Findings In Systemic Lupus Erythematosus Research Articles

Echocardiographic findings in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by inflammation of multiple organs. The heart may be seriously involved. Aim of study: to investigate the cardiac involvement in patients diagnosed with SLE assessed from an echocardiographic view. We retrospectively reviewed the records of 75 patients with diagnosis of SLE based on the American College of Rheumatology criteria and who were referred to our echocardiography laboratory between 2010 to 2022. All echocardiographic exams were carried by transthoracic way. Patients were female in 92% of cases. Mean age was 27.8 years (16–70 years). Echocardiography showed 17 cases (22%) of minim or moderate pericardial effusion, tamponadein 2 cases. Valvularabnormalities were observed in 19 cases (25%), this included thickening of valves in all cases associated to 6 cases of significant mitral regurgitation (> grade 1) and 2 cases of Libman sacks mitral valve endocarditis. However, aortic involvement was noted only in 3 cases resulting in thickening and mild regurgitation. Myocardium was involved in 5 cases (6%) including dilated left ventricular in 3 cases and hypertrophy in 2 cases. High arterial pulmonary hypertension was reported in 4 cases (5%) with mean systolic pulmonary arterial pressure was 59 mmHg (38–120 mmHg). Patients with SLE have an increased risk of cardiac involvement. In agreement with previous reports, our study shows that pericardial effusion is the most frequent cardiac complication of lupus and Valvular involvement in SLE is relatively frequent but the degree of valvular dysfunction is not important. Echocardiography should be used as a screening tool in these patients, including annual echocardiographic screening of asymptomatic individuals with systemic autoimmunity.

IL-10‒Producing Potency from Blood B Cells Correlates with the Prognosis of Alopecia Areata

IL-10‒Producing Potency from Blood B Cells Correlates with the Prognosis of Alopecia Areata

Splenic calcifications: an unusual finding in systemic lupus erythematosus.

Splenic calcifications: an unusual finding in systemic lupus erythematosus.

High-resolution computed tomography chest findings in systemic lupus erythematosus

Background Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of autoimmune origin that can affect virtually every organ system of the human body. Aim of the work The aim of this work is to identify high-resolution computed tomography (HRCT) chest findings in patients with SLE and their significance. Patients and methods This study was carried out on 50 patients who were diagnosed with SLE or those sought medical advice at Chest Departments of Bab El-Sharia and Al-Hussein University Hospitals in the period from February 2017 to December 2017. The mean age of the studied patients was 35.9±9.5 years with a minimum age of 18 years and maximum age of 50 years; four (8%) patients were men while 46 (92%) patients were women. Results In this study, 12 (24%) patients have no HRCT chest findings and 38 (76%) patients have HRCT chest findings;, pleural effusion is the most common finding and appears in 19 (38%) patients, with bilateral effusion in 15 patient, atelectasis appears in four (8%) patients, pleural thickening appears in six (12%) patients, bronchiectasis appears in five (10%) patients, lymphadenopathy appears in six (12%) patients, consolidation appears in 11 (22%) patients, solitary pulmonary nodule appears in one (2%) patient, interlobular thickening appears in seven (14%) patients, honeycombing appears in two (4%) patients, ground glass appears in five (10%) patients, and emphysema appears in three (6%) patients. Conclusion Respiratory system affection is common in patients with SLE. HRCT chest is the gold standard method for diagnosis of pleuroparenchymal changes in SLE.

The importance of microRNAs in the development of systemic autoimmune disorders

MicroRNAs (miRNAs) are 18-25 nucleotide long, single stranded, endogenous, non-coding small RNAs playing an important role in regulating gene expression at posttranscriptional level. miRNAs control approximately 90% of protein-coding genes, and play a central role in various biological processes including immune cell lineage commitment, differentiation, proliferation, apoptosis and maintenance of immune homeostasis. Changes in the expression of certain miRNAs may lead to the development of many diseases, including systemic autoimmune diseases. In this study, we summarize the biogenesis of miRNAs, their role in regulation of the immune system, and review the latest research findings in systemic lupus erythematosus, primary Sjögren's syndrome, rheumatoid arthritis and systemic sclerosis. In the future, miRNAs may help not only in establishing diagnosis and prognosis but potentially serve as targets for modern therapeutic approaches in autoimmune diseases. Orv Hetil. 2019; 160(15): 563-572.

