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Polis B, Cuda CM, Putterman C. Animal models of neuropsychiatric systemic lupus erythematosus: deciphering the complexity and guiding therapeutic development. Autoimmunity 2024; 57:2330387. [PMID: 38555866 DOI: 10.1080/08916934.2024.2330387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/10/2024] [Indexed: 04/02/2024]
Abstract
Systemic lupus erythematosus (SLE) poses formidable challenges due to its multifaceted etiology while impacting multiple tissues and organs and displaying diverse clinical manifestations. Genetic and environmental factors contribute to SLE complexity, with relatively limited approved therapeutic options. Murine models offer insights into SLE pathogenesis but do not always replicate the nuances of human disease. This review critically evaluates spontaneous and induced animal models, emphasizing their validity and relevance to neuropsychiatric SLE (NPSLE). While these models undoubtedly contribute to understanding disease pathophysiology, discrepancies persist in mimicking some NPSLE intricacies. The lack of literature addressing this issue impedes therapeutic progress. We underscore the urgent need for refining models that truly reflect NPSLE complexities to enhance translational fidelity. We encourage a comprehensive, creative translational approach for targeted SLE interventions, balancing scientific progress with ethical considerations to eventually improve the management of NPSLE patients. A thorough grasp of these issues informs researchers in designing experiments, interpreting results, and exploring alternatives to advance NPSLE research.
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Affiliation(s)
- Baruh Polis
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Research Institute, Galilee Medical Center, Nahariya, Israel
| | - Carla M Cuda
- Division of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chaim Putterman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Research Institute, Galilee Medical Center, Nahariya, Israel
- Division of Rheumatology and Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
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2
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Wang L, Han K, Huang Q, Hu W, Mo J, Wang J, Deng K, Zhang R, Tan X. Systemic lupus erythematosus-related brain abnormalities in the default mode network and the limbic system: A resting-state fMRI meta-analysis. J Affect Disord 2024; 355:190-199. [PMID: 38548195 DOI: 10.1016/j.jad.2024.03.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/29/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is an immune-mediated and multi-systemic disease which may affect the nervous system, causing neuropsychiatric SLE (NPSLE). Recent neuroimaging studies have examined brain functional alterations in SLE. However, discrepant findings were reported. This meta-analysis aims to identify consistent resting-state functional abnormalities in SLE. METHODS PubMed and Web of Science were searched to identify candidate resting-state functional MRI studies assessing SLE. A voxel-based meta-analysis was performed using the anisotropic effect-size version of the seed-based d mapping (AES-SDM). The abnormal intrinsic functional patterns extracted from SDM were mapped onto the brain functional network atlas to determine brain abnormalities at a network level. RESULTS Twelve studies evaluating fifteen datasets were included in this meta-analysis, comprising 572 SLE patients and 436 healthy controls (HCs). Compared with HCs, SLE patients showed increased brain activity in the bilateral hippocampus and right superior temporal gyrus, and decreased brain activity in the left superior frontal gyrus, left middle temporal gyrus, bilateral thalamus, left inferior frontal gyrus and right cerebellum. Mapping the abnormal patterns to the network atlas revealed the default mode network and the limbic system as core neural systems commonly affected in SLE. LIMITATIONS The number of included studies is relatively small, with heterogeneous analytic methods and a risk of publication bias. CONCLUSIONS Brain functional alterations in SLE are predominantly found in the default mode network and the limbic system. These findings uncovered a consistent pattern of resting-state functional network abnormalities in SLE which may serve as a potential objective neuroimaging biomarker.
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Affiliation(s)
- Linhui Wang
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kai Han
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qin Huang
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenjun Hu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiaying Mo
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jingyi Wang
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kan Deng
- Philips Healthcare, Guangzhou, China
| | - Ruibin Zhang
- Cognitive control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| | - Xiangliang Tan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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3
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Rosenberg R, Thorpy MJ, Doghramji K, Morse AM. Brain fog in central disorders of hypersomnolence: a review. J Clin Sleep Med 2024; 20:643-651. [PMID: 38217475 PMCID: PMC10985301 DOI: 10.5664/jcsm.11014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
Brain fog is an undefined term describing a cluster of symptoms related to fatigue and impaired memory, attention, and concentration. Brain fog or brain fog-like symptoms have been reported in central disorders of hypersomnolence and in a range of seemingly unrelated disorders, including coronavirus disease 2019, major depressive disorder, multiple sclerosis, lupus, and celiac disease. This narrative review summarizes current evidence and proposes a consensus definition for brain fog. Brain fog is prevalent in narcolepsy and idiopathic hypersomnia, with more than three-quarters of patients with either disorder reporting this symptom in a registry study; it has also been reported as particularly difficult to treat in idiopathic hypersomnia. Studies directly evaluating brain fog are rare; tools for evaluating this symptom cluster typically are patient reports, with few objective measures validated in any disorder. Evaluating brain fog is further complicated by confounding symptoms, such as excessive daytime sleepiness, which is a hallmark of hypersomnolence disorders. No treatments specifically address brain fog. The paucity of literature, assessment tools, and medications for brain fog highlights the need for research leading to better disambiguation and treatment. Until a clear consensus definition is established, we propose brain fog in hypersomnia disorders be defined as a cognitive dysfunction that may or may not be linked with excessive sleepiness, related to an underlying neuronal dysfunction, which reduces concentration and impairs information processing, leading to a complaint of lack of clarity of mental thinking and awareness. CITATION Rosenberg R, Thorpy MJ, Doghramji K, Morse AM. Brain fog in central disorders of hypersomnolence: a review. J Clin Sleep Med. 2024;20(4):643-651.
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Affiliation(s)
| | | | - Karl Doghramji
- Jefferson Sleep Disorders Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anne Marie Morse
- Department of Child Neurology and Sleep Medicine, Geisinger Medical Center, Janet Weis Children’s Hospital, Danville, Pennsylvania
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4
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Li N, Liu X, Wu P, Liu J, Chen P, Zeng J. Three cases of systemic lupus erythematosus presenting with ischemic stroke as the initial symptom: Case reports and literature review. Immun Inflamm Dis 2024; 12:e1183. [PMID: 38332684 PMCID: PMC10853674 DOI: 10.1002/iid3.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Ischemic stroke constitutes a grave complication within the context of systemic lupus erythematosus (SLE), typically manifesting several years postdiagnosis of SLE. Incidents where ischemic stroke precedes and acts as an initial symptom of SLE are comparatively rare in its early stages, and such presentations are frequently misdiagnosed as ischemic cerebrovascular diseases, posing significant diagnostic challenges. CASE REPORTS This article presents three cases of young females in whom ischemic stroke emerged as the initial manifestation of SLE. It incorporates a review of 17 case reports published over the past two decades, focusing on patients with SLE where ischemic stroke was a primary symptom. This discussion encompasses the clinical presentation, outcomes, and therapeutic approaches for these patients. CONCLUSION In young patients, particularly females presenting with ischemic stroke and especially in cases accompanied by hematologic or multisystemic involvement, there should be heightened vigilance for SLE-induced ischemic stroke. Early diagnosis and treatment significantly enhance patients' quality of life and survival rates.
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Affiliation(s)
- Na Li
- Department of Rheumatology and ImmunologyThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Xiaoxia Liu
- Department of Rheumatology and ImmunologyThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Pengjia Wu
- Department of Rheumatology and ImmunologyThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Jun Liu
- Department of Rheumatology and ImmunologyThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Pengyu Chen
- Radiology DepartmentThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Jiashun Zeng
- Department of Rheumatology and ImmunologyThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
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5
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Barraclough M, Erdman L, Diaz-Martinez JP, Knight A, Bingham K, Su J, Kakvan M, Grajales CM, Tartaglia MC, Ruttan L, Wither J, Choi MY, Bonilla D, Appenzeller S, Parker B, Goldenberg A, Katz P, Beaton D, Green R, Bruce IN, Touma Z. Systemic lupus erythematosus phenotypes formed from machine learning with a specific focus on cognitive impairment. Rheumatology (Oxford) 2023; 62:3610-3618. [PMID: 36394258 PMCID: PMC10629781 DOI: 10.1093/rheumatology/keac653] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE To phenotype SLE based on symptom burden (disease damage, system involvement and patient reported outcomes), with a specific focus on objective and subjective cognitive function. METHODS SLE patients ages 18-65 years underwent objective cognitive assessment using the ACR Neuropsychological Battery (ACR-NB) and data were collected on demographic and clinical variables, disease burden/activity, health-related quality of life (HRQoL), depression, anxiety, fatigue and perceived cognitive deficits. Similarity network fusion (SNF) was used to identify patient subtypes. Differences between the subtypes were evaluated using Kruskal-Wallis and χ2 tests. RESULTS Of the 238 patients, 90% were female, with a mean age of 41 years (s.d. 12) and a disease duration of 14 years (s.d. 10) at the study visit. The SNF analysis defined two subtypes (A and B) with distinct patterns in objective and subjective cognitive function, disease burden/damage, HRQoL, anxiety and depression. Subtype A performed worst on all significantly different tests of objective cognitive function (P < 0.03) compared with subtype B. Subtype A also had greater levels of subjective cognitive function (P < 0.001), disease burden/damage (P < 0.04), HRQoL (P < 0.001) and psychiatric measures (P < 0.001) compared with subtype B. CONCLUSION This study demonstrates the complexity of cognitive impairment (CI) in SLE and that individual, multifactorial phenotypes exist. Those with greater disease burden, from SLE-specific factors or other factors associated with chronic conditions, report poorer cognitive functioning and perform worse on objective cognitive measures. By exploring different ways of phenotyping SLE we may better define CI in SLE. Ultimately this will aid our understanding of personalized CI trajectories and identification of appropriate treatments.
