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Kapsala N, Nikolopoulos D, Fanouriakis A. The Multiple Faces of Systemic Lupus Erythematosus: Pearls and Pitfalls for Diagnosis. Mediterr J Rheumatol 2024; 35:319-327. [PMID: 39193185 PMCID: PMC11345601 DOI: 10.31138/mjr.130124.ppa] [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: 01/13/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 08/29/2024] Open
Abstract
Systemic lupus erythematosus is the prototype multisystem autoimmune disorder characterised by a broad spectrum of organ involvement and a multitude of laboratory abnormalities. Clinical heterogeneity, unpredictable course and lack of pathognomonic clinical and serological features pose a considerable challenge in the diagnosis of SLE. The latter remains largely clinical, typically accompanied however by features of serologic autoimmunity, which are characteristic for the disease. Despite significant improvements in treatment strategies, an early diagnosis often continues to be an unmet need, as the median reported delay from symptom onset to SLE diagnosis is approximately 2 years. Classification criteria are usually used to support the diagnosis, yet with significant caveats. In this article, we provide an updated review of the clinical presentation of lupus and give clues for an accurate diagnosis.
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Affiliation(s)
- Noemin Kapsala
- ”Attikon” University Hospital of Athens, Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dionysis Nikolopoulos
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Antonis Fanouriakis
- ”Attikon” University Hospital of Athens, Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Eryavuz Onmaz D, Tezcan D, Yilmaz S, Onmaz M, Unlu A. Altered kynurenine pathway metabolism and association with disease activity in patients with systemic lupus. Amino Acids 2023; 55:1937-1947. [PMID: 37925676 DOI: 10.1007/s00726-023-03353-7] [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: 04/12/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease accompanied by increased release of proinflammatory cytokines that are known to activate the indoleamine 2,3-dioxygenase (IDO-1) enzyme, which catalyzes the rate-limiting step of the kynurenine pathway (KP). This study aimed to measure KP metabolite levels in patients with SLE and investigate the relationship between disease activity, clinical findings, and KP. The study included 100 patients with SLE and 100 healthy controls. Serum tryptophan (TRP), kynurenine (KYN), kynurenic acid (KYNA), 3-hydroxyanthranilic acid (3HAA), 3-hydroxykynurenine (3HK), quinolinic acid (QA) concentrations were measured with tandem mass spectrometry. Serum KYN, KYNA, 3HAA, 3HK, and QA levels of the patients with SLE were significantly higher than the control group. Serum QA levels were elevated in patients with neurological involvement (four patients with peripheral neuropathy and two patients with mononeuropathy), serum KYN levels and KYN/TRP ratio increased in patients with joint involvement, and serum KYN, 3HK, and 3HAA levels and the KYN/TRP ratio were increased in patients with renal involvement. Moreover, KYN and KYN/TRP ratios were positively correlated with the disease activity score. These findings indicated that imbalances in KP metabolites may be associated with the pathogenesis, activation, and clinical manifestations of SLE.
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Affiliation(s)
- Duygu Eryavuz Onmaz
- Department of Biochemistry, Selcuk University Faculty of Medicine, Alaaddin Keykubat Campus, Selcuklu, 42075, Konya, Turkey.
| | - Dilek Tezcan
- Division of Rheumatology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Sema Yilmaz
- Division of Rheumatology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mustafa Onmaz
- Faculty of Medicine, Department of Family Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ali Unlu
- Department of Biochemistry, Selcuk University Faculty of Medicine, Alaaddin Keykubat Campus, Selcuklu, 42075, Konya, Turkey
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Prabhu SS, Nair AS, Nirmala SV. Multifaceted roles of mitochondrial dysfunction in diseases: from powerhouses to saboteurs. Arch Pharm Res 2023; 46:723-743. [PMID: 37751031 DOI: 10.1007/s12272-023-01465-y] [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: 02/05/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023]
Abstract
The fact that mitochondria play a crucial part in energy generation has led to the nickname "powerhouses" of the cell being applied to them. They also play a significant role in many other cellular functions, including calcium signalling, apoptosis, and the creation of vital biomolecules. As a result, cellular function and health as a whole can be significantly impacted by mitochondrial malfunction. Indeed, malignancies frequently have increased levels of mitochondrial biogenesis and quality control. Adverse selection exists for harmful mitochondrial genome mutations, even though certain malignancies include modifications in the nuclear-encoded tricarboxylic acid cycle enzymes that generate carcinogenic metabolites. Since rare human cancers with mutated mitochondrial genomes are often benign, removing mitochondrial DNA reduces carcinogenesis. Therefore, targeting mitochondria offers therapeutic options since they serve several functions and are crucial to developing malignant tumors. Here, we discuss the various steps involved in the mechanism of cancer for which mitochondria plays a significant role, as well as the role of mitochondria in diseases other than cancer. It is crucial to understand mitochondrial malfunction to target these organelles for therapeutic reasons. This highlights the significance of investigating mitochondrial dysfunction in cancer and other disease research.
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Affiliation(s)
- Surapriya Surendranath Prabhu
- Department of Pharmaceutical Chemistry and Analysis, Amrita School of Pharmacy, AIMS Health Sciences Campus, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India
| | - Aathira Sujathan Nair
- Department of Pharmaceutical Chemistry and Analysis, Amrita School of Pharmacy, AIMS Health Sciences Campus, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India
| | - Saiprabha Vijayakumar Nirmala
- Department of Pharmaceutical Chemistry and Analysis, Amrita School of Pharmacy, AIMS Health Sciences Campus, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India.
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Usategui I, Barbado J, Torres AM, Cascón J, Mateo J. Machine learning, a new tool for the detection of immunodeficiency patterns in systemic lupus erythematosus. J Investig Med 2023; 71:742-752. [PMID: 37158077 DOI: 10.1177/10815589231171404] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Systemic lupus erythematosus (SLE) is a complex autoimmune disease that affects several organs and causes variable clinical symptoms. Early diagnosis is currently the most effective way to save the lives of patients with SLE. But it is very difficult to detect in the early stages of the disease. Because of this, this study proposes a machine learning system to help diagnose patients with SLE. To carry out the research, the extreme gradient boosting method has been implemented due to its performance characteristics, as it allows high performance, scalability, accuracy, and low computational load. From this method we try to recognize patterns in the data obtained from patients, which allow the classification of SLE patients with high accuracy and differentiate these patients from controls. Several machine learning methods have been analyzed in this study. The proposed method achieves a higher prediction value of patients who may suffer from SLE than the rest of the compared systems. The proposed algorithm achieved an improvement in accuracy of 4.49% over k-Nearest Neighbors. As for the Support Vector Machine and Gaussian Naive Bayes (GNB) methods, they achieved a lower performance than the proposed one, reaching values of 83% and 81%, respectively. It should be noted that the proposed system showed a higher area under the curve (90%) and a balanced accuracy (90%) than the other machine learning methods. This study shows the usefulness of ML techniques for identifying and predicting SLE patients. These results demonstrate the possibility of developing automatic diagnostic support systems for SLE patients based on machine learning techniques.
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Affiliation(s)
- Iciar Usategui
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Julia Barbado
- Autoimmune Diseases Unit, Río Hortega University Hospital, Valladolid, Spain
| | - Ana María Torres
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Joaquín Cascón
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Jorge Mateo
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
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Mazhariazad F, Dianati M, Taghadosi M, Zamani B. Uncertainty and its related coping strategies in systemic lupus erythematosus. Life in the fog. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:233. [PMID: 37727415 PMCID: PMC10506748 DOI: 10.4103/jehp.jehp_1080_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/09/2022] [Indexed: 09/21/2023]
Abstract
BACKGROUND One of the most prevalent problems of patients with systemic lupus erythematosus (SLE) is the uncertainty over an indefinite future. Uncertainty has significant effects on quality of life. The aim of this study was to explore uncertainty and personal strategies to cope with it among patients with SLE. MATERIALS AND METHODS This qualitative study was conducted in 2020-2021 using conventional content analysis. Participants were 21 patients with SLE who were purposefully selected from rheumatology clinics in Kashan, Kerman, and Bandar Abbass in Iran. Data collection was performed using face-to-face, in-depth, semi-structured interviews and was continued up to data saturation. Data were analyzed concurrently with data collection through conventional content analysis approach proposed by Graneheim and Lundman. RESULTS Two main themes, namely, "life in the fog" and "attempt to find peace" emerged from patients' experiences of illness uncertainty of SLE. Life in the fog included three main categories of "perception of threat to health", "challenge of doubt and certainty," and "indefinite future." Attempt to find peace included three main categories of "spirituality," "reflection," and "attempt to acquire SLE-related knowledge. CONCLUSIONS Uncertainty is a major psychological stress for patients with SLE. Healthcare providers should therefore consider the challenges and concerns faced by patients and, through utilizing appropriate training and communicational practices, plan interventions and strategies to empower patients for coping with uncertainty.
