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Cheng J, Peng Y, Wu Q, Wu Q, He J, Yuan G. Efficacy and safety of telitacicept therapy in systemic lupus erythematosus with hematological involvement. Clin Rheumatol 2024:10.1007/s10067-024-06992-7. [PMID: 38767710 DOI: 10.1007/s10067-024-06992-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of telitacicept in SLE patients specifically with hematological involvement. METHOD A total of 22 patients with SLE and hematological involvement were included in this study. These patients received telitacicept in addition to standard therapy. We compared their demographic characteristics, clinical manifestations, and laboratory indicators before and after the administration of telitacicept. RESULTS A total of 22 patients received telitacicept treatment for a median duration of 10.4 months (ranging from 6 to 19 months). Following telitacicept therapy, significant improvements were observed in various parameters compared to baseline. Specifically, white blood cell count increased from (3.98 ± 1.80) 109/L to (6.70 ± 2.47) 109/L, (P = 0.002), hemoglobin levels increased from (100 ± 19) g/L to (125 ± 22) g/L, (P < 0.001), and platelet count increased from (83 ± 60) 109/L to (161 ± 81) 109/L, (P = 0.004). SLE Disease Activity Index (SLEDAI) scores decreased from 12(5,15) to 0(0,4), (P < 0.001). Additionally, C3 and C4 levels showed improvement. Telitacicept treatment also resulted in a significant reduction in serum IgG levels and daily prednisone dosage. Only one adverse event (4.5%) was reported during the treatment, which was a urinary tract infection. CONCLUSION The combination of telitacicept and standard treatment demonstrated significant improvements in anemia, as well as increased leukocyte and platelet levels in patients with SLE and hematological involvement. Importantly, the observed adverse events were manageable and controllable. Key Points • Telitacicept effectively improves anemia, clinical outcomes, and increases leukocyte and platelet counts. • Treatment with telitacicept leads to decreased levels of lgG, IgA, anti-dsDNA, and SLEDAI scores, while serum complement C3 and C4 returned to normal. • During the follow-up period there were observed changes in individual parameters, clinical symptoms, and organ involvement, all without significant adverse events.
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Affiliation(s)
- Jirong Cheng
- Department of Rheumatology and Immunology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Yuanhong Peng
- Jinan University, Guangzhou, China
- Department of Rheumatology and Immunology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Qiurong Wu
- Department of Rheumatology and Immunology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Qian Wu
- Department of Rheumatology and Immunology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Jing He
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South St., Beijing, 100044, China.
| | - Guohua Yuan
- Jinan University, Guangzhou, China.
- Department of Rheumatology and Immunology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
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Tsoi A, Nikolopoulos D, Parodis I. Advances in the pharmacological management of systemic lupus erythematosus. Expert Opin Pharmacother 2024:1-12. [PMID: 38756102 DOI: 10.1080/14656566.2024.2354457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/10/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Despite setbacks in clinical trials for systemic lupus erythematosus (SLE), three drugs have been approved for SLE and lupus nephritis (LN) treatment in the past decade. Several ongoing clinical trials, some viewed optimistically by the scientific community, underscore the evolving landscape. Emerging clinical data have established specific therapeutic targets in routine clinical practice for treating SLE, aiming to improve long-term outcomes. AREAS COVERED Research related to treatment of SLE and LN is discussed, focusing on randomized clinical trials during the last 5 years and recommendations for the management of SLE published by the European Alliance of Associations for Rheumatology (EULAR), American College of Rheumatology (ACR), Asia Pacific League of Associations for Rheumatology (APLAR), and Pan-American League of Associations of Rheumatology (PANLAR). EXPERT OPINION The landscape of SLE and LN treatments is evolving, as new drugs and combination treatment approaches redefine the traditional concepts of induction and maintenance treatment phases. As the therapeutic armamentarium in SLE continues to expand, the research focus is shifting from the imperative for new therapies to advancing our understanding of optimal treatment selection for individual patients, steering toward precision medicine strategies.
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Affiliation(s)
- Alexander Tsoi
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Dionysis Nikolopoulos
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Terminiello A, Marrani E, Pagnini I, Maccora I, Maniscalco V, Rumeileh SA, Mastrolia MV, Simonini G. Childhood mixed connective tissue disease at disease onset: Evidence from a systematic review. Autoimmun Rev 2024; 23:103513. [PMID: 38191065 DOI: 10.1016/j.autrev.2023.103513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/30/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Childhood Mixed Connective Tissue Disease (cMCTD) is the rarest pediatric connective tissue disease that includes features of systemic lupus erythematosus, polymyositis/dermatomyositis, juvenile idiopathic arthritis, and systemic sclerosis, identified by Sharp in 1972 and whose diagnosis remains challenging. This systematic review aims to identify clinical features at the onset of cMCTD and manifestations not currently included into the available diagnostic criteria. METHODS A systematic literature review was performed in accordance with PRISMA guidelines 2020 using bibliographic databases: MEDLINE via PubMed and EMBASE. ELIGIBILITY CRITERIA patients diagnosed with MCTD with onset before 18 years. STUDIES INCLUDED registries, retrospective and prospective cohort studies, case series and reports with analysis of data on signs and symptoms of presentation. RESULTS 39 articles were included (215 subjects, 82.5% female), mean age of 141 months (± 41 months DS, range 2.5-204). The most used criteria for the diagnosis of MCTD were the Kasukawa criteria (54.5%). The clinical manifestations described at onset were Raynaud's phenomenon (69.7%), arthritis (60.9%), muscular involvement (53.5%), dermatological signs (39.5%), swollen fingers or hands (29.3%), arthralgias (25.6%), fever (22.3%), lung involvement (14.4%), sclerodactily (13.5%), lymphadenopathy (10.7%) serositis (10.2%), esophageal involvement (6.9%), nervous system involvement (6.9%), xeroftalmia (3.7%), xerostomia (3.7%), hepatosplenomegaly (2.8%), cardiac involvement (2.8%), hepatitis (2.3%), parotiditis (2.3%), Hashimoto's thyroiditis (0.9%), ocular involvement (0.9%). CONCLUSIONS The data from this systematic review suggest great heterogeneity of the clinical presentation of cMCTD for which there are no validated diagnostic criteria that may suggest a new diagnostic approach to allow earlier or more accurate diagnosis in the future.
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Affiliation(s)
| | - Edoardo Marrani
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Ilaria Pagnini
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Ilaria Maccora
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy; NEUROFARBA Department, University of Florence, Florence, Italy
| | - Valerio Maniscalco
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Sarah Abu Rumeileh
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | - Gabriele Simonini
- Rheumatology Unit, ERN-ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy; NEUROFARBA Department, University of Florence, Florence, Italy
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Kumari S, Nath S, Narasimha VL, Sarkar M, Kumar R. Psychosis Unmasking a Diagnosis of Systemic Lupus Erythematosus: a Case Report. East Asian Arch Psychiatry 2023; 33:100-103. [PMID: 37771217 DOI: 10.12809/eaap2316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects multiple organs. Neuropsychiatric SLE (NPSLE) can manifest with a multitude of neurological and psychiatric symptoms. Psychosis is a rare NPSLE manifestation that can occur at any phase of the illness; 21% of SLE-related psychosis cases occur at the onset of SLE, but the evidence base for this is lacking. We report a case of acute-onset psychosis in a woman that led to a diagnosis of SLE, which was substantiated by physical evaluation and laboratory assessments. Assessment of acute-onset psychosis requires consideration of all differential diagnoses, especially in the presence of atypical features. This case also underscores the importance of physical examination and laboratory investigations in psychosis.
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Affiliation(s)
- S Kumari
- Department of Psychiatry, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - S Nath
- Department of Psychiatry, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - V L Narasimha
- Department of Psychiatry, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - M Sarkar
- Department of General Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - R Kumar
- Department of General Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
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Abstract
The immigration of people from other countries or even from other continents represents new challenges even for rheumatologists. Although all inflammatory rheumatic diseases that occur in this country also exist in the countries of origin of immigrants, the frequencies are different. Diseases such as familial Mediterranean fever (FMF) or Behçet syndrome (BS) are rare in western Europe but are often more frequent than rheumatoid arthritis (RA) and spondylarthritis (SPA) in North Africa and Mediterranean countries. Furthermore, FMF is associated with the occurrence of spondyloarthritis, which is then frequently negative for the human leucocyte antigen B27 (HLA-B27). There is also an association with BS. Rheumatic fever also still occurs relatively frequently especially in African countries, whereas it is almost eradicated in Europe. Possible differential diagnoses such as rheumatic symptoms in genetically determined anemia or infections such as human immunodeficiency virus (HIV) infections, hepatitis, tuberculosis and parasitosis need to be considered as they are all much more frequent in the countries of origin of immigrants than in northwestern Europe. Last but not least, the treatment situation with modern diagnostic and treatment modalities is different in the countries of origin of the migrants, either because these possibilities are unavailable due to limited resources or because the situation has dramatically deteriorated due to acute events, such as the recent war in Ukraine.
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Affiliation(s)
- Ina Kötter
- III. Medizinische Klinik, Sektion für Rheumatologie und Entzündliche Systemerkrankungen, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Oskar-Alexander Str. 26, 24576, Bad Bramstedt, Deutschland.
| | - Martin Krusche
- III. Medizinische Klinik, Sektion für Rheumatologie und Entzündliche Systemerkrankungen, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Teixeira Santos FPS, Ferreira GA, de Paula JJ, de Souza KCP, Cançado Silva SL, Correa H. Cognitive dysfunction in patients with childhood-onset systemic lupus erythematosus may impact treatment. Adv Rheumatol 2023; 63:18. [PMID: 37095585 DOI: 10.1186/s42358-023-00300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/07/2022] [Accepted: 04/12/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Cognitive dysfunction (CD) is a widespread manifestation in adult systemic lupus erythematosus (SLE) patients, but this subject is rarely examined in patients with childhood-onset SLE (cSLE). This study aimed to assess the frequency of CD, its associations with lupus clinical manifestations and its impact on the health-related quality of life (HRQL) in young adult cSLE patients. METHODS We evaluated 39 cSLE patients older than 18 years. They underwent a rheumatologic evaluation and extensive neuropsychological assessment, encompassing all cognitive domains described by the American College of Rheumatology. HRQL was assessed with the WHOOQOL-BREEF, General Activities of Daily Living Scale (GADL) and Systemic Lupus Erythematosus-specific quality-of-life instrument (SLEQOL). The activity of SLE was evaluated with the modified sle disease activity index (sledai-2k). RESULTS Impairment in at least one cognitive domain was found in 35 (87.2%) patients. The most compromised domains were attention (64.1%), memory (46.2%), and executive functions (38.5%). Patients with cognitive impairment were older, had more accumulated damage and had worse socioeconomic status. Regarding the association between cognitive dysfunction and HRQL, memory impairment was correlated with worse environmental perception and a worse relationship with the treatment. CONCLUSION In this study, the frequency of CD in cSLE patients was as high as that in the adult SLE population. CD can significantly impact the response of cSLE patients to treatment, justifying preventive measures in the care of this population.
