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Pinto B, Suresh SC, Ramyasri K, Narayan G, Susan D, Manuel S, Wodeyar A, Shivanna A, Janardana R, Chanakya K, Charles BS, Nanjundaswamy SK, Desai AM, Nadig R, Shobha V. Neuropsychiatric manifestations are associated with increased mortality in Indian patients with lupus: A single centre retrospective observational study. Lupus 2022; 31:1563-1571. [PMID: 36134692 DOI: 10.1177/09612033221127898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the prevalence of different NPSLE manifestations in our cohort and to compare clinical and immunological features and outcomes including mortality of patients with NPSLE and SLE controls without NP involvement. METHODS This was a retrospective study in a tertiary care referral centre. All patients of SLE seen in the last 10 years and fulfilling the SLICC criteria with neuropsychiatric manifestations as per the ACR definitions were included. Patients of SLE without NP involvement were sequentially assigned as controls in a ratio of 1:2. RESULTS Of the 769 patients diagnosed with SLE from Jan 2011 to December 2020, 128 (16.6%) had NPSLE manifestations as per the ACR definitions. The commonest NPSLE manifestation was seizures (6.5%) followed by cerebrovascular accident (3.9%). NPSLE manifestation occurred at the first presentation of SLE in 99/128 (77.3%) patients and 58 (45.3%) patients had more than one NPSLE manifestation. Lupus anticoagulant and anticardiolipin antibody were tested in 120 patients and were positive in 16 (13.3%) and 12 (10%), respectively. No difference was found in anti-ribosomal p, lupus anticoagulant and anticardiolipin antibodies between the cases and controls. Twenty-one (16.4%) deaths occurred in patients with NPSLE (median follow-up of 40 months) as compared to 13 (5%) in controls (median follow-up of 32 months) (p = <0.001). The cumulative survival of patients with NPSLE was lower as compared to controls (p < 0.001). Relapse of NPSLE was seen in 11(8.6%) patients and was associated with mortality (p = 0.017). CONCLUSIONS Seizures and cerebrovascular accidents are the commonest NPSLE syndromes in our patients. The presence of NPSLE was associated with high mortality in Indian patients with lupus.
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Affiliation(s)
- Benzeeta Pinto
- Departments of Clinical Immunology and Rheumatology, St John's Medical College, Bengaluru, India
| | - Sumatha C Suresh
- Departments of Clinical Immunology and Rheumatology, St John's Medical College, Bengaluru, India
| | - Kodali Ramyasri
- Departments of Clinical Immunology and Rheumatology, St John's Medical College, Bengaluru, India
| | - Girish Narayan
- Emergency Medicine, St John's Medical College, Bengaluru, India
| | - Deepa Susan
- Radiodiagnosis, St John's Medical College, Bengaluru, India
| | - Sandra Manuel
- Departments of Clinical Immunology and Rheumatology, St John's Medical College, Bengaluru, India
| | - Aishwarya Wodeyar
- Departments of Clinical Immunology and Rheumatology, St John's Medical College, Bengaluru, India
| | - Archana Shivanna
- Departments of Clinical Immunology and Rheumatology, St John's Medical College, Bengaluru, India
| | - Ramya Janardana
- Departments of Clinical Immunology and Rheumatology, St John's Medical College, Bengaluru, India
| | - Kodishala Chanakya
- Departments of Clinical Immunology and Rheumatology, St John's Medical College, Bengaluru, India
| | - B Sheba Charles
- Departments of Clinical Immunology and Rheumatology, St John's Medical College, Bengaluru, India
| | | | - Anu M Desai
- Departments of Clinical Immunology and Rheumatology, St John's Medical College, Bengaluru, India
| | | | - Vineeta Shobha
- Departments of Clinical Immunology and Rheumatology, St John's Medical College, Bengaluru, India
