Newsroom Hospital for Special Surgery

Lupus: 11 Things Doctors Want You to Know

Mon, 15 Sep 2025 16:50:12 -0400

According to Healthgrades, Lupus is a disease that can affect almost any part of the body and can be mistaken for conditions from arthritis to rosacea. Flu-like illness, joint pain and skin problems are only a few of the many symptoms of lupus, which can also lead to more serious complications like heart and kidney disease. Lupus is a complex but usually manageable illness, as experts including Jane E. Salmon, MD, rheumatologist at HSS explain.

There is a test that can help diagnose lupus, but it’s only part of the picture. “An ANA test is a blood test that’s positive in the overwhelming majority of people with lupus, but not everybody with a positive test has lupus,” Dr. Salmon explained.

Women of childbearing age are the most likely to develop lupus, so pregnancy must be carefully timed for women who have the disease. “If your disease is quiescent–not active–and you’re on low doses of steroids, you’re feeling good, all of your organs are working well, and you don't have active kidney disease, then your pregnancy is likely to be uncomplicated,” said Dr. Salmon, who studies lupus and pregnancy.

Read the full article at healthgrades.com.

Past ACR President Named a PANLAR Master

Tue, 08 Jul 2025 10:06:00 -0400

During the 2025 Congress of the Pan-American League of Rheumatology (PANLAR), held in Mexico City, Mary K. Crow, MD, rheumatologist at HSS, was designated a PANLAR Master of Rheumatology. This distinction is awarded to individuals whose scientific contribution and/or recognized academic work has contributed significantly to the development of rheumatology in their country.

Dr. Crow, a former ACR president and Henry Kunkel Society president, said she experienced a warm reception from PANLAR attendees, and that it was very gratifying to receive this honor—not just the award itself, “but what it means for other people having a relationship with you and your work.”

Read the full article at the-rheumatologist.org.

A Cutting-Edge Cancer Therapy Offers Hope for Patients With Lupus

Wed, 18 Jun 2025 13:24:17 -0400

The New York Times reports that CAR T-cell therapy, a kind of “living drug” that modifies patients’ immune cells to help them attack misbehaving ones, has been used with significant success to treat some cancers, particularly of the blood. A growing body of evidence has suggested that the therapy can also treat a severe form of lupus that, at best, can be managed as a lifelong condition and, at worst, resists treatment and can lead to organ failure and death.

“It’s really promising, and honestly the first therapy that we’ve talked about as a cure,” said Lisa R. Sammaritano, MD, rheumatologist at HSS, and the lead author on a set of recently updated guidelines for lupus treatment. Until now, she said, “we haven’t had a cure — we’ve had control.”

Read the full article at nytimes.com. A subscription is required to access.

HSS Study at EULAR 2025 Congress Uses an AI Model to Predict Readmissions of Pregnant Women with Lupus Based on Social Determinants of Health

Sat, 14 Jun 2025 08:00:00 -0400

Hospital for Special Surgery (HSS) presented a research study at the European Alliance of Associations for Rheumatology (EULAR) Annual Meeting showing that an artificial intelligence (AI)-based model can predict readmissions of pregnant women with lupus by looking at patients’ social factors and clinical comorbidities.

Systemic lupus erythematosus (SLE), commonly known as lupus, is a chronic autoimmune disease in which the immune system attacks the individual’s own healthy tissue, causing pain, inflammation, and eventually damage to various organs. It commonly affects young women, and pregnancy is a particularly vulnerable period for this high-risk population. Although lupus-related medical complications affect pregnancy outcomes, social determinants and economic conditions, known as social determinants of health (SDOH), may also be important in shaping maternal health outcomes.

“Pregnant women with lupus have five times higher maternal mortality compared to those without lupus,” said Sandhya Shri Kannayiram, MBBS, MD, rheumatology fellow at HSS and principal author of the study. “There is little data on how social factors, including Income, Insurance, housing stability, access to transportation, availability of utilities, and literacy, along with clinical comorbidities, affect pregnancy outcomes in individuals with lupus.”

To better understand how SDOH impact readmissions for pregnant patients with SLE, the team used ten-year data (from 2011 to 2021) from the National Readmissions Database of the US, encompassing approximately 66,000 hospitalizations in the United States, and counted the number of readmissions within 30 days of discharge during pregnancy and delivery. “We found that approximately 2,500 [pregnant women with lupus] were readmitted to the hospital within 30 days,” said Dr. Kannayiram.