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Affiliation(s)
- Flávia Patrícia Sena Teixeira Santos
- Post graduation Program in Molecular Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
- Division of Rheumatology, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Gilda Aparecida Ferreira
- Department of the Locomotor Apparatus, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Jonas Jadim de Paula
- Post graduation Program in Molecular Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Department of Psychology, Faculdade de Ciências Médicas de Minas Gerais, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Kalline Cristina Prata de Souza
- Post graduation Program in Molecular Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Sandro Luiz Cançado Silva
- Post graduation Program in Molecular Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Humberto Correa
- Post graduation Program in Molecular Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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7
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Weinmann-Menke J. [Lupus nephritis: from diagnosis to treatment]. Inn Med (Heidelb) 2023; 64:225-233. [PMID: 36763102 DOI: 10.1007/s00108-023-01489-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
Renal involvement in systemic lupus erythematosus (SLE), so-called lupus nephritis (LN), is one of the most frequent organ manifestations with an incidence of approximately 40-60%. It is not uncommon for renal involvement to be the initial manifestation of SLE or to occur in the first 5-10 years after diagnosis of SLE. Urinalysis is useful in screening for the presence of LN, demonstrating proteinuria or active sediment with acanthocytes. Histologic confirmation of LN, and thus the LN class present, is currently the gold standard for confirming the diagnosis. In addition, knowledge of the LN class is a relevant component of adequate treatment planning in SLE patients with LN. In particular, early diagnosis and rapid response to therapy are of prognostic importance for the preservation of renal function as well as morbidity and mortality of the mostly young patients at the time of initial diagnosis. Thus, the focus of therapy is to achieve complete remission, as well as to avoid active disease phases. Due to a complex pathogenesis and at the same time a very heterogeneous clinical presentation, with six different histological classes of LN, there are different therapeutic targets. This in turn results in a significant expansion of the study landscape in the field of LN with an increasing understanding of the signaling pathways and influencing factors, and fortunately in a growing armamentarium of available targeted therapy options. Simultaneously, new insights into drug therapy to inhibit progression of chronic renal disease are opening up supportive therapy options that can further improve preservation of renal function.
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Affiliation(s)
- Julia Weinmann-Menke
- I. Medizinische Klinik und Poliklinik, Schwerpunkt Nephrologie und Nierentransplantation, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
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Vale ECSD, Garcia LC. Cutaneous lupus erythematosus: a review of etiopathogenic, clinical, diagnostic and therapeutic aspects. An Bras Dermatol 2023; 98:355-372. [PMID: 36868923 PMCID: PMC10173173 DOI: 10.1016/j.abd.2022.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/27/2022] [Revised: 09/03/2022] [Accepted: 09/12/2022] [Indexed: 03/05/2023] Open
Abstract
Cutaneous lupus erythematosus is an autoimmune disease of varied clinical expression, which may present as an exclusively cutaneous disease or be one of the multiple manifestations of systemic lupus erythematosus. Its classification includes acute, subacute, intermittent, chronic and bullous subtypes, which are usually identified based on clinical features and histopathological and laboratory findings. Other non-specific cutaneous manifestations may be associated with systemic lupus erythematosus and are usually related to disease activity. Environmental, genetic and immunological factors play a role in the pathogenesis of skin lesions in lupus erythematosus. Recently, considerable progress has been made in elucidating the mechanisms involved in their development, which allows for foreseeing future targets for more effective treatments. This review proposes to discuss the main etiopathogenic, clinical, diagnostic and therapeutic aspects of cutaneous lupus erythematosus, aiming to update internists and specialists from different areas.
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Affiliation(s)
| | - Lucas Campos Garcia
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Huang SP, Guisinger A, Averell C, Bell CF, Rubin B. Clinical and Economic Burden of Systemic Lupus Erythematosus in the Years Preceding End-Stage Kidney Disease Diagnosis: A Retrospective Observational Study. Rheumatol Ther 2023. [PMID: 36738424 DOI: 10.1007/s40744-023-00532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION This study aimed to describe the clinical burden, healthcare resource utilisation (HCRU) and healthcare costs for patients with systemic lupus erythematosus (SLE) in the 12-60 months preceding an end-stage kidney disease (ESKD) diagnosis in the USA. METHODS This retrospective observational study identified adult patients with SLE with newly diagnosed ESKD between 1 March 2012 and 31 December 2018 using administrative claims data. Clinical characteristics, mean all-cause HCRU (i.e. any HCRU visit and pharmacy fill) and total all-cause healthcare costs (comprising medical and pharmacy costs in 2019 US dollars) were assessed during the 12 months pre-ESKD diagnosis and yearly during the 5 years pre-ESKD diagnosis among patients with ≥ 5 years of continuous health plan enrolment. RESULTS Of the 1356 patients included, 51.2% had severe SLE, 71.2% had lupus nephritis (LN) and 20.6% underwent kidney biopsy during the 12 months pre-ESKD. The mean (standard deviation [SD]) number of HCRU visits during the 12 months pre-ESKD was 78.0 (64.1) per patient. The mean (SD) total healthcare costs per patient in the 12 months pre-ESKD diagnosis was $64,887 (106,822), driven by medical costs $51,764 (96,458). The proportions of patients with severe SLE, LN and those undergoing biopsy increased from year 5 to year 1 pre-ESKD diagnosis. The mean (SD) number of HCRU visits increased from year 5 (61.6 [54.0]) to year 1 (83.2 [62.1]) pre-ESKD. Mean (SD) total healthcare costs rose year on year from year 5 ($34,890 [74,346]) to year 1 ($73,236 [114,584]) pre-ESKD. CONCLUSION There were substantial clinical burden and healthcare costs among patients with SLE in the 12 months pre-ESKD diagnosis. The clinical burden and healthcare costs generally increased with each year approaching ESKD diagnosis. Early interventions for patients with SLE could prevent the development of ESKD, mitigating the burden of the disease.
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Garcia LC, Morato IB, de Melo RFQ, Vale ECSD. Comedogenic lupus: a rare variant of chronic cutaneous lupus erythematosus - case series. An Bras Dermatol 2023; 98:159-167. [PMID: 36707354 PMCID: PMC9984717 DOI: 10.1016/j.abd.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Comedogenic lupus is an uncommon variant of cutaneous lupus, clinically characterized by the presence of comedones, papules and erythematous-infiltrated plaques, cysts and scars in photo-exposed areas, mimicking acne vulgaris and acneiform eruptions. OBJECTIVES To report clinicopathological characteristics of patients with comedogenic lupus in a tertiary dermatology service over a 15-year period and review cases described in the literature. METHODS Retrospective study of patients with clinical and histopathological diagnoses of comedogenic lupus between the years 2006 and 2021. The literature search was carried out in the PubMed and VHL Regional Portal databases, using the terms: "comedogenic lupus" and "acneiform lupus" in Portuguese and English. RESULTS Five patients were diagnosed during the described period, all female, with a mean age of 56.6 years. Smoking was observed in three cases, as well as pruritus. The most affected site was the face, especially the pre-auricular, malar and chin regions. Follicular plugs, epidermal thinning and liquefaction degeneration of the basal layer were predominant histopathological findings. Hydroxychloroquine was used as the first-line treatment; however, other medications were used, such as dapsone, methotrexate, tretinoin cream, and topical corticosteroids. The literature search identified 17 cases, with a mean age of 38.9 years, 82% of which were women. Only 23% had a diagnosis of systemic lupus erythematosus. Hydroxychloroquine was the most recommended systemic medication. STUDY LIMITATIONS Retrospective, single-center study. The literature search was carried out in two databases. CONCLUSIONS Dermatologists should be aware of acneiform conditions with poor response to the usual treatment. Early diagnosis and treatment reduce the risk of unaesthetic scars.
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Affiliation(s)
- Lucas Campos Garcia
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil,Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Isabela Boechat Morato
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Luo X, Piao S, Li H, Li Y, Xia W, Bao Y, Liu X, Geng D, Wu H, Yang L. Multi-lesion radiomics model for discrimination of relapsing-remitting multiple sclerosis and neuropsychiatric systemic lupus erythematosus. Eur Radiol 2022; 32:5700-5710. [PMID: 35243524 DOI: 10.1007/s00330-022-08653-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 09/08/2021] [Revised: 01/18/2022] [Accepted: 02/06/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To develop an MRI-based multi-lesion radiomics model for discrimination of relapsing-remitting multiple sclerosis (RRMS) and its mimicker neuropsychiatric systemic lupus erythematosus (NPSLE). METHODS A total of 112 patients with RRMS (n = 63) or NPSLE (n = 49) were assigned to training and test sets with a ratio of 3:1. All lesions across the whole brain were manually segmented on T2-weighted fluid-attenuated inversion recovery images. For each single lesion, 371 radiomics features were extracted and trained using machine learning algorithms, producing Radiomics Index for Lesion (RIL) for each lesion and a single-lesion radiomics model. Then, for each subject, single lesions were assigned to one of two disease courts based on their distance to decision threshold, and a Radiomics Index for Subject (RIS) was calculated as the mean RIL value of lesions on the higher-weighted court. Accordingly, a subject-level discrimination model was constructed and compared with performances of two radiologists. RESULTS The subject-based discrimination model satisfactorily differentiated RRMS and NPSLE in both training (AUC = 0.967, accuracy = 0.892, sensitivity = 0.917, and specificity = 0.872) and test sets (AUC = 0.962, accuracy = 0.931, sensitivity = 1.000, and specificity = 0.875), significantly better than the single-lesion radiomics method (training: p < 0.001; test: p = 0.001) Besides, the discrimination model significantly outperformed the senior radiologist in the training set (training: p = 0.018; test: p = 0.077) and the junior radiologist in both the training and test sets (training: p = 0.008; test: p = 0.023). CONCLUSIONS The multi-lesion radiomics model could effectively discriminate between RRMS and NPSLE, providing a supplementary tool for accurate differential diagnosis of the two diseases. KEY POINTS • Radiomic features of brain lesions in RRMS and NPSLE were different. • The multi-lesion radiomics model constructed using a merging strategy was comprehensively superior to the single-lesion-based model for discrimination of RRMS and NPSLE. • The RRMS-NPSLE discrimination model showed a significantly better performance or a trend toward significance than the radiologists.
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Affiliation(s)
- Xiao Luo
- Academy for Engineering and Technology, Fudan University, 220 Handan Road, Shanghai, 200433, China
| | - Sirong Piao
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Haiqing Li
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Wei Xia
- Academy for Engineering and Technology, Fudan University, 220 Handan Road, Shanghai, 200433, China
| | - Yifang Bao
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xueling Liu
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Daoying Geng
- Academy for Engineering and Technology, Fudan University, 220 Handan Road, Shanghai, 200433, China.,Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Hao Wu
- Department of Dermatology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.
| | - Liqin Yang
- Academy for Engineering and Technology, Fudan University, 220 Handan Road, Shanghai, 200433, China. .,Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China. .,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
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12
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Ghodsi S, Jenab Y, Mohebi M, Kamranzadeh H, Mohammadi Z. ST-Segment-Elevation Myocardial Infarction Unmasking Underlying Systemic Lupus Erythematosus or Representing Thrombotic Thrombocytopenic Purpura? Report of a Challenging Case. J Tehran Heart Cent 2022; 16:84-88. [PMID: 35082877 PMCID: PMC8742866 DOI: 10.18502/jthc.v16i2.7391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a multisystem disorder that frequently manifests itself with renal and neurological involvements. Cardiac involvement, however, has been rarely reported. In this report, we present a rare case of acquired TTP with acute myocardial infarction (AMI) as the initial manifestation. Although AMI was successfully managed by percutaneous coronary intervention, the patient developed hemolytic anemia, fever, marked thrombocytopenia, oliguria, and renal dysfunction, requiring treatment with plasma exchange and corticosteroids. TTP, albeit extremely rare, should be considered in cases with unexpected thrombocytopenia during acute-phase treatment for AMI as it can be highly lethal if not treated immediately.