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Affiliation(s)
- Fereshteh Mazhariazad
- Department of Medical-Surgical Nursing, Kashan University of Medical Sciences, Kashan, Iran
| | - Mansour Dianati
- Department of Medical-Surgical Nursing, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohsen Taghadosi
- Department of Medical-Surgical Nursing, Kashan University of Medical Sciences, Kashan, Iran
| | - Batool Zamani
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Venuturupalli S, Kumar A, Bunyan A, Davuluri N, Fortune N, Reuter K. Using Patient-Reported Health Data From Social Media to Identify Diverse Lupus Patients and Assess Their Symptom and Medication Expressions: A Feasibility Study. Arthritis Care Res (Hoboken) 2023; 75:365-372. [PMID: 35157364 PMCID: PMC9375779 DOI: 10.1002/acr.24868] [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: 09/10/2021] [Revised: 01/10/2022] [Accepted: 02/10/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Patient communities use social media for peer support and information seeking. This study assessed the feasibility of using public patient-generated health data from the social network Twitter to identify diverse lupus patients and gather their perspectives about disease symptoms and medications. METHODS We extracted public lupus-related Twitter messages (n = 47,715 tweets) in English posted by users (n = 8,446) in the US between September 1, 2017 and October 31, 2018. We analyzed the data to describe lupus patients and the expressed themes (symptoms and medications). Two independent coders analyzed the data; Cohen's kappa coefficient was used to ensure interrater reliability. Differences in symptom and medication expressions were analyzed using 2-tailed Z tests and a combination of 1-way analysis of variance tests and unpaired t-tests. RESULTS We found that lupus patients on Twitter are diverse in gender and race: approximately one-third (34.64%, 62 of 179) were persons of color (POCs), and 85.47% were female. The expressed disease symptoms and medications varied significantly by gender and race. Most of our findings correlated with documented clinical observations, e.g., expressions of general pain (8.39%, 709 of 8,446), flares (6.05%, 511 of 8,446), and fatigue (4.18%, 353 of 8,446). However, our data also revealed less well-known patient observations, e.g., possible racial disparities within ocular manifestations of lupus. CONCLUSION Our results indicate that social media surveillance can provide valuable data of clinical relevance from the perspective of lupus patients. The medical community has the opportunity to harness this information to inform the patient-centered care within underrepresented patient groups, such as POCs.
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Affiliation(s)
- Swamy Venuturupalli
- MD, Cedars-Sinai Medical Center, Los Angeles, CA, United States; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Amit Kumar
- BS, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Alden Bunyan
- BS, MHDS, Borra College of Health Sciences, Dominican University, IL, United States
| | - Nikhil Davuluri
- BS, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Natalie Fortune
- MS, RDN, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Katja Reuter
- PhD, Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, United States; Southern California Clinical and Translational Science Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
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Alrashdi MN, Alrasheedi SM, Alkhdairi A, Alburaq FN, Muteb AE, Alshamikh AS, Almutairi K, Ammar AN, Saleh AL, Nawaf AW. Primary Healthcare Practitioners' Knowledge, Attitude, and Practice Toward Systemic Lupus Erythematosus in the Qassim Region, Saudi Arabia. Cureus 2022; 14:e30297. [PMID: 36407197 PMCID: PMC9658483 DOI: 10.7759/cureus.30297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 06/16/2023] Open
Abstract
Objective The study aims to evaluate the primary healthcare practitioner's (PHCP) knowledge, attitude, and practice toward systemic lupus erythematosus (SLE) and to explore the difficulties of early referral to specialized clinics. Method This is a cross-sectional study conducted between February and March 2022 targeting the PHCP among the primary healthcare centers in Qassim, Saudi Arabia. The study was conducted among 203 participants who enrolled via a cluster random sampling technique depending on the survey. Qualitative categorical variables are expressed as frequencies and percentages, while continuous variables are reported as means and standard deviations (SD). The one-way analysis of variance (ANOVA) test and the independent T-test have been used to explore the relationship between participants' knowledge scores and their socio-demographic characteristics. A P-value ≤0.05 was considered statistically significant. Result The study found that only 4.4% of participating PHCPs had good knowledge related to SLE, while 45.8% of them had fair knowledge, and nearly half of them (49.8%) had poor knowledge. It was noted that GPs who specialized in family medicine or saw more than 40 patients each week had comparably better knowledge than others, which was statistically significant (p<0.05). The difficulty in diagnosing SLE patients was mentioned by 48.3% of the PHCPs. Family medicine consultants (p<0.001), those who worked in a tertiary care facility for more than six months (p<0.001) and those who worked in a rheumatology department (p<0.05), reported considerably better levels of comfort when treating SLE patients. Conclusion This study found that included participants' understanding of SLE, its diagnosis, and management was inadequate. Coordination between rheumatologists and experts from many disciplines at the primary, secondary, and tertiary levels of care is critical for overcoming ambiguities and obstacles in the diagnosis and therapy of SLE patients.
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Affiliation(s)
- Mousa N Alrashdi
- Department of Medicine, Unaizah Collage of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Sami M Alrasheedi
- Department of Medicine, Unaizah Collage of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Ahmad Alkhdairi
- Department of Medicine, Unaizah Collage of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | | | | | | | - Khalid Almutairi
- Department of Medicine, Unaizah Collage of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
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Karremah MF, Hassan RY, Faloudah AZ, Alharbi LK, Shodari AF, Rahbeeni AA, Alharazi NK, Binjabi AZ, Cheikh MM, Manasfi H, Abdulaziz S, Hussein AH, Alhazmi A, Almoallim H. From Symptoms to Diagnosis: An Observational Study of the Journey of SLE Patients in Saudi Arabia. Open Access Rheumatol 2022; 14:103-111. [PMID: 35791408 PMCID: PMC9250784 DOI: 10.2147/oarrr.s362833] [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: 02/17/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives Early diagnosis and treatment is associated with improved outcomes in patients with systemic lupus erythematosus (SLE). Studying the journey of SLE patients in Saudi Arabia is essential to direct future health-care plans. Patients and Methods This is a cross-sectional, multicenter study. Eligibility criteria included a diagnosis of SLE that was confirmed by a rheumatologist. Patients younger than 18 at the time of interview were excluded. Primary objectives were to determine time from first symptoms to initial physician visit (Lag 1), time from initial physician visit to encounter with rheumatologist (Lag 2), time from first visit to a rheumatologist to diagnosis of SLE (Lag 3), and time from diagnosis to start of treatment (Lag 4). Secondary objectives were to determine the number and specialty of physicians seen by patients, the speciality type that confirmed the diagnosis, first symptoms experienced, and age at first diagnosis of SLE. Results Three hundred patients (92.3% women) with SLE were evaluated. Mean age at diagnosis was 29.92 years. Mean disease duration was 8.1 years. The majority were college educated (43.0%). The most common initial symptom was joint pain (68%), followed by skin rash (23%), and fever (3.7%). Lag 1 was less than one month in 68.2% of patients. Lag 2 was less than one month in 33.4% of patients and exceeded one year in 25.8%. Lag 3 was less than 1 month in 68.7% of patients. Lag 4 was less than one month in 94.4% of patients. The diagnosis of SLE was made most frequently by rheumatologists (80%). Evaluation by primary care, orthopedic and dermatology physicians were associated with delays in diagnosis. Conclusion Delay was marked in Lag 2. Causes of delay included evaluation by non-specialists and visiting higher numbers of physicians before diagnosis confirmation.
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Affiliation(s)
- Mishal F Karremah
- Department of Medicine, College of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Rola Y Hassan
- Department of Medicine, Division of Rheumatology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.,Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia
| | - Ammar Z Faloudah
- Department of Medicine, College of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Lujain K Alharbi
- Department of Medicine, Division of Rheumatology, King Fahad Hospital, Madinah, Saudi Arabia
| | - Albraa F Shodari
- Department of Medicine, College of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Ahmad A Rahbeeni
- Department of Medicine, College of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Nouf K Alharazi
- Department of Medicine, College of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Ahmad Z Binjabi
- Department of Medicine, College of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Mohamed M Cheikh
- Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia.,Department of Medicine, College of Medicine, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | - Hanadi Manasfi
- Department of Medicine, Specialized Medical Center, Riyadh, Saudi Arabia
| | - Sultana Abdulaziz
- Department of Medicine, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Albadr Hamza Hussein
- Department of Medicine, Division of Rheumatology, King Fahad Hospital, Madinah, Saudi Arabia
| | - Ahmed Alhazmi
- Department of Medicine, Division of Rheumatology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Hani Almoallim
- Department of Medicine, College of Medicine, Umm Alqura University, Makkah, Saudi Arabia.,Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia.,Department of Medicine, Dr. Sameer Abbas Hospital, Jeddah, Saudi Arabia
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Stappers S, van der Graaff D, Hoffman I, Moorkens W, Hantson I, Stappaerts I, Nowé V, Vervliet L. Systemic lupus erythematosus presenting as non-resolving pneumonia: a case report. Acta Clin Belg 2022; 77:616-623. [PMID: 34027835 DOI: 10.1080/17843286.2021.1925817] [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: 10/21/2022]
Abstract
BackgroundSystemic lupus erythematosus (SLE) is a rheumatological disorder with a heterogeneous clinical presentation and disease course. Case presentationWe report a case concerning a young woman with pleuropneumonia, non-responsive to conventional antibiotic therapy, who was, upon further inquiry and passage of time, diagnosed with SLE. Key pointsBy means of this case, we would like to emphasize the clinical implications and prognostic significance of lymphopenia in patients with SLE. Moreover, we attempt to make the reader aware of some of the protean manifestations of SLE and we would like to raise suspicion of acute lupus pneumonitis by demonstrating a case of a young female with non-resolving pneumonia.