“We used a supervised ‘glass box’ machine learning model called the Explainable Boosting Machine (EBM), which helped predict who is likely to return to the hospital within 30 days,” said Dr. Kannayiram. She explained that EBM is a form of machine learning with a type of AI that learns from data to make predictions. “It’s an AI model that can be trained on the dataset to predict outcomes with transparency and accuracy compared to traditional statistical models,” she added.

The team specifically examined the major social determinants from the database that may influence readmissions during pregnancy in SLE, including Income and insurance status (public, private, or self-pay). Dr. Kannayiram explained that the results obtained showed patients living in lower-income neighborhoods were nearly twice as likely to be readmitted compared to those from wealthier areas, and those with Medicaid or Medicare insurance were more likely to be readmitted within 30 days. Patients discharged to locations other than home, such as rehabilitation facilities or nursing homes, were also more likely to return. However, they also found unexpected correlations. “We found that the size of hospitals was highly related to readmissions, rather than the location, such as cities or rural areas,” said Dr. Kannayiram, with large hospitals being the ones with more readmissions. Additionally, unlike most pregnancy studies, where older mothers are usually at higher risk, this study found that younger women with lupus were more likely to be readmitted. Dr. Kannayiram said that this result may be related to severe lupus in younger individuals since about half of the readmitted patients had Medicare coverage, which may suggest a high prevalence of disability or kidney disease within that younger population.

By using the predictive AI model, the team also discovered that income and insurance status were among the top five predictors of 30-day readmission during pregnancy and delivery-related hospitalizations, explained Bella Mehta, MBBS, MS, MD, rheumatologist at HSS and lead author of the study. She noted that these results could inform targeted interventions, such as policy actions to advocate for improved Medicaid and Medicare coverage, as well as post-discharge care coordination. “Integrating SDOH screening into prenatal care for SLE patients, and incorporating a multidisciplinary team of social workers, could reduce preventable readmissions and improve maternal outcomes,” added Dr. Mehta.

According to Dr. Mehta, in future studies, the team plans to analyze in detail how individual-level social factors, such as housing instability, food insecurity, education, mental health, transportation access, and patient demographics, interact with clinical comorbidities to determine pregnancy outcomes for women with SLE. “This study underscores the vital intersection between clinical care and structural inequality,” said Dr. Mehta. “The lupus community and broader maternal health initiatives must not only consider disease management but also address the social factors that influence outcomes.”

Poster details

Title: Predictors of 30-Day Readmissions in Pregnant Patients with Systemic Lupus Erythematosus: The Role of Social Determinants of Health
Authors: Sandhya Shri Kannayiram, Yiyuan Wu, Lisa Sammaritano, Michael Lockshin, Rich Caruna, D. Ware Branch, Jane E. Salmon, Bella Mehta.
Abstract n°: 2325
Presentation: June 14th, 2025. 10:00 AM CEST

My Lupus Symptoms Went Away During Pregnancy—but Returned With a Vengeance Postpartum

Mon, 09 Jun 2025 13:28:00 -0400

HSS patient, Kiana Cornejo, is featured in SELF magazine where she shares her personal experience living with lupus and navigating pregnancy with a chronic illness. Diagnosed at age 11, Kiana discusses the challenges she faced, the importance of a supportive care team, and how HSS helped her manage her health during pregnancy.

Read the full article at self.com.

Pregnant mothers with lupus face risks but have better outlooks than ever before, doctor says

Tue, 27 May 2025 15:15:06 -0400

CBS News featured Lisa R. Sammaritano, MD, rheumatologist at HSS, in a story highlighting the improved outlook for pregnant women living with lupus. The segment follows HSS patient Kiana Cornejo, who was diagnosed with lupus at age 11 and navigated a high-risk pregnancy with careful planning and medical guidance. Dr. Sammaritano emphasized that with proactive disease management and appropriate medication adjustments, women with lupus can achieve healthy pregnancies.

Watch the story at cbsnews.com.

Social Isolation a Common Theme Among Older People With SLE

Tue, 27 May 2025 13:06:00 -0400

Med Page Today reports that in a study published in ACR Open Rheumatology, 30 older adults with systemic lupus erythematosus (SLE) with a mean age of 71.3 years reported a sense of social isolation and a reluctance to burden loved ones -- realities that could justify an uptick in screening for isolation, investigators concluded.