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Affiliation(s)
- Michelle Barraclough
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Lauren Erdman
- Genetics and Genome Biology, Department of Computer Science, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, University of Toronto, Toronto, ON, Canada
| | - Juan Pablo Diaz-Martinez
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, Toronto, ON, Canada
| | - Andrea Knight
- Division of Rheumatology, Hospital for Sick Children, Toronto, ON, Canada
| | - Kathleen Bingham
- Centre for Mental Health, University Health Network, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jiandong Su
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, Toronto, ON, Canada
| | - Mahta Kakvan
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, Toronto, ON, Canada
| | - Carolina Muñoz Grajales
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, Toronto, ON, Canada
| | | | - Lesley Ruttan
- University Health Network-Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Joan Wither
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - May Y Choi
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dennisse Bonilla
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, Toronto, ON, Canada
| | | | - Ben Parker
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Anna Goldenberg
- Genetics and Genome Biology, Department of Computer Science, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, University of Toronto, Toronto, ON, Canada
| | - Patricia Katz
- University of California, San Francisco, Novato, CA, USA
| | - Dorcas Beaton
- Institute for Work and Health, University of Toronto, Toronto, ON, Canada
| | - Robin Green
- University Health Network-Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Zahi Touma
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, Toronto, ON, Canada
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6
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Tan X, Liu X, Han K, Zhao L, Niu M, Yao Q, Huang Q, Zhong M, Mei Y, Huang R, Xu Y. Disrupted resting-state brain functional network properties in non-neuropsychiatric systemic lupus erythematosus patients. Lupus 2023; 32:538-548. [PMID: 36916282 DOI: 10.1177/09612033231160725] [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: 03/16/2023]
Abstract
INTRODUCTION Previous fMRI studies revealed that the abnormal functional connectivity (FC) was related to cognitive impairment in patients with SLE. However, it remains unclear how the disease severity affects the functional topological organization of the whole-brain network in SLE patients without neuropsychiatric symptoms (non-NPSLE). OBJECTIVE We aim to examine the impairment of the whole-brain functional network in SLE patients without neuropsychiatric symptoms (non-NPSLE), which may improve the understanding of neural mechanism in SLE. METHODS We acquired resting-state fMRI data from 32 non-NPSLE patients and 32 healthy controls (HC), constructed their whole-brain functional network, and then estimated the topological properties including global and nodal parameters by using graph theory. Meanwhile, we also investigated the differences in intra- and inter-network FC between the non-NPSLE patients and the HC. RESULTS The non-NPSLE patients showed significantly lower clustering coefficient, global and local efficiency, but higher characteristic path length than the HC. The non-NPSLE patients had significantly lower nodal strength in two regions, ventromedial prefrontal cortex (vmPFC) and anterior PFC (aPFC) than the HC. We found the non-NPSLE patients had significantly lower intra-network FC within frontal-parietal network (FPN) and within default mode network (DMN), and significantly lower inter-network FC between DMN and FPN than the HC. The intra-network FC within DMN was negatively correlated with systemic lupus erythematosus disease activity index (SLEDAI). CONCLUSION Abnormal whole-brain functional network properties and abnormal intra- and inter-network FC may be related to cognitive impairment and disease degree in the non-NPSLE patients. Our findings provide a network perspective to understand the neural mechanisms of SLE.
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Affiliation(s)
- Xiangliang Tan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaojin Liu
- Center for Educational Science and Technology, Beijing Normal University, Zhuhai, China.,Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, Guangzhou, China
| | - Kai Han
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ling Zhao
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, Guangzhou, China
| | - Meiqi Niu
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, Guangzhou, China
| | - Qiaoli Yao
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qin Huang
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Miao Zhong
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, Guangzhou, China
| | | | - Ruiwang Huang
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, Guangzhou, China
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
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Monahan RC, Beaart-van de Voorde LJJ, Fronczek R, de Bresser J, Eikenboom J, Kloppenburg M, Middelkoop HAM, Terwindt GM, van der Wee NJA, Huizinga TWJ, Steup-Beekman GM. Clinical outcome in patients with suspected inflammatory neuropsychiatric lupus treated with immunosuppression: an observational cohort study. Lupus Sci Med 2023; 10:10/1/e000850. [PMID: 36737098 PMCID: PMC9900068 DOI: 10.1136/lupus-2022-000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/28/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The short-term and long-term outcome of inflammatory neuropsychiatric SLE (NPSLE) with immunosuppressive treatment is largely unknown. We used clinical data from our tertiary referral centre for NPSLE to investigate the type of inflammatory NPSLE manifestations, type of immunosuppressive treatment prescribed for these manifestations and clinical outcomes. METHODS All patients with SLE visiting the Leiden University Medical Centre NPSLE clinic between 2007 and 2021 receiving immunosuppressive therapy for neuropsychiatric symptoms were included. Clinical, immunological and radiological information was collected in as standardised way during a 1-day multidisciplinary assessment. In a multidisciplinary consensus meeting, the presence of NPSLE and the type of NPSLE manifestations and treatment were determined. For this study, short-term (0-6 months) and long-term outcomes (7-24 months) of the NP symptoms were assessed by two independent readers and scored on a 7-point Likert scale, ranging from death to resolved. RESULTS In total, 95 out of 398 (24%) patients visiting the NPSLE clinic between 2007 and 2021 received any form of immunosuppressive treatment for 101 separate NPSLE events. The most common NP manifestation was cognitive dysfunction (50%) as identified by formal cognitive assessment, often present in combination with other NPSLE manifestations. Treatment modalities were induction (24%), induction and maintenance (73%) and other therapy (3%). The treatments mostly consisted of (combinations of) prednisone (97%), methylprednisolone (53%), azathioprine (generally 2 mg/kg daily) (49%) and cyclophosphamide (generally induction 750 mg/m2 every 4 weeks for 24 weeks or 500mg biweekly for 12 weeks) (42%). Short-term outcome showed improvement on the Likert scale in 73% (improved: 22%, much improved: 29%, resolved: 22%), no change in 21% and worsening in 6% of patients. Long-term outcome was available for 78 out of 101 events and showed improvement in 70% (improved: 14%, much improved: 28%, resolved: 28%), no change in 17%, worsening in 10% and death in 3% of patients (none directly NPSLE-related). CONCLUSION The outcome of inflammatory NPSLE after immunosuppressive treatment is generally good, with improvement of neuropsychiatric symptoms occuring in approximately 70% of events.
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Affiliation(s)
- Rory C Monahan
- Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | | | - Rolf Fronczek
- Department of Neurology, LUMC, Leiden, The Netherlands,SEIN, Hoofddorp, The Netherlands
| | | | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, LUMC, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Huub A M Middelkoop
- Department of Neurology, LUMC, Leiden, The Netherlands,Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | | | - Nic J A van der Wee
- Department of Psychiatry, LUMC, Leiden, The Netherlands,Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Gerda M Steup-Beekman
- Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands,Department of Rheumatology, Haaglanden Medical Centre, the Hague, The Netherlands
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8
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Gwinnutt JM, Toyoda T, Barraclough M, Verstappen SMM, Hornberger M, MacGregor A. Cognitive impairment in the immune-mediated inflammatory diseases compared with age-matched controls: Systematic review and meta-regression. Semin Arthritis Rheum 2023; 58:152131. [PMID: 36527929 DOI: 10.1016/j.semarthrit.2022.152131] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/31/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare the magnitude of cognitive impairment against age-expected levels across the immune mediated inflammatory diseases (IMIDs: systemic lupus erythematosus [SLE], rheumatoid arthritis [RA], axial spondyloarthritis [axSpA], psoriatic arthritis [PsA], psoriasis [PsO]). METHODS A pre-defined search strategy was implemented in Medline, Embase and Psychinfo on 29/05/2021. Inclusion criteria were: (i) observational studies of an IMID, (ii) healthy control comparison, (iii) measuring cognitive ability (overall, memory, complex attention/executive function, language/verbal fluency), and (iv) sufficient data for meta-analysis. Standardised mean differences (SMD) in cognitive assessments between IMIDs and controls were pooled using random-effects meta-analysis. IMIDs were compared using meta-regression. RESULTS In total, 65 IMID groups were included (SLE: 39, RA: 19, axSpA: 1, PsA: 2 PsO: 4), comprising 3141 people with IMIDs and 9333 controls. People with IMIDs had impairments in overall cognition (SMD: -0.57 [95% CI -0.70, -0.43]), complex attention/executive function (SMD -0.57 [95% CI -0.69, -0.44]), memory (SMD -0.55 [95% CI -0.68, -0.43]) and language/verbal fluency (SMD -0.51 [95% CI -0.68, -0.34]). People with RA and people with SLE had similar magnitudes of cognitive impairment in relation to age-expected levels. People with neuropsychiatric SLE had larger impairment in overall cognition compared with RA. CONCLUSIONS People with IMIDs have moderate impairments across a range of cognitive domains. People with RA and SLE have similar magnitudes of impairment against their respective age-expected levels, calling for greater recognition of cognitive impairment in both conditions. To further understand cognition in the IMIDs, more large-scale, longitudinal studies are needed.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Task Toyoda
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Michelle Barraclough
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | | | - Alex MacGregor
- Norwich Medical School, University of East Anglia, Norwich, UK; Rheumatology Department, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
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9
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Stefanov K, Al-Wasity S, Parkinson JT, Waiter GD, Cavanagh J, Basu N. Brain mapping inflammatory-arthritis-related fatigue in the pursuit of novel therapeutics. THE LANCET. RHEUMATOLOGY 2023; 5:e99-e109. [PMID: 38251542 DOI: 10.1016/s2665-9913(23)00007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 01/26/2023]
Abstract
Despite developments in pharmacological treatments, chronic fatigue is an unresolved issue for most people with inflammatory arthritis that severely disrupts their personal and working lives. Fatigue in these patients is not strongly linked with peripheral disease activity but is associated with CNS-derived symptoms such as chronic pain, sleep disturbance, and depression. Therefore, a neurobiological basis should be considered when pursuing novel fatigue-specific therapeutics. In this Review, we focus on clinical imaging biomarkers that map candidate brain regions and are crucial in fatigue pathophysiology. We then evaluate neuromodulation techniques that could affect these candidate brain regions and are potential treatment strategies for fatigue in patients with inflammatory arthritis. We delineate work that is still required for neuroimaging and neuromodulation to eventually become part of a clinical pathway to treat and manage fatigue.
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Affiliation(s)
- Kristian Stefanov
- School of Infection and Immunity, University of Glasgow, Glasgow, UK.
| | - Salim Al-Wasity
- School of Infection and Immunity, University of Glasgow, Glasgow, UK; College of Engineering, University of Wasit, Al Kūt, Iraq
| | - Joel T Parkinson
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Gordon D Waiter
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Jonathan Cavanagh
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Neil Basu
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
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10
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Robl R, Eudy A, Bachali PS, Rogers JL, Clowse M, Pisetsky D, Lipsky P. Molecular endotypes of type 1 and type 2 SLE. Lupus Sci Med 2023; 10:10/1/e000861. [PMID: 36720488 PMCID: PMC9950972 DOI: 10.1136/lupus-2022-000861] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/04/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To character the molecular landscape of patients with type 1 and type 2 SLE by analysing gene expression profiles from peripheral blood. METHODS Full transcriptomic RNA sequencing was carried out on whole blood samples from 18 subjects with SLE selected by the presence of manifestations typical of type 1 and type 2 SLE. The top 5000 row variance genes were analysed by Multiscale Embedded Gene Co-expression Network Analysis to generate gene co-expression modules that were functionally annotated and correlated with various demographic traits, clinical features and laboratory measures. RESULTS Expression of specific gene co-expression modules correlated with individual features of type 1 and type 2 SLE and also effectively segregated samples from patients with type 1 SLE from those with type 2 SLE. Unique type 1 SLE enrichment included interferon, monocytes, T cells, cell cycle and neurotransmitter pathways, whereas unique type 2 SLE enrichment included B cells and metabolic and neuromuscular pathways. Gene co-expression modules of patients with type 2 SLE were identified in subsets of previously reported patients with inactive SLE and idiopathic fibromyalgia (FM) and also identified subsets of patients with active SLE with a greater frequency of severe fatigue. CONCLUSION Gene co-expression analysis successfully identified unique transcriptional patterns that segregate type 1 SLE from type 2 SLE and further identified type 2 molecular features in patients with inactive SLE or FM and with active SLE with severe fatigue.