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Affiliation(s)
- Saeed Ghodsi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Jenab
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Mohebi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosein Kamranzadeh
- Hematology-Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohre Mohammadi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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13
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Hellmich B, Henes JC. [Biologics for connective tissue diseases and vasculitides]. Internist (Berl) 2022; 63:143-154. [PMID: 35029701 DOI: 10.1007/s00108-021-01249-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 12/04/2022]
Abstract
Despite therapy with glucocorticoids (GC) and conventional immunosuppressants, patients with connective tissue diseases and vasculitides often develop functionally relevant and prognostically unfavourable internal organ damage. Based on new pathogenetic insights, biologics and small molecules have recently been studied as targeted therapies for collagen vascular diseases and vasculitides. The B lymphocyte stimulator antagonist belimumab has been used for the treatment of systemic lupus erythematosus (SLE) for several years and has recently also been approved as an add-on therapy for lupus nephritis. Anifrolumab, an antibody against the type‑1 interferon receptor, has also been shown to be effective in phase III trials for the treatment of SLE. The interleukin (IL)-6-antagonist tocilizumab showed efficacy in the treatment of interstitial lung disease (ILD) in systemic sclerosis (SSc) and thus has been approved in the USA, although the phase III trial had a negative primary endpoint. In Europe the tyrosine inhibitor nintedanib is approved for progressive ILD in SSc. Tocilizumab is approved for the treatment of giant cell arteritis and reduces both the risk of recurrence and the cumulative GC requirement. The B‑lymphocyte depleting antibody rituximab is approved for induction and maintenance therapy of granulomatosis with polyangiitis and microscopic polyangiitis (MPA) and is currently also being investigated for the treatment of eosinophilic granulomatosis with polyangiitis (EGPA). In patients with EGPA, the IL‑5 antibody mepolizumab leads to improved disease control and reduces GC requirements. A phase III trial of the small molecule antagonist avacopan targeting the complement C5a receptor as a replacement for high-dose GC in induction therapy of GPA and MPA met its primary endpoints. Various other biologics and small molecule antagonists are currently in clinical development for several type of vasculitis and collagen vascular diseases, some of them at advanced stages.
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Affiliation(s)
- Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, medius Kliniken, Akademisches Lehrkrankenhaus, Universität Tübingen, Eugenstr. 3, 73230, Kirchheim u. Teck, Deutschland.
- Vaskulitiszentrum-Süd, Tübingen & Kirchheim-Teck, Deutschland.
| | - Joerg C Henes
- Zentrum für Interdisziplinäre Klinische Immunologie, Rheumatologie und Autoimmunerkrankungen (INDIRA), Universitätsklinikum Tübingen, Tübingen, Deutschland
- Medizinische Klinik II (Onkologie, Hämatologie, Klinische Immunologie und Rheumatologie), Universitätsklinikum Tübingen, Tübingen, Deutschland
- Vaskulitiszentrum-Süd, Tübingen & Kirchheim-Teck, Deutschland
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14
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Good SD, Wade SD, Kyttaris VC. The spectrum of hemophagocytic lymphohistiocytosis: a retrospective study comparing adult macrophage activation syndrome to malignancy-associated hemophagocytic lymphohistiocytosis. Rheumatol Int 2022. [PMID: 35015099 DOI: 10.1007/s00296-021-05087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/30/2021] [Indexed: 11/05/2022]
Abstract
Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening inflammatory syndrome that can be triggered by autoimmune diseases, malignancy, or infection. In rheumatologic patients, sHLH is referred to as macrophage activation syndrome (MAS). Differentiating between triggers is important for prompt treatment and prognosis. Data comparing subsets of sHLH are limited due to the rarity of this disease. We aim to explore differences in clinical features that may differentiate MAS from malignancy-associated HLH (mHLH) patients. We conducted a single-center retrospective study assessing clinical characteristics, laboratory parameters, treatment regimens and outcomes in 34 patients with sHLH over a 16 year period. We compared patients with MAS to those with mHLH. Hepatomegaly was not present in the MAS group but was present in the mHLH group (0 vs. 25%, p = 0.024). MAS patients had on average nearly double the concentration of platelets at 50.0 (IQR: 31.0–78.0 Kµ/L) vs. 29.0 Kµ/L (IQR: 14.0–37.5 Kµ/L), p = 0.003. Soluble IL-2R concentrations were four times lower in the MAS group with a median soluble IL-2R concentration of 6814.5 kU/L (IQR: 2101–2610 kU/L) vs. 27972.0 kU/L (IQR: 12,820–151,650 kU/L), p = 0.010. The MAS group fared better overall than the mHLH group but was not statistically significant (mortality 22 vs. 44%, p = 0.18). MAS and mHLH patients exhibited different laboratory parameters and clinical features, most notably differences in platelet counts, soluble IL-2R concentration and hepatomegaly, which may help differentiate these conditions early in their course.
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15
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田 佳, 张 霞, 程 功, 刘 庆, 王 世, 何 菁. [Serum interleukin-2 receptor α as a clinical biomarker in patients with systemic lupus erythematosus]. Beijing Da Xue Xue Bao Yi Xue Ban 2021; 53:1083-1087. [PMID: 34916686 PMCID: PMC8695147 DOI: 10.19723/j.issn.1671-167x.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the clinical relevance of serum interleukin-2 receptor α (IL-2Rα) in patients with systemic lupus erythematosus (SLE). METHODS One hundred and seven SLE patients and 39 healthy controls with comparable age and gender were recruited at Peking University People's Hospital from January 2019 to December 2020. Complete clinical data in 107 SLE patients at baseline and follow-up were collected. SLE disease activity index 2000 (SLEDAI-2K) was used to assess the disease activity of the SLE patients. The serum level of IL-2Rα in the SLE patients and healthy controls was measured using enzyme-linked immunosorbent assay (ELISA). The association between serum IL-2Rα and clinical and laboratory parameters was investigated. Mann-Whitney U test or t test, Chi-square test and Spearman correlation were used for statistical analysis. RESULTS The serum IL-2Rα levels were significantly higher in the SLE patients [830.82 (104.2-8 940.48) ng/L], compared with those in the healthy controls [505.1 (78.65-1 711.52) ng/L] (P < 0.001). Association analysis showed that the increased serum IL-2Rα was positively associated with SLEDAI-2K scores and anti-nucleosome antibody (r=0.357, P < 0.001; r=0.25, P=0.027, respectively). Thirty-six of 107 (33.6%) SLE patients had lupus nephritis. Serum IL-2Rα levels were significantly higher in the patients accompanied with lupus nephritis [1 102.14 (126.52-8 940.48) ng/L] than in the patients without lupus nephritis [743.89 (104.19-4 872.06) ng/L] (P=0.032). The patients in the high IL-2Rα group had more lupus nephritis compared with those in the low IL-2Rα group (40.8% vs. 19.4%, P=0.031). Meanwhile, SLEDAI-2K scores were found significantly higher in the high IL-2Rα group than in the low IL-2Rα group [10 (3-21) vs. 7 (3-16), P=0.001]. With the improvement of disease activity in the SLE patients after conventional treatments, serum levels of IL-2Rα [1 119.1 (372.25-2 608.86) ng/L] in the week 12 decreased significantly compared with the baseline [1 556.73 (373.08-8 940.48) ng/L] (P=0.042). CONCLUSION Serum IL-2Rα may be used as a biomarker of disease activity in patients with SLE. There is certain correlation between serum IL-2Rα and renal involvement in SLE.
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Affiliation(s)
- 佳宜 田
- />北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 霞 张
- />北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 功 程
- />北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 庆红 刘
- />北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 世阳 王
- />北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 菁 何
- />北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
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16
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Bartels LE, Ammitzbøll C, Andersen JB, Vils SR, Mistegaard CE, Johannsen AD, Hermansen MF, Thomsen MK, Erikstrup C, Hauge EM, Troldborg A. Local and systemic reactogenicity of COVID-19 vaccine BNT162b2 in patients with systemic lupus erythematosus and rheumatoid arthritis. Rheumatol Int 2021; 41:1925-31. [PMID: 34476603 DOI: 10.1007/s00296-021-04972-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were launched in December 2020. Vaccination of patients with rheumatic diseases is recommended, as they are considered at higher risk of severe COVID-19 than the general population. Patients with rheumatic disease have largely been excluded from vaccine phase 3 trials. This study explores the safety and reactogenicity of BNT162b2 among patients with rheumatic diseases. Patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), median age 58.8 years, 285 subjects in total, were vaccinated twice with the BNT162b2 (Pfizer/BioNTech). Questionnaires on reactogenicity matching the original phase 3 study were answered seven days after completed vaccination. The majority of SLE and RA patients experienced either local (78.0%) or systemic reactions (80.1%). Only 1.8% experienced a grade-4 reaction. Compared to the original study, we found more frequent fatigue [Odds ratio (OR) 2.2 (1.7–2.8)], headache [OR 1.7 (1.3–2.2)], muscle pain [OR 1.8 (1.4–2.3)], and joint pain [OR 2.3 (1.7–3.0)] in patients. In contrast, the use of antipyretics was less frequent [OR 0.5 (0.3–0.6)]. Patients with SLE and RA experience reactogenicity to the Pfizer-BioNTech BNT162b2 COVID-19 vaccine. Reactogenicity was more frequent in patients, however, not more severe compared with healthy controls.
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17
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Dörner T, Szelinski F, Lino AC, Lipsky PE. Therapeutic implications of the anergic/postactivated status of B cells in systemic lupus erythematosus. RMD Open 2021; 6:rmdopen-2020-001258. [PMID: 32675278 PMCID: PMC7425190 DOI: 10.1136/rmdopen-2020-001258] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/28/2020] [Accepted: 06/12/2020] [Indexed: 12/19/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is characterised by numerous abnormalities in B lineage cells, including increased CD27++ plasmablasts/plasma cells, atypical CD27-IgD- B cells with increased CD95, spleen tyrosine kinase (Syk)++, CXCR5- and CXCR5+ subsets and anergic CD11c+Tbet+ age-associated B cells. Most findings, together with preclinical lupus models, support the concept of B cell hyperactivity in SLE. However, it remains largely unknown whether these specific B cell subsets have pathogenic consequences and whether they provide relevant therapeutic targets. Recent findings indicate a global distortion of B cell functional capability, in which the entire repertoire of naïve and memory B cells in SLE exhibits an anergic or postactivated (APA) functional phenotype. The APA status of SLE B cells has some similarities to the functional derangement of lupus T cells. APA B cells are characterised by reduced global cytokine production, diminished B cell receptor (BCR) signalling with decreased Syk and Bruton's tyrosine kinase phosphorylation related to repeated in vivo BCR stimulation as well as hyporesponsiveness to toll-like receptor 9 engagement, but intact CD40 signalling. This APA status was related to constitutive co-localisation of CD22 linked to phosphatase SHP-1 and increased overall protein phosphatase activities. Notably, CD40 co-stimulation could revert this APA status and restore BCR signalling, downregulate protein tyrosine phosphatase transcription and promote B cell proliferation and differentiation. The APA status and their potential rescue by bystander help conveyed through CD40 stimulation not only provides insights into possible mechanisms of escape of autoreactive clones from negative selection but also into novel ways to target B cells therapeutically.
