Cells Region Scouting Reports

Posted on February 14, 2022 by David Leverenz

The scouting reports for the Cells Region are here! The reports are posted on the website of The Rheumatologist. Click on the team names below for a link to each report.

Anti-NET Antibodies, written by the UNC Rheumatology Fellowship Program: Leah Bettner, MD; Shruti Chandramouli, MD; Christopher Overton, MD; Astia Allenzara, MD; Michael Cunningham, MD; & Luis Palomino, MD

Cytokine networks, written by The RheumMadness Leadership Team: David Leverenz, MD; Akrithi Udupa, MD; Guy Katz, MD; Lauren He, MD; Ben Kellog, MD; Michael Macklin, MD; Courtney Bair; Matthew Sparks, MD; & Lisa Criscione-Schreiber, MD, MEd

CAR-T Cells, written by the Mass General Hospital Rheumatology Fellowship Program: Guy Katz, MD; Ian Cooley, MD; Duncan Moore, MD; Jacquelyn Nestor, MD, PhD; & Steven Witte, MD, PhD

Pim kinases, written by the residents from the RheumMadness Leadership team: Michael Macklin, MD, PharmD; Ben Kellogg, MD; Lauren He, MD; & David Leverenz, MD

How to Play RheumMadness

Bracket submissions for the 2022 tournament will open in March 2022. For updates, you can join our email newsletter, listen to the RheumMadness Podcast, and/or join the conversation on Twitter using #RheumMadness. Important dates for RheumMadness 2022 are below:

Monday, March 14: Bracket entries open
Friday, March 24: Bracket entries close
Saturday, March 25: Round 1
Monday, March 28: Round 2
Saturday, April 2: Round 3
Monday, April 4: Round 4

Want to learn more about RheumMadness?

For a quick summary, head to our “What is RheumMadness?” page, read our write-up in the July 2021 issue of The Rheumatologist, or just watch the 4-minute explainer video below:

RheumMadness 2022 Regions

Posted on February 9, 2022 by David Leverenz

RheumMadness 2022 is all about the Planet of the Rheumatologists.

Over 70 collaborators from 13 institutions wrote the scouting reports for RheumMadness 2022. This includes 43 fellows, 23 faculty, 3 residents, and 1 medical student. What an amazing collaboration!

We are also thankful to collaborate with the editorial staff of the Rheumatologist. Starting February 15, the scouting reports for each region in RheumMadness 2022 will be sent out on a weekly basis. We will also post links here.

Scouting Report Archive

Click here if you’d like to review the scouting reports from RheumMadness 2021

Meet the 2022 Leadership Team

Posted on February 9, 2022 by David Leverenz

RheumMadness is growing, and that includes our leadership team. The 2022 leadership team includes some familiar faces and some new ones. We want RheumMadness to engage everyone who is crazy about rheumatology, from attendings to medical students. That’s why our leadership team has attendings, fellows, residents, and even a medical student!

RheumMadness Leadership

David Leverenz, MD is the creator and director of RheumMadness. He is an Assistant Professor of Medicine at Duke University School of Medicine, Department of Medicine, Division of Rheumatology and Immunology.

Akrithi Udupa Garren, MD serves on the RheumMadness Leadership Team and is the leader of the Machines Region. She is an Assistant Professor of Medicine at Medstar / Georgetown Washington Hospital Center.

Guy Katz, MD serves on the RheumMadness Leadership Team and is the leader of the Cells Region. He is a second year rheumatology fellow at Massachusetts General Hospital (MGH).

Lauren He, MD serves on the RheumMadness Leadership Team and is the leader of the People Region. She is a third year internal medicine resident at the University of Chicago School of Medicine.

Ben Kellog, MD serves on the RheumMadness Leadership Team and is the leader of the Animal House Region. He is a second year internal medicine resident at Duke University School of Medicine.

Michael Macklin, MD serves on the RheumMadness Leadership Team as a resident contributor. He is a third year internal medicine resident at the University of Pittsburg Medical Center.

Courtney Bair serves on the RheumMadness Leadership Team as our medical student advisor. She is a second year medical student at Duke University School of Medicine.

Lisa Criscione-Schreiber, MD, MEd is an advisor and mentor for RheumMadness. She is a Professor of Medicine at Duke University School of Medicine, Department of Medicine, Division of Rheumatology and Immunology.

Matthew Sparks, MD is the creator of NephMadness and serves an advisor and mentor for RheumMadness. He is an Associate Professor of Medicine at Duke University School of Medicine, Department of Medicine, Division of Nephrology.

Thank you also to past members of our leadership team from RheumMadness 2021, Didem Saygin and Allen Whitt.

Welcome Back!

Posted on July 15, 2021 by David Leverenz

Welcome to RheumMadness – the place for everyone who is crazy about rheumatology to connect, collaborate, compete, and learn together. RheumMadness is a project funded by a Clinician Scholar Educator Award from the Rheumatology Research Foundation and inspired by a similar project in nephrology called NephMadness.

We had an amazing 2021 tournament and we are looking forward to an even bigger and better 2022 season. Keep reading to learn more.

RheumMadness in the Rheumatologist!

We were thrilled to have RheumMadness featured in the July 2021 issue of The Rheumatologist. Read it here!

Join our Team!

We are looking for rheumatology educators of all types – attendings, fellows, residents, medical students, advanced practice providers, etc – to join our leadership team to create the 2022 tournament. Please contact us at David.Leverenz@Duke.edu or find us on Twitter (@DavidLeverenz).

In addition, we are looking for fellowship programs to help us write the scouting reports for the 2022 tournament. This was a huge success in RheumMadness 2021 – the fellows that participated learned AND had fun! Learn more about this by clicking “Info for Fellowships.”

How does RheumMadness work?

The main event of RheumMadness is a tournament of rheumatology concepts that occurs every year in March. The RheumMadness bracket is comprised of rheumatology concepts that compete against each other just like basketball teams in the NCAA March Madness tournaments. The winner of each match-up is decided by a blue ribbon panel of rheumatology experts who will vote to determine which topic they think is most important to patients, providers, researchers, both now and in the future.

Before the tournament starts, you will get a chance to learn about each team by reading scouting reports created by rheumatology fellows from fellowship programs all over the country that review the strengths and weaknesses of each team. You can also learn more by subscribing to the RheumMadness podcast, available wherever you get your podcasts.

For a quick summary, watch the 4-minute explainer video below:

How to connect with RheumMadness

Even when the tournament is not happening, there is always something going on in the RheumMadness community! Here are some ways to connect.

Subscribe to the RheumMadness Podcast, available wherever you get your podcasts.
Check out #RheumMadness on Twitter to follow the latest updates and conversation.
For rheumatology fellows, internal medicine residents, medical students, advanced practice provider trainees, or any other trainee interested in rheumatology, please join the private RheumMadness Facebook group to connect with your peers!

RheumMadness Leadership

Akrithi Udupa, MD serves on the RheumMadness Leadership Team. She is a second year rheumatology fellow at Duke University School of Medicine.

Guy Katz, MD serves on the RheumMadness Leadership Team. He is a first year rheumatology fellow at Massachusetts General Hospital (MGH).

Didem Saygin, MD serves on the RheumMadness Leadership Team. She is a first year rheumatology fellow at the University of Chicago.

Christopher “Allen” Witt, MD serves on the RheumMadness Leadership Team. He is a third year internal medicine resident at Duke University School of Medicine.

Matthew Sparks, MD is the creator of NephMadness and serves an advisor and mentor for RheumMadness. He is an Assistant Professor of Medicine at Duke University School of Medicine, Department of Medicine, Division of Nephrology.

Interleukin Two Results!

Posted on April 5, 2021 by David Leverenz

The Rheum Ribbon Panel votes for the Interleukin Two (final round) are here! Avacopan has been crowned the winning rheumatology concept, and congratulations to Rheum Boss for having a perfect bracket in the first ever RheumMadness tournament. But the real winners are all the participants who engaged in a collaborative learning experience with the rheumatology community. This was so much fun!

What’s Next?

All participants will receive a Qualtrics survey invitation so we can learn from this year’s tournament and make it even better next year. We are interested in hearing everyone’s responses, from those who tweeted every day about RheumMadness to those who submitted a bracket last minute and are not on social media. Tell us what you think!

The Results

Keep scrolling to find out how your bracket is doing, then tell us your reaction on Twitter and/or the Facebook group using #RheumMadness. You can also find even more detailed bracket results directly on the Challonge website here: https://challonge.com/RheumMadness2021/predictions

Click here for a downloadable PDF of the Interleukin Two results

How did your bracket do?

Each bracket title is a link that takes you to the Challonge.com site where you will be able to see all of the predictions entered for that bracket.