First author Sarah Lieber, MD, MS, a rheumatologist at HSS, explained that screening for isolation could help improve care. Once this information is obtained, it is important for the clinician to be able to point to tangible resources. Resources may include local lupus support groups or an individualized referral to another member of the care team such as a social worker. It is also valuable to consider the extent to which social isolation reflects a response to lupus symptoms that can be addressed through further treatments.

Read the full article at medpagetoday.com.

Need Help With Lupus Nephritis Management? ACR Has Your Back

Thu, 08 May 2025 16:48:00 -0400

Med Page Today reports that over the past dozen years, treatment approaches in lupus nephritis (LN) have changed substantially, and this is reflected in a long-awaited update to the American College of Rheumatology's (ACR) official guideline on the topic.

Whereas a two-step plan -- induction followed by maintenance therapy -- was called for in the ACR's last LN guideline, issued in 2012, medications introduced since then have prompted a "conceptual shift" in LN management, according to Lisa R. Sammaritano, MD, rheumatologist at HSS, and co-author of the new update.

With targeted drugs including the biologic agent belimumab (Benlysta) and the calcineurin inhibitor voclosporin (Lupkynis) now available, management now centers on early and continued use of combination treatment "targeting different arms of the immune system," the group explained.

Read the full article at medpagetoday.com.

2024 Lupus Guideline

Wed, 07 May 2025 11:35:00 -0400

HSS rheumatologists Lisa R. Sammaritano, MD, and Kyriakos A. Kirou, MD, DSc, FACP, and clinical research coordinator Christele Felix contributed to the latest American College of Rheumatology (ACR) Clinical Practice Guideline. The manuscript provides recommendations regarding screening, treatment, and management of lupus nephritis (LN) in both adults and children.

Read the full article at rheumatology.org.

Lupus Research Alliance Grants Lupus Innovation Awards to Eleven Talented Researchers to Accelerate Pace of Discovery in Lupus Research

Tue, 15 Apr 2025 10:27:00 -0400

The Lupus Research Alliance is proud to announce the recipients of this year’s Lupus Innovation Award including Franck Barrat, PhD, the Michael R. Bloomberg Chair in Autoimmune Diseases at HSS and Theresa T. Lu, MD, PhD, the St. Giles Chair for Research in the HSS Research Institute, and pediatric rheumatologist at HSS.

This award addresses many critical themes in lupus research including novel therapeutic strategies, the impact of chronic inflammation, and the identification of biomarkers for improved diagnosis and monitoring. These prestigious grants provide investigators from around the world with up to $150,000 per year for two years to accelerate the pace of discovery in lupus research, empowering scientists to tackle high-risk, high-reward projects that could transform how lupus is understood and treated. Together, these projects highlight the breadth and creativity of approaches needed to solve the complex puzzle of lupus.

Read the full article at lupusresearch.org.

Biologic Therapy Significantly Improves Pregnancy Outcomes in Women with Antiphospholipid Syndrome at High Risk for Serious Complications

Thu, 10 Apr 2025 10:00:00 -0400

A landmark clinical trial co-led by Hospital for Special Surgery (HSS) has found that blocking inflammation with the drug certolizumab significantly reduces the risk of serious adverse pregnancy outcomes in women with antiphospholipid syndrome (APS).

The phase 2 IMPACT Trial (IMProve Pregnancy in APS with Certolizumab Therapy) was co-led by Jane E. Salmon, MD, a rheumatologist and the Collette Kean Research Chair at HSS and D. Ware Branch, MD, an obstetrician/gynecologist at University of Utah Health. It is the first clinical trial to evaluate a biologic therapy to prevent serious adverse outcomes in pregnant women with APS and their babies. The study results were published online in Annals of the Rheumatic Diseases.

“The IMPACT study represents a bold and very successful partnership over many years between government, industry, foundations, and academic health research institutions,” said Dr. Salmon, the senior study author. “It is exciting to see our preclinical work in the laboratory, which began more than a decade ago, translate into such promising results for patients. I hope our findings will allow the drug to become widely available so that more pregnant women with APS and high-risk pregnancies can benefit.”

APS is a rare autoimmune disorder affecting up to 0.05% of people. It is frequently associated with lupus, a disease most prevalent in women during their reproductive years. In APS, the body produces autoantibodies that react with blood vessels and circulating cells, causing dangerous blood clots throughout the body, which can lead to strokes, heart attacks, and phlebitis. During pregnancy, APS raises the risk of serious complications arising from issues with the placenta, including fetal death, preeclampsia, and restricted fetal growth.