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Affiliation(s)
| | | | - Andreia C Lino
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany.,German Rheumatism Research Center Berlin (DRFZ), Berlin, Germany
| | - Peter E Lipsky
- RILITE Research Institute, Charlottesville, Virginia, USA
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18
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Kirchgesner T, Stoenoiu M, Michoux N, Libouton X, Houssiau F, Vande Berg B. Instability of the extensor digitorum tendons in Jaccoud arthropathy assessed by semi-dynamic MRI of the metacarpophalangeal joints. Diagn Interv Imaging 2021; 102:553-559. [PMID: 33903055 DOI: 10.1016/j.diii.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/15/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to test the hypothesis that Jaccoud arthropathy (JA) in patients with systemic lupus erythematosus (SLE) is associated with instability of the extensor digitorum (ED) tendons during flexion of the metacarpophalangeal (MCP) joints by comparing the position of the ED tendons between SLE patients with JA and control subjects on hand MRI obtained with flexed and extended MCP joints. MATERIALS AND METHODS Thirty-two hands of SLE patients with JA (13 women and 3 men; mean age, 50.0±12.2 [SD] years; age range: 26-68years) and 24 hands of sex- and age-matched control subjects (20 women and 4 men; mean age, 50.1±13.0 [SD] years; age range: 24-68years) were included in the study. Axial spin echo T1-weighted MRI images of the second to fifth MCP joints in flexion and in extension were obtained. Two radiologists (R1 and R2) separately measured the amplitude and assessed the direction of the displacement of the ED tendons with respect to the midline at the level of each MCP joint. Statistical analysis included two-way ANOVA with random effects to assess differences in amplitude and Fisher-Freeman-Halton exact test to assess differences in direction with P-values<0.0083 and<0.0063 considered as statistically significant respectively. RESULTS Amplitude of the displacement of the ED tendons was statistically significantly greater in SLE patients with JA than in control subjects in flexion for both readers (median 58°, 95% confidence interval [CI]: 50°-65° vs. 20°, 95% CI: 16°-24°; P<0.0001 for R1 and 54°, 95% CI: 47°-61° vs. 25°, 95% CI: 22°-28°; P<0.0001 for R2) and in extension for one reader (17°, 95% CI: 15°-20° vs. 14°, 95% CI: 11°-16°; P=0.0048 for R1 and 20°, 95% CI: 15°-25° vs. 16°, 95% CI: 12°-18°; P=0.0292 for R2). Ulnar deviation of the ED tendons was statistically significantly more frequent in SLE patients with JA than in control subjects in flexion and in extension for both readers (P<0.0001). CONCLUSION JA is associated with instability of the ED tendons in patients with SLE best depicted when MCP joints are flexed.
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Affiliation(s)
- Thomas Kirchgesner
- Department of Medical Imaging, Musculoskeletal Imaging Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Brussels, Belgium.
| | - Maria Stoenoiu
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Brussels, Belgium
| | - Nicolas Michoux
- Department of Medical Imaging, Musculoskeletal Imaging Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Brussels, Belgium
| | - Xavier Libouton
- Department of Orthopedic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Brussels, Belgium
| | - Frédéric Houssiau
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Brussels, Belgium
| | - Bruno Vande Berg
- Department of Medical Imaging, Musculoskeletal Imaging Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Brussels, Belgium
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19
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Kim CS, Han KD, Jung JH, Choi HS, Bae EH, Ma SK, Kim SW. Incidence and risk factors for osteoporotic fractures in patients with systemic lupus erythematosus versus matched controls. Korean J Intern Med 2021; 36:154-163. [PMID: 31234614 PMCID: PMC7820659 DOI: 10.3904/kjim.2018.378] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/02/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND/AIMS Despite recent improvements in the quality of life of patients with systemic lupus erythematosus (SLE), osteoporosis, and osteoporotic fractures are one of the major complications of SLE. Furthermore, limited data are available on the incidence and predictor of osteoporotic fractures in Korean patients with SLE. Herein, we aimed to assess the incidence and risk factors for osteoporotic fractures in Korean SLE patients compared to those without SLE. METHODS SLE patients aged ≥ 40 years (n = 10,434; mean age, 51.3 ± 9.1 years; women, 89.7%) were selected from the Korean National Health Insurance Service database, spanning a period from 2008 to 2014. Age- and sex-matched controls (n = 52,170) were randomly sampled in a 5:1 ratio from non-SLE individuals. The primary outcome was the first occurrence of osteoporotic fracture. RESULTS The incidence of osteoporotic fractures was significantly higher in the SLE patients (19.085 per 1,000 person-years) than in matched controls (6.530 per 1,000 person-years). According to the multivariable Cox proportional analysis, patients with SLE exhibited a higher osteoporotic fracture rate than the control group (hazards ratio, 2.964; 95% confidence interval, 2.754 to 3.188), even after adjustment for confounding variables. In the subgroup analysis, male SLE patients or SLE patients aged 40 to 65 years were associated with a higher osteoporotic fracture rate than women SLE patients or SLE patients aged ≥ 65 years, respectively. CONCLUSION We found a 2.964-fold increased risk of osteoporotic fracture in SLE patients compared to age- and sex-matched non-SLE controls. Male or middle-aged SLE patients had a relatively higher fracture risk among patients with SLE.
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Affiliation(s)
- Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung-Do Han
- Department of Medical statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Hyung Jung
- Department of Medical statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Correspondence to Soo Wan Kim, M.D. Department of Internal Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6271 Fax: +82-62-220-8578 E-mail:
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20
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Jiang MD, Zhao JL, Zhou YZ, Jiang Y, Zhang X, Zeng XF. [The 482nd case: vomiting, paroxysmal dizziness and anhidrosis]. Zhonghua Nei Ke Za Zhi 2020; 59:1013-1016. [PMID: 33256348 DOI: 10.3760/cma.j.cn112138-20200417-00390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 31-year-old woman was admitted to Peking Union Medical College Hospital presented with intermittent vomiting and abdominal pain for 2 years, and recurrence with paroxysmal dizziness for 1 month. This patient was diagnosed with systemic lupus erythematosus (SLE) 2 years ago with involvement of gastrointestinal and urinary tracts. One month ago, repeated vomiting and nausea recurred. No laboratory and imaging abnormalities were found in central nervous system and gastrointestinal evaluation. Orthostatic hypotension and fluctuation of blood pressure were recorded during hospitalization. Combined with sexual dysfunction, left adie pupil, anhidrosis and abnormal sympathetic skin response, autonomic nerve dysfunction related to SLE was diagnosed. After treated with pulse glucocorticoids and intravenous immunoglobulin, the patient's symptoms improved remarkably. Orthostatic hypotension in SLE patients may link to autonomic nerve dysfunction.
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Affiliation(s)
- M D Jiang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J L Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing 100730, China
| | - Y Z Zhou
- Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y Jiang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - X Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - X F Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing 100730, China
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郭 倩, 马 晓, 高 辉, 石 连, 钟 昱, 谢 琳, 邵 苗, 张 学. [Association of Semaphorin 3A with thrombocytopenia in systemic lupus erythematosus]. Beijing Da Xue Xue Bao Yi Xue Ban 2020; 52:892-896. [PMID: 33047725 PMCID: PMC7653423 DOI: 10.19723/j.issn.1671-167x.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To measure the level of serum Semaphorin 3A (Sema3A) and to analyze the relationship between serum Sema3A and systemic lupus erythematosus (SLE) with thrombocytopenia. METHODS The concentration of serum Sema3A was detected by enzyme-linked immuno sorbent assay (ELISA) in 170 SLE patients, 50 Sjögren's syndrome (SS) patients, 19 hypersplenism (HS) patients and 150 healthy controls (HC). Based on the presence of thrombocytopenia and whether the thrombocytopenia was in remission, the SLE patients were divided into three groups: SLE with thrombocytopenia (41 cases), SLE with thrombocytopenia remission (28 cases), and SLE without thrombocytopenia (101 cases). According to whether there was thrombocytopenia, the SS patients were divided into SS with thrombocytopenia (18 cases) and SS without thrombocytopenia (32 cases). The 28 SLE patients who underwent bone marrow aspiration biopsy were divided into two groups from the aspect of whether the bone marrow hyperplasia was normal (19 cases) or low (9 cases), as well as from the aspect of whether the maturity disturbance of megakaryocyte was positive (8 cases) or negative (20 cases). The serum Sema3A levels in SLE, SS, HS with HC were compared, meanwhile, the correlation between serum Sema3A level and platelet (PLT) in the patients with different diseases analyzed. RESULTS (1) Serum Sema3A levels in SLE were significantly lower than in HC [(3.84±2.76) μg/L vs. (6.96±2.62) μg/L, P < 0.001], serum Sema3A levels in SS were also obviously lower than in HC [(4.35±3.57) μg/L vs. (6.96±2.62) μg/L, P < 0.001], and in HS it was lower than HC at a certain extant [(5.67±2.26) μg/L vs. (6.96±2.62) μg/L, P=0.041]. (2) Serum Sema3A levels in SLE were slightly lower than in SS, but there was no significant difference [(3.84±2.76) μg/L vs. (4.35±3.57) μg/L, P=0.282]. However, when compared with HS, serum Sema3A levels in SLE were significantly lower [(3.84±2.76) μg/L vs. (5.67±2.26) μg/L, P=0.006]. (3) Serum Sema3A concentration in SLE with thrombocytopenia was significantly lower than in SLE with thrombocytopenia remission [(1.28±1.06) μg/L vs. (3.83±2.65) μg/L, P < 0.001], and in SLE patients without thrombocytopenia [(1.28±1.06) μg/L vs. (4.87±2.60) μg/L, P < 0.001]. There was no significant difference between SLE with thrombocytopenia remission and SLE without thrombocytopenia [(3.83±2.65) μg/L vs. (4.87±2.600 μg/L, P=0.123]. Serum Sema3A concentration in SLE with thrombocytopenia was slightly lower than in SS with thrombocytopenia, but there was no significant difference [(1.28±1.06) μg/L vs. (1.68±1.11) μg/L, P=0.189]. (4) Strong positive correlations were found between serum Sema3A and PLT in SLE (r=0.600, P < 0.001). Positive correlations were also found between serum Sema3A and PLT in SS (r=0.573, P < 0.001). However, there was no such correlation showed in HS patients (P=0.393). (5) There was no significant difference of serum Sema3A concentration in SLE whether the bone marrow hyperplasia was normal or low. And the same situation appeared in the patients whether the maturity disturbance of megakaryocyte was positive or negative (P>0.05). CONCLUSION Serum Sema3A was significantly reduced in SLE patients, and it was highly correlated with the blood damage. Similar conclusions could be drawn in patients with SS. The serum level of Sema3A was generally decreasing in desmosis which merged thrombocytopenia, and was obviously positive correlated with platelet counts.
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Affiliation(s)
- 倩 郭
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
- 北京大学国际医院风湿免疫科,北京 102206Department of Rheumatology and Immunology, Peking University International Hospital, Beijing 102206, China
| | - 晓旭 马
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 辉 高
- 北京大学国际医院风湿免疫科,北京 102206Department of Rheumatology and Immunology, Peking University International Hospital, Beijing 102206, China
| | - 连杰 石
- 北京大学国际医院风湿免疫科,北京 102206Department of Rheumatology and Immunology, Peking University International Hospital, Beijing 102206, China
| | - 昱超 钟
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 琳峰 谢
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 苗 邵
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - 学武 张
- 北京大学人民医院风湿免疫科,北京 100044Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
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Wille F, Birkmeier S, Tiemann K, Lewalter T, Klingel K, Rabe C, Sick P. [Proximal myopathy and fulminant heart failure in a 57 year-old female patient with lupus erythematosus]. Internist (Berl) 2020; 61:854-9. [PMID: 32504300 DOI: 10.1007/s00108-020-00820-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A case report is presented of fulminant hydroxychloroquine-induced cardiomyopathy in a 57 year-old female patient with a long history of systemic lupus erythematosus. Diagnosis was established based on clinical findings, imaging (echocardiography and cardiac magnetic resonance imaging) as well as endomyocardial biopsy. Despite immediate discontinuation of the medication, the patient died from heart failure within a few days. Since the rare adverse effect described here might be reversible, early diagnosis and discontinuation of hydroxychloroquine are crucial for the prognosis of these patients.
