![Page 1: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/1.jpg)
Undifferentiated Connective Tissue Disease(What is the relationship between UCTD and SLE?)
R. John Looney, MDStephen and Elise Rosenfeld Distinguished Professor
of Allergy and Clinical Immunology
![Page 2: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/2.jpg)
Looking for Lupus
![Page 3: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/3.jpg)
![Page 4: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/4.jpg)
![Page 5: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/5.jpg)
![Page 6: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/6.jpg)
![Page 7: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/7.jpg)
![Page 8: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/8.jpg)
![Page 9: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/9.jpg)
![Page 10: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/10.jpg)
![Page 11: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/11.jpg)
![Page 12: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/12.jpg)
![Page 13: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/13.jpg)
![Page 14: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/14.jpg)
![Page 15: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/15.jpg)
Copyright © 1972-2004 American College of Rheumatology Slide Collection. All rights reserved.
Red blood cell cast, urine
![Page 16: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/16.jpg)
Copyright © 1972-2004 American College of Rheumatology Slide Collection. All rights reserved.
Systemic lupus erythematosus: brain (MRI)
![Page 17: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/17.jpg)
M. Petri, et al. Arthritis and Rheumatism 64: 2677–2686, 2012
Sensitivity and specificity of each criterion for SLE
![Page 18: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/18.jpg)
When do you call it lupus?
![Page 19: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/19.jpg)
When do you call it lupus?
What difference does it make?
![Page 20: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/20.jpg)
JM Roberson, et al. Rheum Dis Clin N Am 40 (2014) 621–635
![Page 21: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/21.jpg)
JM Roberson, et al. Rheum Dis Clin N Am 40 (2014) 621–635
![Page 22: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/22.jpg)
Z Liu, et al. Nat. Med. 18; 871-82, 2012
![Page 23: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/23.jpg)
Arbuckle NEJM 2003
![Page 24: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/24.jpg)
• Preclinical lupus thus encompasses a broad range of individuals, from individuals with enhanced genetic risk for SLE development without current clinical symptoms to individuals with autoantibodies and some clinical features of SLE that do not meet ACR disease classification criteria.
• Latent lupus identifies a group of individuals with features consistent with SLE that meet one or two of the ACR classification criteria along with the presence of minor criteria such as fever, fatigue, or lymphadenopathy.
• Incomplete lupus (ILE) refers to individuals with fewer than four of the ACR SLE classification criteria.
JM Roberson, et al. Rheum Dis Clin N Am 40 (2014) 621–635
Preclinical lupusLatent Lupus
Incomplete Lupus
![Page 25: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/25.jpg)
JM Roberson, et al. Rheum Dis Clin N Am 40 (2014) 621–635
ILE 223SLE 4319%
![Page 26: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/26.jpg)
• Undifferentiated connective tissue disease (UCTD) is a broader term referring to clinical symptom manifestations suggestive of a specific connective tissue disease without meeting disease classification criteria.
JM Roberson, et al. Rheum Dis Clin N Am 40 (2014) 621–635
Undifferentiated Systemic Rheumatic Disease(Undifferentiated Connective Tissue Disease )
1. Raynauds2. Skin rash3. Inflammatory arthritis
![Page 27: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/27.jpg)
Undifferentiated Systemic Rheumatic Disease(Undifferentiated Connective Tissue Disease )
What happens over 10 years?
1. 60% remain USRD2. 30% meet criteria 3. 10% complete remission
![Page 28: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/28.jpg)
JM Roberson, et al. Rheum Dis Clin N Am 40 (2014) 621–635
1137 UCTD115 SLE
10%
![Page 29: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/29.jpg)
Can we prevent lupus?
R. John Looney, MDStephen and Elise Rosenfeld Distinguished Professor
of Allergy and Clinical Immunology
![Page 30: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/30.jpg)
JM Roberson, et al. Rheum Dis Clin N Am 40 (2014) 621–635
![Page 31: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/31.jpg)
EC Somers, et al. Lupus (2014) 23, 568–576
![Page 32: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/32.jpg)
A Finckh, et al. Rheum Dis Clin N Am 40 (2014) 771–785
Can we prevent lupus?
![Page 33: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/33.jpg)
A Finckh, et al. Rheum Dis Clin N Am 40 (2014) 771–785
+++++++--
-
![Page 34: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/34.jpg)
Triggering Clinical Disease In SLEis often availability of antigen
• Exposure to UV light damages keratinocytes releasing autoantigens
• Viral infections or adverse reaction to drugs
• Breakdown of the blood-brain barrier allows anti-neuronal antibodies to enter the CNS
![Page 35: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/35.jpg)
How does smoking affect people with lupus?
• Smoking or being around people who smoke may increase your risk of pneumococcal pneumonia.
• If you smoke and have lupus you greatly increase the risk of damaging your heart.
• Smoking can magnify the effect of Raynaud's• Smoking nworsens peripheral vascular disease.• Smoking increases the risk of stroke. • Smokers progressed to end-stage kidney disease far more quickly than did non-
smokers.• Smoking can contribute to common disorders as heartburn.• Lupus skin disease is more active in smokers than non-smokers.• Studies in mice have linked smoking hair loss.• Smoking has been shown to interfere with the benefits of drugs such as
hydroxychloroquine • Smoking slows bone healing
More than any other lifestyle choice you make, quitting cigarettes will have the greatest positive impact on your lupus!
![Page 36: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/36.jpg)
![Page 37: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/37.jpg)
JA James, et al. Lupus (2007) 16, 401–409
![Page 38: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/38.jpg)
JA James, et al. Lupus (2007) 16, 401–409
![Page 39: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/39.jpg)
JA James, et al. Lupus (2007) 16, 401–409
P = 0.018
P = 0.011
P = 0.03
NS
![Page 40: Undifferentiated Connective Tissue Disease (What is the relationship between UCTD and SLE?) R. John Looney, MD Stephen and Elise Rosenfeld Distinguished](https://reader036.vdocument.in/reader036/viewer/2022081501/5697c0241a28abf838cd45c8/html5/thumbnails/40.jpg)
NEJM 347: 911-20, 2002