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Affiliation(s)
- Robert Robl
- Bioinformatics, AMPEL BioSolutions, Charlottesville, Virginia, USA
| | - Amanda Eudy
- Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jennifer L Rogers
- Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Megan Clowse
- Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - David Pisetsky
- Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA,Rheumatology, Durham Veterans Administration Medical Center, Durham, North Carolina, USA
| | - Peter Lipsky
- Bioinformatics, AMPEL BioSolutions, Charlottesville, Virginia, USA
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11
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Ferrara V, Perrone ME, Mina C, Ceccarelli F, Olivieri G, Fattapposta F, Conti F. Science and visual Arts: Binomial or Dichotomy? A Pilot study in Systemic Lupus Erythematosus patients. Lupus 2022; 31:1744-1749. [PMID: 36189670 DOI: 10.1177/09612033221131179] [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: 10/07/2022]
Abstract
Scientific literature demonstrated the impairment in cognitive/executive functions and pragmatic language in SLE patients, potentially involving also asymptomatic subjects. The present study focuses on the assessment in an SLE cohort of emotional intelligence, which is an ability regulated by the network of the executive functions, cognitive abilities involved in the initiation, planning, organization, and regulation of achievement-oriented behaviors: with emotional. Thus, emotional intelligence, defined as the ability to reason with emotions, was evaluated in a SLE cohort diagnosed according to the 1997 American College of Rheumatology criteria. As control healthy subjects were enrolled. The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), a skill-scale that measures the ability to perform tasks and solve emotional problems, was administered to patients and controls. Second, a group of SLE patients underwent the Visual Thinking Strategies (VTS) method in order to assess the potential impact of art in cognitive skills like critical thinking, problem solving, and emotional intelligence quotient. The protocol also included the evaluation of the improvement of some skills using a validated VTS skill grid. Self-reported scales for anxiety and depression were performed to rule out the influence of mood disorders on emotional intelligence. The present study demonstrated similar quotient scores of emotional intelligence in SLE patients and healthy controls. Furthermore, VTS method could help in improving this cognitive ability in patients, by implementing critical thinking and problem solving, promoting empathy, and improving tolerance to ambiguity and relational capacity.
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Affiliation(s)
- Vincenza Ferrara
- Art and Medical Humanities Lab - Pharmacy and Medicine Faculty, Sapienza University of Rome, Roma, Italy
| | | | - Concetta Mina
- Human Neurosciences Department Sapienza, University of Rome, Rome, Italy
| | - Fulvia Ceccarelli
- Lupus Clinic, Reumatology, Clinical Internal, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Giulio Olivieri
- Lupus Clinic, Reumatology, Clinical Internal, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | | | - Fabrizio Conti
- Lupus Clinic, Reumatology, Clinical Internal, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
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12
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Cognitive dysfunction in SLE: An understudied clinical manifestation. J Autoimmun 2022; 132:102911. [PMID: 36127204 DOI: 10.1016/j.jaut.2022.102911] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022]
Abstract
Neuropsychiatric lupus (NPSLE) is a debilitating manifestation of SLE which occurs in a majority of SLE patients and has a variety of clinical manifestations. In the central nervous system, NPSLE may result from ischemia or penetration of inflammatory mediators and neurotoxic antibodies through the blood brain barrier (BBB). Here we focus on cognitive dysfunction (CD) as an NPSLE manifestation; it is common, underdiagnosed, and without specific therapy. For a very long time, clinicians ignored cognitive dysfunction and researchers who might be interested in the question struggled to find an approach to understanding mechanisms for this manifestation. Recent years, however, propelled by a more patient-centric approach to disease, have seen remarkable progress in our understanding of CD pathogenesis. This has been enabled through the use of novel imaging modalities and numerous mouse models. Overall, these studies point to a pivotal role of an impaired BBB and microglial activation in leading to neuronal injury. These insights suggest potential therapeutic modalities and make possible clinical trials for cognitive impairment.
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13
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Su L, Zhuo Z, Duan Y, Huang J, Qiu X, Li M, Liu Y, Zeng X. Structural and Functional Characterization of Gray Matter Alterations in Female Patients With Neuropsychiatric Systemic Lupus. Front Neurosci 2022; 16:839194. [PMID: 35585919 PMCID: PMC9108669 DOI: 10.3389/fnins.2022.839194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/05/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate morphological and functional alterations within gray matter (GM) in female patients with neuropsychiatric systemic lupus (NPSLE) and to explore their clinical significance. Methods 54 female patients with SLE (30 NPSLE and 24 non-NPSLE) and 32 matched healthy controls were recruited. All subjects received a quantitative MRI scan (FLAIR, 3DT1, resting-state functional MRI). GM volume (GMV), fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), and degree of centrality (DC) were obtained. Between-group comparison, clinical correlation, and discrimination of NPSLE from non-NPSLE were achieved by voxel-based analysis, cerebellar seed-based functional connectivity analysis, regression analysis, and support vector machine (SVM), respectively. Results Patients with NPSLE showed overt subcortical GM atrophy without significantly abnormal brain functions in the same region compared with controls. The dysfunction within the left superior temporal gyri (L-STG) was found precede the GM volumetric loss. The function of the nodes in default mode network (DMN) and salience network (SN) were weakened in NPSLE patients compared to controls. The function of the cerebellar posterior lobes was significantly activated in non-NPSLE patients but attenuated along with GM atrophy and presented higher connectivity with L-STG and DMN in NPSLE patients, while the variation of the functional activities in the sensorimotor network (SMN) was the opposite. These structural and functional alterations were mainly correlated with disease burden and anti-phospholipid antibodies (aPLs) (r ranges from -1.53 to 1.29). The ReHos in the bilateral cerebellar posterior lobes showed high discriminative power in identifying patients with NPSLE with accuracy of 87%. Conclusion Patients with NPSLE exhibit both structural and functional alterations in the GM of the brain, which especially involved the deep GM, the cognitive, and sensorimotor regions, reflecting a reorganization to compensate for the disease damage to the brain which was attenuated along with pathologic burden and cerebral vascular risk factors. The GM within the left temporal lobe may be one of the direct targets of lupus-related inflammatory attack. The function of the cerebellar posterior lobes might play an essential role in compensating for cortical functional disturbances and may contribute to identifying patients with suspected NPSLE in clinical practice.
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Affiliation(s)
- Li Su
- Department of Rheumatology and Clinical Immunology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Rheumatology and Clinical Rheumatology, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Education, Beijing, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Huang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaolu Qiu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Rheumatology and Clinical Rheumatology, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Education, Beijing, China
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Key Laboratory of Rheumatology and Clinical Rheumatology, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Education, Beijing, China
- *Correspondence: Xiaofeng Zeng,
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14
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Langensee L, Mårtensson J, Jönsen A, Zervides K, Bengtsson A, Nystedt J, Cannerfelt B, Nilsson P, Mannfolk P, Lätt J, Rumetshofer T, Sundgren PC. Cognitive performance in systemic lupus erythematosus patients: a cross-sectional and longitudinal study. BMC Rheumatol 2022; 6:22. [PMID: 35440096 PMCID: PMC9019974 DOI: 10.1186/s41927-022-00253-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
Background Previous research has provided evidence for cognitive dysfunction as a common symptom of systemic lupus erythematosus (SLE). In light of this, the primary goal of this study was to investigate how cognitive impairment in this patient group develops over time. In addition, the present dataset contributes to delineating the specific abilities that are impaired in SLE patients as well as answering the question whether the disease affects the cognition of SLE patients with neuropsychiatric manifestations (NPSLE) and without (non-NPSLE) in distinct ways. Methods 91 female participants (33 NPSLE, 29 non-NPSLE, 29 healthy controls (HC)) underwent standardized neurocognitive testing. A total of ten different cognitive abilities were assessed, among others executive function, memory, and attention. Some of the participants (30 NPSLE patients, 22 non-NPSLE, 13 HC) were tested twice (mean time between testing sessions: 50 months) to enable longitudinal tracking of cognitive abilities. Analyses of Variance (ANOVA) were conducted to determine whether cognitive performance differed cross-sectionally between the groups. Linear mixed effects models were fit to investigate performance differences between the groups over time. Results Cross-sectional analysis at follow-up demonstrated that the cognitive performance of both NPSLE and non-NPSLE was significantly lower than that of HC for the motor speed and the psychomotor speed domain. Additionally, NPSLE patients performed significantly weaker than HC in the complex attention domain. At the same time, the cross-sectional data did not yield any support for performance differences between NPSLE and non-NPSLE patients. Weak positive correlations between disease duration and psychomotor speed, motor speed and reaction time emerged. A temporal progression of cognitive dysfunction in SLE patients was not confirmed. Conclusions Cognitive performance is affected in both non-NPSLE and NPSLE patients. However, a linear decline in performance over time could not be verified. More in-depth longitudinal assessments of cognition in SLE patients are needed to establish how cognitive abilities in this patient population develop over time. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00253-3.
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Affiliation(s)
- L Langensee
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - J Mårtensson
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - A Jönsen
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - K Zervides
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, 22185, Lund, Sweden.,Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - A Bengtsson
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - J Nystedt
- Department of Clinical Sciences Lund, Radiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - B Cannerfelt
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden
| | - P Nilsson
- Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - P Mannfolk
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden
| | - J Lätt
- Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden
| | - T Rumetshofer
- Department of Clinical Sciences Lund, Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden
| | - P C Sundgren
- Department of Clinical Sciences Lund, Radiology, Faculty of Medicine, Lund University, 22185, Lund, Sweden. .,Department of Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden. .,Lund University BioImaging Center (LBIC), Lund University, 22185, Lund, Sweden.
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15
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Vitronectin, a Novel Urinary Proteomic Biomarker, Promotes Cell Pyroptosis in Juvenile Systemic Lupus Erythematosus. Mediators Inflamm 2022; 2022:8447675. [PMID: 35462789 PMCID: PMC9020974 DOI: 10.1155/2022/8447675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/09/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Identifying new markers of juvenile systemic lupus erythematosus (JSLE) is critical event to predict patient stratification and prognosis. The aim of the present study is to analyze alteration of urinary protein expression and screen potential valuable biomarkers in juvenile systemic lupus erythematosus (JSLE). Methods The urine was collected from the patients with or without JSLE and detected by mass spectrometry to analyze proteomic changes. ELISA was used to verify the Vitronectin (VTN) changes in a new set of patients. The clinical correlation was performed to analyze between VTN and clinical pathological parameters. WB and ELISA were used to analyze VTN-mediated cell pyroptosis. Results Herein, we have identified a group of 105 differentially expressed proteins with ≥1.3-fold upregulation or ≤0.77-fold downregulation in JSLE patients. These proteins were involved in several important biological processes, including acute phase inflammatory responses, complement activation, hemostasis, and immune system regulation through Gene Ontology and functional enrichment analysis. Interestingly, urinary ephrin type-A receptor 4 (EPHA4) and VTN were significantly reduced in both inactive and active JSLE patients, and VTN treatment in THP-1 derived macrophages led to a significant increased cell pyroptosis by activation of Nod-like receptor family protein 3 (NLRP3) inflammasomes, resulting in caspase-1 activation, cleaved gasdermin D (GSDMD), and IL-18 secretion. Most importantly, the urinary VTN was also linearly correlated with clinical characteristics of JSLE, implying that VTN could be a specific diagnostic biomarker to distinguish inactive and active JSLE. Conclusion This study provided a novel role of VTN in pyroptosis in JSLE through the urinary proteomic profile for JSLE, which could be a nonintrusive monitoring strategy in clinical diagnosis.