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23
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Bae EH, Lim SY, Han KD, Jung JH, Choi HS, Kim HY, Kim CS, Ma SK, Kim SW. Trend of prevalence and incidence of systemic lupus erythematosus in South Korea, 2005 to 2015: a nationwide population-based study. Korean J Intern Med 2020; 35:652-661. [PMID: 31212409 PMCID: PMC7214355 DOI: 10.3904/kjim.2018.303] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/08/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/AIMS The aim of this study was to evaluate the trend of incidence and prevalence of systemic lupus erythematosus (SLE) in South Korea from 2005 to 2015. METHODS From 2005 to 2015, individuals with SLE were identified from the National Health Insurance database, which records information on almost all Koreans. SLE was defined according to the International Classification of Diseases, 10th revision (ICD-10), code M32. The incidence was calculated per 100,000 person-years. The prevalence was calculated per 100,000 people and stratified by year, age group, sex, region, and income. RESULTS The annual prevalence of SLE increased slightly from 21.25/100,000 people in 2005 to 35.45/100,000 people in 2015. In contrast, the annual incidence of SLE decreased slightly from 5.42/100,000 person-years in 2005 to 3.6/100,000 person-years in 2015. The prevalence and incidence of SLE were 10- and 6-fold higher in women than in men, respectively. The peak age of prevalence and incidence was 30 to 39 years in 2005; in 2015, the peak age of prevalence was 30 to 49 years and of incidence was 20 to 49 years. Regional variation was observed in both incidence and prevalence of SLE. Jeju province showed the highest prevalence of SLE (44.54/100,000 person-years), and Gwangju province showed the highest incidence of SLE (6.98/100,000 person-years) in 2015. The income status did not affect the prevalence or incidence of SLE except in patients without income who received medical aid. CONCLUSION The incidence of SLE has declined, but the prevalence has increased in Korea in recent years. Peak age of SLE trend to right shift in Korea.
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Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Yeob Lim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Kyung-Do Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Hyung Jung
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ha Yeon Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Correspondence to Soo Wan Kim, M.D. Department of Internal Medicine, Chonnam National University Medical School 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6271 Fax : +82-62-225-8578 E-mail:
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24
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Guo JY, Ren ZG, Xuan YY, Li TF, Liu XJ, Niu CZ, Li JY, Liu SY. [Clinical characteristics and risk factors of patients with systemic lupus erythematosus and cancer]. Zhonghua Nei Ke Za Zhi 2020; 59:218-21. [PMID: 32146749 DOI: 10.3760/cma.j.issn.0578-1426.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To investigate the clinical manifestations and risk factors in patients with systemic lupus erythematosus (SLE) and cancers. From October 2010 to February 2019, 5 566 SLE patients hospitalized in the First Affiliated Hospital of Zhengzhou University were enrolled. A total of 69 cancer patients were identified, and the clinical characteristics and previous treatment were analyzed. Cervical carcinoma (21.74%, 15/69) and thyroid cancer (21.74%, 15/69) were the most common types of cancer. Most cancers were diagnosed in SLE patients with an age 40~50 years. The disease duration of SLE was from 60~120 months. SLE patients without cancers were usually diagnosed between 20~30 years with duration of symptoms less than 12 months. As to the previous treatment of SLE, the uses of glucocorticoid, cyclophosphamide, methotrexate and azathioprine were comparable between patients with cancers and without (P>0.05). However, the use of hydroxychloroquine was more frequent in SLE patients than in patients with cancers (P<0.01). Correlation analysis revealed significant correlation between disease course of SLE (OR=4.25, 95%CI 1.79~10.01,P<0.001), hydroxychloroquine (OR=0.26, 95%CI 0.12~0.59,P<0.001) and cancer risk. Long disease course may be a risk factor for SLE patients to develop cancer, whereas hydroxychloroquine could be a protective factor.
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Abstract
Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. In 2019, under the leadership of the Chinese Rheumatology Association, a multidisciplinary guideline development group was established. The objective was to develop an evidence-based diagnosis and treatment guideline for SLE in China based on emerging new evidence. The guideline was registered at International Practice Guidelines Registry Platform (IPGRP-2019CN022). The grading of recommendations assessment, development and evaluation (GRADE) approach was used to rate the quality of evidence and the strength of recommendations, and the RIGHT (Reporting Items for Practice Guidelines in Healthcare) checklist was followed to report the guideline. The guideline provides recommendations for the SLE classification criteria, disease activity monitoring and assessing, medication principles and considerations organ and system involvement and management of patients during pregnancy. This guideline is intended to serve as a tool for Chinese clinicians for the best decisions-making on diagnosis and treatment of SLE.
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26
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Zhou YZ, Zhao JL, Cao XY, Zheng K, Wu QJ, Zeng XF. [The 476th case: skin rash, edema, thrombocytopenia and anemia]. Zhonghua Nei Ke Za Zhi 2020; 59:250-252. [PMID: 32146758 DOI: 10.3760/cma.j.issn.0578-1426.2020.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The 21-year-old male patient was admitted to the Department of Rheumatology and Immunology at Peking Union Medical College Hospital with chief complaints of "skin rash for 1 year and edema for 2 months". He was diagnosed with systemic lupus erythematosus (SLE) with renal, cardiac and hematological involvement. Remission was not achieved after glucocorticoid pulse treatment. The patient experienced oliguria, malignant hypertension, accompanied by thrombocytopenia and low serum complements, and elevated lactate dehydrogenase and serum creatinine. Schistocytes were seen in the peripheral blood smear. Thrombotic microangiopathy (TMA) secondary to SLE was diagnosed. Though plasma exchange was partially effective, TMA could not be controlled yet. The activity of serum von Willebrand factor -cleaving protease (ADAMTS 13) was 100%, and ADAMTS 13 inhibitor was negative. Finally, remission of the disease was achieved after second glucocorticoid pulse therapy and rituximab treatment. At the 3-month follow-up, the patient's condition was stable with mild anemia and normal platelet count. Patients with TMA secondary to SLE are heterogenous, while normal ADAMT 13 activity indicates poor prognosis. Early and aggressive treatment is important for disease control, and plasma exchange is helpful as a supportive care.
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Affiliation(s)
- Y Z Zhou
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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27
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Li MY, Bai YQ, Liu Y. [Matrix metalloproteinase-3 in patients with systemic lupus erythematosus and its significance in differentiating disease activity from pulmonary infections]. Zhonghua Nei Ke Za Zhi 2020; 59:58-61. [PMID: 31887838 DOI: 10.3760/cma.j.issn.0578-1426.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this study is to investigate the matrix metalloproteinase-3 (MMP-3) levels in patients with systemic lupus erythematosus (SLE) and its significance in identifying disease activity and pulmonary infections. A total of 122 SLE patients were enrolled, including 21 with pulmonary infections, 16 with arthritis, 26 with nephritis, 10 with vasculitis, and 23 healthy controls. Serum MMP-3, C-reactive protein (CRP), serum amyloid A (SAA), and haptoglobin (HPT) levels were measured in all subjects. The results showed that the levels of MMP-3 in SLE combined with pulmonary infections [(230.10±44.92) μg/L], arthritis [(140.20±20.76) μg/L], nephritis [(155.40±23.36) μg/L] were higher than those in SLE only [(91.74±10.47) μg/L]. The levels of MMP-3 [(210.30±45.71) μg/L], CRP [(12.11±5.21) mg/L], HPT [(1.57±0.23) g/L] in active SLE combined with pulmonary infections were higher than those inactive SLE without pulmonary infections including MMP-3 [(124.00±15.22) μg/L], CRP [(7.76±2.96) mg/L], HPT [(0.89±0.09) g/L]. The levels of CRP [(10.03±2.70) mg/L], SAA [(89.22±36.77) mg/L] in active SLE with pulmonary infections and CRP[(7.76±2.96) mg/L], SAA [(60.22±19.7) mg/L] in active SLE without pulmonary infections were higher than CRP [(1.90±0.39) mg/L], SAA [(17.60±3.89) mg/L] in stable SLE with pulmonary infections. It suggests that the levels of CRP and SAA are elevated in active SLE with pulmonary infections. Serum MMP-3 in combination with CRP may assist in differentiating from SLE pulmonary infections.
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Affiliation(s)
- M Y Li
- Department of Rheumatology and Immunology, Subsidiary Hospital, Southwestern Medical University, Luzhou, Sichuan Province 646000, China
| | - Y Q Bai
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y Liu
- Department of Rheumatology and Immunology, Subsidiary Hospital, Southwestern Medical University, Luzhou, Sichuan Province 646000, China; Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
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28
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Sohn KC, Heo WG, Chu MS, Kim EJ, Chung JH, Choi SC, Yun KJ, Seo GS. [Rectal Ulcer Developed in Systemic Lupus Erythematosus without Ischemic Colitis]. Korean J Gastroenterol 2019; 73:299-302. [PMID: 31132828 DOI: 10.4166/kjg.2019.73.5.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/09/2019] [Accepted: 01/27/2019] [Indexed: 11/03/2022]
Abstract
Rectal involvement by systemic lupus erythematosus (SLE) is quite rare. Approximately 14 cases have been reported worldwide, but only one with ischemic colitis has been reported in Korea. A 17-year-old female patient was hospitalized with abdominal pain and hematochezia. Sigmoidoscopy revealed only a simple rectal ulcer without ischemic colitis. cytomegalovirus and bacterial infections were excluded. A sigmoidoscopic rectal biopsy indicated a rectal invasion by SLE, but the patient showed an acute worsening conditions that did not respond to treatment. This paper reports a case of rectal ulcer that developed in SLE without ischemic colitis with a review of the relevant literature.
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Affiliation(s)
- Ki Chang Sohn
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Won Gak Heo
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Min Su Chu
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Eui Joong Kim
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Jong Hyeok Chung
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Suck Chei Choi
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Ki Jung Yun
- Departments of Pathology, Wonkwang University School of Medicine, Iksan, Korea
| | - Geom Seog Seo
- Departments of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
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29
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Yi CL, Yang XJ, Lin KZ, Wu JZ, Xiao JH. [A multicenter study of the condition of children's rheumatic disease associated medical resources in Fujian province]. Zhonghua Er Ke Za Zhi 2019; 57:913-916. [PMID: 31795556 DOI: 10.3760/cma.j.issn.0578-1310.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: To investigate general condition of children's rheumatic disease associated medical resources in Fujian Province. Methods: This questionnaire-based survey was conducted in 19 hospitals in Fujian province from December 2, 2018 to May 1, 2019. The questionnaire was designed to survey the general condition of the medical resources and the hospitalization of patients with rheumatic diseases from January 1, 2014 to December 1, 2018. Results: In the 19 hospitals, there were 15 general hospitals and 4 children's hospitals, and only 5 hospitals had children's rheumatic specialist clinic. There were only 53-62 beds for rheumatic disease patients in the 19 hospitals, accounting for 1.7%-2.0% of the total inpatient beds (3 137). There are 29 pediatric rheumatologists in total, accounting for 2.6% (29/1 120) of the total pediatricians. In the past five years, 613 patients with rheumatic diseases, accounting for 0.1% (613/625 214) of total hospitalized patients, were treated in these hospitals. Among them, 201 had juvenile idiopathic arthritis, 295 had systemic lupus erythematosus, 39 had dermatomyositis, 7 had scleroderma, and 57 had inflammatory bowel disease, 9 had Sjogren's syndrome, 5 had Behcet's disease, and none had overlap syndrome or mixed connective tissue disease. Conclusion: The medical resources of children rheumatic diseases in Fujian province are insufficient which need to be developed.
