Loutfi Succari MD MPH

Rheumatology Division Chief @ USF/TGH | Promoting excellence in patient care & medEd | Advancing multidisciplinary care & innovation in autoimmune diseases.

[Loutfi Succari MD MPH @DrSuccari]

Mitochondrial dysfunction continues to emerge as a key player in #SystemicSclerosis. This study provides mechanistic evidence linking mitochondrial Ca²⁺ overload to mtDNA leakage, cGAS-STING activation, and fibrosis, while highlighting circulating mtDNA as a potential biomarker of disease severity. An exciting avenue for future therapeutic development. #Rheumatology

[ACR_Journals @ACR_Journals]

Findings from a study of 50 patients with systemic sclerosis showed mitochondrial Ca2+ overload drives mtDNA leakage and activates cGAS-STING signaling, promoting fibroblast activation and skin fibrosis. Plasma mtDNA also correlated with disease severity, highlighting a potential biomarker and therapeutic target

A&R
https://t.co/3xvfEugVJo

Image: Illustration of the proposed mechanism of mitochondrial DNA on promoting skin fibrosis in systemic sclerosis

[Loutfi Succari MD MPH @DrSuccari]

Gastrointestinal involvement in systemic sclerosis extends well beyond esophageal dysmotility. This study highlights anorectal dysfunction as an underrecognized manifestation, with potential associations between autoantibody profiles and anorectal manometry findings. Another reminder to proactively ask about lower GI symptoms in patients with #SystemicSclerosis. #Rheumatology

[ACR_Journals @ACR_Journals]

In a cohort of 50 patients with SSc who underwent anorectal manometry, anti-centromere antibodies were assoc with reduced rectal sensation, and anti-centromere/Ro52 antibodies with hypotensive resting pressures. Nearly all patients showed an abnormal rectoanal inhibitory reflex

AC&R
https://t.co/F8pj1QHzHc

[Loutfi Succari MD MPH @DrSuccari]

Important review on the evolving role of AI in systemic sclerosis.
From ILD imaging to skin fibrosis and microvascular disease, AI may help move us toward more objective, precise assessment and risk stratification.

Will be interesting to see how this translates into routine practice.

#Rheumatology #Scleroderma #ILD #ArtificialIntelligence #PrecisionMedicine

[ACR_Journals @ACR_Journals]

Can AI change how we assess systemic sclerosis? New review in Arthritis Care & Research examines AI applications across: 🫁 ILD imaging 🫀 Cardiac involvement 🔬 Skin fibrosis 🔍 Nailfold capillaroscopy

https://t.co/pdvKoqiGbP
@cristianasieiro

[Loutfi Succari MD MPH @DrSuccari]

Important data in anti-MDA5+ DM-ILD.
Upadacitinib appears non-inferior to tofacitinib for 6-month transplant-free survival.

Encouraging to see expanding JAK inhibitor options in this high-risk population. #Rheumatology #ILD #Dermatomyositis

[Respirology @RespirologyAPSR]

Upadacitinib Versus Tofacitinib in Anti-MDA5-Positive Dermatomyositis With Interstitial Lung Disease: A Multi-Centre Cohort Study Emulating a Target Trial
https://t.co/XBF2uGIrdq

[Loutfi Succari MD MPH @DrSuccari]

AH​SCT has clearly moved from experimental to evidence-based therapy for carefully selected patients with rapidly progressive dcSSc and SSc-ILD. This review nicely synthesizes RCT data, long-term outcomes, and the critical importance of patient selection and expert centers.
This work also points toward next-generation cellular therapies that may further reshape treatment of severe autoimmune disease, improve safety and transform outcomes. #Ssc #Scleroderma #SARDILD #AHSCT #CellularTherapy #CART #Rheumatology

[ACR_Journals @ACR_Journals]

AHSCT has emerged as an effective treatment strategy for patients with rapidly progressive diffuse cutaneous SSc & interstitial lung disease. Review in ACR Open Rheumatology summarizes RCT evidence, immune reconstitution, long-term outcomes, & future directions

https://t.co/nbQCG3iTwC

[Loutfi Succari MD MPH @DrSuccari]

Impressive breadth of new papers in ACR Open Rheumatology this month. From SSc-ILD and lupus nephritis to pediatric rheumatology and stem cell transplantation. Great to see such a wide range of clinically relevant work published. #Rheumatology

[ACR_Journals @ACR_Journals]

Lots of papers online this week in ACR Open Rheumatology (and still more to post!)

