Complications In Systemic Lupus Erythematosus Patients Research Articles

Cardiovascular Complications in Lupus Patients in the Aseer Region, Saudi Arabia.

Systemic lupus erythematosus (SLE) is an autoimmune disease with high morbidity. The objective of this study was to investigate the prevalence and types of cardiovascular complications among patients with SLE in the Aseer region of Saudi Arabia. This study is retrospective record-based research conducted at Aseer Central Hospital in the Aseer region from 2020 to 2022. We conducted a comprehensive review of the medical records of patients. Out of the 189 patients diagnosed with SLE, 18.0% (34 out of 189) experienced cardiovascular complications. Of the patients who experienced cardiovascular complications, around two-fifths (15/34) fell between 35 and 44 years (44.12%), females represented (31/34) 91.20%, the majority were nonsmokers (32/34) 94.0%, (6/32) 17.65% were diabetic, (17/34) 50.0% had hypertension, and (13/34) 38.24% had vasculitis.Pericarditis and myocarditis are seen in (5/34) 14.7% of each of the cases, endocarditis accounts for (4/34) 11.7% of the cases, a myocardial infarction occurs in (7/34) 20.6% of patients, coronary artery disease is prevalent in (14/34) 38.2% of cases, and valvular lesionsat (5/34) 14.7%. Understanding the prevalence of cardiovascular complications in SLE patients is crucial for healthcare providers to tailor treatment plans and preventive measures to address this aspect of the disease.

Clinical Outcomes and Inpatient Mortality Among Hospitalized Patients With Concomitant Autoimmune Hepatitis and Systemic Lupus Erythematosus.

BackgroundAutoimmune hepatitis (AIH) is an inflammatory disease of the liver that is characterized by a broad disease spectrum, circulating autoantibodies, and elevated serum globulin levels. Systemic lupus erythematosus (SLE) is a chronic disease that is characterized by a high inflammatory state and is associated with multiorgan system involvement. Despite a well-known association between AIH and other autoimmune diseases, the literature is deficient on the associations between AIH-related outcomes and complications in SLE patients. This study aims to evaluate the effects of SLE on clinical outcomes and inpatient mortality in patients with AIH.MethodThe National Inpatient Sample (NIS) database was used to identify AIH-related hospitalizations from 2012 to 2014 using International Classification of Diseases Ninth Edition Revision (ICD-9) codes. Patients were divided into two groups, those with and without SLE. Primary outcomes were mortality, hospital charges, and length of stay (LOS). Secondary outcomes were complications associated with AIH: cirrhosis, gastrointestinal (GI) bleed, acute liver failure (ALF), cholangitis, pancreatitis, and sepsis. Chi-squared tests for categorical data and independent t-test for continuous data were used to compare outcomes. Multivariate analysis was performed to assess the primary outcomes after adjusting for confounding variables.ResultsThere were 17,050 AIH-related hospitalizations from 2012 to 2014 and 1,115 patients had SLE. In patients with SLE and AIH, 1,035 were female with average age of 48.6. The average LOS was 6.3 days, mortality rate was 1.35%, and total hospital charges were $48,146. SLE was associated with a statistically significant lower mortality rate compared to the control. LOS, hospital cost, and CCI (Charlson Comorbidity Index) were not found to be significantly different. For secondary outcomes, SLE was statistically significant for having higher pancreatitis rates. SLE patients had statistically significant lower cholangitis, and ALF. Differences in complications such as sepsis and GI bleed were non-significant.ConclusionSLE is known to have a high inflammatory state so it was hypothesized that there would be higher rates of complications and a higher mortality rate in those with concomitant AIH. This study showed that the mortality rate was lower in SLE patients with lower rates of complications including ALF and cholangitis. We postulate that SLE patient outcomes are likely affected by the treatment regimen involved with SLE, including corticosteroids. This would provide an immunosuppressive state, limiting the autoreactivity cascade in AIH, in effect leading to better outcomes and a mortality benefit. This study identifies a lower mortality rate and lower complication rates in patients with AIH and SLE overlap as compared to patients with AIH alone and future studies are needed to confirm these associations.

