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Harada T, Yamashita H, Nakajima S, Kobayashi T, Takahashi H, Kaneko H. Lupus nephritis prolongs improvement of serositis in systemic lupus erythematosus. Joint Bone Spine 2024; 91:105727. [PMID: 38582364 DOI: 10.1016/j.jbspin.2024.105727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/18/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Takuya Harada
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, 162-8655 Tokyo, Japan
| | - Hiroyuki Yamashita
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, 162-8655 Tokyo, Japan.
| | - Sotaro Nakajima
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, 162-8655 Tokyo, Japan
| | - Toshiaki Kobayashi
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, 162-8655 Tokyo, Japan
| | - Hiroyuki Takahashi
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, 162-8655 Tokyo, Japan
| | - Hiroshi Kaneko
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, 162-8655 Tokyo, Japan
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Amro AM, Deeb S, Rije R, Deeb N, Qunaibi YY, Amr B, Irzeqat K, Alhadad B, Emar A. Systemic Lupus Erythematosus Presenting as Cardiac Tamponade and Pleural Effusion: A Case Report. Cureus 2024; 16:e52894. [PMID: 38406136 PMCID: PMC10893996 DOI: 10.7759/cureus.52894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect the heart, lungs, and other organs. We describe the case of a 36-year-old female patient who first presented with non-specific symptoms before receiving a diagnosis of SLE, along with initial evidence of pleural effusion and cardiac tamponade. Heart tamponade, which is characterized by fluid accumulation in the pericardial space, is an unusual but serious side effect of SLE. Pleural effusion, or an accumulation of fluid in the pleural cavity, is a typical hallmark of SLE; however, it rarely manifests as the disease's initial symptom. The early identification and diagnosis of these cardiovascular symptoms of SLE is critical for timely intervention and improved patient outcomes. This case report highlights the significance of considering SLE when performing a differential diagnosis for patients who have cardiovascular symptoms, particularly when pleural effusion and cardiac tamponade are present. To increase awareness and knowledge of these uncommon presentations of SLE, more investigations and comprehension of the underlying pathophysiology are required.
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Affiliation(s)
| | - Salah Deeb
- College of Medicine, Al-Quds University, Hebron, PSE
| | - Rama Rije
- College of Medicine, Palestine Polytechnic University, Hebron, PSE
| | - Nour Deeb
- College of Medicine, Al-Quds University, Hebron, PSE
| | - Yaman Y Qunaibi
- College of Medicine, Palestine Polytechnic University, Hebron, PSE
| | - Bajis Amr
- Department of Cardiology, Al-Ahli Hospital, Hebron, PSE
| | | | - Baha Alhadad
- Department of Cardiology, Al-Ahli Hospital, Hebron, PSE
| | - Ahmad Emar
- Department of Cardiology, Al-Ahli Hospital, Hebron, PSE
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Khayata M, Wang TKM, Chan N, Alkharabsheh S, Verma BR, Oliveira GH, Klein AL, Littlejohn E, Xu B. Multimodality Cardiac Imaging in Patients with Systemic Lupus Erythematosus. Curr Probl Cardiol 2023; 48:101048. [PMID: 34774920 DOI: 10.1016/j.cpcardiol.2021.101048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/05/2021] [Indexed: 02/01/2023]
Abstract
Systemic lupus erythematous (SLE) is an autoimmune disease with a wide range of cardiovascular complications. The main manifestations include diseases of the coronary arteries, valves, pericardium, and myocardium. Multimodality cardiovascular imaging techniques are critical for evaluating the extent of cardiac manifestations in SLE patients, which can provide valuable prognostic information. However, their utility has previously not been well defined. This review provides a state-of-the-art update on the cardiovascular manifestations of lupus, as well as the role of multimodality cardiac imaging in guiding management of patients with SLE.
