Geographies of wellbeing and chronic illness: A Canadian case study

Nonstandard and adjunctive medical therapies for systemic lupus erythematosus

Studies have demonstrated that male systemic lupus erythematosus (SLE) patients present with atypical manifestations, serious kidney involvement and worse prognosis. This article summarizes the findings obtained from the literature review of 16 studies to obtain an understanding of the gender correlation with SLE and lupus nephritis. We compared the influence of gender on various factors of SLE like incidence of lupus nephritis, age at manifestation of SLE, time between SLE manifestation and lupus nephritis diagnosis, frequency of dialysis, mortality risk and biopsy findings. Studies included in our review composed of remote published work, case-control studies, case reports and cross-sectional studies. Of 16 studies, 14 were conducted exclusively on lupus nephritis in SLE with comparison of gender correlation and remaining 2 studied SLE generally without any gender comparison. Six studies pointed to an increase in incidence of lupus nephritis in males, 9 studies demonstrated no disparity in gender, and one study showed contradicting results. In addition, 4 studies pointed that males had a more severe renal outcome as revealed by laboratory tests. Interestingly the age at which SLE manifests was the same in both genders according to 2 studies. Moreover, the frequency of dialysis and remission were similar between both genders. There is no consensus if these atypical manifestations are more common in males. Although some studies do show a significant increase in lupus nephritis among male SLE patients, others showed no difference or contradicting results. Hence, we suggest further studies comparing the disease manifestations.

Lupus nephritis (LN) is the leading cause of death in systemic lupus erythematosus (SLE), so its early detection and treatment is of utmost importance. Features of the onset, clinical signs, certain morphological classes, as well as more aggressive therapy make it possible to assign SLE with LN to a distinct disease phenotype.Objective: to characterize the clinical, immunological and morphological features of the SLE phenotype with a predominant kidney involvement based on a comparative analysis of patients with LN and without LN.Patients and methods. The study included 400 patients with SLE who met the 2012 SLICC criteria and were hospitalized to V.A. Nasonova Research Institute of Rheumatology from 2013 to 2021. The diagnosis of LN was established in 192 (48%) patients, of which in 82 (43%) it was confirmed by pathological study of kidney biopsy specimens (the SLE group with LN). In 208 (52%) patients, no kidney damage was observed, and they constituted the SLE group without LN.All patients underwent a standard examination with an assessment of disease activity according to the SLEDAI-2K index, irreversible changes in organs according to the SLICC damage index, immunological disorders, clinical and biochemical blood tests, urinalysis according to unified methods, glomerular filtration rate, as well as pathological examination of kidney biopsy specimens for confirmation of LN in the presence of an appropriate clinical picture. In patients of both groups, a comparative study of the main clinical, laboratory, immunological manifestations of SLE, the features of the disease onset, its first clinical signs, possible trigger factors, and the drugs used was carried out.Results and discussion. In the LN group, insolation was more likely to trigger the development of SLE than in the group without LN (respectively, in 26% and 13% of cases; p=0.007). In turn, SLE without kidney damage more often than SLE with LN debuted during pregnancy or after childbirth.The first signs of the disease in almost 40% of patients with LN were proteinuria and/or changes in urinary sediment, edema, increased blood pressure, the development of LN in some cases was preceded by polyarthritis or combined lesions of the skin and joints, but no later than 6 months, signs of kidney damage appeared. In the SLE group without LN, polyarthritis (in 33%), combined lesions of the skin and joints (in 26%), and Raynaud's syndrome (in 16%; p <0.0001) were more often observed at the onset. In patients with LN, erythematous lesions of the facial skin ("butterfly", in 42%), serositis (exudative pleuritis — in 44%, pericarditis — in 46%, ascites and hydrothorax — in 5%; p<0.0001), as well as hematological disorders such as anemia (in 63%), leukopenia (in 49%) and thrombocytopenia (in 42%) were present more frequently. With the development of LN, an acute course and high activity of the disease occurred significantly more often. In the study of immunological parameters in the group without LN, lupus anticoagulant (in 6%) and antibodies to SS-A/Ro and SS-B/La (in 18 and 9% of patients, respectively) were detected significantly more often, while in the LN group — hypocomplementemia (in 81%; p<0.0001). Therapy also differed significantly: patients with LN received higher doses of glucocorticoids (p<0.0001), mycophenolate mofetil, and cyclophosphamide.Conclusion. SLE with LN can be considered a distinct disease phenotype with a set of characteristics (clinical and laboratory parameters, response to therapy, prognosis) that distinguish it from other SLE variants.

