Involvement In Systemic Lupus Erythematosus Patients Research Articles

A novel long noncoding RNA ENST00000597482 serves as a potential biomarker for disease activity and diagnosis of systemic lupus erythematosus.

Emerging evidence indicate that long noncoding RNAs (lncRNAs) may play an important role in the pathogenesis of systemic lupus erythematosus (SLE) however, the contribution of lncRNAs to SLE remains largely unclear. Our study aimed to explore the lncRNA expression profiles in peripheral blood mononuclear cells (PBMCs) from SLE patients. LncRNA sequencing was used to detect differentially expressed genes in PBMCs from 5 SLE-MIX samples and 3 healthy controls (HC)-MIX samples, and the expression of selected lncRNAs was further verified by real-time quantitative polymerase chain reaction (RT‒qPCR). The correlation of lncRNA expression with laboratory indicators as well the SLE disease activity index 2000 (SLEDAI‒2K) score from 72 SLE patients was assessed by Spearman's test. The association between lncRNA ENST00000597482 and organ involvement in SLE patients was determined by the Mann‒Whitney U test. Moreover, lymphocyte subsets in peripheral blood from SLE patients were measured by flow cytometry. In addition, the diagnostic value of lncRNAs in predicting SLE was evaluated by receiver operating characteristic (ROC) curve analysis. The lncRNA expression profiles demonstrated 218 differentially expressed lncRNAs, including 121 upregulated genes and 97 downregulated genes, in PBMCs from SLE patients compared to HCs. Among the 10 candidate genes selected, only lncRNA ENST00000597482, which was lower in SLE PBMCs than in HCs, was consistent with the sequencing results. LncRNA ENST00000597482 expression was negatively correlated with SLEDAI-2K score and the titres of ANA antibodies and anti-double-stranded DNA (anti-dsDNA) antibodies. Of note, SLE patients with lower expression of lncRNA ENST00000597482 were prone to develop organ involvement. Furthermore, lncRNA ENST00000597482 exhibited potential diagnostic value in differentiating SLE patients from HCs. LncRNA ENST00000597482 expression was lower in PBMCs from SLE patients than HCs and was negatively correlated with the SLEDAI-2K score and autoantibody titres. In addition, lncRNA ENST00000597482 could act as a novel biomarker for disease activity and diagnosis of SLE.

Serum Levels of Interleukin-2 in a Cohort of Egyptian Systemic Lupus Erythematosus Patients with Glomerulonephritis

Abstract Background Lupus nephritis is a serious complication of systemic lupus erythematosus(SLE).It is clinically evident in 50-60% of SLE patients, and it is histologically evident in most SLE patients. Defective Interleukin-2(IL-2) production contributes to the unbalanced immune system in SLE. Aim of the Work To evaluate the relationship between serum IL-2 level and renal involvement in SLE patients. Patients and Methods 60 adult SLE patients were studied. SLE Disease Activity Index-2000 (SLEDAI-2K) and serum IL-2 level by ELISA were assessed. Results Patients were (93.3%) females and (6.7%) males; their ages (19- 58 years) with median disease duration 4 (0.25-24years). The median IL-2 level was significantly lower in SLE patients with nephritis 25.5 ng/L (5-90 ng/L) than in patients without nephritis 53.5 ng/L (29-165 ng/L) (p ≤ 0.001). There was negative correlation between serum IL-2 and serum creatinine (r= -0.494 p ≤ 0.001) and between serum IL-2 and protein/creatinine ratio (r=-0.512 p ≤ 0.001). Although there was no relationship between SLE disease activity and serum IL-2; the level of serum IL-2 was higher with mild SLE disease activity (45-60 ng/L) followed by moderate activity (15-135 ng/L) and the lowest with high disease activity (5-165 ng/L). An increase in s.creatinine and a decrease in S.IL-2 had an independent effect on increasing probability of occurrence of nephritis in SLE patients (p < 0.01). Conclusion Serum IL-2 might have an important role in predicting the occurrence of lupus nephritis in SLE.

