Immunology for the Rheumatologist: The Devil Is in the Details

In another installment in the ongoing Arthritis & Rheumatology immunology series, guest David S. Pisetsky, MD, PhD, author of Unique Interplay Between Antinuclear Antibodies and Nuclear Molecules in the Pathogenesis of Systemic Lupus Erythematosus, takes us on a deep dive into research in SLE on how the combination of ANAs and immunologically active DNA can create new structures that can promote inflammation throughout the body as well as drive organ inflammation and damage.

This week, our next guest, ACR Master Dr. Joan T. Merrill, joins us to discuss her latest study which endeavored to evaluate the efficacy and safety of upadacitinib and elsubrutinib in those with systemic lupus erythematosus (SLE). Join us for an in-depth analysis of the SLEek Study, its findings regarding the efficacy of these medications and Dr. Merrill’s conclusions. 

For those with rheumatic disease, everyday challenges can mean an increase in disease flare. However, research is increasingly pointing to the idea that psychosocial stressors could even heighten the risk of developing rheumatic diseases. Dr. Christine Parks looked deeper into this among those with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) in her latest study Life Events, Caregiving, and Risk of Autoimmune Rheumatic Diseases in the Women's Health Initiative Observational Study 

This week, we explore a groundbreaking study on the prevalence of fibromyalgia and widespread pain in patients with psoriatic arthritis with first author and ACR Master, Dr. Philip J. Mease. In his latest article, titled: Prevalence of Fibromyalgia and Widespread Pain in Psoriatic Arthritis: Association with Disease Severity Assessment in a Large US RegistryUID , Dr. Mease explains what the presence of these conditions reveals about disease severity and how they converge. 

As the dawn of the Ai revolution marches on, scientific research and clinical medicine are adopting new and more streamlined ways to investigate and serve our patients. Today, we look at how Ai-driven, large language models (LLMs) might aid our field’s researchers in analyzing data from patient interviews. Dr. Bella Mehta, corresponding author of A Novel Approach for Mixed-Methods Research Using Large Language Models: A Report Using Patients’ Perspectives on Barriers to Arthroplasty , joins us this week to give us her insights on this this quickly evolving technology and how it can be employed in both the research and clinical setting. 

Genetic conditions, inherited personality traits, brain chemistry...these are but a few of the well-known biological determinants of health and are but a small sample of factors that can determine how severe disease may affect a patient. But what role can social factors play in determining a patient’s health? What of the ‘Social Determinants of Health (SDoH)’? Dr. Shivani Garg set out to identify these factors and understand how they play a role in determining the severity of symptoms in those with Lupus Nephritis (LN). What she discovered was that not only do these factors play a significant role, but each one added has a multiplicative effect on the patient’s reported outcome! Dr. Garg is our guest today and her study, published in Arthritis Care & Rheumatology titled: Multiplicative Impact of Adverse Social Determinants of Health on Outcomes in Lupus Nephritis: A Meta-analysis and Systematic Review, will be the focus of our discussion. 

The process of weaning our patients off biologic disease-modifying antirheumatic drug (b-DMARD) therapy is not unfamiliar in our clinics. However, when attending to our patients, many complications and questions arise. Specific guidance is needed, but where do we turn? Thankfully, our latest guest, Dr. Paul Emery, may have some answers. His latest study, Predicting Flare in Patients With Rheumatoid Arthritis in Biologic Induced Remission, on Tapering, and on Stable Therapy attempted to “identify predictors of flare in patients in stable b-DMARD–induced clinical remission”. Let’s dive in together and see what he and his team have found! 

To better understand the mechanisms that drive antiphospholipid syndrome (APS), Dr. Yu Zuo and his team, evaluated the presence of circulating calprotectin (cCLP) to detect any clinical associations or even the mechanistic role among a cohort of primary APS and aPL-positive patients. Dr. Zuo sits down with us this week to discuss whether calprotectin can be a functional biomarker for those with APS thrombocytopenia and what the future holds for this study’s conclusions. 

Benjamin Franklin once said: “An ounce of prevention is worth a pound of cure”. This week, we have the opportunity to see this realized in a recent clinical study entitled, Vitamin D and Marine n-3 Fatty Acids for Autoimmune Disease Prevention: Outcomes Two Years After Completion of a Double-Blind, Placebo-Controlled Trial. Our guest is the study’s first author, Dr. Karen Costenbader. She explains the results of this research, which suggests Vitamin D and marine n-3 fatty acids play a significant role in preventing autoimmune disease!  

Caring for our patients means reducing symptoms and occurrences of flare-ups. However, caring for their whole self means a watchful eye on how chronic disease symptoms impact their daily life and mental health. Discovering patterns between depression and anxiety and such chronic diseases, like ankylosing spondylitis, psoriatic arthritis and rheumatoid arthritis, was the focus of Dr. Alyssa Howren’s latest study. Today, we take a look at this study, titled: “What Came First?” Population-Based Evaluation of Health Care Encounters for Depression and Anxiety Before and After Inflammatory Arthritis Diagnosis: Disentangling the Relationship Between Mental Health and Arthritis and try to disentangle the web of disease-related depression and anxiety