Background Systemic lupus erythematosus (SLE) is an autoimmune disease that causes inflammation in connective tissues and can involve multiple organs systems. Lupus nephritis (LN) is an inflammatory kidney disease caused by SLE. There is a gap in the literature regarding the standard of care in SLE and LN patients. Objectives This study generated real world medication use among SLE and LN patients. Methods This retrospective study used data from two large administrative databases in the US: Truven Health MarketScan® and Optum® databases to identify adult patients (≥18 years of age) with ≥2 medical claims on different dates for SLE or LN diagnoses from 01JAN2013-31DEC2015. SLE was identified using the International Classification of Diseases, 9th and 10th Revision, Clinical Modification [ICD-9-CM] codes (710.0) OR ICD-10-CM (M32.10-M32.19, 32.8, 32.9). LN was captured as a subset of SLE using [ICD-9-CM: 710.0 AND (581.81 or 582.81 or 583.81); OR (ICD-10-CM:M32.14)]. The first SLE or LN diagnosis was designated as the index date. Patients were required to have continuous health plan enrollment for 1 year pre-index date (baseline period) and 1 year post-index date (follow-up period) and no prior SLE/LN diagnosis claims or belimumab medical/prescription claim during the baseline period to ensure incident patients were captured. The Truven Health MarketScan® and Optum® databases were pooled together and duplicates were identified and retained in MarketScan® only. Patient demographics and clinical characteristics during the baseline period were assessed. SLE treatment used during the follow-up period was evaluated and the proportion of patients that used SLE medications and average number of medical/prescription claims (#Rx) for each medication were provided. Results A total of 31,345 patients were identified including 30,086 SLE and 1,259 LN patients. Key results are shown in Table 1. The mean age was 52.7 years for SLE and 48.3 years for LN patients. Over 80% of the patients were female, with a mean Charlson Comorbidity Index (CCI) score of 1.1 and 1.8 for SLE and LN patients respectively. The most common comorbidities at baseline were hypertension and infections. Corticosteroids (SLE= 58.3%, #Rx=4.5; LN=66.2%, #Rx=6.5) and hydroxychloroquine (SLE=43.4%, #Rx=5.8; LN=40.7% #Rx=6.2) were the most commonly used SLE medications during 1-year follow up period. Approximately 2% of patients used biologics including belimumab (SLE=1.1%, #Rx=8.8; LN=1.4%, #Rx=8.3) and rituximab (SLE=0.9%, #Rx=4.2; LN=2.1%, #Rx=4.0). Conclusion Our findings indicate a nominal use of biologics (∼2%) among SLE and LN patients. Corticosteroids and hydroxychloroquine were the most commonly used SLE treatments. These data reveal an unmet need for availability of advanced therapy to treat SLE and LN. Future studies are warranted to understand the underlying causes. Disclosure of Interests: Lin Xie Grant/research support from: Janssen Research & Development, LLC, Furaha Kariburyo Grant/research support from: Janssen Research & Development, LLC, Janvi Sah Grant/research support from: Janssen Research & Development, LLC, Jennifer H. Lofland Employee of: Janssen Global Commercial Strategic Organization, Nan Li Shareholder of: J&J, Employee of: Janssen Scientific Affairs, LLC