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Affiliation(s)
- Mohamed Khayata
- Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Tom Kai Ming Wang
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiovascular Imaging, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicholas Chan
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Saqer Alkharabsheh
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Beni R Verma
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Guilherme H Oliveira
- Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Allan L Klein
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiovascular Imaging, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emily Littlejohn
- Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Ohio, USA
| | - Bo Xu
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiovascular Imaging, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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4
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Chen YF, Hsieh MR, Chang CT, Tsai PH, Fang YF. Exploring the Risk Factors for Poor Survival in Lupus Pericarditis Patients: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11185473. [PMID: 36143120 PMCID: PMC9502775 DOI: 10.3390/jcm11185473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with systemic lupus erythematosus (SLE) have a higher risk of pericarditis, which could be fatal. The goal of this study was to identify the prognostic factors for mortality in patients with lupus pericarditis. Patients with lupus pericarditis treated at Chang Gung Memorial Hospital were included in this observational cohort study. This study conducted univariate and multivariate COX regression, as well as Kaplan−Meier survival curve analysis, to investigate mortality risk in SLE patients. The average age at admission was 40.78 ± 15.92 years. A total of 113 (16.4%) of the 689 patients had lupus pericarditis. Patients with lupus pericarditis exhibited older age, shorter follow-up, higher disease activities, and higher incidence rates of comorbidities than patients without pericarditis. Cox regression adjusted analysis indicated that lupus pericarditis (hazard ratio = 1.963, 95% CI = 1.315, 2.963, p = 0.001), old age at admission (HR = 1.053, 95% CI = 1.040, 1.065, p < 0.001), high SLEDAI score (HR = 1.079, 95% CI = 1.043, 1.116, p < 0.001), and end-stage kidney disease (ESKD) (HR = 2.533, 95% CI = 1.620, 3.961, p < 0.001) were all linked to increased mortality. Moreover, the Kaplan−Meier survival curve analysis revealed that patients with pericarditis compared to those without pericarditis had a higher mortality rate (log-rank test, p < 0.001). A high proportion of SLE patients have manifestations of lupus pericarditis. Moreover, patients with lupus pericarditis have a greater risk of mortality even if they have no pericardial tamponade. Therefore, these patients need prompt diagnosis and treatment.
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Affiliation(s)
- Yen-Fu Chen
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
| | - Meng-Ru Hsieh
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
| | - Che-Tzu Chang
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
| | - Ping-Han Tsai
- Division of Rheumatology, Allergy and Immunology, New Taipei Municipal TuCheng Hospital, New Taipei City 236, Taiwan
| | - Yao-Fan Fang
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
- Correspondence: ; Tel.: +886-3-3281200 (ext. 8812)
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Mosaad GM, Abdel moneam SM, Soliman AF, Ameen SG, Amer AS. Implication of plasma gelsolin in systemic lupus erythematosus patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-021-00103-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with more than one organ involvement. Kidney is the foremost commonly affected one. Gelsolin is a protein that induces depolymerization of actin filaments thus preventing downstream stimulation of inflammatory reactions. The aim of this work was to detect the relation of plasma gelsolin to SLE disease activity and severity indices in order to find out if plasma gelsolin could be used as a biomarker of the disease. This study was conducted on 50 SLE female patients and 30 matched control. SLE disease activity Index (SLEDAI) and SLE damage index (SDI) were assessed. All lupus nephritis (LN) patients were subjected to an ultrasound-guided kidney biopsy. Plasma gelsolin level was measured.
Results
The mean age of the patients was 38.5 ± 6.3 years (26–51 years) with median disease duration of 5 (3–9.3) years. Eighteen patients had LN, 11 had cardiac manifestations and 12 had chest manifestations. The mean SLEDAI was 13.1 ± 4.5 (4–22) and the median SDI was 2 (1–3). Plasma gelsolin level was significantly lower in SLE patients (74.9 mg/l; 57.5–98.8 mg/l) compared to control (801.5 mg/l; 225–1008.3 mg/l) (p < 0.001). There were significant negative correlations of gelsolin levels with anti-ds DNA (r = − 0.63, p < 0.001), SLEDAI (r = − 0.79, p < 0.001), and SDI (r = − 0.74, p = 0.001). Plasma gelsolin level was significantly lower in SLE patients with high/very high activity grades compared to those with low and moderate (p = 0.007 and p < 0.001 respectively). A gelsolin level of ≤ 78.95 mg/l significantly predicted renal affection (p < 0.001), with a sensitivity of 100%, specificity 71.9%, and a positive predictive value 66.7%.
Conclusion
A decreased gelsolin level is associated with disease activity in SLE patients. Plasma gelsolin was well related to disease activity and severity with a high predictive value for renal affection comparable to anti-ds DNA titre. Plasma gelsolin is a potentially important predictive biomarker for SLE and LN.