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Affiliation(s)
- Sofie Stappers
- Department of Internal Medicine, GZA Sint-Vincentius Hospital, Antwerp, Belgium
| | | | - Ilse Hoffman
- Department of Rheumatology, GZA Sint-Vincentius Hospital, Antwerp, Belgium
| | - Walter Moorkens
- Department of Pneumology, GZA Sint-Vincentius Hospital, Antwerp, Belgium
| | - Inge Hantson
- Department of Pneumology, GZA Sint-Vincentius Hospital, Antwerp, Belgium
| | - Inge Stappaerts
- Department of Pneumology, GZA Sint-Vincentius Hospital, Antwerp, Belgium
| | - Vicky Nowé
- Department of Pneumology, GZA Sint-Vincentius Hospital, Antwerp, Belgium
| | - Liesbeth Vervliet
- Department of Pneumology, GZA Sint-Vincentius Hospital, Antwerp, Belgium
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Baharudin R, Idris NS, Muhammad J, Abdullah WNHW. A Case Report of Male Systemic Lupus Erythematous with Antinuclear Antibodies-Negative: A Challenging Diagnosis. Korean J Fam Med 2022; 43:150-154. [PMID: 35320902 PMCID: PMC8943239 DOI: 10.4082/kjfm.20.0211] [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: 09/03/2020] [Accepted: 10/08/2020] [Indexed: 11/09/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a connective tissue disease of unknown etiology that predominantly affects women of childbearing age. We report a case of male systemic lupus erythematous with antinuclear antibodies and typical clinical presentations of multiple skin lesions, polyarticular joint pain, fatigue, anorexia, and hair loss. Full evaluations were used to establish a diagnosis of SLE. The lower prevalence of SLE among males and antinuclear antibody-negative patients poses a great challenge for diagnosis. Therefore, as primary care doctors, we need to have a high suspicion of systemic lupus erythematous even in male and antinuclear antibody-negative patients. Thus, early treatment may help patients improve their quality of life.
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Affiliation(s)
- Ruziana Baharudin
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nur Suhaila Idris
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Corresponding Author: Nur Suhaila Idris Tel: +60-19-937-3950, Fax: +60-97653370, E-mail:
| | - Juliawati Muhammad
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Broadway-Duren JB, Cesario SK. The Lived Experiences of Women Seeking a Diagnosis of Systemic Lupus Erythematosus. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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van Vollenhoven R, Askanase AD, Bomback AS, Bruce IN, Carroll A, Dall'Era M, Daniels M, Levy RA, Schwarting A, Quasny HA, Urowitz MB, Zhao MH, Furie R. Conceptual framework for defining disease modification in systemic lupus erythematosus: a call for formal criteria. Lupus Sci Med 2022; 9:9/1/e000634. [PMID: 35346982 PMCID: PMC8961173 DOI: 10.1136/lupus-2021-000634] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/03/2022] [Indexed: 12/15/2022]
Abstract
Disease modification has become a well-established concept in several therapeutic areas; however, no widely accepted definition of disease modification exists for SLE. We reviewed established definitions of disease modification in other conditions and identified a meaningful effect on ‘disease manifestations’ (ie, signs, symptoms and patient-reported outcomes) and on ‘disease outcomes’ (eg, long-term remission or progression of damage) as the key principles of disease modification, indicating a positive effect on the natural course of the disease. Based on these findings and the treatment goals and outcome measures for SLE, including lupus nephritis, we suggest a definition of disease modification based on disease activity indices and organ damage outcomes, with the latter as a key anchor. A set of evaluation criteria is also suggested. Establishing a definition of disease modification in SLE will clarify which treatments can be considered disease modifying, provide an opportunity to harmonise future clinical trial outcomes and enable comparison between therapies, all of which could ultimately help to improve patient outcomes. This publication seeks to catalyse further discussion and provide a framework to develop an accepted definition of disease modification in SLE.
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Affiliation(s)
- Ronald van Vollenhoven
- Amsterdam Rheumatology and Immunology Center and Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Andrew S Bomback
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ian N Bruce
- The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Angela Carroll
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Maria Dall'Era
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Roger A Levy
- GlaxoSmithKline, Philadelphia, Pennsylvania, USA
| | - Andreas Schwarting
- Rheumatology Center Rhineland Palatinate, Bad Kreuznach, Germany.,University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Holly A Quasny
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | | | - Ming-Hui Zhao
- Peking University First Hospital, Peking-Tsinghua Center for Life Sciences, Beijing, China
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Kapsala N, Nikolopoulos D, Flouda S, Chavatza A, Tseronis D, Aggelakos M, Katsimbri P, Bertsias G, Fanouriakis A, Boumpas DT. First Diagnosis of Systemic Lupus Erythematosus in Hospitalized Patients: Clinical Phenotypes and Pitfalls for the Non-Specialist. Am J Med 2022; 135:244-253.e3. [PMID: 34411524 DOI: 10.1016/j.amjmed.2021.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/05/2021] [Accepted: 07/25/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Prompt recognition of systemic lupus erythematosus (SLE) in hospitalized patients presenting with severe disease is essential to initiate treatment. We sought to characterize the phenotype of hospitalized patients with new-onset SLE and estimate potential diagnostic delays. METHODS An observational study of 855 patients ("Attikon" SLE cohort). Clinical phenotype was categorized according to the leading manifestation that led to hospitalization. Disease features, time to diagnosis, classification criteria, and the SLE Risk Probability Index (SLERPI) were recorded for each patient. RESULTS There were 191 patients (22.3% of the total cohort) hospitalized due to manifestations eventually attributed to SLE. Main causes of admission were neuropsychiatric syndromes (21.4%), cytopenias (17.8%), nephritis (17.2%), and thrombotic events (16.2%). Although 79.5% of patients were diagnosed within 3 months from hospitalization, in 39 patients diagnosis was delayed, particularly in those with hematological manifestations. At hospitalization, a SLERPI >7 (indicating high probability for SLE) was found in 87.4% of patients. Patients missed by the SLERPI had fever, thrombotic or neuropsychiatric manifestations not included in the algorithm. Lowering the SLERPI threshold to 5 in patients with fever or thrombotic events increased the diagnostic rate from 88.8% to 97.9% in this subgroup, while inclusion of all neuropsychiatric events yielded no additional diagnostic value. CONCLUSION One in five patients with new-onset SLE manifest disease presentations required hospitalization. Although early diagnosis was achieved in the majority of cases, in approximately 20%, diagnosis was delayed. A lower SLERPI cut-off (≥5) in patients with fever or thrombosis could enhance early diagnosis.
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Affiliation(s)
- Noemin Kapsala
- "Attikon" University Hospital of Athens, Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dionysis Nikolopoulos
- "Attikon" University Hospital of Athens, Rheumatology and Clinical Immunology, Medical School, 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
| | - Sofia Flouda
- "Attikon" University Hospital of Athens, Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Chavatza
- "Attikon" University Hospital of Athens, Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tseronis
- "Attikon" University Hospital of Athens, Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Aggelakos
- "Attikon" University Hospital of Athens, Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Pelagia Katsimbri
- "Attikon" University Hospital of Athens, Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Crete, Greece; Institute of Molecular Biology and Biotechnology, Foundation of Research and Technology-Hellas, Heraklion, Crete, Greece
| | - Antonis Fanouriakis
- "Attikon" University Hospital of Athens, Rheumatology and Clinical Immunology, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Rheumatology, "Asklepieion" General Hospital, Voula, Athens, Greece
| | - Dimitrios T Boumpas
- "Attikon" University Hospital of Athens, Rheumatology and Clinical Immunology, Medical School, 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; Medical School, University of Cyprus, Nicosia, Cyprus.
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Papageorgiou L, Alkenaris H, Zervou MI, Vlachakis D, Matalliotakis I, Spandidos DA, Bertsias G, Goulielmos GN, Eliopoulos E. Epione application: An integrated web‑toolkit of clinical genomics and personalized medicine in systemic lupus erythematosus. Int J Mol Med 2021; 49:8. [PMID: 34791504 PMCID: PMC8612305 DOI: 10.3892/ijmm.2021.5063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/02/2021] [Indexed: 12/16/2022] Open
Abstract
Genome wide association studies (GWAS) have identified autoimmune disease-associated loci, a number of which are involved in numerous disease-associated pathways. However, much of the underlying genetic and pathophysiological mechanisms remain to be elucidated. Systemic lupus erythematosus (SLE) is a chronic, highly heterogeneous auto-immune disease, characterized by differences in autoantibody profile, serum cytokines and a multi-system involvement. This study presents the Epione application, an integrated bioinformatics web-toolkit, designed to assist medical experts and researchers in more accurately diagnosing SLE. The application aims to identify the most credible gene variants and single nucleotide polymorphisms (SNPs) associated with SLE susceptibility, by using patient's genomic data to aid the medical expert in SLE diagnosis. The application contains useful knowledge of >70,000 SLE-related publications that have been analyzed, using data mining and semantic techniques, towards extracting the SLE-related genes and the corresponding SNPs. Probable genes associated with the patient's genomic profile are visualized with several graphs, including chromosome ideograms, statistic bars and regulatory networks through data mining studies with relative publications, to obtain a representative number of the most credible candidate genes and biological pathways associated with the SLE. Furthermore, an evaluation study was performed on a patient diagnosed with SLE and is presented herein. Epione has also been expanded in family-related candidate patients to evaluate its predictive power. All the recognized gene variants that were previously considered to be associated with SLE were accurately identified in the output profile of the patient, and by comparing the results, novel findings have emerged. The Epione application may assist and facilitate in early stage diagnosis by using the patients' genomic profile to compare against the list of the most predictable candidate gene variants related to SLE. Its diagnosis-oriented output presents the user with a structured set of results on variant association, position in genome and links to specific bibliography and gene network associations. The overall aim of the present study was to provide a reliable tool for the most effective study of SLE. This novel and accessible webserver tool of SLE is available at http://geneticslab.aua.gr/epione/.