Systemic lupus erythematosus (SLE) is a life-long, life-limiting and multi-systemic autoimmune disease. Glomerulonephritis is one of the most serious manifestations of SLE. Younger children have an increased incidence, severity and morbidity of lupus nephritis (LN) compared with adult-onset disease. Monocyte chemoattractant protein-1 (MCP-1) enhances leukocyte adhesiveness and endothelial permeability in the kidneys of murine and human LN models. Our study aimed to assess the role of urinary MCP-1 in the early diagnosis of LN activity. Sixty children, of whom 45 children aged from six to 12 years old and of both sexes (15 SLE patients without nephritis, 15 active LN and 15 inactive LN) fulfilling the American College of Rheumatology Classification Criteria for SLE were studied in comparison with 15 healthy subjects. We investigated the serum and urinary MCP-1 in all groups using the enzyme-linked immunosorbent assay test. Urinary MCP-1 was significantly higher in active LN in comparison with inactive LN and controls, and also significantly higher in inactive LN in comparison with SLE without nephritis and controls. There was also a significant difference between SLE without nephritis and controls. Serum MCP-1 was significantly higher in the group with active LN in comparison with the inactive group and SLE without nephritis and controls, but there was no significant difference between SLE and controls. The urinary MCP-1 level correlated well with SLE disease activity as measured by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Urinary MCP-1 correlates positively with proteinuria, blood urea nitrogen level and creatinine and negatively with hemoglobin and creatinine clearance. We concluded that measurement of MCP-1 in urine may be useful for monitoring the severity of renal involvement in SLE. We recommend measuring urinary MCP-1 in pediatric SLE for the early diagnosis of LN and for the evaluation of the severity of renal involvement.

Background:Lupus nephritis (LN) is one of the most serious organic manifestations of systemic lupus erythematosus (SLE). Ethnicity can contribute to disparities in the prevalence and disease activity of LN.Objectives:To assess the prevalence of LN in Brazilian patients with SLE and to determine factors associated with LN activity across the country.Methods:This cross-sectional study (GSK Study 207353) was carried out through face-to-face interviews and review of medical records (12-month study period). Adult patients with SLE (American College of Rheumatology [ACR] criteria, 1997) were included. Five SLE reference teaching centres were selected: North (NO), Northeast (NE), Midwest (CO), Southeast (SE), and South (SU). Patients with another disease whose morbidity surpassed SLE were excluded. LN was defined as reported in the medical record or history of confirmed renal biopsy; disease activity by pre-defined changes in SLE Disease Activity Index (SLEDAI) or the patient’s kidney disease during the study. Activity was assessed during (T0), 6 months before (T6), and 12 months before (T12) the interview. Systemic Lupus International Collaborating Clinics/ACR Damage Index score mapped damage accrual. Two pairings were performed, aiming to discriminate factors associated with LN and its activity, respectively. Matching technique was used to select similar individuals based on propensity scores, obtained from a logistic regression model. A bootstrapping method explored characteristic variables associated with the risk of progressing to LN.Results:Overall, 300 Brazilian patients with SLE were included in the study. Two groups were paired: LN group (N=150) and non-LN group (N = 141). The prevalence of LN in the paired sample (N=291) was 51.5%, with a disparity between centres (p<0.001; Figure 1A). Most patients were female (LN: 92.7%; non-LN: 94.3%) and the mean (standard deviation [SD]) age for the LN and non-LN groups was 39.46 (11.86) and 43.96 (12.18), respectively. History of serositis was associated with the presence of LN (42 [28.0%] vs 21 [14.9%] non-LN; p=0.010). Type IV histological class predominated in both groups, with no disparity between centres. Social disparities were noted between groups. Non-active workers prevailed among the LN group (115 [76.7%] vs 98 [69.5%] for non-LN, p=0.024).When pairing for disease activity at T12, 73 (50.3%) patients with LN (N=145) had active disease. There was regional disparity in terms of disease activity (Figure 1B), with a predominance of active LN in the NO (28 [68.3%]) and SU (16 [55.2%], p=0.026). Type IV histological class was the component most associated with active LN (active: 32 [43.8%]; non-active: 11 [15.3%], p<0.001). Variation in SLEDAI during the study period discriminated between active and non-active LN. The mean (SD) SLEDAI score at T12 was substantially higher in those with active LN compared with non-active LN (7.18 [4.83] vs 2.47 [4.63], p<0.001). As for the pattern of care, corticosteroids users prevailed in those with active LN (62 [84.9%] vs 45 [62.5%] for non-active LN, p=0.004). There was no disparity in the use of immunosuppressants, with the exception of cyclophosphamide use, noted among 16 (21.9%) patients with active LN and 6 (8.3%) patients with non-active LN (p=0.041). Psychotropic or anticonvulsant use was higher in patients with non-active LN (32 [44.4%] vs 17 [23.3%] patients with active LN, p=0.012). Consultation with a neurologist was verified in 15 (20.8%) patients with non-active LN and 6 (8.2%) with active LN (p=0.055). Hospitalisation occurred in 17 patients with non-active (23.6%) and active (23.3%) LN.Conclusion:Disparities in the prevalence of LN and its activity were evident between the regions across Brazil, highlighting differences in clinical factors, regional factors, and patterns of care.Funding:GSKFigure 1.Prevalence of A) LN among regional centres, comparing them to disease activity profile and prescriptive practice, and B) Active and non-active LN according to prescriptive practiceCQ, chloroquine; HCQ, hydroxychloroquine*At T12Acknowledgements:Medical writing assistance was provided by Helen Taylor, Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GSK.Disclosure of Interests:Mirhelen Abreu Grant/research support from: GSK, Amgen, Biogen, Libbs, Odirlei Monticielo Speakers bureau: GSK, AbbVie, UCB, Roche, Novartis, Consultant of: GSK, AbbVie, Janssen, Vander Fernandes Speakers bureau: Janssen, Novartis, Roche, AbbVie, Pfizer, Grant/research support from: Novartis, GSK, Pfizer, Alexandre Cristovão Maiorano: None declared, Fernando dos Santos Beserra: None declared, Flavia Lamarao Employee of: GSK, Nathalie David Shareholder of: GSK, Employee of: GSK, Bruna de Veras Employee of: GSK, Blanca Bica: None declared, Domingos Sávio Nunes de Lima Grant/research support from: GSK, Marta Maria das Chagas Medeiros: None declared