	Rank	Score	Picks
Rheum BOSS Avacopan, FAST Study, VEXAS, SEMIRA	1	32	15 / 15
No Rheum For Error Avacopan, FAST Study, VEXAS, PT vs. GC Injection for Knee OA	2	30	14 / 15
May the best man win! Avacopan, FAST Study, VEXAS, SEMIRA	3	30	13 / 15
Sinead Maguire Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	4	29	13 / 15
Advocate FTW Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	4	29	13 / 15
Avacopan ftw Avacopan, FAST Study, VEXAS, SEMIRA	6	29	12 / 15
Cut the nets/steoids Avacopan, SEMIRA, VEXAS, FAST Study	7	28	14 / 15
RheumMadnessIsAwesome Avacopan, SEMIRA, VEXAS, FAST Study	7	28	14 / 15
RheumWins Avacopan, SEMIRA, VEXAS, FAST Study	7	28	14 / 15
Rheumothorax Avacopan, FAST Study, VEXAS, PT vs. GC Injection for Knee OA	10	28	12 / 15
Rookie C5a inhibitor edges out SAMIRA with its promise of vasculitis remission AND less steroids. A finals match-up showing that we are FINALly moving beyond high dose steroids. Avacopan, SEMIRA, VEXAS, FAST Study	11	27	13 / 15
KWB Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	12	27	11 / 15
Prednisone is Poison — mightymab Avacopan, FAST Study, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	13	26	11 / 15
DFM Avacopan, PRIME Cells, VEXAS, SEMIRA	14	25	12 / 15
CCHMC Peds Rheum Fellows Avacopan, SEMIRA, VEXAS, Synovial B Cells & Therapy Response	14	25	12 / 15
Game of Madness: To Conquer to Rule Avacopan, SEMIRA, VEXAS, Synovial B Cells & Therapy Response	14	25	12 / 15
Dr. Willie Avacopan, Synovial B Cells & Therapy Response, VEXAS, SEMIRA	14	25	12 / 15
What’s a bracket? Avacopan, ACR Gout Guidelines, VEXAS, SEMIRA	14	25	12 / 15
Untitled Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	19	25	9 / 15
AvaPoCan! — Thanks4theComplement Avacopan, SEMIRA, VEXAS, ACR Gout Guidelines	20	24	11 / 15
My Winning Prediction — StephenSlade Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	21	23	11 / 15
Just Dua It Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	21	23	11 / 15
Avocopan Avengers Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	21	23	11 / 15
Avacopan Beats Knee PT at the Buzzer Avacopan, PT vs. GC Injection for Knee OA, IgG4-RD Classification Criteria, FAST Study	21	23	11 / 15
Ruairí Floyd Prediction Avacopan, Harms of Short Term Steroids, VEXAS, PRIME Cells	25	22	10 / 15
Didem Avacopan, PRIME Cells, VEXAS, Harms of Short Term Steroids	25	22	10 / 15
All About Avacopan Avacopan, PT vs. GC Injection for Knee OA, VEXAS, ACR Gout Guidelines	25	22	10 / 15
Perry Fuchs’ Bracket Avacopan, ACR Gout Guidelines, Anti-CD38 in Refractory SLE, SEMIRA	25	22	10 / 15
CYCBI — ChangUCanSpare Avacopan, SEMIRA, Anti-CD38 in Refractory SLE, Synovial B Cells & Therapy Response	25	22	10 / 15
Rheum’sYourDaddy Avacopan, Synovial B Cells & Therapy Response, VEXAS, PT vs. GC Injection for Knee OA	25	22	10 / 15
Irelande Douze Pointes Avacopan, Harms of Short Term Steroids, VEXAS, FAST Study	31	22	9 / 15
psufka — paulsufka Avacopan, UK Frost for Frozen Shoulder, IgG4-RD Classification Criteria, FAST Study	32	21	9 / 15
Avacopanhandle Avacopan, PRIME Cells, VEXAS, Harms of Short Term Steroids	32	21	9 / 15
Rheumania Avacopan, Harms of Short Term Steroids, VEXAS, Synovial B Cells & Therapy Response	32	21	9 / 15
“Bye Bye Bye” Steroids Avacopan, ACR Gout Guidelines, IgG4-RD Classification Criteria, Harms of Short Term Steroids	35	20	9 / 15
XxFlare_BearxX Avacopan, ACR Gout Guidelines, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	35	20	9 / 15
Nostradamus Avacopan, PRIME Cells, VEXAS, Harms of Short Term Steroids	37	20	8 / 15
Penelope Proactive Patient’s Prediction Avacopan, PT vs. GC Injection for Knee OA, VEXAS, ACR Gout Guidelines	37	20	8 / 15
Rheumba Avacopan, ACR Gout Guidelines, Anti-CD38 in Refractory SLE, SEMIRA	37	20	8 / 15
Rheum’sYourDaddy Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	37	20	8 / 15
Rheum for Rheum Madness Avacopan, ACR Gout Guidelines, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	41	19	8 / 15
GoComplements — saikrishna133 Avacopan, Harms of Short Term Steroids, IgG4-RD Classification Criteria, Synovial B Cells & Therapy Response	41	19	8 / 15
Avacopan for ANCA vasculitis… now have to spell it right! (not “avacpoan” like on the list here https://sites.duke.edu/rheummadness/bracket-and-scouting-reports/ :)) Avacopan, Synovial B Cells & Therapy Response, VEXAS, Harms of Short Term Steroids	43	19	7 / 15
Resident gone (Rheum)Mad SEMIRA, Avacopan, VEXAS, FAST Study	44	18	11 / 15
Fabulous FebuX — magnifique2020 FAST Study, Avacopan, IgG4-RD Classification Criteria, UK Frost for Frozen Shoulder	45	18	10 / 15
Rheumie Avacopan, ACR Gout Guidelines, Anti-CD38 in Refractory SLE, Harms of Short Term Steroids	46	18	7 / 15
Vasculitis winner PEXIVAS, FAST Study, VEXAS, SEMIRA	47	17	11 / 15
Blys FTW Belimumab for Lupus Nephritis, FAST Study, VEXAS, SEMIRA	48	16	10 / 15
Untitled PEXIVAS, FAST Study, VEXAS, PT vs. GC Injection for Knee OA	49	15	10 / 15
Vexas for win VEXAS, FAST Study, Belimumab for Lupus Nephritis, SEMIRA	50	15	9 / 15
Rheum_L VEXAS, PRIME Cells, Avacopan, SEMIRA	51	14	11 / 15
LeadershipTest — DavidLeverenz FAST Study, RP Subtypes, Avacopan, PT vs. GC Injection for Knee OA	52	14	9 / 15
Criscione for the “W” PEXIVAS, FAST Study, IgG4-RD Classification Criteria, SEMIRA	52	14	9 / 15
Get VEXED by VEXAS! VEXAS, FAST Study, PEXIVAS, PT vs. GC Injection for Knee OA	52	14	9 / 15
Belim u me Belimumab for Lupus Nephritis, FAST Study, VEXAS, Harms of Short Term Steroids	52	14	9 / 15
ESR — esr_ VEXAS, SEMIRA, Avacopan, ACR Gout Guidelines	56	13	10 / 15
Guy Katz VEXAS, PRIME Cells, Avacopan, SEMIRA	56	13	10 / 15
gOUTisIN ACR Gout Guidelines, Avacopan, VEXAS, PT vs. GC Injection for Knee OA	58	13	8 / 15
idkijustlikegout ACR Gout Guidelines, Avacopan, VEXAS, PT vs. GC Injection for Knee OA	58	13	8 / 15
Void the ‘Roid SEMIRA, Avacopan, RP Subtypes, FAST Study	60	13	7 / 15
Tincan VEXAS, PT vs. GC Injection for Knee OA, Avacopan, FAST Study	61	12	9 / 15
Roid Rules Synovial B Cells & Therapy Response, VEXAS, Avacopan, SEMIRA	61	12	9 / 15
No Rheum for Steroids! PEXIVAS, FAST Study, Anti-CD38 in Refractory SLE, SEMIRA	63	12	7 / 15
NETosis: what is dead may never die VEXAS, SEMIRA, Belimumab for Lupus Nephritis, PRIME Cells	64	11	9 / 15
PLEXING CAN BE TAXING AND NEEDLESS ESPECIALLY ON THE BEANS!!! PEXIVAS, PT vs. GC Injection for Knee OA, VEXAS, FAST Study	64	11	9 / 15
CAT Harms of Short Term Steroids, VEXAS, Avacopan, FAST Study	66	11	8 / 15
Pexivasteroids are overrated PEXIVAS, FAST Study, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	67	11	7 / 15
Going all the way VEXAS, SEMIRA, Belimumab for Lupus Nephritis, ACR Gout Guidelines	68	10	8 / 15
Rheum’s GOAT Belimumab for Lupus Nephritis, SEMIRA, VEXAS, ACR Gout Guidelines	68	10	8 / 15
Rheum service VEXAS, PRIME Cells, PEXIVAS, SEMIRA	68	10	8 / 15
PR3-Pointer PEXIVAS, SEMIRA, VEXAS, Synovial B Cells & Therapy Response	68	10	8 / 15
Rheum for improvement VEXAS, PRIME Cells, Belimumab for Lupus Nephritis, SEMIRA	68	10	8 / 15
NAR — NAR12 Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	73	9	8 / 15
Rheum To Improve PEXIVAS, SEMIRA, IgG4-RD Classification Criteria, PRIME Cells	73	9	8 / 15
Adam Taylor PEXIVAS, Harms of Short Term Steroids, VEXAS, FAST Study	75	9	7 / 15
Doodle Harms of Short Term Steroids, VEXAS, Avacopan, PRIME Cells	75	9	7 / 15
Wait, this isn’t NephMadness… VEXAS, Harms of Short Term Steroids, Avacopan, Synovial B Cells & Therapy Response	75	9	7 / 15
Rheum Warrior PEXIVAS, SEMIRA, VEXAS, ACR Gout Guidelines	75	9	7 / 15
Killing the wolf : Beyond steroids Belimumab for Lupus Nephritis, Synovial B Cells & Therapy Response, VEXAS, SEMIRA	75	9	7 / 15
U of RA PRIME Cells, VEXAS, PEXIVAS, PT vs. GC Injection for Knee OA	80	8	7 / 15
BadgerRheum Belimumab for Lupus Nephritis, Synovial B Cells & Therapy Response, VEXAS, UK Frost for Frozen Shoulder	80	8	7 / 15
Blysfull thinking — patelaarat Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	80	8	7 / 15
Nayan Arora Belimumab for Lupus Nephritis, SEMIRA, Anti-CD38 in Refractory SLE, PRIME Cells	80	8	7 / 15
Going BLYSful Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	80	8	7 / 15
T-Rex cell in Helper CT VEXAS, PRIME Cells, Avacopan, Harms of Short Term Steroids	85	8	6 / 15
SLE For the Win Anti-CD38 in Refractory SLE, PRIME Cells, Belimumab for Lupus Nephritis, PT vs. GC Injection for Knee OA	86	7	7 / 15
CINDERELLA SEMIRA	86	7	7 / 9
christian laettner’s buzzer beater VEXAS, PRIME Cells, PEXIVAS, UK Frost for Frozen Shoulder	88	7	6 / 15
Wiseguy PEXIVAS, Harms of Short Term Steroids, IgG4-RD Classification Criteria, FAST Study	88	7	6 / 15
The Rheum Dark Horse PEXIVAS, SEMIRA, IgG4-RD Classification Criteria, ACR Gout Guidelines	88	7	6 / 15
UBA-WON VEXAS, ACR Gout Guidelines, PEXIVAS, Harms of Short Term Steroids	88	7	6 / 15
iheartkidneys Belimumab for Lupus Nephritis, ACR Gout Guidelines, VEXAS, Harms of Short Term Steroids	88	7	6 / 15
Stacy Bagrova PEXIVAS, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	88	7	6 / 15
SJB Belimumab for Lupus Nephritis, PRIME Cells, IgG4-RD Classification Criteria, Harms of Short Term Steroids	94	6	6 / 15
U of RheUtahlogy — ShrewdFanfare ACR Gout Guidelines, Belimumab for Lupus Nephritis, Anti-CD38 in Refractory SLE, PT vs. GC Injection for Knee OA	94	6	6 / 15
Blissful champion Belimumab for Lupus Nephritis, PRIME Cells, IgG4-RD Classification Criteria, Harms of Short Term Steroids	94	6	6 / 15
Rheum 2 Grow PEXIVAS, ACR Gout Guidelines, VEXAS, PT vs. GC Injection for Knee OA	97	6	5 / 15
Phat Jointz PT vs. GC Injection for Knee OA, PEXIVAS, Anti-CD38 in Refractory SLE, FAST Study	97	6	5 / 15
Rheuminator 3: Rise of the MABs VEXAS, PRIME Cells, PEXIVAS, Harms of Short Term Steroids	97	6	5 / 15
Rheuma-zooma-tology Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	97	6	5 / 15
Untitled PEXIVAS, ACR Gout Guidelines, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	101	5	5 / 15
Matthew Sparks ACR Gout Guidelines, PEXIVAS, VEXAS, Harms of Short Term Steroids	102	5	4 / 15
Rheumatology is our daddy VEXAS, ACR Gout Guidelines, Belimumab for Lupus Nephritis, Harms of Short Term Steroids	102	5	4 / 15
B -cause B cells are the BEST! Synovial B Cells & Therapy Response, IgG4-RD Classification Criteria, PEXIVAS, SEMIRA	102	5	4 / 15
Rheum Over Milwaukee PEXIVAS, Synovial B Cells & Therapy Response, VEXAS, Harms of Short Term Steroids	102	5	4 / 15
LeadershipTest2 Belimumab for Lupus Nephritis, Harms of Short Term Steroids, IgG4-RD Classification Criteria, PRIME Cells	106	4	4 / 15
Cut it gout you guys ACR Gout Guidelines, IgG4-RD Classification Criteria, Belimumab for Lupus Nephritis, Harms of Short Term Steroids	106	4	4 / 15
WHY PLEXING IS VEXING?? PEXIVAS, PT vs. GC Injection for Knee OA,	108	3	3 / 8
Synovial B cells Synovial B Cells & Therapy Response, Anifrolumab, Anti-CD38 in Refractory SLE, Harms of Short Term Steroids	109	1	1 / 15

