International Collaborating Clinics Damage Index Research Articles

Structural Brain MR Imaging Alterations in Patients with Systemic Lupus Erythematous with and without Neuropsychiatric Events.

Systemic lupus erythematosus is a complex autoimmune disease known for its diverse clinical manifestations, including neuropsychiatric systemic lupus erythematosus, which impacts a patient's quality of life. Our aim was to explore the relationships among brain MR imaging morphometric findings, neuropsychiatric events, and laboratory values in patients with systemic lupus erythematosus, shedding light on potential volumetric biomarkers and diagnostic indicators for neuropsychiatric systemic lupus erythematosus. Twenty-seven patients with systemic lupus erythematosus (14 with neuropsychiatric systemic lupus erythematosus, 13 with systemic lupus erythematosus), 24 women and 3 men (average age, 43 years, ranging from 21 to 62 years) were included in this cross-sectional study, along with 10 neuropsychiatric patients as controls. An MR imaging morphometric analysis, with the VolBrain online platform, to quantitatively assess brain structural features and their differences between patients with neuropsychiatric systemic lupus erythematosus and systemic lupus erythematosus, was performed. Correlations and differences between MR imaging morphometric findings and laboratory values, including disease activity scores, such as the Systemic Lupus Erythematosus Disease Activity Index and the Systemic Lupus International Collaborating Clinics Damage Index, were explored. An ordinary least squares regression analysis further explored the Systemic Lupus Erythematosus Disease Activity Index and Systemic Lupus International Collaborating Clinics Damage Index relationship with MR imaging features. For neuropsychiatric systemic lupus erythematosus and non-neuropsychiatric systemic lupus erythematosus, the brain regions with the largest difference in volumetric measurements were the insular central operculum volume (P value = .003) and the occipital cortex thickness (P = .003), which were lower in neuropsychiatric systemic lupus erythematosus. The partial correlation analysis showed that the most correlated morphometric features with neuropsychiatric systemic lupus erythematosus were subcallosal area thickness asymmetry (P < .001) and temporal pole thickness asymmetry (P = .011). The ordinary least squares regression analysis yielded an R 2 of 0.725 for the Systemic Lupus Erythematosus Disease Activity Index score, with calcarine cortex volume as a significant predictor, and an R 2 of 0.715 for the Systemic Lupus International Collaborating Clinics Damage Index score, with medial postcentral gyrus volume as a significant predictor. The MR imaging volumetric analysis, along with the correlation study and the ordinary least squares regression analysis, revealed significant differences in brain regions and their characteristics between patients with neuropsychiatric systemic lupus erythematosus and those with systemic lupus erythematosus, as well as between patients with different Systemic Lupus Erythematosus Disease Activity Index and Systemic Lupus International Collaborating Clinics Damage Index scores.

Clinical Characteristics of Pre-pubescent Patients with Systemic Lupus Erythematosus (SLE)

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune condition that affects multiple organ systems, including cutaneous, renal, neurological, and hematological disorders. Pediatric SLE (pSLE) has a prevalence of 3.3-8.8 cases per 100,000 children. Children with SLE (cSLE) have higher disease severity than adults, but the evidence on cSLE is mostly from pubertal patients, and the reasons for the variation on presentation is unclear. There is limited data on prepubertal SLE, as SLE rarely affects pre-pubescent patients. This study aims to outline the clinical characteristics, disease activity and organ damage of pre-pubescent patients with SLE. Methods: A retrospective study was performed on prospectively collected multi-center data from 2005-2015. Patient data, including race, ethnicity, sex, age of presentation and diagnosis, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, and Systemic Lupus International Collaborating Clinics (SLICC) damage index was collected using REDcap. Results: This study included 43 pre-pubescent SLE patients, with an average age at diagnosis of 9.7 years and 10.7 years at the study's start. Organ systems with the highest prevalence rates were musculoskeletal (Arthritis – 69.77%) and cutaneous (Malar rash – 58.14%). The organ systems with the highest involvement frequency, according to the SLICC damage index, were skin (alopecia - 9.3%), ocular (retinal changes/optic atrophy/cataracts - 9.3%), gastrointestinal (pancreatic insufficiency – 4.65%), neuropsychiatric (cognitive impairment – 4.65%), and renal (reduced glomerular filtration rate – 4.65%). Throughout the study, all patients had SLEDAI scores ranging from no activity to high activity, with 55.8% having mild activity, 27.9% having moderate activity, and 14% having high activity. Conclusion: Similar to SLE studies on pediatric populations, our study found that cutaneous, gastrointestinal, and renal manifestations were common. However, we found a high prevalence of damage in prepubertal patients, in particular ocular and cognitive impairment. This highlights the need to prioritize ocular exams and cognitive assessments in patients with prepubertal SLE.