Lupus nephritis (LN) remains one of the most severe manifestations in patients with systemic lupus erythematosus (SLE). Onset and overall LN risk among SLE patients remains considerably difficult to predict. Utilizing a territory-wide longitudinal cohort of over 10 years serial follow-up data, we developed and validated a risk stratification strategy to predict LN risk among Chinese SLE patients - Risk and Factors associated with disease manifestations in systemic Lupus Erythematosus - Lupus Nephritis (RIFLE-LN). Demographic and longitudinal data including autoantibody profiles, clinical manifestations, major organ involvement, LN biopsy results and outcomes were documented. Association analysis was performed to identify factors associated with LN. Regression modelling was used to develop a prediction model for 10-year risk of LN and thereafter validated. A total of 1652 patients were recruited: 1382 patients were assigned for training and validation of the RIFLE-LN model; while 270 were assigned for testing. The median follow-up duration was 21 years. In the training and validation cohort, 845 (61%) of SLE patients developed LN. Cox regression and log rank test showed significant positive association between male sex, age of SLE onset and anti-dsDNA positivity. These factors were thereafter used to develop RIFLE-LN. The algorithm was tested in 270 independent patients and showed good performance (AUC = 0·70). By using male sex, anti-dsDNA positivity, age of SLE onset and SLE duration; RIFLE-LN can predict LN among Chinese SLE patients with good performance. We advocate its potential utility in guiding clinical management and disease monitoring. Further validation studies in independent cohorts are required.