The Beneficial Effect of Exercise and Vitamin D Supplementation on Comorbidities Associated with Systemic Lupus Erythematosus

Objective: A multisystem chronic autoimmune illness with recurrent and relapsing episodes that can affect the locomotor system as well as the liver and kidneys is known as systemic lupus erythematosus (SLE). Vitamin D deficiency is thought to play a role in the pathogenesis of SLE. Therefore, our primary aim in this literature review is to determine the role of vitamin D deficiency on SLE symptoms. Our secondary aim is to explain the benefits of exercise on SLE-related comorbidities. Method: A comprehensive literature search on SLE symptoms, biochemistry, and pathophysiology was performed via Google Scholar. The effect of exercise on SLE comorbidities was investigated. Results: Some studies suggest that SLE is caused by environmental and genetic factors. The exact cause of the disease is still unknown, but there is evidence that vitamin D deficiency is associated with SLE symptoms. In addition to drug treatment for locomotor system involvement in SLE patients, physiotherapy applications are also included. In this study, the positive effects of exercise in SLE patients on pain, fatigue, and sleep problems caused by both disease-related and side effects of pharmacological applications used in treatment are reported. Information about the effects of vitamin D deficiency in SLE and how exercise contributes to the improvement of these symptoms is presented. Conclusion: Vitamin D deficiency in the symptoms seen in Systemic Lupus Erythematosus cannot be corrected by vitamin D supplementation alone. At this point, exercise provides possible benefits in correcting vitamin D deficiency. Therefore, exercise has positive effects on SLE comorbidities. Future studies should be planned with the aim of establishing a suitable exercise prescription for SLE.

#2051 Long-term follow-up of Israeli patients with lupus nephritis

Abstract Background and Aims Systemic lupus erythematosus (SLE) often affects the kidneys, and is associated with morbidity and mortality. Ethnic variations in clinical response to treatment and outcomes have been described. Information on real-life, long-term cohorts of the Middle Eastern Israeli population is lacking. We aimed to characterize the prevalence and long-term outcomes of kidney involvement in SLE patients in Israel and to identify variables associated with lupus nephritis (LN) and end-stage kidney disease (ESKD). Method This retrospective study, conducted between 2014-2023, included adult patients with SLE diagnosed for at least 12 months. Kidney involvement was based on a diagnosis of LN on a kidney biopsy. SLE patients without LN served as controls. Associated variables were collected including socio-demographics, disease-related characteristics, kidney-related factors, comorbidities, and all-cause mortality. Results A total of 182 adult patients with SLE were included. Of them, 54 (29.6%) had LN. Mean follow-up since diagnosis was 16.2 ± 13.8 years. Compared to the control group, patients with LN were diagnosed with SLE at younger ages (26.8 ± 12.9 vs. 35.5 ± 15.4 years, p < 0.01). Patients with LN and controls had similar proportions of females/males and Jewish/Arab patients (Table 1), and had comparable baseline eGFR before LN diagnosis (110 ± 48 vs. 107 ± 39 ml/min/m2, p = 0.66). The LN group had lower complement C3 levels at diagnosis and higher dsDNA titers (p = 0.001, 0.023 respectively; Table 1). Patients with LN had more hospitalization for SLE exacerbations [38.4% vs. 24.5%, odds ratio (OR) 1.9, 95% confidence interval (CI) 1-3.9, p = 0.06]. Of 54 patients with LN, 45 had available treatment information. All patients were treated with hydroxychloroquine, 19 patients (42.2%) were treated with cyclophosphamide, and 36 (80%) were treated with mycophenolate mofetil or mycophenolic acid. During follow-up of the LN patients, 5 patients (9.3%) were diagnosed with diabetes, 21 patients (38.9%) were diagnosed with hypertension, 5 patients (9.3%) had a stroke and 6 patients (11.1%) had an acute coronary syndrome. Eight of the LN patients (14.8%) developed ESKD as compared with one patient (0.8%) of the controls (OR 22.1, 95% CI 2.7-181.5, p < 0.001). On univariate analysis, ESKD was significantly associated with LN, hypertension, heart failure, and non-employment status. No difference in the rate of ESKD was found between Jewish and Arab patients. On multivariate regression analysis, LN and hypertension were the most important predictors for developing ESKD. Mortality among patients with ESKD was 22% vs. 4.6% among non-ESKD patients (p = 0.02) )Fig. 1). Conclusion This long-term study on Israeli SLE patients reveals that despite advances in SLE treatments, LN is associated with significant morbidity and mortality. The elevated risk of ESKD, particularly associated with LN and hypertension, underscores the imperative for targeted interventions to improve outcomes.