Echocardiographic findings in systemic lupus erythematosus and its relation to disease activity and damage index

Aim of the workTo assess the echocardiographic changes using Trans Thoracic Echocardiograghy in systemic lupus erythematosus (SLE) patients with and without antiphospholipid syndrome (APS) and to study the relation of the changes to the disease activity and damage. Patients and methodsThis study was conducted on 50 SLE patients (25 with and 25 without APS) and 50 controls. The SLE disease activity index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage index (SLICC/DI) were assessed. Laboratory investigations were performed and transthoracic echocardiography (TTE) was done. ResultsThe mean age of the patients was 27.7 ± 8.5 years and disease duration 4.1 ± 3.7 years; 44 females and 6 males; 7.3:1. There was a high frequency of mitral (64%), aortic (22%) and tricuspid (24%) valve regurges as well as pericardial effusion (22%). Left ventricular hypertrophy and atrial dilation was present in 10% of the patients. The frequency of mitral, aortic and tricuspid regurge in SLE patients with APS tended to be higher (84%, 32% and 36%) than in those without (44%, 12% and 12%, respectively). There was a significant correlation between SLEDAI and pericardial effusion (p = 0.001), between the SLICC/DI with the left ventricular diastolic dysfunction (LVDD) (p = 0.001), the presence of lupus nephritis with the ejection fraction (p = 0.02) and between hypertension with the LVDD (p = 0.001). ConclusionAll SLE patients especially those with APS should be screened for the presence of structural cardiac abnormalities. TTE can be helpful as a noninvasive diagnostic tool for early detection of the abnormalities, resulting in earlier treatment and reduction in mortality and morbidity.

Silent cerebral MRI findings in lupus nephritis patients: Is it clinically significant?

Lupus nephritis (LN) carries high morbidity and mortality and whenever added to neuropsychiatric manifestations lead to more unfavorable prognosis. Though silent brain MRI findings in systemic lupus erythematosus (SLE) had been widely studied, the current work focused on LN patients comparing them to those without kidney affection, studying their cerebral MRI and its correlation with the histopathological classes of LN and disease activity. This may enable us to know more about early brain affection in LN patients for better follow up, management, and prognosis of this serious comorbidity. Cerebral MRI and MRA were studied in 40 SLE patients without neuropsychiatric manifestations; 20 LN patients with different histopathological classes and 20 patients without kidney affection. Disease activity was assessed for all patients using SLE disease activity index (SLEDAI). Abnormal MRI brain findings were more common in LN patients “though non significant” (P = 0.9). The most common lesions were white matter hyperintense lesions (WMHLs). Number and size of such lesions were significantly higher in LN patients (1.8 fold that of non nephritis, P = 0.003 and 0.03, respectively) and positively correlated with urea, creatinine, urinary albumin/creatinine ratio, SLEDAI, ESR, CRP, and grades of renal biopsy and negatively correlated with C3 and C4. Cortical atrophy and prepontine space dilatation were also significantly higher in LN patients (P = 0.01). Asymptomatic MRI brain lesions whenever present in LN patients, they are usually clinically significant and well correlate to laboratory parameters of LN, grades of renal biopsy, and disease activity independent to age, sex and hypertension.

