc2bd22049aa3524940b3fc7b01cc1d218c809-1200x1200.jpg?fit=crop&auto=format" alt="Image of the world" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 19th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/sle-rates-vary-worldwide-and-require-further-study-study-emphasizes">SLE Rates Vary Worldwide and Require Further Study, Study Emphasizes</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/sle-rates-vary-worldwide-and-require-further-study-study-emphasizes"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Data suggest incidence and prevalence of systemic lupus erythematosus (SLE) vary widely among regions, although the authors noted some regions have been studied more extensively than others.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/case-report-highlights-rare-hypoparathyroidism-case-with-sle"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/bc427f9331ab087c49a03731c910d589290a457a-300x200.jpg?fit=crop&auto=format" alt="graphic illustrating a person with rare condition" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 15th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/case-report-highlights-rare-hypoparathyroidism-case-with-sle">In Rare Cases, Hypoparathyroidism Can Be Linked With SLE</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/case-report-highlights-rare-hypoparathyroidism-case-with-sle"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Only about 10 cases of hypoparathyroidism related to systemic lupus erythematosus (SLE) have been reported, according to researchers who recently described such a case.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/hydroxychloroquine-for-primary-sj-gren-s-syndrome-does-not-lower-risk-of-sle"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/274af143b30e49f0f58a8629667e51df593bb666-5000x3750.jpg?fit=crop&auto=format" alt="graphic of a question mark with a stethoscope" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 12th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/hydroxychloroquine-for-primary-sj-gren-s-syndrome-does-not-lower-risk-of-sle">Hydroxychloroquine for Primary Sjögren Syndrome Does Not Lower Risk of SLE</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/hydroxychloroquine-for-primary-sj-gren-s-syndrome-does-not-lower-risk-of-sle"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">However, the researchers said their findings should not be interpreted as completely refuting the possibility that hydroxychloroquine might be a useful tool in preventing or slowing the development of systemic lupus erythematosus (SLE).</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-13"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/importance-of-jaccoud-arthropathy-investigation-highlighted-in-sle-case-report"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/01c5e3647e097b386e083745b1a281a12a3cc1f8-1000x667.jpg?fit=crop&auto=format" alt="Physician reviewing a case report" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 8th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/importance-of-jaccoud-arthropathy-investigation-highlighted-in-sle-case-report">Importance of Jaccoud Arthropathy Investigation Highlighted in SLE Case Report </a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/importance-of-jaccoud-arthropathy-investigation-highlighted-in-sle-case-report"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The question of whether bone erosion is a feature of Jaccoud arthropathy has remained controversial among persons who have systemic lupus erythematosus (SLE). </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/different-drugs-affect-sle-quality-of-life-differently-study-finds"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/4c4db20efb17c7274cefb5e22b03f8e3d4f0739f-1200x799.jpg?fit=crop&auto=format" alt="Image of female patient and doctor having consultation" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 4th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/different-drugs-affect-sle-quality-of-life-differently-study-finds">Different Drugs Affect SLE Quality of Life Differently, Study Finds</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/different-drugs-affect-sle-quality-of-life-differently-study-finds"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The research shows a disease-specific quality-of-life (QOL) tool is more sensitive than a generic version.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/case-report-complicated-case-of-sle-infection-required-nonstandard-treatment-choice"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/decb0f2bcf8d79c54d030e495c9d42171b0b103b-1200x799.jpg?fit=crop&auto=format" alt="Doc and patient discussing care report" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 25th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/case-report-complicated-case-of-sle-infection-required-nonstandard-treatment-choice">Case Report: Complicated Case of SLE, Infection Required Nonstandard Treatment Choice</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/case-report-complicated-case-of-sle-infection-required-nonstandard-treatment-choice"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The patient was successfully treated with rituximab and intravenous immunoglobulin.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/late-onset-sle-case-underscores-possibilities-of-unusual-presentation"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/985459ce944578c8e23985870321635a9df2fbbb-1200x788.jpg?fit=crop&auto=format" alt="Doc writing a case report" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 19th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/late-onset-sle-case-underscores-possibilities-of-unusual-presentation">Late-Onset SLE Case Underscores Possibilities of Unusual Presentation</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/late-onset-sle-case-underscores-possibilities-of-unusual-presentation"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The case involved a 69-year-old man who presented with lupus nephritis. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/shifting-landscape-role-of-belimumab-in-sle-and-lupus-nephritis-explored"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/255f3a95dd100c086adf1a608e259a4d4ebfcdc5-219x107.jpg?fit=crop&auto=format" alt="Image of lab research" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 15th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/shifting-landscape-role-of-belimumab-in-sle-and-lupus-nephritis-explored">Shifting Landscape, Role of Belimumab in SLE and Lupus Nephritis Explored</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/shifting-landscape-role-of-belimumab-in-sle-and-lupus-nephritis-explored"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new review article explains the role of biologics in treatment systemic lupus erythematosus (SLE) and lupus nephritis.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/phase-2-study-finds-litifilimab-improves-joint-arthritis-in-sle"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/de1e14304a1394e91abb8a098b720beb2a02eab5-375x250.jpg?fit=crop&auto=format" alt="Image of painful hands" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 13th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/phase-2-study-finds-litifilimab-improves-joint-arthritis-in-sle">Phase 2 Study Finds Litifilimab Improves Joint Arthritis in SLE</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/phase-2-study-finds-litifilimab-improves-joint-arthritis-in-sle"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">New data show litifilimab outperformed placebo in patients with active arthritis and skin manifestations due to systemic lupus erythematosus (SLE).</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-19"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/lupus-anticoagulant-linked-with-cardiac-dysfunction-in-sle"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/8ff779cfbce2e75fac28b5ef56785dd7fd1be37d-290x193.jpg?fit=crop&auto=format" alt="image of cardiac care" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 7th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/lupus-anticoagulant-linked-with-cardiac-dysfunction-in-sle">Lupus Anticoagulant Linked With Cardiac Dysfunction in SLE </a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/lupus-anticoagulant-linked-with-cardiac-dysfunction-in-sle"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The authors found the association by comparing echocardiographic and biochemical changes after 5 years in patients with systemic lupus erythematosus (SLE).