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16
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Papadaki E, Simos NJ, Kavroulakis E, Bertsias G, Antypa D, Fanouriakis A, Maris T, Sidiropoulos P, Boumpas DT. Converging evidence of impaired brain function in systemic lupus erythematosus: changes in perfusion dynamics and intrinsic functional connectivity. Neuroradiology 2022; 64:1593-1604. [DOI: 10.1007/s00234-022-02924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
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17
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Zhang L, Liu X, Chen X, Warden AR, Yu Y, Huang B, Ding X. SCANCell reveals diverse inter-cluster interaction patterns in systemic lupus erythematosus across the disease spectrum. Bioinformatics 2022; 38:1361-1368. [PMID: 34664638 DOI: 10.1093/bioinformatics/btab713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/20/2021] [Accepted: 10/13/2021] [Indexed: 01/05/2023] Open
Abstract
MOTIVATION High-dimensional mass cytometry (CyTOF), which provides both cellular signatures and inter-cluster interactions like the antagonism between immune activation and suppression, and the pro-inflammatory synergy, sheds light on the cellular and molecular basis of disease pathogenesis. However, revealing the aberrance of inter-cluster communication networks in CyTOF datasets remains a significant challenge. RESULTS Here, we developed Sample Classification and direct Association Network among Cell clusters (SCANCell) that quantifies the direct association (DA) network of cell clusters. SCANCell was applied to profile inter-cluster interaction patterns of a well-recruited systemic lupus erythematosus (SLE) cohort, including 8 healthy controls, 10 active SLE patients (APs) and 8 remission SLE patients (RPs). SCANCell identified decreased inter-cluster interactions of CD8+ T cells in APs compared with RPs, and enhanced DA of CD8+ T cells after stimulation with immunostimulatory cytokine interleukin-2 in vitro. These discoveries prove that SCANCell can uncover pathology- and drug stimulation-associated inter-cluster interactions, which potentially benefits understanding of pathogenesis and novel therapeutic strategies. AVAILABILITY AND IMPLEMENTATION The main processing scripts of SCNACell are available at https://github.com/Lxc417/SCANCell. Other codes for the following data statistics are available from the corresponding author upon request. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Lulu Zhang
- State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xiao Liu
- State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xiaoxiang Chen
- Department of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai 200030, China
| | - Antony R Warden
- State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Youyi Yu
- State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Baozhen Huang
- Department of Chemical Pathology, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Xianting Ding
- State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
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18
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Tayer-Shifman OE, Bingham KS, Touma Z. Neuropsychiatric Systemic Lupus Erythematosus in Older Adults: Diagnosis and Management. Drugs Aging 2021; 39:129-142. [PMID: 34913146 DOI: 10.1007/s40266-021-00911-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/29/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem chronic autoimmune disease with variable clinical manifestations. Neuropsychiatric systemic lupus erythematosus (NPSLE) includes the neurologic syndromes of the central, peripheral and autonomic nervous system and the psychiatric syndromes observed in patients with SLE. Neuropsychiatric systemic lupus erythematosus events may present as an initial manifestation of SLE or may be diagnosed later in the course of the disease. Older adults with NPLSE include those who are ageing with known SLE and those with late-onset SLE. The diagnosis of NPSLE across the lifespan continues to be hampered by the lack of sensitive and specific laboratory and imaging biomarkers. In this review, we discuss the particular complexity of NPSLE diagnosis and management in older adults. We first discuss the epidemiology of late-onset NPSLE, then review principles of diagnosis of NPSLE, highlighting issues that are pertinent to older adults and that make diagnosis and attribution more challenging, such as atypical disease presentation, higher medical comorbidity, and differences in neuroimaging and autoantibody investigations. We also discuss clinical issues that are of particular relevance to older adults that have a high degree of overlap with SLE, including drug-induced lupus, cerebrovascular disease and neurocognitive disorders. Finally, we review the management of NPSLE, mainly moderate to high- dose glucocorticoids and immunosuppressants, again highlighting considerations for older adults, such as increased medication (especially glucocorticoids) adverse effects, ageing-related pharmacokinetic changes that can affect SLE medication management, medication dosing and attention to medical comorbidities affecting brain health.
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Affiliation(s)
- Oshrat E Tayer-Shifman
- Rheumatology Unit, Meir Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Kathleen S Bingham
- University Health Network Centre for Mental Health, Toronto General Hospital, Toronto, ON, Canada
| | - Zahi Touma
- Division of Rheumatology, Department of Medicine, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital-Lupus Clinic, University of Toronto, EW, 1-412, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
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Barraclough M, McKie S, Parker B, Elliott R, Bruce IN. The effects of disease activity, inflammation, depression and cognitive fatigue on resting state fMRI in systemic lupus erythematosus. Rheumatology (Oxford) 2021; 61:SI39-SI47. [PMID: 34747435 DOI: 10.1093/rheumatology/keab734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Cognitive dysfunction (CD) and depression are interlinked comorbidities of SLE. They may be the result of altered brain mechanisms. This study aimed to examine SLE effects on functional connectivity (FC) within the default mode network (DMN) using resting state fMRI-and how depression may impact this. METHODS Demographic, clinical and psychiatric data were collected from 19 SLE-active, 23 SLE-stable and 30 healthy controls (HC) participants. A T2*-weighted rsfMR scan was acquired and analysed using independent component analysis (ICA). Group z-scores for nodes associated with the DMN were tested. Significant nodes were entered into a factor analysis. The combined factor was used in correlations with factors of interest. Significant variables were used in a mediation analysis. RESULTS 14 DMN nodes were defined using ICA. In five nodes, the SLE groups had significantly reduced FC compared with the HC group (p < 0.01). Factor analysis generated one factor that only depression score correlated with for both the HC group (rs=-0.510) and SLE groups combined (rs=-0.390). Mediation analysis revealed depression score accounted for 22% of the altered FC in the DMN. Disease state accounted for the remaining 78%. CONCLUSIONS Altered FC was evident in DMN nodes for SLE groups irrespective of disease activity. Depression accounts for some of this effect but SLE directly accounted for more. Further studies are needed to assess if these changes may be a precursor to CD in SLE. If so, rs-fMRI could be an early marker for CD in SLE and help in future CD in SLE treatment trials.
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Affiliation(s)
- Michelle Barraclough
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Shane McKie
- FBMH Platform Sciences, Enabling Technologies & Infrastructure, FBMH Research & Innovation, The University of Manchester & Manchester Academic Health Science Centre, Manchester, UK
| | - Ben Parker
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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20
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Peter E, Robert M, Guinet V, Krolak-Salmon P, Desestret V, Jacquin-Courtois S, Cohen F, Sève P, Garnier-Crussard A. [Importance of cognitive disorders in internal medicine: Pathophysiology, diagnosis, management. The example of systemic lupus erythematosus]. Rev Med Interne 2021; 43:39-47. [PMID: 34563395 DOI: 10.1016/j.revmed.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/18/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
Systemic diseases, which are in France mainly monitored in internal medicine, affect multiple organs or tissues. While cutaneous or articular manifestations are the most common, neurological involvement is often associated with severity. Diagnosis of peripheral (e.g, neuropathies) or central (e.g, myelitis) nervous disorders is quite easy through clinical examination and dedicated complementary tests. However, neuropsychological manifestations that affect cognition, including memory, attention, executive functions or reasoning, are difficult to diagnose, sometimes trivialized by practitioners. Their causes are often numerous and interrelated. Nevertheless, these cognitive manifestations are closely related to patients' quality of life, affecting their social life, family dynamics and professional integration but also the treatment adherence. The purpose of this review, focused on the example of systemic lupus erythematosus, is to raise awareness of cognitive dysfunction in systemic diseases including their management from diagnosis to treatments. The final aim is to go further into setting up research groups and care programs for patients with cognitive impairment followed in internal medicine.
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Affiliation(s)
- E Peter
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, université de Lyon, Lyon, France
| | - M Robert
- Service de médecine interne et immunologie clinique, hospices civils de Lyon, hôpital Édouard-Herriot, université de Lyon, Lyon, France
| | - V Guinet
- Service de neurologie fonctionnelle et d'épileptologie, hospices civils de Lyon, hôpital Pierre-Wertheimer, Lyon, France
| | - P Krolak-Salmon
- Centre mémoire ressource et recherche de Lyon (CMRR), hospices civils de Lyon, institut du vieillissement I-vie, hôpital des Charpennes, Lyon, France
| | - V Desestret
- Centre mémoire ressource et recherche de Lyon (CMRR), hospices civils de Lyon, institut du vieillissement I-vie, hôpital des Charpennes, Lyon, France; Service de neurocognition et de neuro-ophtalmologie, hospices civils de Lyon, hôpital Pierre-Wertheimer, Lyon, France
| | - S Jacquin-Courtois
- Service de médecine physique et de réadaptation, rééducation neurologique, hospices civils de Lyon, hôpital Henry-Gabrielle, 69230 Saint-Genis-Laval, France
| | - F Cohen
- Service de médecine Interne 2, institut E3M, groupe hospitalier Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - P Sève
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, université de Lyon, Lyon, France
| | - A Garnier-Crussard
- Centre mémoire ressource et recherche de Lyon (CMRR), hospices civils de Lyon, institut du vieillissement I-vie, hôpital des Charpennes, Lyon, France.
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Cao ZY, Wang N, Wei H, Jia JT, Zhang HY, Shang SA, Zhu QQ, Luo XF, Wu JT. The altered functional modular organization in systemic lupus erythematosus: an independent component analysis study. Brain Imaging Behav 2021; 16:728-737. [PMID: 34535879 DOI: 10.1007/s11682-021-00528-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate the abnormities in functional connectivity (FC) within each modular network and between modular networks in patients with systemic lupus erythematosus (SLE). Twelve meaningful modular networks were identified via independent component analysis from 41 patients and 40 volunteers. Parametric tests were used to compare the intra- and intermodular FC between the groups. Partial correlation analysis was used to seek the relationships between abnormal FCs and the clinical data. Compared to the controls, SLE patients showed decreased intramodular FC in the anterior default mode network (aDMN), posterior default mode network (pDMN), ventral attention network (VAN), and sensorimotor network (SMN) and increased intramodular FC in the medial visual network (mVN) and left frontoparietal network. In addition, SLE patients showed decreased intermodular FC between the SMN and the lateral visual network (lVN), between the SMN and the VAN, and between the pDMN and the lVN and exhibited increased intermodular FC between the SMN and the salience network (SAN), between the pDMN and the SAN, and between the aDMN and the VAN. Moreover, we found several correlations among the abnormal FCs and the Mini-Mental State Examination in SLE patients. Mild cognitive impairment is compensated by the hyperconnectivity between the aDMN and the VAN, while severe cognitive impairment tends to be compensated by the hyperconnectivity between the SMN and the SAN. The FC value between the SMN and the SAN and between the aDMN and the VAN may serve as neuroimaging markers for monitoring cognitive progression in SLE patients.