S0916 Analysis of Clinical Outcomes and Length of Stay Among Patients With Systemic Lupus Erythematosus Undergoing Endoscopic Retrograde Cholangiopancreatography: A Nationwide Inpatient Sample Analysis

INTRODUCTION: Systemic Lupus Erythematosus (SLE) is a chronic disease that is characterized by a high inflammatory state and is associated with biliary and pancreatic disease. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the standard of care for diagnosing and treating biliary or pancreatic ductal complications. The literature is deficient on the associations of ERCP related outcomes and complications in SLE patients. This study aims to evaluate the effects of SLE on clinical outcomes and in-patient mortality in patients undergoing ERCP. METHODS: The NIS database was used to identify hospitalized patients who had an ERCP study from 2012 to 2014 using ICD-9 codes. Patients were divided into 2 groups, those with and without SLE. Primary outcomes: mortality, hospital charges, and length of stay (LOS). Secondary outcomes: ERCP related complications (perforation, pancreatitis, gastrointestinal (GI) bleed, fistula/abscess formation, and sepsis). Chi squared tests for categorical data and independent T test for continuous data were used to compare the outcomes between the 2 groups. Multivariate analysis was done to assess the primary outcomes after adjusting for confounding variables. RESULTS: There was 83,900 ERCP related hospitalizations from 2012 to 2014, of which 420 patients had SLE. In patients with SLE who had an ERCP procedure, 390 (92.9%) were female and the average age was 53.1. The average LOS was 7.7 days, mortality rate was 2.4% (10 patients), and total hospital charges was $71,758. There was no statistical significance in the primary outcomes of LOS, mortality, or hospital cost in SLE patients. There was no statistical significance in the rate of pancreatitis, GI bleed, perforation, abscess formation, or sepsis. In SLE patients, there were statistically significant less strictures (20.2% vs 24.9%, OR 0.87, 95% CI 0.68–1.11) and higher fistula formation rates (1.2% vs 0.2%, OR 7.60, 95% CI 3.05–18.9). CONCLUSION: With SLE patients being in a high inflammatory state, it was hypothesized that SLE would be associated with higher rates of complications after ERCP procedures leading to prolonged hospitalization and worse outcomes. However, in this study, the primary outcomes were not found to be statistically significant, but an increased risk of fistula formation was significant. It is possible that many SLE patients do not present with an acute flare and are likely immunosuppressed which can have a protective effect on the results. Further studies are needed to elucidate such associations.Table 1.: Table demonstrating demographics and resource utilization of patients with and without Lupus who had an endoscopic retrograde cholangiopancreatography procedureTable 2.: Table demonstrating clinical outcomes in patients with and without Lupus, who underwent endoscopic retrograde cholangiopancreatography procedures during their hospitalization

Clinical characteristics and long-term outcomes of Libman-Sacks endocarditis in patients with systemic lupus erythematosus.

Treatment of Libman-Sacks (LS) endocarditis in patients with systemic lupus erythematosus (SLE) is challenging due to the lack of data. This study aimed to identify the clinical characteristics of SLE patients and LS endocarditis, and to investigate the treatment and prognosis of LS endocarditis. Of all the patients with SLE who underwent echocardiography between 2010 and 2019, 11 and 29 patients with and without LS endocarditis, respectively, were included. We compared the inflammatory and thrombotic profiles between patients with and without LS endocarditis, and investigated the treatment and long-term outcome of LS endocarditis. No significant differences were observed in disease activity, clinical characteristics and inflammatory marker levels between patients with and without LS endocarditis. Patients with LS endocarditis had a significantly higher prevalence of antiphospholipid antibody (aPL) but a lower prevalence of SLE-specific antibody. Triple positivity of aPL was found in 72.7% and 13.8% of patients with and without LS endocarditis, respectively. Of 11 patients with LS endocarditis, six patients received anticoagulation therapy, and five patients received augmented immunosuppressive therapies. One patient who did not receive anticoagulation therapy developed cerebral infarction. Nine (82%) patients with LS endocarditis were classified as having antiphospholipid syndrome (APS). Despite the residual vegetation and valve dysfunction, surgical intervention was not required during the follow-up period of 56.8 months. A significant correlation was observed between APS and LS endocarditis. Anticoagulation therapy should be considered to prevent thromboembolic complications in SLE patients with LS endocarditis.

