Let’s Discuss: Insights from the ACR Convergence 2025 Review Course

CHICAGO—Each year, the ACR provides a tremendous service to the rheumatology community by organizing its annual Review Course sessions at Convergence. Not only are the subjects selected for these sessions consistently timely and relevant, but also the speakers who present the material are invariably skilled at distilling complex topics down to their essence. This makes for talks that are engaging, high yield and always popular among conference attendees.

Systemic Lupus Erythematosus

Dr. Ardoin

The first lecture this year was given by Stacy Ardoin, MD, division chief of pediatric rheumatology, Nationwide Children’s Hospital and The Ohio State University, Columbus, and its focus was on both pediatric and adult systemic lupus erythematosus (SLE). Dr. Ardoin began by laying out several goals that all clinicians should have in caring for patients with SLE, namely: 1) controlling disease activity, 2) preventing organ damage, 3) improving patients’ quality of life, and 4) minimizing side effects from therapy. At the moment, only one medication—belimumab—is approved for pediatric SLE by the U.S. Food & Drug Administration (FDA), but Dr. Ardoin explained that pediatric rheumatologists often employ a range of therapies that, although off label, are still found to be helpful in managing patients’ disease. Without question, hydroxychloroquine is indicated for every pediatric and adult patient with SLE unless an absolute contraindication to its use exists or if a patient has significant side effects with the medication; in the latter case, Dr. Ardoin recommended trying a lower dose of the medication or using chloroquine in its place.

Similar to other rheumatic conditions, SLE can now be managed using a treat-to-target approach, with the target being either remission or low disease activity state. In the past, Dr. Ardoin explained, such targets would have been aspirational, but in recent years they have become realistic thanks to better treatments and a better understanding of how to use these targets. The Lupus Low Disease Activity State is characterized by the absence of activity in major organ systems, a prednisone dose of no more than 7.5 mg per day and standard maintenance doses of immunosuppressive treatments.¹

Specific ways to measure success in treating lupus nephritis include improvement in glomerular filtration rate (GFR) and proteinuria, and Dr. Ardoin cited the guidelines published by the ACR in 2024 as a particularly helpful resource for clinicians.² Significant innovations from these guidelines were the concept of using triple therapy at time of diagnosis of lupus nephritis and using such factors as the International Society of Nephrology/Renal Pathology Society (ISN/RPS) class of nephritis, GFR, degree of proteinuria and presence or absence of significant hypertension to guide selection of therapy. She noted that the FDA’s approval of obinutuzumab for the treatment of adults with active lupus nephritis came after publication of these guidelines, thus updates may be needed to the guidelines with respect to this medication; recommendations from the European Alliance of Associations for Rheumatology, however, do include obinutuzumab.³