Clinical and Serologic Phenotyping and Damage Indices in Patients With Systemic Lupus Erythematosus With and Without Fibromyalgia.

Given fibromyalgia (FM) frequently co-occurs with autoimmune disease, this study was initiated to objectively evaluate FM in a multiracial/ethnic cohort of patients with systemic lupus erythematosus (SLE). Patients with SLE were screened for FM using the 2016 FM classification criteria during an in-person rheumatologist visit. We evaluated hybrid Safety of Estrogens in Lupus National Assessment (SELENA)-SLE Disease Activity Index (SLEDAI) scores, SLE classification criteria, and Systemic Lupus International Collaborating Clinics damage index. We compared patients with and without FM and if differences were present, compared patients with FM with patients with non-FM related chronic pain. 316 patients with SLE completed the FM questionnaire. 55 (17.4%) met criteria for FM. The racial composition of patients with FM differed from those without FM (P = 0.023), driven by fewer Asian patients having FM. There was no difference in SLE disease duration, SELENA-SLEDAI score, or active serologies. There was more active arthritis in the FM group (16.4%) versus the non-FM group (1.9%) (P < 0.001). The Widespread Pain Index and Symptom Severity Score did not correlate with degree of SLE activity (r = -0.016; 0.107) among patients with FM or non-FM chronic pain (r = 0.009; -0.024). Regarding criteria, patients with FM had less nephritis and more malar rash. Systemic Lupus International Collaborating Clinics damage index did not differ between groups. Except for arthritis, patients with SLE with FM are not otherwise clinically or serologically distinguishable from those without FM, and Widespread Pain Index and Symptom Severity Score indices do not correlate with SLEDAI. These observations support the importance of further understanding the underlying biology of FM in SLE.

Clinical significance of peripheral nervous system involvement in systemic lupus erythematosus patients: Relation to disease activity and damage index

BackgroundDespite its potential impact on disease outcome, peripheral nervous (PN) system involvement in systemic lupus erythematosus (SLE) has received little attention. Aim of the workTo assess the frequency and clinical features of PN system involvement in SLE patients. Patients and methodsThe medical records of 100 patients were revised. Cases with diabetes, hepatitis, vitamin B12 deficiency or carpal tunnel syndrome were excluded. Detailed history, clinical examination and laboratory investigations were recorded. PN events were documented. The SLE disease activity index (SLEDAI) and systemic lupus international collaborating clinics damage index (SLICC-DI) were evaluated. ResultsPatients were 88 females and 12 males (F:M 7.3:1), mean age was 34.2 ± 8.3 years and disease duration 12.7 ± 5.4 years. The frequency of PN system involvement was 8 %; polyneuropathy (n = 5), mononeuritis multiplex (n = 2) and Guillain-Barré syndrome (n = 1). PN was associated with a significantly higher frequency of musculoskeletal (100 %), neuropsychiatric (100 %), pulmonary (62.5 %) and cardiovascular (37.5 %) manifestations as well as Raynaud's phenomenon (37.5 %) and secondary vasculitis (50 %) compared to those without (56.5 %,7.6 %,26.1 %,7.6 %,7.6 % and 12 %;p = 0.02,p < 0.001,p = 0.04,p = 0.03,p = 0.03,p = 0.017 respectively).anti-nuclear antibodies (87.5 % vs 92.4 %) and anti-double stranded DNA (71.4 % vs 69.6 %) positivity were comparable (p > 0.05). SLEDAI and SLICC-DI were significantly increased in patients with PN (26.5 ± 6.36 and 3.75 ± 0.98) compared to those without (11.5 ± 4.76 and 0.61 ± 0.56;p < 0.001 each). ConclusionSLE patients with PN involvement had a higher frequency of musculoskeletal, neuropsychiatric, pulmonary and cardiovascular manifestations in addition to Raynaud's and vasculitis. There is a potential association with disease activity and damage. Careful neurological assessment should be included in the workup of SLE patients.

Mortality in a cohort of Egyptian systemic lupus erythematosus patients: A comparison with African, Arabic, and Mediterranean studies.