Previous research led by Dr. Salmon identified lupus anticoagulant (LA), an autoantibody produced by some APS patients, as the strongest predictor of poor pregnancy outcomes in APS patients. Historically, 39% to 86% of pregnant women with APS who are LA positive have faced severe complications, despite treatment with standard-of-care blood thinners like heparin and aspirin. These patients have the greatest need for better treatments.

Dr. Salmon’s preclinical research in experimental models showed that inflammation in the developing placenta, not blood clots, was the main cause of pregnancy complications in APS. This pivotal discovery led her team to investigate whether TNF-alpha inhibitors, a class of drugs used to treat inflammatory conditions like rheumatoid arthritis, Crohn’s disease and plaque psoriasis, could offer better protection to APS pregnancies than blood thinners alone.

The IMPACT trial enrolled 51 pregnant women ages 18 to 40 with high-risk APS, defined as positive for lupus anticoagulant. All participants were treated with certolizumab, a TNF-alpha inhibitor that does not cross the placenta, in addition to standard-of-care heparin and aspirin, starting at week eight of pregnancy. Medication was stopped at week 28, the point at which the placenta is well-developed. The unique design of the IMPACT study made it possible for pregnant patients from 16 states and one Canadian province to participate.

The 20% complication rate in patients treated with certolizumab was dramatically lower than their prior pregnancies in which 69% to 79% had severe adverse outcomes, despite standard treatment with heparin and aspirin. The average gestational of age at delivery was 36.5 weeks in certolizumab-treated pregnancies, compared to 24 weeks in patients’ prior pregnancies. Among IMPACT participants, 93% brought home a healthy baby—a remarkable improvement over the 38% survival rate for their previous pregnancies. Notably, none experienced serious infections or lupus flares, a concern when the study began.

The trial supports the concept derived from basic laboratory studies that targeting inflammation, rather than blood clotting, is effective in preventing pregnancy complications in high-risk pregnant patients with APS. It also shows the power of collaboration between rheumatologists and obstetricians.

“Our study heralds a new era for trials with biologics to prevent adverse pregnancy outcomes. We have shown that it is possible to gain the confidence of regulators and the trust of pregnant women who will enroll in clinical trials,” said Dr. Salmon. “We are grateful to the patients and their care providers, who were committed partners in this trial, and to our funders who watched our trial with anticipation and excitement,” said Dr. Salmon.

“These results also open a window for studying whether TNF-alpha blockade could help prevent preeclampsia in women without autoimmune disorders,” she added. “Preeclampsia is the most common cause of morbidity and mortality of pregnant women and their babies, and there are currently no effective therapies.”

The study was supported by funding from the National Institutes of Health, the Lupus Foundation of America, the Morris and Alma Schapiro Fund, the James R. and Jo Scott Research Endowment at the University of Utah and UCB Inc., the maker of certolizumab (Cimzia).

9 Essential Questions to Ask About Managing Lupus

Tue, 01 Apr 2025 12:22:00 -0400

Lisa R. Sammaritano, MD, rheumatologist at HSS and Director of the Rheumatology Reproductive Health Program of the Barbara Volcker Center for Women and Rheumatic Diseases speaks to Health Central about pregnancy and reproductive health considerations for women living with lupus.

Lupus, also known as systemic lupus erythematosus, is a chronic disease that causes the immune system to attack its own tissues. Anyone can get lupus, but mostly women develop the autoimmune condition. The inflammation that goes along with lupus can cause a variety of issues including arthritis, fevers, rashes, and fatigue.

Many women with lupus have concerns about whether they can safely become pregnant.

“Most women living with lupus can have successful pregnancies. The key to pregnancy success lies in planning. The presence of quiet or low-level disease activity improves outcomes for both mother and baby,” explained Dr. Sammaritano. Dr. Sammaritano says that six months of low disease activity before conception can reduce the risk of lupus flare during pregnancy and improve pregnancy outcomes.

Read the full article at healthcentral.com.

HSS Participates in Promising Phase 3 Lupus Trial of Investigational Therapy DZP

Tue, 19 Nov 2024 13:26:00 -0500

HSS rheumatologists Kyriakos A. Kirou, MD, DSc, FACP and David R. Fernandez, MD, PhD, participated in the multicenter Phase 3 clinical trial PHOENYCS GO, which evaluated dapirolizumab pegol (DZP) as a treatment for people with moderate-to-severe systemic lupus erythematosus (SLE). In fall 2024, UCB and Biogen announced positive results, presented at the American College of Rheumatology conference in Washington, D.C.

