Systemic Lupus Erythematosus Duration Research Articles

Active but not quiescent lupus nephritis during pregnancy is associated with a higher rate of adverse obstetric outcomes: Analysis of a prospective cohort.

To compare the maternal-fetal/neonatal outcome in patients with systemic lupus erythematosus (SLE) with and without lupus nephritis (LN) in remission or with active disease. A prospective cohort of pregnant patients with SLE (ACR 1997 criteria) was studied from January 2009 to December 2021. Demographic, clinical, biochemical, and immunological variables as well as the usual maternal-fetal/neonatal complications were recorded. We compared four groups according to the status of SLE during pregnancy: patients with quiescent SLE without lupus nephritis, patients with active SLE without lupus nephritis, patients with quiescent lupus nephritis, and patients with active lupus nephritis. Statistical analysis included descriptive statistics, bivariate analysis, and Cox regression analysis. A total of 439 pregnancies were studied, with a median age of 28 ± 6, SLE duration of 60 months (interquartile range 36-120). A higher frequency of maternal and fetal/neonatal complications was observed in patients with active SLE with or without lupus nephritis. Multivariate analysis showed that active LN was a risk factor for gestational hypertension (hazard ratios [HR] 1.95; 95% confidence intervals [CI]: 1.01-6.39), premature rupture of membranes (HR 3.56; 95% CI: 1.79-16.05) and more frequent cesarean section (HR 1.82; 95% CI: 1.13-2.94). LN is associated with a higher frequency of maternal complications, especially in those patients with active disease during pregnancy, and those maternal complications had an impact on poor fetal/neonatal outcomes. Strict control and timely care of LN could improve the obstetric prognosis.

Anxiety and Depression and Associated Risk Factors among Outpatients with Systemic Lupus Erythematosus: Eastern Province, Saudi Arabia.

Although mood disorders are prevalent among systemic lupus erythematosus (SLE) patients, they are usually underrecognized. This study aimed to estimate the prevalence of anxiety and depression among Saudi SLE patients. This cross-sectional study was conducted among SLE patients from July 2022 to June 2023 in the Eastern Province of Saudi Arabia. A self-reported questionnaire was used to collect the data through validated tools including the Hamilton Anxiety Rating Scale-A and the Beck Depression Inventory score. There were 133 females (91.7%) and 12 males (8.3%) included in this study. Based on the HAM-A score, 45.5% of participants had an anxiety disorder, and according to the BDI score, 46.2% had a depression disorder. Anxiety and depression were significantly associated with a longer duration of SLE, unemployment status, smoking, and the presence of comorbidities. Moreover, the present study found a significant association between depression and male gender. This study found that Saudi SLE patients have a high prevalence of both anxiety and depression. Therefore, SLE patients should be screened for neuropsychiatric disorders during routine follow-ups and managed as early as possible.

Glucocorticoid toxicity index in patients with systemic lupus erythematosus (preliminary data)

Objective: to investigate the contribution of glucocorticoids (GC) to the development of irreversible organ damage in patients with systemic lupus erythematosus (SLE) using the GC toxicity index (GTI).Material and methods. The study included 65 patients with SLE who met the 2012 SLICC classification criteria. GTI, disease activity according to the SLEDAI-2K index and the SLICC damage index (DI) were determined in all patients, and standard laboratory and immunological tests were performed.Results and discussion. Patients were predominantly female (n=56, 86%), median disease duration was 76 [2; 288] months, SLEDAI-2K – 8.8 [0; 26], DI SLICC – 1.0 [0; 5], DI SLICC >0 was found in 28 (43%) patients. The median duration of GC therapy during the disease period was 66.0 [0; 288] months, maximum dose of GC – 32.7 [0; 80] mg, median of total GC dose during intravenous administration was 2942 [0; 17 812.5] mg, GTI at the time of enrolment in the study – 19 [0; 37] points. GTI >0 was present in 47 (72%) of 65 patients. GTI correlated with disease duration (r=0.33; p<0.008); maximum dose of oral GCs (r=0.31; p><0.012); duration of GC use (r=0.35; p><0.005); DI SLICC (r=-0.43; p><0.0001). In patients with an average disease duration of more than 3 years, GTI>˂0.008); maximum dose of oral GCs (r=0.31; p˂0.012); duration of GC use (r=0.35; p˂0.005); DI SLICC (r=-0.43; p˂0.0001). In patients with an average disease duration of more than 3 years, GTI was significantly higher than in patients with a disease duration of 1–3 years (p=0.023).Conclusion. An GTI>0 was found in 72% of SLE patients, which increased significantly with disease duration. The GTI value was influenced by the duration of SLE, the duration of GC treatment and the maximum GC dose during the disease period. A statistically significant correlation was found between the GTI and the SLICC DI, allowing the GTI value to be used as an additional component in the assessment of the contribution of GCs to the development of irreversible organ damage in patients with SLE. It is recommended that GTI is assessed in all patients with SLE receiving long-term GC treatment for the purpose of dose adjustment.