IgG Four Results!

Posted on April 3, 2021 by David Leverenz

The Rheum Ribbon Panel votes for the IgG Four (round 3) are shown below (winners in orange).

Keep scrolling to find out how your bracket is doing, then tell us your reaction on Twitter and/or the Facebook group using #RheumMadness.

Click here for a downloadable PDF of the IgG Four results

Next up:

Championship (the Interleukin Two) results will be released Monday, 4/5 at 8pm ET.

How is your bracket doing?

Scroll down to find your bracket title, rank, score, and the score potential that you could end up with if all of the rest of your picks are correct.

Each bracket title is a link that takes you to the Challonge.com site where you will be able to see all of the predictions entered for that bracket. Try clicking on some of the leaders and to guess who you think might win!

Note: Some of the brackets were not given a title when they were submitted. If you can’t find your bracket (or you don’t remember what you named it), please email david.leverenz@duke.edu and we will help you find and/or name your bracket.

You can also find even more detailed bracket results directly on the Challonge website here: https://challonge.com/RheumMadness2021/predictions

	Rank	Score	Score Potential
Rheum BOSS Avacopan, FAST Study, VEXAS, SEMIRA	1	24	32
No Rheum For Error Avacopan, FAST Study, VEXAS, PT vs. GC Injection for Knee OA	2	22	30
May the best man win! Avacopan, FAST Study, VEXAS, SEMIRA	3	22	30
Sinead Maguire Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	4	21	29
Advocate FTW Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	4	21	29
Avacopan ftw Avacopan, FAST Study, VEXAS, SEMIRA	6	21	29
Cut the nets/steoids Avacopan, SEMIRA, VEXAS, FAST Study	7	20	28
RheumMadnessIsAwesome Avacopan, SEMIRA, VEXAS, FAST Study	7	20	28
RheumWins Avacopan, SEMIRA, VEXAS, FAST Study	7	20	28
Rheumothorax Avacopan, FAST Study, VEXAS, PT vs. GC Injection for Knee OA	10	20	28
Rookie C5a inhibitor edges out SAMIRA with its promise of vasculitis remission AND less steroids. A finals match-up showing that we are FINALly moving beyond high dose steroids. Avacopan, SEMIRA, VEXAS, FAST Study	11	19	27
KWB Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	12	19	27
Resident gone (Rheum)Mad SEMIRA, Avacopan, VEXAS, FAST Study	13	18	18
Fabulous FebuX — magnifique2020 FAST Study, Avacopan, IgG4-RD Classification Criteria, UK Frost for Frozen Shoulder	14	18	26
Prednisone is Poison — mightymab Avacopan, FAST Study, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	14	18	26
DFM Avacopan, PRIME Cells, VEXAS, SEMIRA	16	17	25
CCHMC Peds Rheum Fellows Avacopan, SEMIRA, VEXAS, Synovial B Cells & Therapy Response	16	17	25
Game of Madness: To Conquer to Rule Avacopan, SEMIRA, VEXAS, Synovial B Cells & Therapy Response	16	17	25
Dr. Willie Avacopan, Synovial B Cells & Therapy Response, VEXAS, SEMIRA	16	17	25
What’s a bracket? Avacopan, ACR Gout Guidelines, VEXAS, SEMIRA	16	17	25
Vasculitis winner PEXIVAS, FAST Study, VEXAS, SEMIRA	21	17	17
Untitled Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	22	17	25
AvaPoCan! — Thanks4theComplement Avacopan, SEMIRA, VEXAS, ACR Gout Guidelines	23	16	24
Blys FTW Belimumab for Lupus Nephritis, FAST Study, VEXAS, SEMIRA	24	16	16
My Winning Prediction — StephenSlade Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	25	15	23
Just Dua It Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	25	15	23
Avocopan Avengers Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	25	15	23
Avacopan Beats Knee PT at the Buzzer Avacopan, PT vs. GC Injection for Knee OA, IgG4-RD Classification Criteria, FAST Study	25	15	23
Untitled PEXIVAS, FAST Study, VEXAS, PT vs. GC Injection for Knee OA	29	15	15
Vexas for win VEXAS, FAST Study, Belimumab for Lupus Nephritis, SEMIRA	30	15	15
Rheum_L VEXAS, PRIME Cells, Avacopan, SEMIRA	31	14	14
LeadershipTest — DavidLeverenz FAST Study, RP Subtypes, Avacopan, PT vs. GC Injection for Knee OA	32	14	22
Ruairí Floyd Prediction Avacopan, Harms of Short Term Steroids, VEXAS, PRIME Cells	32	14	22
Didem Avacopan, PRIME Cells, VEXAS, Harms of Short Term Steroids	32	14	22
All About Avacopan Avacopan, PT vs. GC Injection for Knee OA, VEXAS, ACR Gout Guidelines	32	14	22
Perry Fuchs’ Bracket Avacopan, ACR Gout Guidelines, Anti-CD38 in Refractory SLE, SEMIRA	32	14	22
CYCBI — ChangUCanSpare Avacopan, SEMIRA, Anti-CD38 in Refractory SLE, Synovial B Cells & Therapy Response	32	14	22
Rheum’sYourDaddy Avacopan, Synovial B Cells & Therapy Response, VEXAS, PT vs. GC Injection for Knee OA	32	14	22
Criscione for the “W” PEXIVAS, FAST Study, IgG4-RD Classification Criteria, SEMIRA	39	14	14
Get VEXED by VEXAS! VEXAS, FAST Study, PEXIVAS, PT vs. GC Injection for Knee OA	39	14	14
Belim u me Belimumab for Lupus Nephritis, FAST Study, VEXAS, Harms of Short Term Steroids	39	14	14
Irelande Douze Pointes Avacopan, Harms of Short Term Steroids, VEXAS, FAST Study	42	14	22
ESR — esr_ VEXAS, SEMIRA, Avacopan, ACR Gout Guidelines	43	13	13
Guy Katz VEXAS, PRIME Cells, Avacopan, SEMIRA	43	13	13
psufka — paulsufka Avacopan, UK Frost for Frozen Shoulder, IgG4-RD Classification Criteria, FAST Study	45	13	21
Avacopanhandle Avacopan, PRIME Cells, VEXAS, Harms of Short Term Steroids	45	13	21
Rheumania Avacopan, Harms of Short Term Steroids, VEXAS, Synovial B Cells & Therapy Response	45	13	21
gOUTisIN ACR Gout Guidelines, Avacopan, VEXAS, PT vs. GC Injection for Knee OA	48	13	13
idkijustlikegout ACR Gout Guidelines, Avacopan, VEXAS, PT vs. GC Injection for Knee OA	48	13	13
Void the ‘Roid SEMIRA, Avacopan, RP Subtypes, FAST Study	50	13	13
Tincan VEXAS, PT vs. GC Injection for Knee OA, Avacopan, FAST Study	51	12	12
Roid Rules Synovial B Cells & Therapy Response, VEXAS, Avacopan, SEMIRA	51	12	12
“Bye Bye Bye” Steroids Avacopan, ACR Gout Guidelines, IgG4-RD Classification Criteria, Harms of Short Term Steroids	53	12	20
XxFlare_BearxX Avacopan, ACR Gout Guidelines, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	53	12	20