</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/anxiety-depression-common-in-people-with-sle-and-lupus-nephritis"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/5cb1b1799fda7be235244ab4533721830a9dea20-1280x853.jpg?fit=crop&auto=format" alt="woman who is depressed" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">September 6th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/anxiety-depression-common-in-people-with-sle-and-lupus-nephritis">Anxiety, Depression Common in People With SLE and Lupus Nephritis </a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/anxiety-depression-common-in-people-with-sle-and-lupus-nephritis"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new study finds anxiety and depression are more common in people with systemic lupus erythematosus (SLE) if they also have nephritis. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/useful-similarities-between-adult-pediatric-sle-study-data-found"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/fc0466adf6a1aa3558c7dc95729853ae2839acc9-849x565.jpg?fit=crop&auto=format" alt="Picture of an adult and child" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 31st 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/useful-similarities-between-adult-pediatric-sle-study-data-found">Useful Similarities Between Adult, Pediatric SLE Study Data Found</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/useful-similarities-between-adult-pediatric-sle-study-data-found"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The findings mean it may be feasible to use adult systemic lupus nephritis (SLE) trial data to reduce the data needed for pediatric indications.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/lupus-nephritis-care-varies-widely-in-children-with-sle"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/60fbdb36488f80d9987f9b51c0b2c7ee6fdc5899-800x400.jpg?fit=crop&auto=format" alt="Silhouetted image of children" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 26th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/lupus-nephritis-care-varies-widely-in-children-with-sle">Lupus Nephritis Care Varies Widely in Children With SLE</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/lupus-nephritis-care-varies-widely-in-children-with-sle"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The use of existing guidelines for pediatric treatment varies significantly among sites, a new study has found.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/more-work-needed-to-make-progress-against-cvd-risk-in-sle"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/d2e16b4911d9f00273e290fd921dd27419752833-300x150.jpg?fit=crop&auto=format" alt="Image of cardiovascular health" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 22nd 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/more-work-needed-to-make-progress-against-cvd-risk-in-sle">More Work Needed to Make Progress Against CVD Risk in SLE</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/more-work-needed-to-make-progress-against-cvd-risk-in-sle"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new review outlines what is known about cardiovascular disease (CVD) risk in patients with systemic lupus erythematosus (SLE) and how that might affect patient care.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/new-report-highlights-rare-cases-of-sle-onset-after-hpv-vaccination"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/9f2dfcc852448591e5e67e24447bbffc930f6e93-300x287.jpg?fit=crop&auto=format" alt="Picture of globe" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 17th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/new-report-highlights-rare-cases-of-sle-onset-after-hpv-vaccination">New Report Highlights Rare Cases of SLE Onset After HPV Vaccination</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/new-report-highlights-rare-cases-of-sle-onset-after-hpv-vaccination"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new case report highlights the potential benefits of risk assessment for women with a family history of autoimmune diseases, such as systemic lupus erythematosus (SLE), who are considering the human papillomavirus (HPV) vaccine. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-25"></div></div></div><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/fibrinogen-to-albumin-ratio-shows-promise-as-sle-predictive-biomarker"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/b9487d2f921168c7fc9ae2a0aab8539d4678f34e-5000x3750.jpg?fit=crop&auto=format" alt="Image of a biomarker" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 13th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/fibrinogen-to-albumin-ratio-shows-promise-as-sle-predictive-biomarker">Fibrinogen to Albumin Ratio Shows Promise as SLE Predictive Biomarker</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/fibrinogen-to-albumin-ratio-shows-promise-as-sle-predictive-biomarker"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">This ratio could be used to better predict disease activity and poor prognosis. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/potential-proteinuria-biomarkers-in-pediatric-ln-identified"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/eb26f471fb8b3ccb14f250eccc73199fb0e2db68-800x533.jpg?fit=crop&auto=format" alt="Image of a child and their patient" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 11th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/potential-proteinuria-biomarkers-in-pediatric-ln-identified">Potential Proteinuria Biomarkers in Pediatric LN Identified</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/potential-proteinuria-biomarkers-in-pediatric-ln-identified"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Elevated levels of HER2, VCAM, and TWEAK indicated proteinuria, study authors say of their new findings.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/rare-instance-of-simultaneous-sle-ttp-presentation-described-in-new-case-report"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/dcc06d206dcf7296f4f486358d5b730b36af0de6-800x400.jpg?fit=crop&auto=format" alt="Image of case reports" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 6th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/rare-instance-of-simultaneous-sle-ttp-presentation-described-in-new-case-report">Rare Instance of Simultaneous SLE, TTP Presentation Described in New Case Report</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/rare-instance-of-simultaneous-sle-ttp-presentation-described-in-new-case-report"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Investigators said they were able to confirm diagnoses of systemic lupus erythematosus (SLE) and thrombotic thrombocytopenic purpura (TTP) because they took a multidisciplinary approach. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/new-therapies-on-horizon-as-science-of-cle-advances"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/7d4ecd6de589fb8dc5e742398e6de07ad73a9f18-1279x852.jpg?fit=crop&auto=format" alt="Image of scientific research" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">August 2nd 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/new-therapies-on-horizon-as-science-of-cle-advances">New Therapies on Horizon as Science of CLE Advances</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/new-therapies-on-horizon-as-science-of-cle-advances"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Investigators say recent research into the development of cutaneous lupus erythematosus has created the potential for new therapies.