The study aimed to examine the frequency, causes, and predictors of mortality in a cohort of Egyptian systemic lupus erythematosus (SLE) patients and compare mortality causes and the survival rate in our cohort to African, Arabic, and Mediterranean studies. In this retrospective study, a review of medical records of 563 SLE patients (516 females, 47 males; median of age: 32 [IQR: 26-38 years]; range, 14 to 63 years) fulfilling the 1997 American College of Rheumatology (ACR) criteria between January 2015 and December 2019 was done. The data extracted included demographic, clinical, and laboratory features, treatments used, disease activity as measured by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and damage index as measured by Systemic Lupus International Collaborating Clinics (SLICC) damage index. Causes of mortality were also reported. Out of 563 reviewed medical records, 50 (8.9%) patients died. Infection (28%) and organ damage (18%) were the most commonly reported causes of death. Multivariate Cox regression analysis showed that patients with cardiac manifestations, renal failure, those receiving higher doses of either oral (in their last visit) or intravenous (higher cumulative pulse steroids) steroids were at increased risk of mortality (p=0.011, p<0.001, p=0.01, and p<0.001, respectively; 95% confidence intervals 7.2, 63.9, 1.2, and 1.09, respectively). The overall survival at 5, 10, 15, and 20 years was 96.6%, 93.3%, 91.0%, and 83.2%, respectively, and 56.2% at 25 years until the end of the follow-up. Cardiac manifestations, renal failure, and higher steroid doses were independent predictors of mortality in our cohort. As in most African countries, infection was the main cause of death in our study; however, the mortality rate and the five-year survival among our cohort were better than in African (sub-Saharan) countries and similar to Arabic and Mediterranean countries.

Characteristics of Hearing Loss in Patients with Systemic Lupus Erythematosus.

To investigate the clinical characteristics of hearing loss (HL) in patients with systemic lupus erythematosus (SLE) and its related factors. Ninety-one hospitalized SLE patients and thirty healthy controls were enrolled. All subjects completed pure tone audiometry (PTA), extended high frequency audiometry (EHFA) and distortion product otoacoustic emission (DPOAE) to assess hearing function. SLE patients were divided into two groups according to the presence or absence of HL, and the risk factors of HL were determined by multivariate logistic regression. The incidence of HL was 27.47% in SLE patients, significantly higher than in the control group (3.3%) and most cases were mild-to-moderate, bilateral and predominantly sensorineural. Compared with the control group, the hearing thresholds of SLE patients increased significantly in the middle and high frequencies starting from 2000 Hz. Even though the PTA test results were normal, the EHFA test results showed significant differences in hearing impairment between SLE patients and normal controls. For patients with abnormal PTA results, the signal-to-noise ratio (SNR) in DPOAE was markedly reduced, and the pass rate was also decreased. The Systemic Lupus International Collaborating Clinics Damage Index (SDI, OR 9.13) and secondary Sjögren's syndrome (sSS, OR 8.20) were identified as independent associated factors for HL, and there was no difference in PTA and EHFA at all frequencies between hydroxychloroquine users and non-users. HL is not rare in SLE patients, and EHFA can help identify early hearing impairment. Having a high SDI score and secondary Sjögren's syndrome may predict the presence of HL in SLE.

Glucocorticoid tapering and associated outcome in patients with newly diagnosed systemic lupus erythematosus: the real-world GULP prospective observational study

ObjectiveA subanalysis of the multicentre Early Lupus inception cohort was performed to investigate the real-world Glucocorticoids (GCs) Use in newly diagnosed systemic lupus erythematosus (SLE) Patients (GULP).MethodsPatients starting prednisone (PDN)...

AB0479 RELATIONSHIP BETWEEN DISEASE ACTIVITY, ORGAN DAMAGE AND HEALTH-RELATED QUALITY OF LIFE AS ASSESSED BY LUPUSQOL AND SF-36 IN 400 RUSSIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