The study found that adding DZP to standard care led to greater improvements in disease activity, fewer severe flare-ups, and reduced corticosteroid use compared to placebo. The treatment was generally well tolerated, with mostly mild side effects.

For patients with SLE, this study suggests that DZP could be a promising new treatment option that helps better control lupus symptoms, potentially reducing flare-ups and the need for high doses of steroids.

For healthcare providers, this could mean having a new tool to offer patients who are not responding well to current treatments, helping to improve their disease management and quality of life.

Building on these findings, a second Phase 3 trial, PHOENYCS FLY, launched in 2025, with HSS again participating as a study site.

To view the full abstract, please visit: acrabstracts.org.

HSS Presents New Research at the ACR Convergence 2024

Sat, 16 Nov 2024 10:30:00 -0500

At this year’s American College of Rheumatology (ACR) annual meeting, HSS presented exciting research related to rheumatology and orthopedics.

Research highlights include a study showing that online search trends can lead to more personalized rheumatic disease care, and blood changes in people at risk for rheumatoid arthritis, a study revealing that having rheumatoid arthritis was not a risk factor for needing a blood transfusion during or after total knee replacement, new discoveries in antiphospholipid syndrome, the effectiveness of avacopan for severe vasculitis, new insights on rheumatic diseases and reproductive health and a study that shows knee osteoarthritis causes more pain and inflammation in women.

New Study Signals How Online Search Trends Could Lead to More Personalized Rheumatic Disease Care

Physicians are learning how to better support the needs of people with rheumatoid arthritis from online search trends, according to a new study from researchers at HSS and colleagues at Columbia University Vagelos College of Physicians & Surgeons.

New Research Reveals Alterations in Blood of People at Risk of Developing Rheumatoid Arthritis

A new study by HSS and collaborating centers identified distinct immune cell patterns in the blood that signal an increased risk of developing rheumatoid arthritis before symptoms occur.

Surprising Study Finds No Link Between Rheumatoid Arthritis and Transfusion Risk After Knee Replacement

Having rheumatoid arthritis was not a risk factor for needing a blood transfusion during or after total knee replacement, according to a new study by HSS researchers.

New Antiphospholipid Syndrome Research Findings Presented at ACR Convergence 2024

Investigators from the Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) presented new research findings in antiphospholipid syndrome (APS). These studies explore differences in clinical manifestations of APS in children versus adults, identify key risk factors for thrombosis in persistently antiphospholipid antibody-positive patients, and investigate the prevalence and implications of lupus-related autoantibodies in patients without lupus.

Study Shows Avacopan Effective for Most Serious Vasculitis Cases

New multicenter study by HSS and others by HSS shows avacopan is effective in achieving disease control with less steroid exposure in patients with ear, nose and throat manifestations of ANCA associated vasculitis.

HSS Presents Cutting-Edge Discoveries in Rheumatic Disease and Reproductive Health at ACR Convergence 2024

HSS presented a number of studies focused on reproductive health for patients with rheumatic diseases including factors influencing infant feeding, predicting pregnancy outcomes in lupus, and improving contraception screening for women on teratogenic medications in rheumatology.

Study Shows Knee Osteoarthritis Causes More Pain and Inflammation in Women

Women with knee osteoarthritis experience more pain and inflammation than men, according to a new study led by researchers at HSS and The Rockefeller University.

Direct-to-Consumer Rheumatologic Tests Carry Some Benefit but Plenty of Potential Risk

Fri, 27 Sep 2024 17:48:00 -0400

According to Medscape, a growing number of patients who are ordering direct-to-consumer (DTC) lab tests without the recommendation or guidance of a doctor. They're offered online by labs ranging from well-established giants to smaller, potentially less vetted companies, although.

"Among the possible reasons people might order these tests are the delay in diagnosis that can often occur with a lot of rheumatologic conditions and that it can take a while to see a rheumatologist, depending on what part of the country you're in and what the availability is," said Timothy B. Niewold, MD, FACR, Vice Chair for Research in the HSS Department of Medicine. He's not surprised to see tests for Sjögren disease among the offerings, for example, because it's a condition that's difficult to diagnose but reasonably common within autoimmune diseases.

Read the full article at Medscape.com.