Nostradamus Avacopan, PRIME Cells, VEXAS, Harms of Short Term Steroids	55	12	20
Penelope Proactive Patient’s Prediction Avacopan, PT vs. GC Injection for Knee OA, VEXAS, ACR Gout Guidelines	55	12	20
Rheumba Avacopan, ACR Gout Guidelines, Anti-CD38 in Refractory SLE, SEMIRA	55	12	20
Rheum’sYourDaddy Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	55	12	20
No Rheum for Steroids! PEXIVAS, FAST Study, Anti-CD38 in Refractory SLE, SEMIRA	59	12	12
NETosis: what is dead may never die VEXAS, SEMIRA, Belimumab for Lupus Nephritis, PRIME Cells	60	11	11
PLEXING CAN BE TAXING AND NEEDLESS ESPECIALLY ON THE BEANS!!! PEXIVAS, PT vs. GC Injection for Knee OA, VEXAS, FAST Study	60	11	11
CAT Harms of Short Term Steroids, VEXAS, Avacopan, FAST Study	62	11	11
Rheum for Rheum Madness Avacopan, ACR Gout Guidelines, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	63	11	19
GoComplements — saikrishna133 Avacopan, Harms of Short Term Steroids, IgG4-RD Classification Criteria, Synovial B Cells & Therapy Response	63	11	19
Pexivasteroids are overrated PEXIVAS, FAST Study, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	65	11	11
Avacopan for ANCA vasculitis… now have to spell it right! Avacopan, Synovial B Cells & Therapy Response, VEXAS, Harms of Short Term Steroids	66	11	19
Going all the way VEXAS, SEMIRA, Belimumab for Lupus Nephritis, ACR Gout Guidelines	67	10	10
Rheum’s GOAT Belimumab for Lupus Nephritis, SEMIRA, VEXAS, ACR Gout Guidelines	67	10	10
Rheum service VEXAS, PRIME Cells, PEXIVAS, SEMIRA	67	10	10
PR3-Pointer PEXIVAS, SEMIRA, VEXAS, Synovial B Cells & Therapy Response	67	10	10
Rheum for improvement VEXAS, PRIME Cells, Belimumab for Lupus Nephritis, SEMIRA	67	10	10
Rheumie Avacopan, ACR Gout Guidelines, Anti-CD38 in Refractory SLE, Harms of Short Term Steroids	72	10	18
NAR — NAR12 Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	73	9	9
Rheum To Improve PEXIVAS, SEMIRA, IgG4-RD Classification Criteria, PRIME Cells	73	9	9
Adam Taylor PEXIVAS, Harms of Short Term Steroids, VEXAS, FAST Study	75	9	9
Doodle Harms of Short Term Steroids, VEXAS, Avacopan, PRIME Cells	75	9	9
Wait, this isn’t NephMadness… VEXAS, Harms of Short Term Steroids, Avacopan, Synovial B Cells & Therapy Response	75	9	9
Rheum Warrior PEXIVAS, SEMIRA, VEXAS, ACR Gout Guidelines	75	9	9
Killing the wolf : Beyond steroids Belimumab for Lupus Nephritis, Synovial B Cells & Therapy Response, VEXAS, SEMIRA	75	9	9
U of RA PRIME Cells, VEXAS, PEXIVAS, PT vs. GC Injection for Knee OA	80	8	8
BadgerRheum Belimumab for Lupus Nephritis, Synovial B Cells & Therapy Response, VEXAS, UK Frost for Frozen Shoulder	80	8	8
Blysfull thinking — patelaarat Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	80	8	8
Nayan Arora Belimumab for Lupus Nephritis, SEMIRA, Anti-CD38 in Refractory SLE, PRIME Cells	80	8	8
Going BLYSful Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	80	8	8
T-Rex cell in Helper CT VEXAS, PRIME Cells, Avacopan, Harms of Short Term Steroids	85	8	8
SLE For the Win Anti-CD38 in Refractory SLE, PRIME Cells, Belimumab for Lupus Nephritis, PT vs. GC Injection for Knee OA	86	7	7
CINDERELLA SEMIRA	86	7	7
christian laettner’s buzzer beater VEXAS, PRIME Cells, PEXIVAS, UK Frost for Frozen Shoulder	88	7	7
Wiseguy PEXIVAS, Harms of Short Term Steroids, IgG4-RD Classification Criteria, FAST Study	88	7	7
The Rheum Dark Horse PEXIVAS, SEMIRA, IgG4-RD Classification Criteria, ACR Gout Guidelines	88	7	7
UBA-WON VEXAS, ACR Gout Guidelines, PEXIVAS, Harms of Short Term Steroids	88	7	7
iheartkidneys Belimumab for Lupus Nephritis, ACR Gout Guidelines, VEXAS, Harms of Short Term Steroids	88	7	7
Stacy Bagrova PEXIVAS, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	88	7	7
SJB Belimumab for Lupus Nephritis, PRIME Cells, IgG4-RD Classification Criteria, Harms of Short Term Steroids	94	6	6
U of RheUtahlogy — ShrewdFanfare ACR Gout Guidelines, Belimumab for Lupus Nephritis, Anti-CD38 in Refractory SLE, PT vs. GC Injection for Knee OA	94	6	6
Blissful champion Belimumab for Lupus Nephritis, PRIME Cells, IgG4-RD Classification Criteria, Harms of Short Term Steroids	94	6	6
Rheum 2 Grow PEXIVAS, ACR Gout Guidelines, VEXAS, PT vs. GC Injection for Knee OA	97	6	6
Phat Jointz PT vs. GC Injection for Knee OA, PEXIVAS, Anti-CD38 in Refractory SLE, FAST Study	97	6	6
Rheuminator 3: Rise of the MABs VEXAS, PRIME Cells, PEXIVAS, Harms of Short Term Steroids	97	6	6
Rheuma-zooma-tology Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	97	6	6
Untitled PEXIVAS, ACR Gout Guidelines, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	101	5	5
Matthew Sparks ACR Gout Guidelines, PEXIVAS, VEXAS, Harms of Short Term Steroids	102	5	5
Rheumatology is our daddy VEXAS, ACR Gout Guidelines, Belimumab for Lupus Nephritis, Harms of Short Term Steroids	102	5	5
B -cause B cells are the BEST! Synovial B Cells & Therapy Response, IgG4-RD Classification Criteria, PEXIVAS, SEMIRA	102	5	5
Rheum Over Milwaukee PEXIVAS, Synovial B Cells & Therapy Response, VEXAS, Harms of Short Term Steroids	102	5	5
LeadershipTest2 Belimumab for Lupus Nephritis, Harms of Short Term Steroids, IgG4-RD Classification Criteria, PRIME Cells	106	4	4
Cut it gout you guys ACR Gout Guidelines, IgG4-RD Classification Criteria, Belimumab for Lupus Nephritis, Harms of Short Term Steroids	106	4	4
WHY PLEXING IS VEXING?? PEXIVAS, PT vs. GC Injection for Knee OA,	108	3	3
Synovial B cells Synovial B Cells & Therapy Response, Anifrolumab, Anti-CD38 in Refractory SLE, Harms of Short Term Steroids	109	1	1

Entheseal Eight Results!

Posted on March 29, 2021 by David Leverenz

The Rheum Ribbon Panel votes for the Entheseal Eight (round 2) are shown below (winners in orange).

Keep scrolling to find out how your bracket is doing, then tell us your reaction on Twitter and/or the Facebook group using #RheumMadness. We will record a RheumMadness podcast episode on Tuesday evening summarizing rounds 1 and 2 and your reactions to the results.