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Affiliation(s)
- Louis Papageorgiou
- Laboratory of Genetics, Department of Biotechnology, Agricultural University of Athens, 11855 Athens, Greece
| | - Haris Alkenaris
- Laboratory of Genetics, Department of Biotechnology, Agricultural University of Athens, 11855 Athens, Greece
| | - Maria I Zervou
- Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Dimitriοs Vlachakis
- Laboratory of Genetics, Department of Biotechnology, Agricultural University of Athens, 11855 Athens, Greece
| | - Ioannis Matalliotakis
- Department of Obstetrics and Gynecology, Venizeleio and Pananio General Hospital of Heraklion, 71409 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - George Bertsias
- Department of Rheumatology and Clinical Immunology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - George N Goulielmos
- Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Elias Eliopoulos
- Laboratory of Genetics, Department of Biotechnology, Agricultural University of Athens, 11855 Athens, Greece
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15
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Petrou P. A Systematic Review of the Economic Evaluations of Belimumab in Systemic Lupus Erythematosus. Value Health Reg Issues 2021; 27:32-40. [PMID: 34784546 DOI: 10.1016/j.vhri.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/24/2021] [Accepted: 06/20/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Systemic lupus erythematosus is a heterogeneous, multisystem autoimmune disease. These attributes cause lupus to be a challenging condition to adequately manage, which is further aggravated by the lack of treatment modalities. Belimumab is a full human monoclonal antibody, and its safety and efficacy in lupus management have been demonstrated in a number of randomized clinical trials. However, these gains come at a high cost in an era that is demarcated by soaring pharmaceutical expenditure. Therefore, the objective of this paper is to critically assess the economic evaluations of belimumab. METHODS A systematic review was performed for economic evaluations of belimumab and the retrieved studies were assessed with the quality of health economic studies questionnaire. RESULTS A total of 3 studies and 5 abstracts were retrieved. Belimumab demonstrated a consistent favorable economic profile across Spain, Italy, Portugal, Greece, Hong Kong, Canada, and Greece. The sensitivity analyses revealed that the effectiveness of treatment and the discontinuation rate had the greatest effect on the outcome. CONCLUSION Current data underscore a favorable cost-effectiveness ratio of belimumab in the treatment of systemic lupus erythematosus. Results are consistent across Spain, Italy, Portugal, Greece, Hong Kong, Canada, and Greece, countries for which an economic evaluation was available. Nevertheless, the low number of assessments, along with concerns regarding its long-term effectiveness, underpin areas that necessitate further research.
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Affiliation(s)
- Panagiotis Petrou
- Pharmacoepidemiology-Pharmacovigilance, Pharmacy School, School of Sciences and Engineering, University of Nicosia and Health Insurance Organization, Nicosia, Cyprus.
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16
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Orme ME, Voreck A, Aksouh R, Ramsey-Goldman R, Schreurs MWJ. Systematic review of anti-dsDNA testing for systemic lupus erythematosus: A meta-analysis of the diagnostic test specificity of an anti-dsDNA fluorescence enzyme immunoassay. Autoimmun Rev 2021; 20:102943. [PMID: 34508916 DOI: 10.1016/j.autrev.2021.102943] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS The objective of this meta-analysis was to review the diagnostic performance of anti-dsDNA testing, to determine whether test specificity meets the revised 2019 EULAR/ACR classification criteria for systemic lupus erythematosus (SLE). The new criteria state that anti-dsDNA testing should be conducted using "an immunoassay with demonstrated ≥ 90% specificity for SLE against relevant disease controls". MATERIALS AND METHODS A systematic review (MEDLINE, Embase, CENTRAL and DARE) identified cross-sectional or case-control studies published January 2004 to August 2019, reporting anti-dsDNA test accuracy data. Studies included cases of SLE (confirmed using one or more of three validated SLE classification criteria sets) and a disease control group. Data were adjusted to exclude healthy controls. A hierarchical, bivariate mixed-effect meta-analysis of eligible quantitative studies was conducted in STATA MP v16.1 to produce a pooled estimate of sensitivity and specificity. RESULTS The review identified six fluorescence immunoassay (FEIA) dsDNA studies (1977 total patients, of whom 47% had SLE) eligible to be included in quantitative meta-analysis and all reported a point estimate >90% for specificity. The meta-analysis estimated a pooled specificity of 94.7% (95% CI 91.67%-96.67%). CONCLUSION The meta-analysis has demonstrated that the specificity of FEIA dsDNA is ≥90% for SLE, against relevant disease controls, and therefore performs in accordance with the 2019 classification criteria.
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Affiliation(s)
| | - Anja Voreck
- Thermo Fisher Scientific, Phadia AB, Uppsala, Sweden
| | - Redha Aksouh
- Thermo Fisher Scientific, Phadia AB, Uppsala, Sweden
| | - Rosalind Ramsey-Goldman
- Department of Medicine/Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marco W J Schreurs
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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17
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Hansen RB, Simard JF, Faurschou M, Jacobsen S. Distinct patterns of comorbidity prior to diagnosis of incident systemic lupus erythematosus in the Danish population. J Autoimmun 2021; 123:102692. [PMID: 34364172 DOI: 10.1016/j.jaut.2021.102692] [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: 04/12/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 01/11/2023]
Abstract
The objective of this study was to assess the cumulative prevalence of pre-existing comorbidities among patients diagnosed with systemic lupus erythematosus (SLE) in Denmark. The study included patients aged ≥18 years at the index date set to the date of first registration of SLE in the Danish National Patient Registry (DNPR) between 1996 and 2018. Up to 19 age- and sex-matched general population comparators per case were selected. Comorbidity diagnoses were retrieved from the DNPR based on International Classification of Diseases codes. We estimated cumulative prevalence of various comorbidities among cases and comparators, prevalence differences (PDs), and prevalence ratios (PRs), with PDs and PRs adjusted for age and sex, at the index date and 1, 2, 5, and 10 years before the index date. We identified 3,010 SLE cases and 57,046 comparators (mean age at index date: 47.3 years). Most comorbidities occurred more often in SLE patients versus comparators at the index date and up to 10 years before. Overrepresented comorbidities in SLE patients 10 years before SLE diagnosis included neuropsychiatric, cardiovascular, and venous thromboembolic diseases; PDs (95% CI) were 2.3% (1.4-3.3%), 1.3% (0.6-1.9%), and 1.1% (0.6-1.5%), respectively; corresponding PRs (95% CI) were 1.5 (1.3-1.8), 1.7 (1.4-2.1), and 4.3 (3.1-6.1). We found a higher prevalence of multiple comorbidities-not only at the time of SLE diagnosis but likewise during the 10-year pre-diagnosis period-among individuals with SLE. These findings underscore the importance of early clinical vigilance toward comorbidities starting in the diagnostic phase of SLE.
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Affiliation(s)
- Renata Baronaite Hansen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Blegdamsvej 9, 2100, København, Denmark; Department of Epidemiology and Population Health, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA, 94305-5101, USA.
| | - Julia F Simard
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA, 94305-5101, USA; Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA, 94305-5101, USA.
| | - Mikkel Faurschou
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Blegdamsvej 9, 2100, København, Denmark.
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Blegdamsvej 9, 2100, København, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Nørregade 10, 1165, København, Denmark.
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18
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Adamichou C, Genitsaridi I, Nikolopoulos D, Nikoloudaki M, Repa A, Bortoluzzi A, Fanouriakis A, Sidiropoulos P, Boumpas DT, Bertsias GK. Lupus or not? SLE Risk Probability Index (SLERPI): a simple, clinician-friendly machine learning-based model to assist the diagnosis of systemic lupus erythematosus. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2020-219069
expr 893510318 + 842823336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
ObjectivesDiagnostic reasoning in systemic lupus erythematosus (SLE) is a complex process reflecting the probability of disease at a given timepoint against competing diagnoses. We applied machine learning in well-characterised patient data sets to develop an algorithm that can aid SLE diagnosis.MethodsFrom a discovery cohort of randomly selected 802 adults with SLE or control rheumatologic diseases, clinically selected panels of deconvoluted classification criteria and non-criteria features were analysed. Feature selection and model construction were done with Random Forests and Least Absolute Shrinkage and Selection Operator-logistic regression (LASSO-LR). The best model in 10-fold cross-validation was tested in a validation cohort (512 SLE, 143 disease controls).ResultsA novel LASSO-LR model had the best performance and included 14 variably weighed features with thrombocytopenia/haemolytic anaemia, malar/maculopapular rash, proteinuria, low C3 and C4, antinuclear antibodies (ANA) and immunologic disorder being the strongest SLE predictors. Our model produced SLE risk probabilities (depending on the combination of features) correlating positively with disease severity and organ damage, and allowing the unbiased classification of a validation cohort into diagnostic certainty levels (unlikely, possible, likely, definitive SLE) based on the likelihood of SLE against other diagnoses. Operating the model as binary (lupus/not-lupus), we noted excellent accuracy (94.8%) for identifying SLE, and high sensitivity for early disease (93.8%), nephritis (97.9%), neuropsychiatric (91.8%) and severe lupus requiring immunosuppressives/biologics (96.4%). This was converted into a scoring system, whereby a score >7 has 94.2% accuracy.ConclusionsWe have developed and validated an accurate, clinician-friendly algorithm based on classical disease features for early SLE diagnosis and treatment to improve patient outcomes.
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19
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Nimesh S, Ahmad MI, Dhama S, Kumar P, Akram M, Hasaroeih NEN. Systemic Lupus Erythematosus Disease: An Overview of the Clinical Approach to Pathogenesis, Diagnosis, and Treatment. BORNEO JOURNAL OF PHARMACY 2021. [DOI: 10.33084/bjop.v4i2.1950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The systemic lupus erythematosus (SLE), commonly known as Lupus, is a rare and complex multisystem autoimmune disease where one’s immune system is overactive, and the body attacks its organ systems. SLE is a historically old disease described already in antiquity; it is an example of a chronic disease with physical, psychological, financial, and social implications for individuals diagnosed. It has inspired medical and basic biological scientists that focus on molecular biology, basic immunology, immunopathology, clinical science, genetics, and epidemiology. The syndrome is real in its existence-although hidden behind obstacles, cumbersome for patients and clinicians, and rebellious for scientists. There is currently no cure for SLE. The goal of treatment is to ease symptoms. This article will review information on the general approach to SLE therapy, focusing on currently approved therapies and novel approaches that might be used in the future.