Updated ACR/EULAR APS criteria require positive antiphospholipid antibody test

Wed, 06 Dec 2023 18:28:00 -0500

Healio reports that The American College of Rheumatology and EULAR have released the first updated classification criteria for antiphospholipid syndrome since 2006, raising specificity from 86% to 99%. The new guidelines require at least one positive antiphospholipid antibody test within three years of a related clinical event and use weighted clinical and laboratory domains to improve accuracy. Developed through a rigorous international effort, the criteria reflect advances in understanding APS manifestations and risk stratification. “These modern, weighted criteria provide high specificity and a stronger foundation for APS research,” said Medha Barbhaiya, MD, MPH, rheumatologist at HSS.

Read the full article at healio.com.

Revamped ACR-EULAR Antiphospholipid Syndrome Classification Criteria: What Do They Mean for Clinical Research?

Wed, 06 Dec 2023 12:15:00 -0500

Medscape reports on the revamped ACR-EULAR Antiphospholipid Syndrome Classification Criteria and what it means for clinical research according to HSS rheumatologists Medha Barbhaiya, MD, MPH and Doruk Erkan, MD, MPH.

Updated criteria for classifying antiphospholipid syndrome (APS) will increase the specificity of identifying patients with the condition to aid clinical research, according to researchers. The revamped criteria, originally presented in draft form at the American College of Rheumatology (ACR) 2022 annual scientific meeting, were published this year in late August.

APS classification criteria were last updated in 2006 and did not incorporate the wider range of manifestations of APS, including heart valve and kidney disease. The ACR and the European Alliance of Associations for Rheumatology (EULAR) jointly commissioned the update.

The new criteria include six clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and two laboratory domains (antiphospholipid antibody [aPL] tests by solid-phase assay and coagulation assay). The criteria are weighted, with items in each of the eight domains receiving a score between 1 and 7. Patients who score at least three points from all clinical domains as well as three points from the laboratory domains are classified as having APS.

Dr. Erkan and Dr. Barbhaiya explained what this new criteria will mean for clinical research.

“The major problem with APS research has been the inclusion of a heterogeneous group of aPL-positive patients — for instance, patients with both low- and high-risk aPL and/or thrombosis risk profiles, or patients with controversial pregnancy-related manifestations. This heterogeneity makes it difficult to compare and generalize the results of studies in patients with APS. More specific classification criteria will standardize the identification of a homogeneous group of patients with APS for inclusion in clinical studies and trials, thereby enhancing study interpretation and applicability," Dr. Erkan said.

"In addition to novel manifestations included in the new criteria, macrovascular events such as venous or arterial thromboses, which were also included in the previous criteria, now require careful consideration of risk factors present at the time of thrombotic events. Weighting thrombotic events by the presence or absence of provoking risk factors may seem like a minor nuance of the new criteria but is critical to how thrombotic events in APS should be considered. Furthermore, quantification of thrombotic events in this way should help ensure that those patients with highly likely APS are truly the ones being included in clinical studies and trials related to potentially risky treatments, such as long-term anticoagulation," explained Dr. Barbhaiya.

Read the full article at medscape.com.

2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria

Wed, 06 Sep 2023 13:00:00 -0400

In a paper published in Arthritis & Rheumatology, investigators including HSS rheumatologists Doruk Erkan, MD, MPH (North American Co-principal investigator [PI]), and Medha Barbhaiya, MD, MPH, and Stephane Zuily, MD, MPH, PhD (European Co-PI), a vascular medicine specialist at the Université de Lorraine, have unveiled a new classification criteria for antiphospholipid syndrome (APS), a life-threatening autoimmune clotting disorder.

The international initiative is jointly supported by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR).

The methodology involved four phases: 1) criteria generation by surveys and literature review; 2) criteria reduction by modified Delphi and nominal group technique exercises; 3) criteria definition with the guidance of real-world patient scenarios, weighting via consensus-based multicriteria decision analysis, and threshold identification; and 4) validation using independent adjudicators’ consensus as the gold standard.

The new classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1–7 points each) clustered into 6 clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and 2 laboratory domains (lupus anticoagulant functional coagulation assays and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti–β₂-glycoprotein I antibodies). Patients accumulating at least 3 points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria versus the 2006 revised Sapporo classification criteria had a specificity of 99% versus 86%, and a sensitivity of 84% versus 99%.

The new classification criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.