Clinical and laboratory assessment of the state of periapical tissues in systemic lupus erythematosus.

Aim: To evaluate changes in clinical and laboratory parameters in patients with SLE depending on the severity and activity of the disease. Materials and Methods: The study included 50 patients with SLE of different age groups, 10 men and 40 women. Results: Systemic lupus erythematosus (SLE) is a chronic disease that belongs to the group of rheumatic diseases and is characterised by autoimmune tissue damage. Chronic inflammatory periodontal diseases remain one of the most common dental pathologies. Chronic gingivitis and periodontitis in SLE are described as one of the earliest and most striking symptoms of the disease. Approximately the same trend was found in patients with SLE depending on the degree of clinical and laboratory activity of the disease. Patients with minimal, 1 degree of activity (characterized by the longest duration of SLE) showed the greatest decrease in bone mineral density (up to 2.25 points), and patients with higher activity had a significantly shorter duration of SLE and, accordingly, a smaller decrease in bone mineral density: in patients with 2 degrees of activity (1.79 points), with 3 degrees of activity (1.94 points). Conclusions: In patients with acute SLE, the maximum value of the Muhlemann-Cowell index was 2.31 points, in patients with subacute SLE - 1.89 points, and in patients with chronic SLE - 1.58 points. CPITN values increase inversely with the nature of the course of SLE, which is associated with the duration of the underlying disease.

Cardiac Abnormalities in Relation to the Disease Activity Index Among Systemic Lupus Erythematosus Patients in a Tertiary Hospital: A Cross-Sectional Study.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune connective tissue disorder involving multiple organs and systems. Cardiovascular involvement in SLE patients is a major cause of morbidity and mortality. Although subclinical cardiac abnormalities exist among SLEpatients, they are rarely screened for. Echocardiography has been demonstrated to be a useful tool for the early diagnosis of cardiac abnormalities in SLE patients, many of which are clinically silent. Early recognition of cardiovascular abnormalities is vital for the prompt initiation of the appropriate management.This study aims to determine the prevalence of various structural and functional cardiac abnormalities among SLE patients and to determine its association with the modified SLE Disease Activity Index 2000 (modified SLEDAI-2K). The study was a cross-sectional study of SLE patients at the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana, from June to December 2021. The setting was the rheumatology outpatient clinic of the KBTH and included adult men and women, 18 years and above, diagnosed with SLE with no known cardiac abnormalities. The baseline demographic and clinical characteristics of the participants were determined. A detailed transthoracic echocardiogramwas performed for all patients. The frequency of common cardiac pathologies was determined and compared between those with a high modified SLEDAI-2K and those with a low modified SLEDAI-2K. Ninety-nine SLE patients participated in the study with a mean age of 35.12 years. Females formed the majority (90.9%) of the participants. The mean age at diagnosis of SLE was 28.7 years and the mean disease duration was 4.6 years. All of the participants were on at least two disease-modifying medications. The mean modified SLEDAI-2K score was 9.1. Thirty-five percent (35%) of the patients had mild to moderately active disease and 39% had severely active disease. Sixty-six (66%) out of the severely active disease group had abnormal echocardiographic findings, while 28% of those with mild to moderate disease had abnormal echocardiographic findings. Echocardiographic abnormalities were found in 56 patients (47%), out of which 8.7% had valvular involvement, 15.7% had diastolic dysfunction, 5.2% had left ventricular hypertrophy (LVH), and 0.9% had left ventricular systolic dysfunction (LVSD). About 12% of the participants had pulmonary hypertension and 1% had pericardial involvement. The odds of echocardiographic abnormalities were 13.7 times higher in SLE patients with high disease activity compared to those with low disease activity (odds ratio (OR) = 13.714, 95% confidence interval (CI) = 3.804-49.442, p < 0.001). There was no significant association between cardiac abnormalities and SLE duration. No significant correlation between cardiac abnormalities and modified SLEDAI-2K score was found. Conclusion:Cardiac abnormalities, especially left ventricular diastolic dysfunction (LVDD),valvular involvement, and pulmonary hypertension, are common in SLE patients.For SLE patients, especially those with active diseases, echocardiographicassessment should be considered in the management of SLE patients to enable early detection of cardiac abnormalities, early treatment, and thus a decrease in morbidity and mortality associated with cardiovascular involvement in SLE patients.