Neutrophils-derived Parameters as Cost-effective Inflammatory, Disease Activity Marker in Systemic Lupus Erythematosus (SLE) and Role in Prediction of Lupus Nephritis

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with various clinical manifestations and approximately 50% of the SLE patients develop lupus nephritis (LN), which increases the risk of renal failure, cardiovascular diseases and overall survival. Objectives: Evaluation of neutrophil-derived parameters (Neut-X, Neut-Y and Neut-Z) as an inflammatory, disease activity marker and as a predictor of nephritis in SLE patients. Material and Methods: In this cross-sectional study, 3 ml K3EDTA blood was taken from 110 SLE patients presented in Department of Clinical Immunology to evaluate neutrophil-derived parameters in Sysmex XT2000i haematology analyser and their correlation with other inflammatory biomarkers like, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as SLE disease activity index-2000 (SLEDAI-2K). 24-hours urine protein levels were also estimated as a marker of renal involvement. Records of renal biopsy were available in 73 SLE patients, who belonged to different morphologic classification of LN. Results: After performing bivariate Spearman correlation analysis (SPSS software, version 26.0), Neut-X (measures cytoplasmic granularity by side scattering) and Neut-Z (vector sum of Neut-X and Neut-Y) showed a significant positive correlation ( r > 0.200, P < .05) with ESR, CRP and SLEDAI-2K while Neut-Y (measures nucleic acid content by sideward fluorescence) showed a significant negative correlation ( r > 0.200, P < .05) with ESR and CRP. Receiver-operating characteristic curve analysis was used to evaluate diagnostic value of 24-hour urine protein and predictive values of neutrophil-derived parameters for renal involvement in SLE patients. Among neutrophil-derived parameters, Neut-X was found to be the best predictor of renal dysfunction with highest AUC of 0.710 (95% CI: 0.604-0.816; cut-off: 1344.50; sensitivity: 84.7%; specificity: 50%) followed by Neut-Z with AUC of 0.707 (95% CI: 0.600-0.813; cut-off: 1403.67; sensitivity: 87.5%; specificity: 50%). Conclusion: Our study shows that neutrophil-derived parameters may be used as novel cost-effective, non-invasive biomarker of disease activity as well as for predicting renal involvement in SLE patients.

Two-dimensional speckle-tracking echocardiography in left ventricular systolic function in patients with systemic lupus erythematosus.

To investigate whether two-dimensional speckle-tracking echocardiography (2DSTE) can be considered a criterion for early left ventricular (LV) systolic impairment in patients with systemic lupus erythematosus (SLE) and to further explore the association with each other. We included 38 patients with SLE and assessed the degree of disease activity according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) 2000 scoring criteria, together with 38 healthy controls who were matched by sex and age. Routine LV systolic function evaluation parameters were obtained by echocardiography as well as 2DSTE measurement of LV strain parameters to obtain global longitudinal strain (GLS) values, respectively. (I) On routine LV function parameters such as ejection fractions (EF) and left ventricular end-diastolic internal diameter (LVIDd), the SLE group and the control group did not reflect differences. In contrast, on the LV strain parameter obtained from 2DSTE measurements, the GLS values in all cardiac planes were lower in the SLE group than in the control group and showed statistically significant differences. (II) Correlation analysis showed that there was a correlation between SLEDAI and GLS, especially a meaningful correlation with GLS Avg and GLS A4C, with correlation coefficients of 0.35 and 0.47, respectively. The use of 2DSTE can detect early impaired LV systolic function in SLE patients, and GLS is progressively gaining attention as an indicator of subclinical myocardial injury and LV function in SLE patients. The correlation that exists between GLS and SLEDAI might contribute to a better assessment of cardiac involvement in SLE patients. Key Points • Cardiac involvement has become one of the major factors in the poor prognosis of SLE patients, which directly affects the mortality of SLE patients. Traditional echocardiography is difficult to detect early left ventricular function impairment, thus affecting clinicians' judgment and diagnosis. • 2DSTE can recognize subclinical myocardial injury in SLE patients at an early stage, and its derived strain parameters may be used as an indicator to evaluate myocardial involvement and reflect disease activity in SLE patients.