ObjectivesWe conducted this study to compare the efficiency of LupusQoL with the 36-item Short-Form Health Survey (SF-36), a generic quality of life (QoL) scale, in Russian patients with lupus.MethodsBoth questionnaires were conducted for one visit to the clinic. Disease activity was evaluated by the SLEDAI-2K, while the chronic damage was assessed by the Systemic Lupus International Collaborating Clinics Damage Index score (SDI). Associations between the LupusQoL and SF-36 domains were examined according to SLEDAI 2K and SDI.ResultsA total of 400 patients with lupus (F/M 363:37, mean age 34,2±11.5 years, mean disease duration 106,3±91,9.0 months) were included. All patients were divided into 4 groups: SLEDAI 2K ≤4 – 136 pts, SLEDAI-2K ≥4 – 264 pts, SDI =0 – 177 pts, SDI ≥1 – 223 pts.QOL as assessed by SF-36 and LupusQoL was low in all groups of patients with SLE. The mean scores for each of the domains of the LupusQoL and SF-36 are shown in Table 1.Table 1.Relationship between disease activity, organ damage and health-related quality of life as assessed by LupusQoL and SF-36 in 400 Russian patients with systemic lupus erythematosusLupusQoLdomainsSLEDAI 2K≤4Mean (SD)SLEDAI 2K ≥4Mean (SD)PSF-36domainsSLEDAI2K ≤4Mean (SD)SLEDAI-2K ≥4Mean (SD)PComparablePhysical health70,1±22,164,9±23,60,07PF65,6±28,260,6±28,50,1Emotional health67,3±24,863,2±24,60,13MH52,2±9,049,6±7,80,001Pain74,7±23,667,5±24,80,007BP46,3±9,547,3±8,40,09Fatigue65,7±24,565,5±24,80,22VT55,5±23,348,3±9,50,007NoncomparablePlanning71,1±27,960,1±28,00,0004SF71,0±24,071,1±24,10,003Intimaterelationships78,3±28,769,9±31,10,003GH55,9±18,755,9±18,70,34Burden to others61,2±26,854,2±28,10.003RE59,3±42,459,3±42,40,012Body image71,1±24,762,2±28,50,007RP65,6±28,265,6±28,20,028LupusQoLdomainsSDI =0 Mean (SD)SDI ≥1 Mean (SD)PSF-36 domainsSDI =0 Mean (SD)SDI ≥1 Mean (SD)PComparablePhysical health71,2±22.563,3±23,10,002PF69,2±27,457,1±28,20,0007Emotional health66,2±25,263,3±24,30,24MH50,31±7,950,6±8,70,6Pain72,3±24,268,2±24,80,03BP47,02±8,446,9±9,10,84Fatigue65,7±25,360,35±24,10,03VT55,6±20,349,5±24,90.02NoncomparablePlanning67,7±27,360,9±29.10.03SF64,05±28,160,5±26,40,21Intimaterelationships76,1±28,470,6±32,50,22GH52,11±20,247,41±20,10.06Burden to others55,7±28,457,4±27,30,68RE56,29±42,146,9±41,80,06Body image66,6±27,964,1±27,30,33RP50,54±42,439,15± 13,10,0001It was shown that the domain of pain of the LupusQoL questionnaire (p&lt;0.007) statistically significantly responds to disease activity in contrast to the comparable SF-36 scale. The domains MH (p&lt;0.001) аnd VT (p&lt;0.007) of the SF-36 are more sensitive to change of disease activity.It was found that in patients with SLE with a high activity of the disease, the noncomparable domains such as Planning (p&lt;0.0004), Intimate relationship (p&lt;0.003), Burden to others (p&lt;0.03), Body image (p&lt;0.007) significantly change. The QOL in patients with SLE with SDI ≥1 was poor in the domain of Physical health of the LupusQoL and in the comparable domain of the SF-36 PF. Higher QOL in these domains was in patients without damages. The domains Fatigue and VT are also significantly affected by the damage. So, in patients with SDII ≥1, there was a significant decrease of QOL in these domains up to 60.35±24.0 and 49.55±20.32, respectively, as compared with patients without damages 65.7±25.3 (p≤0.03) and 55.69±20.32 (p≤0.02) respectively.ConclusionLupusQoL is more sensitive to changes in SLE activity. Both SF-36 and LupusQoL are equally sensitive to changes in organ damage.Disclosure of InterestsNone declared

The association of urinary plasmin level with renal involvement and disease flare among systemic lupus erythematosus patients.

To explore the ability to use urinary level of plasmin as an indicator for renal affection and activity in systemic lupus erythematosus (SLE) patients. Between April 2020 and October 2020, urine samples from 50 SLE patients (2 males, 48 females; mean age: 35.5±8.1 years; range, 22 to 39 years) and 20 age- and sex-matched healthy controls (2 males, 18 females; mean age: 34.1±6.5 years; range, 27 to 38 years) were collected. The patients were divided into two groups according to the presence or absence of renal manifestations as those with renal disease (n=28) and those without renal disease (n=22). The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), renal activity (rSLEDAI), and Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI) scores were calculated. Renal biopsy was performed to patients with active lupus nephritis (LN). The activity index (AI) and Chronicity Index (CI) were scored. There was a highly statistically significant difference in the mean urinary plasmin levels between SLE cases and the control group (88.9±42.6 ng/mL vs. 21.3±26.8 ng/mL, respectively; p<0.001). A significant elevation was observed (p<0.05) in patients with LN (97.9±46.6 ng/mL) than without (42.7±12.7 ng/mL), particularly in patients with active renal involvement (82.9±26.6 ng/mL) than patients with inactive renal disease (63.2±15.5 ng/mL). There were significant positive correlations between the mean urinary plasmin levels and inflammatory markers, SLEDAI, and rSLEDAI scores. Urinary level of plasmin is significantly elevated among SLE cases, particularly in those with active LN. The remarkable association between urinary plasmin level and various activity status implies that urinary plasmin can be used as a beneficial marker to monitor lupus nephritis flare.

