{
  "abstract": "The heterogeneity of lupus arthritis complicates clinical management and trial endpoints. Musculoskeletal ultrasound (MSK US), and MRI have been proposed as objective assessment tools. In a systematic literature review and metanalysis that included 16 MSK US publications the pooled analysis showed a strong association between arthritis/arthralgia and US synovitis (10.89 [4.02, 29.48]) and tenosynovitis (5.93 [1.99, 17.72]); association between joint symptoms and US synovitis decreased to 5.00 (1.11, 22.60) when restricted to physician confirmed arthritis. 1 Of the 8 MRI publications included in the review the main abnormalities reported were synovitis, tenosynovitis, bone erosions, bone marrow oedema, peri-tendinitis, bone cysts, and capsular swelling/joint effusion. Additionally, we reported on the use of optical imaging, frequency-domain optical imaging (FDOI) and a glove-like optical imaging system (GLOIS) to differentiate inflamed from normal joints by measuring transmitted and reflected lights to assess changes in tissue properties compared to physical exam and US evaluation lupus arthritis. 3D tomographically reconstructed images showed higher haemoglobin concentration in systemic lupus erythematosus (SLE) joints with PDGS of 2 compared to controls.2 In one SLE patient examined at the time of flare and after symptom resolution AUC decreased in 4 of 6 fingers, suggesting improvement.In a serum proteomic evaluation, an unsupervised machine learning algorithm was able to agnostically identify patients with more severe arthritis as measured by MSK US but not physical exam. These data suggest significant aberrations in the serum proteome likely contribute to arthritis severity in SLE.This workshop offers an up-to-date review of available information on the use of advanced imaging modalities in the evaluation of hand and wrist involvement in SLE and emerging data on proteomics appraisals of patients with lupus arthritis. These data demonstrate the need for further research to substantiate the use of advanced imaging and biomarkers as outcome measures for the MSK manifestations in patients with SLE.Case 1: A 45-year-old woman with longstanding SLE A 45-year-old woman with longstanding systemic lupus erythematosus (SLE) has generalized inflammatory joint pain, morning stiffness and is limited in her daily duties at home and at work. No objective joint swelling is present. She is currently being treated with NSAIDs, hydroxychloroquine, methotrexate and anifrolumab. Questions for Discussion: How would you define those complaints (i.e., arthritis/tenosynovitis/fibromyalgia/other)?How would you treat this patient? In particular, should we treat this patient as having arthritis yes/no?Case 2: An 18-year-old woman with recent onset of SLE An 18-year-old woman with recent onset of SLE (characterized by polyarthritis, subacute cutaneous LE, ANA, anti Ro52 and low titer of IgM-RF) is initially treated with hydroxychloroquine, azathioprine and topical steroids. Because of insufficient improvement of her arthritis, belimumab is added to the treatment regimen. After 4 months of treatment with belimumab, she still has joint pain, however without objective swelling of the joints. Questions for Discussion: Is she a responder to treatment with belimumab?What is your differential diagnosis of the joint pain?Would you perform additional diagnostic tests? If so, which ones?Learning Objectives At the end of this workshop participants will be able to:Discuss the differential diagnosis of joint pain in the context of SLEExplain how to assess arthritis in SLEDescribe the different imaging modalities in assessing arthritis in SLEReferences Tang W, Khalili L, Gong R, et al. Advanced imaging in the evaluation of lupus arthritis: a systematic literature review and meta-analysis. Semin Arthritis Rheum. 2025;71:152661. doi: 10.1016/j.semarthrit.2025.152661Marone A, Tang W, Kim Y, et al. Evaluation of SLE arthritis using frequency domain optical imaging. Lupus Sci Med. 2021;8(1) doi: 10.1136/lupus-2021-000495",
  "authors": [
    {
      "affiliations": [
        "Columbia University Lupus Center, New York, USA"
      ],
      "name": "Anca D Askanase"
    },
    {
      "affiliations": [
        "Amsterdam University Medical Centers, The Netherlands"
      ],
      "name": "Alexandre Voskuyl"
    }
  ],
  "title": "14 Assessing and managing lupus arthritis",
  "uid": "2e5b9c12-9408-5488-a3f6-99a90bc624a7"
}