High-density lipoprotein functionality in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a heterogeneous disease which is characterized with excessive inflammation and autoantibodies, macrophage and complement activation, and subsequently immunologically mediated tissue damage. In spite of improved treatments of SLE, these patients experience premature atherosclerosis and the rate of mortality among them remains high. Autoantibodies and circulating immune complexes might contribute to the pathogenesis of atherosclerosis by injuring the endothelium, as well as inducing pro-inflammatory and pro-adhesive endothelial cell phenotypes, as well as altering the metabolism of lipoproteins involved in atherogenesis. Hence, high levels of atherogenic lipoproteins (like low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL)) and low levels of high-density lipoprotein (HDL-C) are important risk factors for atherosclerotic cardiovascular complications in SLE patients but these traditional risk factors fail to fully explain the increased risk of cardiovascular disease (CVD) in these patients. The exact mechanism by which inflammation decreases HDL levels is not defined, but decreases in apoA-I production and lecithin cholesterol acyltransferase (LCAT) activity, as well as increased serum amyloid A (SAA), endothelial lipase and secretory phospholipase A2 activity (PLA2) could all contribute. In addition, during inflammation multiple changes in HDL structure occur, leading to alterations in HDL function which may be implicated in the CVD complications of SLE. Therefore, this review will aim to identify the mechanisms implicated in HDL dysfunction which occurs in SLE patients.

SAT-411 Anti nuclear Antibody negative Lupus like Nephritis. A 5 case series report

Systemic lupus erythematosus (SLE) is a disease due to an autoantibody response to nuclear and cytoplasmic antigen which is associated with the inflammatory cascades and end-organ damage in multiple organs like kidney, skin, brain, etc. In the kidney, immune-complex deposits leads to the deterioration of renal function leading to a condition called lupus nephritis. Lupus nephritis is a common but serious complication in SLE patients. Previously, American College of Rheumatology (ACR) required at least 4 of 11 clinical or laboratory criteria to diagnose SLE which included malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, pleuritis or pericarditis, kidney disorder, neurological disorder, hematologic disorder and positive antinuclear antibody. In 2019, there has been an update in this criteria, where positive antinuclear antibody is given as entry level criterion. If negative, cases cannot be classified as Systemic lupus erythematosus. If positive, further accumulation of 10 points is required for diagnosis of SLE. Lupus-like glomerulonephritis is defined as immune complex kidney disease with full house pattern in glomeruli where immunofluorescence staining for immunoglobulin G (IgG), IgA, IgM, complement (C3), and C1q are positive in an ANA negative patients. This findings is otherwise described as diagnostic criteria for lupus nephritis in SLE patients. Extraglomerular immune deposits within tubular basement membranes and tubuloreticular inclusions are other characteristic features that can be found in lupus nephritis. A total of 5 cases of ANA negative lupus like nephritis were reported in the department of renal pathology in University of Alberta between 1st January 2019 to 30th September, 2019. All of our cases were positive (IgG, IgA, IgM, C3, C1q) in immunofluorescence and were described as full house pattern. In light microscopy, 2 of the cases correlated with stage IV lupus nephritis, 2 correlated with stage V lupus nephritis and 1 case correlated with stage I lupus nephritis. Tubuloreticular inclusions were present in the one of the case. All patients responded to prednisolone as suggested by follow up laboratory datas.Table 1Variations in parameters among five cases.Case 1Case 2Case 3Case 4Case 5Age/sex62y/f56y/f24y/m42y/m7y/fANANegativeNegativeNegativeNegativeNegativedsDNANegative (positive after 2 month borderline 127 <120MFU)NegativeNegativeNegativeNegativeProtein creatinine ratio (PCR)306.3553.9(Normal <13.0 mg/mmol)238.57439.33975.52Urine Hemoglobin2+1+3+1+1+Serum. Creatinine121 (40-100 µmol/L)84 (40-100 µmol/L)106 (50-120 µmol/L)146 (50-120 µmol/L)29 (20-75 µmol/L)HematologyNormalNormalNormalNormalNormalLupus Nephritis gradeIVIIVVV Open table in a new tab In ANA negative patients, immune complex mediated glomerulonephritis with full house immunofluorescence pattern may be considered as lupus like glomerulonephritis. Other features like tubuloreticular inclusions, DsDNA might be positive in these patients. These patients present and response to treatment like renal limited lupus nephritis. They may develop full blown SLE in long term; hence close follow up is required. However, other causes of immune complex mediated glomerulonephritis must be ruled out before considering this diagnosis.

