18 Lupus arthritis: adequate joint assessment in SLE trials

Recently, the European Renal Association has highlighted the need to shift treatment targets for immune-mediated kidney diseases (IMKDs) from symptom management to disease modification. 1Disease modification requires treatment strategies that not only address kidney injury caused by inflammation, but also prevent the progression of kidney damage.To achieve disease modification in clinical practice, rapid inflammatory control is essential, which can be achieved using fast-acting glucocorticoids and antiproliferative agents.However, to achieve sustained remission and preserve kidney function, these conventional therapies must be complemented by innovative, immunomodulatory drugs. 2 3 Therefore, effectively implementing disease modification in lupus nephritis requires a deep understanding of its pathophysiology, enabling the identification of targeted immunomodulatory agents that can interfere with key pathological processes through a multitargeted and personalized approach. 4 In this presentation, the pivotal pathophysiological mechanisms of lupus nephritis will be addressed providing an overview of local kidney inflammation in lupus nephritis.Based on these insights, the new paradigm focused on disease modification allows for sensibly combining conventional glucocorticoids and antiproliferative agents with emerging immunomodulatory therapies.The influence of disease modification on future research and clinical trial designs will be discussed.Learning Objectives At the end of this presentation participants will be able to:. Explain the pathophysiological immune dysregulation underpinning systemic lupus erythematosus and resulting in lupus nephritis .Discuss the novel concept of disease modification for lupus nephritis .Translate disease modification to combination therapy for lupus nephritis