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Gimeno-Torres L, Carrión-Barberà I, Durán X, Villegas E, Monfort J, Salman-Monte TC. Prevalence and risk factors for serositis in patients with systemic lupus erythematosus: A case-control study. Lupus 2021; 30:2095-2101. [PMID: 34794346 DOI: 10.1177/09612033211049305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is an autoimmune multisystemic disease with a wide variety of clinical manifestations. One of its symptoms, associated to high morbidity, is serositis. Its prevalence ranges between 11% and 54%, and little is known about factors associated to this manifestation. The aim of this study is to determine the prevalence of serositis in SLE patients visited at the outpatient Lupus Unit of the Hospital del Mar and identify risk factors that can be used as predictors of this manifestation. METHODS A retrospective case-control study was performed based on the review of 297 medical records of SLE patients. Twenty-eight patients were identified to have suffered serositis (cases) and were age- and sex-matched with 2 controls with SLE without serositis. RESULTS The overall prevalence of serositis in our cohort was 9.42%, being higher in men than in women, 30% versus 7.9% (p = 0.001, 95% CI: 1.7-42.4%). In 40.7%, it was the first manifestation of the disease. When looking for serositis-associated factors, an association was found with anti-dsDNA antibodies measured by the Crithidia method (p = 0.016), and different measures of corticosteroids, where cases had required higher maximum doses and more pulses than controls throughout the disease, although this last correlation was lost when adjusting for confounding variables as nephritis and arthritis. Cases also received more mycophenolic acid (p = 0.021) and, marginally, more belimumab (p = 0.056). CONCLUSION The overall prevalence of serositis was 9.42%, being significantly higher in men (30%). Therefore, male gender constitutes a risk factor for serositis, and almost one third of men will develop this manifestation, so greater awareness is required in SLE men. CrithidiaDNA+ was also identified as a risk factor, and it should be determined in all SLE patients. Cases significantly received more corticosteroid pulses and higher maximum doses in relation to other SLE severe manifestations, which could imply a more aggressive form of SLE in patients with serositis.
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Affiliation(s)
- Laura Gimeno-Torres
- School of Medicine, Pompeu Fabra University-UPF, Barcelona, Spain.,Rheumatology Department, 16548Hospital del Mar/Parc de Salut Mar, Barcelona, Spain
| | | | - Xavier Durán
- Statistics Deparment, 16551Institut Hospital del Mar D'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Eduardo Villegas
- Immunology Department, 504927Laboratori de Referència de Catalunya SA, Barcelona, Spain
| | - Jordi Monfort
- Rheumatology Department, 16548Hospital del Mar/Parc de Salut Mar, Barcelona, Spain
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Abstract
Pericarditis is a common cardiac manifestation in systemic lupus erythematosus (SLE). Serositis is recognized in the ACR, SLICC, and EULAR/ACR classification criteria. We reviewed the prior research regarding the epidemiology, risk factors, presentation, and treatment of pericarditis in SLE.
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Affiliation(s)
- Eric Dein
- Rheumatology, Johns Hopkins Bayview Medical Center, Baltimore, USA
| | | | - Michelle Petri
- Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Genevieve Law
- Rheumatology, FETCH (For Everything That's Community Health) South Island, Victoria, CAN
| | - Homa Timlin
- Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA
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8
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Ryu S, Fu W, Petri MA. Associates and predictors of pleurisy or pericarditis in SLE. Lupus Sci Med 2017; 4:e000221. [PMID: 29118999 PMCID: PMC5663266 DOI: 10.1136/lupus-2017-000221] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/15/2017] [Accepted: 06/17/2017] [Indexed: 12/27/2022]
Abstract
Background/Purpose Serositis is one of both ACR and SLICC classification criteria for systemic lupus erythematosus (SLE) and a common type of extra renal flare. However, little is known about clinical or immunological associations of pleurisy or pericarditis. The aim of this study is to analyze associates and predictors of pleurisy versus pericarditis in Caucasians and African Americans with SLE. Methods 2,390 SLE patients in the Hopkins Lupus Cohort were analyzed for demographic, clinical and serologic associates of pleurisy or pericarditis, defined using the SELENA revision of the SLE Disease Activity Index (SLEDAI). The cross-sectional and prospective study using either univariate or multivariate analysis were performed to evaluate the associates of serositis in SLE. We reported associates with a p-value of less than 0.05 for pleurisy or pericarditis. Results 43% had pleurisy and 22% had pericarditis. African-American ethnicity was a predictive factor for new pericarditis. Hemolytic anemia, proteinuria, lymphadenopathy and anti-Sm were predictive only of pericarditis, whereas pulmonary fibrosis and GI infarction were predictive only of pleurisy. Fever, Raynaud’s syndrome, and anti-DNA were predictors for both pericarditis and pleurisy. Conclusion Our study provides further insights into the associates of pleurisy and pericarditis in SLE. Predictors of pleurisy and pericarditis are shown for the first time. The long term consequences from the cross-sectional analysis gives a lesson that serositis in SLE should not be considered benign.