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/sle-cardiovascular-disease-have-complex-interplay"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/5ea1073b2d97e9bdf98434ceae891d9e6e64588e-1200x1152.jpg?fit=crop&auto=format" alt="Enhanced images of the human body" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">July 26th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/sle-cardiovascular-disease-have-complex-interplay">SLE, Cardiovascular Disease Have Complex Interplay</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/sle-cardiovascular-disease-have-complex-interplay"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new study highlights potential therapies to decrease cardiovascular risk in people with systemic lupus erythematosus (SLE) and identifies biomarkers that may indicate a heightened risk.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/path-to-diagnosis-is-long-frustrating-damaging-for-women-with-sle"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/8ce79caa1315c15e373385f09f8cb932eb183fbb-902x506.jpg?fit=crop&auto=format" alt="Image of a frustrated physician" width="288" class="jsx-ad50481d5ee26850 w-full xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 font-bold article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">July 20th 2022</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/path-to-diagnosis-is-long-frustrating-damaging-for-women-with-sle">Path to Diagnosis Is Long, Frustrating, Damaging for Women With SLE</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#000] text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/path-to-diagnosis-is-long-frustrating-damaging-for-women-with-sle"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new study outlining the experiences of women with systemic lupus erythematosus (SLE) finds many women feel their initial symptoms are downplayed by providers, leading to costly delays in diagnosis.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div><div class="w-full text-center flex justify-center pb-24"><a class="px-4 py-2 border-y border-r bg-primary text-white" href="/compendium/lupus?page=1">1</a><a class="px-4 py-2 border-y border-r " href="/compendium/lupus?page=2">2</a><a class="px-4 py-2 border-y border-r " href="/compendium/lupus?page=3">3</a><a class="px-4 py-2 border-y border-r " href="/compendium/lupus?page=4">4</a><a class="px-4 py-2 border-y border-r " href="/compendium/lupus?page=5">5</a><a class="px-4 py-2 border-y border-r" 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the disease to be overlooked, said Liz Lightstone, MBBS, PhD, FRCP, professor of Renal Medicine for the Faculty of Medicine, Imperial College London.","_key":"53bbee08db1e2","_type":"span"}],"_type":"block","style":"normal","_key":"616a2354506d"},{"style":"normal","_key":"ce9ae281f2f1","markDefs":[],"children":[{"_key":"18dc2a6f66e00","_type":"span","marks":[],"text":"\n"},{"marks":["strong","underline"],"text":"Transcript","_key":"32924431ef84","_type":"span"}],"_type":"block"},{"style":"normal","_key":"71a68ef33b9a","markDefs":[],"children":[{"text":"What is a misconception on lupus nephritis among patients and clincians?","_key":"83fb8cbdf9f90","_type":"span","marks":["strong"]}],"_type":"block"},{"markDefs":[],"children":[{"text":"I don't know. I mean, there are assumptions about who gets it. So, if you see a young Black woman with a rash and joint pains, you may well think of lupus. But equally I would say they're often underdiagnosed. So, the biggest problem I face is that because it's women, and it's women of childbearing age, a lot of their early symptoms are, you're tired, you're busy with your kids, it's your hormones—all that rubbish that comes into the discrepancies in how we look after women, which we know now impact on cardiovascular disease, impact on everything.\n","_key":"da74ced9b4db0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"2fb3622a1fd1"},{"_key":"b2af674c137c","markDefs":[],"children":[{"text":"So, that sexism if you like, everyday sexism, that impacts on how someone who's coming in saying I'm really not well, and somebody listening and hearing that there's a pattern and this is out of the ordinary. Just doing a blood test and dipping the urine, you might find you've got an answer. I also think people find lupus really difficult. So, in a way that would be good if they then just refer them to someone who didn't find it so difficult. But if you hang on to the patient and you're not treating them properly, you're doing them in enormous disservice. And the biggest problem I have is people who will just stick someone on sterapred and a few weeks later refer them, and you sit there and go, oh you could have done better.","_key":"a245fe04e6e60","_type":"span","marks":[]}],"_type":"block","style":"normal"}],"title":"Dr Liz Lightstone: Lupus Nephritis Misconceptions Contributing to Underdiagnosis, Low-Value Care","url":{"current":"dr-liz-lightstone-misconceptions-on-lupus-nephritis-contributing-to-underdiagnosis-low-value-care","_type":"slug"},"internalTag":["lupus"],"_id":"52c2d73f-a118-49cf-8ddd-1b6bc6fb2272","ExcludeFromPubMedXML":false,"seoTag":["lupus","lupus nephritis","women","diagnosis","sexism","cardiovascular disease"],"authorMapping":[{"_updatedAt":"2022-08-30T13:21:06Z","displayName":"Matthew Gavidia","biography":[{"markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.medicalworldnews.com/","_key":"05038db40dcf"}],"children":[{"marks":[],"text":"Matthew is an associate editor for The American Journal of Managed Care® (AJMC®). He joined AJMC® in 2019 and creates content for ","_key":"d1727692f2b60","_type":"span"},{"_type":"span","marks":["05038db40dcf"],"text":"Medical World News®","_key":"091659f48be7"},{"_type":"span","marks":[],"text":", a 24-hour online program developed MJH Life Sciences® focusing on pressing topics within managed care, as well as the nonwork-related activities of health care stakeholders.","_key":"7f932b925058"}],"_type":"block","style":"normal","_key":"d74a985f4a4e"},{"children":[{"_key":"8ab357e4275e","_type":"span","marks":[],"text":"He has a BA in journalism \u0026 media studies and economics from Rutgers University. You can connect with Matthew on "},{"_type":"span","marks":["67d17c87ecce"],"text":"LinkedIn","_key":"d1727692f2b61"},{"marks":[],"text":".","_key":"d1727692f2b62","_type":"span"}],"_type":"block","style":"normal","_key":"6965a2051bdd","markDefs":[{"_key":"67d17c87ecce","nofollow":true,"blank":true,"_type":"link","href":"https://www.linkedin.com/in/matthew-gavidia-59a188165/"}]}],"profileImage":{"_type":"mainImage","asset":{"_ref":"image-2cd30ae97c0fe37c1f2ff21fe177d495bbd01d41-400x400-jpg","_type":"reference"}},"url":{"current":"matthew-gavidia","_type":"slug"},"firstName":"Matthew","lastName":"Gavidia","_createdAt":"2020-05-05T10:50:09Z","_rev":"0TowddpnSMVYA5OKF41jOP","_type":"author","_id":"author_087f792921dadfc62f4c9a0206eaaa4a"}],"is_visible":true,"summary":"Liz Lightstone, MBBS, PhD, FRCP, professor of Renal Medicine for the Faculty of Medicine, Imperial College London, discussed how sexism and other factors cause certain symptoms of lupus nephritis to be overlooked, 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least 40 years, with respect to the treatment of these patients. We recognize that MMF [mycophenolate mofetil] took a role from the data from [the University of] Miami, and Dr [Gabriel] Contreras and Dr [Gerald] Appel. It was found to be noninferior to Cytoxan therapy, which is the original therapy from the 1980s that was approved by the NIH [National Institutes of Health]. The complications of Cytoxan therapy led to significant problems.","_key":"074572c471741","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"24945dba627f0"}],"_type":"block","style":"normal","_key":"73c2acb4af4e"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Around 2009, MMF took the role as the mainstay of adjunct therapy along with steroids. But as far as steroid therapy in combination with MMF or other types of regimens, we’ve known data from 2016 or 2017 that high-dose systemic steroids lead to significant end-organ complications. In particular, about 74% of new end-organ target damage occurs with steroid therapies greater than 7.5 mg per day. These data aren’t new. They’ve been out for a while. We’ve just been implementing it with the new data that have been set forward.","_key":"f77c992e53eb0"}],"_type":"block","style":"normal","_key":"97f5228fd52f"},{"_type":"block","style":"normal","_key":"87ed44938a51","markDefs":[],"children":[{"_key":"6b6563b823990","_type":"span","marks":[],"text":""}]},{"children":[{"_type":"span","marks":[],"text":"We