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Affiliation(s)
- C L Yi
- Department of Pediatrics, the First Affiliated Hospital of Xiamen University, Xiamen 361000, China
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30
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Abstract
Lupus nephritis (LN) is the most frequent and one of the most severe organ manifestations of systemic lupus erythematosus. The central pathogenetic mechanism is characterized by the loss of immune tolerance against autoantigens of the cell nucleus, which can lead to renal inflammation via the formation of nuclear autoantibodies. The clinical manifestations of LN encompass nephritic syndrome with the special form of rapidly progressive glomerulonephritis, nephrotic syndrome and thrombotic microangiopathy. The diagnostic procedures consist of renal function and urine analysis as well as the determination of serum autoantibody profiles and complement components. An early renal biopsy enables a differentiation between the prognostically different forms of LN. In addition to supportive measures, a differentiated immunosuppressive treatment is the main approach for prognostically unfavorable forms. Important components are corticosteroids, cyclophosphamide and mycophenolate mofetil for induction treatment. Currently investigated treatment principles include next generation calcineurin inhibitors and anti-B cell treatment.
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Abstract
Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are chronic inflammatory diseases of the central nervous system (CNS). They may cause inflammation in the brain, spinal cord and optic nerve. Both conditions must be differentiated from CNS manifestations of other systemic autoimmune diseases such as systemic lupus erythematosus (SLE), Sjögren's syndrome, autoinflammtory diseases and sarcoidosis, since amongst others myelitis and optic nerve inflammation may also occur in these conditions. Nevertheless, coexistence of MS or NMOSD with rheumatic disorders such as SLE or Sjögren's syndrome has also been reported especially in NMOSD. Since the therapeutic approach is different it is important to determine a clear diagnosis. In addition some drugs used in rheumatic disease such as anti-tumor necrosis factor biologics may induce inflammatory disease of the CNS and should be avoided in MS. An interdisciplinary approach between neuroimmunology and rheumatology is important for optimal care and treatment in such patients.
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Lin Q, Zhang M, Tang H, Shen Y, Zhu Y, Xu Q, Li X. Acute pancreatitis and macrophage activation syndrome in pediatric systemic lupus erythematosus: case-based review. Rheumatol Int 2019; 40:811-819. [PMID: 31377830 DOI: 10.1007/s00296-019-04388-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 07/17/2019] [Indexed: 12/14/2022]
Abstract
Pancreatitis is uncommon in systemic lupus erythematosus (SLE) and is rarely reported in children, possibly being related to macrophage activation syndrome (MAS). The incidence of MAS in children with lupus pancreatitis is unknown, as is their prognosis. In this case-based review, we report a pediatric patient with SLE complicated with pancreatitis and MAS, and performed a literature review. We report an 11-year-old girl with SLE and MAS who developed pancreatitis on the second day of methylprednisolone pulse therapy (500 mg/day). We continued methylprednisolone pulse therapy, and performed three rounds of DNA-immunoadsorption and three rounds of hemoperfusion. A second course of methylprednisolone pulse therapy was initiated 9 days later. The patient received a monthly cyclophosphamide pulse therapy (10 mg/kg/day, 2 consecutive days every month) for 6 months, after which she was treated with mycophenolate mofetil 20 mg/kg/day. The condition of the patient gradually improved, her blood amylase and lipase decreased. She was in a stable condition during 13-month follow-up period. Review of the literature of pediatric patients with SLE and pancreatitis showed that there are 127 cases that have been reported in the past 30 years, 40 cases were excluded in our study because of inadequate information. Of the 87 patients included in our literature review, the mortality rate was 33.33%, and 52.86% of the patients with pancreatitis had MAS at the same time. Pancreatitis is uncommon in SLE, but must be suspected if a patient with SLE develops digestive symptoms. Patients with SLE with pancreatitis have a high incidence of MAS and high mortality rate; however, early recognition and effective treatment can relieve the disease symptoms.
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Affiliation(s)
- Qiang Lin
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China
| | - Man Zhang
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China
| | - Hanyun Tang
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China
| | - Yunyan Shen
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China
| | - Yun Zhu
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China
| | - Qinying Xu
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China
| | - Xiaozhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303, Jingde Road, Suzhou, Jiangsu, The People's Republic of China.
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Cui W, Stern C, Hickey M, Goldblatt F, Anazodo A, Stevenson WS, Phillips KA. Preventing ovarian failure associated with chemotherapy. Med J Aust 2019; 209:412-416. [PMID: 30376664 DOI: 10.5694/mja18.00190] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 02/18/2018] [Accepted: 04/23/2018] [Indexed: 12/17/2022]
Abstract
Alkylating chemotherapy is often used to treat pre-menopausal women for various malignancies and autoimmune diseases. Chemotherapy-associated ovarian failure is a potential consequence of this treatment which can cause infertility, and increases the risk of other long term adverse health sequelae. Randomised trials, predominantly of women undergoing alkylating chemotherapy for breast cancer, have shown evidence for the efficacy of gonadotropin-releasing hormone agonists (GnRHa) in preventing chemotherapy-associated ovarian failure. The European St Gallen and United States National Comprehensive Cancer Network guidelines recommend the use of concurrent GnRHa to reduce the risk of ovarian failure for pre-menopausal women undergoing chemotherapy for breast cancer. The GnRHa goserelin, a monthly 3.6 mg depot subcutaneous injection, has recently been listed on the Australian Pharmaceutical Benefits Scheme to reduce risk of ovarian failure for pre-menopausal women receiving alkylating therapies for malignancy or autoimmune disease. The first dose of goserelin should ideally be administered at least 1 week before commencement of alkylating treatment and continued 4-weekly during chemotherapy. Concurrent goserelin use should now be considered for all pre-menopausal women due to commence alkylating chemotherapy (except those with incurable cancer), regardless of their childbearing status, in an effort to preserve their ovarian function. For women who have not completed childbearing, consideration of other fertility preservation options, such as cryopreservation of embryos or oocytes, is also important.
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Affiliation(s)
- Wanyuan Cui
- Peter MacCallum Cancer Centre, Melbourne, VIC
| | | | | | - Fiona Goldblatt
- Flinders Medical Centre and Flinders University, Adelaide, SA
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Abstract
Antiphospholipid syndrome is characterised by recurrent thrombosis (arterial, venous, microvascular) and/or pregnancy complications in the presence of persistent antiphospholipid antibodies (lupus anticoagulant, anti-β2-glycoprotein 1 and anticardiolipin). It can be a primary disease or associated with another autoimmune disease (especially systemic lupus erythematosis). Testing for antiphospholipid antibodies should be considered in patients < 50 years of age with unprovoked venous or arterial thromboembolism, thrombosis at unusual sites or pregnancy complications. The mainstay of treatment is antithrombotic therapy and recommendations vary based on arterial, venous or pregnancy complications. If associated with systemic lupus erythematosis, hydroxychloroquine is recommended both as primary and secondary prophylaxis. Antithrombotic treatment is gold standard and effective.
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Affiliation(s)
| | | | - Huyen Tran
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
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35
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Men K, Chen Y, Zhang J, Wei D. The evaluation of cellular immune function in elderly patients with systemic lupus erythematosus. Korean J Intern Med 2019; 34:932-937. [PMID: 29172398 PMCID: PMC6610183 DOI: 10.3904/kjim.2017.224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/07/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/AIMS To evaluate cellular immune function in systemic lupus erythematosus (SLE) patients over 60 years old, the association between antinuclear antibody (ANA) titers and the ratio of CD4+ /CD8+ was analyzed in this study. The distribution of ANAs and extractable nuclear antibodies (ENAs) in a healthy elderly population was also investigated. METHODS Serum ANA titers were assayed by indirect immunofluorescence (IIF) and the CD4+ /CD8+ T-cell ratio was determined by flow cytometry in 76 SLE patients and 30 healthy control individuals. IIF of cytoplasm and nuclear and nucleolar staining were performed on samples taken from 286 healthy elderly individuals. ENA levels were determined using a strip enzyme immunoassay among patients that tested positive for ANAs. RESULTS ANA titers were negative in the 30 control individuals, but were positive in the 76 SLE patients. Based on ANA titers, the SLE patients were stratified to low (≤ 1:320), medium (1:640 to 1:1,280), and high (≥ 1:2,560) titer groups. The average CD4+ /CD8+ ratio of the SLE group was significantly lower than that of the control group. Among the 286 healthy elderly volunteers, 59 (20.63%) tested positive for ANAs. A homogeneous pattern was present in 47.46% of those 59 patients and a granule pattern in the karyoplasm was present in 33.90%. Furthermore, of the 59 patients, ENAs immunoassay was positive in 18 (30.51%); Sjogren syndrome-related antigen A (SSA)/52 kd and Sjogren syndrome antigen B (SSB)/La were the two major antibodies. CONCLUSION The significantly lower CD4+ /CD8+ ratio among SLE patients over 60 years old is associated with deregulated immune responses and the development of SLE. A low ANA titer (1:160) is common in healthy elders, emphasizing the importance of considering age when determining if the evaluation of ANA titers is to be included in autoimmune disease diagnosis.
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Affiliation(s)
- Kun Men
- Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yu Chen
- Department of Endocrinology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jingwei Zhang
- Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Dianjun Wei
- Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin, China
- Correspondence to Dianjun Wei, Ph.D. Department of Internal Medicine, Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, No. 23 PingJiang Rd, He’xi Dist, Tianjin, 300211, China Tel: +86-22-88328930 Fax: +86-22-88326837 E-mail:
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36
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Abstract
Systemic lupus erythematosus (SLE) is a complex multi-systemic autoimmune disease with considerable clinical and immunological heterogeneity. Family physicians should be familiar with the protean manifestations of SLE to aid early diagnosis and monitoring of disease progression. The role of family physicians in SLE includes education, counselling, psychological support, management of mild disease, and recognition of the need for referral to other specialists for more serious disease and complications. Surveillance of cardiovascular risk factors and osteoporosis and advice about vaccination and reproductive issues can be performed in the primary care setting under close collaboration with rheumatologists and other specialists. This review provides family physicians with the latest classification criteria for SLE, recommendations on SLE-related health issues, and pharmacological therapies for SLE.
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Affiliation(s)
- C C Mok
- Department of Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong
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Wang ZR, Ren LM, Li R, Guan X, Han QM, Liu ML, Shao M, Zhang X, Chen S, Li ZG. [Analysis of 20-year survival rate and prognostic indicators of systemic lupus erythematosus]. Zhonghua Yi Xue Za Zhi 2019; 99:178-182. [PMID: 30669759 DOI: 10.3760/cma.j.issn.0376-2491.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective: To analyze the 20-year survival rate, causes of death and predictors of systemic lupus erythematosus (SLE). Methods: A retrospective analysis was performed on 217 newly SLE patients who were diagnosed and treated by Peking University People's Hospital before June 2008. The clinical features and serologic data were studied. Survival rate of SLE patients over time, living conditions, causes of death and prognostic indicators of mortality were studied. Results: The 10-, 15-and 20-year cumulative survival rate was 90.3%,88.1%and 79.6%, respectively. Infection and lupus encephalopathy were the main causes of death. Cox regression analysis revealed that lupus nephritis, neuropsychiatric systemic lupus erythematosus and age at the diagnosis were independent risk determinants for mortality. Conclusion: Prognosis of SLE remains to be improved. Early diagnosis, control of SLE organ damage and infection prevention are critical to improve survival of SLE patients.
