Events In Systemic Lupus Erythematosus Research Articles

TNFSF13B rs9514828 C>T Polymorphism is Associated with Incidence of Atherosclerosis and Therapeutic Outcomes in Patients with Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with numerous clinical manifestations. Organ involvement can aggravate patients with SLE and cause comorbidities such as atherosclerosis. Recently, the TNFSF13B gene has been found to be linked with SLE events. This study aimed to analyze the association between single nucleotide polymorphisms of the TNFSF13B rs9514828 with incidence of atherosclerosis and therapeutic outcomes in patients with SLE. This case-control study included 84 SLE patients, of whom 21 patients with SLE with atherosclerosis and 63 patients with SLE without atherosclerosis. Using enzyme-linked immunosorbent assay method, interleukin-6 and interferon gamma levels were quantified. The TNFSF13B gene polymorphism was evaluated using polymerase chain reaction followed by sequencing. The lupus low disease activity state (LLDAS) criteria were used to measure the therapeutic outcomes. Statistical analysis was conducted using binary logistic regression. The genetic variations of TNFSF13B rs9514828 were CC = 35, CT = 41, and TT = 8. There was an association between TNFSF13B rs9514828 C>T polymorphism in patients with SLE with and without atherosclerosis (p = 0.03; odds ratio (OR) 4.72, 95% confidence interval [CI] 1.22-18.37). Furthermore, the TNFSF13B rs9514828 C>T polymorphism had association with the therapeutic outcomes of patients with SLE who manifested with LLDAS (p = 0.00; OR 7.58, 95% CI 2.61-21.99). The association of TNFSF13B rs9514828 C>T polymorphism and incidence of atherosclerosis as well as the therapeutic outcomes in patients with SLE indicate the potential utility of the gene variation as screening tool to employ personalized medicine to undertake preventive measures in order to prevent atherosclerosis and to predict a poor prognosis in SLE patient.

Prevalence, Epidemiology, Mortality and Morbidity of Thrombotic Events in SLE: A Nationwide Study in the United States

CONCLUSION Thrombotic events (TE) are a major cause of morbidity and mortality in patients with Systemic Lupus Erythematosus (SLE). Data is scant, however, on the prevalence, epidemiological characteristics, in hospital morbidity and mortality of TEs in this population. To perform a comprehensive epidemiological study on patients with SLE and DVT, PE or atypical thrombosis and their variation by gender, geographic region and hospital status. We also aimed to explore the associated morbidity and mortality for each TE and potential associations with other risk factors such as obesity and smoking. We conducted a retrospective cohort study, using the 2003-2018 Nationwide Inpatient Sample (NIS) database. All adult patients with a diagnosis of SLE using ICD-9 and 10 codes were included. The ICD 9 and 10 codes were also used to find other TE variables including DVT, PE, Cerebral venous sinus thrombosis (CVST), Splanchnic thrombosis (ST)and Arterial thrombosis (AT). Of the 513,904 SLE patients included, PE, DVT, ST, CVST and AT were identified in 1.38%, 3.07%, 1.34%, 0.04% and 0.35% patients respectively. Each TE (except CVST) had a statistically significant increase in length of hospital stay, cost of hospitalization and all-cause in-hospital mortality. Higher prevalence of PE, DVT, ST and AT were reported in males with SLE, and higher prevalence of obesity was seen in SLE patients with TEs, except AT, which interestingly was associated with a lower prevalence of obesity. Despite comprising only one third of the cohort, African Americans (AAs) faced the highest burden of PEs and DVTs. No significant differences were seen between geographic regions. This study is limited by administrative claims data, lack of antiphospholipid antibody status, and only includes inpatient encounters. Additionally, this is an observational retrospective study, and the assessment is limited to association of these thrombotic events in the SLE population. Arterial, venous and atypical thrombosis exert significant morbidity and mortality in patients with SLE. Racial and gender variations exist in each category of thrombosis, and identifying these differences is crucial while taking management decisions for patients with SLE. Particular attention should be directed to AAs with SLE, who appear to be particularly vulnerable.