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Affiliation(s)
- Zheng-Ye Cao
- Department of Radiology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, China
| | - Na Wang
- Department of Ultrasound, Affiliated Hospital of Yangzhou University, Yangzhou University, No.368 Middle Hanjiang Road, Yangzhou, Jiangsu, China
| | - Hua Wei
- Department of Rheumatology, Subei People's Hospital of Jiangsu Province, No.98 Nantong West Road, Yangzhou, Jiangsu, China
| | - Jie-Ting Jia
- Department of Rheumatology, Subei People's Hospital of Jiangsu Province, No.98 Nantong West Road, Yangzhou, Jiangsu, China
| | - Hong-Ying Zhang
- Department of Radiology, Subei People's Hospital of Jiangsu Province, No.98 Nantong West Road, Yangzhou, Jiangsu, China
| | - Song-An Shang
- Department of Radiology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, China
| | - Qing-Qiang Zhu
- Department of Radiology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, China
| | - Xian-Fu Luo
- Department of Radiology, Subei People's Hospital of Jiangsu Province, No.98 Nantong West Road, Yangzhou, Jiangsu, China
| | - Jing-Tao Wu
- Department of Radiology, Subei People's Hospital of Jiangsu Province, Central South University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
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22
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Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Comparison of Mechanisms, Measures and Management. J Clin Med 2021; 10:jcm10163566. [PMID: 34441861 PMCID: PMC8396818 DOI: 10.3390/jcm10163566] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022] Open
Abstract
Fatigue is a common constitutional feature of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). While the two diseases share a common mechanism of autoimmunity, they differ in their clinical manifestations and treatment. Fatigue is one of the most commonly reported symptoms in both groups, associated with pain, depression and anxiety, and affecting function, work and quality of life. Fatigue is not easy to assess or conceptualise. It can be linked to disease activity, although it is not always, and is challenging to treat. Several measures have been trialled in RA and SLE; however, none have been adopted into mainstream practice. Despite being a common symptom, fatigue remains poorly managed in both RA and SLE—more so in the latter, where there have been relatively fewer studies. Additionally, comorbidities contribute to fatigue, further complicating its management. Pain, depression and anxiety also need to be addressed, not as separate entities, but together with fatigue in a holistic manner. Here, we describe the similarities and differences between fatigue in patients with RA and SLE, discuss concepts and practices applicable to both conditions and identify areas for further research. Through this review, we aim to highlight the importance of the holistic management of fatigue in SLE.
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23
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Monahan RC, Inglese F, Middelkoop H, van Buchem M, Huizinga TW, Kloppenburg M, Ronen I, Steup-Beekman GM, de Bresser J. White matter hyperintensities associate with cognitive slowing in patients with systemic lupus erythematosus and neuropsychiatric symptoms. RMD Open 2021; 7:rmdopen-2021-001650. [PMID: 34321253 PMCID: PMC8320250 DOI: 10.1136/rmdopen-2021-001650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/17/2021] [Indexed: 12/31/2022] Open
Abstract
Objective To compare cognitive function between patients with different phenotypes of neuropsychiatric systemic lupus erythematosus (NPSLE) and assess its association with brain and white matter hyperintensity (WMH) volumes. Methods Patients attending the Leiden University Medical Centre NPSLE clinic between 2007 and 2015 without large brain infarcts were included (n=151; 42±13 years, 91% women). In a multidisciplinary consensus meeting, neuropsychiatric symptoms were attributed to systemic lupus erythematosus (SLE) (NPSLE, inflammatory (n=24) or ischaemic (n=12)) or to minor/non-NPSLE (n=115). Multiple regression analyses were performed to compare cognitive function between NPSLE phenotypes and to assess associations between brain and WMH volumes and cognitive function cross-sectionally. Results Global cognitive function was impaired in 5%, learning and memory (LM) in 46%, executive function and complex attention (EFCA) in 39% and psychomotor speed (PS) in 46% of all patients. Patients with inflammatory NPSLE showed the most cognitive impairment in all domains (p≤0.05). Higher WMH volume associated with lower PS in the total group (B: −0.14 (95% CI −0.32 to −0.02)); especially in inflammatory NPSLE (B: −0.36 (95% CI −0.60 to −0.12). In the total group, lower total brain volume and grey matter volume associated with lower cognitive functioning in all domains (all: 0.00/0.01 (0.00;0.01)) and lower white matter volume associated with lower LM, EFCA and PS (all: 0.00/0.01 (0.00;0.01)). Conclusion We demonstrated that an association between brain and WMH volumes and cognitive function is present in patients with SLE, but differs between (NP)SLE phenotypes. WMHs associated with PS especially in inflammatory NPSLE, which suggests a different, potentially more severe underlying pathophysiological mechanism of cognitive impairment in this phenotype.
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Affiliation(s)
| | - Francesca Inglese
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Huub Middelkoop
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.,Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Mark van Buchem
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Tom Wj Huizinga
- Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Margreet Kloppenburg
- Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Itamar Ronen
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Gerda M Steup-Beekman
- Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Rheumatology, Medisch Centrum Haaglanden, the Hague, the Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
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24
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Shi Y, Meng Y, Dong X, Liu Y, Liu Y, Lai J, Tian Z, Zhao J, Peng J, Wang Q, Li M, Zeng X. Quality of life in ambulatory pulmonary arterial hypertension in connective tissue diseases and its relationship with risk stratification. Pulm Circ 2021; 11:20458940211029899. [PMID: 34290858 PMCID: PMC8278470 DOI: 10.1177/20458940211029899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
The Pulmonary Arterial Hypertension Symptoms and Impact Questionnaire (PAH-SYMPACT) is a PAH-specific patient-reported outcome scale assessing patients’ quality of life from four aspects: cardiopulmonary symptoms, cardiovascular symptoms, physical impacts and cognitive/emotional impacts. This study aimed to validate the Chinese version of PAH-SYMPACT and explore its relationship with risk stratification in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH). In addition, 75 patients with CTD-PAH confirmed by right heart catheterization were invited to complete questionnaires including PAH-SYMPACT, the 36-item Medical Outcomes Study Short Form Survey (SF-36) and EuroQol five dimensions questionnaire (EQ-5D). The demographic, clinical, laboratory and treatment data were collected. The endpoint was treatment goal achievement status in 6–12 months after completing the questionnaires, defined as an integrated outcome. Participants’ mean age was 36.4 ± 11.9 years and the mean pulmonary arterial pressure was 38.9 ± 13.67 mmHg. The reliability of the PAH-SYMPACT domains ranged from 0.83 to 0.88. Results of factor analysis basically conformed the original PAH-SYMPACT. The treatment goal achievement (TGA) status in 6–12 months was significantly associated with physical impacts scores (odds ratio: 0.180, 95% confidence interval: 0.036–0.908, P=0.038). The Chinese version of PAH-SYMPACT is a reliable measurement to evaluate quality of life in CTD-PAH patients and is also a potential predictor of patient’s condition change in routine clinical practice.
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Affiliation(s)
- Yue Shi
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yanling Meng
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xingbei Dong
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yang Liu
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yongtai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinzhi Lai
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhuang Tian
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jinmin Peng
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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25
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Qian X, Ji F, Ng KK, Koh AJ, Loo BRY, Townsend MC, Pasternak O, Tay SH, Zhou JH, Mak A. Brain white matter extracellular free-water increases are related to reduced neurocognitive function in systemic lupus erythematosus. Rheumatology (Oxford) 2021; 61:1166-1174. [PMID: 34156469 DOI: 10.1093/rheumatology/keab511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/12/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Brain white matter (WM) microstructural changes evaluated by diffusion MRI were well documented in patients with systemic lupus erythematosus (SLE). Yet, conventional diffusion tensor imaging technique fails to differentiate WM changes that originate from tissue alterations from those due to increased extracellular free water (FW) related to neuroinflammation, microvascular disruption, atrophy, or other extracellular processes. Here, we sought to delineate changes in WM tissue microstructure and extracellular FW volume and examine their relationships with neurocognitive function in SLE patients. METHODS Twenty SLE patients (16 females, aged 36.0±10.6) without clinically-overt neuropsychiatric manifestation and 61 healthy controls (HC) (29 females, aged 29.2±9.4) underwent diffusion MRI and computerized neuropsychological assessments cross-sectionally. The FW imaging method was applied to compare microstructural tissue changes and extracellular FW volume of the brain WM between SLE patients and HC. Association between extracellular FW changes and neurocognitive performance was studied. RESULTS SLE patients had higher WM extracellular FW compared to HC (family-wise-error-corrected p < 0.05) while no group difference was found in FW-corrected tissue compartment and structural connectivity metrics. Extracellular FW increases in SLE patients were associated with poorer neurocognitive performance that probed sustained attention (p = 0.022) and higher cumulative glucocorticoid dose (p = 0.0041). Such findings remained robust after controlling for age, gender, IQ, and total WM volume. CONCLUSIONS The association between WM extracellular FW increases and reduced neurocognitive performance suggest possible microvascular degradation and/or neuroinflammation in SLE patients with clinically-inactive disease. The mechanistic impact of cumulative glucocorticoids on WM FW deserves further evaluation.
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Affiliation(s)
- Xing Qian
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fang Ji
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kwun Kei Ng
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amelia Jialin Koh
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Beatrice Rui Yi Loo
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mary Charlotte Townsend
- Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ofer Pasternak
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Juan Helen Zhou
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore.,Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore, Singapore
| | - Anselm Mak
- Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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26
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Liu C, Song JX, Guo ZB, Chen LM, Zhao CH, Zi WJ, Yang QW. Prognostic Structural Neural Markers of MRI in Response to Mechanical Thrombectomy for Basilar Artery Occlusion. Front Neurol 2021; 12:593914. [PMID: 34177752 PMCID: PMC8220209 DOI: 10.3389/fneur.2021.593914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Mechanical thrombectomy (MT) has been an effective first-line therapeutic strategy for ischemic stroke. With impairment characteristics separating it from anterior circulation stroke, we aimed to explore prognostic structural neural markers for basilar artery occlusion (BAO) after MT. Methods: Fifty-four BAO patients with multi-modal magnetic resonance imaging at admission from the multicenter real-world designed BASILAR research were enrolled in this study. Features including volumes for cortical structures and subcortical regions, locations and volumes of infarctions, and white matter hyperintensity (WMH) volumes were recorded from all individuals. The impact features were identified using ANCOVA and logistic analysis. Another cohort (n = 21) was further recruited to verify the prognostic roles of screened prognostic structures. Results: For the primary clinical outcome, decreased brainstem volume and total infarction volumes from mesencephalon and midbrain were significantly related to reduced 90-day modified Rankin score (mRS) after MT treatment. WMH volume, WMH grade, average cortex thickness, white matter volume, and gray matter volume did not exhibit a remarkable relationship with the prognosis of BAO. The increased left caudate volume was obviously associated with early symptomatic recovery after MT. The prognostic role of the ratio of pons and midbrain infarct volume in brainstem was further confirmed in another cohort with area under the curve (AUC) = 0.77. Conclusions: This study was the first to provide comprehensive structural markers for the prognostic evaluation of BAO. The fully automatic and semiautomatic segmentation approaches in our study supported that the proportion of mesencephalon and midbrain infarct volume in brainstem was a crucial prognostic structural neural marker for BAO.
