APRIL 2024 to JULY 2024
Author: Barbara Russo & Omar Dhrif
Arthritis & Rheumatology
2023 ACR / CHEST Guideline for the Screening, Monitoring and Treatment of ILD in Systemic Autoimmune Rheumatic Diseases
Sindhu R. Johnson et al. (10.1002/art.42860) conducted a systematic literature review, with evidence rated using the GRADE methodology, to guide screening, monitoring and treatment for interstitial lung disease (ILD) in patients with systemic autoimmune rheumatic diseases (SARD). Pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT) were conditionally recommended for screening while PFTs, HRCT, and ambulatory desaturation testing were conditionally recommended for monitoring. Thirty-five recommendations, including two strong ones, were made for first-line SARD-ILD treatment, progression despite first-line therapy, and rapidly progressive ILD, advising against glucocorticoids in systemic sclerosis–ILD as a first-line treatment and after ILD progression.
Impact of Glucocorticoid Dose in Lupus Nephritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Gabriel Figueroa-Parra et al. (10.1002/art.42920) evaluated glucocorticoid regimens on lupus nephritis outcomes using a meta-analysis of randomized clinical trials (RCTs). In 50 RCT arms (3,231 patients), starting prednisone at 25 mg/day led to a complete response (CR) rate of 19.5% (95% CI 7.3–31.5), infections 3.2% (95% CI 2.4–4.0), and death 0.2% (95% CI 0.0–0.4). Increasing to 60 mg/day raised CR to 34.6% (95% CI 16.9–52.3), infections to 12.1% (95% CI 9.3–14.9), and death to 2.7% (95% CI 0.0–5.3). Adding pulses improved CR and death rates but not infections.
Autologous CD19-Targeting CAR T Cells in a Patient With Refractory Juvenile Dermatomyositis
Rebecca Nicolai et al. (10.1002/art.42933) evaluated the safety and efficacy of CD19-targeting chimeric antigen receptor (CAR) T cells in a 12-year-old boy with refractory juvenile dermatomyositis. The patient, unresponsive to multiple treatments including rituximab, received a single infusion of anti-CD19 CAR T cells (1 × 10^6 cells/kg) following lymphodepletion with cyclophosphamide and fludarabine. CAR T cell therapy led to complete B cell depletion, significant CAR T cell expansion, and mild cytokine release syndrome. The patient experienced notable and sustained clinical and radiologic improvement, with no infections or neurotoxicity observed.
EphB2 Receptor Promotes Dermal Fibrosis in Systemic Sclerosis
Erika S. A. Egal et al. (10.1002/art.42858) tested the hypothesis that the receptor tyrosine kinase EphB2 mediates dermal fibrosis in systemic sclerosis (SSc). EphB2 expression was up-regulated in SSc skin tissue fibroblasts compared to healthy controls. Authors found that EphB2 drives dermal fibrosis in both bleomycin-induced and tight skin (Tsk1/+) models. EphB2 forward signaling, upregulated by transforming growth factor-β, was critical for fibroblast-to-myofibroblast differentiation. Silencing EphB2 impaired this differentiation in mice, identifying EphB2 as a potential therapeutic target for SSc.
Air Pollution and Genetic Factors Enhance Systemic Lupus Erythematosus Risk: A UK Biobank Study
Xing et al. (10.1002/art.42929) This UK Biobank study with 459,815 participants found that long-term exposure to air pollutants significantly increases the risk of systemic lupus erythematosus (SLE). Adjusted hazard ratios were 1.18 (95% CI 1.06–1.32) for PM2.5, 1.23 (95% CI 1.10–1.39) for PM10, 1.27 (95% CI 1.14–1.41) for NO2, and 1.13 (95% CI 1.03–1.23) for NOx. The risk was higher among individuals with specific HLA alleles (HLA-DRB103:01, HLA-DRB103:02, HLA-DRB1*15:01). The combined effect of genetic predisposition and pollution was more significant than either factor alone, indicating a synergistic effect. Despite the focus on a UK population limits generalizability, the findings underscore the urgent need for improved air quality management to protect public health.
Barbara Russo
Barbara Russo is a research assistant in the Department of Medicine at HôpitauxUniversitaires de Genève. Her research is focused on the pathogenesis of systemic sclerosis (SSc), with a particular emphasis on fibrosis and mechanotransduction. She is also dedicated to investigating current treatment practices to identify effective strategies for improving the quality of life for patients with SSc.
Barbara actively contributes to the Eustar Young Investigator Group and serves on the EMEUNET Education Sub-Committee.
Omar Dhrif
Omar is an Internal Medicine Specialist, from University Tunis El Manar currently residing in Dijon, France. His main clinical and research interests are focused on Vasculitis, Global access to health care and educational therapy. Omar is the past-Treasurer of the Tunisian Association of Young Internists, Co-Founder of the Francophonic Young Internists Group, member of the Research Committee of the Tunisian Society of Internal Medicine and American College of Rheumatology Social Media Ambassador.
Omar is a member of the EMEUNET Social Media sub-committee.