Systemic Lupus Erythematosus Patients in the Qassim Region, Saudi Arabia: Insights on Peripheral Nervous System Involvements

Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disorder with diverse clinical manifestations. This study aimed to investigate the prevalence, clinical features, and risk factors associated with peripheral nervous system (PNS) involvement in SLE patients. Materials and Methods: This study encompassed a retrospective analysis involving 377 SLE patients diagnosed according to the European Alliance of Associations for Rheumatology/American College of Rheumatology criteria at Qassim region in Saudi Arabia, conducted through a meticulous chart review facilitated by proficient data collectors. A structured data collection form/checklist, incorporating explicit definitions and instructions, was utilized for extracting information from patient files, papers, and databases. Additionally, the SLE Quality of Life Questionnaire was employed to evaluate the quality of life among the participants. A multivariate logistic regression model was employed to identify independent predictors of PNS involvement. Results: Distinct clinical patterns were observed in SLE patients with PNS involvement, including a higher prevalence of nonscarring alopecia, acute cutaneous lesions, oral ulcers, and seizures. Diabetes and chronic kidney disease emerged as significant positive predictors for PNS complications. Hematological abnormalities, renal involvement, and vitamin deficiencies were prevalent, contributing to an overall poor quality of life among these patients. Conclusion: This study underscores the need for heightened clinical awareness of PNS complications in SLE, emphasizing the impact of diabetes and chronic kidney disease as significant risk factors. Early detection and targeted interventions are crucial to improving outcomes and enhancing the overall quality of life for SLE patients with PNS involvement.

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

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

Neuropsychiatric Manifestations in Systemic Lupus Erythematosus Patients at a Tertiary Hospital in Peru.

Systemic lupus erythematosus is a prevalent autoimmune disease that affects multiples systems, exerting its most incapacitating and life-threatening impact through neuropsychiatric involvement. According to the American College of Rheumatology (ACR), 19 neuropsychiatric syndromes types of SLE are classified into categories encompassing the central and peripheral nervous systems. This study aimed to investigate the frequency of neuropsychiatric manifestations in systemic lupus erythematosus patients admitted to Hospital Cayetano Heredia in Lima, Peru, between 2008 and 2019. A retrospective observational study was conducted, entailing the review of 240 medical records of patients diagnosed with systemic lupus erythematosus during the specified period, based on the Systemic Lupus International Collaborating Clinics (SLICC) 2012 criteria. Among these records, 55 patients presented neuropsychiatric systemic lupus erythematosus (NPSLE). Data were collected using standardized form and entered into Microsoft Excel 2019 database. Statistical analysis was performed using Stata v16. The frequency of neuropsychiatric compromise in systemic lupus erythematosus patients was found to be 22.91%. Among the 55 systemic lupus erythematosus patients, 40 demonstrated involvement of the central nervous system (72.72%), 2 exhibited involvement of the peripheral nervous system (3.63%), and 13 displayed involvement in both the central nervous system and peripheral nervous system (23.63%). The most prevalent psychiatric disorder observed was a major depressive disorder, with a prevalence rate of 30.9%. The study revealed a frequency of 22.91% for neuropsychiatric involvement in systemic lupus erythematosuspatients at Cayetano Heredia Hospital between 2008 and 2019, with central nervous system manifestations prevailing. Furthermore, the findings suggest that NPSLE commonly manifested after the diagnosis of systemic lupus erythematosus.

Fragmented QRS complex, highly sensitive CRP, and fibrinogen in early detection of asymptomatic cardiac involvement in systemic lupus erythematosus

BackgroundPatients with systemic lupus erythematosus (SLE) have an increased risk of developing cardiovascular illnesses. Asymptomatic affection might exist, so early diagnosis can improve the outcome.AimThe purpose of this study was to determine the importance of highly sensitive C-reactive protein, fragmented QRS, and fibrinogen levels in identifying subclinical cardiac involvement in SLE patients, as well as how these variables relate to disease activity.ResultsRegarding hs-CRP and fibrinogen, there were significant differences between the SLE and control group, with a higher frequency of fQRS in the lupus group. The lupus group was divided into 2 subgroups: 44 patients with fragmented QRS in ECG (83%) and 9 patients with normal QRS (17%) with a higher mean value of hs-CRP and fibrinogen level (58.76 ± 70.15, 18.54 ± 26.79) and low HDL (53.37 ± 10.37) in those with fQRS ( +). The sensitivity and specificity of hs-CRP at a cut of level (3.5 mg/L) for fQRS in SLE patients were 75.5%, and 71.7%, respectively. Regression analysis showed hs-CRP and were significant predictors for fQRS changes in SLE patients.ConclusionsA more thorough evaluation of SLE patients with fQRS complexes with hs-CRP and fibrinogen is important with close follow-up for the detection of subclinical cardiac involvement in SLE. Also, SLE activity is linked to fQRS and fibrinogen. Therefore, we advise using them for additional medical care for lupus.

