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Dey D, Paruk F, Mody GM, Kalla AA, Adebajo A, Akpabio A, Abu-Zaid MH, du Toit R, Ngandeu-Singwe M, Courage UU, Koussougbo OD, Migowa A, Moosajee F, Nomena RH, Olaosebikan HB, Palalane E, Lebughe PL, Sahli H, Cames LM, Mohamed D, Ndongo S, Idrissa C, Hmamouchi I. Women in rheumatology in Africa. Lancet Rheumatol 2022; 4:e657-e660. [PMID: 38265961 DOI: 10.1016/s2665-9913(22)00255-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 01/26/2024]
Affiliation(s)
- Dzifa Dey
- University of Ghana Medical School, Rheumatology Unit Department of Medicine and Therapeutics, Korle bu Teaching Hospital, Accra, Ghana.
| | - Farhanah Paruk
- Department of Rheumatology, Inkosi Albert Luthuli Central Hospital, School of Clinical Medicine, College of Health Science, University of Kwa-Zulu Natal, eThekwini, South Africa
| | - Girish M Mody
- Department of Rheumatology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Asgar A Kalla
- Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Akpabio Akpabio
- Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | | | - Riëtte du Toit
- DDivision of Rheumatology, Department of Medicine, Stellenbosch University, Tygerberg Academic Hospital, Stellenbosch, South Africa
| | - Madeleine Ngandeu-Singwe
- Rheumatology Unit, Department of Internal Medicine and sub Specialties Faculty of Medicine and Biomedical Sciences, The University of Yaoundé, Yaoundé, Cameroon
| | | | | | - Angela Migowa
- Department of Pediatrics and Child Health, Aga Khan University Medical College East Africa, Nairobi, Kenya
| | - Farzana Moosajee
- DDivision of Rheumatology, Department of Medicine, Stellenbosch University, Tygerberg Academic Hospital, Stellenbosch, South Africa
| | | | - Hakeem B Olaosebikan
- Lagos State University Teaching Hospital, Lagos State University College of Medicine, Ikeja, Nigeria
| | | | - Pierrot Litite Lebughe
- Department of Internal Medicine, Rheumatology unit, University of Kinshasa, University Hospital of Kinshasa, Kinshasha, DR Congo
| | - Hela Sahli
- Rabta Hospital, University Tunis El Manar, Tunis, Tunisia
| | - Landry Missounga Cames
- Department of Internal Medicine and Medical Specialties, CHU of Libreville, University of Health Sciences, Librevilla, Gabon
| | | | - Souhaibou Ndongo
- Faculty of Medicine of Cheikh Anta Diop University, Dakar, Senegal
| | - Cissé Idrissa
- Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | - Ihsane Hmamouchi
- Rheumatology Unit, Temara Hospital Center, Temara, Morocco; Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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du Toit R, Reuter H, Walzl G, Snyders C, Chegou NN, Herbst PG, Doubell AF. Serum cytokine levels associated with myocardial injury in systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:2010-2021. [PMID: 33221897 DOI: 10.1093/rheumatology/keaa540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/21/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To identify cytokines, markers of endothelial activation [soluble vascular cell adhesion molecule-1 (sVCAM-1)] and myocyte strain [soluble ST2 (sST2)] associated with myocardial injury (MInj) in SLE, classified by cardiac magnetic resonance (CMR) criteria. METHODS CMR was performed on patients with SLE, identifying stages of MInj (inflammation and necrosis or fibrosis). Data captured included: clinical assessment, laboratory and serological analyses, cytokine (IL-1β, IL-1Ra, IL-2, IL-6, IL-10, IL-17, IL-18, TNF-alpha), sVCAM-1 and sST2 levels. Cytokines were compared with regard to SLE features and evidence of CMR MInj. Predictors of CMR MInj were determined through regression analyses. RESULTS Forty-one patients with high disease activity (SLEDAI-2K: 13; IQR: 3-17) were included. SLE features included: LN (n = 12), neurolupus (n = 6) and clinical lupus myocarditis (LM) (n = 6). Nineteen patients had CMR evidence of MInj. Patients with a SLEDAI-2K ≥ 12 had higher sVCAM-1 (P = 0.010) and sST2 (P = 0.032) levels. Neurolupus was associated with higher IL-1Ra (P = 0.038) and LN with lower IL-1Ra (P = 0.025) and sVCAM-1 (P = 0.036) levels. Higher IL-1Ra (P = 0.012), IL-17 (P = 0.045), IL-18 (P = 0.003), and sVCAM-1 (P = 0.062) levels were observed in patients with CMR MInj compared with those without. On multivariable logistic regression, IL-1Ra predicted CMR inflammation and fibrosis/necrosis (P < 0.005) while anti-Ro/SSA [odds ratio (OR): 1.197; P = 0.035] and the SLE damage index (OR: 4.064; P = 0.011) predicted fibrosis/necrosis. CONCLUSION This is a novel description of associations between cytokines and SLE MInj. IL-18 and IL-1Ra were significantly higher in patients with MInj. IL-1Ra independently predicted different stages of CMR MInj. Exploration of the role of these cytokines in the pathogenesis of SLE MInj may promote targeted therapies for LM.