Interferon-γ Is Associated with Cerebral Atrophy in Systemic Lupus Erythematosus

Objective: We evaluated the cerebrospinal fluid (CSF) cytokine profile and magnetic resonance imaging (MRI) findings in systemic lupus erythematosus (SLE) patients with central nervous system (CNS) involvement. Methods: Consecutive SLE patients followed at the rheumatology unit were enrolled into this study. Neurologically asymptomatic controls were matched for age and sex and recruited during myelography. SLE patients were assessed for disease activity (Systemic Lupus Erythematosus Disease Activity Index; SLEDAI) and cumulative damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index; SDI). All subjects underwent MRI scans and blood and CSF withdrawal. Immunoglobulin G (IgG) and albumin were measured by nephelometry and link indexes were calculated according to the literature. Interleukin (IL)-12 p40/p70, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, and IL-10 were measured by enzyme-linked immunosorbent assay. Results: We included 20 SLE patients (18 women, mean age 30.2 ± 9.2 years, range 19-45) with CNS manifestations. Increased IL-12 p40/p70, IFN-γ, TNF-α, and IL-10 CSF levels were observed in SLE patients. Mild pleocytosis was observed in 8 (66%) SLE patients and intrathecal production of IgG was observed in 2 (10%) SLE patients. Three (15%) SLE patients had demyelinating lesions, 5 (25%) patients had cerebral atrophy, and 12 (60%) patients had ischemic lesions on MRI. We observed that the cerebral lesion count was associated with CNS manifestations and SDI scores. We observed a significant cerebral volume reduction in SLE patients compared to controls (p < 0.001). Moreover, a direct correlation between cerebral volume reduction and CSF IFN-γ levels was observed (r = 0.5, p = 0.01). Conclusions: IL-12 p40/p70, IFN-γ, TNF-α, and IL-10 CSF levels were increased in SLE patients with CNS manifestations, but only IFN-γ was associated with a cerebral volume reduction in SLE, suggesting an immunological basis for global atrophy in SLE.

Cerebral Venous Sinus Thrombosis Presenting Feature of Systemic Lupus Erythematosus

CVST (cerebral venous sinus thrombosis) may sometimes be associated with autoimmune disorders that require specific treatment. The clinical and magnetic resonance imaging (MRI) findings of systemic lupus erythematosus (SLE) patients with CVST are presented and contrasted with CVST without SLE. Consecutive patients with CVST admitted in neurology service during 2012-2016 were included. The diagnosis of CVST was confirmed by MR venography or digital subtraction angiography. SLE was diagnosed according to American College of Rheumatology criteria. The clinical and MRI findings of CVST with SLE and those without SLE were compared. Forty-three consecutive patients with CVST were included during the study period, 3 of whom had SLE .Their age ranged between 20 and 35 years and all were females. The clinical markers of SLE were present in all and included oral ulceration in 3 patients, serositis in 2 patients, and arthritis and psychosis in 1 patient. The SLE patients did not have antiphospholipid antibodies or lupus anticoagulant. The manifestation of CVST in SLE was similar to the other patients with CVST. The CVST in SLE required long-term anticoagulation and immunosuppression with cyclophosphamide pulse in 1 patient and oral prednisolone in 2 patients. The outcome was good, partial, and poor in 1 patient each. CVST may be the presenting feature of SLE, but these patients often have clinical clues to SLE. These patients need prolonged anticoagulation and immunosuppression.

