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Hou R, Lei J, Xue D, Jing Y, Mi L, Guo Q, Xu K, Zhang L. The association of an elevated Th/Ts ratio and lupus anticoagulant with symptomatic osteonecrosis in systemic lupus erythematosus patients. Front Immunol 2024; 15:1288234. [PMID: 38384449 PMCID: PMC10879316 DOI: 10.3389/fimmu.2024.1288234] [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: 09/04/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Objective This study aimed to assess the risk factors for symptomatic osteonecrosis (ON) in systemic lupus erythematosus (SLE) and identify clinical characteristics and laboratory markers for predicting symptomatic ON occurrence in SLE patients. Methods Seventy (6.0%) of 1175 SLE patients diagnosed with symptomatic ON were included in this study. An equal number of SLE patients without symptomatic ON, matched in terms of age and gender, were enrolled in the control group. Clinical symptoms, routine laboratory examinations, lymphocyte subsets, and treatments of these patients were retrospectively reviewed and compared between the two groups. Logistic regression analysis was employed to identify risk factors associated with symptomatic ON in SLE. Results Among the 70 cases in the symptomatic ON group, 62 (88.6%) patients experienced femoral head necrosis, with bilateral involvement observed in 58 patients. Bone pain was reported in 32 cases (51.6%), and 19 cases (30.6%) presented with multiple symptoms. Univariate analysis revealed significant differences between the two groups in various factors, including disease duration (months), cumulative steroid exposure time, history of thrombosis, neurological involvement, the number of affected organs, myalgia/myasthenia, and the use of medications such as glucocorticoids, immunosuppressants, aspirin, and statins (P<0.05). Moreover, lupus anticoagulant (LA) levels were significantly higher in the symptomatic ON group than in the control group (P<0.05). Furthermore, notable distinctions were observed in peripheral blood immune cells, including an elevated white blood cell count (WBC), a decreased percentage of Ts cells (CD3+CD8+), and an elevated Th/Ts ratio. Logistic regression analysis revealed that a history of thrombosis, LA positivity, and an elevated Th/Ts ratio remained positive factors associated with symptomatic ON (P<0.05). Conclusion Decreased Ts cells and changes in the T lymphocyte subset play an important regulatory role in the development of symptomatic ON. A history of thrombosis and LA are associated with an increased probability of symptomatic ON in SLE and may serve as potential predictors.
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Affiliation(s)
- Ruihong Hou
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Jiamin Lei
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Dengfeng Xue
- Department of Galactophore Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yukai Jing
- Department of Clinical Laboratory, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Liangyu Mi
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Qianyu Guo
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Ke Xu
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Liyun Zhang
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
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Konovalova AM, Pechkurov DV, Tyazheva AA. Chronic Diarrhea as a Debut Manifestation of Crohn’s Disease in Infant: Clinical Case. CURRENT PEDIATRICS 2023. [DOI: 10.15690/vsp.v22i1.2518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Background. Chronic diarrhea can be a symptom of a wide variety of diseases, either of which requires special therapy approaches. The diagnosis of rare causes of chronic diarrhea is especially difficulty as it may be associated with inflammatory bowel disease (IBD) with very early (under 1 year of age) debut.Clinical case description. Boy E. had chronic diarrhea manifested on the first year of life. Ulcerative colitis was diagnosed at the age of 1.5 years, then the diagnosis was changed to Crohn’s disease at the age of 2.5 years. The results of 6-years-follow-up of the patient were presented, as well as analysis of diagnosis and treatment difficulties was carried out.Conclusion. The clinical case of Crohn’s disease with diarrhea as the leading clinical manifestation at the disease onset is described. Sequential diagnostic search allowed us to establish the diagnosis of IBD and to exclude other causes of chronic diarrhea that determined the correct therapeutic strategy.
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Tang Y, Luo Y. Identification of a novel mutation in complement receptor 2 in Chinese familial systemic lupus erythematosus. Arch Rheumatol 2022; 37:566-573. [PMID: 36879571 PMCID: PMC9985375 DOI: 10.46497/archrheumatol.2022.9167] [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: 08/29/2021] [Accepted: 12/23/2021] [Indexed: 03/08/2023] Open
Abstract
Objectives This study aims to analyze the relationship between complement receptor 2 (CR2) gene mutation and the clinical phenotype in Chinese familial systemic lupus erythematosus (SLE). Patients and methods A total of one Chinese familial SLE patients (median age: 30.25 years; range, 22 to 49 years) were included between January 2017 and December 2018. The clinical features and diagnoses of familial SLE patients were analyzed using whole-exome sequencing (WES) of genomic deoxyribonucleic acid (DNA) samples. Sanger sequencing was used to verify candidate mutations detected in the examined family. Results The mother and her three daughters were diagnosed with SLE. The clinical characteristics showed that the patient and her mother were diagnosed with lupus nephritis. The eldest daughter had decreased renal function and lower serum albumin levels. Immunological index analysis showed that all four patients were positive for anti-SSA and antinuclear antibody (ANA), but that only the second daughter was positive for anti-double-stranded DNA (dsDNA). Complement 3 (C3) was significantly decreased in all patients, while evaluation of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) showed that the second and third daughters had mild active SLE. The mother and eldest daughter were treated with prednisolone combined with cyclophosphamide, while the other two daughters were treated with prednisolone alone. The WES and Sanger sequencing analyses revealed an unreported missense T>C mutation c.2804 in the 15th exon of the CR gene in all four patients. Conclusion We identified a novel c.2804 (exon 15) T>C mutation in the CR gene of Chinese familial SLE. This mutation was previously reported, suggesting that the CR gene c.2804 (exon 15) T>C mutation is the probable cause of SLE in this family.