Molecular and Cellular Bases of Immunosenescence, Inflammation, and Cardiovascular Complications Mimicking “Inflammaging” in Patients with Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is an archetype of systemic autoimmune disease, characterized by the presence of diverse autoantibodies and chronic inflammation. There are multiple factors involved in lupus pathogenesis, including genetic/epigenetic predisposition, sexual hormone imbalance, environmental stimulants, mental/psychological stresses, and undefined events. Recently, many authors noted that “inflammaging”, consisting of immunosenescence and inflammation, is a common feature in aging people and patients with SLE. It is conceivable that chronic oxidative stresses originating from mitochondrial dysfunction, defective bioenergetics, abnormal immunometabolism, and premature telomere erosion may accelerate immune cell senescence in patients with SLE. The mitochondrial dysfunctions in SLE have been extensively investigated in recent years. The molecular basis of normoglycemic metabolic syndrome has been found to be relevant to the production of advanced glycosylated and nitrosative end products. Besides, immunosenescence, autoimmunity, endothelial cell damage, and decreased tissue regeneration could be the results of premature telomere erosion in patients with SLE. Herein, the molecular and cellular bases of inflammaging and cardiovascular complications in SLE patients will be extensively reviewed from the aspects of mitochondrial dysfunctions, abnormal bioenergetics/immunometabolism, and telomere/telomerase disequilibrium.

The effect of lupus disease on the pregnant women and embryos: a retrospective study from 2010 to 2014.

Pregnancy in women with systemic lupus erythematosus (SLE) is one of the challenges of recent studies. Women should prevent the onset of relapses with medications before and after pregnancy, and on the other hand, the effect of these medicines considers the health and development of the fetus. In this retrospective study, the effects of anti-phospholipid syndrome and the use of common drugs such as methotrexate, cyclosporine, and azathioprine and their side effects on maternal health and ultimately the development of the fetus have been investigated. This study is a descriptive and retrospective epidemiologic study that was conducted in 2016 to investigate maternal and fetal complications in SLE patients. We prepared forms of data recording, including age, occupation, and other important information and then analyzed them in SPSS version 22. The results showed that the presence of anti-phospholipid syndrome in pregnant women can lead to abnormalities such as preterm, IUGR, abortion, and fetal death (P value 0.0001). It also leads to complications such as nephritis, arthritis, and preeclampsia in the mother (P value 0.003). This study suggests that methotrexate and cyclosporine medications could cause fetal developmental disorders. The P value of cyclosporine was 0.0001 and the P value of methotrexate was 0.001. Anti-phospholipid syndrome in women with SLE who intend to become pregnant can disrupt the development of the embryo. The consumption of methotrexate and cyclosporine medications before and during the pregnancy can have irreparable effects on fetal growth. Key Points • Anti-phospholipid syndrome can disrupt the development of the embryo in women with SLE who intend to become pregnant. • Methotrexate and cyclosporine consumption before and during pregnancy can affect fetal growth. • 7 to 33% of patients whose disease had been suppressed and controlled 6months before pregnancy seams to relapse during the pregnancy. • Taking medications to control the disease during pregnancy plays an important role in the progression of pregnancy and fetus health.

Early outcomes in kidney transplant recipients with systemic lupus erythematosus.

Kidney transplant (KT) is the best treatment for patients who progress to end-stage renal disease. Short-term outcomes in patients with systemic lupus erythematosus (SLE) following KT are not well known. To describe the postoperative outcomes and complications in SLE patients undergoing KT, we conducted a case-control study from 2010 to 2015 including SLE recipients compared to non-SLE controls matched by age and sex. Demographics, comorbidities, donor characteristics, and preoperative tests were retrieved. Main outcomes were 30-day postoperative allograft function, development of infectious or non-infectious complications, and mortality. 68 patients (34 SLE, 34 non-SLE) were included. SLE recipients had median disease duration of 9years; SLEDAI-2K of 2, and SLICC/ACR damage index of 3; 16 (47%) were taking prednisone (median dose 5mg daily) before KT. SLE recipients had a lower frequency of diabetes (0 vs. 27%, p = 0.002). No differences were found in the development of any complication (50% SLE vs. 47% non-SLE, p = 1.00); infectious (44% vs. 41%, p = 1.00), or non-infectious (15% vs. 21%, p = 1.00). There were no deaths in either group, and none of the SLE recipients presented lupus disease activity 30days after the KT. Allograft function determined by serum creatinine, estimated glomerular filtration rate, delayed graft function, and allograft loss was similar in both groups (p > 0.05). There were no differences between SLE recipients with and without complications. Early postoperative outcomes in SLE patients who undergo KT, including allograft function, development of infectious, non-infectious complications, and mortality, are similar to patients without SLE.