recognize that steroid therapy is sometimes needed as induction therapy, but long-term usage of these drugs has led to the complications we recognize: not just as cataracts or glaucoma but also sodium retention, hypertension accelerations, and endovascular acceleration of atherosclerosis, leading to mortality of these patients with steroids. Therefore, we’re glad to see that new conventional therapies and studies have shown that we’re able to treat these patients with these new regimens but with minimal steroids in the long term. We now have other options. For T-cell or B-cell suppression, both studies are quite intriguing and have a role in the treatment of these patients, depending on your interpretation and how your outcomes are. We’re glad to have belimumab as well as MMF and voclosporin in the new regimen for our patients going forward. In the Spiriva trial, only 8.3% of patients had a complete remission, although they had different sets of guidelines. But we’re able to accomplish far better outcomes in these patients with these new types of B-cell and T-cell suppression drugs.","_key":"e07339c6ffbc0"}],"_type":"block","style":"normal","_key":"af3a7ae87603","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"620b399097f00"}],"_type":"block","style":"normal","_key":"9905c9f3b80c"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Alvin Wells, MD, PhD:","_key":"d2478b68a23e0"},{"marks":[],"text":" When we diagnose a patient with lupus nephritis, it can be a little overwhelming [for them]. Think about a 32-year-old who recently married, had a couple of kids, and is being hit in the face with this diagnosis. It can be a little overwhelming. It’s even more overwhelming when we talk about medications. They hear some of the adverse effects of these drugs, and they say, “These adverse effects sound worse than my disease.” I tell them, “If we don’t control your disease and get you under control as quickly as possible, we’re going to see this disease progress.” We think about the structure inside the kidney called the nephron. I like what some of my nephrology colleagues say: “For patients with lupus nephritis, time is nephrons.” I should act very quickly to get the disease under control.","_key":"d2478b68a23e1","_type":"span"}],"_type":"block","style":"normal","_key":"8b5daa905fed"},{"_key":"d69e1b4b1421","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"cdefc69bcbf30"}],"_type":"block","style":"normal"},{"children":[{"marks":[],"text":"When a patient has proteinuria in their urine at baseline, we want to see a 25% decrease at 3 months and a 50% decrease at 6 months. That’s the target. If you aren’t getting there by 6 months, you need to adjust your treatment. In my practice, we start several agents up front to get patients under control. As they get better, we start pulling away drugs. The No. 1 drug we want to decrease and stop if possible is corticosteroids.","_key":"b859caedd3f20","_type":"span"}],"_type":"block","style":"normal","_key":"0f8db0828648","markDefs":[]},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"f5965ebd06070","_type":"span"}],"_type":"block","style":"normal","_key":"64a22875b57b"},{"children":[{"_type":"span","marks":[],"text":"The treatment landscape is changing, but we have more long-term data supported by randomized controlled clinical trials, so the guesswork is no longer needed. You don’t have to worry about whether a drug is going to work while using older drugs that we thought worked from transplant literature and other data. Those days are gone. 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For example, going back to my analogy about what lupus is, these angry cells are turning, and they spill out of the bloodstream and get into the kidneys, causing lupus nephritis. I want to give drugs that dampen the immune system. I use another analogy that [being] young and healthy balance out the scale, but with lupus nephritis, the scale is tilted on the negative side. Those angry cells are attacking the kidneys. I want to see if I can get it back to as balanced as I can. I don’t want to go too low because we’re going to see some adverse effects. That’s why we talk about our drugs as more like immunosuppressor drugs."}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"a76b7ad54f650"}],"_type":"block","style":"normal","_key":"beb4ab9559b4","markDefs":[]},{"_type":"block","style":"normal","_key":"5ebe55e05ef5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"One of the hallmark drugs we use are corticosteroids—mostly prednisone or methylprednisolone. Those drugs are great, but it’s a double-edged sword. They work very quickly. They can get some patients into significant control. But we can’t keep patients on them long term, because with long-term corticosteroids, I’ve got to get back to that balance. I don’t want a young, 30-year-old woman to get cataracts or diabetes or have osteoporosis of her bones. Those are features that we worry and think about regarding what’s good and the bad for some of these treatments.","_key":"0a2bf00c48ee0"}]},{"_key":"6b1cd114458e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1ee99967082b0"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"In addition to corticosteroids, we use other immunosuppressive drugs. Mycophenolate mofetil is one of the hallmarks, along with cyclophosphamide. All of those drugs were borrowed from our oncology counterparts to dampen the immune system. Those are potent drugs, but we don’t want to give too much and turn the immune system too low, because then we see increased risk of certain types of infections and of cancers.","_key":"e60fbfddff690"}],"_type":"block","style":"normal","_key":"ac94bc0d3344","markDefs":[]},{"style":"normal","_key":"33809e8a398c","markDefs":[],"children":[{"text":"","_key":"a78f8031de6b0","_type":"span","marks":[]}],"_type":"block"},{"_key":"ed59c5222700","markDefs":[],"children":[{"_type":"span","marks":[],"text":"For example, cyclophosphamide is used, and a study is coming out from the NIH [National Institutes of Health] and Europe showing that it works for patients with lupus nephritis, but even after 1 dose of that medication, I have to tell the patient, “I need to monitor you on a regular basis to make sure you don’t go on to get bladder cancer coming from the medication.” Mycophenolate is a great drug. I usually prefer it at my practice. It doesn’t have all the other adverse effects, but it’s still an immunosuppressive drug. I want to make sure patients aren’t going to get bowel infections, pneumonia, and other types of illnesses that are triggered by that.","_key":"126cc3037faa0"}],"_type":"block","style":"normal"},{"_key":"2924f17aabe5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a5c8b0c1c7920"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"a95d9a2225ba0","_type":"span","marks":[],"text":"Then we talk about a class of drugs called the calcineurin inhibitors. These drugs work in a number of ways. We’re learning that some of these newer agents are targeting the immune cells, such as the T cells, and they’re stabilizing the part of the cells that anchor the kidneys together, making that dam intact: the podocytes. The landscape has changed. The days of treating people willy-nilly are gone. We have targets in mind. I talked earlier about the goals we set with our patients with lupus. They want to reduce their pain, fatigue, and swelling of the legs. I say, “I want to get the protein in your urine down by 50% in 6 months.” There’s a ratio in which we look at the protein and the urine vs the creatinine. I want to make sure that number goes down to 0.5 mg/dL or less."