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Affiliation(s)
- Z R Wang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing100044, China
| | - L M Ren
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing100044, China
| | - R Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing100044, China
| | - X Guan
- Department of Rheumatology and Immunology, Tong Liao City Hospital, Tongliao 028000, China
| | - Q M Han
- Department of Rheumatology and Immunology, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - M L Liu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - M Shao
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing100044, China
| | - X Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing100044, China
| | - S Chen
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing100044, China
| | - Z G Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing100044, China
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García-Sáenz M, Uribe-Cortés D, Ramírez-Rentería C, Ferreira-Hermosillo A. Difficult-to-diagnose diabetes in a patient treated with cyclophosphamide - the contradictory roles of immunosuppressant agents: a case report. J Med Case Rep 2018; 12:364. [PMID: 30526658 PMCID: PMC6287356 DOI: 10.1186/s13256-018-1925-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022] Open
Abstract
Background Cyclophosphamide may induce autoimmune diabetes through a decrease in suppressor T cells and increase of proinflammatory T helper type 1 response in animal models. In humans, this association is not as clear due to the presence of other risk factors for hyperglycemia, but it could be a precipitant for acute complications. Case presentation A 31-year-old Mestizo-Mexican woman with a history of systemic lupus erythematosus presented with severe diabetic ketoacidosis, shortly after initiating a multi-drug immunosuppressive therapy. She did not meet the diagnostic criteria for type 1 or type 2 diabetes and had no family history of hyperglycemic states. She persisted with hyperglycemia and high insulin requirements until the discontinuation of cyclophosphamide. After this episode, she recovered her endogenous insulin production and the antidiabetic agents were successfully withdrawn. After 1 year of follow up she is still normoglycemic. Conclusion Cyclophosphamide may be an additional risk factor for acute hyperglycemic crisis. Glucose monitoring could be recommended during and after this treatment.
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Affiliation(s)
- Manuel García-Sáenz
- Servicio de Endocrinología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720, Mexico City, Mexico
| | - Daniel Uribe-Cortés
- Servicio de Endocrinología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720, Mexico City, Mexico
| | - Claudia Ramírez-Rentería
- Unidad de Investigación Médica en Endocrinología Experimental, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720, Mexico City, Mexico
| | - Aldo Ferreira-Hermosillo
- Unidad de Investigación Médica en Endocrinología Experimental, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720, Mexico City, Mexico.
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Jing GC, Chen Y, Wang L, Xu D, Zheng WJ, Li MT, Zeng XF, Zhang FC. [The 466th case:myasthenia,fever,blurred vision and pancytopenia]. Zhonghua Nei Ke Za Zhi 2018; 57:942-944. [PMID: 30486568 DOI: 10.3760/cma.j.issn.0578-1426.2018.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 45-year-old woman was admitted to the Department of Rheumatology and Immunology, Peking Union Medical College Hospital, due to weakness of the upper limbs, fever, and blurred vision. She was clinically diagnosed as systemic lupus erythematosus overlapped primary biliary cirrhosis, with renal, retinal, hematological and musculoskeletal involvement, combined with severe pulmonary infection and respiratory failure. Treated with glucocorticoids, ursodeoxycholic acid, antibiotics and respiratory support, the patient got better. A couple of days later, her fever recurred and platelets count dropped to 30×10(9)/L, hemoglobin to 78 g/L, fibrinogen to<1.5 g/L, ferritin to 1 640 ng/ml, natural killer (NK) cell count to 8/μl, the activity of NK cells 2% (reference value 9.5%-23.5%), considering the occurrence of hemophagocytic lymphohistiocytosis (HLH). Cytomegalovirus pp65 antigenemia test: 13 positive cells/2×10(5) WBC. Considered the possibility of HLH caused by cytomegalovirus infection and treated by 250 mg ganciclovir intravenous drip twice a day for a full course. The temperature of the patient was gradually reduced to 36.5 ℃, the count of platelets were increased to 229 ×10(9)/L, the hemoglobin was increased to 94 g/L, and the fibrinogen was increased to 3.26 g/L. When there were unexplained critical signs of the primary disease during systemic lupus erythematosus treatment, severe complications such as infection, HLH, thrombotic thrombocytopenic purpura should be taken into account.
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Affiliation(s)
- G C Jing
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | | | - L Wang
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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40
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Abstract
Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are chronic inflammatory diseases of the central nervous system (CNS). They may cause inflammation in the brain, spinal cord and optic nerve. Both conditions must be differentiated from CNS manifestations of other systemic autoimmune diseases such as systemic lupus erythematosus (SLE), Sjögren's syndrome, autoinflammtory diseases and sarcoidosis, since amongst others myelitis and optic nerve inflammation may also occur in these conditions. Nevertheless, coexistence of MS or NMOSD with rheumatic disorders such as SLE or Sjögren's syndrome has also been reported especially in NMOSD. Since the therapeutic approach is different it is important to determine a clear diagnosis. In addition some drugs used in rheumatic disease such as anti-tumor necrosis factor biologics may induce inflammatory disease of the CNS and should be avoided in MS. An interdisciplinary approach between neuroimmunology and rheumatology is important for optimal care and treatment in such patients.
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Affiliation(s)
- C Trebst
- Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - T Kümpfel
- Institut für klinische Neuroimmunologie, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
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41
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Vieira RM, do Nascimento FBP, Barbosa Júnior AA, Pereira ICMR, Sachetto Z, Appenzeller S, Reis F. Spectrum of central nervous system involvement in rheumatic diseases: pictorial essay. Radiol Bras 2018; 51:262-267. [PMID: 30202131 PMCID: PMC6124581 DOI: 10.1590/0100-3984.2016.0066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The rheumatic diseases, which include systemic lupus erythematosus, rheumatoid
arthritis, Behçet's disease, scleroderma, and ankylosing spondylitis, are
characterized by involvement of connective tissue, with multiple manifestations.
In those diseases, there can be involvement of the peripheral or central nervous
system, and that involvement can be primary, presenting as a major feature of
the clinical presentation, or secondary, as an effect of the drugs used in order
to control a given disease or its complications. Knowledge of the wide variety
of imaging findings is crucial to the diagnosis of a rheumatic disease,
especially in the early stages, enabling effective treatment and minimizing
disability. This pictorial essay, presenting cases from the records of two
tertiary teaching hospitals, encompasses cases of patients diagnosed with
rheumatic disease and illustrates the neuroradiological findings on magnetic
resonance imaging and computed tomography, in order to emphasize the importance
of these methods for properly diagnosing rheumatic diseases.
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Affiliation(s)
- Renata Mendes Vieira
- MD, Resident in Radiology and Diagnostic Imaging at the Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | | | - Alcino Alves Barbosa Júnior
- Medical Coordinator of the Neuroradiology Group at the Hospital Israelita Albert Einstein, Professor of Neuromorphology at the Faculdade de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | | | - Zoraida Sachetto
- PhD, Professor in the Department of Internal Medicine of the Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Simone Appenzeller
- Associate Professor in the Department of Rheumatology of the Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Fabiano Reis
- PhD, Head of the Neuroradiology Sector, Professor in the Department of Radiology and Diagnostic Imaging of the Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
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Carvajal Alegria G, Gazeau P, Hillion S, Daïen CI, Cornec DYK. Could Lymphocyte Profiling be Useful to Diagnose Systemic Autoimmune Diseases? Clin Rev Allergy Immunol 2018; 53:219-236. [PMID: 28474288 DOI: 10.1007/s12016-017-8608-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 12/14/2022]
Abstract
Considering the implications of B, T, and natural killer (NK) cells in the pathophysiology of systemic autoimmune diseases, the assessment of their distribution in the blood could be helpful for physicians in the complex process of determining a precise diagnosis. In primary Sjögren's syndrome, transitional and active naive B cells are increased and memory B cells are decreased compared to healthy controls and other systemic diseases. However, their utility to improve the accuracy of classification criteria has not been proven. In early untreated rheumatoid arthritis, proportions of regulatory T cells are constantly reduced, but other patterns are difficult to determine given the heterogeneity of published studies. In systemic lupus erythematosus, the lack of studies using large cohorts of patients and the diversity of the possible pathological mechanisms involved are also important impediments. Nevertheless, transitional B cell and plasma cell proportions are increased in most of the studies, the CD4/CD8 ratio is decreased, and the number of NK cells is reduced. Despite the low number of studies, anomalies of lymphocyte subset distribution was also described in ANCA-associated vasculitis, systemic scleroderma, and myositis. For now, flow cytometric analysis of lymphocyte subsets has focused mainly on specific subpopulations and is more useful for basic and translational research than for diagnostics in clinical practice. However, new modern methods such as mass cytometry and bioinformatics analyses may offer the possibility to simultaneously account for the relative proportions of multiple lymphocyte subsets and define a global profile in homogeneous groups of patients. The years to come will certainly incorporate such global lymphocyte profiling in reclassification of systemic autoimmune diseases.
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Affiliation(s)
- Guillermo Carvajal Alegria
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, BP 824, 29609, Brest cedex, France.,INSERM U1227, European University of Brest, Brest, France
| | - Pierre Gazeau
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, BP 824, 29609, Brest cedex, France
| | - Sophie Hillion
- INSERM U1227, European University of Brest, Brest, France.,Laboratoire d'Immunologie et Immunothérapie, CHRU Morvan, Brest, France
| | - Claire I Daïen
- Rheumatology Department, Lapeyronie Hospital and Montpellier I University, Montpellier, France.,UMR5535, CNRS, Institute of molecular genetic, Montpellier, France
| | - Divi Y K Cornec
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, BP 824, 29609, Brest cedex, France. .,INSERM U1227, European University of Brest, Brest, France.
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Gao H, Ma XX, Guo Q, Zou YD, Zhong YC, Xie LF, Shao M, Zhang XW. [Expression and Clinical Significance of Semaphorin 3A in serum and mononuclear cells in patients with systemic lupus erythematosus]. Zhonghua Yi Xue Za Zhi 2017; 97:370-4. [PMID: 28219195 DOI: 10.3760/cma.j.issn.0376-2491.2017.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To determine the expression of Sema3A in serum and peripheral blood mononuclear cells (PBMC) of patients with systemic lupus erythematosus (SLE), to analysis the correlation of Sema3A expression and SLE clinical manifestations and laboratory indexes, and to evaluate the diagnostic value of Sema3A in patients with SLE. Methods: The concentration of serum Sema3A was detected by enzyme-linked immuno sorbent assay (ELISA) in patients with SLE, healthy controls (HC) and diseases controls. In addition, the mRNA expression level of Sema3A was examined in PBMC by real-time polymerase chain reaction. The correlation of serum Sema3A level and clinical and laboratory features of SLE patients were analyzed. Unpaired t test, Kruskal-Wallis test, Mann-Whitney U test, χ(2) test, Pearson and Spearman correlation analysis were used to statistical analysis by using SPSS 13.0. Results: (1) Serum Sema3A concentration in patients with SLE was significantly lower than that in HC groups (P<0.01). (2) Consistent with the serum level, the Sema3A mRNA level in SLE was lower than that in HC (P=0.001). And the mRNA expression of Nrp-1 in SLE was also lower than that in HC (P<0.01). (3) The serum Sema3A level in patients with SLE was positively correlated with haemoglobin (HGB) (r=0.271, P<0.013), platelet (PLT) (r=0.600, P<0.011), complement 3 (C3) (r=0.234, P=0.0027) and complement 4 (C4) (r=0.159, P=0.434) levels. Whereas, the expression of Sema3A was negatively correlated with SLE disease activity index (SLEDAI) (r=-0.286, P=0.036). (4) Area under curve illustrated by ROC curve was 0.876 (95% CI: 0.846-0.906). The best cut-off value for the diagnosis of SLE was 6.31 μg/L, with the sensitivity of 80.6% and the specificity of 77.5%. The Youden index was 0.581. Above results indicated good validity of Sema3A as a diagnostic marker for SLE. (5) The HGB, PLT, C3 and C4 levels in the group of Sema3A- positiveSLE patients (≤6.31 μg/L) were lower than that in negative group (>6.31 μg/L), while CRP level and SLEDAI of positive group was higher than that in negative group(P<0.05). In addition, the positive rate of antinuclear antibodies (P=0.046) and anticardiolipin antibody (P=0.018) in the Sema3A-negative group were also significantly higher than that of negative group. Conclusions: Sema3A and Nrp-1 was both decreased in serum and PBMC of SLE patients, suggesting that the circulating expression of Sema3A and Nrp-1 was seriously defected in SLE. Circulating Sema3A was significantly correlated with disease activity and blood damage in patients with SLE. The result of ROC curve showed that Sema3A had the potential to be a new diagnostic biomarker in SLE.