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Chen L, Sun J, Wang Q, Hu L, Zhang Y, Ma H, Jia X, Yang X. Altered Temporal Dynamics of Brain Activity in Multiple-Frequency Bands in Non-Neuropsychiatric Systemic Lupus Erythematosus Patients with Inactive Disease. Neuropsychiatr Dis Treat 2021; 17:1385-1395. [PMID: 33994788 PMCID: PMC8113012 DOI: 10.2147/ndt.s292302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/15/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE In this study, we seek to investigate dynamic changes of brain activity in non-neuropsychiatric systemic lupus erythematosus (non-NPSLE) patients with inactive disease. PATIENTS AND METHODS Thirty-one non-NPSLE patients with inactive disease and 20 matched healthy controls underwent the blood oxygenation level-dependent fMRI examination. Dynamic regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuations (fALFF) were used to analyze the brain activity in typical band (0.01-0.08 Hz), slow-4 (0.027-0.073 Hz) and slow-5 (0.01-0.027 Hz). Pearson's correlation analysis was performed to correlate dynamic regional homogeneity (dReHo) and dynamic fractional amplitude of low-frequency fluctuations (dfALFF) values for clusters of voxels where significant group differences were found with clinical variables in non-NPSLE patients with inactive disease. RESULTS In typical band, non-NPSLE patients showed increased dReHo in left middle occipital gyrus (MOG) compared to healthy controls. Meanwhile, patients showed decreased dfALFF in right superior frontal gyrus (SFG) and bilateral middle frontal gyrus (MFG) in typical band. In slow-4, increased dReHo in left MOG was found in non-NPSLE patients. In slow-5, non-NPSLE patients showed increased dReHo in left MOG, left calcarine fissure and surrounding cortex, right precentral gyrus (PreCG) and left postcentral gyrus (PoCG). Meanwhile, non-NPSLE patients showed decreased dfALFF in left SFG, right MFG, and right PreCG in slow-5. Moreover, the glucocorticoid dose showed significantly negative correlations with dReHo values in right PreCG in slow-5, left PoCG in slow-5, and left MOG in typical band. CONCLUSION dReHo and dfALFF abnormalities in different frequency bands may be the key characteristics in the pathogenesis mechanism of non-NPSLE.
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Affiliation(s)
- Liheng Chen
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, People’s Republic of China
| | - Jiawei Sun
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, People’s Republic of China
- Integrated Medical Research School, Jiamusi University, Jiamusi, People’s Republic of China
| | - Qiaohong Wang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, People’s Republic of China
| | - Lingzhen Hu
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, People’s Republic of China
| | - Yi Zhang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, People’s Republic of China
| | - Huibin Ma
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, People’s Republic of China
- Integrated Medical Research School, Jiamusi University, Jiamusi, People’s Republic of China
| | - Xize Jia
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, People’s Republic of China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, People’s Republic of China
| | - Xuyan Yang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, People’s Republic of China
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Abstract
PURPOSE OF REVIEW This article discusses the specific neurologic issues that arise in patients with rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, and Sjögren syndrome. Diagnosis and management are discussed. RECENT FINDINGS Advances include advanced imaging, serologic and CSF markers, and targeted immune-modulating therapies. The use of these modalities are discussed in detail. SUMMARY Rheumatic disorders are quite common and can result in disabling but many times treatable neurologic sequelae. The key is early diagnosis and management. Awareness of the common presentations and current modalities of diagnosis and treatment is critical to improved outcomes.