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20
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Lee JS, Lee EJ, Yeom J, Oh JS, Hong S, Lee CK, Yoo B, Kim K, Kim YG. Urine β-2-glycoprotein 1 as a biomarker for diagnosis of systemic lupus erythematosus. Lupus 2021; 30:1306-1313. [PMID: 33966541 DOI: 10.1177/09612033211014268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The need for a biomarker with robust sensitivity and specificity in diagnosing systemic lupus erythematosus (SLE) remains unmet. Compared with blood samples, urine samples are more easily collected; thus, we aimed to identify such a biomarker based on urinary proteomics which could distinguish patients with SLE from healthy controls (HCs). METHODS Urine samples were collected from 76 SLE patients who visited rheumatology clinic in 2019 at Asan medical center and from 25 HCs. Urine proteins were analyzed using sequential windowed acquisition of all theoretical fragment ion spectra-mass spectrometry, and the candidate marker was confirmed by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic curve analysis was used to determine the diagnostic value of the candidate biomarker. RESULTS Of 1157 proteins quantified, 153 were differentially expressed in urine samples from HCs. Among them were previously known markers including α-1-acid glycoprotein 1, α-2-HS-glycoprotein, ceruloplasmin, and prostaglandin-H2 D-isomerase. Moreover, the amount of β-2 glycoprotein (APOH) was increased in the urine of patients with SLE. The ELISA results also showed the level of urine APOH was higher in patients with SLE than in HCs and patients with rheumatoid arthritis. Moreover, the level was not different between SLE patients with and without nephritis. The urine APOH had an area under the curve value of 0.946 at a cut-off value of 228.53 ng/mg (sensitivity 91.5%, specificity 92.0%) for the diagnosis of SLE. CONCLUSION The results indicate that the urine APOH level can be an appropriate screening tool in a clinical setting when SLE is suspected.
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Affiliation(s)
- Jung Sun Lee
- Department of Internal Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Eun-Ju Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeonghun Yeom
- Clinical Proteomics Core Laboratory, Convergence Medicine Research Center, Asan Medical Center, Seoul, Korea
| | - Ji Seon Oh
- Department of Information Medicine, Asan Medical Center, Seoul, Korea
| | - Seokchan Hong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Keun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bin Yoo
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyunggon Kim
- Clinical Proteomics Core Laboratory, Convergence Medicine Research Center, Asan Medical Center, Seoul, Korea
| | - Yong-Gil Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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21
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Chang A, Winquist NW, Wescott AB, Lattie EG, Graham AK. Systematic review of digital and non-digital non-pharmacological interventions that target quality of life and psychological outcomes in adults with systemic lupus erythematosus. Lupus 2021; 30:1058-1077. [PMID: 33779388 DOI: 10.1177/09612033211005085] [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] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with systemic lupus erythematous (SLE) experience psychological comorbidities and impaired quality of life (QOL). We conducted a systematic review to examine the efficacy of non-pharmacological interventions for improving psychological outcomes and/or QOL in patients with SLE. To expand on a previous systematic review in this area and enhance our understanding of efficacious interventions for this population, our search included quasi-experimental and experimental studies of interventions delivered or supported by remote methods (including digitally) or in person. METHODS A comprehensive literature search was conducted with a research librarian using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered before data extraction on the international prospective register of systematic reviews PROSPERO Web site (CRD42020154962). The search included controlled-vocabulary and title/abstract terms related to non-pharmacological interventions for SLE published through October 2019 in MEDLINE (Ovid), Cochrane Library databases (Wiley), Embase (Elsevier), CINAHL (EBSCO), PsycINFO (EBSCO), Web of Science (Clarivate), ACM Digital (Association of Computer Machinery), and IEEE Xplore. Studies were synthesized using a systematic narrative synthesis framework. Risk of bias was assessed. RESULTS Twenty-three studies were included: 21 randomized controlled trials and two quasi-experimental studies. Non-pharmacological diet, physical activity, psychological, and course-based interventions improved QOL and psychological outcomes, and were delivered in traditional settings (e.g., hospital) or remotely. No studies assessing digital non-pharmacological interventions were identified in our search. Quality assessments showed serious risk of bias for the two quasi-experimental studies, and high risk of bias in a subset of experimental studies. CONCLUSIONS Non-pharmacological interventions benefit patients with SLE. Future research should include more representative samples in rigorous evaluations and consider ways to incorporate digital technologies to increase accessibility.
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Affiliation(s)
- Angela Chang
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathan W Winquist
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annie B Wescott
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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22
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Tan QEC, Gao X, Ang WHD, Lau Y. Medication adherence: a qualitative exploration of the experiences of adolescents with systemic lupus erythematosus. Clin Rheumatol 2021; 40:2717-2725. [PMID: 33566194 DOI: 10.1007/s10067-021-05583-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/13/2020] [Accepted: 01/10/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/OBJECTIVE There are increasing numbers of children diagnosed with systemic lupus erythematosus (SLE). Given the chronicity of the disease, individuals are confronted with cocktails of medications for an extended period. The present study explores experiences in medication adherence among adolescents with SLE in an acute care hospital. METHOD A descriptive qualitative design was employed. Fourteen adolescents with SLE were purposively selected. Face-to-face audio-recorded semi-structured interviews were conducted. Field notes and reflexive journals were maintained, and frequent debriefing sessions were performed to ensure the study's methodological rigour. Interviews were transcribed verbatim and thematic analyses were used. Constant comparative analysis was used to identify similarities and differences among the participants. RESULTS Four themes emerged from interviews: (1) making sense of the treatment; (2) contending with side effects of medications; (3) maintaining networks of support; and (4) creating a new normal. The participants were motivated to adhere to medications when they developed awareness, received social support from family and friends and created routines for new normal when confronted with their diseases. However, some attributed a lack of parental support, poor doctor-patient relationships and the large numbers of medications as deterrence to medication adherence. CONCLUSIONS This study highlights various medication-taking motivators and deterrents. Interdependent relationships between motivators and deterrents determine medication-taking behaviours. Findings from this multi-ethnic group of individuals of various ages and religious faith across the disease trajectory provide a deep insight into adolescents' experiences of medication adherence. This can contribute to the development of unique interventions for such individuals. Key points • Adolescents with systemic lupus erythematosus struggle with conforming to cocktails of medications. • A variety of factors either facilitate or impede their decisions to adhere to medication regimes. • Results suggest that tackling medication adherence among adolescents requires a multi-pronged approach from individual, familial and medical perspectives.
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Affiliation(s)
- Qiu Er Clarice Tan
- Department of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Xiaocong Gao
- Department of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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23
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Adamichou C, Genitsaridi I, Nikolopoulos D, Nikoloudaki M, Repa A, Bortoluzzi A, Fanouriakis A, Sidiropoulos P, Boumpas DT, Bertsias GK. Lupus or not? SLE Risk Probability Index (SLERPI): a simple, clinician-friendly machine learning-based model to assist the diagnosis of systemic lupus erythematosus. Ann Rheum Dis 2021; 80:758-766. [PMID: 33568388 PMCID: PMC8142436 DOI: 10.1136/annrheumdis-2020-219069] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/23/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Diagnostic reasoning in systemic lupus erythematosus (SLE) is a complex process reflecting the probability of disease at a given timepoint against competing diagnoses. We applied machine learning in well-characterised patient data sets to develop an algorithm that can aid SLE diagnosis. METHODS From a discovery cohort of randomly selected 802 adults with SLE or control rheumatologic diseases, clinically selected panels of deconvoluted classification criteria and non-criteria features were analysed. Feature selection and model construction were done with Random Forests and Least Absolute Shrinkage and Selection Operator-logistic regression (LASSO-LR). The best model in 10-fold cross-validation was tested in a validation cohort (512 SLE, 143 disease controls). RESULTS A novel LASSO-LR model had the best performance and included 14 variably weighed features with thrombocytopenia/haemolytic anaemia, malar/maculopapular rash, proteinuria, low C3 and C4, antinuclear antibodies (ANA) and immunologic disorder being the strongest SLE predictors. Our model produced SLE risk probabilities (depending on the combination of features) correlating positively with disease severity and organ damage, and allowing the unbiased classification of a validation cohort into diagnostic certainty levels (unlikely, possible, likely, definitive SLE) based on the likelihood of SLE against other diagnoses. Operating the model as binary (lupus/not-lupus), we noted excellent accuracy (94.8%) for identifying SLE, and high sensitivity for early disease (93.8%), nephritis (97.9%), neuropsychiatric (91.8%) and severe lupus requiring immunosuppressives/biologics (96.4%). This was converted into a scoring system, whereby a score >7 has 94.2% accuracy. CONCLUSIONS We have developed and validated an accurate, clinician-friendly algorithm based on classical disease features for early SLE diagnosis and treatment to improve patient outcomes.
