Abstract
Background/objective Patients with systemic lupus erythematosus (SLE) are at increased risk for adverse pregnancy outcomes and cardiovascular disease (CVD). The objective of this exploratory study was to investigate the association between a history of adverse pregnancy outcomes and subsequent risk of subclinical CVD assessed by imaging studies and verified clinical CVD events in 129 women with SLE. Methods The occurrence of adverse pregnancy outcomes, specifically pre-eclampsia, preterm birth and low birth weight was ascertained by questionnaire. Subclinical CVD was assessed by coronary artery calcium (CAC) as measured by electron beam CT and carotid plaque measured by B mode ultrasound. Clinical CVD events were verified by medical record review. Logistic regression was used to estimate the association of pregnancy complications with occurrence of subclinical CVD and clinical CVD with a priori adjustment for age, which is associated with CVD and SLE disease duration as a measure of SLE disease burden. Results Fifty-six women reported at least one pregnancy complication while 73 had none. Twenty-six women had at least one pregnancy complicated by pre-eclampsia and were more likely to have a CAC score greater than or equal to 10 (adjusted OR=3.7; 95% CI 1.2 to 11.9), but the presence of plaque was not associated with this pregnancy complication, OR=1.1, (95% CI 0.4 to 2.8). Low birth weight and preterm birth were not associated with CAC or plaque. Conclusions Patients with SLE with a history of pre-eclampsia had a higher rate of subclinical CVD as measured by CAC score. Future studies are needed to confirm the relationship between adverse pregnancy outcomes and subsequent subclinical CVD and clinical CVD events.
Highlights
Prevention of systemic lupus erythematosus (SLE) presents many challenges
In further studies we have demonstrated that the BANK1 splice variant is associated with significantly reduced expression of the Δ2 isoform and that the risk haplotype is further associated with blunted proximal BCR signaling in naïve B cells and enhanced p-AKT in memory B cells
In multivariable regression analyses controlling for age and years since diagnosis, we found a significant interaction between unfair treatment and attributions to racial discrimination (b = -0.52, SE = 0.24, P = 0.03)
Summary
Prevention of systemic lupus erythematosus (SLE) presents many challenges. By contrast, prevention of acquired immunodeficiency syndrome (AIDS) is relatively straightforward: an infective agent has been identified, risk behaviors are well-delineated, antiviral therapeutics are highly effective and neonates have been apparently cured. We are interested in understanding the role of IRF5 in human B cells since previous studies in mice implicated a role for IRF5 in effector B-cell development and function and murine models of lupus lacking the Irf gene showed reduced ANA, glomerulonephritis and pathogenic autoantibody production. Conclusions: These results identify mTOR activation to be a trigger of IL-4 production and necrotic death of DN T cells, predictor of disease flares, and effective target for treatment in patients with SLE. Methods: TLR7-mediated experimental lupus was induced in wild-type and knockout mice by pristane and the expression of IFN-I stimulated genes and numbers of plasmacytoid dendritic cells (pDCs) and inflammatory (Ly6Chi) monocytes were assessed by PCR and flow cytometry, respectively. BILAG and SELENA SLEDAI flares and corticosteroid usage were assessed 4 weekly
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