Risk Factors for Pulmonary Arterial Hypertension in Patients With Systemic Lupus Erythematosus: A Systematic Review and Expert Consensus.

This study aimed to identify risk factors associated with the development of pulmonary arterial hypertension (PAH) in patients with systemic lupus erythematosus (SLE). We conducted a systematic literature review of studies focusing on adult patients classified as having SLE-related PAH by searching the electronic databases Embase, Medline, Medline in-progress, Wanfang, China National Knowledge Infrastructure, Ichushi Web, Kmbase, and KoreaMed. Based on the findings, we conducted a Delphi survey to build expert consensus on issues related to screening for PAH in patients with SLE and on the importance and feasibility of measuring the identified factors in clinical practice. We included 21 eligible studies for data synthesis. Sixteen factors were associated with an increased risk of SLE-PAH: pericardial effusion, serositis, longer duration of SLE, arthritis, acute and subacute cutaneous lupus, scleroderma pattern on nailfold capillaroscopy, diffusion capacity of carbon monoxide in the lungs (DLCO) <70% predicted, interstitial lung disease, thrombocytopenia, and seven serological factors. Six factors were associated with a decreased risk of SLE-PAH: malar/acute rash, hematologic disorder, renal disorder, higher Systemic Lupus Erythematosus Disease Activity Index score, and two serological factors. Among these, there were six risk factors on which the panelists reached strong or general consensus (peak tricuspid regurgitation velocity on echocardiography >2.8 m/s, pericardial effusion, DLCO <70% predicted, scleroderma pattern on nailfold capillaroscopy, brain natriuretic peptide >50 ng/l, and N-terminal pro-brain natriuretic peptide >300 ng/l). The Delphi panel confirmed the need for a screening tool to identify patients with SLE at high risk of developing PAH and provided consensus on the importance and/or practicality of measuring the identified factors. The risk factors we identified could be used in a screening algorithm to identify patients with SLE with a high risk of developing PAH to facilitate early diagnosis, which could improve prognosis and management of these patients.

Purtscher-like retinopathy in systemic lupus erythematosus: clinical features, risk factors and prognosis.

Purtscher-like retinopathy (PLR) is a rare ocular manifestation in systemic lupus erythematosus (SLE) with poor prognosis, but its clear risk factors and treatment consensus are still lacking. To investigate the clinical features, risk factors and prognosis of PLR in SLE patients. A retrospective analysis was conducted on SLE patients with PLR admitted at Peking Union Medical College Hospital from 2013 to 2022. Clinical data, including demographic characteristics, lupus-related features, laboratory findings and ophthalmologic examinations, were collected and analyzed. The prognosis was evaluated based on best-corrected visual acuity and ophthalmologic outcomes. Seventeen SLE patients (32 eyes) diagnosed with PLR were included, along with a random selection of 100 SLE patients without retinopathy and 100 with retinal microvasculopathy as controls. Patients with PLR had a significantly younger age, a higher proportion of hemolytic anemia, a shorter duration of SLE, a higher SLE disease activity index-2000 (SLEDAI-2K) score, higher erythrocyte sedimentation rate (ESR) values and lower hemoglobin (HGB) values than the group without retinopathy (P < 0.05). They also had a significantly higher SLEDAI-2K score, higher ESR values and higher white blood cell values (P < 0.05) than the Microvasculopathy group. The majority of eyes (22/26, 84.62%) achieved stabilization at the last follow-up, with different therapeutic strategies, while a few (4/26, 15.38%) experienced complications or progression. This is the largest reported case series of PLR in SLE, which was associated with higher disease activity and poor visual prognosis. It was also associated with younger age, shorter SLE duration, concomitant hemolytic anemia, lower HGB and higher ESR value. Early recognition and prompt treatment are crucial for improving visual outcomes.