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Affiliation(s)
- Chang Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jia-Xin Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhang-Bao Guo
- Department of Neurology, Wuhan No. 1 Hospital, Chongqing, China
| | - Lu-Ming Chen
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chen-Hao Zhao
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wen-Jie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qing-Wu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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27
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Elnady B, Taha A, Desouky DE, Abd-Elmakoud SF, Rageh EM, Algethami AM, Algethami M, ten Klooster PM, Rasker JJ. Impact of sustained remission on quality of life among women with rheumatoid arthritis and systemic lupus erythematosus: a prospective observational study. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00072-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Abstract
Background
Health-related quality of life (HRQOL) as a patient reported outcome plays important roles in the life of patients with RA (rheumatoid arthritis) and SLE (Systemic lupus erythematosus) as well as their families. Evaluating the impact of sustained remission on HRQOL is important and could be of potential help in daily practice. Thus, we aimed to assess and compare prospectively the impact of sustained remission on HRQOL in Saudi RA and SLE female cohorts.
Results
Sixty-two female patients with active RA and 34 female patients with active SLE fulfilled the inclusion-, entry- and follow-up criteria. At baseline, the SLE patients had significantly better SF-36 scores than the RA patients. In both groups, significant correlations were found between disease activity and physical (PCS) and mental (MCS) components summary of the SF-36 (all p’s ≤ 0.001). In sustained remission, both SLE and RA patients showed significant improvements of the SF-36 scores (p < 0.001) compared to baseline. RA patients in sustained remission had a significantly better general health, bodily pain and physical functioning, and total PCS scores (p < 0.001) than those with SLE.
Conclusions
Both SLE and RA patients in sustained remission showed strongly improved HRQOL. In sustained remission, RA patients had comparable or better HRQOL than SLE patients.
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28
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Seet D, Allameen NA, Tay SH, Cho J, Mak A. Cognitive Dysfunction in Systemic Lupus Erythematosus: Immunopathology, Clinical Manifestations, Neuroimaging and Management. Rheumatol Ther 2021; 8:651-679. [PMID: 33993432 PMCID: PMC8217391 DOI: 10.1007/s40744-021-00312-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022] Open
Abstract
Cognitive dysfunction (CD) is a common yet often clinically subtle manifestation that considerably impacts the health-related quality of life in patients with systemic lupus erythaematosus (SLE). Given the inconsistencies in CD assessment and challenges in its attribution to SLE, the reported prevalence of CD differs widely, ranging from 3 to 88%. The clinical presentation of CD in SLE is non-specific and may manifest concurrently with overt neuropsychiatric illness such as psychosis or mood disorders or as isolated impairment of attention, working memory, executive dysfunction or processing speed. Despite the lack of standardized and sensitive neuropsychological tests and validated diagnostic biomarkers of CD in SLE, significant progress has been made in identifying pathogenic neural pathways and neuroimaging. Furthermore, several autoantibodies, cytokines, pro-inflammatory mediators and metabolic factors have been implicated in the pathogenesis of CD in SLE. Abrogation of the integrity of the blood-brain barrier (BBB) and ensuing autoantibody-mediated neurotoxicity, complement and microglial activation remains the widely accepted mechanism of SLE-related CD. Although several functional neuroimaging modalities have consistently demonstrated abnormalities that correlate with CD in SLE patients, a consensus remains to be reached as to their clinical utility in diagnosing CD. Given the multifactorial aetiology of CD, a multi-domain interventional approach that addresses the risk factors and disease mechanisms of CD in a concurrent fashion is the favourable therapeutic direction. While cognitive rehabilitation and exercise training remain important, specific pharmacological agents that target microglial activation and maintain the BBB integrity are potential candidates for the treatment of SLE-related CD.
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Affiliation(s)
- Dominic Seet
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
| | - Nur Azizah Allameen
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiacai Cho
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anselm Mak
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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29
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Zhan H, Li H, Liu C, Cheng L, Yan S, Li Y. Association of Circulating Vascular Endothelial Growth Factor Levels With Autoimmune Diseases: A Systematic Review and Meta-Analysis. Front Immunol 2021; 12:674343. [PMID: 34122433 PMCID: PMC8191579 DOI: 10.3389/fimmu.2021.674343] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/27/2021] [Indexed: 12/29/2022] Open
Abstract
Background Autoimmune diseases (ADs) are characterized by immune-mediated tissue damage, in which angiogenesis is a prominent pathogenic mechanism. Vascular endothelial growth factor (VEGF), an angiogenesis modulator, is significantly elevated in several ADs including rheumatoid arthritis (RA), systemic sclerosis (SSc), and systemic lupus erythematosus (SLE). We determined whether circulating VEGF levels were associated with ADs based on pooled evidence. Methods The analyses included 165 studies from the PubMed, EMBASE, Cochrane Library, and Web of Science databases and fulfilled the study criteria. Comparisons of circulating VEGF levels between patients with ADs and healthy controls were performed by determining pooled standard mean differences (SMDs) with 95% confidence intervals (CIs) in a random-effect model using STATA 16.0. Subgroup, sensitivity, and meta-regression analyses were performed to determine heterogeneity and to test robustness. Results Compared with healthy subjects, circulating VEGF levels were significantly higher in patients with SLE (SMD 0.84, 95% CI 0.25-1.44, P = 0.0056), RA (SMD 1.48, 95% CI 0.82-2.15, P <0.0001), SSc (SMD 0.56, 95% CI 0.36-0.75, P <0.0001), Behcet's disease (SMD 1.65, 95% CI 0.88-2.41, P <0.0001), Kawasaki disease (SMD 2.41, 95% CI 0.10-4.72, P = 0.0406), ankylosing spondylitis (SMD 0.78, 95% CI 0.23-1.33, P = 0.0052), inflammatory bowel disease (SMD 0.57, 95% CI 0.43-0.71, P <0.0001), psoriasis (SMD 0.98, 95% CI 0.62-1.34, P <0.0001), and Graves' disease (SMD 0.69, 95% CI 0.20-1.19, P = 0.0056). Circulating VEGF levels correlated with disease activity and hematological parameters in ADs. Conclusion Circulating VEGF levels were associated with ADs and could predict disease manifestations, severity and activity in patients with ADs. Systematic Review Registration PROSPERO, identifier CRD42021227843.
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Affiliation(s)
- Haoting Zhan
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haolong Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Chenxi Liu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Linlin Cheng
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Songxin Yan
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yongzhe Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Barraclough M, McKie S, Parker B, Elliott R, Bruce IN. The effects of disease activity on neuronal and behavioural cognitive processes in systemic lupus erythematosus. Rheumatology (Oxford) 2021; 61:195-204. [PMID: 33760068 DOI: 10.1093/rheumatology/keab256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Factors common across many chronic diseases, such as fatigue and depression affect cognitive dysfunction (CD) but the effect of systemic lupus erythematosus (SLE) disease activity on CD remains unclear. We aimed to explore the effects of disease activity in SLE on cognitive function whilst taking into consideration other potential mediators. METHODS Two groups of SLE patients were recruited; stable/low disease activity (SLE-S, n = 36) and active disease (SLE-F, n = 26). The SLE-F group were studied during a flare; with a second visit when disease activity had reduced. In addition to demographic, clinical and psychiatric data, CD was measured using a computerised battery of tests (CANTAB®). fMRI was used to examine neuronal responses to working memory and emotional processing tasks. RESULTS No differences between the groups/visits were found using the CANTAB® battery. The fMRI results showed that the SLE-F group had a less attenuated response in the medial prefrontal cortex (a default mode network-DMN region) compared with the SLE-S group during the working memory task (p = 0.012). Exploratory correlations within the SLE-F group showed associations between neuronal responses and depression, cognitive fatigue, disease activity measures and IL-6. CONCLUSION Functional brain processes but not cognitive behavioural measures were affected by disease activity. Flaring SLE patients were less able to suppress DMN regions during a working memory task. This could reflect emotional interference during cognitive tasks and may cause cognitive fatigue. A number of factors are associated with brain function in flaring patients, which has potential implications for holistic treatments.
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Affiliation(s)
- Michelle Barraclough
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Shane McKie
- FBMH Platform Sciences, Enabling Technologies & Infrastructure, FBMH Research & Innovation, The University of Manchester & Manchester Academic Health Science Centre, Manchester, UK
| | - Ben Parker
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Nikolopoulos D, Fanouriakis A, Bertsias G. Treatment of neuropsychiatric systemic lupus erythematosus: clinical challenges and future perspectives. Expert Rev Clin Immunol 2021; 17:317-330. [PMID: 33682602 DOI: 10.1080/1744666x.2021.1899810] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Neuropsychiatric (NP) involvement represents an emerging frontier in systemic lupus erythematosus (SLE), posing significant challenges due to its clinical diversity and obscure pathophysiology. The authors herein discuss selected aspects in the management of NPSLE based on existing literature and our experience, aiming to facilitate routine medical care.Areas covered: Research related to diagnosis, neuroimaging, treatment and outcome is discussed, focusing on data published in PubMed during the last 5 years. Selected translational studies of clinical relevance are included.Expert opinion: Identification of NPSLE patients who may benefit from appropriate treatment can be facilitated by attribution algorithms. Immunosuppressants are typically indicated in recurrent seizures, optic neuritis, myelopathy, psychosis and peripheral nerve disease, although a low threshold is recommended for cerebrovascular disease and other NP manifestations, especially when SLE is active. With the exception of stroke with positive antiphospholipid antibodies, anti-coagulation is rarely indicated in other syndromes. Refractory NPSLE can be treated with rituximab, whereas the role of other biologics remains unknown. Advances in the fields of biomarkers, neuroimaging for brain structural, perfusion or functional abnormalities, and design of novel compounds targeting not only systemic autoimmunity but also inflammatory and regenerative pathways within the nervous system, hold promise for optimizing NPSLE management.