Complications of systemic lupus erythematosus: A review

Systemic lupus erythematosus (SLE) is a complex autoimmune condition, which often evolves with severe complications. In SLE, autoantibodies appear, with systemic inflammation and multiple tissue destructions. SLE is the most common form of lupus and is considered more severe than other forms. SLE can affect many parts of the body, including the kidneys, heart, lungs, brain, blood, and skin. Symptoms vary among patients. SLE can follow an unpredictable pattern of remissions (symptoms improve) and flares (symptoms worsen). Renal involvement is one of the most severe complications in SLE patients. The process of depositing the immune complexes in the kidneys could lead to the appearance of lupus nephritis. If the treatment is early and treat-to-target, it can change the course of the renal disease.

Risk factors for development of early infectious and noninfectious complications in systemic lupus erythematosus patients undergoing major surgery.

Background We aimed to identify risk factors for early complications in systemic lupus erythematosus (SLE) patients undergoing major surgery. Methods We conducted a retrospective comparative cohort study including patients with SLE undergoing major surgery, and non-SLE patients matched 1:1. Main outcomes were development of infectious and noninfectious complications, and 30-day postoperative mortality. Results A total of 382 patients (191 SLE and 191 non-SLE) were included. Postoperative complications occurred in 82 (43%) SLE patients and 58 (30%) without SLE, ( p = 0.01). Variables associated with infectious complications in SLE patients: prednisone use (OR 1.81, 95% CI 1.13-2.90), anemia (OR 2.43, 95% CI 1.45-4.08), hypoalbuminemia (OR 2.58, 95% CI 1.55-4.30) and lymphopenia (OR 2.43, 95% CI 1.52-3.89), p < 0.05. Variables associated with noninfectious complications: anemia (OR, 1.93, 95% CI 1.03-3.64) and hypoalbuminemia (OR 2.11, 95% CI 1.16-3.86), p < 0.05. Variables associated with any complication: SLEDAI-2K (OR 1.1, 95% CI 1.01-1.20), nephritis (OR 10.08, 95% CI 1.21-83.63), aspirin use (OR 2.68, 95% CI 1.19-6.02, p = 0.01), low C3 (OR 2.00, 95% CI 1.06-3.80), anemia (OR 2.68, 95% CI 1.39-5.18), hypoalbuminemia (OR 3.49, 95% CI 1.83-6.66) and lymphopenia (OR 2.36, 95% CI 1.30-4.26), p < 0.05. More patients with SLE died (6% vs 1%, p = 0.02). Conclusions SLE patients present higher frequency of postoperative complications and mortality compared with non-SLE patients. Hypoalbuminemia, anemia, lymphopenia and aspirin use are independent risk factors.

Mesenchymal stem cell transplantation in systemic lupus erythematous, a mesenchymal stem cell disorder.

Systemic lupus erythematosus (SLE) is a chronic autoimmune and inflammatory disorder with involvement of several organs and systems such as the kidney, lung, brain and the hematopoietic system. As the most prevailing organ manifestation, lupus nephritis is the major cause of mortality and morbidity in SLE patients. The most classically and widely administered immunosuppressive medications, namely corticosteroids and cyclophosphamide, have eventuated in a remarkable amelioration in disease complications over the last few years and reduced the progression to end-stage multiorgan failure. Mesenchymal stem cells (MSCs) are considered as non-hematopoietic and multipotential progenitor cells, which are able to differentiate into multiple cell lineages such as chondrocytes, osteoblasts, myoblasts, endothelial cells, adipocytes, neuron-like cells, hepatocytes and cardiomyocytes. MSCs from SLE patients have demonstrated defects such as aberrant cytokine production. Moreover, impaired phenotype, growth and immunomodulatory functions of MSCs from patients with SLE in comparison to healthy controls have been reported. Therefore, it is hypothesized that SLE is potentially an MSC-mediated disease and, as a result, allogeneic rather than autologous MSC transplantation can be argued to be a potentially advantageous therapy for patients with SLE. On the other hand, the MSC senescence phenomenon may meet the current therapeutic approaches with challenges and demand more attention. Here, we discuss MSC transplantations to date in animal models and humans and focus on the MSC senescence complications in SLE patients.