Clinical and immunologic features of the phenotype of systemic lupus erythematosus combined with Sjögren's syndrome

The problem of clinical and immunological heterogeneity of systemic lupus erythematosus (SLE) is of great interest, especially the combination of SLE and Sjögren's syndrome (SjS) determines a more favorable prognosis and specifics of therapy.Objective: to characterize the clinical and immunological features of SLE combined with SjS.Material and methods. The retrospective study included 44 patients with SLE combined with SjS and 356 patients with SLE without SjS, hospitalized at the V.A. Nasonova Research Institute of Rheumatology between 2013 and 2021. The two groups of patients were compared in terms of life expectancy, clinical manifestations, laboratory parameters and therapy.Results and discussion. The following phenotypic features of the clinical and immunological variant of SLE combined with SjS were found: significantly longer duration of SLE (p&lt;0.01); higher incidence of polyarthritis (p=0.01) and Raynaud's syndrome (p&lt;0.003) at disease onset. Subacute cutaneous lupus erythematosus, Raynaud's syndrome, peripheral nervous system involvement (sensory polyneuropathy and distal sensory-motor polyneuropathy) were found more frequently in SLE combined with SjS than in SLE without SjS, p&lt;0.0001. Among laboratory abnormalities in SLE patients with SjS, leukopenia (p&lt;0.0001), antibodies to SSA/Ro, SSB/La, and rheumatoid factor (p&lt;0.0001) were observed in a greater number of cases. In the group of SLE combined with SjS, the chronic variant of SLE course according to the classification of V.A. Nasonova, and lower activity were observed, which didn't not require therapy with high doses of glucocorticoids; in this group, rituximab (p&lt;0.01), cyclophosphamide and methotrexate were used significantly more often.Conclusion. Thus, significant clinical and laboratory differences were found between SLE with SjS and without SjS. They determine prognosis, approaches to pathogenetic therapy and monitoring.

SLICC-Frailty Index and Its Association with Low Bone Mineral Density and Vertebral Fractures in Women with Systemic Lupus Erythematosus.

The Systemic Lupus International Clinics (SLICC)-Frailty Index (FI) is associated with adverse outcomes in systemic lupus erythematosus (SLE). However, to our knowledge, its association with bone mineral density (BMD) and vertebral fractures (VF), has not been investigated using a standardized methods. Our aim was to evaluate the relationship between frailty assessed by SLICC-FI, and BMD and VF in Mestizo women with SLE. Adult women were included in this cross-sectional study. Information concerning the risk factors for VF and BMD in the lumbar spine and total hip was acquired. SLICC-FI was assessed at baseline. A semi-quantitative method was utilized to evaluate the prevalence of VF on lateral thoracolumbar radiographs. Univariate and multivariate regression analyses were performed adjusting for age, body mass index (BMI), SLE duration, cumulative glucocorticoid dose, bisphosphonate use, and BMD measurements. We included 202 women with SLE (mean age [SD] = 43.3 [13.6] years). The mean (SD) SLICC-FI value was 0.14 (0.09). Eleven (5.4%) patients were categorized as robust, 62 (30.7%) as relatively less fit, 84 (41.6%) as least fit, and 45 (22.3%) as frail. Both univariate and multivariate models showed associations between frailty (defined as SLICC-FI > 0.21) and prevalent VF in the entire population (OR 5.76, 95% CI 2.53-13.12; P < 0.001) and in the premenopausal group (OR 4.29, 95% CI; P = 0.047). We also found an association between the SLICC-FI and low BMD. In conclusion, frailty assessed by SLICC-FI might be associated with VF and low BMD in mestizo females with SLE.

Risk and Factors associated with disease manifestations in systemic lupus erythematosus - lupus nephritis (RIFLE-LN): a ten-year risk prediction strategy derived from a cohort of 1652 patients.

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.