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Affiliation(s)
- Yuewu Tang
- Department of Nephrology, Three Gorges Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yi Luo
- Department of Blood Transfusion, Three Gorges Hospital, School of Medicine, Chongqing University, Chongqing, China
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Association of Specific Genetic Polymorphisms with Atraumatic Osteonecrosis of the Femoral Head: A Narrative Review. Indian J Orthop 2022; 56:771-784. [PMID: 35547337 PMCID: PMC9043172 DOI: 10.1007/s43465-021-00583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/25/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Atraumatic ONFH is one of the leading cause of hip morbidity in the working-age group. It is a multi-factorial disease whose root cause can be attributed to single-nucleotide polymorphism. Identifying such polymorphisms could pave the way for new modalities of treatment for ONFH. METHODOLOGY Two databases were electronically searched for relevant articles. The articles were screened through titles, abstract and full texts to include the relevant studies. A secondary search was done through the reference list of selected articles. RESULTS A total of 52 studies were included among the 181 hits. All 181 were case-control studies. Summary of these studies identifies multiple SNPs which can cause ONFH. There were 117 SNPs in all 181 studies, of which 92 were associated with the causation of ONFH and 25 were protective against ONFH. CONCLUSION SNPs play an essential role in causing atraumatic ONFH. Identification of SNP that contribute to causing ONFH may help reduce the disease burden by early identification, diagnosis and treatment, including targeted gene therapy.
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Kaneko K, Chen H, Kaufman M, Sverdlov I, Stein EM, Park‐Min K. Glucocorticoid-induced osteonecrosis in systemic lupus erythematosus patients. Clin Transl Med 2021; 11:e526. [PMID: 34709753 PMCID: PMC8506634 DOI: 10.1002/ctm2.526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 12/24/2022] Open
Abstract
Osteonecrosis (ON) is a complex and multifactorial complication of systemic lupus erythematosus (SLE). ON is a devastating condition that causes severe pain and compromises the quality of life. The prevalence of ON in SLE patients is variable, ranging from 1.7% to 52%. However, the pathophysiology and risk factors for ON in patients with SLE have not yet been fully determined. Several mechanisms for SLE patients' propensity to develop ON have been proposed. Glucocorticoid is a widely used therapeutic option for SLE patients and high-dose glucocorticoid therapy in SLE patients is strongly associated with the development of ON. Although the hips and knees are the most commonly affected areas, it may be present at multiple anatomical locations. Clinically, ON often remains undetected until patients feel discomfort and pain at specific sites at which point the process of bone death is already advanced. However, strategies for prevention and options for treatment are limited. Here, we review the epidemiology, risk factors, diagnosis, and treatment options for glucocorticoid-induced ON, with a specific focus on patients with SLE.
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Affiliation(s)
- Kaichi Kaneko
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
| | - Hao Chen
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
- Department of OrthopedicsBeijing Friendship HospitalBeijing100050China
| | - Matthew Kaufman
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
- Case Western Reserve School of MedicineClevelandOhio44106USA
| | - Isaak Sverdlov
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
- Tuoro College of Osteopathic Medicine‐New York CampusNew YorkNew York10027USA
| | - Emily M. Stein
- Endocrinology Service, Hospital for Special SurgeryNew YorkNew YorkUSA
- Metabolic Bone Disease Service, Hospital for Special SurgeryNew YorkNew YorkUSA
| | - Kyung‐Hyun Park‐Min
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
- Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
- BCMB allied programWeill Cornell Graduate School of Medical SciencesNew YorkNew York10021USA
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Sun HS, Yang QR, Bai YY, Hu NW, Liu DX, Qin CY. Gene testing for osteonecrosis of the femoral head in systemic lupus erythematosus using targeted next-generation sequencing: A pilot study. World J Clin Cases 2020; 8:2530-2541. [PMID: 32607330 PMCID: PMC7322418 DOI: 10.12998/wjcc.v8.i12.2530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/09/2020] [Accepted: 05/18/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Previous publications indicated that genetic predisposition might play important roles in the onset of osteonecrosis of the femoral head (ONFH) in systemic lupus erythematosus (SLE). Some gene loci such as complement C3d receptor 2 (CR2), nitric oxide synthase 3 (NOS3), collagen type II alpha 1 chain (COL2A1), protein tyrosine phosphatase non-receptor type 22 (PTPN22), and transient receptor potential cation channel subfamily V member 4 (TRPV4) were reported to be involved in this process.
