RhAPPcast: LN Updates Unpacked: Insights on New ACR Guidelines

In this episode of RhAPPcast, Amanda Mixon, PA-C, President of RhAPP and a practicing physician assistant in Northern Colorado, is joined by Jennifer Mylod, NP, a seasoned rheumatology provider at Arizona Arthritis and Rheumatology Associates in Phoenix, Arizona, to discuss the latest American College of Rheumatology (ACR) guideline updates for lupus nephritis.

With the first ACR guideline update since 2012, these new recommendations reflect advancements in therapeutics and a shift toward more targeted treatment approaches. The episode explores key changes, including updated recommendations for lower-dose glucocorticoids, the introduction of triple therapy strategies, and the importance of early intervention in preventing irreversible kidney damage. The discussion also highlights screening protocols, emphasizing the need for regular urine protein monitoring in lupus patients every six to twelve months to detect early signs of kidney involvement.

One of the most significant shifts in the guidelines is the preference for triple therapy over dual therapy for patients with active lupus nephritis. This new approach integrates glucocorticoids with mycophenolate mofetil (MMF) or cyclophosphamide, combined with an additional immunosuppressive agent such as belimumab or a calcineurin inhibitor. The rationale behind this shift is to reduce long-term steroid exposure while improving renal outcomes. The conversation dives into the evidence supporting these recommendations and how providers can implement them effectively in clinical practice.

Beyond treatment selection, the discussion touches on the importance of shared decision-making and addressing healthcare disparities in lupus care. Patients from diverse socioeconomic backgrounds often face barriers to timely treatment, which can significantly impact their prognosis. By fostering strong patient-provider relationships and ensuring open communication, rheumatology teams can better support patients in managing their disease and adhering to treatment plans.

With advancements in lupus nephritis management, providers now have more tools than ever to improve patient outcomes. The insights shared in this episode aim to equip healthcare professionals with the knowledge and strategies needed to implement the latest guidelines in their practice.

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