Canadian Rheumatology Today

Update on Lupus Nephritis

2024-04-18T14:12:09+00:00

Lupus Nephritis (LN) is a common and severe manifestation of systemic lupus erythematosus (SLE), impacting up to 40% of SLE patients. Despite advancements in understanding the pathogenesis of LN, outcomes have not significantly improved since the early 2000s. LN patients face higher mortality, emphasizing the importance of achieving disease remission. Screening for nephritis involves regular monitoring, especially within the first 5 years of SLE diagnosis. Monitoring includes urinalysis, serum creatinine, and immune serology. Kidney biopsy remains the gold standard for LN diagnosis and classification, providing crucial information for treatment decisions. The standard of care involves hydroxychloroquine for all LN patients, with immunosuppressive treatments tailored to the histologic class. The recently approved medications, belimumab and voclosporin, offer additional therapeutic alternatives. Approximately 20% of LN patients exhibit features of thrombotic microangiopathy, warranting anticoagulation. Optimizing glucocorticoid dosing is recommended, favouring lower doses to minimize adverse effects. Lifelong monitoring is essential, as flares can occur at any point, emphasizing the need for continued immunosuppression.

Given the lack of renal response in 30–60% of patients, the addition of combination therapies, such as calcineurin inhibitors or belimumab, should be considered. Duration of treatment is crucial, considering the progressive loss of podocytes and nephron function, which may lead to chronic kidney disease. Regular monitoring, maintenance immunosuppression, and lifestyle modifications contribute to preventing flares and improving long-term outcomes for LN patients.

Sjogren’s Syndrome: Strategies for Treatment

2024-04-18T14:24:57+00:00

Sjogren’s syndrome, characterized by dry eyes, dry mouth, and immunological hyperactivity, has been one of the most difficult rheumatic diseases to differentiate and define. After many hours of consensus group development, studies on large cohorts/registries of over 1500 patients in totality and following national, European, American, and finally consensus iterations, criteria have been agreed upon for the classification of this disease. In the final analysis, these criteria are objective and accessible for measurement, and a number of them can be documented in clinical practice. To treat Sjogren’s syndrome effectively, it is important to rely upon objective evidence with respect to the diagnosis of this disease, as well as the specific component of the condition that one is attempting to manage.

Updates in Treatment of Refractory Inflammatory Myositis

2024-04-18T14:42:30+00:00

Idiopathic immune myopathies (IIM), also known as myositis, are a heterogeneous group of autoimmune diseases with varying phenotypes, prognoses, and treatment responses. They are primarily characterized by muscle inflammation, however, many patients have extramuscular involvement including skin rash, arthritis, interstitial lung disease (ILD), cardiomyopathy, and gastrointestinal dysmotility. The discovery of myositis-specific autoantibodies (MSAs) has been a major advancement in the field of IIMs, shaping the new landscape of the clinical, phenotypical, histological, and serological correlations. Based on this discovery, IIM can be more specifically classified into dermatomyositis (DM) (including amyopathic DM), antisynthetase syndrome (ASyS), immune-mediated necrotizing myopathy (IMNM), inclusion body myositis (IBM), polymyositis (PM), and overlap myositis (OM). An increasing number of histological studies have revealed a misdiagnosis of PM because many patients who were previously diagnosed with PM were later reclassified to other forms of IIM, including IBM, IMNM, ASyS, or DM without a rash.

What the Rheumatologist Needs to Know about IBD Treatment

2024-04-18T14:58:16+00:00

Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), affect almost 1% of the Canadian population and are characterized by debilitating gastrointestinal (GI) symptoms including chronic diarrhea, rectal bleeding and abdominal pain. Beyond involvement of the GI tract, up to half of patients with IBD will also experience extraintestinal manifestations (EIMs) or be diagnosed with comorbid immune-mediated inflammatory diseases (IMIDs), which are associated with substantial morbidity and impaired quality of life. The most common of these are inflammatory joint diseases, including peripheral and axial spondyloarthritis or concomitant rheumatoid (RA) or psoriatic arthritis (PsA), affecting up to 1 in 5 patients with IBD.

Management of Rheumatologic Immune-Related Adverse Events (Rh-irAEs) – An Overview of Immunosuppressive Therapies

2024-04-18T15:10:37+00:00

Cancer treatment has entered a new era with the expanding role of immunotherapy, in particular immune checkpoint inhibitors (ICIs). ICIs, including those that target cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed death protein-1 (PD-1), and programmed death ligand-1 (PD-L1), work by blocking the intrinsic down-regulators of the immune system, leading to sustained activation of effector T-cells to enhance endogenous anti-tumour immune responses.