}],"_type":"block","style":"normal","_key":"f04551f464d1"},{"style":"normal","_key":"c964c933ba2f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"152a0ca31a110"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"There are certain features and targets that we use. With the corticosteroids that we use as a bridge therapy, the No. 1 goal is to get the corticosteroid dose down to less than 7.5 mg. When I was doing my fellowship at Duke University, we talked about 10 or 15 mg of prednisone. That was a low dose. We’ve learned so much more [since then], including that 7.5 mg or more can cause more harm than good. Now I want to get my patients off if possible, or to a target of 2.5 or 5 mg. That means that the landscape in treating patients with lupus nephritis has changed, which is exciting for our patients who have active disease.","_key":"c68c49f71d3b0"}],"_type":"block","style":"normal","_key":"c026465941c4","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5b3fedbf527e0"}],"_type":"block","style":"normal","_key":"5b183337da0c"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"When you think about our different treatment options for lupus nephritis, I want drugs that are FDA approved. When you think about drugs that aren’t FDA approved, they’re experimental, and patients don’t come to my practice wanting to experiment . They want to get the best treatment options based on evidence-based medicine, and that’s what we do. I tell my colleagues, “That’s what we all should be doing.” Let’s start with evidence-based medicine to get these patients under control.","_key":"6a36414fb3760"}],"_type":"block","style":"normal","_key":"d922c539f509"},{"children":[{"_type":"span","marks":[],"text":"","_key":"cbb56d0e9ab00"}],"_type":"block","style":"normal","_key":"59cc1b461241","markDefs":[]},{"_key":"55ed170427e7","markDefs":[],"children":[{"_key":"5805a6790fdd0","_type":"span","marks":[],"text":"[We don’t want to] use drugs that we think have worked. We want to say, “We go to things that have been shown in randomized controlled clinical trials, and these are the ones that the FDA mandates.” This leads to getting data in the peer-reviewed journals. The rheumatology and nephrology journals are all out there to vet those [drugs]. There aren’t many FDA-approved drugs. We have corticosteroids and calcineurin inhibitors, such as voclosporin. These were vetted in clinical trials, which showed that when patients have been on the drug for 1 or 2 years—we now have long-term data—we can decrease the protein in the urine, preserve the glomerular filtration rate, and do that in the setting of low-dose corticosteroids. Many drugs are out there, and some of my colleagues are using them, but they aren’t FDA approved. 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","_key":"80534c716b2e0"},{"_type":"span","marks":["6d790b5c0f7c"],"text":"lupus nephritis","_key":"80534c716b2e1"},{"marks":[],"text":" have been associated with non–Northern European White individuals and those from low socioeconomic backgrounds, said Liz Lightstone, MBBS, PhD, FRCP, professor of renal medicine for the Faculty of Medicine, Imperial College London.","_key":"80534c716b2e2","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"52d03f60da8b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"\n","_key":"5eead8810c730"},{"_type":"span","marks":["strong","underline"],"text":"Transcript","_key":"31e08407f9e7"}]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"How do race and sociodemographic factors impact patient outcomes and care management in lupus nephritis?","_key":"e63bc85528630"}],"_type":"block","style":"normal","_key":"09f9298902e7"},{"_type":"block","style":"normal","_key":"89a6e0343dfa","markDefs":[],"children":[{"_key":"41d82ca203df0","_type":"span","marks":[],"text":"So, we know that being from a deprived background is likely to lead to a worse outcome. And that's really complex—it’s education level, it’s access to treatment, it’s speed with which you get your treatment. If you're in a job that you're only paid when you're there, and you need to go to clinic—it's a choice between do you earn or do you get your health care done. So, all those factors, I think, feed in hugely.\n"}]},{"_key":"bcd321973cfb","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Everyone who is non–Northern European White has a risk of worse outcomes with lupus. I'm not quite sure why that is and what the genetic impacts are. In the Black population, it's related to the ","_key":"7dbfbaa61aec0"},{"_type":"span","marks":["em"],"text":"APOL1","_key":"7dbfbaa61aec1"},{"_type":"span","marks":[],"text":" gene, almost certainly giving them an extra bonus hit of doing badly if you've already got kidney disease, that's work known from a long time ago.","_key":"7dbfbaa61aec2"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"59b2f710b7c0","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"90200fb9b64a0"}]},{"markDefs":[],"children":[{"text":"There's also issues about trust, involvement, and understanding of the need to be in trials. And I think we need to do a huge piece of work. I know particularly in the United States, there's enormous distrust in the African American community around trials. And I think it's our duty and our job to find ways of showing that we can be trusted and that it is hugely valuable to their communities for people to go in. And it just takes time. It takes time and effort to involve people. I treat, in West London, a very, very diverse community, and I have to say nearly everyone I've gotten into trials has been non-White, but it takes a lot of time and effort.","_key":"7be8580299500","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"0298581bc407"}],"contentCategory":{"_updatedAt":"2020-04-03T20:03:44Z","_createdAt":"2020-04-03T20:03:44Z","_rev":"Yw6MEKZDMdk6hC2JCPjfiB","_type":"contentCategory","name":"Videos","_id":"ee14ccb3-3542-4414-9046-927be1198c76"},"_createdAt":"2022-12-02T15:15:37Z","_id":"55f46edc-8d93-4adf-86f3-9f2f1fe909db","authorMapping":[{"firstName":"Matthew","lastName":"Gavidia","_createdAt":"2020-05-05T10:50:09Z","_rev":"0TowddpnSMVYA5OKF41jOP","_type":"author","_id":"author_087f792921dadfc62f4c9a0206eaaa4a","_updatedAt":"2022-08-30T13:21:06Z","displayName":"Matthew Gavidia","biography":[{"children":[{"marks":[],"text":"Matthew is an associate editor for The American Journal of Managed Care® (AJMC®). 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patients with lupus nephritis have changed over time. Based on the MAINTAIN trial in 2016, we know protein reduction is critical for long-term renal outcome. Therefore, prompt diagnosis, biopsies, and therapeutic interventions are important for these patients in focusing on reducing proteinuria, obtaining a bland urinalysis, and trying to get the urine PCR [protein-creatinine ratio] less than 700 mg/g, depending on what you read, or less than 500 mg/g, depending on the study.","_key":"f4451f99c0431"}],"_type":"block","style":"normal","_key":"b391bf570d47"},{"children":[{"_type":"span","marks":[],"text":"","_key":"1aed2ee973dd0"}],"_type":"block","style":"normal","_key":"d98dcd38cd4b","markDefs":[]},{"style":"normal","_key":"00ffabb09fa4","markDefs":[],"children":[{"marks":[],"text":"We have lacked data in academic research for over 40 years regarding the management of lupus nephritis. The lack of data has left us with a status quo of partial remission—in essence, having patients with protein leakages greater than 1.5 g or above. We often relied on a 50% reduction, which we clearly know based on the data hasn’t been sufficient to treat these patients to a complete remission. Depending on the articles you read, complete remissions and partial remissions are varied. But overall, the consensus is that if we’re able to get a protein excretion less than 700 mg per day, those patients do quite well with less deterioration from a renal perspective in outcome.","_key":"b2d1a52b17790","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"729f5d48e1350","_type":"span"}],"_type":"block","style":"normal","_key":"e8d82e06dd33"},{"markDefs":[],"children":[{"_key":"a63985772a2c0","_type":"span","marks":[],"text":"We also know the European guidelines have been well defined and accepted by the US guidelines, where the reduction of urine PCR with the standard of therapy of blood pressure control, RAS blockade, etc, has led to the backbone of management of these patients along with the standard of care that has been set forward. Dr [Gerald] Appel, Dr [Gabriel] Contreras from the University of Miami, and other colleagues [showed the value of] MMF [mycophenolate mofetil]–Cytoxan therapy and steroid therapies, which were the standard of therapy for many years until 2020. We now have 2 medications with good outcomes that we’re able to add to the revolver and treat the complexity of these patients that we haven’t had in 40 years."