Click here for a downloadable PDF of the Entheseal Eight results

Next up:

Round 3 (the IgG Four) results will be released Saturday, 4/3 at 2pm ET.
Round 4 (the Interleukin Two) results will be released Monday, 4/5 at 8pm ET.

How is your bracket doing?

Scroll down to find your bracket title, rank, score, and the score potential that you could end up with if all of the rest of your picks are correct.

You can also find even more detailed bracket results directly on the Challonge website here: https://challonge.com/RheumMadness2021/predictions

	Rank	Score	Score Potential
Rheum BOSS Avacopan, FAST Study, VEXAS, SEMIRA	1	16	32
Cut the nets/steoids Avacopan, SEMIRA, VEXAS, FAST Study	1	16	32
RheumMadnessIsAwesome Avacopan, SEMIRA, VEXAS, FAST Study	1	16	32
RheumWins Avacopan, SEMIRA, VEXAS, FAST Study	1	16	32
Rookie C5a inhibitor edges out SAMIRA with its promise of vasculitis remission AND less steroids. A finals match-up showing that we are FINALly moving beyond high dose steroids. Avacopan, SEMIRA, VEXAS, FAST Study	5	15	31
No Rheum For Error Avacopan, FAST Study, VEXAS, PT vs. GC Injection for Knee OA	6	14	30
Rheum_L VEXAS, PRIME Cells, Avacopan, SEMIRA	7	14	26
May the best man win! Avacopan, FAST Study, VEXAS, SEMIRA	8	14	30
Resident gone (Rheum)Mad SEMIRA, Avacopan, VEXAS, FAST Study	8	14	30
Sinead Maguire Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	10	13	29
CCHMC Peds Rheum Fellows Avacopan, SEMIRA, VEXAS, Synovial B Cells & Therapy Response	10	13	29
Game of Madness: To Conquer to Rule Avacopan, SEMIRA, VEXAS, Synovial B Cells & Therapy Response	10	13	29
Advocate FTW Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	10	13	29
ESR — esr_ VEXAS, SEMIRA, Avacopan, ACR Gout Guidelines	10	13	29
DFM Avacopan, PRIME Cells, VEXAS, SEMIRA	15	13	25
Guy Katz VEXAS, PRIME Cells, Avacopan, SEMIRA	15	13	25
Dr. Willie Avacopan, Synovial B Cells & Therapy Response, VEXAS, SEMIRA	15	13	25
What’s a bracket? Avacopan, ACR Gout Guidelines, VEXAS, SEMIRA	15	13	25
Vasculitis winner PEXIVAS, FAST Study, VEXAS, SEMIRA	19	13	17
Avacopan ftw Avacopan, FAST Study, VEXAS, SEMIRA	20	13	29
Rheumothorax Avacopan, FAST Study, VEXAS, PT vs. GC Injection for Knee OA	21	12	28
AvaPoCan! — Thanks4theComplement Avacopan, SEMIRA, VEXAS, ACR Gout Guidelines	21	12	28
Tincan VEXAS, PT vs. GC Injection for Knee OA, Avacopan, FAST Study	23	12	24
Roid Rules Synovial B Cells & Therapy Response, VEXAS, Avacopan, SEMIRA	24	12	16
Blys FTW Belimumab for Lupus Nephritis, FAST Study, VEXAS, SEMIRA	24	12	16
NETosis: what is dead may never die VEXAS, SEMIRA, Belimumab for Lupus Nephritis, PRIME Cells	26	11	27
My Winning Prediction — StephenSlade Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	27	11	23
Just Dua It Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	27	11	23
Avocopan Avengers Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	27	11	23
Avacopan Beats Knee PT at the Buzzer Avacopan, PT vs. GC Injection for Knee OA, IgG4-RD Classification Criteria, FAST Study	27	11	23
Untitled PEXIVAS, FAST Study, VEXAS, PT vs. GC Injection for Knee OA	31	11	15
PLEXING CAN BE TAXING AND NEEDLESS ESPECIALLY ON THE BEANS!!! PEXIVAS, PT vs. GC Injection for Knee OA, VEXAS, FAST Study	32	11	11
KWB Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	33	11	27
Vexas for win VEXAS, FAST Study, Belimumab for Lupus Nephritis, SEMIRA	33	11	27
CAT Harms of Short Term Steroids, VEXAS, Avacopan, FAST Study	35	11	15
Fabulous FebuX — magnifique2020 FAST Study, Avacopan, IgG4-RD Classification Criteria, UK Frost for Frozen Shoulder	36	10	26
Going all the way VEXAS, SEMIRA, Belimumab for Lupus Nephritis, ACR Gout Guidelines	36	10	26
Get VEXED by VEXAS! VEXAS, FAST Study, PEXIVAS, PT vs. GC Injection for Knee OA	36	10	26
CYCBI — ChangUCanSpare Avacopan, SEMIRA, Anti-CD38 in Refractory SLE, Synovial B Cells & Therapy Response	36	10	26
Prednisone is Poison — mightymab Avacopan, FAST Study, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	36	10	26
LeadershipTest — DavidLeverenz FAST Study, RP Subtypes, Avacopan, PT vs. GC Injection for Knee OA	41	10	22
Ruairí Floyd Prediction Avacopan, Harms of Short Term Steroids, VEXAS, PRIME Cells	41	10	22
Didem Avacopan, PRIME Cells, VEXAS, Harms of Short Term Steroids	41	10	22
All About Avacopan Avacopan, PT vs. GC Injection for Knee OA, VEXAS, ACR Gout Guidelines	41	10	22
Perry Fuchs’ Bracket Avacopan, ACR Gout Guidelines, Anti-CD38 in Refractory SLE, SEMIRA	41	10	22
Rheum service VEXAS, PRIME Cells, PEXIVAS, SEMIRA	41	10	22
Rheum’sYourDaddy Avacopan, Synovial B Cells & Therapy Response, VEXAS, PT vs. GC Injection for Knee OA	41	10	22
Rheum for improvement VEXAS, PRIME Cells, Belimumab for Lupus Nephritis, SEMIRA	41	10	22
Criscione for the “W” PEXIVAS, FAST Study, IgG4-RD Classification Criteria, SEMIRA	49	10	14
Rheum’s GOAT Belimumab for Lupus Nephritis, SEMIRA, VEXAS, ACR Gout Guidelines	49	10	14
Belim u me Belimumab for Lupus Nephritis, FAST Study, VEXAS, Harms of Short Term Steroids	49	10	14
PR3-Pointer PEXIVAS, SEMIRA, VEXAS, Synovial B Cells & Therapy Response	49	10	14
Irelande Douze Pointes Avacopan, Harms of Short Term Steroids, VEXAS, FAST Study	53	10	22
Rheum To Improve PEXIVAS, SEMIRA, IgG4-RD Classification Criteria, PRIME Cells	54	9	13
NAR — NAR12 Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	55	9	9
psufka — paulsufka Avacopan, UK Frost for Frozen Shoulder, IgG4-RD Classification Criteria, FAST Study	56	9	21
Avacopanhandle Avacopan, PRIME Cells, VEXAS, Harms of Short Term Steroids	56	9	21
Wait, this isn’t NephMadness… VEXAS, Harms of Short Term Steroids, Avacopan, Synovial B Cells & Therapy Response	56	9	21
Rheumania Avacopan, Harms of Short Term Steroids, VEXAS, Synovial B Cells & Therapy Response	56	9	21
Doodle Harms of Short Term Steroids, VEXAS, Avacopan, PRIME Cells	60	9	13
Rheum Warrior PEXIVAS, SEMIRA, VEXAS, ACR Gout Guidelines	60	9	13
gOUTisIN ACR Gout Guidelines, Avacopan, VEXAS, PT vs. GC Injection for Knee OA	60	9	13
idkijustlikegout ACR Gout Guidelines, Avacopan, VEXAS, PT vs. GC Injection for Knee OA	60	9	13
Adam Taylor PEXIVAS, Harms of Short Term Steroids, VEXAS, FAST Study	64	9	9
Killing the wolf : Beyond steroids Belimumab for Lupus Nephritis, Synovial B Cells & Therapy Response, VEXAS, SEMIRA	64	9	9
Void the ‘Roid SEMIRA, Avacopan, RP Subtypes, FAST Study	66	9	25
Untitled Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	66	9	25
“Bye Bye Bye” Steroids Avacopan, ACR Gout Guidelines, IgG4-RD Classification Criteria, Harms of Short Term Steroids	68	8	20
XxFlare_BearxX Avacopan, ACR Gout Guidelines, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	68	8	20
U of RA PRIME Cells, VEXAS, PEXIVAS, PT vs. GC Injection for Knee OA	70	8	12
Nayan Arora Belimumab for Lupus Nephritis, SEMIRA, Anti-CD38 in Refractory SLE, PRIME Cells	70	8	12
BadgerRheum Belimumab for Lupus Nephritis, Synovial B Cells & Therapy Response, VEXAS, UK Frost for Frozen Shoulder	72	8	8
Blysfull thinking — patelaarat Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	72	8	8
Going BLYSful Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	72	8	8
Nostradamus Avacopan, PRIME Cells, VEXAS, Harms of Short Term Steroids	75	8	20
Penelope Proactive Patient’s Prediction Avacopan, PT vs. GC Injection for Knee OA, VEXAS, ACR Gout Guidelines	75	8	20
Rheumba Avacopan, ACR Gout Guidelines, Anti-CD38 in Refractory SLE, SEMIRA	75	8	20
T-Rex cell in Helper CT VEXAS, PRIME Cells, Avacopan, Harms of Short Term Steroids	75	8	20
Rheum’sYourDaddy Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	75	8	20
No Rheum for Steroids! PEXIVAS, FAST Study, Anti-CD38 in Refractory SLE, SEMIRA	80	8	12
SLE For the Win Anti-CD38 in Refractory SLE, PRIME Cells, Belimumab for Lupus Nephritis, PT vs. GC Injection for Knee OA	81	7	7
CINDERELLA SEMIRA	81	7	7
Rheum for Rheum Madness Avacopan, ACR Gout Guidelines, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	83	7	19
christian laettner’s buzzer beater VEXAS, PRIME Cells, PEXIVAS, UK Frost for Frozen Shoulder	83	7	19
GoComplements — saikrishna133 Avacopan, Harms of Short Term Steroids, IgG4-RD Classification Criteria, Synovial B Cells & Therapy Response	83	7	19
UBA-WON VEXAS, ACR Gout Guidelines, PEXIVAS, Harms of Short Term Steroids	83	7	19
The Rheum Dark Horse PEXIVAS, SEMIRA, IgG4-RD Classification Criteria, ACR Gout Guidelines	87	7	11
Pexivasteroids are overrated PEXIVAS, FAST Study, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	87	7	11
Wiseguy PEXIVAS, Harms of Short Term Steroids, IgG4-RD Classification Criteria, FAST Study	89	7	7
Untitled Belimumab for Lupus Nephritis, ACR Gout Guidelines, VEXAS, Harms of Short Term Steroids	89	7	7
Stacy Bagrova PEXIVAS, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	89	7	7
Avacopan for ANCA vasculitis… now have to spell it right! Avacopan, Synovial B Cells & Therapy Response, VEXAS, Harms of Short Term Steroids	92	7	19
SJB Belimumab for Lupus Nephritis, PRIME Cells, IgG4-RD Classification Criteria, Harms of Short Term Steroids	93	6	6
U of RheUtahlogy — ShrewdFanfare ACR Gout Guidelines, Belimumab for Lupus Nephritis, Anti-CD38 in Refractory SLE, PT vs. GC Injection for Knee OA	93	6	6
Blissful champion Belimumab for Lupus Nephritis, PRIME Cells, IgG4-RD Classification Criteria, Harms of Short Term Steroids	93	6	6
Rheuminator 3: Rise of the MABs VEXAS, PRIME Cells, PEXIVAS, Harms of Short Term Steroids	96	6	18
Rheumie Avacopan, ACR Gout Guidelines, Anti-CD38 in Refractory SLE, Harms of Short Term Steroids	96	6	18
Rheum 2 Grow PEXIVAS, ACR Gout Guidelines, VEXAS, PT vs. GC Injection for Knee OA	98	6	6
Phat Jointz PT vs. GC Injection for Knee OA, PEXIVAS, Anti-CD38 in Refractory SLE, FAST Study	98	6	6
Rheuma-zooma-tology Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	98	6	6
Untitled PEXIVAS, ACR Gout Guidelines, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	101	5	5
Rheumatology is our daddy VEXAS, ACR Gout Guidelines, Belimumab for Lupus Nephritis, Harms of Short Term Steroids	102	5	17
Matthew Sparks ACR Gout Guidelines, PEXIVAS, VEXAS, Harms of Short Term Steroids	103	5	5
B -cause B cells are the BEST! Synovial B Cells & Therapy Response, IgG4-RD Classification Criteria, PEXIVAS, SEMIRA	103	5	5
Rheum Over Milwaukee PEXIVAS, Synovial B Cells & Therapy Response, VEXAS, Harms of Short Term Steroids	103	5	5
LeadershipTest2 Belimumab for Lupus Nephritis, Harms of Short Term Steroids, IgG4-RD Classification Criteria, PRIME Cells	106	4	4
Cut it gout you guys ACR Gout Guidelines, IgG4-RD Classification Criteria, Belimumab for Lupus Nephritis, Harms of Short Term Steroids	106	4	4
WHY PLEXING IS VEXING?? PEXIVAS, PT vs. GC Injection for Knee OA,	108	3	3
Synovial B cells Synovial B Cells & Therapy Response, Anifrolumab, Anti-CD38 in Refractory SLE, Harms of Short Term Steroids	109	1	1