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Affiliation(s)
- Riëtte du Toit
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Helmuth Reuter
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.,Institute of Orthopaedics and Rheumatology, Stellenbosch, South Africa
| | - Gerhard Walzl
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, South Africa
| | - Candice Snyders
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, South Africa
| | - Novel N Chegou
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, South Africa
| | - Phillip G Herbst
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Anton F Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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du Toit R, Herbst PG, Ackerman C, Pecoraro AJ, du Toit RH, Hassan K, Joubert LLH, Reuter H, Doubell AF. Myocardial injury in systemic lupus erythematosus according to cardiac magnetic resonance tissue characterization: clinical and echocardiographic features. Lupus 2020; 29:1461-1468. [PMID: 32631204 DOI: 10.1177/0961203320936748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the prevalence of myocardial injury (MInj) in systemic lupus erythematosus (SLE) according to cardiac magnetic resonance (CMR) criteria. To compare clinical and echocardiographic features of patients with and without MInj and identify predictors of myocardial tissue characteristics according to CMR. METHODS SLE inpatients underwent CMR screening for MInj based on the Lake Louise Criteria (LLC). Tissue characteristics included inflammation (increased T2-weighted signal or early gadolinium enhancement ratio (EGEr)) and necrosis or fibrosis (late gadolinium enhancement (LGE)). Echocardiographic parameters included left (left ventricular ejection fraction (LVEF)) and right ventricular function (tricuspid annular plane systolic excursion (TAPSE)), global longitudinal strain (GLS), wall motion score (WMSi) and left ventricular internal diameter index (LVIDi). Variables were compared with regards to the presence/absence of CMR criteria. Logistic regression identified variables predictive of CMR tissue characteristics. RESULTS A hundred and six SLE patients were screened of whom 49 patients were included. Fifty-seven patients were excluded due to intolerance of or contraindication to CMR (27/57 due to renal impairment). Twenty-three patients had CMR evidence of MInj, of which 60.9% was subclinical. Inflammation occurred in 16/23 and necrosis/fibrosis in 12/23 patients. Patients with any evidence of MInj were more frequently anti-dsDNA positive (p = 0.026) and patients fulfilling LLC for myocarditis had higher SLE disease activity (p = 0.022). The LVIDi (p = 0.005), LVEF (p = 0.005) and TAPSE (p = 0.011) were more abnormal in patients with an increased EGEr, whereas WMSi (p = 0.002) and GLS (0.020) were more impaired in patients with LGE. On multivariable logistic regression analyses, TAPSE predicted inflammation (OR: 0.045, p = 0.006, CI: 0.005-0.415) and GLS predicted necrosis/fibrosis (OR: 1.329, p = 0.031, CI: 1.026-1.722). A model including lymphocyte count, TAPSE and LVIDi predicted an increased EGEr on CMR (receiver operating characteristic-curve analyses: area under the curve: 0.901, p < 0.001, sensitivity: 88.9%, specificity: 76.3%). CONCLUSIONS CMR evidence of MInj frequently occurs in SLE and is often subclinical. The utility of CMR in SLE is limited by a high exclusion rate, mainly due to renal involvement. Models including echocardiographic parameters (TAPSE, LVIDi and GLS) are predictive of CMR myocardial injury. Echocardiography can be used as a cost-effective screening tool with a high negative predictive value, in particular when CMR is contraindicated or unavailable.
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Affiliation(s)
- Riëtte du Toit
- Division of Rheumatology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Phillip G Herbst
- Division Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Christelle Ackerman
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Alfonso Jk Pecoraro
- Division Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Rudolf Hr du Toit
- Division Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Karim Hassan
- Division Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - LLoyd H Joubert
- Division Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Helmuth Reuter
- Division of Clinical Pharmacology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.,Institute of Orthopaedics and Rheumatology, Stellenbosch, South Africa
| | - Anton F Doubell
- Division Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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du Toit R, Whitelaw D, Taljaard JJ, du Plessis L, Esser M. Lack of specificity of anticyclic citrullinated peptide antibodies in advanced human immunodeficiency virus infection. J Rheumatol 2011; 38:1055-60. [PMID: 21324964 DOI: 10.3899/jrheum.100713] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the prevalence and specificity of anticyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) for rheumatoid arthritis (RA) in human immunodeficiency virus (HIV) infection and to evaluate the effect of immune reconstitution on these markers. METHODS Patients with advanced HIV infection without arthritis were enrolled. CD4+ T lymphocyte counts (CD4), anti-CCP, and RF were determined before initiating antiretroviral therapy (ART) and repeated after 6 months. Results were compared to those of healthy controls. Patients were followed for the development of RA for 1 year. RESULTS Sixty patients and 26 controls were studied. Six-month followup results were available on 49 patients. Mean (SD) levels of anti-CCP were higher in patients with HIV compared to controls: respectively, 9.50 (11.41) versus 0.80 (1.32) units (p < 0.001). Mean (SD) levels decreased to 4.85 (8.12) units (p = 0.006) after 6 months of ART (HIV-infected group). Fifteen percent of patients initially tested positive for anti-CCP, 4% after 6 months versus no controls (p = 0.031). Forty-seven percent of patients initially tested positive for RF, 18% after 6 months versus 8% of controls (p < 0.001). Decreases in RF and anti-CCP after ART were accompanied by increased mean (SD) CD4: from 129 (56) to 278 (140) cells/mm(3) (p < 0.001). Anti-CCP and RF positivity was not associated with the development of RA. CONCLUSION Increased titers of anti-CCP and RF occur in advanced HIV infection. Although more specific than RF, before immune reconstitution, anti-CCP is an unreliable diagnostic marker for RA and does not necessarily predict future RA. After immune reconstitution, the specificity of anti-CCP approaches that of a control group.
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Affiliation(s)
- Riëtte du Toit
- Division of Rheumatology, Department of Internal Medicine, PO Box 19063, Tygerberg Campus, Francie van Zijl Avenue, Bellville 7505, South Africa.
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