PREDICTION OF ATHEROSCLEROSIS DEVELOPMENT AND MODIFICATION OF ITS RISK FACTORS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Objective: Early-onset atherosclerosis with cardiovascular (CV) sequelae is the major cause of death in systemic lupus erythematosus (SLE); that cannot be explained only by traditional Framingham risk factors as SLE-related factors may also have an impact. The present study aimed to analyze the determinants of atherosclerosis development and risk factors modification by statin therapy in SLE patients. Design and method: This prospective randomized study included 100 SLE patients aged 40.9±1.4 years (90 females, 10 males) and 32 age-, sex-matched healthy controls. Brachial artery flow-mediated dilation (FMD), ultrasound of extracranial and peripheral arteries, and cardiac calcium scoring were used for the identification of atherosclerosis. 52 SLE patients with dyslipidemia were randomized to receive simvastatin 40 mg/day (n = 27) or placebo (n = 25). Lipid panel, FMD, and inflammatory markers were assessed at baseline and after 6 months. Results: The mean duration of SLE was 9.9±0.88 years. The disease activity index (SLEDAI) and SLE damage score (SLICC) were 11.8±0.6 and 1.85±0.13 points, respectively. In 66% of SLE patients, atherosclerosis was present in at least one vascular area which was 3.5 times more frequently compared with controls. Atherosclerosis of carotid arteries was detected in 41% of SLE patients, lower limb arteries, and coronary arteries in 58% and 39% of patients, respectively. FMD was significantly decreased in SLE patients compared to controls (7.95±0.49% vs 11.6±0.3%, p&lt;0.001). In multiple linear regression, age (p&lt;0.001), nephritis (p = 0.001), polyarthritis (p = 0.019), and Raynaud's syndrome (p = 0.045) were associated with low FMD. In binary logistic regression, independent determinants of the atherosclerosis development in SLE were age (p&lt;0.001), body mass index (BMI) (p = 0.001), anti-dsDNA (p = 0.023), FMD (p = 0.017) and malar rash (p = 0.02). After simvastatin treatment, the level of LDL-Cholesterol reduced by 42%, erythrocyte sedimentation rate, C-reactive protein, and interleukin-6 decreased by 34.7%, 51.1%, and 47.7% respectively, while FMD increased by 26.0% (p&lt;0.05); in the placebo group, there were no significant changes. Conclusions: The independent determinants of atherosclerosis in SLE patients were both traditional CV risk factors (age, BMI) and SLE-specific factors (anti-dsDNA, malar rash, FMD). In SLE patients with dyslipidemia, simvastatin may have not only lipid-lowering but also potentially anti-inflammatory benefits.

AB1818-HPR QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

BackgroundAccording to the Treat to Target strategy, in addition to monitoring the activity of the process and monitoring the formation of irreversible organ damage, it is necessary to recognize the Health-Related Quality of Life, which allows a full assessment of the patient’s condition. Quality of life is defined as an integral characteristic of the patient’s physical, psychological, emotional and social functioning, based on his subjective perception. Often, changes in quality-of-life indicators precede the dynamics of clinical manifestations of the disease, so they can be used as auxiliary criteria for the effectiveness of treatment already in the early stages of the course of the disease.ObjectivesTo evaluate the quality of life of children and adolescent patients with systemic lupus erythematosus (SLE) depending on the activity and duration of the disease.Methods18 children and adolescents with SLE aged from 8.5 to 18.6 years (14.3 ± 0.7) were examined. The average duration of SLE was 3.1 ± 0.7 years, the age of onset was 11.4 ± 0.8 years. Most of the examined were girls (94.4%). The diagnosis was established according to the classification criteria EULAR/ASR 2019 for SLE[1]with at least 10 points. High activity of SLE was found in 5.56% of patients, moderate in 33.33%, minimal in 61.11%.The patients’ quality of life was assessed using the Lupus QoL questionnaire, which is a questionnaire with 34 questions, combined for 2–8 questions in 8 separate blocks: physical health, pain, planning, intimate relationships, dependence on other people, emotional health I, body image (the patient’s assessment of his body), fatigue. The questionnaire was filled out by the patients themselves, the answers to the questions were modeled on a five-point Likert scale (0 – constantly, 1 – almost always, 2 – quite often, 3 – occasionally, 4 – never). Zero points corresponded to the worst quality of life, 100 points to the best state of quality of life for each domain (scale) of the questionnaire.ResultsHhe quality of life related to health was worsened in all persons. The average total score for all domains was 65.51 ± 2.09 points and ranged from 38.41 to 89.45 points. The spheres “intimate relations” and “body image” were the most disturbed, which had the lowest score according to the test data (35.58 ± 4.87 and 62.08 ± 6.89, respectively). The best the quality-of-life indicator was recorded in the “pain” domain, which scored the highest number of points (82.41 ± 4.99 points). According to other scales of Lupus QoL, the quality of life was equal: in the domain “physical health” 77.60 ± 4.17 points, “planning” - 79.63 ± 5.52 points, “dependence on other people” - 66.21 ± 5.74 points, “emotional health” and “fatigue” - 76.15 ± 4.24 and 75.00 ± 4.46 points, respectively. Correlation analysis revealed inverse correlations between the degree of disease activity and the domains “pain” (r = -0.530; p &lt; 0.05), “planning” (r = -0.529; p &lt; 0.05), “intimate relationships” (r = -0.720; p &lt; 0.05), “emotional health” (r = -0.728; p &lt; 0.01). Direct correlations were found between the age of patients and indicators of the domain “pain” (r = 0.647; p &lt; 0.01) and “planning” (r = 0.642; p &lt; 0.01, respectively), the age of patients at the onset of the disease and the indicator the “body image” scale (r = 0.611; p &lt; 0.01), the duration of the disease and the “fatigue” scale (r = 0.638; p &lt; 0.05).ConclusionIn all patients with SLE, a violation of the health-related quality of life was established. Its deterioration was recorded in all domains and was due to the activity of the disease. Monitoring the quality of life of adolescents with SLE in combination with disease activity monitoring will allow for a better assessment of the health status of patients and timely identification of the need for correction of therapy and the selection of the most effective treatment program.