Extensive Alternative Splicing Patterns in Systemic Lupus Erythematosus Highlight Sexual Differences.

Substantial evidence highlights divergences in immune responses between men and women. Women are more susceptible to autoimmunity, whereas men suffer from the more severe presentation of autoimmune disorders. The molecular mechanism of this sexual dimorphism remains elusive. Herein, we conducted a comprehensive analysis of sex differences in whole-blood gene expression focusing on alternative splicing (AS) events in systemic lupus erythematosus (SLE), which is a prototype sex-biased disease. This study included 79 SLE patients with active disease and 58 matched healthy controls who underwent whole-blood RNA sequencing. Sex differences in splicing events were widespread, existent in both SLE and a healthy state. However, we observed distinct gene sets and molecular pathways targeted by sex-dependent AS in SLE patients as compared to healthy subjects, as well as a notable sex dissimilarity in intron retention events. Sexually differential spliced genes specific to SLE patients were enriched for dynamic cellular processes including chromatin remodeling, stress and inflammatory responses. Remarkably, the extent of sexual differences in AS in the SLE patients and healthy individuals exceeded those in gene expression. Overall, this study reveals an unprecedent variation in sex-dependent splicing events in SLE and the healthy state, with potential implications for understanding the molecular basis of sexual dimorphism in autoimmunity.

Speckle tracking echocardiography in the assessment of left ventricular systolic function in patients with autoimmune disorders: review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Autoimmune disorders, namely Systemic lupus erythematosus (SLE) and Systemic Sclerosis (SSc) are characterized with high incidence of cardiovascular morbidity and mortality. Autopsy data shows high prevalence of myocardial involvement in these patients, however left ventricular systolic dysfunction is diagnosed in few of them, due to low sensitivity of current diagnostic tools. Purpose The present study aimed to perform an extensive systemic review and meta-analysis of the current case-control studies based on the assessment of the left ventricular systolic function with advanced echocardiographic methods such as speckle tracking echocardiography (STE) derived left ventricular global longitudinal strain (LV GLS), which has been proven to be a more sensitive tool for the detection of subtle myocardial changes in different entities. Methods The objectives, literature search strategies, inclusion and exclusion criteria, outcome measurements, and methods of statistical analysis were analyzed according to an established protocol of the Cochrane collaboration steps and meta-analysis of observational studies in epidemiology recommendations (MOOSE). Results A total of 420 papers were collected according to our searching criteria, of those 9 studies including 462 SLE patients and 356 controls and also 8 studies including 660 SSc patients and 370 controls with evaluated LV GLS were selected. We found, that overall patients with SLE exhibited lower levels of LV GLS as compared to controls: [Std. Mean Difference, (95% CI) −1.35 (−1.86 to −0.83); p<0.00001]. From selected 9 studies, one study had performed three-dimensional (3D) STE derived LV GLS assessment, including 34 SLE patients and also 34 controls. Subgroup analysis showed that 3D STE derived LV GLS was significantly lower in SLE patients as compared to healthy controls [Std. Mean Difference, (95% CI) −1.17 (−1.69 to −0.65); p<0.00001]. LV GLS was significantly lower in SSc patients in every reported study as compared to controls: [Std. Mean Difference, (95% CI) −2.26 (−2.88 to −1.64); p<0.00001]. Moreover, some studies showed significant association between deteriorated LV GLS and cardiovascular events in SLE and SSc patients. Conclusions LV systolic function as measured by LV GLS is significantly affected in SLE and SSc patients. Meta-analysis suggests that in autoimmune disorders STE derived LV GLS assessment potentially represents a new tool in the detection of subtle myocardial changes even at subclinical stage of the heart failure and therefore may improve risk-stratification in patients with SLE and SSc.