Prevalence and biopsychosocial factors associated with depressive symptoms among patients living with systemic lupus erythematosus in clinical settings in urban Thailand

BackgroundDepressive symptoms are globally recognized as a significant mental health problem in patients with chronic disease, particularly those with systemic lupus erythematosus (SLE). The purpose of this study was to estimate the prevalence and examine biopsychosocial factors of depressive symptoms among patients with SLE.MethodsThis cross-sectional study was conducted among 185 participants diagnosed with SLE and received treatment for at least 3 months, aged 18–59 years attending the outpatient clinic of a university hospital, Bangkok, Thailand. Depressive symptoms were measured by the Thai version of the Patient Health Questionnaire-9. We assessed Demographic data, the Systemic Lupus Erythematosus Activity Index, the Systemic Lupus International Collaborating Clinics Damage Index, Numeric Rating Scale, Fatigue Severity Scale, Body Image Scale, and the ENRICHD Social Support Instrument. Data were collected from March to May 2021. Multivariable logistic regression was used to analyze the data.ResultsThe proportion of the participants with depressive symptoms was 43.2%, which 8.1% of those patients presented moderate to severe depressive symptoms. In a multivariable logistic regression model, SLE patients with depressive symptoms were more likely to be severe pain (aOR = 12.11, 95% CI: 1.35, 108.46), fatigue (aOR = 2.36, 95%CI: 1.08, 5.14), taking prednisolone ≥15 mg daily (aOR = 5.75, 95%CI: 1.76, 18.80), low satisfied of body image (aOR = 12.49, 95%CI: 2.23, 69.80), and low social support (aOR = 17.96, 95% CI: 1.86, 173.77). Disease flare, organ damage, and family income sufficiency did not significantly increase the risk of depressive symptoms in patients with SLE.ConclusionsThe findings highlight depressive symptoms in patients with SLE. Therefore, the health professional should be concerned about the perception of body image, level of social support, fatigue, and pain while treating patients with SLE. Public health screening programs to identify depressive symptoms in patients with SLE are needed. In addition, a high dose of prednisolone should be considered if required, along with monitoring.

Частота и структура поражения сердца при системной красной волчанке

Study Objective: To identify the structure and prevalence of cardiac involvement in patients with systemic lupus erythematosus (SLE); evaluation of the relationship with the activity, disease duration and antirheumatic therapy. Study Design: Prospective cross-sectional study. Material and Methods. The study included 87 patients with SLE (90.8% women), with the median age of 32 [28; 41] years old and disease duration of 6 [1; 10] years; Systemic Lupus Erythematosus Disease Activity Index, modification 2К, was 9 [4; 16] points, Systemic Lupus International Collaborating Clinics Damage Index was 0 [0; 1] points. All patients were examined by a cardiologist, and traditional risk factors (TRF) of cardiovascular diseases were identified. Patients underwent transthoracic echocardiography (ECHO); if indicated, 24-hour ECG and blood pressure monitoring was performed. Serum NT-proBNP concentration was measured with electrochemiluminescence. Study Results. The most common cardiac complication was valvular insufficiency with various degree of regurgitation, which was diagnosed in 92% patients; endocarditis was recorded in 30%; mitral or tricuspid valve prolapse was observed in 33.3%. Pericardium pathologies were diagnosed in 44.8% patients, and adhesive pericarditis prevailed (61.5%). Myocarditis was observed in 4.6%, ischemic heart disease (IHD) — in 5.7%, cardiac failure (CF) — in 11.5%, rhythm and cardiac conduction disturbances — in 18.4% and 2.3%, respectively, myocardial infarction (MI) — in 2.3%. Dislipidemy and arterial hypertension (AH) were recorded in 50.6% and 46% patients. 31% demonstrated high NT-proBNP levels (&gt; 125.0 pg/mL); median NT-proBNP concentration was 91.8 [27.1–331.2] pg/mL. Patients were divided into two groups: group 1 did not take any glucocorticoids (GC), immunosuppressants and genetically engineered biologic drugs; group 2 had various combinations of these products. Patients in both groups were of similar age and sex; they did not have any differences in the prevalence of valvular insufficiency (86.7% and 97.6%), endocarditis (26.2% and 33.3%), pericarditis (42.9% and 46.7%), rhythm disturbance (19% and 17,8%), and impaired cardiac conduction (2.4% and 2.2%), IHD (2.4% and 8.9%), CF (7% and 15.5%). MI and myocarditis were diagnosed only in group 1 (4.4% and 9.5%, respectively); however, these differences were not statistically significant. AH was observed more frequently in group 2 than in group 1 (62.2% and 28.6%, р &lt; 0.01); other TRFs did not demonstrate any differences; however, total cholesterol concentration and body mass index in group 2 were higher than in group 1: 5.7 and 4.5 mmol/L (р &lt; 0.05); 22.66 and 22.10 kg/m2 (р &lt; 0.01). NT-proBNP concentration in untreated patients was higher than in group 2 (150.7 and 32.6 pg/mL, respectively, р &lt; 0.01), exceeding the normal values. Conclusion. Despite the juvenile age of patients, the therapy (mostly GC) and longer disease duration are associated with higher incidence of TRF (AH, hypercholesterolemia, overweight), while myocarditis and high NT-proBNP concentration are typical of untreated patients with highly active SLE. SLE patients should be followed up by a cardiologist; symptom-free CF markers should be identified as this condition is life-threatening, especially in patients with extremely active disease; TRFs should be monitored; and minimal GC doses should be used during remission/low-activity disease. Keywords: systemic lupus erythematosus; cardiac involvement; pericarditis; myocarditis; endocarditis; NT-proBNP; ECHO.