Glucocorticoids Induced End Organs Damage in Patients with Systemic Lupus Erythematosus

Background: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that affects multiple organs and requires long term treatment with GCs. GC-related end organ damage in SLE appears in the form of: osteoporosis, Avascular Necrosis (AVN), cataracts, diabetes (DM) and cardiovascular disease. Aim of the work: the present work was to assess the prevalence of the complications in SLE patients who were treated with GCs for long periods and with moderate to severe cumulative steroid doses. Patients and Methods: This study was done on 50 SLE patients who fulfilled the SLICC criteria for diagnosis of SLE. All patients subjected to full history taking, clinical examination, slit-lamp examination to assess cataract, laboratory investigations (ESR, CRP, FBS, 2-H PP, CBC, C3, C4 and anti-dsDNA), DEXA scan, MRI scan (when needed), SLEDAI score and SLICC score assessments. All data were collected, tabulated and statistically analyzed. Results: Regarding the frequency of steroid induced complications, 38% were osteopenic, while 18% were osteoporotic patients. 10% had AVN. 18% had cataract. 14% had DM. There was very strong relationship between steroid duration and the frequency of DM and cataract. But in osteopenia, osteoporosis and AVN, there were weak relationship regarding steroid duration. There was very strong relationship between cumulative steroid dose and the frequency of DM, cataract, osteoporosis and AVN. There was no relationship between age and osteoporosis and AVN but in cataract and DM, there was strong relationship. There was no relationship between sex and complications (DM, cataract, osteopenia, osteoporosis and AVN). There was no relationship between disease activity (measured by SLEDAI score) and frequency of steroid complications (DM, cataract, osteopenia, osteoporosis and AVN). There was strong relationship between end organ damage (measured by SLICC damage index) and frequency of steroid complications (DM, cataract, osteoporosis and AVN). Conclusion: Steroid intake (duration and dose) were major risk factors for developing end organ damage in SLE patients.

Choc hémorragique révélant des micro-anévrismes digestifs au cours du lupus : cas clinique et revue de la littérature

IntroductionThe vascular disorders in systemic lupus erythematosus (SLE) result from various mechanisms and presentations (inflammatory disease or vasculitis, atherosclerosis). Case reportWe report on a 34-year-old man with cutaneous, articular, neurological and nephrologic SLE. He presented with catastrophic haemorrhage on microaneurysm rupture of the left hepatic artery. After blood transfusions and immunosuppressive treatments, his condition improves. ConclusionUncommon complication in SLE patients, digestive vasculitis with microaneurysms may occur as in polyarteritis nodosa. In the literature, we identified 10 additional cases of hepatic microaneurysms in SLE patients. The main issue is an earlier diagnosis in order to give appropriate treatment and improve prognosis.

The Role of Autophagy in Lupus Nephritis.

Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease characterized by the generation of immune responses to self-antigens. Lupus nephritis is one of the most common and severe complications in SLE patients. Though the pathogenesis of lupus nephritis has been studied extensively, unresolved questions are still left and new therapeutic methods are needed for disease control. Autophagy is a conserved catabolic process through which cytoplasmic constituents can be degraded in lysosome and reused. Autophagy plays vital roles in maintaining cell homeostasis and is involved in the pathogenesis of many diseases. In particular, autophagy can affect almost all parts of the immune system and is involved in autoimmune diseases. Based on genetic analysis, cell biology, and mechanism studies of the classic and innovative therapeutic drugs, there are growing lines of evidence suggesting the relationship between autophagy and lupus nephritis. In the present review, we summarize the recent publications investigating the relationship between autophagy and lupus nephritis and provide a new perspective towards the pathogenesis of lupus nephritis.

Predictors of maternal and fetal complications in SLE patients: a prospective study.