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Affiliation(s)
- Seungwon Ryu
- Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Wei Fu
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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9
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Etiologies and Outcomes of Pleural Effusions in Patients With Systemic Lupus Erythematosus. J Clin Rheumatol 2014; 20:418-21. [DOI: 10.1097/rhu.0000000000000179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Gonçalves MJ, Sousa S, Inês LS, Duarte C, Borges J, Silva C, Romão VC, Terroso G, Bernardes M, Cerqueira M, Raposo A, Sequeira G, Barcelos A, Macieira C, Canas da Silva J, Costa L, Pereira da Silva JA, Cunha-Miranda L, Da Silva JAP, Canhão H, Santos MJ. Characterization of damage in Portuguese lupus patients: analysis of a national lupus registry. Lupus 2014; 24:256-62. [DOI: 10.1177/0961203314555172] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Although the survival rate has considerably improved, many patients with systemic lupus erythematosus (SLE) develop irreversible organ damage. Objectives: The objectives of this paper are to characterize cumulative damage in SLE patients and identify variables associated with its presence and severity. Methods: A cross-sectional analysis of SLE patients from the Portuguese Lupus register Reuma.pt/SLE in whom damage assessment using the SLICC/ACR-Disability Index (SDI) was available was performed. Predictor factors for damage, defined as SDI ≥ 1, were determined by logistic regression analyses. A sub-analysis of patients with severe damage (SDI ≥ 3) was also performed. Results: In total, 976 patients were included. SDI was ≥1 in 365 patients, of whom 89 had severe damage. Musculoskeletal (24.4%), neuropsychiatric (24.1%) and ocular (17.2%) domains were the most commonly affected. Older age, longer disease duration, renal involvement, presence of antiphospholipid antibodies and current therapy with steroids were independently associated with SDI ≥ 1. The subpopulation with severe damage had, in addition, a greater interval between the first manifestation attributable to SLE and the clinical diagnosis as well as and more frequently early retirement due to SLE. Conclusions: This large lupus cohort confirmed that demographic and clinical characteristics as well as medication are independently associated with damage. Additionally, premature retirement occurs more often in patients with SDI ≥ 3. Diagnosis delay might contribute to damage accrual.
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Affiliation(s)
- M J Gonçalves
- Hospital de Santa Maria, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
| | - S Sousa
- Hospital Garcia de Orta, Almada, Portugal
| | - L S Inês
- Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - C Duarte
- Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - J Borges
- Instituto Português de Reumatologia, Lisboa, Portugal
| | - C Silva
- Instituto Português de Reumatologia, Lisboa, Portugal
| | - V C Romão
- Hospital de Santa Maria, Lisboa, Portugal
- Hospital Garcia de Orta, Almada, Portugal
| | - G Terroso
- Hospital de São João, Porto, Portugal
| | | | - M Cerqueira
- Hospital Conde de Bertiandos, Ponte de Lima, Portugal
| | - A Raposo
- Hospital Conde de Bertiandos, Ponte de Lima, Portugal
| | | | | | - C Macieira
- Hospital de Santa Maria, Lisboa, Portugal
| | - J Canas da Silva
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
| | - L Costa
- Hospital de São João, Porto, Portugal
| | | | | | | | - H Canhão
- Hospital de Santa Maria, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
| | - M J Santos
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
- Hospital Garcia de Orta, Almada, Portugal
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Lutalo PMK, Jordan N, D'Cruz DP. Which dose of steroids and which cytotoxics for severe lupus? Presse Med 2014; 43:e157-65. [PMID: 24882275 DOI: 10.1016/j.lpm.2014.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/04/2014] [Indexed: 12/25/2022] Open
Abstract
There have been a number of major advances in the treatment of systemic lupus erythematosus and we are now in the era of biologic therapies for this multisystem autoimmune disorder. There has been a greater awareness of the toxicities of the traditional therapies including the recognition that the doses of corticosteroids used in the past have been excessive, resulting in unacceptable toxicities. Other advances have included the development of lower cumulative doses of cyclophosphamide and the widespread acceptance of mycophenolate mofetil for the treatment of lupus nephritis. This review addresses the current management of severe lupus with corticosteroids and cytotoxic agents.