Seronegative Sixteen Results!

Posted on March 27, 2021 by David Leverenz

The Blue Ribbon Panel votes for the Seronegative Sixteen (round 1) are shown below (winner in orange). This round was so close! Five of the match-ups were decided by a 4-3 vote.

Round 2 results will be released Monday, 4/29 at 8pm ET.

Click here for a downloadable PDF of the Seronegative Sixteen Results

Results can also be found here: https://challonge.com/RheumMadness2021

How is your bracket doing?

Scroll down to find your bracket title, rank, score, and the score potential that you could end up with if all of the rest of your picks are correct.

***Note*** – some of the brackets were not given a title when they were submitted. If you can’t find your bracket (or you don’t remember what you named it), please email david.leverenz@duke.edu and we will help you find and/or name your bracket.

You can also find bracket results directly on the Challonge website here: https://challonge.com/RheumMadness2021/predictions

Bracket Title (Final 4 Prediction with Winner Underlined)	Rank	Score	Score Potential
Rheum BOSS Avacopan, FAST Study, VEXAS, SEMIRA	1	8	32
Rheum_L VEXAS, PRIME Cells, Avacopan, SEMIRA	1	8	32
Cut the nets/steoids Avacopan, SEMIRA, VEXAS, FAST Study	1	8	32
RheumMadnessIsAwesome Avacopan, SEMIRA, VEXAS, FAST Study	1	8	32
RheumWins Avacopan, SEMIRA, VEXAS, FAST Study	1	8	32
No Rheum For Error Avacopan, FAST Study, VEXAS, PT vs. GC Injection for Knee OA	1	8	32
DFM Avacopan, PRIME Cells, VEXAS, SEMIRA	7	7	31
My Winning Prediction — StephenSlade Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	7	7	31
Just Dua It Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	7	7	31
NETosis: what is dead may never die VEXAS, SEMIRA, Belimumab for Lupus Nephritis, PRIME Cells	7	7	31
Guy Katz VEXAS, PRIME Cells, Avacopan, SEMIRA	7	7	31
Rookie C5a inhibitor edges out SAMIRA with its promise of vasculitis remission AND less steroids. A finals match-up showing that we are FINALly moving beyond high dose steroids. Avacopan, SEMIRA, VEXAS, FAST Study	7	7	31
Avocopan Avengers Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	7	7	31
Avacopan Beats Knee PT at the Buzzer Avacopan, PT vs. GC Injection for Knee OA, IgG4-RD Classification Criteria, FAST Study	7	7	31
Sinead Maguire Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	15	7	29
CCHMC Peds Rheum Fellows Avacopan, SEMIRA, VEXAS, Synovial B Cells & Therapy Response	15	7	29
Game of Madness: To Conquer to Rule Avacopan, SEMIRA, VEXAS, Synovial B Cells & Therapy Response	15	7	29
Advocate FTW Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	15	7	29
ESR — esr_ VEXAS, SEMIRA, Avacopan, ACR Gout Guidelines	15	7	29
NAR — NAR12 Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	20	7	25
Dr. Willie Avacopan, Synovial B Cells & Therapy Response, VEXAS, SEMIRA	20	7	25
What’s a bracket? Avacopan, ACR Gout Guidelines, VEXAS, SEMIRA	20	7	25
Untitled PEXIVAS, FAST Study, VEXAS, PT vs. GC Injection for Knee OA	23	7	17
SLE For the Win Anti-CD38 in Refractory SLE, PRIME Cells, Belimumab for Lupus Nephritis, PT vs. GC Injection for Knee OA	23	7	17
Vasculitis winner PEXIVAS, FAST Study, VEXAS, SEMIRA	23	7	17
Rheum To Improve PEXIVAS, SEMIRA, IgG4-RD Classification Criteria, PRIME Cells	23	7	17
PLEXING CAN BE TAXING AND NEEDLESS ESPECIALLY ON THE BEANS!!! PEXIVAS, PT vs. GC Injection for Knee OA, VEXAS, FAST Study	23	7	17
CINDERELLA SEMIRA	28	7	7
Tincan VEXAS, PT vs. GC Injection for Knee OA, Avacopan, FAST Study	29	6	30
Rheumothorax Avacopan, FAST Study, VEXAS, PT vs. GC Injection for Knee OA	29	6	30
May the best man win! Avacopan, FAST Study, VEXAS, SEMIRA	29	6	30
Blys FTW Belimumab for Lupus Nephritis, FAST Study, VEXAS, SEMIRA	29	6	30
Prednisone is Poison — mightymab Avacopan, FAST Study, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	29	6	30
Resident gone (Rheum)Mad SEMIRA, Avacopan, VEXAS, FAST Study	29	6	30
Rheum for improvement VEXAS, PRIME Cells, Belimumab for Lupus Nephritis, SEMIRA	29	6	30
SJB Belimumab for Lupus Nephritis, PRIME Cells, IgG4-RD Classification Criteria, Harms of Short Term Steroids	36	6	28
U of RA PRIME Cells, VEXAS, PEXIVAS, PT vs. GC Injection for Knee OA	36	6	28
Fabulous FebuX — magnifique2020 FAST Study, Avacopan, IgG4-RD Classification Criteria, UK Frost for Frozen Shoulder	36	6	28
Didem Avacopan, PRIME Cells, VEXAS, Harms of Short Term Steroids	36	6	28
Going all the way VEXAS, SEMIRA, Belimumab for Lupus Nephritis, ACR Gout Guidelines	36	6	28
Get VEXED by VEXAS! VEXAS, FAST Study, PEXIVAS, PT vs. GC Injection for Knee OA	36	6	28
All About Avacopan Avacopan, PT vs. GC Injection for Knee OA, VEXAS, ACR Gout Guidelines	36	6	28
Blissful champion Belimumab for Lupus Nephritis, PRIME Cells, IgG4-RD Classification Criteria, Harms of Short Term Steroids	36	6	28
Rheum’s GOAT Belimumab for Lupus Nephritis, SEMIRA, VEXAS, ACR Gout Guidelines	36	6	28
Nayan Arora Belimumab for Lupus Nephritis, SEMIRA, Anti-CD38 in Refractory SLE, PRIME Cells	36	6	28
Belim u me Belimumab for Lupus Nephritis, FAST Study, VEXAS, Harms of Short Term Steroids	36	6	28
Rheum service VEXAS, PRIME Cells, PEXIVAS, SEMIRA	36	6	28
AvaPoCan! — Thanks4theComplement Avacopan, SEMIRA, VEXAS, ACR Gout Guidelines	36	6	28
CYCBI — ChangUCanSpare Avacopan, SEMIRA, Anti-CD38 in Refractory SLE, Synovial B Cells & Therapy Response	49	6	26
LeadershipTest — DavidLeverenz FAST Study, RP Subtypes, Avacopan, PT vs. GC Injection for Knee OA	50	6	24
Ruairí Floyd Prediction Avacopan, Harms of Short Term Steroids, VEXAS, PRIME Cells	50	6	24
Blysfull thinking — patelaarat Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	50	6	24
XxFlare_BearxX Avacopan, ACR Gout Guidelines, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	50	6	24