Factors associated with cardiovascular events in systemic lupus erythematosus in a monocentric cohort with up to 40 years of follow-up

ObjectivesSystemic lupus erythematosus (SLE) is associated with an increased cardiovascular risk. Several traditional and disease-specific risk factors have been shown to correlate with the occurrence of cardiovascular events (CVE) in patients with SLE. However, results of previous studies are diverse. The objectives of this study were to report number, type and those factors associated with CVE in patients with SLE in a large, single-center, ethnically diverse cohort with a long follow-up duration. MethodsMedical records of patients treated at the Lupus Clinic at University College London Hospital (UCLH) between 1979 and 2020 were retrospectively reviewed. Data about CVE, traditional cardiovascular risk factors, demographic and disease features, and treatment history were collected. Only patients with complete available information were included in the study. Regression analyses were performed to identify factors associated with CVE. ResultsFour hundred and nineteen patients were included in the study. Maximum follow-up length was 40 years. Seventy-one (17%) patients had at least one CVE. Multivariable analysis showed that only antiphospholipid antibody positivity (p-value<0.001) was associated with CVE. When analysing different types of CVE, antiphospholipid antibodies were specifically associated with both venous thromboembolic events (p-value<0.001) and cerebrovascular events (p-value=0.007). Dedicated subanalyses revealed that cumulative glucocorticoid dose (p-value=0.010) and a diagnosis of SLE before 2000 (p-value<0.001) were significantly associated with CVE. ConclusionsCardiovascular disease is highly prevalent among patients with SLE and is associated with antiphospholipid antibodies, glucocorticoid therapy, and diagnosis before 2000.

Role of Platelet-Bound C4d (PC4d) in Predicting Risk of Future Thrombotic Events in Systemic Lupus Erythematosus.

Platelet-bound complement activation product C4d (PC4d) levels correlate with history of thrombosis in patients with systemic lupus erythematosus (SLE). The present study evaluated whether PC4d levels could assess risk of future thrombosis events. PC4d level was measured by flow cytometry. Thromboses were confirmed by electronic medical record data review. The study included 418 patients. Nineteen events (13 arterial and 6 venous) occurred in 15 subjects in the 3 years post-PC4d level measurement. PC4d levels above the optimum cutoff of 13 mean fluorescence intensity (MFI) predicted future arterial thrombosis with a hazard ratio of 4.34 (95% confidence interval [95% CI] 1.03-18.3) (P=0.046) and a diagnostic odds ratio (OR) of 4.30 (95% CI 1.19-15.54). Negative predictive value of PC4d level of ≤13 MFI for arterial thrombosis was 99% (95% CI 97-100%). Although a PC4d level of >13 MFI did not reach statistical significance for prediction of total thrombosis (arterial and venous) (diagnostics OR 2.50 [95% CI 0.88-7.06]; P=0.08), it was associated with all thrombosis (n=70 historic and future arterial and venous events in the 5 years pre- to 3 years post-PC4d level measurement) with an OR of 2.45 (95% CI 1.37-4.32; P=0.0016). In addition, the negative predictive value of PC4d level of ≤13 MFI for all future thrombosis events was 97% (95% CI 95-99%). A PC4d level of >13 MFI predicted future arterial thrombosis and was associated with all thrombosis. Patients with SLE presenting with a PC4d level of ≤13 MFI had high probability of not experiencing arterial or any thrombosis in the 3 years afterwards. Taken together, these findings indicate that PC4d levels may help predict the risk of future thrombosis events in SLE.