Clinical significance of platelet-lymphocyte ratio in systemic lupus erythematosus patients: Relation to disease activity and damage

Aim of the workTo assess platelet–lymphocyte ratio (PLR) in systemic lupus erythematosus (SLE) patients and study its clinical significance, its relation to disease activity and damage. Patients and methodsThis study included 52 adult SLE patients and 50 matched control. All patients were subjected to full clinical examination, disease activity was measured by SLE disease activity index (SLEDAI), and damage was assessed by using Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI). Laboratory and immunology profiles included the complete blood count (CBC) with differential white blood cell (WBC) counts and estimation of PLR, erythrocyte sedimentation rate (ESR), liver and kidney function, alkaline phosphatase (ALP), serum calcium (Ca) and phosphorous (P), lipid profile, 24hr urinary protein, renal biopsy, anti-nuclear antibody (ANA), anti-double stranded deoxyribonucleic acid (anti-dsDNA), serum complements (C3,C4). ResultsThe mean age of SLE patients was 33.1 ± 9.2 years (20–58 years), with mean disease duration of 5.4 ± 5.02 years (0.25–20 years). The PLR was significantly higher in patients (189.9 ± 136.4; 23.9–782.9) than control (95 ± 29.9; p < 0.0001). The WBC and platelets count was comparable between patients and control (7.1 ± 1.7 x103/mm3 and 243.4 ± 51.3 x103/mm3; p = 0.3 and p = 0.51 respectively). The lymphocytic count was significantly lower in patient compared to control (1.9 ± 1.1 x103/mm3 vs 2.7 ± 0.8 x103/mm3)(p < 0.0001). PLR would significantly predict activity (p = 0.02) with a sensitivity of 94.3% and specificity of 100% at a cut-off value of 33.6. There was no association of PLR with the damage index. ConclusionPLR might be considered a valuable and un-expensive tool in assessment and prediction of SLE disease activity.

Factors Associated With Use of Telemedicine for Follow-Up of SLE in the COVID-19 Outbreak.

Objective: To investigate the factors associated with telemedicine (TM) use for follow-up of Systemic Lupus Erythematous (SLE) patients in the COVID-19 pandemic.Methods: This was a single-centered cross-sectional study conducted in Hong Kong. Consecutive patients followed up at the lupus nephritis clinic were contacted for their preference in changing the coming consultation to TM in the form of videoconferencing. The demographic, socioeconomic, and disease data of the first 140 patients opted for TM and 140 control patients preferred to continue standard in-person follow-up were compared.Results: The mean age of all the participants was 45.6 ± 11.8 years, and the disease duration was 15.0 ± 9.2 years. The majority of them were on prednisolone (90.0%) and immunosuppressants (67.1%). The mean SLEDAI-2k was 3.4 ± 2.4, physician global assessment (PGA) was 0.46 ± 0.62 and Systemic Lupus International Collaborating Clinics (SLICC) damage index was 0.97 ± 1.23. A significant proportion of the patients (72.1%) had 1 or more comorbidities. It was found that patients with higher mean PGA (TM: 0.54 ± 0.63 vs. control: 0.38 ± 0.59, p = 0.025) and family monthly income > USD 3,800 (TM: 36.4% vs. control: 23.6%; p = 0.028) preferred TM, while full-time employees (TM: 40.0% vs. control: 50.7%; p = 0.041) preferred in-person follow-up. These predictors remained significant in the multivariate analysis after adjusting for age and gender. No other clinical factors were found to be associated with the preference of TM follow-up.Conclusion: When choosing the mode of care delivery between TM and physical clinic visit for patients with SLE, the physician-assessed disease activity and patient's socio-economic status appeared to be important.

Lupus-related vasculitis in a cohort of systemic lupus erythematosus patients.