Read the full article at acrjournals.onlinelibrary.wiley.com.

The impact of autoimmune disease on women

Tue, 29 Nov 2022 18:52:00 -0500

New research from HSS led by Lucy Masto, BS; Caroline Siegel, MD, MS; Sanjana Adurty, BA; and senior authors Medha Barbhaiya, MD, MPH, and Lisa Sammaritano, MD, highlights key reproductive health challenges for women with autoimmune rheumatic diseases, including menstrual‑cycle–related flares, low HPV vaccination rates, and misconceptions about contraception. The team also found that assisted reproductive technologies such as egg freezing and IVF can offer important options for patients facing fertility concerns.

Read the full article at contemporaryobgyn.com.

Lupus Foundation of America New Three-Year Grant Supports Research to Improve Pregnancy Outcomes in Women with Lupus

Wed, 31 Mar 2021 15:14:00 -0400

The Lupus Foundation of America announces a new three-year grant, funded by the Festa Family Foundation, supporting the IMPACT study (IMprove Pregnancy in APS with Certolizumab Therapy), the first trial of a biologic therapy to prevent adverse pregnancy outcomes in high-risk pregnancies in patients with antiphospholipid syndrome (APS) with or without systemic lupus erythematosus (SLE). HSS rheumatologist Jane E. Salmon, MD is the lead investigator.

Nine out of 10 people with lupus are women and the disease typically develops during childbearing years, which can make reproductive health an important topic for many women with lupus. A specific autoantibody (lupus anticoagulant, LAC, a type of APS), which can be detected in the blood in the first trimester, is linked to a 10-fold increase in risk of complications. Treatments are needed for women living with lupus and APS who are at risk of pre-term birth, poor placental development and preeclampsia. These complications, which can also lead to inadequate nutrition and oxygenation of the developing fetus, can cause 10-20 percent of pregnant women with SLE to deliver at 24-28 weeks.

The IMPACT study has the potential to provide a new approach to protecting pregnancies for people with lupus and countless other women at risk for these complications. The treatment being studied, certolizumab which blocks TNFα – a key inflammatory mediator in inflamed placenta, is being evaluated and has the potential to be the first biologic that may help prevent these pregnancy complications, enabling women to deliver healthy, full-term babies.

“Women with lupus are at higher risk for complications including preeclampsia, growth restricted babies and fetal death, which are manifestations of placental failure. And, currently, we don’t have good approaches to prevent these poor outcomes. With the support from the Lupus Foundation of America for our IMPACT study, we are conducting the first trial with a biologic therapy to prevent these pregnancy complications and hope to expand our understanding of why complications occur so people living with lupus can have safe, successful pregnancies,” cited Dr. Salmon.

Read the full press release at Lupus.org.

Lisa Sammaritano, MD: Rheumatic Diseases, Pregnancy, and the Importance of Communication

Mon, 14 Sep 2020 08:12:00 -0400

HCP Live reports on a presentation by HSS rheumatologist Lisa R. Sammaritano, MD at the 2020 Congress of Clinical Rheumatology-East discussing the importance of rheumatologists and OB-GYNs communicating openly with one another and to patients with rheumatic disease who are considering pregnancy.

“Rheumatology patients have special concerns and risk with regard to pregnancy, and therefore it is very, very important that this be planned,” explained Dr. Sammaritano. Systemic lupus and antiphospholipid antibodies syndrome historically have posed the greatest risk for both the mother’s health and the outcome of the pregnancy. Dr. Sammaritano encouraged rheumatologists to inquire into their patients’ intentions, and to caution against inadvertent pregnancies. Furthermore, the ideal treatment and management scenario would be a level of synergy between both the rheumatologist and OB-GYN; both specialists must be attuned to patient conditions and pregnancy plans. “We may think of this as the domain of the OB-GYN. Of course, they know everything about pregnancy and contraception. But we know everything about lupus and other related diseases,” she said. “And really, it takes both of those knowledge bases to come up with the right solution for any given patient.”

Read the full article at HCPlive.com.

Gut Microbiome Implicated in Antiphospholipid Syndrome

Tue, 18 Jun 2019 12:15:00 -0400

Researchers have identified a gut bacterium that can trigger the antiphospholipid antibodies seen in patients with antiphospholipid syndrome (APS), an underrecognized autoimmune disease that can lead to abnormal blood clot formation in arteries and veins. Until now, exactly what triggers these antibodies or what triggers some people with these antibodies to have blood clots has been unknown. In the new study, published in Cell Host & Microbe (2019;26:1-14), researchers say that the human gut microbiome and specifically Roseburia intestinalis is a trigger for autoantibodies in patients who are susceptible to the disease.