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Abstract
An abundant and diverse set of commensal microbial communities covers the body's surfaces, collectively so-called microbiome. It has a functional impact on various immune processes and modulates many health-related processes, including autoimmunity. An active site of microorganism-host interplay is the intestinal mucosa. Growing evidence has helped us to learn how a specific microbiota composition and its functionality determine the intestinal barrier function and, furthermore, modulate pro-inflammatory and anti-inflammatory immune mechanisms in remote organs. In addition, the microbial composition of the skin is important for the functionality of the skin barrier and autoimmune skin diseases. Here, we review the importance of the microbiome for the local and systemic immune system and how a disturbed microbiome-host interaction can affect the development and progression of autoimmune diseases. Understanding these associations will help to unravel new diagnostic and therapeutic approaches for those diseases.
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Zhang Y, Duan XM, Mei HB. [Imaging findings of bone infarction in children with systemic lupus erythematosus]. Zhongguo Gu Shang 2018; 31:272-275. [PMID: 29600681 DOI: 10.3969/j.issn.1003-0034.2018.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate diagnostic value of MRI, X ray and CT for bone infarction in children with systemic lupus erythematosus. METHODS Eleven systemic lupus erythematosus children with bone infarction were retrospectively analyzed from January 2015 to January 2017 , and tested by MRI, X-ray and CT. Among them, including 1 male and 10 females aged from 6 to 16 years old with an average of 13 years old. All patients were detected by MRI, 9 patients were detected by X-ray and 3 patients were detected by CT, imaging findings were analyzed. RESULTS The location of bone infarction involved 60 sits, 30 sites located on metaphyseal-diaphyseal region, 8 located on patella, 21 located on epiphysis, and 1 located on talus. Focus of 11 patients were detected by MRI, the main manifestation showed geographic change, long T1 and T2 signal could seen around focus, and showed double ring sign and three ring sign; 5 of 9 patients by X-ray examination detected focus;2 of 3 patients by CT examination detected focus. No abnormity seen at early stage by X-ray and CT examination, and low density focus around harden edge at chronic stage. CONCLUSIONS MRI could display bone fracture at early stage, X-ray and CT could only display lesion at chronic stage, MRI is the most effective method in diagnosing bone infarction.
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Affiliation(s)
| | - Xiao-Min Duan
- Imaging Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China;
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Qin L, Qiu ZF, Xie J, Geng TR, Zhao JL, Wan L, Li TS. [Opportunistic infection in systemic lupus erythematosus patients: the disease spectrum and the characteristics of peripheral lymphocyte subsets]. Zhonghua Nei Ke Za Zhi 2018; 57:32-36. [PMID: 29325308 DOI: 10.3760/cma.j.issn.0578-1426.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the common opportunistic infections and the characteristics of peripheral lymphocyte subsets in patients with systemic lupus erythematosus (SLE). Methods: From December 2013 to December 2016, peripheral lymphocyte subsets were consecutively detected by flow cytometry in treated SLE patients with or without opportunistic infections (OIs) . The lymphocyte subsets in healthy donors were used as normal control group. Results: A total of 145 treated SLE patients were enrolled including 108 with OIs and 37 without OIs. The common OIs were cytomegalovirus (CMV) diseases (66/108), Pneumocystis jirovecii pneumonia (PJP, 16/108), other fungal infections (16/108), Epstein-Barr virus (EBV, 15/108) and tuberculosis (14/108). Compared with treated SLE without OIs, total lymphocyte, CD(4+) T, and CD(8+) T lymphocyte counts were significantly reduced in SLE with OIs [1 260 (780, 1 810) cells/μl vs. 565 (399, 1 043) cells/μl, P<0.001; 485 (280, 811) cells/μl vs. 173 (95, 327) cells/μl, P<0.001; 464 (339, 764) cells/μl vs. 265 (158, 424) cells/μl, P=0.003, respectively]. Conclusions: The common OIs in treated SLE patients were CMV diseases, PJP, other fungi, EBV and tuberculosis. OIs are prone to develop in SLE patients with severe lymphocytopenia, especially CD(4+) T cell depletion.
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Affiliation(s)
| | | | | | | | | | | | - T S Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that affects many different organ systems, with excessive production of type I interferons (IFNs) and autoantibodies against nucleic acids as hallmarks. Activation of the type I IFN system in SLE is due to continuous stimulation of plasmacytoid dendritic cells by endogenous nucleic acids, leading to sustained type I IFN production. This is reflected by an overexpression of type I IFN-regulated genes or an IFN signature. Type I IFNs have effects on both the innate and adaptive immune systems, which contribute to both loss of tolerance and the autoimmune disease process. In this review, we discuss the current understanding of IFNs in SLE, focusing on their regulation, the influence of genetic background, and environmental factors and therapies that are under development aiming to inhibit the type I IFN system in SLE.
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Affiliation(s)
- Anders A Bengtsson
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, 22185 Lund, Sweden.
| | - Lars Rönnblom
- Department of Medical Sciences, Science for Life Laboratory, Section of Rheumatology, Uppsala University, SE-751 85 Uppsala, Sweden.
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48
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Escudié JB, Rance B, Malamut G, Khater S, Burgun A, Cellier C, Jannot AS. A novel data-driven workflow combining literature and electronic health records to estimate comorbidities burden for a specific disease: a case study on autoimmune comorbidities in patients with celiac disease. BMC Med Inform Decis Mak 2017; 17:140. [PMID: 28962565 PMCID: PMC5622531 DOI: 10.1186/s12911-017-0537-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 09/12/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Data collected in EHRs have been widely used to identifying specific conditions; however there is still a need for methods to define comorbidities and sources to identify comorbidities burden. We propose an approach to assess comorbidities burden for a specific disease using the literature and EHR data sources in the case of autoimmune diseases in celiac disease (CD). METHODS We generated a restricted set of comorbidities using the literature (via the MeSH® co-occurrence file). We extracted the 15 most co-occurring autoimmune diseases of the CD. We used mappings of the comorbidities to EHR terminologies: ICD-10 (billing codes), ATC (drugs) and UMLS (clinical reports). Finally, we extracted the concepts from the different data sources. We evaluated our approach using the correlation between prevalence estimates in our cohort and co-occurrence ranking in the literature. RESULTS We retrieved the comorbidities for 741 patients with CD. 18.1% of patients had at least one of the 15 studied autoimmune disorders. Overall, 79.3% of the mapped concepts were detected only in text, 5.3% only in ICD codes and/or drugs prescriptions, and 15.4% could be found in both sources. Prevalence in our cohort were correlated with literature (Spearman's coefficient 0.789, p = 0.0005). The three most prevalent comorbidities were thyroiditis 12.6% (95% CI 10.1-14.9), type 1 diabetes 2.3% (95% CI 1.2-3.4) and dermatitis herpetiformis 2.0% (95% CI 1.0-3.0). CONCLUSION We introduced a process that leveraged the MeSH terminology to identify relevant autoimmune comorbidities of the CD and several data sources from EHRs to phenotype a large population of CD patients. We achieved prevalence estimates comparable to the literature.
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Affiliation(s)
- Jean-Baptiste Escudié
- Georges Pompidou European Hospital (HEGP), AP-HP, Paris, France
- INSERM UMRS 1138, Paris Descartes University, Paris, France
- Pôle Informatique Médicale et Santé Publique, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - Bastien Rance
- Georges Pompidou European Hospital (HEGP), AP-HP, Paris, France
- INSERM UMRS 1138, Paris Descartes University, Paris, France
| | - Georgia Malamut
- Georges Pompidou European Hospital (HEGP), AP-HP, Paris, France
| | - Sherine Khater
- Georges Pompidou European Hospital (HEGP), AP-HP, Paris, France
| | - Anita Burgun
- Georges Pompidou European Hospital (HEGP), AP-HP, Paris, France
- INSERM UMRS 1138, Paris Descartes University, Paris, France
| | | | - Anne-Sophie Jannot
- Georges Pompidou European Hospital (HEGP), AP-HP, Paris, France
- INSERM UMRS 1138, Paris Descartes University, Paris, France
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Li HJ, Du Q, Wang SY, Guan SQ, Zhan HH, Tian W, Shao YX, Zhang ZY, Mei YF. [The application and influence factors of FACIT Fatigue Scale in SLE patients]. Zhonghua Yi Xue Za Zhi 2017; 97:2775-8. [PMID: 28954338 DOI: 10.3760/cma.j.issn.0376-2491.2017.35.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the application and influence factors of the Functional Assessment of Chronic Illness Therapy (FACIT-Fatigue) scale in patients with systemic lupus erythematosus (SLE). Methods: SF-36 questionnaires were used to estimate the health-related quality of life (HRQOL) of SLE patients in Chinese Han population.FACIT-Fatigue scale was applied to measure fatigue.Disease activity was determined by SLE disease activity index (SLEDAI), meanwhile demographic parameters such as gender, disease duration, etc. were recorded. Results: A total of 223 patients with SLE were enrolled in the survey.FACIT-Fatigue scale was negatively correlated with SF-36 (P<0.05). FACIT-Fatigue scale of patients with SLE were correlated with education, erythrocyte sedimentation rate (ESR), C3, and SLEDAI score (P<0.05). The degree of bodily pain, the status of mental health and the amount of complement C3 were the independent factors of FACIT-Fatigue (P<0.1). Conclusion: FACIT-Fatigue scale is related to disease activity, quality of life, age and ESR in patients with SLE.There fore, reduce the disease activity and improve the quality of life of SLE patients may be helpful to reduce the fatigue of patients with SLE.
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Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse manifestations, and its pathogenesis is unclear and complicated. Infection and SLE are similar in that they both cause inf lammatory reactions in the immune system; however, one functions to protect the body, whereas the other is activated to damage the body. Infection is known as one of the common trigger factors for SLE; there are a number of reports on infectious agents that provoke autoimmune response. Several viruses, bacteria, and protozoa were revealed to cause immune dysfunction by molecular mimicry, epitope spreading, and bystander activation. In contrast, certain pathogens were revealed to protect from immune dysregulation. Infection can be threatening to patients with SLE who have a compromised immune system, and it is regarded as one of the common causes of mortality in SLE. A clinical distinction between infection and lupus f lare up is required when patients with SLE present fevers. With a close-up assessment of symptoms and physical examination, C-reactive protein and disease activity markers play a major role in differentiating the different disease conditions. Vaccination is necessary because protection against infection is important in patients with SLE.
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Affiliation(s)
| | - Chang-Hee Suh
- Correspondence to Chang-Hee Suh, M.D. Department of Rheumatology, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5118 Fax: +82-31-219-5157 E-mail:
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