LUPUS ARTHRITIS: ADEQUATE JOINT ASSESSMENT IN SLE TRIALS.

Vital, E.

LUPUS ARTHRITIS: ADEQUATE JOINT ASSESSMENT IN SLE TRIALS.

All Authors

Vital, E.

LTHT Author

Vital, Edward

LTHT Department

Rheumatology

Publication Date

2025

Item Type

Conference Abstract

Abstract

Lupus arthritis sometimes receives less attention than other manifestations of systemic lupus erythematosus (SLE) in routine practice and clinical trials. At a population level, however, patients rated musculoskeletal manifestations and pain as their second most impactful symptom after fatigue.1 Moreover, in currently accepted clinical trial designs, the ability of novel therapies to impact on musculoskeletal symptoms is almost always required to obtain regulatory approval. Recent studies in imaging and clinical assessment have suggested new approaches to assessment. A substantial proportion of patients with arthralgia are revealed to have objective joint and tendon inflammation on ultrasound or MRI, and this is associated with worse serology and symptoms.2 Other patients clinically thought to have swollen joints in fact have no proven inflammation and the presence of imaging synovitis predicts response to therapy.3 Clinical variables to help identify objective synovitis without using ultrasound have been described and ultrasound data have been used to define the best clinical assessment tools for use in clinical trials. These include revisions to the SLE Disease Activity Index (SLEDAI), different ways to assess joint counts, and most importantly a new composite outcome measure for lupus arthritis called Lupus Arthritis and Musculoskeletal Disease Activity (LAMDA).4 LAMDA shows sensitivity to ultrasound-only synovitis, better responsiveness to therapy and good association with patient-reported outcomes. New arthritis focussed trials have been evaluated, including Rituximab Objective Outcome measures Trial in SLE (ROOTS) that combines all these elements into a new randomised controlled trial design.5 Learning Objectives At the end of this presentation participants will be able to: . Explain the clinical impact of different manifestations of lupus arthritis . Describe the role of imaging in lupus arthritis assessment . Discuss the most recent evidence on clinical assessment of joints in clinical trials.