The aim of the study was to evaluate predictors of disease flares during pregnancy and obstetric and fetal complications in a cohort of systemic lupus erythematosus (SLE) patients. One hundred and thirty-two pregnancies in 96 SLE patients were prospectively followed by monthly clinical and laboratory evaluations. Predictors of lupus flares, fetal and obstetric complications during pregnancy were identified performing stepwise logistic regression analysis. Maternal lupus flares occurred in 57 % of pregnancies and were being best predicted by the number of flares before conception. Manifestations during flares were best predicted by the same features occurred before conception: dermatological flares by skin rash, renal flares by nephritis, and hematological flares by hematological abnormalities. There were 110 live births and 22 fetal losses. Among live newborns, 22 % were premature. Fetal loss was best predicted by hypertension at conception; miscarriages by the amount of steroids taken during the last year before conception; stillbirth by the number of flares during the last year before conception; preterm birth by the coexistence of anti-phospholipid antibody syndrome and anti-double-stranded DNA antibody levels before conception; premature rupture of membranes by high ECLAM score during the 6 months before conception, small for gestation age by hypertension at conception; and preeclampsia by positive lupus anticoagulant. Some independent predictors of lupus flares and fetal and obstetric complications were identified, which can help the risk assessment of pregnancy in SLE patients.

Risk factors of systemic lupus erythematosus flares during pregnancy.

This review examines the risk factors for the development of systemic lupus erythematosus (SLE) flares during pregnancy. In preconception, anti-DNA, hypocomplementemia, previous thrombosis, triple antiphospholipid (aPL) antibody positivity, active lupus nephritis and discontinuation of medications such as hydroxychloroquine and azathioprine are factors associated with pregnancy failure. During pregnancy, SLE flares are associated with aPL antibodies, synergic changes of pregnancy on Th1 and TH2 cytokines, other cytokines and chemokines that interact with hormones such as estrogen and prolactin that amplify the inflammatory effect. From the clinical point of view, SLE activity at pregnancy onset, thrombocytopenia, lupus nephritis, arterial hypertension, aPL syndromes, preeclampsia is associated with lupus flares and fetal complications. In puerperium, the risk factors of flares are similar to pregnancy. Hyperactivity of immune system, autoantibodies, hyperprolactinemia, active lupus nephritis, decrease in TH2 cytokines with increase in TH1 cytokines probably participate in SLE flare. The SLE flares during pregnancy make the difference between an uncomplicated pregnancy and pregnancy with maternal and fetal complications. Therefore, the knowledge of risk factors leads the best treatment strategies to reduce flares and fetal complications in SLE patients.

ROLE OF INFLAMMATION MARKERS IN DEVELOPMENT OF ATHEROSCLEROSIS AND ITS COMPICATIONS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

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FRI0304 Incidence of and risk factors for a first cardiovascular event among german patients with systemic lupus erythematosus (SLE)

BackgroundCardiovascular disease remains a major cause of morbidity and mortality in SLE. Despite much research in this area, epidemiologic studies in specific populations are lacking.ObjectivesWe assessed the rate of a...

Subclinical hypothyroidism and its association with lupus nephritis: a case control study in a large cohort of Chinese systemic lupus erythematosus patients

The aim of this study was to evaluate the prevalence of thyroid diseases in Chinese systemic lupus erythematosus (SLE) patients and the relevance of subclinical hypothyroidism (SCH) with lupus nephritis (LN). A large cohort of 1006 SLE patients was retrospectively analyzed. The prevalence of autoimmune thyroid disease was 2.78%, clinical hypothyroidism 1.69%, subclinical hypothyroidism 10.04%, central hypothyroidism 1.29%, hyperthyroidism 1.19%, euthyroid sick syndrome (ESS) 9.54%, and nodules 1.09%, respectively. Compared with the prevalence of thyroid abnormalities in the general Chinese population (0.91-6.05%), SCH was much higher (10.04%) in this study. In addition, SCH was more frequent in patients with LN (13.4%) than those without LN (7.3%, p = 0.001). Case control study was performed to explore the relative risk factors of SCH. In multiple logistic regression models, 24 h urine protein and estimated glomerular filtration rate (eGFR) were retained as independent correlates of SCH after adjusting for demographic variables, risk factors, and other potential confounders. The results of the present study suggest that SCH is a common complication in SLE patients, and closely related with LN.