Retinal Involvement in Systemic Lupus Erythematosus

Aim: To report fundus findings in systemic lupus erythematosus (SLE), systemic associations and treatment outcome. Methods: This was a retrospective case series study of 18 eyes of nine patients SLE patients who presented to the clinic from October 2002 to June 2016 at a tertiary eye care centre in south India. Results: The mean age of presentation with ocular involvement in SLE patients was 25.56 years (16 to 36 years). The mean duration of patients’ follow up was 28.08 months. The average duration of systemic disease at presentation was 46.71 ± 50.57 months. The systemic features present in all of our SLE patients, the commonest being arthritis (44.44%) and cytopenias (44.44%) followed by nephritis (22.22%) and dermal rashes (22.22%). In regards to auto antibodies, antinuclear antibody (ANA) was positive in four (44.4%) patients, anti dsDNA in two (22.2%) cases, anticardiolipin antibody (aCLAb) levels raised in one (11.1%) patient and borderline in two (18%) patients. Lupus anticoagulant was positive in one (11.1%) case and two (22.2%) cases were diagnosed to have antiphospholipid antibody syndrome (APLS). Visual impairment was present in 9/18 eyes (50%) at presentation. SLE retinopathy was seen in 14/18 eyes (77.78%) which was in the form of hard exudates, cotton wool spots, roth spots, vascular sheathing, retinal, vitreous and subhyaloid hemorrhage, macular edema, neo-vascularisation, tractional retinal detachment, combined retinal artery and vein occlusion. One eye of one patient had SLE choroidopathy. Treatment instituted included systemic corticosteroid, immunosuppressive therapy, laser photocoagulations, and vitreo-retinal surgery. The mean final visual acuity was 0.92 ± 0.83 Log MAR units, which was slightly better than the mean visual acuity at presentation (0.96 ± 0.9 Log MAR units); however was not statistically significant (p=0.82). Conclusion: Ocular fundus findings in SLE patients are not uncommon and should be examined cautiously.

Chest CT findings in systemic lupus erythematosus and its correlation with serum markers

ObjectiveThe aim of this study was to assess the CT findings of chest lesions in patients with systemic lupus erythematosus (SLE), and to explore its correlation with the age and serum markers (anti-dsDNA antibodies, anti-Sm antibodies, CRP, ESR, C3, C4 and IgG), in an attempt to speculate the possible mechanism of chest lesions in SLE patients. Materials and methodsThirty nine patients who met the SLE classification criteria were enrolled into this study. All patients underwent serological tests and chest CT examination. The chest CT findings of each patients were analyzed, and its correlation with the age, serum markers were explored. All data were analyzed by using SPSS 19.0 software. Two-sample t-test was used to analyze the age difference between the two groups with or without chest lesions. Relationship between the serum markers and the chest lesions was analyzed by using the Fisher's exact probability method. ResultsAll the 39 patients (34 females and 5 males), aged from 19 to 74 years old, the mean age was 44.13 ± 12.17 years old. Among the serum markers, the positive rate of C3 was the highest (79.49%), ESR positive in 22 patients (56.41%), 9 patients of CRP positive (23.08%). Of all the 39 patients, abnormal manifestations of chest CT were found in 29 patients (74.36%), the most common changes were pulmonary interstitial changes (66.67%), the second were mediastinal/pleural changes (61.54%), then were the pulmonary parenchymal changes (25.64%) and pulmonary vascular changes (12.82%). ESR positive rate difference was found between the two groups with or without pulmonary parenchymal lesions (P < 0.05), and CRP positive rate difference was found between the two groups with or without mediastinal/pleural lesions (P < 0.05). ConclusionChest involvement occurred with high frequency in SLE patients, and the CT manifestations were complex and various, pulmonary interstitial lesions were the most common. Patients with ESR positive were more susceptible to have pulmonary parenchymal lesions, and mediastinal/pleural lesions were more common in patients with CRP positive.

Dr Eng M. Tan: a tribute to an enduring legacy in autoimmunity.

At the age of ninety years, Dr Eng Meng Tan has had a remarkable impact on the accumulated knowledge of autoimmune diseases, including seminal findings in systemic lupus erythematosus (SLE) and a wide range of other autoimmune diseases. Dating to the first description of the Sm (Smith) autoantibody in SLE, his focus has been the use of autoantibodies as probes to identify and elucidate novel cellular molecules and then translating these discoveries into biomarkers and immunoassays for a wide range of these diseases and, later, cancer. He led efforts to standardize autoantibody nomenclature and testing protocols. Through his mentorship a great number of trainees and collaborators have had remarkably successful careers, and by that virtue he has garnered a remarkable continuing legacy.