Retrospective cohort study of thromboembolic events in systemic lupus erythematosus with or without secondary antiphospholipid syndrome and their correlation to lupus activity and dyslipidemia

BackgroundAntiphospholipid syndrome (APS) is one of the most frequent forms of acquired thrombophilia and is associated with an increased risk of stroke, heart attack, pulmonary embolism, and miscarriage in young women. Thirty to 40% of systemic lupus erythematosus (SLE) patients have associated APS. Patients with SLE often have abnormal plasma lipid concentrations. The study aimed to assess the prevalence of thromboembolic insults in SLE patients, with or without APS, and its correlation with disease activity and dyslipidemia. This study included one hundred three patients, seventy-five of whom had SLE without associated APS and twenty-eight had SLE associated with APS.ResultsVascular affection, neurological affection, and abortion were significantly higher in SLE patients associated with APS than SLE patients without APS (39.3% vs 6.7%, 46.4% vs 14.7%, 28.6% vs 5.3%, respectively; P < 0.001). Thromboembolic insults were present in 20% of SLE patients without APS, and those patients with thromboembolism demonstrated significantly higher SLEDAI (median = 15 vs 10, P < 0.001) and TG (median = 27.5 vs 18.2, P = 0.007), respectively, than other patients of the same group. The SLEDAI score was significantly higher in SLE patients associated with APS than in SLE patients without APS (P < 0.001). Serum cholesterol and low-density lipoprotein (LDL) were significantly higher in SLE patients associated with APS (93.8 ± 25.3 mg/dl) than in SLE patients without APS (82.3 ± 19.6 mg/dl, P = 0.018; 50 ± 15.9 mg/dl, P = 0.048, respectively).ConclusionsSLE patients are at significantly high risk for accelerated atherosclerosis, thromboembolism, and pregnancy loss which is multifactorial. Active disease should be well controlled. Lupus patients should be screened for aPL antibodies, and positive cases must be treated according to international guidelines. All patients with SLE should undergo lipid profile screening, and any abnormalities should be managed promptly.

Systematic Literature Review and Meta-analysis of Venous Thromboembolism Events in Systemic Lupus Erythematosus.

The objective of this work was to conduct a systematic literature review (SLR) and meta-analysis (MA) to evaluate the relative risk (RR) of venous thromboembolism (VTE) events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), in patients with systemic lupus erythematosus (SLE) compared with patients without SLE, as well as the absolute risk (AR) (measured by incidence proportion) and incidence rate (IR) of VTE events in patients with SLE. The SLR was conducted using Embase, MEDLINE, and MEDLINE In-Process to identify observational studies evaluating the risk of VTE, DVT, and PE events in adult patients with SLE compared with the general population, published January 2000 to September 2020. Random-effects models were used as the primary approach in the MA. Heterogeneity was assessed on the basis of the I2 value. Sensitivity analyses were performed to assess the robustness of results to various conditions, and subgroup analysis was performed for the AR of VTE by antiphospholipid status (aPLs) and antiphospholipid syndrome (APS). Of the 50 publications included for data extraction, 44 contained data for consideration in the MA of any one of the measures of interest (RR, AR, or IR) for VTE, DVT, or PE. The pooled RR indicates statistically significantly higher risk of VTE (RR 4.38, 95% confidence interval 2.63-7.29) in patients with SLE compared with the general population. Considerable heterogeneity was present in nearly all MA (I2 = 75-100%). Moreover, a higher pooled AR of VTE was estimated in patients with SLE with aPLs (n/N = 0.13) and APS (n/N = 0.63) compared with patients with SLE without aPLs/APS (n/N = 0.07). Overall, there was evidence of an increased risk of VTE, DVT, and PE in patients with SLE compared with the general population.

Peroxisome proliferator activated receptor-γ agonist pioglitazone improves vascular and metabolic dysfunction in systemic lupus erythematosus

ObjectivesPremature cardiovascular events in systemic lupus erythematosus (SLE) contribute to morbidity and mortality, with no effective preventive strategies described to date. Immune dysregulation and metabolic disturbances appear to play prominent...

Seroprevalence of SARS-CoV-2-specific antibodies and vaccination-related adverse events in systemic lupus erythematosus and rheumatoid arthritis.