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Affiliation(s)
- Christina Adamichou
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Irini Genitsaridi
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Dionysis Nikolopoulos
- Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Myrto Nikoloudaki
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Argyro Repa
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Alessandra Bortoluzzi
- Section of Rheumatology, Department of Medical Sciences, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
| | - Antonis Fanouriakis
- Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Rheumatology, "Asklepieion" General Hospital, Athens, Greece
| | - Prodromos Sidiropoulos
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Crete, Greece.,Institute of Molecular Biology and Biotechnology, Foundation of Research and Technology-Hellas, Heraklion, Crete, Greece
| | - Dimitrios T Boumpas
- Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, 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, Attica, Greece
| | - George K Bertsias
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Crete, Greece .,Institute of Molecular Biology and Biotechnology, Foundation of Research and Technology-Hellas, Heraklion, Crete, Greece
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Tummala R, Abreu G, Pineda L, Michaels MA, Kalyani RN, Furie RA, Morand EF. Safety profile of anifrolumab in patients with active SLE: an integrated analysis of phase II and III trials. Lupus Sci Med 2021; 8:e000464. [PMID: 33597205 PMCID: PMC7893670 DOI: 10.1136/lupus-2020-000464] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In phase II and III trials, anifrolumab, a human monoclonal antibody that binds type I interferon receptor subunit 1, has shown efficacy in adults with moderate to severe SLE. We evaluated the safety and tolerability of anifrolumab using data pooled from these trials to more precisely estimate the rate and severity of adverse events (AEs). METHODS Data were pooled from patients receiving monthly intravenous anifrolumab 300 mg or placebo in MUSE, TULIP-1 and TULIP-2. Key safety endpoints included percentages and exposure-adjusted incidence rates (EAIRs) of patients who experienced AEs, serious AEs (SAEs), AEs leading to discontinuation and AEs of special interest. RESULTS During treatment, 86.9% of patients receiving anifrolumab 300 mg (n=459) experienced AEs (≥1) versus 79.4% receiving placebo (n=466), and 4.1% versus 5.2% experienced an AE leading to discontinuation of investigational product. SAEs (≥1) were experienced by 11.8% and 16.7% of patients receiving anifrolumab and placebo, respectively (EAIR risk difference (95% CI) -7.2 (-12.5 to -1.9)), including lupus exacerbations classified as SAEs (1.5% and 3%, respectively). Infections occurred in 69.7% and 55.4% of patients receiving anifrolumab and placebo, respectively; difference in reported rates was driven by herpes zoster (HZ) and mild and moderate respiratory (excluding pneumonia) infections. The risk of HZ was increased with anifrolumab versus placebo (6.1% vs 1.3%, respectively; EAIR risk difference (95% CI) 5.4 (2.8 to 8.4)); most HZ events were mild or moderate, cutaneous and resolved without treatment discontinuation. Serious infections occurred in 4.8% and 5.6% of patients receiving anifrolumab and placebo, respectively. CONCLUSIONS In this pooled analysis of 925 patients with moderate to severe SLE, monthly intravenous anifrolumab 300 mg was generally well tolerated over 52 weeks with an acceptable safety profile. Anifrolumab was associated with an increased incidence of HZ and respiratory tract infections and lower reported rate of SLE worsening as SAEs.
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Affiliation(s)
- Raj Tummala
- Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Gabriel Abreu
- BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Lilia Pineda
- Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - M Alex Michaels
- Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Rubana N Kalyani
- Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Richard A Furie
- Division of Rheumatology, Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Eric F Morand
- Centre for Inflammatory Disease, Monash University, Melbourne, Victoria, Australia
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Hikmah Z, Endaryanto A, Gede Ugrasena ID. Systemic lupus erythematosus organ manifestation and disease activity in children based on Mexican systemic lupus erythematosus disease activity index score at East Java, Indonesia. INDIAN JOURNAL OF RHEUMATOLOGY 2021. [DOI: 10.4103/injr.injr_76_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Piedra-Quintero ZL, Wilson Z, Nava P, Guerau-de-Arellano M. CD38: An Immunomodulatory Molecule in Inflammation and Autoimmunity. Front Immunol 2020; 11:597959. [PMID: 33329591 PMCID: PMC7734206 DOI: 10.3389/fimmu.2020.597959] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022] Open
Abstract
CD38 is a molecule that can act as an enzyme, with NAD-depleting and intracellular signaling activity, or as a receptor with adhesive functions. CD38 can be found expressed either on the cell surface, where it may face the extracellular milieu or the cytosol, or in intracellular compartments, such as endoplasmic reticulum, nuclear membrane, and mitochondria. The main expression of CD38 is observed in hematopoietic cells, with some cell-type specific differences between mouse and human. The role of CD38 in immune cells ranges from modulating cell differentiation to effector functions during inflammation, where CD38 may regulate cell recruitment, cytokine release, and NAD availability. In line with a role in inflammation, CD38 appears to also play a critical role in inflammatory processes during autoimmunity, although whether CD38 has pathogenic or regulatory effects varies depending on the disease, immune cell, or animal model analyzed. Given the complexity of the physiology of CD38 it has been difficult to completely understand the biology of this molecule during autoimmune inflammation. In this review, we analyze current knowledge and controversies regarding the role of CD38 during inflammation and autoimmunity and novel molecular tools that may clarify current gaps in the field.
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Affiliation(s)
- Zayda L. Piedra-Quintero
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, College of Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Zachary Wilson
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, College of Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- Biomedical Science Undergraduate Program, College of Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Porfirio Nava
- Departamento de Fisiología, Biofísica y Neurociencias, Centro de Investigación y de Estudios Avanzados (CINVESTAV), México City, México
| | - Mireia Guerau-de-Arellano
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, College of Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, OH, United States
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, United States
- Department of Neuroscience, The Ohio State University, Columbus, OH, United States
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Hovde AM, McFarland CA, Garcia GM, Gallagher F, Gewanter H, Klein-Gitelman M, Moorthy LN. Multi-pronged approach to enhance education of children and adolescents with lupus, caregivers, and healthcare providers in New Jersey: Needs assessment, evaluation, and development of educational materials. Lupus 2020; 30:86-95. [PMID: 33210558 DOI: 10.1177/0961203320969975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Childhood Systemic Lupus Erythematosus (cSLE) patients are younger at diagnosis and have a more severe disease course compared to adult onset SLE patients and develop significant complications related to disease and or immunosuppression. Moreover, female and minority populations experience higher rates of cSLE, with African American, Afro-Caribbean, and Hispanic populations being at greatest risk and having poor prognosis. METHODS The Pediatric Alliance for Lupus initiative addressed the dearth in education and resources in a multi-stage process. First, we conducted a need assessment identifying knowledge gaps among healthcare providers (HCPs), and resources needed to care for cSLE patients and their families. Second, we educated HCPs about the diagnosis and treatment of cSLE by Continuing Medical Education (CME) sessions/webinars (presented here). Third, HCPs participated in a Quality Improvement (QI) program on cSLE approved by the American Board of Pediatrics Maintenance of Certification Part 4. Finally, patients and caregivers were educated through the development of appropriate, culturally and linguistically sensitive cSLE resources. PAL disseminated materials among HCPs and the community to improve the awareness of the availability of these materials. RESULTS According to results from the statewide needs assessment (representative of every county throughout NJ), HCPs face significant challenges in providing care to cSLE patients and their families, in part due to the multi-systemic nature of the autoimmune disease. CONCLUSION Based on this need, we developed educational sessions, with pre-post comparison data showing a significant increase in knowledge after HCP education. The 15 different materials developed as part of the endeavor is a major contribution to the cSLE community, HCPs and pediatric rheumatologists. Resources are available in multiple formats (PDF and web pages), and are accessible on the National Resource Center on Lupus, the latest web site of the Lupus Foundation of American that houses materials for SLE patients, their families, schools, HCPs, and the community at large.Improving cSLE knowledge will empower the children and adolescents and families by increasing their self-efficacy; and positively impact key health outcomes (transition readiness and HRQOL) that are not optimally addressed with current medical treatment alone.
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Affiliation(s)
- Aldina M Hovde
- New Jersey Chapter, American Academy of Pediatrics, East Windsor, USA
| | | | | | - Fran Gallagher
- New Jersey Chapter, American Academy of Pediatrics, East Windsor, USA
| | | | - Marisa Klein-Gitelman
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - L Nandini Moorthy
- Rutgers University/Robert Wood Johnson Medical School, New Brunswick, USA
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Eldeiry D, Zandy M, Tayer-Shifman OE, Kwan A, Marzouk S, Su J, Bingham K, Touma Z. Association between depression and anxiety with skin and musculoskeletal clinical phenotypes in systemic lupus erythematosus. Rheumatology (Oxford) 2020; 59:3211-3220. [DOI: 10.1093/rheumatology/keaa098] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Abstract
Objectives
To study the clinical phenotypes, determined based on cumulative disease activity manifestations, and sociodemographic factors associated with depression and anxiety in SLE.
Methods
Patients attending a single centre were assessed for depression and anxiety. SLE clinical phenotypes were based on the organ systems of cumulative 10-year SLE Disease Activity Index 2000 (SLEDAI-2K), prior to visit. Multivariable logistic regression analyses for depression, anxiety, and coexisting anxiety and depression were performed to study associated SLE clinical phenotypes and other factors.
Results
Among 341 patients, the prevalence of anxiety and depression was 34% and 27%, respectively, while 21% had coexisting anxiety and depression. Patients with skin involvement had significantly higher likelihood of anxiety compared with patients with no skin involvement [adjusted odds ratio (aOR) = 1.8; 95% CI: 1.1, 3.0]. Patients with skin involvement also had higher likelihood of having coexisting anxiety and depression (aOR = 2.0, 95% CI: 1.2, 3.9). Patients with musculoskeletal (MSK) (aOR = 1.9; 95% CI: 1.1, 3.5) and skin system (aOR = 1.8; 95% CI: 1.04, 3.2) involvement had higher likelihood of depression compared with patients without skin or musculoskeletal involvement. Employment status and fibromyalgia at the time of the visit, and inception status were significantly associated with anxiety, depression, and coexisting anxiety and depression, respectively.
