Wallace Muñoz, MD

Internal Medicine | Rheumatology Fellow- Clinical & academic focus on autoimmune and inflammatory disorders 🧬 Rheumatology Teaching Physician, Médica Sur

[Wallace Muñoz, MD @wallacin_]

💀 What Actually Kills in Lupus

Lupus nearly triples the risk of death, but the cause matters.

Highest risks: kidney disease (SMR 7.9), infection (SMR 5.0), cardiovascular disease (SMR 2.7).

The pattern shifts by region: infection leads in much of the world, while cardiovascular disease now tops the list in the West.

📎 Lee & Song, Lupus 2024 · Piga, Eur J Intern Med 2023 · CDC 2026

#SLE #MedTwitter #lupus

[Wallace Muñoz, MD @wallacin_]

🦋 Lupus & Cancer: The Butterfly Paradox

In a study of 16,409 patients, lupus increased the risk of non-Hodgkin lymphoma by 4x — but lowered the risk of breast (SIR 0.73), endometrial (0.44) and ovarian cancer.

Why? One idea: lupus anti-DNA antibodies can penetrate cells and kill tumors that have faulty DNA repair — like triple-negative breast cancer.

The same antibodies that harm the patient may also fight cancer.

📎 Bernatsky, J Autoimmun 2013 · Ladouceur, Rheum Dis Clin 2020

#SLE #MedTwitter #oncology #Rheumatology #LUPUS

[Wallace Muñoz, MD @wallacin_]

🔵 When Lupus Pain Isn’t Lupus

Fibromyalgia affects ~16% of SLE patients — nearly 4x the general population (OR 3.7).

The catch: FM doesn’t correlate with lupus activity, but it mimics it.

Mistaking FM pain for a flare means escalating immunosuppression a patient doesn’t need.

📎 Meta-analysis, 58,052 patients, 2024

#Lupus #MedTwitter #SLE #Fibromyalgia

[Wallace Muñoz, MD @wallacin_]

🔵 Orelabrutinib: First BTK Inhibitor With Efficacy in Lupus

Phase 2b, 187 patients: SRI-4 at week 48 57.1% vs 34.4% placebo (p=0.01).

71.1% tapered steroids to ≤7.5 mg vs 43.6%.

Two prior BTK inhibitors failed in lupus. This one didn’t.

📎 Phase 3 recruiting

#SLE #Lupus

[Wallace Muñoz, MD @wallacin_]

🔵 Enpatoran: Oral TLR7/8 Blockade

Phase 2 WILLOW missed its primary endpoint—but delivered on skin

Active lupus rash: CLASI-70 60.9% vs 11.5% placebo (week 16)

The race for the first drug approved for lupus rash without systemic disease is on

📎 Lancet 2026

#SLE #lupus

[Wallace Muñoz, MD @wallacin_]

🔵 Dapirolizumab Pegol: CD40L Blockade in SLE

Phase 3: BICLA response at week 48 — 50% vs 35% placebo (p=0.011). 321 patients.

An Fc-free CD40L inhibitor. New target, new class.

Steroid-sparing effect observed.

📎 Clowse et al., Lancet 2026

#SLE #Rheumatology #lupus

[Aravind Palraj @Rheumat_Aravind]

Lupus can become life-threatening within hours.

Remember LUPUS CRASH:
🫁 Lung emergencies
🩺 Renal emergencies
🤰 Pregnancy complications
❤️ Unstable heart
🧠 Seizure/Stroke/Spinal cord disease
🩸 Catastrophic APS
🔴 Red cell & platelet crises
⚕️ Acute abdomen
🦠 Sepsis
🔥 HLH/MAS

In any rapidly deteriorating lupus patient, think beyond disease activity and actively exclude these emergencies.

#Lupus #Rheumatology #MedTwitter #AutoimmuneDisease #MedEd @docakx @IhabFathiSulima

[Ravi Kumar @RheumattDoc]

🧬 Obexelimab: A New Way to Control B Cells

Unlike rituximab, which removes B cells, obexelimab functionally silences them by co-engaging CD19 and the inhibitory receptor FcγRIIB (CD32B).

🔹 Inhibits B-cell activation
🔹 Reduces plasmablast formation
🔹 Decreases antibody production
🔹 Suppresses inflammatory cytokines
🔹 Minimal B-cell depletion

Obexelimab turns B cells “OFF” rather than wiping them out, potentially preserving immune function while controlling autoimmune disease.

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

[Dr Gurdeep S Dulay @gurdeep_dulay]

ASAS-SPARTAN #AxSpA classification criteria 2025

⚠️ MRI needs to have inflammatory PLUS structural lesions

#EULAR2026 @Official_ASAS #sacroilitis #IBD #Uveitis #enthesitis

[Nelly ZIADE 🍀 @Nellziade]

🧲 Does GUS+GOL combo beat GUS alone on MRI in PsA?

YES for joints - AFFINITY Phase 2a RCT: greater MRI inflammation reduction in 91pts

#OP0186 #EULAR2026 @RheumNow

[Dr Gurdeep S Dulay @gurdeep_dulay]

#EULAR2026
Promising trial data in Relapsing #PMR showing improved remission rates with 24 wk steroid taper using #Secukinumab #REPLENISH

[Rheumatology update @aabdogafar]

Neuro-Behçet’s Management

[Rheumatology update @aabdogafar]

Neuro-Behçet’s Management

[Wallace Muñoz, MD @wallacin_]

🇬🇧 Heading to EULAR 2026 — London

The European Congress of Rheumatology kicks off June 3–6 at ExCeL London

170+ scientific sessions. The latest in lupus, RA, vasculitis & beyond

I’ll be sharing the most relevant lupus advances as they break

#EULAR2026 #Lupus #Rheumatology

[Rheumatology update @aabdogafar]

SJOGREN DISEASE

[Rheumatology update @aabdogafar]

arthritis in IBD

[Wallace Muñoz, MD @wallacin_]

🫁 Inflammatory Cardiopulmonary Lupus

67 studies (1990–2025)

Glucocorticoids first-line for ALL manifestations. Cyclophosphamide the most used

Myocarditis, pneumonitis & alveolar hemorrhage still carry 40–60% mortality

📎 Hao et al., Adv Rheumatol 2026

#Lupus #Rheumatology

[Wallace Muñoz, MD @wallacin_]

🔵 Belimumab in Cutaneous Lupus: 5-Year Data

29 SLE patients. CLASI reduced from 8.76 to 4.67 at 60 months (p=0.017)

30% achieved CLASI 100 (complete skin clearance) at 5 years

Best response: acute & discoid CLE

📎 Schellin et al., Int J Dermatol Apr 2026

#SLE #rheumatology

[Ravi Kumar @RheumattDoc]

Managing Giant Cell Arteritis (GCA): treatment at a glance 👇

• Visual/ischemic symptoms → consider IV methylprednisolone
• Start prednisone 40–60 mg/day
• Tocilizumab or upadacitinib can help reduce steroid exposure
• Relapse management depends on severity

📚 Source: Nature Reviews Rheumatology

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1