BackgroundThis study aimed to investigate the seroreactivity of Coronavirus disease 2019 (COVID-19) vaccination and its adverse events among systemic lupus erythematosus (SLE) patients, rheumatoid arthritis (RA) patients, and healthy controls (HCs).MethodsA total of 60 SLE patients, 70 RA patients and 35 HCs, who received a complete inactivated COVID-19 vaccine (Vero cells) regimen, were recruited in the current study. Serum IgG and IgM antibodies against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) were determined by using chemiluminescent microparticle immunoassay (CMIA).ResultsThere were no significant differences regarding the seroprevalences of IgG and IgM antibodies against SARS-CoV-2, and the self-reported vaccination-related adverse events among SLE patients, RA patients and HCs. The inactivated COVID-19 vaccines appeared to be well-tolerated and moderately immunogenic. In addition, case-only analysis indicated that in SLE patients, the disease manifestation of rash and anti-SSA autoantibody were associated with seroprevalence of IgG antibody against SARS-CoV-2, whereas the uses of ciclosporin and leflunomide had influence on the seroprevalence of IgM antibody against SARS-CoV-2. In RA patients, rheumatoid factor (RF) appeared to be associated with the seroprevalence of IgG antibody against SARS-CoV-2.ConclusionOur study reveals that the seroprevalences of IgG and IgM antibodies against SARS-CoV-2 and vaccination-related adverse effects are similar among SLE, RA and HCs, suggesting that COVID-19 vaccine is safe and effective for SLE and RA patients to prevent from the pandemic of COVID-19.

Assessing the validity of QRISK3 in predicting cardiovascular events in systemic lupus erythematosus

ObjectivesTraditional cardiovascular risk calculators such as the Framingham Risk Score (FRS) have been shown to underestimate risk in patients with SLE. The QRISK3 calculator is unique in including SLE and...

Neuropsychiatric Events in Systemic Lupus Erythematosus: Predictors of Occurrence and Resolution in a Longitudinal Analysis of an International Inception Cohort.

To determine predictors of change in neuropsychiatric (NP) event status in a large, prospective, international inception cohort of patients with systemic lupus erythematosus (SLE). Upon enrollment and annually thereafter, NP events attributed to SLE and non-SLE causes and physician-determined resolution were documented. Factors potentially associated with the onset and resolution of NP events were determined by time-to-event analysis using a multistate modeling structure. NP events occurred in 955 (52.3%) of 1,827 patients, and 593 (31.0%) of 1,910 unique events were attributed to SLE. For SLE-associated NP (SLE NP) events, multivariate analysis revealed a positive association with male sex (P=0.028), concurrent non-SLE NP events excluding headache (P < 0.001), active SLE (P = 0.012), and glucocorticoid use (P = 0.008). There was a negative association with Asian race (P = 0.002), postsecondary education (P = 0.001), and treatment with immunosuppressive drugs (P = 0.019) or antimalarial drugs (P = 0.056). For non-SLE NP events excluding headache, there was a positive association with concurrent SLE NP events (P < 0.001) and a negative association with African race (P = 0.012) and Asian race (P < 0.001). NP events attributed to SLE had a higher resolution rate than non-SLE NP events, with the exception of headache, which had comparable resolution rates. For SLE NP events, multivariate analysis revealed that resolution was more common in patients of Asian race (P = 0.006) and for central/focal NP events (P < 0.001). For non-SLE NP events, resolution was more common in patients of African race (P = 0.017) and less common in patients who were older at SLE diagnosis (P < 0.001). In a large and long-term study of the occurrence and resolution of NP events in SLE, we identified subgroups with better and worse prognosis. The course of NP events differs greatly depending on their nature and attribution.