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Affiliation(s)
- Pamela M K Lutalo
- Louise Coote Lupus Unit, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom; King's College School of Medicine, Peter Gorer Department of Immunobiology, 2nd Floor, Borough Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Natasha Jordan
- Louise Coote Lupus Unit, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom; Centre for Molecular and Cellular Biology of Inflammation King's College London - Guy's Campus New Hunt's House, 1st Floor, London SE1 1UL, United Kingdom
| | - David P D'Cruz
- Louise Coote Lupus Unit, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom. david.d'
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Bryson T, Sundaram B, Khanna D, Kazerooni EA. Connective tissue disease-associated interstitial pneumonia and idiopathic interstitial pneumonia: similarity and difference. Semin Ultrasound CT MR 2013; 35:29-38. [PMID: 24480141 DOI: 10.1053/j.sult.2013.10.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Interstitial lung diseases (ILDs) are increasingly recognized in patients with systemic diseases. Patients with early ILD changes may be asymptomatic. Features of ILD overlap among systemic diseases and with idiopathic variety. High-resolution computed tomography plays a central role in diagnosing ILDs. Imaging features are often nonspecific. Therapy- and complication-related lung changes would pose difficulty in diagnosing and classifying an ILD. Biology and prognosis of secondary ILDs may differ between different disease-related ILDs and idiopathic variety. Combination of clinical features, serological tests, pulmonary and extrapulmonary imaging findings, and pathology findings may help to diagnose ILDs.
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Affiliation(s)
- Thomas Bryson
- Department of Diagnostic Radiology, University of Michigan Health System, Ann Arbor, MI
| | - Baskaran Sundaram
- Department of Diagnostic Radiology, University of Michigan Health System, Ann Arbor, MI.
| | - Dinesh Khanna
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Ella A Kazerooni
- Department of Diagnostic Radiology, University of Michigan Health System, Ann Arbor, MI
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13
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Kvarnström M, Dzikaite-Ottosson V, Ottosson L, Gustafsson JT, Gunnarsson I, Svenungsson E, Wahren-Herlenius M. Autoantibodies to the functionally active RING-domain of Ro52/SSA are associated with disease activity in patients with lupus. Lupus 2013; 22:477-85. [PMID: 23554036 DOI: 10.1177/0961203313479420] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The Ro52 protein of the Ro/SSA antigen was recently defined as an E3 ligase controlling cytokine production. Autoantibodies from systemic lupus erythematosus (SLE) patients targeting the Ro52-RING domain, containing the E3 ligase activity, have been shown to inhibit the E3 ligase activity of Ro52. The objective of the present study was to investigate correlations between clinical parameters in patients with SLE and levels of Ro/SSA (Ro52 and Ro60) and La/SSB autoantibodies, including autoantibodies directed towards the functional RING and B-box domains of the Ro52 protein. SLE patients (n=232) were clinically examined and disease activity indices collected concurrently to blood sampling. The samples were analyzed for immunological parameters including autoantibodies. Ro52 autoantibody levels were associated with more variables than the other analyzed antibodies and were significantly associated with several individual items related to sSS and the diagnosis of sSS itself (p=0.004). Other associated variables were high sedimentation rate (p=0.0003), levels of immunoglobulins (p=0.0003), and an inverse correlation with levels of lymphocytes (p=0.003) and leukocytes (p=0.01). Antibodies to the RING domain of Ro52, which is the functionally active domain with E3 ligase activity, were significantly correlated with disease activity as measured by the SLAM score. We conclude that autoantibodies against Ro52 and in particular its functional RING domain are important in lupus patients and associated with several clinical and laboratory features of the disease. The impact on disease activity of Ro52-RING specific antibodies was especially noted, and could imply a functional role for these autoantibodies in inhibiting Ro52 activity, which is important for the control of proinflammatory cytokine production, including type 1 interferons.