AIM To investigate whether the risk of ONFH in SLE is associated with single nucleotide variations (SNVs) in these five genes.
METHODS SNVs in the CR2, NOS3, COL2A1, PTPN22, and TRPV4 genes were examined by using FastTarget and Illumina Miseq sequencing technologies in 49 cases of SLE with ONFH. Burrows–wheeler aligner was used to align the sequencing reads to hg19, and GATK and Varscan programs were used to perform SNV calling. PolyPhen-2, SIFT, and MutationTaster were used to assess the functional effects of non-synonymous SNVs.
RESULTS Six of the 49 patients were confirmed to have low frequency SNVs, including one patient with SNVs in NOS3 (exon 6: c.814G>A: p.E272K and exon 7: c.814G>A: p.E272K.), four in COL2A1 (rs41263847: exon 29: c.1913C>T: p.T638I, exon 28: c.1706C>T: p.T569I, and rs371445823: exon 8: c.580G>A: p.A194T, exon 7: c.373G>A: p.A125T), and one in CR2 (rs45573035: exon 2: c.200C>G: p.T67S).
CONCLUSION The onset of ONFH in SLE might be associated with the identified SNVs in NOS3, COL2A1, and CR2.
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Affiliation(s)
- Hong-Sheng Sun
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Qing-Rui Yang
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Yan-Yan Bai
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Nai-Wen Hu
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Dong-Xia Liu
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Cheng-Yong Qin
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
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An F, Du J, Cao Y, Shi J, Guo Y, Jin T, Li J, Chen J, Li P, Dong M, Wang G, Wang J. MMP8 polymorphism is associated with susceptibility to osteonecrosis of the femoral head in a Chinese Han population. Oncotarget 2017; 8:21561-21566. [PMID: 28423488 PMCID: PMC5400606 DOI: 10.18632/oncotarget.15371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/09/2017] [Indexed: 01/23/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is an orthopedic refractory disease that adversely affects quality of life. Matrix metalloproteinase-8 (MMP-8) produced by the bone marrow has been implicated in the degradation of collagen during bone development. We assessed whether MMP8 polymorphisms are associated with ONFH. In a case-control study, using χ2 tests and genetic model analyses, we genotyped 5 MMP8 single-nucleotide polymorphisms (SNPs) in 585 ONFH patients and 507 healthy control subjects in a Chinese Han population. The MMP8 rs11225394 SNP was associated with an increased risk of ONFH in an allele model (OR=1.34; 95% CI, 1.003-1.786, P=0.047). In addition, rs11225394 was associated with an increased risk of ONFH in a dominant model (OR =1.39, 95% CI, 1.02-1.89, P=0.036), over-dominant model (OR=1.39, 95% CI, 1.02-1.89, P=0.038), and log-additive model (OR =1.36, 95% CI, 1.01-1.84, P=0.039). After adjusting for age and gender, rs11225394 was associated with ONFH in a dominant (OR =1.44, 95% CI, 1.05-1.96, P=0.023), over-dominant (OR =1.44, 95% CI, 1.05-1.98, P=0.022), and log-additive model (OR =1.40, 95% CI, 1.04-1.90, P=0.027). These results provide the first evidence that MMP8 SNP at the rs11225394 locus is associated with the increased risk of ONFH in Chinese Han population.
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Affiliation(s)
- Feimeng An
- Inner Mongolia Medical University, Hohhot, Inner Mongolia, China.,Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Inner Mongolia University, Hohhot, Inner Mongolia, China
| | - Jieli Du
- Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Inner Mongolia University, Hohhot, Inner Mongolia, China
| | - Yuju Cao
- Zhengzhou TCM Traumatology Hospital, Zhengzhou, Henan, China
| | - Jianping Shi
- Department of TCM Diagnosis, Inner Mongolia Medical University, Hohhot, China
| | - Yongchang Guo
- Zhengzhou TCM Traumatology Hospital, Zhengzhou, Henan, China
| | - Tianbo Jin
- MOE Key Laboratory of Resource Biology and Modern Biotechnology, Northwest University, Xi'an, China
| | - Jian Li
- Zhengzhou TCM Traumatology Hospital, Zhengzhou, Henan, China
| | - Junyu Chen
- Inner Mongolia Medical University, Hohhot, Inner Mongolia, China.,Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Inner Mongolia University, Hohhot, Inner Mongolia, China
| | - Ping Li
- Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Inner Mongolia University, Hohhot, Inner Mongolia, China
| | - Mei Dong
- Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Inner Mongolia University, Hohhot, Inner Mongolia, China
| | - Guoqiang Wang
- Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Inner Mongolia University, Hohhot, Inner Mongolia, China
| | - Jianzhong Wang
- Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Inner Mongolia University, Hohhot, Inner Mongolia, China
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