Four trajectories of 24-hour urine protein levels in real-world lupus nephritis cohorts

ObjectivesA 24-hour urine protein (24hUP) is a key measurement in the management of lupus nephritis (LN); however, trajectories of 24hUP in LN is poorly defined.MethodsTwo LN cohorts that underwent renal...

Circulatory System Organs Comorbid Lesions in Patients with Systemic Lupus Erythematosus: Nature and Frequency; Characteristics Depending on Gender, Age and Disease Duration

Introduction. Systemic lupus erythematosus (SLE) is a disease with numerous clinical manifestations and an unpredictable course. It often lasts for several months or years, with alternating remissions and exacerbations. Multiple organs can be affected simultaneously with varying degrees of severity, resulting in treatment- and disease-related comorbidities, including circulatory system diseases, which are one of the leading causes of death of SLE patients. The aim of the study. To find out the nature and frequency of the circulatory system organs comorbid lesions in patients with systemic lupus erythematosus, to characterize them depending on the gender, age and the disease duration. Materials and methods. Prior to performing the study all patients signed the voluntary consent to participate in accordance with the requirements of Helsinki Declaration of Human Rights, the Council of Europe Convention on Human Rights and Biomedicine. The cohort under investigation included 112 patients with diagnosed SLE of different severity with preliminary stratification as follows: females 89.29 %, patients of working age (57.14 % – young and 39.29 % – middle aged), unemployed (58.04 %), III disability group patients (45.54 %), city residents (62.50 %). According to the results of the disease duration assessment, a significant number of patients with SLE and circulatory system organs comorbid lesions have been ill for 1–5 years (36.61 %) and more than 10 years (38.39 %). All of them were patients of the rheumatology department of the Communal Non-Profit Enterprise of the Lviv Regional Council “Lviv Regional Clinical Hospital” from 2016 to 2021.The research was carried out in several stages, during which the nature and frequency of the circulatory system comorbid lesions with respect to gender, age and disease duration were estimated. Results. While completing the study, almost half of patients with SLE were diagnosed with Raynaud’s syndrome, mitral valve insufficiency and atherosclerosis, about 1/3 – with myocarditis, retinal angiopathy, symptomatic arterial hypertension and livedo reticularis. The varicose veins of the lower extremities, hypertensive disease, diffuse cardiosclerosis, tricuspid valve insufficiency, vein thrombosis, post-thrombophlebitis syndrome, aortic valve insufficiency, capillaritis, pulmonary hypertension, coronary artery disease (CAD) including stable angina pectoris, cardiomyopathy and post-infarction cardiosclerosis were found with the decreasing frequency. Raynaud’s syndrome was significantly more often diagnosed in females and young people; retinal angiopathy, livedo reticularis and symptomatic arterial hypertension – in females and those patients whose SLE lasted for more than 10 years; myocarditis, varicose veins of the lower extremities – in males; capillaritis – in patients with the shortest duration of SLE; atherosclerosis and mitral valve insufficiency – in elderly patients and patients with SLE lasting for 6–10 years; vein thrombosis and stable angina – in elderly patients and those with SLE lasting for more than 10 years; hypertensive disease, diffuse cardiosclerosis, aortic valve insufficiency, post-infarction cardiosclerosis were the most characteristic for the elderly patients with SLE. Conclusions. In patients with systemic lupus erythematosus, a number of circulatory system organs comorbid lesions were found. Having studied their nature and frequency, characterizing them depending on gender, age and the disease duration, we found out the certain features that should be taken into consideration during the screening examination of circulatory system disorders in patients with systemic lupus erythematosus and providing them the integrated care to improve their life quality. With this in mind, systemic lupus erythematosus requires further detailed study.