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Lee JW, Kang JH, Hong HJ, Ju SM, Lee KE, Wen L, Park DJ, Kim TJ, Park YW, Lee SS. A Case of Acute Inflammatory Demyelinating Polyradiculoneuropathy in a Patient with Systemic Lupus Erythematosus. JOURNAL OF RHEUMATIC DISEASES 2014. [DOI: 10.4078/jrd.2014.21.3.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jeong-Won Lee
- Department of Rheumatology, Chonnam National University Medical School, Gwangju, Korea
| | - Ji-Hyoun Kang
- Department of Rheumatology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyoung-Ju Hong
- Department of Rheumatology, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Mi Ju
- Department of Rheumatology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung-Eun Lee
- Department of Rheumatology, Chonnam National University Medical School, Gwangju, Korea
| | - Lihui Wen
- Department of Rheumatology, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Jin Park
- Department of Rheumatology, Chonnam National University Medical School, Gwangju, Korea
| | - Tae-Jong Kim
- Department of Rheumatology, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Wook Park
- Department of Rheumatology, Chonnam National University Medical School, Gwangju, Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Medical School, Gwangju, Korea
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Burnstock G, Arnett TR, Orriss IR. Purinergic signalling in the musculoskeletal system. Purinergic Signal 2013; 9:541-72. [PMID: 23943493 PMCID: PMC3889393 DOI: 10.1007/s11302-013-9381-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/12/2013] [Indexed: 12/11/2022] Open
Abstract
It is now widely recognised that extracellular nucleotides, signalling via purinergic receptors, participate in numerous biological processes in most tissues. It has become evident that extracellular nucleotides have significant regulatory effects in the musculoskeletal system. In early development, ATP released from motor nerves along with acetylcholine acts as a cotransmitter in neuromuscular transmission; in mature animals, ATP functions as a neuromodulator. Purinergic receptors expressed by skeletal muscle and satellite cells play important pathophysiological roles in their development or repair. In many cell types, expression of purinergic receptors is often dependent on differentiation. For example, sequential expression of P2X5, P2Y1 and P2X2 receptors occurs during muscle regeneration in the mdx model of muscular dystrophy. In bone and cartilage cells, the functional effects of purinergic signalling appear to be largely negative. ATP stimulates the formation and activation of osteoclasts, the bone-destroying cells. Another role appears to be as a potent local inhibitor of mineralisation. In osteoblasts, the bone-forming cells, ATP acts via P2 receptors to limit bone mineralisation by inhibiting alkaline phosphatase expression and activity. Extracellular ATP additionally exerts significant effects on mineralisation via its hydrolysis product, pyrophosphate. Evidence now suggests that purinergic signalling is potentially important in several bone and joint disorders including osteoporosis, rheumatoid arthritis and cancers. Strategies for future musculoskeletal therapies might involve modulation of purinergic receptor function or of the ecto-nucleotidases responsible for ATP breakdown or ATP transport inhibitors.
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Affiliation(s)
- Geoffrey Burnstock
- Autonomic Neuroscience Centre, University College Medical School, Rowland Hill Street, London, NW3 2PF, UK,
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Sterling K, Gallop K, Swinburn P, Flood E, French A, Al Sawah S, Iikuni N, Naegeli A, Nixon A. Patient-reported fatigue and its impact on patients with systemic lupus erythematosus. Lupus 2013; 23:124-32. [PMID: 24197552 DOI: 10.1177/0961203313511554] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fatigue is a hallmark symptom of systemic lupus erythematosus (SLE), often associated with flares, side effects of treatment, and extensive organ damage and may have a significant impact on health-related quality of life (HrQoL). To date, the experience of fatigue in patients with SLE is underexplored. This study explored the experience of fatigue in patients with SLE and its impact on their lives through qualitative interviews. This cross-sectional qualitative study was conducted with 22 adult patients with SLE, recruited from two clinical sites in the United States. In-person semi-structured interviews were conducted and thematic analysis was performed focusing on the experience of fatigue in SLE. Results indicated that 21 out of 22 patients experienced fatigue due to SLE. Patients reported that fatigue was variable in nature in terms of both severity and frequency. Fatigue was described as having an impact on multiple aspects of a patient's life: emotions, cognition, work, activities of daily living, leisure activities, social activities, and family activities. Understanding how patients with SLE describe the symptom of fatigue and how it impacts their lives is the key to better understanding how to measure fatigue in clinical studies evaluating new treatments for SLE.
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Affiliation(s)
- Kl Sterling
- 1Eli Lilly and Company, Indianapolis, IN, USA
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