Lupus Arthritis: Experts Describe Strides Made in Understudied Condition

“We really don’t know what the distribution of lupus arthritis is,” he said. “We really don’t know how to define treatment success.”

Lupus Arthritis Treatment

A report from a 2022 symposium suggested that the treatment choice requires the consideration of the clinical phenotypes, each with a different pathogenesis. They identified a non-deforming, non-erosive form with a type 1 interferon signature, a deforming arthritis marked by MMP3 and MMP12 enzymes, and a rheumatoid-like form marked by rheumatoid factor, ACPA, and anti-CarP antibodies.⁵

Nonetheless, with these and other guidelines, including the EULAR guidelines, questions remain about whether there are enough data to support these suggestions.

Analysis of belimumab data in lupus has found that patients with arthritis at baseline seem to have improved on the drug—a significant effect was seen in as little as 8 weeks, with 55.8% of belimumab patients having sustained resolution of symptoms compared to 47.8% of placebo patients, which Dr. Kalunian called “not a huge difference but a suggestion that something’s there.”⁶

An analysis of anifrolumab data done with his colleague, Dr. Rashmi Dhital, formerly a fellow at his center and now on the faculty at Vanderbilt University, found improvement for anifrolumab versus placebo among those with a swollen joint count of 2 at baseline, but no difference was seen with higher swollen joint counts until the count was more than 10. Dr. Kalunian said it wasn’t clear what to make of the data.

Improvements with the treatment were seen with smaller joints, but not with larger joints, the analysis also found.

Thomas Collins is a freelance medical writer based in Florida.

References

1. Mahmoud K, Zayat A, Vital EM, et al. Musculoskeletal manifestations of systemic lupus erythematosus. Curr Opin Rheumatol. 2017 Sep;29(5):486–492.
2. Marone A, Tang W, Kim Y, et al. Evaluation of SLE arthritis using frequency domain optical imaging. Lupus Sci Med. 2021 Aug 29;8(1):e000495.
3. Diaz-Gallo L-M, Oke V, Lundstrom E, et al. Four systemic lupus erythematosus subgroups, defined by autoantibodies status, differ regarding HLA-DRB1 genotype associations and immunological and clinical manifestations. ACR Open Rheumatol. 2022 Jan;4(1):27–39.
4. Sippl N, Faustini F, Ronnelid J, et al. Arthritis in systemic lupus erythematosus is characterized by local IL-17A and IL-6 expression in synovial fluid. Clin Exp Immunol. 2021 Jul;205(1):44–52.
5. Ceccarelli F, Govoni M, Piga M, et al. Arthritis in systemic lupus erythematosus: From 2022 International GISEA/OEG Symposium. J Clin Med. 2022 Oct 12;11(20):6016.
6. Leuchten N, Parodis I, Brinks R, Aringer M. Belimumab induces early and sustained resolution of lupus thrombocytopenia and lupus arthritis [abstract]. Arthritis Rheumatol. 2024;76(suppl 9).