Conclusion
SLE clinical phenotypes, specifically skin or MSK systems, along with fibromyalgia, employment and shorter disease duration were associated with anxiety or depression. Routine patient screening, especially among patients with shorter disease duration, for these associations may facilitate the diagnosis of these mental health disorders, and allow for more timely diagnosis.
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Affiliation(s)
- David Eldeiry
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Moe Zandy
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Oshrat E Tayer-Shifman
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Andrew Kwan
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | | | - Jiandong Su
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Kathleen Bingham
- Centre for Mental Health, Psychiatry Department, University Health Network, Toronto General Hospital
| | - Zahi Touma
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
- Institute of Health Policy, University of Toronto, Toronto, Ontario, Canada
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Radmanesh F, Mahmoudi M, Yazdanpanah E, Keyvani V, Kia N, Nikpoor AR, Zafari P, Esmaeili SA. The immunomodulatory effects of mesenchymal stromal cell-based therapy in human and animal models of systemic lupus erythematosus. IUBMB Life 2020; 72:2366-2381. [PMID: 33006813 DOI: 10.1002/iub.2387] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 12/17/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune inflammatory disease with no absolute cure. Although the exact etiopathogenesis of SLE is still enigmatic, it has been well demonstrated that a combination of genetic predisposition and environmental factors trigger a disturbance in immune responses and thereby participate in the development of this condition. Almost all available therapeutic strategies in SLE are primarily based on the administration of immunosuppressive drugs and are not curative. Mesenchymal stromal cells (MSCs) are a subset of non-hematopoietic adult stem cells that can be isolated from many adult tissues and are increasingly recognized as immune response modulating agents. MSC-mediated inhibition of immune responses is a complex mechanism that involves almost every aspect of the immune response. MSCs suppress the maturation of antigen-presenting cells (DC and MQ), proliferation of T cells (Th1, T17, and Th2), proliferation and immunoglobulin production of B cells, the cytotoxic activity of CTL and NK cells in addition to increasing regulatory cytokines (TGF-β and IL10), and decreasing inflammatory cytokines (IL17, INF-ϒ, TNF-α, and IL12) levels. MSCs have shown encouraging results in the treatment of several autoimmune diseases, in particular SLE. This report aims to review the beneficial and therapeutic properties of MSCs; it also focuses on the results of animal model studies, preclinical studies, and clinical trials of MSC therapy in SLE from the immunoregulatory aspect.
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Affiliation(s)
| | - Mahmoud Mahmoudi
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Esmaeil Yazdanpanah
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahideh Keyvani
- Molecular Genetics, Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Nadia Kia
- Skin Cancer Prevention Research Center, Torvergata University of Medical Sciences, Rome, Italy
| | - Amin Reza Nikpoor
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Parisa Zafari
- Department of Immunology, School of Medicine, Mazandaran University of Medical Science, Sari, Iran.,Student Research Committee, Mazandaran University of Medical Science, Sari, Iran
| | - Seyed-Alireza Esmaeili
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Genetic variants of microRNA-146a gene: an indicator of systemic lupus erythematosus susceptibility, lupus nephritis, and disease activity. Mol Biol Rep 2020; 47:7459-7466. [PMID: 32929657 DOI: 10.1007/s11033-020-05802-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022]
Abstract
Genetic variations of microRNA encoding genes influence various sorts of diseases by modifying the expression or activity of microRNAs. MicroRNA 146a is an epigenetic regulator of immune response through controlling the type I interferon (IFN) and nuclear factor kappa B (NF-κB) pathways. Genetic variations of microRNA 146a impact the susceptibility to systemic lupus erythematosus (SLE) and its clinical presentations. This study aimed to investigate the polymorphisms of microRNA-146a gene (rs2431697 and rs57095329) in patients with SLE and its association with disease activity. Sixty-five patients with SLE and 40 apparently healthy controls were enrolled in this study. Patients were subjected to history taking, clinical examination, and disease activity evaluation by SLEDAI score. The microRNA-146a variants were determined by allele discrimination real-time PCR method in all participants. We found a statistically significant association between rs2431697 T allele and SLE (P-value < 0.05), but there was no significant association between rs57095329 and SLE. The T/T genotype of microRNA-146a rs2431697 was associated with lupus nephritis, higher disease activity, and autoantibodies production. The microRNA-146a rs2431697 T allele could be a potential risk factor that contributes to SLE susceptibility, development of lupus nephritis, and disease activity.
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Firizal AS, Sugianli AK, Hamijoyo L. Cut off point of neutrophil-to-lymphocyte ratio as a marker of active disease in systemic lupus erythematosus. Lupus 2020; 29:1566-1570. [PMID: 32807022 DOI: 10.1177/0961203320950822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIM We aimed to measure sensitivity, specificity, and to determine the cut-off value (COV) ratio of neutrophil-to-lymphocyte (NLR) in patients with active systemic lupus erythematosus (SLE). METHODS A cross sectional study was conducted using the retrospective data from Hasan Sadikin Lupus Registry (HSLR). The inclusion criteria were SLE patients aged 18 years or older who had documented data of neutrophil, lymphocyte, and SLE disease activity index (SLEDAI). Patients with infections, malignancies, and other inflammatory diseases recorded in registry were excluded. SLEDAI with a score of ≤ 4 is considered inactive and score of > 4 is considered active. The neutrophil-to-lymphocyte ratio was calculated by dividing the absolute number of neutrophils by the absoulte number of lymphocytes. Receiver Operating Characteristic (ROC) curve was used to analyze and determine optimal COV of NLR. RESULTS The total sample in this study were 112 subjects with a dominant of female (95.54%) and the mean age of 34.45 ± 9.40 years. The median of SLEDAI was 4.5 with a range from 0 to 16, while the median of NLR was 2.68 with a range of 0.59 to 19.02. The ROC analysis showed the optimal cut-off in this study was 2.94 with sensitivity and specificity as high as 60.71% and 76.79%, respectively. CONCLUSION Neutrophil-to-lymphocyte ratio with cut off value of 2.94 can be used to determine active disease of systemic lupus eythematousus.
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Affiliation(s)
| | - Adhi Kristianto Sugianli
- Department of Clinical Pathology, Faculty of Medicine, University of Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Laniyati Hamijoyo
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, University of Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia.,Immunology Study Centre, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
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[Participatory research in the German Rheumatism League. Content implementation and practical realisation of participatory research in a patient organisation]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 155:64-70. [PMID: 32753283 DOI: 10.1016/j.zefq.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 01/05/2023]
Abstract
The German Rheumatism League ("Deutsche Rheuma-Liga") is the largest patient organisation in Germany, with about 300,000 members. In the sense of participatory research, the Deutsche Rheuma-Liga involves trained patient representatives in research projects funded by either the Deutsche Rheuma-Liga or other organisations. In order to invigorate the principle of participatory research in the field of rheumatology in Germany various measures have been undertaken: the principle of participatory research has been implemented as obligatory in the funding guidelines of the German Rheumatism League. A training course for German-speaking patients was created, and reference cards and an explanatory brochure were provided. In a letter campaign, about 70 universities and hospitals with rheumatology departments were contacted and informed about the benefits of participatory research. Since 2014, three training courses with 21 participants have been conducted. The trained patient representatives have participated in more than 30 projects up to the end of 2019. The overall experience of the patient representatives actively involved in research projects was mainly positive, and participatory research was perceived as being interesting and enriching. The implementation of participatory research in the German Rheumatism League can be described as successful. The article describes the measures taken to implement the principle of participatory research into the structures of the German Rheumatism League and summarises the experiences of patients and the patient organisation during five years of active participation in research projects.
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Pirri S, Lorenzoni V, Andreozzi G, Mosca M, Turchetti G. Topic Modeling and User Network Analysis on Twitter during World Lupus Awareness Day. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5440. [PMID: 32731600 PMCID: PMC7432829 DOI: 10.3390/ijerph17155440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
Twitter is increasingly used by individuals and organizations to broadcast their feelings and practices, providing access to samples of spontaneously expressed opinions on all sorts of themes. Social media offers an additional source of data to unlock information supporting new insights disclosures, particularly for public health purposes. Systemic lupus erythematosus (SLE) is a complex, systemic autoimmune disease that remains a major challenge in therapeutic diagnostic and treatment management. When supporting patients with such a complex disease, sharing information through social media can play an important role in creating better healthcare services. This study explores the nature of topics posted by users and organizations on Twitter during world Lupus day to extract latent topics that occur in tweet texts and to identify what information is most commonly discussed among users. We identified online influencers and opinion leaders who discussed different topics. During this analysis, we found two different types of influencers that employed different narratives about the communities they belong to. Therefore, this study identifies hidden information for healthcare decision-makers and provides a detailed model of the implications for healthcare organizations to detect, understand, and define hidden content behind large collections of text.
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Affiliation(s)
- Salvatore Pirri
- Institute of Management, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (V.L.); (G.A.); (G.T.)
| | - Valentina Lorenzoni
- Institute of Management, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (V.L.); (G.A.); (G.T.)
| | - Gianni Andreozzi
- Institute of Management, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (V.L.); (G.A.); (G.T.)
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Università di Pisa, 56126 Pisa, Italy;
| | - Giuseppe Turchetti
- Institute of Management, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (V.L.); (G.A.); (G.T.)