Objectives This study aims to examine the frequency and clinical association of lupus-related vasculitis in patients with systemic lupus erythematosus (SLE).Patients and methods We retrospectively analyzed medical records of a total of 565 SLE patients (42 males, 523 females; mean age: 32.7±9.5 years; range, 13 to 63 years) between January 2017 and February 2020. Demographic, clinical data, and laboratory data and treatment modalities applied were recorded. Lupus-related vasculitis and its different types were documented, and the patients with vasculitis were compared with those without vasculitis.Results The mean disease duration was 8.9±6.3 years. Vasculitis associated with lupus was found in 191 (33.45%) patients. Cutaneous vasculitis was found in 59.2%, visceral vasculitis in 34.0%, and both in 6.8% of total vasculitis patients. The patients with vasculitis had a longer disease duration (p=0.01), were more likely to have juvenile onset (p=0.002), livedo reticularis (p<0.001), Raynaud's phenomenon (RP) (p<0.001), digital gangrene (p<0.001), thrombosis (p=0.003), and cranial neuropathy (p=0.004). The patients with vasculitis showed a higher prevalence of hypercholesterolemia (p=0.045), diabetes mellitus (p=0.026), higher Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) at disease onset (p<0.001), and Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (p=0.003) scores. They had more prevalent hematological manifestations (p<0.001), hypocomplementemia (p=0.007), received a higher cumulative dose of intravenous methylprednisolone (p<0.001), and had also more frequent cyclophosphamide (p=0.016) and azathioprine intake (p<0.001). In the logistic regression analysis, SLE vasculitis was independently associated with juvenile disease onset, livedo reticularis, RP, hematological manifestations, and higher scores of SLEDAI at disease onset (p<0.05).Conclusion Juvenile disease onset, livedo reticularis, RP, hematological manifestations, and higher SLEDAI scores at disease onset may be associated with the development of vasculitis in SLE patients.

Serum BDNF and cognitive dysfunction in SLE: findings from a cohort of 111 patients

The association between brain-derived neurotrophic factor (BDNF) and neuropsychiatric systemic lupus erythematosus (NPSLE) is controversial in the literature. Cognitive dysfunction (CD) is a common, underdiagnosed NPSLE manifestation, but its pathophysiology is unknown. Thus, we investigate serum BDNF as a potential biomarker of CD in a cohort of SLE patients. We included 63 SLE patients, 48 NPSLE, and 57 age- and gender-matched controls (CON). All participants underwent neuropsychological assessment. Data on cardiovascular comorbidities, SLE disease activity index (SLEDAI), and Systemic Lupus International Collaborating Clinics damage index (SLICC-DI) were compiled. Multiple regression analyses evaluated predictors of serum BDNF levels. Serum BDNF levels were lower in SLE and NPSLE patients than in CON (SLE 800.4 ± 502.7 vs. NPSLE 779.7 ± 426.3 vs. CON 1,345.5ng/mL ± 438.4; p < 0.001). In addition, hypertension (B: - 192.5, SE: 84.3, 95% CI: - 359.7 to - 25.3, p = 0.024) and SLICC-DI score (B: - 75.9, SE: 27.2, 95% CI: - 129.8 to - 22, p = 0.006) were predictors of serum BDNF levels in SLE. There was no relation between BDNF levels and CD. BDNF levels are lower in SLE patients than CON and inversely associated with hypertension and SLICC-DI scores. No association between BDNF levels and CD or NPSLE was observed in this cohort. These findings indicate that BDNF may be associated with overall burden in SLE rather than specific manifestations such as cognition impairment. Key Points • BDNF is associated with an overall burden in SLE rather than specific manifestations such as cognition dysfunction. • BDNF levels are reduced in patients with SLE, and higher SLICC-DI scores and hypertension are independent predictors of lower serum BDNF levels. • The cognitive dysfunction rate is elevated (46%) among Brazilian SLE patients.

Sexual dysfunction and physical performance in female systemic lupus erythematosus patients

Aim of the workTo investigate the sexual dysfunction in systemic lupus erythematosus (SLE) patients and its relation to physical fitness and other disease parameters. Patients and methodsThe study included 47 SLE females and 47 matched healthy controls. SLE disease activity index (SLEDAI) and systemic lupus international collaborative clinics damage index (SLICC DI) were assessed. Physical performance of the patients was assessed by the grip ability test (GAT), gait velocity test, Jebsen hand function test, fatigue severity scale (FSS) and the modified health assessment questionnaire (mHAQ). Sexual dysfunction of the patients was assessed by the sexual function index (FSFI). Depressive disorders of the patients were assessed by Beck depression inventory. ResultsThe mean age of the patients was 28.7 ± 7.2 years and disease duration 4.4 ± 2.9 years. GAT was significantly lower (43.65 vs 70.00; p = 0.001), and FSS higher (6.5 vs 1; p = 0.001) in patients compared to control. The total FSFI was significantly lower (23.41 vs 29.60; p = 0.001) and all domains scores were significantly lower except the pain domain (p = 0.001). Beck depression inventory score was higher in patients (13.29 vs 12.74; p = 0.365). SLE females with prescribed corticosteroids and azathioprine had significantly lower FSFI as compared to those without while FSFI score was higher in those receiving hydroxychloroquine. The FSFI significantly correlated with C4 level (r = 0.328, p = 0.024 and inversely with, SLEDAI (r = −0.07, p = 0.001), FSS (r = −0.54, p = 0.001), mHAQ (−0.37, p = 0.01) and with Beck depression inventory (r = −0.57, p = 0.001). ConclusionMarried female patients with SLE revealed a higher degree of sexual dysfunction of all domains except pain.