Going BLYSful Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	50	6	24
Rheum’sYourDaddy Avacopan, Synovial B Cells & Therapy Response, VEXAS, PT vs. GC Injection for Knee OA	50	6	24
“Bye Bye Bye” Steroids Avacopan, ACR Gout Guidelines, IgG4-RD Classification Criteria, Harms of Short Term Steroids	56	6	22
BadgerRheum Belimumab for Lupus Nephritis, Synovial B Cells & Therapy Response, VEXAS, UK Frost for Frozen Shoulder	56	6	22
Perry Fuchs’ Bracket Avacopan, ACR Gout Guidelines, Anti-CD38 in Refractory SLE, SEMIRA	56	6	22
Roid Rules Synovial B Cells & Therapy Response, VEXAS, Avacopan, SEMIRA	59	6	16
Criscione for the “W” PEXIVAS, FAST Study, IgG4-RD Classification Criteria, SEMIRA	59	6	16
U of RheUtahlogy — ShrewdFanfare ACR Gout Guidelines, Belimumab for Lupus Nephritis, Anti-CD38 in Refractory SLE, PT vs. GC Injection for Knee OA	61	6	14
PR3-Pointer PEXIVAS, SEMIRA, VEXAS, Synovial B Cells & Therapy Response	61	6	14
Avacopan ftw Avacopan, FAST Study, VEXAS, SEMIRA	63	5	29
Vexas for win VEXAS, FAST Study, Belimumab for Lupus Nephritis, SEMIRA	63	5	29
KWB Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	65	5	27
Avacopanhandle Avacopan, PRIME Cells, VEXAS, Harms of Short Term Steroids	65	5	27
christian laettner’s buzzer beater VEXAS, PRIME Cells, PEXIVAS, UK Frost for Frozen Shoulder	67	5	25
psufka — paulsufka Avacopan, UK Frost for Frozen Shoulder, IgG4-RD Classification Criteria, FAST Study	68	5	23
Rheum for Rheum Madness Avacopan, ACR Gout Guidelines, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	68	5	23
Killing the wolf : Beyond steroids Belimumab for Lupus Nephritis, Synovial B Cells & Therapy Response, VEXAS, SEMIRA	68	5	23
GoComplements — saikrishna133 Avacopan, Harms of Short Term Steroids, IgG4-RD Classification Criteria, Synovial B Cells & Therapy Response	71	5	21
Wait, this isn’t NephMadness… VEXAS, Harms of Short Term Steroids, Avacopan, Synovial B Cells & Therapy Response	71	5	21
Rheumania Avacopan, Harms of Short Term Steroids, VEXAS, Synovial B Cells & Therapy Response	71	5	21
iheartkidneys Belimumab for Lupus Nephritis, ACR Gout Guidelines, VEXAS, Harms of Short Term Steroids	71	5	21
UBA-WON VEXAS, ACR Gout Guidelines, PEXIVAS, Harms of Short Term Steroids	75	5	19
CAT Harms of Short Term Steroids, VEXAS, Avacopan, FAST Study	76	5	15
Doodle Harms of Short Term Steroids, VEXAS, Avacopan, PRIME Cells	76	5	15
Pexivasteroids are overrated PEXIVAS, FAST Study, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	76	5	15
gOUTisIN ACR Gout Guidelines, Avacopan, VEXAS, PT vs. GC Injection for Knee OA	76	5	15
idkijustlikegout ACR Gout Guidelines, Avacopan, VEXAS, PT vs. GC Injection for Knee OA	76	5	15
The Rheum Dark Horse PEXIVAS, SEMIRA, IgG4-RD Classification Criteria, ACR Gout Guidelines	81	5	13
Rheum Warrior PEXIVAS, SEMIRA, VEXAS, ACR Gout Guidelines	81	5	13
Adam Taylor PEXIVAS, Harms of Short Term Steroids, VEXAS, FAST Study	83	5	9
Untitled PEXIVAS, ACR Gout Guidelines, IgG4-RD Classification Criteria, PT vs. GC Injection for Knee OA	83	5	9
Wiseguy PEXIVAS, Harms of Short Term Steroids, IgG4-RD Classification Criteria, FAST Study	83	5	9
Stacy Bagrova PEXIVAS, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	83	5	9
Rheum’sYourDaddy Avacopan, PRIME Cells, VEXAS, PT vs. GC Injection for Knee OA	87	4	28
Nostradamus Avacopan, PRIME Cells, VEXAS, Harms of Short Term Steroids	88	4	26
Penelope Proactive Patient’s Prediction Avacopan, PT vs. GC Injection for Knee OA, VEXAS, ACR Gout Guidelines	88	4	26
T-Rex cell in Helper CT VEXAS, PRIME Cells, Avacopan, Harms of Short Term Steroids	88	4	26
Rheuminator 3: Rise of the MABs VEXAS, PRIME Cells, PEXIVAS, Harms of Short Term Steroids	91	4	24
Irelande Douze Pointes Avacopan, Harms of Short Term Steroids, VEXAS, FAST Study	92	4	22
LeadershipTest2 Belimumab for Lupus Nephritis, Harms of Short Term Steroids, IgG4-RD Classification Criteria, PRIME Cells	92	4	22
Rheuma-zooma-tology Belimumab for Lupus Nephritis, ACR Gout Guidelines, IgG4-RD Classification Criteria, SEMIRA	92	4	22
Phat Jointz PT vs. GC Injection for Knee OA, PEXIVAS, Anti-CD38 in Refractory SLE, FAST Study	95	4	20
Rheumba Avacopan, ACR Gout Guidelines, Anti-CD38 in Refractory SLE, SEMIRA	95	4	20
Rheumie Avacopan, ACR Gout Guidelines, Anti-CD38 in Refractory SLE, Harms of Short Term Steroids	97	4	18
No Rheum for Steroids! PEXIVAS, FAST Study, Anti-CD38 in Refractory SLE, SEMIRA	98	4	12
Cut it gout you guys ACR Gout Guidelines, IgG4-RD Classification Criteria, Belimumab for Lupus Nephritis, Harms of Short Term Steroids	98	4	12
Rheum 2 Grow PEXIVAS, ACR Gout Guidelines, VEXAS, PT vs. GC Injection for Knee OA	100	4	8
Void the ‘Roid SEMIRA, Avacopan, RP Subtypes, FAST Study	101	3	25
Untitled Avacopan, FAST Study, VEXAS, Harms of Short Term Steroids	101	3	25
Rheumatology is our daddy VEXAS, ACR Gout Guidelines, Belimumab for Lupus Nephritis, Harms of Short Term Steroids	103	3	19
Avacopan for ANCA vasculitis… now have to spell it right! (not “avacpoan” like on the list here https://sites.duke.edu/rheummadness/bracket-and-scouting-reports/ :)) Avacopan, Synovial B Cells & Therapy Response, VEXAS, Harms of Short Term Steroids	103	3	19
B -cause B cells are the BEST! Synovial B Cells & Therapy Response, IgG4-RD Classification Criteria, PEXIVAS, SEMIRA	105	3	11
Matthew Sparks ACR Gout Guidelines, PEXIVAS, VEXAS, Harms of Short Term Steroids	106	3	5
WHY PLEXING IS VEXING?? PEXIVAS, PT vs. GC Injection for Knee OA,	106	3	5
Rheum Over Milwaukee PEXIVAS, Synovial B Cells & Therapy Response, VEXAS, Harms of Short Term Steroids	106	3	5
Synovial B cells Synovial B Cells & Therapy Response, Anifrolumab, Anti-CD38 in Refractory SLE, Harms of Short Term Steroids	109	1	1

The Scouting Reports are Here!