Background and Aims Systemic lupus erythematosus (SLE) often affects the kidneys, and is associated with morbidity and mortality. Ethnic variations in clinical response to treatment and outcomes have been described. Information on real-life, long-term cohorts of the Middle Eastern Israeli population is lacking. We aimed to characterize the prevalence and long-term outcomes of kidney involvement in SLE patients in Israel and to identify variables associated with lupus nephritis (LN) and end-stage kidney disease (ESKD). Method This retrospective study, conducted between 2014-2023, included adult patients with SLE diagnosed for at least 12 months. Kidney involvement was based on a diagnosis of LN on a kidney biopsy. SLE patients without LN served as controls. Associated variables were collected including socio-demographics, disease-related characteristics, kidney-related factors, comorbidities, and all-cause mortality. Results A total of 182 adult patients with SLE were included. Of them, 54 (29.6%) had LN. Mean follow-up since diagnosis was 16.2 ± 13.8 years. Compared to the control group, patients with LN were diagnosed with SLE at younger ages (26.8 ± 12.9 vs. 35.5 ± 15.4 years, p < 0.01). Patients with LN and controls had similar proportions of females/males and Jewish/Arab patients (Table 1), and had comparable baseline eGFR before LN diagnosis (110 ± 48 vs. 107 ± 39 ml/min/m2, p = 0.66). The LN group had lower complement C3 levels at diagnosis and higher dsDNA titers (p = 0.001, 0.023 respectively; Table 1). Patients with LN had more hospitalization for SLE exacerbations [38.4% vs. 24.5%, odds ratio (OR) 1.9, 95% confidence interval (CI) 1-3.9, p = 0.06]. Of 54 patients with LN, 45 had available treatment information. All patients were treated with hydroxychloroquine, 19 patients (42.2%) were treated with cyclophosphamide, and 36 (80%) were treated with mycophenolate mofetil or mycophenolic acid. During follow-up of the LN patients, 5 patients (9.3%) were diagnosed with diabetes, 21 patients (38.9%) were diagnosed with hypertension, 5 patients (9.3%) had a stroke and 6 patients (11.1%) had an acute coronary syndrome. Eight of the LN patients (14.8%) developed ESKD as compared with one patient (0.8%) of the controls (OR 22.1, 95% CI 2.7-181.5, p < 0.001). On univariate analysis, ESKD was significantly associated with LN, hypertension, heart failure, and non-employment status. No difference in the rate of ESKD was found between Jewish and Arab patients. On multivariate regression analysis, LN and hypertension were the most important predictors for developing ESKD. Mortality among patients with ESKD was 22% vs. 4.6% among non-ESKD patients (p = 0.02) )Fig. 1). Conclusion This long-term study on Israeli SLE patients reveals that despite advances in SLE treatments, LN is associated with significant morbidity and mortality. The elevated risk of ESKD, particularly associated with LN and hypertension, underscores the imperative for targeted interventions to improve outcomes.

Lupus nephritis (LN) is the main manifestation of systemic Lupus Erythematosus (SLE). MicroRNAs (miRNAs) and autoantibodies could be suitable candidate biomarkers of LN. This study evaluates the expression of circulating miR-148a and miR-126 along with anti-dsDNA, anti-C1q, and anti-C3b autoantibodies in SLE patients with LN (SLE + LN). 30 women with SLE, 30 women with SLE + LN, and 25 women as healthy controls (HCs) were enrolled in this study. The plasma expression of selected miRNAs was evaluated by real-time PCR. The serum level of anti-dsDNA, C1q, and C3b antibodies was measured by the ELISA. The expression of miR-148a was significantly increased in SLE and SLE+LN groups compared with the control group. No significant difference was found in the expression of miR-126 among the groups. The frequency of autoantibodies was significantly higher in the SLE + LN group than SLE. The Higher levels of circulating miR-148a in the SLE samples compared with the HCs suggest that this miRNA could be a reliable biomarker for SLE patients (with or without LN). Also, autoantibodies against dsDNA, C1q, and, C3 could be used for the prediction of SLE nephritis, independently. However, further studies are needed to confirm these findings.