Mortality in a cohort of Egyptian systemic lupus erythematosus patients: retrospective two-center study

BackgroundSystemic lupus erythematosus is a debilitating autoimmune disease with major contribution to the worldwide morbidity and mortality. This study aimed to investigate the causes of mortality in systemic lupus erythematosus (SLE) patients and the relation between clinical activity, disease-associated end-organ damage, laboratory markers and mortality.ResultsAmong the 771 patients who were successfully followed up, 34 patients (4.4%) died. The leading causes of death were infectious causes (35.29%), cardiopulmonary causes (26.48%), renal causes (14.7%), unknown causes (14.7%), neuropsychiatric causes (5.88%), and lastly gastrointestinal causes (2.94%). Subjects who died had lower complement 3 level, more anemia, lymphopenia, neutropenia, leukocytosis, thrombocytopenia, decreased glomerular filtration rate, higher incidence of infection, end-stage renal disease, and cardiopulmonary complications. Higher glucocorticoid dosage with more immunosuppressant (mofetil and cyclophosphamide) treatment was observed in patients who died. SLE disease Activity Index and Systemic Lupus International Collaborating Clinics damage index were both significantly higher in deceased persons. Multivariable hazards regression analysis revealed that lymphopenia (p = 0.017), decreased glomerular filtration rate < 50% (p = 0.002) with end-stage renal disease (p = 0.001), and high steroid daily use of > 40 mg (p = 0.016) were independent risk factors for the mortality of SLE patients.ConclusionInfections and cardiopulmonary complications are the leading causes of death in two centers caring for Egyptian SLE patients. Lymphopenia, end-stage renal failure, and high steroid daily use were associated with poor outcomes.

Patients with SLE have higher risk of cardiovascular events and mortality in comparison with controls with the same levels of traditional risk factors and intima-media measures, which is related to accumulated disease damage and antiphospholipid syndrome: a case–control study over 10 years

ObjectiveSLE is a strong risk factor for premature cardiovascular (CV) disease and mortality. We investigated which factors could explain poor prognosis in SLE compared with controls.MethodsPatients with SLE and population...

Apolipoprotein L1 risk genotypes in Ghanaian patients with systemic lupus erythematosus: a prospective cohort study

ObjectiveTwo apolipoprotein L1 (APOL1) risk variants (RV) are enriched in sub-Saharan African populations due to conferred resistance to Trypanosoma brucei. These variants associate with adverse renal outcomes by multiple causes...

Biomarkers of myocardial injury in lupus nephritis

Background Cardiovascular disease (CVD) is the main cause of death in patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN). This study aimed to evaluate the prevalence of myocardial injury among patients with SLE without nephritis and patients with LN, determine whether serum high-sensitivity cardiac troponin T and creatine phosphokinase-MB (CKMB) might help to identify patients with LN at risk for CVD, and identify LN as a risk factor for myocardial injury. Patients and methods This study was conducted on 50 patients (30 patients with LN and 20 patients with SLE without nephritis). The SLE disease activity index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage Index (SLICC/DI) were assessed. Laboratory investigations, cardiac enzymes (Hs-TnT and CKMB), and transthoracic echocardiography were performed. Results The results demonstrated a higher prevalence of CVD in patients with LN. A total of 28 patients with LN (93.3%) vs 10 patients with SLE (50%) had detectable high-sensitivity troponin (Hs-TnT) levels, with a mean 29.77±18.22 vs 7.2±6.21 ng/l, respectively. The mean value of CKMB was higher in patients with LN than patients with SLE (23.9±18.6 vs 14.8±9.4 μg/l, respectively). Multilinear regression analysis for Hs-TnT revealed that low estimated glomerular filtration rate, high urinary albumin-to-creatinine ratio, low ejection fraction, and different ECHO diameters were the most statistically significant predictors of troponin elevation, with a P value less than 0.05. The strongest renal predictors of CKMB were estimated glomerular filtration rate and proteinuria, with a P value less than 0.05. Conclusion CVD is more in patients with LN than patients with SLE. Hs-TnT levels is a signature of subclinical cardiac disease, which could be used to identify at-risk individuals. CKMB and echocardiography lack adequate sensitivity for the diagnosis of myocardial injury in patients with LN.