Platelet bound complement split product (PC4d) is a marker of platelet activation and arterial vascular events in Systemic Lupus Erythematosus

Platelet-bound complement activation products (PC4d) are associated with thrombosis in Systemic Lupus Erythematosus (SLE). This study investigated the effect of PC4d on platelet function, as a mechanistic link to arterial thrombosis. In a cohort of 150 SLE patients, 13 events had occurred within five years of enrollment. Patients with arterial events had higher PC4d levels (13.6 [4.4–24.0] vs. 4.0 [2.5–8.3] net MFI), with PC4d 10 being the optimal cutoff for event detection. The association of arterial events with PC4d remained significant after adjusting for antiphospholipid status, smoking, and prednisone use (p = 0.045). PC4d levels correlated with lower platelet counts (r = −0.26, p = 0.002), larger platelet volumes (r = 0.22, p = 0.009) and increased platelet aggregation: the adenosine diphosphate (ADP) concentration to achieve 50% maximal aggregation (EC50) was lower in patients with PC4d 10 compared with PC4d < 10 (1.6 vs. 3.7, p = 0.038, respectively). These results suggest that PC4d may be a mechanistic marker for vascular disease in SLE.

Association of Higher Hydroxychloroquine Blood Levels With Reduced Thrombosis Risk in Systemic Lupus Erythematosus

Hydroxychloroquine (HCQ) has a primary role in the prophylaxis and treatment of systemic lupus erythematosus (SLE) and may be protective against thrombosis in SLE. Optimal weight-based dosing of HCQ is unknown. This study examined the usefulness of HCQ blood monitoring in predicting thrombosis risk in a longitudinal SLE cohort. HCQ levels were serially quantified from EDTA whole blood by liquid chromatography-tandem mass spectrometry. Mean HCQ blood levels calculated prior to thrombosis or until the last visit were compared between patients with and without thrombosis using t-test. Pooled logistic regression was used to analyze the association between rates of thrombosis and HCQ blood level. In 739 patients with SLE, thrombosis occurred in 38 patients (5.1%). Mean HCQ blood level was lower in patients who developed thrombosis vs without thrombosis (720±489 vs 935±580, p=0.025). Thrombosis rates were reduced by 12% for every 200 ng/mL increase in the most recent HCQ blood level (0.87 [0.78, 0.98], p=0.025) and by 13% for mean HCQ blood level (rate ratio 0.87 [0.76,1.00], p=0.056). Thrombotic events were reduced by 69% in patients with mean HCQ blood levels >1068 ng/mL vs <648 ng/mL (0.31 [0.11, 0.86], p=0.024). This remained significant after adjustment for confounders (0.34 [0.12, 0.94], p=0.037). Low HCQ blood levels are associated with thrombotic events in SLE. Longitudinal measurement of HCQ levels may allow for personalized HCQ dosing strategies. Recommendations for empirical dose reduction may reduce or eliminate the benefits of HCQ in this high-risk population.

Assessment of cardiovascular risk tools as predictors of cardiovascular disease events in systemic lupus erythematosus

BackgroundSLE is an independent risk factor for cardiovascular disease (CVD). This study aimed to determine which among QRISK2, QRISK3, Framingham Risk Score (FRS), modified Framingham Risk Score (mFRS) and SLE...

Basophils and Systemic Lupus Erythematosus in Murine Models and Human Patients.

Simple SummaryImmunomodulatory properties have been recognized in basophils, in addition to their role as immune effector cells. Recent evidence has suggested that basophils may play a role in autoimmunity as well. The aim of the present systematic review is to summarize and discuss the available studies assessing basophils homeostasis in systemic lupus erythematosus by considering both murine models and human research. As a result, the final search output consisted of three and eight articles investigating basophils’ role in murine models of lupus and patients affected with systemic lupus erythematosus, respectively. The selected studies supported a potential immunomodulatory activity of basophils in systemic lupus erythematosus (possibly by influencing some aspects of the adaptive immune response), but additional basic research and clinical studies are needed to clarify the relevance of their contribution and the precise immunopathological mechanisms.Basophils are the rarest cell population in the blood. Even though basophils are known to participate in some allergic reactions and immune responses to parasitic infections, their immunological role is still largely elusive. Recent evidence has suggested that in some murine models of systemic lupus erythematosus and lupus-like nephritis, basophils may also be implicated in autoimmunity processes by promoting autoantibody production and tissue injury. We conducted a systematic search to collect the available evidence on basophils’ potential immunomodulatory role in autoimmunity and, particularly, systemic lupus erythematosus. We identified several articles investigating basophils’ role in murine models of lupus (n = 3) and in patients affected with systemic lupus erythematosus (n = 8). Even though the alteration of the “adaptive” immune response is considered the main immunopathological event in systemic lupus erythematosus, the contribution from the mechanisms of “innate” immunity and, particularly, basophils may be relevant as well, by modulating the activation, polarization, and survival of lymphocytes.