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Affiliation(s)
- M Kvarnström
- Department of Medicine, Karolinska Institutet, Sweden
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14
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Feldman CH, Bermas BL, Zibit M, Fraser P, Todd DJ, Fortin PR, Massarotti E, Costenbader KH. Designing an intervention for women with systemic lupus erythematosus from medically underserved areas to improve care: a qualitative study. Lupus 2013; 22:52-62. [PMID: 23087258 PMCID: PMC3543784 DOI: 10.1177/0961203312463979] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (lupus) disproportionately affects women, racial/ethnic minorities and low-income populations. We held focus groups for women from medically underserved communities to discuss interventions to improve care. METHODS From our Lupus Registry, we invited 282 women, ≥18 years, residing in urban, medically underserved areas. Hospital-based clinics and support groups also recruited participants. Women were randomly assigned to three focus groups. Seventy-five-minute sessions were recorded, transcribed and coded thematically using interpretative phenomenologic analysis and single counting methods. We categorized interventions by benefits, limitations, target populations and implementation questions. RESULTS Twenty-nine women with lupus participated in three focus groups, (n = 9, 9, 11). 80% were African American and 83% were from medically underserved zip codes. Themes included the desire for lupus education, isolation at the time of diagnosis, emotional and physical barriers to care, and the need for assistance navigating the healthcare system. Twenty of 29 participants (69%) favored a peer support intervention; 17 (59%) also supported a lupus health passport. Newly diagnosed women were optimal intervention targets. Improvements in quality of life and mental health were proposed outcome measures. CONCLUSION Women with lupus from medically underserved areas have unique needs best addressed with an intervention designed through collaboration between community members and researchers.
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Affiliation(s)
- C H Feldman
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Allen D, Fischer A, Bshouty Z, Robinson DB, Peschken CA, Hitchon C, El-Gabalawy H, Meyers M, Mittoo S. Evaluating systemic lupus erythematosus patients for lung involvement. Lupus 2012; 21:1316-25. [DOI: 10.1177/0961203312454343] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: We set out to determine the frequency of respiratory symptoms, abnormal lung function, and shrinking lung syndrome (SLS) among patients with systemic lupus erythematosus (SLE) and to determine correlates of SLS. Methods: Consecutive adult patients who fulfilled the American College of Rheumatology classification criteria for SLE were enrolled. Demographics, clinical, and serologic characteristics were recorded; all patients underwent pulmonary function tests (PFT) and had either a chest X-ray or computed tomography scan. SLS was defined as dyspnea with restrictive lung physiology (defined as a forced vital capacity (FVC) <80% predicted in the absence of obstruction) who did not have any evidence of interstitial lung disease on chest imaging; controls were symptomatic patients with no restrictive physiology and the absence of interstitial changes on chest imaging. Results: Sixty-nine out of 110 (63%) patients had respiratory symptoms, 73 (66%) patients had abnormal lung function, and 11 (10%) patients met the definition for SLS. In a multivariate model controlling for disease duration, a history of pleuritis, modified American College of Rheumatology total score, seropositivity for dsDNA and RNP antibodies, increased disease duration (odds ratio (OR) = 1.2; 95% confidence interval (CI) of 1.0–1.3, p = 0.04), seropositivity for anti-RNP (OR = 24.4; 95% CI of 1.6–384.0, p = 0.02), and a history of serositis were significantly associated with SLS when compared with symptomatic controls. Conclusion: Respiratory symptoms, abnormal lung function, and SLS are common in SLE. Clinicians should consider evaluation for SLS among symptomatic patients with long-standing disease and a history of pleuritis.
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Affiliation(s)
- D Allen
- Department of Medicine, University of Manitoba, Canada
| | - A Fischer
- Autoimmune Lung Center, University of Colorado, USA
| | - Z Bshouty
- Department of Medicine, University of Manitoba, Canada
| | - DB Robinson
- Department of Rheumatology, University of Manitoba, Canada
| | - CA Peschken
- Department of Rheumatology, University of Manitoba, Canada
| | - C Hitchon
- Department of Rheumatology, University of Manitoba, Canada
| | - H El-Gabalawy
- Department of Rheumatology, University of Manitoba, Canada
| | - M Meyers
- Department of Radiology University of Manitoba, Canada
| | - S Mittoo
- Department of Rheumatology, University of Toronto, Canada
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