Posted on March 15, 2021 by David Leverenz

Below you will find the 2021 RheumMadness Bracket and scouting reports reviewing each topic in the tournament. Over 40 adult rheumatology fellows from 14 fellowship programs collaborated to create these scouting reports. A huge thank you to all those who submitted a scouting report; they are all fantastic, educational, and engaging reads!

Want a refresher on what RheumMadness is all about? Click here!

Ready to submit your picks? Click here to learn how to enter a bracket (it’s FREE and FUN). You have until Friday, March 26 at midnight (ET) to finalize your bracket submissions.

Click here for a downloadable (and larger) PDF of the bracket

Use the links below to access each scouting report

Belimumab for Lupus Nephritis, written by the Duke University School of Medicine Adult Rheumatology Fellowship Program
Anifrolumab for SLE, written by the Medical University of South Carolina Adult Rheumatology Fellowship Program
PEXIVAS for ANCA vasculitis, written by the Medical College of Wisconsin Adult Rheumatology Fellowship Program
Avacopan for ANCA vasculitis, written by the Northwestern University Adult Rheumatology Fellowship Program
IgG4-RD Classification Criteria, written by the Massachusetts General Hospital Adult Rheumatology Fellowship Program
Relapsing Polychondritis Subtypes, written by the Wake Forest School of Medicine Adult Rheumatology Fellowship Program
Anti-CD38 in Refractory Lupus, written by the University of North Carolina Adult Rheumatology Fellowship Program
VEXAS, written by the RheumMadness Leadership Team
SEMIRA, written by the Allegheny Health Network Adult Rheumatology Fellowship Program
Harms of Short Term Steroids, written by the University of Kentucky Adult Rheumatology Fellowship Program
UK Frost for Frozen Shoulder, written by C. Allen Witt (RheumMadness Leadership Team)
PT vs. GC Injection for Knee OA, written by the Oschner Medical Center Adult Rheumatology Fellowship Program
PRIME Cells in RA, written by the University of Colorado Adult Rheumatology Fellowship Program
Synovial B Cells & Therapy Response in RA (R4RA), written by the Vanderbilt University School of Medicine Adult Rheumatology Fellowship Program
FAST Study, written by the University of Chicago Adult Rheumatology Fellowship Program
ACR Gout Guidelines, written by the Loma Linda University Adult Rheumatology Fellowship Program

Belimumab for Lupus Nephritis Scouting Report

Posted on March 15, 2021 by David Leverenz

Written by: Aki Udupa, Ryan Anderson, Isaac Smith, Poorva Apte, Megan Milne, Catherine Sims, Lisa Criscione-Schreiber, and David Leverenz

Based on: Furie et al. NEJM.2020;383(12):1117-28

Topic Overview

Are you ready for a BLySfull scouting report? Don’t look so BAFFled! You’ve come to the right place! With the burden of disease unacceptably high and so few tolerable and effective current therapies available for our patients, the urgency to identify novel therapeutic targets to treat systemic lupus erythematous cannot be overstated. Comprising up to half of this at-risk population is a particularly vulnerable subset of patients with lupus nephritis, who, left untreated, are at high risk for progression to ESRD and death¹.

B cells are key orchestrators of the abnormal immune response in lupus and lupus nephritis; they facilitate the activation of autoreactive T cells via self-antigen presentation, promote the release of inflammatory cytokines, and produce harmful autoantibodies². Autoreactive B cells are, at least in part, enabled by B-lymphocyte stimulator (BLyS), a cytokine which promotes B cell proliferation, differentiation, and survival^2,3. BLyS is elevated in lupus patients, is locally expressed at the level of the kidney in lupus nephritis, and levels may correlate with disease activity ^1-4.

Belimumab, a fully human monoclonal IgG1 antibody, neutralizes BLyS and subsequently depletes the autoreactive B cell pool contributing to the pathogenic autoimmune milieu of lupus. This medication has been FDA approved for the treatment of serologically and clinically active lupus since 2011 and has recently been awarded the title of the first FDA approved treatment for lupus nephritis. Approval was based on the results of a two year phase III double blind randomized placebo controlled trial by Furie and colleagues titled BLISS-LN¹. This study sought to examine the effect of adding intravenous belimumab to standard of care lupus nephritis induction and maintenance regimens on renal response in patients with serologically and clinically active lupus plus biopsy proven active lupus nephritis¹. Remarkably, the use of belimumab significantly improved the primary efficacy renal response, with a significantly greater proportion of patients in the belimumab group achieving reduced proteinuria, stable renal function, and less need for rescue therapy such as steroids.

Implications for Patients, Providers, & Researchers

Current implications: Previously, belimumab was primarily shown to work for patients with milder forms of lupus activity, such as skin and joint disease. The BLISS-LN study proves that belimumab also works for lupus nephritis when added on to standard induction regimens, and the recent FDA stamp of approval means that this treatment option is available right now! This is a huge win for patients with lupus nephritis.

Future implications: While we are excited about a new FDA-approved medication for SLE nephritis, this study also makes us wonder what other SLE manifestations may benefit from belimumab (i.e. neuropsychiatric). As with all other rheumatologic medications, trials of belimumab with pregnant women have not yet been performed. If this medication were studied and deemed safe in pregnant women, it would be wonderful to have an alternative to Azathioprine (AZA) for SLE nephritis during pregnancy. It will also be interesting to see if initiation of belimumab prior to pregnancy improves maternal and/or fetal outcomes (pregnancy loss, HTN, pre-eclampsia, heart block etc.) as compared to AZA/hydroxychloroquine. Another natural next step is to evaluate the effectiveness of this medication in children to see if belimumab may prevent progression of renal disease. Long term data will need to be evaluated in the future focusing on outcome measures such as proteinuria, serum creatinine, and new dependence on hemodialysis (HD). This will be important to know for patient expectations, anticipatory guidance, and financial burden of care. Finally, prior studies have suggested a possible increase in depression in patients treated with belimumab, though this was not seen in BLISS-LN. We would like to see additional studies that have a baseline assessment of depression prior to belimumab initiation. Lupus patients have a higher rate of depression than the general public and the addition of a weekly injection or monthly infusion may increase burden of care and make depression worse. These confounding variables are important to stratify before determining that belimumab is the cause of depression as opposed to a potential bystander.

Will BLISS-LN Win its First Round Match-up?

Belimumab is the clear favorite in the first-round match-up against anifrolumab. Though its competitors are often “BLYS”-fully ignorant, when it comes to shooting “BAFF”-kets, there is none better than belimumab. Leading experts in the field have been keeping a close eye on the upcoming match-up, and in the words of one prominent lupologist, “What is anifrolumab anyway? Only FDA-approved medications should be allowed to compete.” While it is true that anifrolumab isn’t even a prescribable medication, supporters of the drug turn to sports history to defend their position. “Our inspiration for TULIP 2 came from one of the greatest athletes of all time, Tom Brady. If you’re not getting the results you want, deflate the endpoint, and you’ll be sure to score a win.” Reviewers and practitioners of evidence-based medicine alike will need to be vigilant to ensure the goal-posts aren’t moved again leading up to the first round match-up. In spite of these concerns, APRIL showers are just around the corner, and belimumab is expected to rain destruction on its competitor. After all is said and done, belimumab will reign supreme.

Could BLISS-LN Win it All?

The BLISS-LN trial is a strong contender to win the tournament. Other trials in this tournament may boast that their interventions significantly limit steroid exposure. BLISS-LN demonstrates that belimumab is both a steroid-sparing agent and an effective disease-modifying agent in controlling a major rheumatic disease. Belimumab does not just have the potential to be steroid-sparing. It is potentially life-sparing. Belimumab decreased renal-related events or death in a well-selected treatment group of lupus nephritis patients. The same cannot be said for trials that had to alter primary endpoints or did not find positive results in the initial study population. BLISS-LN clearly represents a new frontier for the treatment of lupus nephritis. The discerning rheumatologist can easily foresee that belimumab, which has already undergone the rigors of FDA-approval, will change the management of lupus nephritis. The well-designed, clinically meaningful BLISS-LN trial is responsible for this major innovation.

References:

Furie, Richard, et al. “Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis.” The New England Journal of Medicine, vol. 383, no. 12, 2020, pp. 1117–1128., doi:10.1056/NEJMoa2001180. Accessed 7 Mar. 2021.
Furie, Richard et al. “Biologic activity and safety of belimumab, a neutralizing anti-B-lymphocyte stimulator (BLyS) monoclonal antibody: a phase I trial in patients with systemic lupus erythematosus.” Arthritis research & therapy vol. 10,5 (2008): R109. doi:10.1186/ar2506
Furie, Richard et al. “A phase III, randomized, placebo-controlled study of belimumab, a monoclonal antibody that inhibits B lymphocyte stimulator, in patients with systemic lupus erythematosus.” Arthritis and rheumatism vol. 63,12 (2011): 3918-30. doi:10.1002/art.30613
Neusser, M., Lindenmeyer, M., Edenhofer, I. et al. Intrarenal production of B-cell survival factors in human lupus nephritis. Mod Pathol 24, 98–107 (2011). https://doi.org/10.1038/modpathol.2010.184

Keep Reading!

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