Phase 2 trial of pirfenidone + MMF vs placebo + MMF in SSc-ILD
https://t.co/KdzzxfUXw6

EuroLupus regimen & clinical characteristic patterns in CYC dosing for pediatric LN
https://t.co/fzXQ6Mks22

Systematic review: renal replacement therapies in LN & end-stage kidney disease
https://t.co/Di9E4r7QFU

Review: Autologous hematopoietic stem cell transplantation in SSc
https://t.co/nbQCG3iTwC

Review: rare disease research in pediatric rheumatology
https://t.co/A8vjge5PZG

Experiences of people with knee OA using an online Tai Chi program
https://t.co/FSQ8FBbgwa

Review: a framework for rheumatologists to manage CAR T cell clinical trials for SLE
https://t.co/NtuLtI5tzl

[Loutfi Succari MD MPH @DrSuccari]

Important data highlighting how geography continues to influence outcomes in GCA. Delayed diagnosis and higher hospitalization risk in rural settings underscore the need for better access pathways and serves as an important reminder of ongoing gaps in access and equity across rheumatologic care. #GCA #Vasculitis #healthequity #Rheumatology #AccessToCare

[JCR: Journal of Clinical Rheumatology @JRheumatology]

Association between rurality and diagnostic delay in GCA in Iowa.
✔️Time to diagnosis was longer in rural
patients (130 vs 45 days)
✔️Risk of hospitalization was also higher
✔️Risk factors in multivariable analysis: rurality⏫️, age🔽, headache🔽
https://t.co/R805RF0IlP

[Loutfi Succari MD MPH @DrSuccari]

Another strong issue from The Journal of Rheumatology. Important updates the full spectrum of rheumatic diseases. Worth a read for anyone in the field as we close out 2025. #Rheumatology #RhematologyResearch

[The Journal of Rheumatology @jrheum]

The final issue of 2025 is here! ✨📚

Explore new insights on RA, SpA, lupus, vasculitis, OA, and more.

👉 Read the December issue:
https://t.co/gjqHRaISmy

#Guidelines #RheumatoidArthritis #Spondyloarthritis #Lupus #Vasculitis #Osteoarthritis #COVID19

[Loutfi Succari MD MPH @DrSuccari]

CAR T-cell therapy is opening a new frontier in rheumatology. Great to see a practical framework for launching SLE trials; one step closer to bringing transformative cellular therapies to patients with severe autoimmune disease. #SLE #Lupus #CART #ClinicalTrials #Rheumatology

[ACR_Journals @ACR_Journals]

CAR T-cell therapy is increasingly being investigated for autoimmune rheumatic diseases, but its translation into rheumatology involves logistical, regulatory, clinical, & ethical complexities. Review in ACROR discusses a framework for rheumatologists to initiate & manage CAR T-cell clinical trials for SLE

https://t.co/NtuLtI5tzl

[Loutfi Succari MD MPH @DrSuccari]

Important data for SSc-ILD community: PFD added to MMF didn’t yield significant FVC gains, but trends in physical function are worth noting. Highlights the ongoing need for robustly powered studies to refine combination therapy strategies. #Ssc #Scleroderma #ILD #SARDILD

[ACR_Journals @ACR_Journals]

Randomized phase 2 trial of pirfenidone (PFD) or placebo along with MMF in SSc-ILD:
https://t.co/KdzzxfUXw6
• no statistically or clinically significant difference in FVC% improvement from baseline
• mean time to ≥3% improvement in FVC% was numerically shorter with MMF+PFD
• MMF+PFD assoc. with better improvement in PROMIS-29 physical function
• AEs, including serious AEs, more common with MMF+PFD
• low recruitment limited statistical power

[Loutfi Succari MD MPH @DrSuccari]

Great articles and roundup of new rheumatology insights.

[The Journal of Rheumatology @jrheum]

New month, new insights in rheumatology . ✨

Explore the latest articles on SpA, PsA, lupus, myositis, pediatric rheumatology & more.

📖 Read the November issue here: https://t.co/qOBkqGXU7R

#Spondyloarthritis #PsoriaticArthritis #Lupus #Myositis #Pediatric #Rheumatology

[Loutfi Succari MD MPH @DrSuccari]

An important reminder: pulmonary involvement in Behçet’s is often underestimated.
TCT can unmask not only vascular lesions but also subtle parenchymal injury that may explain atypical symptoms or persistent inflammation. Early detection can be lifesaving.

[JCR: Journal of Clinical Rheumatology @JRheumatology]

🫁 In Behçet’s disease, lungs can suffer silently!
TCT scans reveal not just vascular issues like thrombosis & aneurysms, but also hidden parenchymal damage — especially in those with odd symptoms or high inflammation.
📸 Don’t ignore the scan!

https://t.co/tMHe5K01lL

[Loutfi Succari MD MPH @DrSuccari]

“Promising mechanistic insight into IIM-ILD. IL-33 appears to be a key upstream driver of inflammation, fibrosis, and ERK-mediated EMT in myositis-associated ILD. Targeting this could open new therapeutic avenues for SARD-ILD; an area in urgent need of options #SARDILD #ILD

[ACR_Journals @ACR_Journals]

Role of IL-33 as a central mediator in idiopathic inflammatory myopathy interstitial lung disease
https://t.co/qqUi5WNzaz

Key findings:
•IL-33 elevated in IIM-ILD patient sera & lungs
•IL-33 deletion attenuated lung inflammation & fibrosis in myositis-assoc. ILD mice
•in vitro, IL-33 knockdown suppressed ERK-driven EMT
•ERK inhibition mitigated ILD progression

[Loutfi Succari MD MPH @DrSuccari]

Fascinating genetic insight in SSc. Variation in C4A and C4B copy numbers appears to influence susceptibility to specific serologic and clinical subtypes. Important step toward better understanding SSc heterogeneity & risk stratification.