“In APS, we haven’t known what triggers the antiphospholipid antibodies. This study sheds light on an important area to understand the mechanisms of APS,” said Doruk Erkan, MD, MPH, a rheumatologist at the Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, in New York City, an APS expert, and a coauthor of the research. “Millions of microorganisms exist in our gastrointestinal system, and usually these microorganisms are harmless. However if they elicit systemic immune responses, these microorganisms can be problematic by triggering autoimmunity outside the gut.”

APS can occur in patients with or without other systemic autoimmune diseases, such as lupus. In addition to blood clots, APS increases the risk for pregnancy complications, low platelet counts, anemia, kidney disease, and heart valve disease. Antiphospholipid antibodies mainly bind to the antigen β₂-glycoprotein-I, a phospholipid binding protein in the blood, and this binding triggers blood clotting and inflammation.

In the new study, the researchers investigated whether APS can be triggered by gut microorganisms, because other research has implicated the role of certain gut bacteria in autoimmune diseases such as lupus. The investigators searched a bacterial protein database to identify bacteria that had a similar snippet in their molecules to the APS-associated self molecule β₂-glycoprotein-I targeted in patients by their immune system. This snippet, called epitope, is the part of an antigen molecule to which an antibody attaches itself. They found that core epitopes of β₂-glycoprotein-I are conserved in Roseburia intestinalis, paving the way for cross reactivity. In other words, antibodies produced against this bacteria can also dock and bind on β₂-glycoprotein-I.

The researchers then recruited, from HSS and Yale, 20 healthy controls and 15 individuals who were persistently antiphospholipid antibody-positive. Cassyane Aguiar, MD a previous HSS fellow and currently a pediatric rheumatologist at Children’s Hospital for the King’s Daughters, Norfolk, VA, was also part of the research team helping with the HSS patient recruitment and follow-up. They collected blood and stool samples at baseline (month 1), and then at month 2 and month 3, to capture microbial and immune marker variability over time. They gathered information on health status, medications, 24-hour diet history, and APS-relevant genetic and immune markers such as other antibodies against self molecules.

Based on studies completed in the laboratory of Martin Kriegel, MD, PhD, at Yale School of Medicine, researchers found that Roseburia intestinalis was capable of eliciting an immune response in humans and that T cells from APS patients respond systemically to the bacteria in a manner that depended on the patient’s genetic predisposition. They found long-lasting T and B cell immune responses against this bug in APS patients. Studies in mice further supported this hypothesis and linked the cross-reactive immune responses with tissue damage. “Benign cross-reactive immune responses to gut microbes is probably very common given that we have so many of them living inside of us,” said Dr. Kriegel, who is the lead investigator on the project. “Some of them, however, can lead to damaging immune responses in predisposed individuals, which we have shown here.”

“This study is important because if we can eliminate Roseburia, then we may be able to decrease the levels of antiphospholipid antibodies,” said Dr. Erkan. “The similar epitopes between β₂-glycoprotein-I and the gut microbiome can help us better understand the mechanisms of antiphospholipid antibody production and also open doors for future treatment options.” This includes the use of antibiotics or the development of vaccines for APS and APS-associated autoimmune diseases.

According to Michael Lockshin, MD, Director of Barbara Volcker Center for Women and Rheumatic Diseases, at Hospital for Special Surgery, moving the research forward will require verifying that Roseburia intestinalis is a major, if not the most important, trigger for antiphospholipid antibodies. Since most people with this bacterium do not develop antiphospholipid syndrome, the next step will be to determine why patients develop disease.

“The microbiome itself and the concept of cross-reactivity is hard to study in humans,” said Dr. Kriegel. “We have used molecular approaches and supported our culture dish findings with animal models to show that cross-reactivity induced by a common gut bacterium in APS patients can lead to tissue damage. This study thus went far beyond the typical microbiome surveying studies and made causal links to disease, something still lacking in many studies in the field.”

The current study was a collaborative effort with researchers from HSS; Yale School of Medicine, in New Haven, Connecticut; Benaroya Research Institute, in Seattle, Washington; the Frederick National Laboratory for Cancer Research, in Frederick, Maryland; and Sackler School of Medicine, in Tel Aviv, Israel.