Oral Findings of Systemic Lupus Erythematosus- A Grand Round Case

A case of an SLE patient with an erythematous plaque at hard palate surrounded by white striae and a chronic cutaneous lupus erythematosous (CCLE) history is being reported. Other authors’ findings are being critically discussed and we focus on the following: i. Need of oral lesions histopathologic examination in SLE patients as they contribute to diagnosis establishment. ii. Oral ulcers do not certainly constitute neither the unique nor the main oral lesion in SLE since apart from them are reported red and white plaques, red macules, lechinoid reactions as well as periodontal manifestations (marginal or/and desquamative gingivitis). iii. Biopsy is crucial for excluding oral squamous cell carcinoma, especially in oral ulcers. iv. In the case of SLE xerostomia minor salivary glands biopsy contributes to secondary Sjogren syndrome diagnosis. v. Contribution of oral manifestations in early SLE diagnosis, leads to effective treatment and prevention of serious systemic malfunctions, potentially lethal.

Isolated cutaneous findings of systemic lupus erythematosus due to propylthiouracil

Isolated cutaneous findings of systemic lupus erythematosus due to propylthiouracil

Periodontal findings in systemic lupus erythematosus patients and healthy controls.

Objectives:To compare periodontal findings in systemic lupus erythematosus (SLE) patients and healthy controls, and to determine, whether there is a correlation between periodontal parameters and SLE biomarkers.Methods:This cross-sectional study was conducted in the Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia between November 2012 and February 2014. Twenty-five participants diagnosed with SLE and 50 healthy controls were selected. Periodontal assessment consisted of clinical attachment level (CAL), probing depth (PD), bleeding on probing, and plaque scores. For the SLE group, several laboratory tests were obtained, such as, white blood cell count, hemoglobin level, platelet count, anti-nuclear antibody, anti-double-stranded DNA antibody, calcium level, and vitamin D.Results:Periodontal findings in SLE patients and controls were not significantly different. The SLE patients who had no flare-ups for more than a year showed significant bleeding on probing and deeper PD compared with those who had flare-ups less than a year before starting the study. The SLE patients with arthritis symptoms showed more CAL than those without arthritis. In the SLE patients, no significant correlation was found between their periodontal findings and SLE biomarkers.Conclusion:Periodontal health was not different between SLE patients and healthy controls. In SLE patients however, flare-ups and presence of arthritis had a significant relation with periodontal health.

Pattern of MRI brain in neuro-psychiatric SLE. Effect of anti-phospholipid antibodies: A study at a tertiary care teaching hospital.

Objective:To compare the neuro-radiologic findings in Systemic lupus erythematosus (SLE) patients with and without antiphospholipid antibodies (aPL) in different neuro-psychiatric manifestations.Methods:This cross-sectional comparative study was carried out at King Khalid University Hospital, a tertiary care teaching hospital, Riyadh, Saudi Arabia from June 2012 to January 2015. Ninety seven SLE patients with neuro-psychiatric manifestations were included in the study and divided into two groups. Group I (50 patients) SLE with aPL and group II (47 patients) SLE without aPL. We compared Demographic features, clinical manifestations and magnetic resonance imaging (MRI) brain findings.Results:Demographic and clinical characteristics of two groups were similar. In Group-I, anticardiolipin antibodies (aCL) were most common (86%). In patients with headache, most of the patients in Group-I had white matter hyperintensities (WMHIs) (50% vs 27%) while most of the patients in Group-II had normal MRI brain (38% vs 73%). Similarly WMHIs were found more in Group-I patients with seizures (60% vs 21%), while ischemia/infarction, atrophy and normal MRI were found in Group-II. MRI brain in patients with neurological deficit and psychiatric disorder were not much different in both the groups.Conclusion:We found no statistically significant differences in frequencies of MRI brain abnormalities in SLE patients with and without aPL antibodies. Each of the three aPL may have a variable effect on the brain.

