lupus carousel Predicting Lupus FlaresDRS. JUDITH JAMES, MELISSA MUNROE AND COLLEAGUES HAVE DISCOVERED A WAY TO PEER INTO THE FUTURE THAT COULD EASE PATIENTS’ SYMPTOMS

In lupus patients, the immune system is usually out of balance. But when inflammation outweighs regulation, the mechanisms designed to protect the body become overwhelmed, causing flares that can lead to tissue and organ damage. Patients usually don’t know when a disease flare is about to occur, which delays treatment and allows inflammation to continue unabated. But when OMRF investigators were researching the effects of the influenza vaccine in lupus patients, their work yielded some unexpected results: a method of assessing certain factors in the blood that could forecast a flare on the horizon. The researchers monitored blood samples from patients before and in the weeks after receiving the vaccine and found a panel of mediators that predict disease flares. These molecules, James and Munroe found, increase or decrease the chance of a lupus flare by driving or suppressing inflammation. Physicians can use this information to “score” patients to predict who might need pre-flare treatment up to three months in advance. “Even if patients aren’t feeling too bad, their immune systems are warning us that a flare is coming,” says James, who holds the Lou C. Kerr Endowed Chair in Biomedical Research. Doctors can then initiate treatment to try to prevent or lessen disease activity. Conversely, says James, “If we know they’re not going to flare, we can avoid giving them a lot of unnecessary and potentially toxic drugs.” The discovery will help physicians tailor therapies for patients, and it could also have a potential benefit for clinical trials. “One challenge in testing new medications for lupus is discerning if a lack of disease activity is due to a drug’s effects or other factors,” James says. Doctors could draw on this information to identify patients for clinical trials who are at the highest risk for lupus disease flare and, therefore, have the highest potential benefit from the drug. “For a clinician, it’s an exciting prospect to be able to define patients from a molecular standpoint and really get at precisely what’s happening in their disease process,” says James. OMRF has filed for a provisional patent for the discovery. The foundation is searching for a biotechnology partner to help transform the work into a disease-management tool that rheumatologists everywhere could use to manage patient care and treatment.