Incidence of acute kidney injury in women with systemic lupus erythematosus

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease with high mortality and morbidity. Despite the advances in the medical field and overall improvement in patient health outcomes, it remains a challenging illness to treat globally. This study aimed at determining acute kidney injury (AKI) incidence in female patients with an SLE of reproductive age in Jeddah, Saudi Arabia. Methods: This retrospective cohort study included all confirmed female patients with SLE between 15 and 50 years of age diagnosed with AKI from 2009 to 2019. Microsoft Excel was used for data entry and analyzed it using Statistical Package for the Social Sciences version 21. A chi-square was used to test association, where appropriate. Result: This study found that 11 (4.8%) out of 230 people developed AKI. The remaining 219 patients did not develop AKI. Based on our results, we deduced that there is a lack of association between the duration of SLE in patients with AKI and the duration of SLE in patients without AKI (p-values of 0.292 and 0.193, respectively) Conclusion: More population-based studies need to be conducted in Saudi Arabia on the epidemiological aspects of SLE and its relationship with renal diseases.

Monitoring of Sleep Indicators, Physical Activity, Pain, and Fatigue in Patients with Systemic Lupus Erythematosus and Relations among These Variables: A Pilot Study

Background: Poor sleep, fatigue, and pain are major health problems in patients with systemic lupus erythematosus (SLE). However, only cross-sectional surveys on these health outcomes have been conducted, and the association between day-to-day fluctuations remains unknown. Objectives: We aimed to characterize daily fluctuations in sleep quality, physical activity, pain, and fatigue in patients with SLE. Method: Exploratory study with a cross-sectional design. Two rheumatology centers (a university hospital and a prefectural hospital) in Japan between September 2017 and May 2019. The sample size was set to 20. Demographic and clinical data were collected. Sleep and physical activity were measured with monitoring devices; pain and fatigue levels were recorded daily during the 4-week period. The Pittsburgh Sleep Quality Index, Short Form Health Survey-12, the Japanese version of the Lupus Patient Outcome, and SLE Disease Activity Index 2000 were collected at the start and end of the study. Descriptive statistics and coefficients of variation (CV) were tabulated to examine daily fluctuations. Pearson correlation coefficients were obtained for monitored variables. Results: The mean age was 43.7 ± 8.5 years, and the mean SLE duration was 16.0 ± 7.2 years. The mean moderate-to-vigorous physical activity (MVPA) duration was 7.8 ± 5.8 min/day, and the mean total sleep duration was 391.8 ± 65.3 min, with a mean sleep efficiency of 88.6% ± 6.1%. Daily fluctuations were high for leaving the bed frequency, MVPA duration, pain, and waking after sleep onset. Seventeen participants showed correlations between some of the variables, such as fatigue or longer MVPA duration and poorer sleep outcomes; longer sleep latency and increased frequency of leaving the bed; and higher physical activity and increased pain and fatigue. Conclusion: The quality of sleep and fatigue fluctuated daily, and correlations existed between these variables, as well as for pain and physical activity. The impact of MVPA duration on pain and fatigue is of concern as increased physical activity may worsen the quality of life patients with SLE. The monitoring of sleep and physical activity using the device seems feasible for SLE symptom management.

Povezanost dužine trajanja bolesti i primenjene terapije sa metaboličkim sindromom kod pacijenata obolelih od sistemskog eritemskog lupusa

Aim. The aim of the paper was to examine the impact of disease duration and administered therapy on the development of metabolic syndrome (MetS) in patients with systemic lupus erythematosus (SLE). Material and methods. This study involved 55 patients (50 females and 5 males) with the diagnosis and 49 healthy controls of similar age. MetS was defined according to modified NCEP-ATP III diagnostic criteria, and obesity was defined by body mass index BMI &gt; 30. Results. In the group of SLE patients with MetS, there were 23 individuals (41.82%). In the control group, there were 10 (20.4%) patients with MetS. There were significantly more SLE patients with MetS in comparison to the controls (p = 0.04). Duration of the disease in the group with MetS was longer in comparison to those without MetS, but it was not statistically significant (15.35 ± 10.26 vs 10.44 ± 7.88, p = 0.073). The study confirmed that there is a moderate association (CC = 0.355) between disease duration and number of MetS parameters, however, this dependency was not statistically significant (p = 0.439). In the group without MetS, there were statistically more patients treated with antimalarial drugs monotherapy (p = 0.023). It has been found that the patients with MetS were treated with corticosteroid therapy longer than those without MetS, but it was not statistically significant (153.57 ± 103.34 vs 114.75 ± 83.32, p = 0.129). Conclusion. Patients with longer SLE duration have more often MetS. It has been shown that, statistically, more patients without MetS were treated with antimalarial drugs monotherapy, and that long-term CS use, in our study, was not associated with higher incidence of MetS.