Background and Aims 7%–10% of patients with early-onset systemic lupus erythematosus (SLE) underlie a monogenic cause and lupus nephritis (LN) is one of the earliest and more severe complications affecting long-term prognosis. In this study we analyze the clinical, laboratory and prognostic differences between monogenic and non-monogenic LN and the predictors of end-stage kidney disease (ESKD). Method In this Italian multicenter retrospective study we enrolled patients with kidney biopsy-proven early-onset LN (biopsy performed ≤18 years old) and analyzed the data at disease onset and last follow-up. Whole exome sequencing was only performed in a fraction of patients. We defined patients with monogenic LN as patients with mutations in genes known to cause monogenic SLE. Results We collected data from 84 patients with a median age at diagnosis of LN of 14 years and a median follow-up of 10.6 years. During follow-up more than 50% of patients had at least one renal flare, 12% developed severe adverse effects from immunosuppressive therapy (mainly osteoporosis and cataracts), one patient died for sepsis and 26.2% developed stage 3 or more chronic kidney disease. Thirty patients underwent whole exome sequencing and a monogenic cause was found in 9 patients (30%). Genetic data of these patients are shown in Table 1. Patients with monogenic LN showed, compared to non-monogenic LN, an earlier age of SLE onset (6 vs 14 years) and LN (9 vs 15 years) diagnosis, a more balanced M:F ratio, a more severe renal presentation (eGFR 43 ml/min/1.73 m vs 70 ml/min/1.73 m), a different percentage of ANCA (43 vs 15%), anti-dsDNA (38 vs 76%) and anti-ENA (14 vs 48%) positivity, a higher prevalence of renal thrombotic microangiopathy (TMA) at biopsy (40 vs 7%) and a higher probability of ESKD. 56% of patients with monogenic LN reached ESKD (after a median of 5.3 years) compared to 14% of non-monogenic patients (median 7.5 years). The renal survival analysis is shown in Fig. 1. Lower age and a lower eGFR at LN diagnosis, the presence of renal TMA, involvement of the nervous system and monogenic cause were predictors of ESKD at Cox univariate regression model (Table 2). Conclusion Early-onset LN is a severe disease, with a substantial risk of ESKD. Monogenic LN is a distinct pathological entity that differs from non-monogenic LN for its severity, renal prognosis, autoantibody profile and histopathology. The genetic study in early-onset LN provides relevant prognostic implications and allows for further knowledge of disease pathogenic mechanisms.

ABSTRACTObjective: Lupus nephritis (LN) is the most common and serious manifestation of systemic lupus erythematosus (SLE) and an important cause ofmorbidity and mortality. Although diagnosis of LN is straight forward in a patient with SLE and proteinuria, and active urine sediment and perhapsrenal insufficiency, still renal biopsies are required at diagnosis to enable classification of nephritis severity, to provide prognostic information, and toguide treatment. Hence, the objective of this study is to determine the frequency of distribution of different classes of LN based on renal biopsy reportsand to correlate it with various laboratory findings.Methods: Retrospective study was done in all patients with LN who had at least one representative renal biopsy and evaluated in NephrologyDepartment of SCB Medical College, Cuttack, in 6-month duration. Various laboratory values were recorded and correlated with histopathologicallupus classifications.Results: Out of 35 patients enrolled, 33 (94.28%) were females and 2 (5.71%) were males. Mean age was 27.53±12.26 years. Majority of cases belongto Class IV followed by Class V. Patients of Class IV LN have a significantly low hemoglobin level. Similarly, serum urea and creatinine are higher inGroup IV than other groups, and serum creatinine was found to be significant. 24 hrs urinary protein excretion has a significant correlation with theclasses of LN.Conclusion: This study suggests some meaningful correlation between laboratory findings and histopathological lupus classification. This study alsosuggests that renal biopsies are still beneficial for better evaluation of renal status and determination of LN classes.Keywords: Clinico-pathological correlation, Lupus nephritis, Biopsy.