}],"_type":"block","style":"normal","_key":"a287e1b9cc3f"},{"_type":"block","style":"normal","_key":"5998d1b7ed82","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"040fe4a482c60"}]},{"markDefs":[],"children":[{"_key":"3e3b24810de10","_type":"span","marks":["strong"],"text":"Alvin Wells, MD, PhD:"},{"_type":"span","marks":[],"text":" I tell my patients with lupus nephritis that we need to set some goals. I sit down with them and ask, “What are your goals? What do you want to do?” They say, “Dr Wells, I don’t want to have pain or fatigue. I don’t want the swelling in my ankles to continue.” As a rheumatologist, I want to make sure your disease is under control, that you don’t get end-stage kidney disease and end up on dialysis. We try to put those features together. Even though we talk about kidney disease, some of the biggest things that drive patients into the clinic are swelling of their ankles, weight gain, and fatigue. These patients might go to bed at night and think they’re sleeping for 6 or 7 hours, but when they wake up, they feel like they’ve been hit by a truck. That’s because the immune system is turning like a machine and not able to shut off unless we use aggressive medications.","_key":"3e3b24810de11"}],"_type":"block","style":"normal","_key":"6e4711a94f20"},{"_type":"block","style":"normal","_key":"62741314142f","markDefs":[],"children":[{"text":"","_key":"7871797b89c20","_type":"span","marks":[]}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"With patients with lupus and lupus nephritis, I say “Let’s talk about our goals.” Let’s see if I can minimize certain drugs, such as corticosteroids, which have some adverse effects we don’t like for long-term [use]. 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Many patients experience delay in care for multiple reasons, including socioeconomic status, insurance, young age, and not seeking attention until it’s too late. But there are some data from Medicaid years ago that say that 1 of 8 patients with lupus nephritis are seen in a hospital setting in a very critical state with rapidly progressive crescentic renal diseases. This has suggested that there’s poor, inadequate interactive collaborative management and transitions of patients’ care among physicians and hospitals.","_key":"075ff6989aa61"}],"_type":"block","style":"normal","_key":"2ffe1182f978"},{"_key":"f24c8d7f6978","markDefs":[],"children":[{"text":"","_key":"beaa2679dd250","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"0fbfcf455bae0","_type":"span","marks":[],"text":"Furthermore, the percentage of patients who have received immunosuppressive therapy after the diagnosis of lupus nephritis is quite impressive in the sense that 13% of patients get immunosuppressive therapy within 30 days of having a lupus nephritis diagnosis. Roughly 22% of the patients get immunosuppressive therapy at 90 days, and 34% get it 1 year after a lupus nephritis diagnosis. This is clearly unacceptable. These are data from the Medicaid trials. These patients need to be seen [and receive] intravenous [treatment] as urgently as possible. Otherwise, it’s ultimately about renal demise and patient survival."}],"_type":"block","style":"normal","_key":"2380f568e5ca"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"880160f7c74f0"}],"_type":"block","style":"normal","_key":"2ad21e566d45"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Alvin Wells, MD, PhD:","_key":"b0afd7b2c8970"},{"_type":"span","marks":[],"text":" Many patients with lupus and lupus nephritis utilize a lot of aspects of our medical system. That young female patient with lupus nephritis has to be seen every 3 months by a rheumatologist. She has to get bloodwork. She has to get her urine tested. She’s going to be on several medications to treat her disease. Because of the disease and the medications patients are on, they can have other complications. Patients with lupus nephritis are at increased risk for infections. They can end up with cardiovascular disease. All of those features cost a lot in the medical system, and these patients need to be seen and followed closely.","_key":"b0afd7b2c8971"}],"_type":"block","style":"normal","_key":"e1f165eb71e1"},{"markDefs":[],"children":[{"_key":"33a3fa360dc40","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"3e5b01d25970"},{"_type":"block","style":"normal","_key":"b24d227db078","markDefs":[],"children":[{"_type":"span","marks":[],"text":"At my practice, I tell my patients: “If you have a flare of your disease or other or new symptoms, don’t go to the emergency department. Call me. Because I know you and the drugs that you’re on. You know my staff, and we can treat almost everything that can trigger or be associated with a flare.” If a patient is retaining fluid or their blood pressure goes up, we can address that. When a patient is having a fever and a cough, it could be a sign of an infection. We can address that. Even though patients with lupus nephritis use a lot of health care resources, we can mitigate that and minimize how much they use by having them seen on a regular basis in a rheumatology clinic and by us if they have any acute or urgent needs.","_key":"612b7c53ba870"}]},{"children":[{"text":"","_key":"06836935e6af0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"9fea8e6a3711","markDefs":[]},{"_key":"c7001c9e50a9","markDefs":[],"children":[{"text":"If patients with lupus nephritis have disease progression—meaning they aren’t responding to therapy—they require a lot more utilization of health care resources. If you have a patient on multiple drugs to treat their lupus nephritis and they continue to progress—meaning they’re seeing more protein in their urine—there are certain markers in the bloodwork that are going up, and that correlates with some of their other symptoms as well. That patient is going to require more medications to get them under control.","_key":"5ed55aabd1a20","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"b2808a3955140","_type":"span"}],"_type":"block","style":"normal","_key":"87584f3c7ee4"},{"children":[{"_type":"span","marks":[],"text":"When patients require more medications, we’re going to follow their laboratory values [more frequently than] every 3 or 4 months. I have some patients whom we test every month until we get them under control. Because as we worry about the balance of the benefits of the medicines, I also want to make sure there are no adverse effects of the medication. That’s why these patients have to be followed closely. One pearl I’ll put in a plug for is that even if your patients aren’t able to be seen physically in the clinic, they can take advantage of telemedicine. I can do a telephone call to address their acute or urgent needs. 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Lightstone, MBBS, PhD, FRCP, professor of renal medicine for the Faculty of Medicine, Imperial College London, discussed how the potential teratogenic effects of novel therapies being investigated for lupus nephritis can impede clinical trial recruitment for women of childbearing age.","title":"Dr Liz Lightstone Explains Impact of Pregnancy, Fertility on Clinical Trial Recruitment for Lupus Nephritis","body":[{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2dbb487cf074"}],"_type":"block","style":"normal","_key":"e1055bf26726"},{"_key":"9c9ca1fe5c19","_type":"video","videoID":"6315685058112","source":"brightcove"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"19fb9b4bc3b2"}],"_type":"block","style":"normal","_key":"9dfbb7b3dce5"},{"_type":"block","style":"normal","_key":"eb75e545df0e","markDefs":[{"nofollow":false,"_type":"link","href":"https://www.ajmc.com/compendium/lupus","_key":"73e51e38854a"}],"children":[{"_type":"span","marks":[],"text":"Clinical trial recruitment and determining the efficacy and safety of novel therapies for ","_key":"86c8d9b6c7ff0"},{"_type":"span","marks":["73e51e38854a"],"text":"lupus nephritis","_key":"9846fa3e9411"},{"_type":"span","marks":[],"text":" in women of childbearing age are challenging, as the risk of pregnancy and potential teratogenic effects of these drugs are not well established, said Liz Lightstone, MBBS, PhD, FRCP, professor of renal medicine for the Faculty of Medicine, Imperial College