[ACR_Journals @ACR_Journals]

Genetic contributions of C4A and C4B in systemic sclerosis subtypes susceptibility - https://t.co/XcckAq9kXv
•lower copy numbers (CNs) of C4 were associated with increased risk of different clinical and serologic subtypes of SSc
•C4A CNs had stronger association with ATA+ serology (associated with dcSSc)
•C4B CN had stronger association with ACA+ serology (associated with lcSSc)

[Loutfi Succari MD MPH @DrSuccari]

New data on RA-ILD risk prediction:
A combined clinical + genetic risk score (VARA-ILD) performs significantly better than a genetic score alone.
In external validation, sensitivity reached 92–93%. A promising step toward earlier RA-ILD detection. https://t.co/LJDFCWqNXA #SARDILD

[Loutfi Succari MD MPH @DrSuccari]

Interesting findings:
Digital gangrene after lung or heart–lung transplant in systemic sclerosis can be devastating, with rapid onset and markedly worse survival.
Reinforces the need for close vascular monitoring and early recognition. #Scleroderma #Ssc

[ACR_Journals @ACR_Journals]

Digital gangrene in systemic sclerosis after lung or heart–lung transplant surgery - https://t.co/TvkRDM7Hoq
•25% (4/16) developed dry digital gangrene
•median time to onset 44.5 days (range 8–90) post-op
•all SSc patients with gangrene also had diabetes
•median survival time with digital gangrene was significantly shorter

[Loutfi Succari MD MPH @DrSuccari]

Great to see further validation of tools that help us identify RA-ILD earlier.
Combining genetic risk scores with clinical variables meaningfully improves detection. This is a promising step toward more precise, risk-stratified screening for our RA patients. #RA #ILD #SARDILD

[ACR_Journals @ACR_Journals]

External validation of a genetic risk score (GRS) and combined risk score for identifying risk of RA-ILD. Combining a genetic risk score with clinical risk factors performed significantly better than the GRS alone

Arthritis Care & Research
https://t.co/i8s3Ibpg4g

[Loutfi Succari MD MPH @DrSuccari]

Great study with important insights into relapse patterns in IIM. Autoantibody profile clearly shapes the type of flare (muscle, skin, or ILD). Sharing a visual summary👇
#IIM #IMAC #MSA #ILD #SARDILD #Myositis #Dermatomyositis

[ACR_Journals @ACR_Journals]

New IIM study in A&R – https://t.co/ud2KDI1Wno
• Swedish cohort of adults with IIM
• Relapses after achieving steroid-free remission were frequent (up to 76% over 12 years)
• Patients with anti-Jo1 had nearly twice the risk of relapse
• International Myositis Assessment and Clinical Studies Group (IMACS) flare/worsening definition may lack sensitivity

[Loutfi Succari MD MPH @DrSuccari]

Big news for the ILD community!
The FDA has approved nerandomilast (PDE4B inhibitor) for adults with IPF, based on the FIBRONEER-IPF & FIBRONEER-ILD trials showing slowed lung function decline in IPF & PPF.
An encouraging step forward for SARD-ILD. #SARDILD #IPF

[Dr. John Cush @RheumNow]

FDA has approved nerandomilast (PDE4b inhibitor) for treatment of adults with idiopathic pulmonary fibrosis (IPF). Approval is based on 2 RCTs, FIBRONEER-IPF & FIBRONEER-ILD, that show slowing of lung function decline IP & progressive pulmonary fibrosis (PPF) pts. https://t.co/NoUeXi7ioc

[Loutfi Succari MD MPH @DrSuccari]

A remarkable step forward in IL-23 targeting! Exciting to see an oral formulation showing promising efficacy and safety across psoriasis and psoriatic arthritis.

[Dr. John Cush @RheumNow]

IL-23 Blockade Goes Oral

A new player is entering the IL-23 arena — and it’s a tablet! Icotrokinra (ICO), a first-in-class peptide that binds and blocks the interleukin-23 receptor (IL-23R), is showing encouraging efficacy and safety across a range of psoriasis (PSO) and psoriatic disease (PsD) studies.

https://t.co/NtrFLBAbn7