Polypharmacy prevalence and associated factors in patients with systemic lupus erythematosus: A single-centre, cross-sectional study.

This study aimed to clarify factors associated with polypharmacy among patients with systemic lupus erythematosus. This single-centre cross-sectional study was conducted by reviewing the medical records and questionnaire data of 261 systemic lupus erythematosus patients at a teaching hospital in Japan from 1 September to 30 November 2020. Polypharmacy was defined as the regular administration of five or more oral medications; excessive polypharmacy consisted of the regular use of 10 or more oral medications. This study investigated (1) the prevalence of polypharmacy and excessive polypharmacy, (2) the distribution of medication types, and (3) the factors associated with polypharmacy and excessive polypharmacy. The proportions of patients who exhibited polypharmacy and excessive polypharmacy were 70% and 19%, respectively. Polypharmacy was associated with older age, long duration of systemic lupus erythematosus, high disease activity, and administration of glucocorticoids or immunosuppressive agents. Excessive polypharmacy was associated with a higher updated Charlson comorbidity index, history of visits to multiple internal medicine clinics, and presence of public assistance. Polypharmacy and excessive polypharmacy in patients with systemic lupus erythematosus are related to medical aspects such as disease severity and comorbidities in addition to social aspects such as hospital visitation patterns and economic status.

Polypharmacy and Potentially Inappropriate Medication Use in Older Adults With Systemic Lupus Erythematosus.

To assess the prevalence and potential risk factors for polypharmacy and prescribing of the potentially inappropriate medications, opioids and benzodiazepines/Z-drugs, in older adults with systemic lupus erythematosus (SLE). The study population comprised adults age ≥50 years meeting American College of Rheumatology or Systemic Lupus International Collaborating Clinics classification criteria followed at a tertiary care rheumatology clinic. Information on prescriptions filled in the 4 months preceding chart review was obtained from the Manitoba Drug Program Information Network. Clinical data, including age, sex, Charlson Comorbidity Index (CCI) score, Systemic Lupus Erythematosus Disease Activity Index 2000 score, prednisone use, SLE duration, and rural residence were abstracted from electronic medical records. Logistic regression analyses were performed to assess any association between polypharmacy (using 2 definitions: ≥5 and ≥10 medications), potentially inappropriate medication use, and clinical features. A total of 206 patients (mean age 62 years, 91% female, 36% rural) were included: 148 (72%) filled ≥5 medications, 71 (35%) filled ≥10 medications, 63 (31%) used benzodiazepines/Z-drugs, and 50 (24%) used opioids. Among the 77 patients age ≥65 years, 57 (74%) filled ≥5 medications, and 26 (34%) filled ≥10 medications, compared to 30% and 4%, respectively, of Manitobans age ≥65 years (National Prescription Drug Utilization Information System, 2016). The odds of polypharmacy were greater with prednisone use (adjusted odds ratio [OR] 3.70 [95% confidence interval (95% CI) 1.40-9.79] for ≥5 medications), CCI score (adjusted OR 1.62 [95% CI 1.20-2.17]), and rural residence (adjusted OR 2.05 [95% CI 1.01-4.18]). Odds of benzodiazepine/Z-drug use were increased with polypharmacy (adjusted OR 4.35 [95% CI 1.69-11.22]), and odds of opioid use were increased with polypharmacy (adjusted OR 6.75 [95% CI 1.93-23.69]) and CCI score (adjusted OR 1.29 [95% CI 1.08-1.54]). The prevalence of polypharmacy in this SLE cohort was higher than in the general Manitoban population. Polypharmacy is a strong marker for use of prescription benzodiazepines/Z-drugs and opioids.

SUBCLINICAL PREDICTORS OF HEART FAILURE IN UNTREATED SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITHOUT KNOWN HEART DISEASE

SUBCLINICAL PREDICTORS OF HEART FAILURE IN UNTREATED SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITHOUT KNOWN HEART DISEASE