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Affiliation(s)
- Dionysis Nikolopoulos
- 4th Department of Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece.,Laboratory of Immune Regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | | | - George Bertsias
- Department of Rheumatology, Clinical Immunology, University of Crete Medical School and University Hospital of Heraklion, Heraklion, Greece.,Laboratory of Rheumatology, Autoimmunity and Inflammation, Infections & Immunity Division, Institute of Molecular Biology and Biotechnology (FORTH), Heraklion, Greece
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Vandenberg AE, Drenkard C, Goldstein FC, Dunlop-Thomas C, Lim SS, Bowling CB, Plantinga LC. Cognitive problems and their clinical assessment in SLE: contrasting patient and provider views. Arthritis Care Res (Hoboken) 2021; 74:1468-1476. [PMID: 33734607 DOI: 10.1002/acr.24599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/17/2021] [Accepted: 03/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a complex chronic disease associated with reduced cognitive functioning. Patients with SLE report cognitive symptoms, but cognitive assessment is not routine and little is known about day-to-day cognitive problems and their effect on disease management. As part of a pilot exploring the use of a cognitive functioning report prototype for shared decision making in clinical encounters (Approaches to Positive Patient-Centered Experiences of Aging in Lupus study-APPEAL), we investigated the relevance of cognitive assessments performed using the NIH Toolbox among patients with SLE. METHODS We conducted four focus groups, two with SLE patients (n=18) and two with lupus providers (physicians and nurses; n=9) addressing cognitive issues and interest in communicating about cognition. We compared how NIH Toolbox cognitive domains (episodic memory; working memory; processing speed; attention and inhibitory control; cognitive flexibility) matched with patient- and provider-identified cognitive problems and needs. RESULTS Patients identified all NIH domains with rich experiential examples; providers identified fewer domains and offered less detail. An unanticipated additional domain was prospective memory, i.e., problems in remembering future actions. Use of technological aids (e.g., smart phone alerts) was mentioned by some patients, but not providers, and represent a potential opportunity for medical care. All participants expressed interest in discussing cognition in clinic. CONCLUSION Cognitive assessment using the NIH Cognitive Toolbox is relevant to this population, with the possible addition of a prospective memory assessment. Cognitive problems and indications of communication gaps suggest the appropriateness of more clinical communication about cognition in this population.
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Affiliation(s)
- Ann E Vandenberg
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, United States
| | - Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, United States.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Felicia C Goldstein
- Department of Neurology, Division of Neuropsychology, Emory University School of Medicine, Atlanta, GA, United States
| | - Charmayne Dunlop-Thomas
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, United States
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, United States.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - C Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC, United States.,Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Laura C Plantinga
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, United States.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Zhang Y, Kong Y, Yang Y, Yin Y, Hou Z, Xu Z, Yuan Y. Asthma-Specific Temporal Variability Reveals the Effect of Group Cognitive Behavior Therapy in Asthmatic Patients. Front Neurol 2021; 12:615820. [PMID: 33776882 PMCID: PMC7994749 DOI: 10.3389/fneur.2021.615820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Group cognitive behavior therapy (GCBT) is a successful therapy for asthma. However, the neural biomarker of GCBT which could be used in clinic remains unclear. The temporal variability is a novel concept to characterize the dynamic functional connectivity (FC), which has many advantages as biomarker. Therefore, the aim of this study is to explore the potential difference of temporal variability between asthmatic patients and healthy controls, then determine the different patterns of temporal variability between pre- and post-treatment group and reveal the relationship between the variability and the symptoms improvement reduced by GCBT. Methods: At baseline, 40 asthmatic patients and 40 matched controls received resting-state functional magnetic resonance imaging (fMRI) scans and clinical assessments. After 8 weeks of GCBT treatment, 17 patients received fMRI scans, and assessments again. Temporal variability at baseline and post-treatment were calculated for further analysis. Results: Compared with controls, asthmatic patients showed widespread decreases in temporal variability. Moreover, the variability in both right caudate and left putamen were positively correlated with asthma control level. After GCBT, asthma control level and depression of patients were improved. Meanwhile, compared with pre-GCBT, patients after treatment showed lower variability in left opercular of Rolandic, right parahippocampal gyrus and right lingual gyrus, as well as higher variability in left temporal pole. Variability in regions which were found abnormal at baseline did not exhibit significant differences between post-GCBT and controls. Conclusions: Asthma-specific changes of dynamic functional connectivity may serve as promising underpinnings of GCBT for asthma. Clinical Trial Registration: http://www.chictr.org.cn/index.aspx, identifier: Chi-CTR-15007442.
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Affiliation(s)
- Yuqun Zhang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.,Department of Psychosomatic and Psychiatry, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Youyong Kong
- Lab of Image Science and Technology, Key Laboratory of Computer Network and Information Integration, School of Computer Science and Engineering, Ministry of Education, Southeast University, Nanjing, China
| | - Yuan Yang
- Department of Respiratory, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yingyin Yin
- Department of Psychosomatic and Psychiatry, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhenghua Hou
- Department of Psychosomatic and Psychiatry, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhi Xu
- Department of Psychosomatic and Psychiatry, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yonggui Yuan
- Department of Psychosomatic and Psychiatry, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Abstract
Neuropsychiatric lupus (NPSLE) comprises a disparate collection of syndromes affecting the central and peripheral nervous systems. Progress in the attribution of neuropsychiatric syndromes to SLE-related mechanisms and development of targeted treatment strategies has been impeded by a lack of objective imaging biomarkers that reflect specific neuropsychiatric syndromes and/or pathologic mechanisms. The present review addresses recent publications of neuroimaging techniques in NPSLE.
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Fanouriakis A, Tziolos N, Bertsias G, Boumpas DT. Update οn the diagnosis and management of systemic lupus erythematosus. Ann Rheum Dis 2020; 80:14-25. [PMID: 33051219 DOI: 10.1136/annrheumdis-2020-218272] [Citation(s) in RCA: 275] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Abstract
Clinical heterogeneity, unpredictable course and flares are characteristics of systemic lupus erythematosus (SLE). Although SLE is-by and large-a systemic disease, occasionally it can be organ-dominant, posing diagnostic challenges. To date, diagnosis of SLE remains clinical with a few cases being negative for serologic tests. Diagnostic criteria are not available and classification criteria are often used for diagnosis, yet with significant caveats. Newer sets of criteria (European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019) enable earlier and more accurate classification of SLE. Several disease endotypes have been recognised over the years. There is increased recognition of milder cases at presentation, but almost half of them progress overtime to more severe disease. Approximately 70% of patients follow a relapsing-remitting course, the remaining divided equally between a prolonged remission and a persistently active disease. Treatment goals include long-term patient survival, prevention of flares and organ damage, and optimisation of health-related quality of life. For organ-threatening or life-threatening SLE, treatment usually includes an initial period of high-intensity immunosuppressive therapy to control disease activity, followed by a longer period of less intensive therapy to consolidate response and prevent relapses. Management of disease-related and treatment-related comorbidities, especially infections and atherosclerosis, is of paramount importance. New disease-modifying conventional and biologic agents-used alone, in combination or sequentially-have improved rates of achieving both short-term and long-term treatment goals, including minimisation of glucocorticoid use.
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Affiliation(s)
| | - Nikolaos Tziolos
- 4th Department of Internal Medicine, "Attikon" University Hospital, Athens, Greece
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Crete, Greece.,Laboratory of Autoimmunity-Inflammation, Institute of Molecular Biology and Biotechnology, Heraklion, Crete, Greece
| | - Dimitrios T Boumpas
- 4th Department of Internal Medicine, "Attikon" University Hospital, Athens, Greece .,Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Medical School, University of Cyprus, Nicosia, Cyprus.,Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Cyprus
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Petra CV, Visu-Petra L, Buta M, Tămaș MM, Benga O, Rednic S. A Computerized Assessment of Verbal and Visuospatial Memory (Dys)functions in Patients with Rheumatoid Arthritis. Psychol Res Behav Manag 2020; 13:619-629. [PMID: 32801959 PMCID: PMC7414973 DOI: 10.2147/prbm.s261312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/21/2020] [Indexed: 01/13/2023] Open
Abstract
Purpose Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease associated with various degrees of impairment across different cognitive domains. We aimed to provide a detailed computerized investigation of verbal and visuospatial short-term and working memory (dys)functions in RA patients, assessing both accuracy and response speed, while relating them to age, disease-related activity, affective problems, psychomotor speed and other clinical parameters. Patients and Methods The study included 29 RA patients (mean age 50.6 ± 12.3 years, 79% female) and 30 controls (matched according to age, gender and education), assessed with short-term and working memory tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Automated Working Memory Assessment (AWMA). Results RA patients were significantly slower on the basic processing speed test (Motor Screening Test, p =0.003). Their short-term information storage (verbal and visuospatial) was comparable to controls, yet this similar accuracy came at the expense of a longer response time to retain information correctly (on spatial span, p = 0.04). On tasks with higher executive demands, both visuospatial and verbal working memory were compromised, as RA patients took longer (p = 0.004) and had a higher number of total errors (p = 0.02) when conducting a strategic memory-guided search (Spatial Working Memory), and had a significantly lower verbal working memory span on the backwards digit recall test (p = 0.02). Conclusion The findings of this study emphasize the usefulness of performing computerized tests to detect subtle signs of cognitive impairment and of intact performance, which can inform memory training protocols for this vulnerable population.
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Affiliation(s)
- Cristian Vasile Petra
- Department of Rheumatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Laura Visu-Petra
- Developmental Psychology Lab, Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Monica Buta
- Developmental Psychology Lab, Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Maria Magdalena Tămaș
- Department of Rheumatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Oana Benga
- Developmental Psychology Lab, Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Simona Rednic
- Department of Rheumatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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The association between systemic inflammation and cognitive performance in healthy adults. J Neuroimmunol 2020; 345:577272. [PMID: 32534387 DOI: 10.1016/j.jneuroim.2020.577272] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Several studies have indicated that mild systemic inflammation is associated with the risk of cognitive impairment. However, not every cognitive domain has been evaluated to have a correlation with peripheral inflammation in healthy individuals. Therefore, we aimed to investigate the association between C-reactive protein (CRP) as a marker of peripheral inflammation with various domains of cognition in healthy adults. METHOD This study consisted of 216 healthy native German adults (138 males and 78 females, mean age: 39.12 ± 20.19 years) from "Leipzig Study for Mind-Body-Emotion Interactions" (LEMON) database. After the initial assessment and conducting the cognitive battery, a blood sample was collected and CRP level was evaluated. Patients were categorized into three groups based on their CRP level. Subsequently, demographic and cognitive features were compared across three groups and to confirm the association between CRP level and cognitive performance, general linear models (GLM) were applied. RESULTS All California Verbal Learning Task (CVLT)-evaluated aspects of memory performance were inversely associated with CRP level, some of which remained significant after the adjustment for age, gender, education, smoking status and body mass index. Moreover, GLM analysis indicated that mean reaction time of the Test of Attentional Performance-Alertness (TAP-A) test (with and without signal) was also significantly associated with CRP level. CONCLUSION The current study indicated that healthy subjects with higher levels of CRP exhibit poorer performance in verbal learning memory and general wakefulness domains of cognition.