FRI0391 The Association between Type I Interferon Response, Complement Activation and Clinical Findings in Systemic Lupus Erythematosus

BackgroundThe complement system plays an important role in systemic lupus erythematosus (SLE) and it might be a therapeutic target for therapy. Type I interferon (IFN) response and type I IFN-induced...

Systemic lupus erythematosus cardiomyopathy—a case series demonstrating a reversible form of left ventricular dysfunction.

Myocarditis is reported to be a common postmortem finding of systemic lupus erythematosus (SLE). However, most case reports on SLE cardiomyopathy (CM) have not found evidence of myocarditis upon biopsy. Our aim was to characterize the nature, course, and reversibility of left ventricular (LV) dysfunction in patients with SLE. The records of 526 SLE patients were reviewed. Patients were included if: (1) at least 4 of 11 American College of Rheumatology criteria for SLE were met, (2) testing for erythrocyte sedimentation rate and hs-CRP were performed during hospitalization, and (3) echocardiogram demonstrated left ventricular ejection function (LVEF) <50%. We identified 14 patients meeting study criteria. Mean LVEF was 33.1 ± 9% upon presentation. The main echocardiographic pattern observed was generalized hypokinesis. Twelve patients demonstrated reversal of cardiomyopathy within 1 week, showing a mean improvement in LVEF of 21.0 ± 7%. Of these, 2 patients underwent coronary angiography demonstrating no evidence of obstructive coronary disease, and 1 underwent cardiac biopsy with no evidence of myocarditis. Four patients (29%) demonstrated improvement within 3 days. Two of the 14 patients died due to their underlying medical illness and did not have a repeat echocardiogram. The pattern of wall-motion abnormalities and reversibility demonstrated in the majority of these patients with SLE suggests an etiology more consistent with stress cardiomyopathy rather than myocarditis.

Incidence of progression from newly diagnosed systemic lupus erythematosus to end stage renal disease and all-cause mortality: a nationwide cohort study in Taiwan

End-stage renal disease (ESRD) is a common finding in systemic lupus erythematosus (SLE) and may contribute to mortality. The purpose of the study was to investigate the incidence of ESRD and all-cause mortality and their risk factors in patients newly diagnosed with SLE in Taiwan. This nationwide cohort study used data from the National Health Insurance Research Database. We identified 4130 newly diagnosed SLE patients at risk for ESRD during 2000-2002; among them, 103 developed ESRD by the end of 2008. Additional 412 age- and sex-matched incident ESRD non-SLE patients served as controls for the survival analysis. Of the newly diagnosed SLE patients, 2.5% developed ESRD. Age (adjusted hazards ratio [HR] 0.66 for each 1-year increase; 95% confidence interval [CI] 0.47-0.94) and male gender (adjusted HR 2.24; 95% CI 1.4-3.6) were significantly associated with ESRD development. Survival analysis conducted after ESRD development revealed a higher mortality risk among the older patients (HR 1.04; 95% CI 1.02-1.05). Survival analysis in the younger population (age < 40 years) after ESRD development revealed a significant mortality risk among SLE patients (HR 2.73; 95% CI 1.22-6.07). In the follow-up of newly diagnosed SLE patients in Taiwan, younger age and male gender were risk factors for ESRD development. After entering ESRD, these risk factors had different impacts on mortality. Despite the overall improvement in care of patients with lupus nephritis, survival is still poorer in the younger age population.

Transcatheter aortic valve replacement for advanced valvular disease in active SLE and APS

Valvular heart disease is a relatively common finding in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), sometimes necessitating valve surgery. Valve replacement may result in significant early and late morbidity and mortality. Surgical risks are even greater when co-morbid conditions including active SLE and renal involvement are present. This is the first report of the successful use of transcatheter aortic valve replacement (TAVR) for severe critical aortic stenosis in a patient with active SLE, renal failure and APS. TAVR may represent an additional, safer, approach to cardiac valve replacement in appropriately selected patients particularly where surgical risk is high and active disease present.