London.","_key":"9ab33865bc3c"}]},{"children":[{"marks":[],"text":"\n","_key":"6104cb9d97c40","_type":"span"},{"text":"Transcript","_key":"0729f56a53a8","_type":"span","marks":["strong","underline"]}],"_type":"block","style":"normal","_key":"fef52a7467dc","markDefs":[]},{"markDefs":[],"children":[{"text":"Can you discuss the challenge of pregnancy for women with lupus nephritis participating in clinical trials?","_key":"d0078b8e54020","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"290cc0475f39"},{"_key":"891c2c956d61","markDefs":[],"children":[{"_type":"span","marks":[],"text":"So, it's really hard, because all the studies say these women have got to use 2 forms of contraception, they can't get pregnant, etc. We're tending in trials to elongate the primary endpoint. So, 2 years—so you cannot get pregnant for 2 years. You might be in a very good remission and you might be 38, so are you really going to go into a study when you have no prospect of being allowed to get pregnant? Of course, the other thing that happens is they do get pregnant and then they're pregnant on a drug that's not tested in pregnancy. So, I think it's a real issue.","_key":"0b45120de42f0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"","_key":"8ce87603a8b10","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"4a73ee7a9255"},{"style":"normal","_key":"e83af12e0bf2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"I understand the caution of a brand new drug; you don't want to suddenly find you've got a teratogenic drug. But I think we need to be a little bit more pragmatic, if the preclinical studies really show no reason for any damage. Whereas for MMF [mycophenolate mofetil], we could have predicted from the studies that went before, there were some data to suggest it was going to be teratogenic.\n","_key":"071834eee35d0"}],"_type":"block"},{"style":"normal","_key":"bb67f759cd6e","markDefs":[],"children":[{"text":"Cyclophosphamide we predicted would be teratogenic, whereas I'm not sure something like voclosporin [would be], unless it's so different from the other CNIs [calcineurin inhibitors]. We use them in pregnancy all the time; we use cyclosporine tacrolimus all the time, perhaps that will be fine.\n","_key":"16b6ca90bbc70","_type":"span","marks":[]}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"And we're so cautious about it where I think you can give women risk-benefit ratios. But I think it's very hard, and the demographic you're treating [for] lupus nephritis is women of childbearing age. 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Time is nephron survival. We recognize that lupus nephritis can lead to a 45-fold increase in kidney failure and end-stage renal disease. We also recognize that the involvement of lupus nephritis can lead to significant cardiovascular complications: about an 8-fold increase of myocardial infarctions and a 4-fold increase in myocardial death, all associated with the risk of proteinuria and renal involvement. In addition to this, hospitalizations, the length of stay, the cost, and the complications associated with patients with lupus in a hospital setting lead to even more complicated status than the disease itself.","_key":"3675c6ec2a2c1"}],"_type":"block","style":"normal","_key":"356646c14e92"},{"_key":"d3dffd7789f4","markDefs":[],"children":[{"marks":[],"text":"","_key":"0fd1900051db0","_type":"span"}],"_type":"block","style":"normal"},{"_key":"a07138f6d615","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The urgency is quite real, and we should prompt ourselves to [aim for] early diagnosis, early biopsies, and early interventions. We often have significant impediments of our approach to these patients, but it should be treated how cardiology treats patients with acute angina and myocardial infarction. There should be an increased aggressiveness and urgency to treat these patients because they can quickly progress to a very critical state.","_key":"3111e84d2a280"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d3de324d61f30"}],"_type":"block","style":"normal","_key":"a57783312316"},{"_type":"block","style":"normal","_key":"83df5a8093ed","markDefs":[],"children":[{"_type":"span","marks":[],"text":"In 2012, we were following guidelines from the American College of Rheumatology [ACR], which recommended to monitor patients every 6 months. In reality, 58% of the patients aren’t being screened in a 6-month basis with the standard laboratory data that one would expect. In addition, it was left up to the physicians regarding how to treat and manage the different types and stages of lupus nephritis depending on the findings. There were no direct criteria or guidance with respect to some of the stages. In addition to monitoring patients who had more than 1 g of protein excretion along with hematuria, those patients will be indicated for a renal biopsy.","_key":"e37b7272ad0f0"}]},{"style":"normal","_key":"6b938f74688f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"fb169f6fb3600"}],"_type":"block"},{"_key":"97bfad87f33e","markDefs":[],"children":[{"marks":[],"text":"The list goes on with respect to the 2012 ACR guidelines that we followed for many years, until 2019, when the European Alliance of Associations of Rheumatology and the European Renal Association and European Dialysis and Transplant Association got together and gave us new guidelines, which we’re now following and which have been [adopted] by the American guidelines. Those are the latest that we have. Those are much more stringent guidelines as far as intervention. We recognize that the threshold for biopsy for patients with lupus nephritis has been lowered to 500 mg of protein excretion from 1000 mg per day. Patients who have microscopic hematuria should be biopsied, which is [recommended by the] new guidelines, along with patients with RBCs [red blood cells], CAS, or dysmorphic red blood cells. In addition, we have better guidance with respect to our target goal, where we should be regarding intervention based on a bland urinalysis or urine protein reduction.","_key":"1404596802030","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"be3ea082e2cf","markDefs":[],"children":[{"text":"Transcript edited for clarity.","_key":"2bcdf5b4e3b7","_type":"span","marks":["strong","em"]}]}],"_type":"article","contentCategory":{"_createdAt":"2020-04-03T20:03:44Z","_rev":"Yw6MEKZDMdk6hC2JCPjfiB","_type":"contentCategory","name":"Videos","_id":"ee14ccb3-3542-4414-9046-927be1198c76","_updatedAt":"2020-04-03T20:03:44Z"},"summary":"Jorge Larranaga, MD, provides his opinion regarding the criticality of urgency in LN treatment.","taxonomyMapping":[{"identifier":"video-series","_createdAt":"2020-10-14T04:51:21Z","_rev":"ChnBnF2xw1R5u2UJBDlozJ","_type":"taxonomy","name":"Video 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including the scalp, skin, kidneys, heart, and lungs. Some patients have kidney involvement at the time of diagnosis of lupus. One way we tell is by doing a blood test to look for elevation of the creatinine, and then we do a urine test to look for protein in the urine, or proteinuria. The data show that of every 3 patients with lupus who present for the first time to a rheumatology clinic, 1 will have lupus nephritis. That triggers us to start aggressive therapy so that we don’t let that patient progress to end-stage renal disease, which essentially means dialysis. Unfortunately, if patients have lupus nephritis, they’re 45 times more likely to get kidney disease than a patient without lupus nephritis. That’s a bad sign."}],"_type":"block","style":"normal"},{"style":"normal","_key":"62c44a97f2eb","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c77141626c5e0"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Jorge Larranaga, MD:","_key":"e5557c5e4b400"},{"_key":"e5557c5e4b401","_type":"span","marks":[],"text":" With respect to the progressive nature of lupus nephritis over time, the disease tends to progress to transplant and dialysis. Depending on what you read, between 45% and 55% of patients with SLE [systemic lupus erythematosus] develop lupus nephritis. There are multiple histologic phases of lupus nephritis. Some remain stagnant, and others proceed in aggressive fashion to end-stage renal disease. Seventy percent of patients with lupus nephritis have stage III, IV, or V [disease], which tend to be the most aggressive [stages] with respect to the early intervention and management of the disease state. It can fluctuate. Many years in the past, we probably weren’t as aggressive with stage III. But now we recognize that the fluctuations and aggressiveness of the insult of the autoimmune disease can lead to significant deposition and rapid progression to the end stage, causing renal demise and ultimately patient survival and death."