I was recently consulted by Rheumatology for a lupus patient with progressively worsening periarticular calcifications/swelling in the small joints of her hands. She does have nephritis but medications to treat her lupus have not stalled the progression of joint involvement. Aspiration of one of the joints showed a thick white paste- many WBCs, no crystals, culture negative. I presume the calcifications are related to calcinosis from the lupus nephritis (??) but would love to hear your thoughts.
Thanks!
Jennifer
FROM THE RHEUMATOLOGIST:
She has Lupus that treatment has been driven by her active lupus nephritis urine protein/creatinine around time of start of the white paste substance 4.839 mg/mg (>3, nephrotic)
peak UPCR 24.529 very high a little over 1 year ago
but still with UPCR 6.874 last week.
=>she was on tacrolimus (calcineurin inhibitor) at time this white paste stuff flared up in the joints, then transitioned to voclosporin (another calcineurin inhibitor)
Vitamin D levels have been interesting 4/2022 vit D 25 OH (pre kidney) was low 12.4, 1/2023 vit D 25 OH was 33.2 but vit D 1, 25 dihydroxyvit D (after kidney) was 7.0 L, then most recently vit D 25 OH was 85.1 but vit D 1, 25 dihydroxy vit D (after kidney) was 34.8
Urine with calcium oxalate crystals 1X only in March
Phosphorus normal
kidney function normal
uric acid normal
most recent kidney biopsy 12/2022 class III + V (proliferative lupus nephritis in combination with membranous LN)
==> she has arthritis but the kidneys have been the main target