Background: Lupus nephritis (LN) is an inflammation of the kidneys that is related to systemic lupus erythematosus (SLE). This study aimed to evaluate the differences in clinical and laboratory characteristics between LN and non-LN SLE patients. Methods: We conducted a retrospective analysis of medical records collected from SLE patients treated at the University Hospital in Kraków, Poland, from 2012 to 2022. All patients met the 2019 European League Against Rheumatism and the American College of Rheumatology (EULAR/ACR) criteria for SLE. Results: Among 921 SLE patients, LN was documented in 331 (35.94%). LN patients were younger at SLE diagnosis (29 vs. 37 years; p < 0.001) and had a male proportion that was 2.09 times higher than the non-LN group (16.62% vs. 7.97%; p < 0.001). They were more often diagnosed with serositis and hematological or neurological involvement (p < 0.001 for all). Hypertension and hypercholesterolemia occurred more frequently in these patients (p < 0.001 for both). LN patients exhibited a higher frequency of anti-dsDNA, anti-histone, and anti-nucleosome antibodies (p < 0.001 for all). Conversely, the non-LN group had a 1.24-fold (95% CI: 1.03-1.50; p = 0.021) increase in the odds ratio of having positive anti-cardiolipin IgM antibody results. LN patients were more frequently treated with immunosuppressants. The risk factors for experiencing at least three LN flares included female sex, younger age at the onset of LN or SLE, LN occurring later than SLE onset, the presence of anti-nucleosome or anti-dsDNA antibodies, and certain SLE manifestations such as myalgia, arthritis, proteinuria > 3.5 g/day, and pathological urinary casts in the urine sediment. Conclusions: LN patients differ from non-LN patients in the age of SLE diagnosis, treatment modalities, and autoantibody profile and have more frequent, severe manifestations of SLE. However, we still need more prospective studies to understand the diversity of LN and its progression in SLE patients.

Background:Patients with lupus nephritis (LN) face 9x higher risk of premature cardiovascular disease (CVD) compared to patients with systemic lupus without nephritis and healthy peers. Renin-angiotensin system (RAS) blocking medications...

Background:Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE) and can be present in both early-onset (age less than 50) (eSLE) and late-onset lupus (age greater than...

To explore whether Soluble tumor necrosis factor-receptor 1 (sTNF-R1) and linc0597 can be used as indicators for disease activity and diagnosis of lupus nephritis (LN). Eighty LN patients treated in our hospital were enrolled as the LN group, while 60 Systemic Lupus Erythematosus (SLE) patients without nephritis were included in the SLE group, and 50 healthy subjects who conducted physical examination during the same period as the control group. After admission, 5 mL of venous blood was taken from all the study subjects to measure sTNF-R1 level and linc0597 expression by enzyme-linked immunosorbent assay (ELISA) and RT-qPCR respectively. In addition, the receiver operating characteristic (ROC) curves were employed to evaluate the diagnostic value of serum sTNF-R1 and linc0597 for LN, and Spearman correlation coefficient was adopted for the correlation between sTNF-R1, linc0597, and LN clinical disease Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Moreover, the logistic multiple regression analysis was applied to analyze the independent risk factors affecting the complication of LN in SLE patients. The LN group presented significantly higher serum sTNF-R1 and linc0597 levels than the control group and the SLE group. Besides, ROC curve analysis revealed that sTNF-R1 and linc0597 had good clinical diagnostic value in LN and SLE. Furthermore, Spearman correlation coefficient indicated that serum sTNF-R1 and linc0597 were positively correlated with disease activity index SLEDAI (r=0.551, p<0.001; R =0.604, p<0.001). Moreover, multivariate Logistic regression analysis demonstrated that age (p=0.001), fever (p=0.004), arthralgia (p=0.034), serum uric acid (p=0.019), decreased complement C3 (p=0.023), ANA peripheral type (p=0.007), anti-ds-DNA antibody (p=0.003), ANCA (p=0.002), sTNF-R1 (p=0.001), and linc0597 (p<0.001) were all independent risk factors affecting the complication of LN in SLE patients. STNF-R1 and linc0597 can be used as the indicators for disease activity and diagnosis of LN.