ACR 2013 State-of-the-Art Clinical Symposium: What’s Next in Therapy for Osteoarthritis, Rheumatoid Arthritis, and Lupus?

Dr. Massarotti highlighted changes that have been made in the past year to classification criteria for SLE. The Systemic Lupus International Collaborating Clinics (SLICC) Revised SLE Criteria is a revision and validation of the ACR classification criteria. According to the SLICC criteria, a patient must satisfy at least four criteria for classification of SLE, including at least one clinical criterion and one immunologic criterion, OR the patient must have biopsy-proven lupus nephritis in the presence of antinuclear antibodies or anti–double-stranded DNA antibodies.⁷

As with OA and RA, the search for biomarkers continues in SLE, but there is not yet a single parameter that reliably identifies or subtypes all lupus patients, Dr. Massarotti said. “Because SLE is heterogeneous, it is likely that several biomarkers may be at play.” The several being investigated include those that define disease activity, those that define disease severity or disease subtype, and the organ-specific biomarkers.” She said that the complement system may be a source of biomarkers.

Treatment of lupus nephritis has been refined in recent years. Among the important issues learned about treatment is recognition of both an induction phase and a maintenance phase and that remission predicts patient survival and renal survival. About 20% to 30% of patients with lupus nephritis do not respond to therapy, and for many patients, the response can take months. Response rates also can differ depending on the patient’s ethnicity, Dr. Massarotti said.

Clinical trials of lupus therapies need more homogeneous groups “so that we can group patients a bit better in terms of autoantibodies and clinical manifestations. Racial and ethnic differences will be important features of clinical trials that we could learn from,” she said.

Kathy Holliman is a medical journalist based in New Jersey.

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