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Gazes Y, Liu M, Sum M, Cong E, Kuo J, Lee JA, Silverberg S, Stern Y, Walker M. Functional magnetic resonance imaging in primary hyperparathyroidism. Eur J Endocrinol 2020; 183:21-30. [PMID: 32348956 PMCID: PMC7472931 DOI: 10.1530/eje-20-0123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/29/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The neurophysiological mechanisms underlying cognitive dysfunction in primary hyperparathyroidism (PHPT) and the brain regions affected are not clear. We assessed neural activation during cognitive testing (matrix reasoning, paired associates, and logical memory) using functional MRI (fMRI) in 23 patients with PHPT and 23 healthy controls. A subset with PHPT was re-assessed 6 months post-parathyroidectomy (PTX). DESIGN This is an observational study comparing neural activation by fMRI in patients with PHPT to normative controls. Postmenopausal women were studied at a tertiary referral center. RESULTS There were no between-group differences in cognitive task performance. Patients with PHPT had lower neural activation vs controls (max Z = 4.02, all P < 0.01) during matrix reasoning in brain regions involved in executive function (left frontal lobe (k = 57) and right medial frontal gyrus (k = 72)) and motor function (right precentral gyrus (k = 51)). During paired associates (verbal memory), those with PHPT had greater activation in the right inferior parietal lobule (language/mathematical operations; k = 65, P < 0.01). Greater activation in this region bilaterally correlated with higher PTH (k = 96, P < 0.01). Post-PTX, activation decreased during matrix reasoning, but in different regions than those affected pre-PTX. CONCLUSIONS PHPT is associated with differences in task-related neural activation patterns, but no difference in cognitive performance. While this may indicate compensation to maintain the same cognitive function, there was no clear improvement in neural activation after PTX. Larger, longitudinal studies that include PHPT patients followed without surgery are needed to determine if PTX could prevent worsening of altered neural activation patterns in PHPT.
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Affiliation(s)
- Yunglin Gazes
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032
| | - Minghao Liu
- Division of Endocrinology, Department of Medicine, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, NY
| | - Melissa Sum
- Division of Endocrinology, Department of Medicine, New York University Langone Medical Center, New York, NY 10016
| | - Elaine Cong
- Department of Medicine, Division of Endocrinology, Columbia University Irving Medical Center, New York, NY 10032
| | - Jennifer Kuo
- Department of Surgery, Columbia University Irving Medical Center, New York, NY 10032
| | - James A. Lee
- Department of Surgery, Columbia University Irving Medical Center, New York, NY 10032
| | - Shonni Silverberg
- Department of Medicine, Division of Endocrinology, Columbia University Irving Medical Center, New York, NY 10032
| | - Yaakov Stern
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032
| | - Marcella Walker
- Department of Medicine, Division of Endocrinology, Columbia University Irving Medical Center, New York, NY 10032
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Abstract
PROPOSE OF REVIEW Neuropsychiatric systemic lupus erythematosus (NPSLE) is an emerging frontier in lupus care encompassing a wide spectrum of clinical manifestations. Its pathogenesis remains poorly understood because of the complexity of pathophysiologic mechanisms involved and limited access to tissue. We highlight recent advances in the pathophysiology of neuropsychiatric lupus. RECENT FINDINGS Disruption of blood-brain barrier (BBB) facilitating entrance of neurotoxic antibodies into the central nervous system (CNS), neuroinflammation and cerebral ischemia are the key mechanisms. Disruption of the BBB may occur not only at the traditional BBB, but also at the blood-cerebrospinal fluid barrier. Certain autoantibodies, such as anti-N-methyl-D-aspartate receptors, antiribosomal P and antiphospholipid antibodies may cause injury in subsets of patients with diffuse neuropsychiatric disease. Activation of microglia via autoantibodies, interferon-a or other immune reactants, may amplify the inflammatory response and promote neuronal damage. New inflammatory pathways, such as TWEAK/Fn14, Bruton's tyrosine kinase, Nogo-a and ACE may represent additional potential targets of therapy. Novel neuroimaging techniques suggest alterations in brain perfusion and metabolism, increased concentration of neurometabolites, indicative of glial activation, vasculopathy and neuronal impairment. SUMMARY NPSLE encompasses a diverse phenotype with distinct pathogenic mechanisms, which could be targeted by novel therapies or repositioning of existing drugs.
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Oláh C, Schwartz N, Denton C, Kardos Z, Putterman C, Szekanecz Z. Cognitive dysfunction in autoimmune rheumatic diseases. Arthritis Res Ther 2020; 22:78. [PMID: 32293528 PMCID: PMC7158026 DOI: 10.1186/s13075-020-02180-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/01/2020] [Indexed: 02/08/2023] Open
Abstract
For people with chronic autoimmune rheumatic diseases (AIRD), such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or systemic sclerosis (SSc), normal cognitive functions are essential for performing daily activities. These diseases may be associated with cognitive dysfunction (CD). In RA, CD has been associated with age, lower education and disease duration and activity. Great advances have been achieved in neuropsychiatric SLE in the identification of pathogenic pathways, assessment and possible treatment strategies. SSc rarely exerts direct effects on the brain and cognitive function. However, the psychological burden that includes depression, anxiety and social impact may be high. AIRD patients with sustained disease activity, organ damage or lower education should be evaluated for CD. The control of systemic inflammation together with tailored behavioural cognitive therapies may benefit these patients.
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Affiliation(s)
- Csaba Oláh
- Departments of Neurosurgery, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Noa Schwartz
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Christopher Denton
- Centre for Rheumatology, Royal Free Campus, University College London, London, UK
| | - Zsófia Kardos
- Departments of Rheumatology, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Chaim Putterman
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.,Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.,Azrieli Faculty of Medicine of Bar Ilan University, Zefat, Israel.,Research Institute, Galilee Medical Center, Nahariya, Israel
| | - Zoltán Szekanecz
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 98, Debrecen, 4032, Hungary.
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Makinde HM, Winter DR, Procissi D, Mike EV, Stock AD, Kando MJ, Gadhvi GT, Droho S, Bloomfield CL, Dominguez ST, Mayr MG, Lavine JA, Putterman C, Cuda CM. A Novel Microglia-Specific Transcriptional Signature Correlates With Behavioral Deficits in Neuropsychiatric Lupus. Front Immunol 2020; 11:230. [PMID: 32174913 PMCID: PMC7055359 DOI: 10.3389/fimmu.2020.00230] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
Neuropsychiatric symptoms of systemic lupus erythematosus (NP-SLE) affect over one-half of SLE patients, yet underlying mechanisms remain largely unknown. We demonstrate that SLE-prone mice (CReCOM) develop NP-SLE, including behavioral deficits prior to systemic autoimmunity, reduced brain volumes, decreased vascular integrity, and brain-infiltrating leukocytes. NP-SLE microglia exhibit numerical expansion, increased synaptic uptake, and a more metabolically active phenotype. Microglia from multiple SLE-prone models express a "NP-SLE signature" unrelated to type I interferon. Rather, the signature is associated with lipid metabolism, scavenger receptor activity and downregulation of inflammatory and chemotaxis processes, suggesting a more regulatory, anti-inflammatory profile. NP-SLE microglia also express genes associated with disease-associated microglia (DAM), a subset of microglia thought to be instrumental in neurodegenerative diseases. Further, expression of "NP-SLE" and "DAM" signatures correlate with the severity of behavioral deficits in young SLE-prone mice prior to overt systemic disease. Our data are the first to demonstrate the predictive value of our newly identified microglia-specific "NP-SLE" and "DAM" signatures as a surrogate for NP-SLE clinical outcomes and suggests that microglia-intrinsic defects precede contributions from systemic SLE for neuropsychiatric manifestations.
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Affiliation(s)
- Hadijat M Makinde
- Division of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Deborah R Winter
- Division of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Daniele Procissi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Elise V Mike
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, The Bronx, NY, United States
| | - Ariel D Stock
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, The Bronx, NY, United States
| | - Mary J Kando
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Gaurav T Gadhvi
- Division of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Steven Droho
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Christina L Bloomfield
- Division of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Salina T Dominguez
- Division of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Maximilian G Mayr
- Division of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jeremy A Lavine
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Chaim Putterman
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, The Bronx, NY, United States.,Research Division, Azrieli Faculty of Medicine and Galilee Medical Center, Nahariya, Israel
| | - Carla M Cuda
- Division of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Barete S. Quoi de neuf en médecine interne ? Ann Dermatol Venereol 2019; 146:12S24-12S31. [DOI: 10.1016/s0151-9638(20)30103-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jia J, Xie J, Li H, Wei H, Li X, Hu J, Meng D, Zhang Y, Zhang X. Cerebral blood flow abnormalities in neuropsychiatric systemic lupus erythematosus. Lupus 2019; 28:1128-1133. [PMID: 31315530 DOI: 10.1177/0961203319861677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the clinical characteristics, imaging changes and early diagnostic methods of neuropsychiatric systemic lupus erythematosus (NPSLE). METHODS Thirty-five SLE patients, of which 16 had overt neuropsychiatric symptoms, underwent examination for multiple autoantibodies, including anti-double-stranded DNA (anti-dsDNA) antibody, anti-nucleosome antibody, anti-cardiac-phospholipid antibody (aCL)-IgG, aCL-IgM, anti-β2-glycoprotein I antibody and anti-ribosomal P antibody, and the SLEDAI score of every patient was recorded. All patients further received neuropsychological tests, including the Mini-Mental State Examination, the Self-Rating Anxiety Scale and the Self-Rating Depression Scale. Imaging examination using 3D arterial spin labeling was performed on 3.0 T MRI scanners. After processing the 3D arterial spin labeling image, the cerebral blood flow map was obtained and the cerebral blood flow value was calculated. RESULTS The values of anti-dsDNA, anti-nucleosome antibody, aCL-IgG and anti-β2-glycoprotein I antibodies were significantly higher in the NPSLE group than those in the SLE group. The SLEDAI scores of the NPSLE group were significantly higher than those of the SLE group. There were no significant differences between the NPSLE group and the SLE group in the directional ability, memory, attention, numeracy, recall ability or language ability scores on the Mini-Mental State Examination scale. Furthermore, there were no symptoms of anxiety or depression in any of the patients, according to the Self-Rating Anxiety Scale and Self-Rating Depression Scale. In the 35 patients with SLE, decreases in blood perfusion were seen in some areas, and were unilateral and asymmetrically distributed. There was obvious asymmetry between sides in areas including the frontal lobe, temporal lobe, parietal lobe and occipital lobe. The incidence of perfusion decreases in frontal lobe in the NPSLE group was significantly higher than in the SLE group. CONCLUSION Neurological lesions in SLE patients can be detected by arterial spin labeling. Cerebral blood flow abnormalities may be helpful for the early diagnosis of neurological lesions in NPSLE.
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Affiliation(s)
- J Jia
- 1 Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - J Xie
- 1 Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - H Li
- 1 Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - H Wei
- 1 Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - X Li
- 2 Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - J Hu
- 1 Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - D Meng
- 1 Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Y Zhang
- 1 Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - X Zhang
- 1 Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
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