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Torricelli AK, Ugolini-Lopes MR, Bonfá E, Andrade D. Antiphospholipid syndrome damage index (DIAPS): distinct long-term kinetic in primary antiphospholipid syndrome and antiphospholipid syndrome related to systemic lupus erythematosus. Lupus 2020; 29:256-262. [PMID: 31986962 DOI: 10.1177/0961203320901598] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is an acquired thrombophilia that affects young productive individuals, with permanent damage and negative impact on quality of life. Recently, a damage index specific for APS (DIAPS) was developed. There are, however, no data regarding the comparison of its performance and long-term damage in primary antiphospholipid syndrome (PAPS) and APS related to systemic lupus erythematosus (SLE; APS + SLE). The primary purpose of this study was therefore to compare the long-term damage in patients with these conditions. METHODS This is a retrospective analysis of a single tertiary center cohort followed for approximately 10 years using a standardized prospective electronic chart database. Fifty consecutive PAPS patients age matched with 50 APS+SLE patients were consecutively selected for the study, and DIAPS was calculated once a year during follow-up. Long-term damage and damage kinetics in both groups were compared. RESULTS PAPS and APS + SLE had comparable age (47.10 ± 12.4 vs. 44.04 ± 10.80 years; p = 0.19) and time of follow-up (9.40 ± 3.60 vs. 10.94 ± 4.50 years; p = 0.06). At diagnosis, PAPS had higher DIAPS than APS + SLE (1.72 ± 1.17 vs. 0.82 ± 0.96; p < 0.001). At the end of the 10-year follow-up, both groups presented comparable mean damage scores (2.04 ± 1.50 vs. 2.24 ± 1.61; p = 0.52). The damage increment throughout the observation period for PAPS was solely 35%, whereas for APS + SLE it was gradual, persistent and reached 139% at the end of follow-up, with a total damage increment for PAPS lower than APS + SLE (0.43 ± 0.30 vs. 1.22 ± 1.24; p < 0.001). Of note, the frequency of individuals who acquired damage was lower in PAPS than in APS + SLE (32% vs. 71%; p < 0.001). PAPS also had a longer delay in diagnosis than APS + SLE (4.00 ± 4.20 vs. 2.54 ± 3.05 years; p = 0.04). This delay was positively correlated with a higher damage score at diagnosis (r = 0.36, p < 0.001) in all groups. CONCLUSION We identified a distinct pattern of damage in PAPS and APS related to SLE. Damage in PAPS is an early event, while APS+SLE is associated with higher long-term damage, with a striking increment of damage along the follow-up. A diagnosis delay is correlated with higher damage scores. Damage surveillance therefore requires different approaches for these two conditions.
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Affiliation(s)
- A Kuhl Torricelli
- Rheumatology Division - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - M Remião Ugolini-Lopes
- Rheumatology Division - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - E Bonfá
- Rheumatology Division - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - D Andrade
- Rheumatology Division - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
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James JA, Chen H, Young KA, Bemis EA, Seifert J, Bourn RL, Deane KD, Demoruelle MK, Feser M, O'Dell JR, Weisman MH, Keating RM, Gaffney PM, Kelly JA, Langefeld CD, Harley JB, Robinson W, Hafler DA, O'Connor KC, Buckner J, Guthridge JM, Norris JM, Holers VM. Latent autoimmunity across disease-specific boundaries in at-risk first-degree relatives of SLE and RA patients. EBioMedicine 2019; 42:76-85. [PMID: 30952617 PMCID: PMC6491794 DOI: 10.1016/j.ebiom.2019.03.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/15/2019] [Accepted: 03/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Autoimmune disease prevention requires tools to assess an individual's risk of developing a specific disease. One tool is disease-associated autoantibodies, which accumulate in an asymptomatic preclinical period. However, patients sometimes exhibit autoantibodies associated with a different disease classification. When and how these alternative autoantibodies first appear remain unknown. This cross-sectional study characterizes alternative autoimmunity, and associated genetic and environmental factors, in unaffected first-degree relatives (FDRs) of patients, who exhibit increased future risk for the same disease. METHODS Samples (n = 1321) from disease-specific autoantibody-positive (aAb+) systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and type 1 diabetes (T1D) patients; and unaffected aAb+ and autoantibody-negative (aAb-) SLE and RA FDRs were tested for SLE, RA, and T1D aAbs, as well as anti-tissue transglutaminase, anti-cardiolipin and anti-thyroperoxidase. FDR SLE and RA genetic risk scores (GRS) were calculated. FINDINGS Alternative autoimmunity occurred in SLE patients (56%) and FDRs (57·4%), RA patients (32·6%) and FDRs (34·8%), and T1D patients (43%). Expanded autoimmunity, defined as autoantibodies spanning at least two other diseases, occurred in 18·5% of SLE patients, 16·4% of SLE FDRs, 7·8% of RA patients, 5·3% of RA FDRs, and 10·8% of T1D patients. SLE FDRs were more likely to have alternative (odds ratio [OR] 2·44) and expanded (OR 3·27) autoimmunity than RA FDRs. Alternative and expanded autoimmunity were associated with several environmental exposures. Alternative autoimmunity was associated with a higher RA GRS in RA FDRs (OR 1·41), and a higher SLE GRS in aAb+ RA FDRs (OR 1·87), but not in SLE FDRs. INTERPRETATION Autoimmunity commonly crosses disease-specific boundaries in systemic (RA, SLE) and organ-specific (T1D) autoimmune diseases. Alternative autoimmunity is more common in SLE FDRs than RA FDRs, and is influenced by genetic and environmental factors. These findings have substantial implications for preclinical disease pathogenesis and autoimmune disease prevention studies. FUND: NIH U01AI101981, R01AR051394, U19AI082714, P30AR053483, P30GM103510, U54GM104938, U01AI101934, R01AI024717, U01AI130830, I01BX001834, & U01HG008666.
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Affiliation(s)
- Judith A James
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA; University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Hua Chen
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | | | | | - Rebecka L Bourn
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | | | | | | | | | | | | | | | | | - John B Harley
- Cincinnati Children's Hospital Medical Center, The University of Cincinnati College of Medicine, and Cincinnati US Department of Veterans Affairs VA Medical Center, Cincinnati, OH, USA
| | | | | | | | - Jane Buckner
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
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36
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Adawi M, Bragazzi NL, McGonagle D, Watad S, Mahroum N, Damiani G, Conic R, Bridgewood C, Mahagna H, Giacomelli L, Eggenhöffner R, Mahamid M, Pigatto PDM, Amital H, Watad A. Immunogenicity, safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis. Autoimmun Rev 2018; 18:73-92. [PMID: 30408581 DOI: 10.1016/j.autrev.2018.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 12/16/2022]
Abstract
The immunological perturbations associated with systemic lupus erythematosus (SLE) put many patients at a higher risk of infections, including pneumococcal pneumonia. However, the uptake and utility of anti-pneumococcal vaccines in SLE patient is both controversial and not completely agreed upon. Indeed, several epidemiological studies of anti-pneumococcal vaccine safety and efficacy in SLE have reported short-term immunogenicity with elevated anti-pneumococcal antibody titres but inconsistent long-term findings, with some studies finding poor responses, mainly for long-term immune protection. Moreover, the safety and efficacy of the pneumococcal vaccine in SLE patients remains controversial due to the different types of anti-pneumococcal vaccines, and the heterogeneity of SLE patients. Several reviews addressing anti-pneumococcal vaccination in SLE patients exist, however, to the best of our knowledge, the present is the first systematic review and meta-analysis. To better understand the efficacy and safety of pneumococcal vaccination in SLE, a comprehensive literature search was performed identifying 18 studies, which have been included in the present systematic review and meta-analysis. All studies were designed as longitudinal investigations, 2, in particular, were of high quality, being randomized, double-blind trials (RCTs). Four studies had control groups. Total sample size included 601 participants. Vaccine immunogenicity in terms of subjects with protective antibody titers ranged from 36% to 97.6%. According to our systematic review and metanalysis, high erythrocyte sedimentation rate (ESR), older age, earlier SLE onset, high disease activity, and immunosuppressive therapy were predictors of poor immunogenicity, although belimumab was found to have no significant impact. With regard to safety, no serious adverse events were found, with up to one third of cases reporting mild/low-grade complaints. In conclusion, due to the high risk of pneumococcal infection in SLE patients and given the safety and, at least partial, effectiveness, according to our systematic review and meta-analysis, in such patients, preventive strategies mainly by immunization, are required in all age groups and, in those needing immunosuppressive therapy, immunization should be given prior the initiation of the treatment. PROSPERO registration code CRD42018103605.
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Affiliation(s)
- Mohammad Adawi
- Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel; Padeh and Ziv Medical Centers, Zefat, Israel
| | - Nicola Luigi Bragazzi
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Dennis McGonagle
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Samaa Watad
- Department of Statistics and Operations Research, Tel Aviiv University, Tel Aviv, Israel
| | - Naim Mahroum
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Giovanni Damiani
- Young Dermatologists Italian Network (YDIN), GISED, Bergamo, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, Milano, Italy; Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopaedic Institute, University of Milan, 20126 Milan, Italy
| | - Rosalynn Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
| | - Charlie Bridgewood
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Hussein Mahagna
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Luca Giacomelli
- Dipartimento di Scienze chirurgiche e Diagnostiche Integrate (DISC) Università degli Studi di Genova, Genova, Italy
| | - Roberto Eggenhöffner
- Dipartimento di Scienze chirurgiche e Diagnostiche Integrate (DISC) Università degli Studi di Genova, Genova, Italy
| | - Mahmud Mahamid
- Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel; Endoscopy Unit of the Nazareth Hospital EMMS, Nazareth, Israel
| | - Paolo Daniele Maria Pigatto
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, Milano, Italy
| | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Abdulla Watad
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK; Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
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