}],"_type":"block","style":"normal","_key":"8733c43f67a7"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"05987d3f51a00"}],"_type":"block","style":"normal","_key":"09b9ddf1d5ed"},{"_type":"block","style":"normal","_key":"840bd30f7173","markDefs":[],"children":[{"_type":"span","marks":[],"text":"With respect to a renal flare, we recognize that a single episode of lupus nephritis can lead to irreversible and permanent damage of nephron loss. Subsequent renal insults lead to end-stage nephron survival and the need of renal replacement therapy. This has shown that lupus flare-ups and nephritis worsen the outcome of the patient’s end-stage renal disease and increase the patient’s morbidity and mortality. Ultimately, patient survival is decreased and death ensues.","_key":"81786e1bec6a0"}]},{"style":"normal","_key":"12e470f394d2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"612bf4366c3f0"}],"_type":"block"},{"style":"normal","_key":"5a19191f880b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We have to be vigilant to the end-organ target damage, which tends to be unpredictable with autoimmune disease. Potential nephron and human demise is what we’re dealing with. That’s where the urgency in the management and aggressive interventions of this disease takes place. Unfortunately, the screening surveillance has statistically shown to be quite poor—in particular the lack of academic guidance, socioeconomic status of the patients, and compliance at a very young age. The unpredictable behavior going from subtle to aggressive deterioration is all based on the histologic stages of this disease.","_key":"a5ac4e611fe90"}],"_type":"block"},{"style":"normal","_key":"4e918690d46f","markDefs":[],"children":[{"marks":[],"text":"","_key":"40dfad9df0b30","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"text":"With respect to the renal flare-ups, in addition to the above, we combine patient clinical presentations and findings, laboratory disease serology, urinary sediments, and renal markers to help assist in recognizing the flare-ups of these patients. In particular, hematuria, dysmorphic RBCs [red blood cells], CAS formations, proteinuria, urine PCR [protein-creatinine ratio], and serum creatinine all get taken into [consideration] in sequential fashion, along with the patient’s clinical findings and complaints and the serology activity of lupus nephritis. Depending on the degree of nephritis or nephrosis components, the serum creatinine behavior can predict the histologic stage, along with proteinuria and RBCs recognizing the potential of all those high-risk patients, which will lead us to the guidance of a renal biopsy, of which indications have changed over the years. With a renal biopsy, histologic tissue is of major importance in the diagnosis, prognosis, and therapeutic intervention.","_key":"1efc53b5c4110","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"0067d81bc9cc"},{"_key":"51b4b8cbf396","markDefs":[],"children":[{"text":"Transcript edited for clarity.","_key":"6966ebe6b83b","_type":"span","marks":["strong","em"]}],"_type":"block","style":"normal"}],"authorMapping":null,"documentGroup":{"_type":"reference","_ref":"84fd2ddf-871b-425a-afb2-31fb5226fbfc"},"is_visible":true,"_updatedAt":"2022-11-23T17:03:13Z","seoTag":["lupus","nephritis","scalp","skin","kidney","heart","lungs","creatinine","proteinuria","LN","SLE","ESRD","kidney disease","CKD","transplant dialysis","nephron","renal insult","nephron survival","renal flare"],"showSocialShare":true,"source":null,"factCheckAuthorMapping":null},{"summary":"Liz Lightstone, MBBS, PhD, FRCP, professor of renal medicine for the Faculty of Medicine, Imperial College London, spoke on issues regarding the current standard of care for lupus nephritis, including steroid overuse, pregnancy, and dose-related toxicity.","_type":"article","body":[{"style":"normal","_key":"b1485cd1c09e","markDefs":[],"children":[{"marks":[],"text":"","_key":"da8b34b00b85","_type":"span"}],"_type":"block"},{"_type":"video","videoID":"6315684334112","source":"brightcove","_key":"857f5e47adcf"},{"style":"normal","_key":"1e1181654e98","markDefs":[],"children":[{"text":"","_key":"81c184944966","_type":"span","marks":[]}],"_type":"block"},{"_key":"b9c9aa5b4c07","markDefs":[{"_key":"7720ced222d6","nofollow":false,"_type":"link","href":"https://www.ajmc.com/compendium/lupus"}],"children":[{"_type":"span","marks":[],"text":"There is an overuse of steroids in the current standard of care for ","_key":"c5f9883402e00"},{"_type":"span","marks":["7720ced222d6"],"text":"lupus nephritis","_key":"8be39efe0b92"},{"marks":[],"text":", as well as pregnacy and fertility concerns that female patients, often of childbearing age, should be aware of, said Liz Lightstone, MBBS, PhD, FRCP, professor of renal medicine for the Faculty of Medicine, Imperial College London.","_key":"6c1997ec3514","_type":"span"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"\n","_key":"0b18a22dbd9a0"},{"_key":"d683ad923863","_type":"span","marks":["strong","underline"],"text":"Transcript"}],"_type":"block","style":"normal","_key":"dd719fcb7c1c","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Can you speak on any issues regarding the current standard of care for lupus nephritis?","_key":"18839b23ba2a0"}],"_type":"block","style":"normal","_key":"f9b29a47edf6"},{"style":"normal","_key":"1143160fcbd6","markDefs":[],"children":[{"marks":[],"text":"So, the current standard of care would either be a combination of steroids with mycophenolate mofetil or steroids with low-dose cyclophosphamide. They're both pretty effective. A few patients never tolerate mycophenolate—they feel nauseated, they feel horrible—but it's usually well tolerated. It damages fetuses, so it's teratogenic. So, it's a real problem.\n","_key":"af7653b236be0","_type":"span"}],"_type":"block"},{"_key":"85cf94712897","markDefs":[],"children":[{"_key":"6965a5459fb10","_type":"span","marks":[],"text":"This is a disease that affects women of childbearing age. They shouldn't get pregnant when they've got active lupus nephritis anyway, but you have to tell them that even when we've got them into remission, they've got to wait, they've got to change to a new drug, usually azathioprine, and wait and see that they're okay on that and then they can change."}],"_type":"block","style":"normal"},{"_key":"fdebb227b534","markDefs":[],"children":[{"_key":"52cd709ee9b60","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Cyclophosphamide is also teratogenic, but also can affect fertility. With the doses we usually use it, not so much and we use ovarian protection to reduce that. But that's an intravenous preparation, it can make people feel a bit sick. It is very effective, but it has a dose-related toxicity so you can't use it repeatedly. You can do a cycle. If they go into remission, fine, then they’re going to go on to [mycophenolate mofetil] for maintenance.\n","_key":"86b5092b75a10"}],"_type":"block","style":"normal","_key":"906d025e22c2"},{"markDefs":[{"_type":"link","href":"https://kdigo.org/guidelines/","_key":"9346274946d1","nofollow":true,"blank":true}],"children":[{"_type":"span","marks":[],"text":"So, there's a real issue around pregnancy and fertility. Patients just don't like taking tablets, and in aiming to minimize steroids, a lot of the current regimens still have a lot of steroids in. The ","_key":"496fc0d900040"},{"_type":"span","marks":["9346274946d1"],"text":"KDIGO [Kidney Disease Improving Global Outcomes] guideline","_key":"496fc0d900041"},{"_type":"span","marks":[],"text":" from last year said, if they're in remission for a year, wean them off completely. I would argue you could wean them off much sooner than that. 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