Complement deposition, C4d, on platelets is associated with vascular events in systemic lupus erythematosus.

ObjectiveComplement components, including C4d, can be found on activated platelets, a process associated with vascular disease in SLE. We investigated whether platelet C4d (PC4d) adds additional value to traditional and known lupus-associated risk factors when identifying SLE patients with vascular disease.MethodsThis cross-sectional study included 308 well-characterized SLE patients and 308 matched general population controls. PC4d deposition was analysed using flow cytometry. Values >95% of controls were considered as PC4d positive (+). aPL were determined by Luminex, and the LA test was performed by DRVVT. History of vascular disease (composite and as separate outcomes) was defined at inclusion.ResultsSLE patients had increased PC4d deposition as compared with population controls (50 vs 5%, P < 0.0001). PC4d+ positively associated with any vascular events, and separately with venous and cerebrovascular events, and also with all investigated aPL profiles. The association for any vascular event remained statistically significant after adjustment for traditional and SLE-associated risk factors (odds ratio: 2.3, 95% CI: 1.3, 4.3, P = 0.008). Compared with patients negative for both PC4d and LA, patients with double positivity were more likely to have vascular disease (odds ratio: 12.3, 95% CI: 5.4, 29.3; attributable proportion due to interaction 0.8, 95% CI: 0.4, 1.1)ConclusionPC4d+ is associated with vascular events in SLE, independently of traditional and SLE-associated risk factors. Concurrent presence of PC4d and LA seem to interact to further increase the odds for vascular events. Prospective studies should examine whether the aPL/PC4d combination can improve prediction of vascular events in SLE and/or APS.

Nine-test panel has superior sensitivity to detect antiphospholipid antibody syndrome in patients with or without SLE

Anti-phospholipid antibodies (aPL) and lupus anticoagulant (LAC) represent diagnostic criteria for systemic lupus erythematosus (SLE) and underlie anti-phospholipid syndrome (APS) in patients with and without SLE. 526 healthy controls and 1633 SLE and 1835 primary APS (PAPS) patients were evaluated. LAC was assessed by hexagonal phase phospholipid neutralization assay (HPPNA), diluted Russell viper venom test (dRVVT), and platelet neutralization procedure (PNP). β2-glycoprotein-I and cardiolipin IgG, IgM, and IgA antibodies (aCL-IgG, aCL-IgM, aCL-IgA) were measured. 222/1633 SLE patients had APS based on the nine-test panel, which afforded the highest sensitivity (74%) and negative predictive value (90%) but lowest specificity (52%). HPPNA was the most sensitive individual test at 52%. The nine-test panel yielded the greatest sensitivity for aPL detection (70%) relative to HPPNA, the most sensitive individual test (36%) in PAPS. Superior sensitivity of a nine-test aPL panel has major implications for preventing potentially fatal thrombotic events in SLE and PAPS.

Impact of the new American College of Cardiology/American Heart Association definition of hypertension on atherosclerotic vascular events in systemic lupus erythematosus

BackgroundThe 2017 American College of Cardiology/American Heart Association guidelines defined hypertension at ≥130/80 mm Hg. Studies on patients with connective tissue diseases were not considered. Our aim was to assess...

Neuropsychiatric events in systemic lupus erythematosus: a longitudinal analysis of outcomes in an international inception cohort using a multistate model approach

ObjectivesUsing a reversible multistate model, we prospectively examined neuropsychiatric (NP) events for attribution, outcome and association with health-related quality of life (HRQoL), in an international, inception cohort of systemic lupus...