I am glad was able to attend a quick but informative conference at the Kentuckiana
Rheumatology Alliance 2026 in Louisville KY earlier this month July 2026. I admit that in
recent last 2 years I feel there is a lot of rapid advancements in some of treatments of
several rheumatologic diseases happening. Here are some points of this past meeting
of this month:
-LUPUS NEPHRITIS WITHOUT PROTEINURIA. There is emphasis now working of
nephrologists (kidney doctors) in lupus nephritis disease – especially after the 2024
lupus nephritis guidelines of treatment where emphasis on triple therapy and so on-
now the medical communities are studying aspects of possibly there is ongoing lupus
nephritis (whether actionable LN disease or in-actionable LN) even if patients do not
meet the criteria of proteinuria (normal range or below like 300 mg mg/d for example!).
So this is still in progress, but it is something to remember as rheumatologist when
evaluating lupus patients no proteinuria in the urine test might not completely exclude
them from having active kidney disease, especially if they have persistently low
complements (hypocomplementemia) or positive dsDNA. Something to keep in mind.
Will see where studies will lead us to.
-VEXAS SYNDROME. There was a presentation case of this somatic genetic disease –
disease due to UBA1 gene mutation- causes inflammatory and hematologic diseases.
Discovered in 2020, now rheumatology college/community have some guidelines of
some treatments of this genetic disease (other than stem cell transplantation) like JAK
inhibitors or IL6 inhibitors (cytokine inhibitors). Most noticeable I noticed that this
disease would cause symptoms of inflammatory symptoms like chondritis (ear redness)
and inflammatory eye or ear diseases. Many times we see patients having redness in
their ears, but with negative serologies, so patients probably have this syndrome
VEXAS afterall. Something for me to keep in mind!
-AVACOPAN: this is ANCA vasculitis treatment approved several years ago help at least
cut down steroids dosing and so. NOW it might be OFF market -not confirmed yet- due
to wrong done in their studies so it is under investigation now. This is important and
probably something we haven’t heard of for long time except every now on very rare. It
can cause liver toxicity. So the medicine might be off market (retracted from market?).
This is something we don’t see in medical field every day (I mean medicine to be
withdrawn from market due to a wrong or something fishy happened during the study).
Wow!
Happy summer everyone!
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Dr Habal