The Immunodiagnostic Utility of Antinuclear Antibody Patterns: A Prediction for Renal Involvement in Systemic Lupus Erythematosus Patients in the Western Region of Saudi Arabia.

Objectives Previous studies have noted associations between the immunofluorescence patterns of antinuclear autoantibodies (ANA) and the autoimmune responses seen in systemic lupus erythematosus (SLE). In this study, the authors tested the hypothesis of whether ANA patterns predict renal involvement in SLE patients. Method A retrospective study was carried out on consecutive SLE patients who had ANA staining pattern dataand who were screened for renal involvement defined as all-stage proteinuria or chronic kidney disease (CKD) at a referral tertiary center in western Saudi Arabia from December 2021 to February 2022. Demographic data and levels of lupus immune markers including ANA titers, anti-double-stranded deoxyribonucleic acid antibodies (anti-dsDNA), complements C3 and C4, anticardiolipin (aCL) immunoglobulin (Ig) G and IgM, anti-β2 glycoprotein (β2-IgM and β2-IgG), and lupus anticoagulant (LA) antibodies were collected. Result Among 243 patients included, 25.1% had renal involvement (95% confidence interval {CI}=19.8-31.0). A mixed ANA pattern was associated with a higher prevalence of renal involvement (46.2%), followed by homogenous (26.5%) and speckled (25.6%) patterns, compared with 4.5% for the other patterns (p=0.044). No further association of renal involvement was observed with other biological markers. Adjusted logistic regression showed age (odds ratio {OR}=0.95; 95% CI=0.92-0.97) and mixed ANA pattern (OR=26.66; 95% CI=2.53-281.11) to be independently associated with renal involvement, explaining 12.6% of the variance. Conclusion A mixed homogenous/speckled ANA staining pattern is associated with an increased risk of renal involvement, independent of ANA titer or other lupus immune markers. The potential clinical applications of the ANA staining pattern in SLE should be explored in various subtypes of SLE and patient groups.

Association of IL-17 serum levels with clinical findings and systemic lupus erythematosus disease activity index

The current study aims to investigate the relationship betweSen serum IL-17 (IL-17) levels and systemic lupus erythematosus disease activity index (SLE-DAEI) in systemic lupus erythematosus (SLE) patients. In this case-control study, 36 patients with SLE and 40 healthy individuals matched for age and sex were included as the control group. The study measured serum IL-17 in both groups. The correlation between serum IL-17 with disease activity (as per SLE-DAI) and organ involvement in SLE patients. The case group in this study consisted of 4 males and 32 females with a mean age of 35 (17–54) years old, and the control group included six males and 34 females with a mean age of 37 (25–53) years old (p = .35). Serum IL-17 was higher in the cases than in the controls (536 pg/mL vs. 110 pg/mL; p < .001). There was a positive correlation between the serum levels of IL-17 and disease activity index (p < .001, rho = 0.93) among cases. Additionally, the serum levels of IL-17 were higher in patients with renal (p = .003) or central nervous system involvement (p < .001) than in patients without such involvement. Serum Il-17 is associated with SLE, and its serum levels correlate positively with the disease activity and renal and nervous system involvement.

Systemic lupus erythematosus with diffuse alveolar hemorrhage.

Systemic lupus erythematosus with diffuse alveolar hemorrhage.

Profiling of kidney involvement in systemic lupus erythematosus by deep learning using the National Database of Designated Incurable Diseases of Japan

BackgroundKidney involvement frequently occurs in systemic lupus erythematosus (SLE), and its clinical manifestations are complicated. We profiled kidney involvement in SLE patients using deep learning based on data from the National Database of Designated Incurable Diseases of Japan.MethodsWe analyzed the cross-sectional data of 1655 patients with SLE whose Personal Clinical Records were newly registered between 2015 and 2017. We trained an artificial neural network using clinical data, and the extracted characteristics were evaluated using an autoencoder. We tested the difference of population proportions to analyze the correlation between the presence or absence of kidney involvement and that of other clinical manifestations.ResultsData of patients with SLE were compressed in a feature space in which the anti-double-stranded deoxyribonucleic acid (anti-dsDNA) antibody titer, antinuclear antibody titer, or white blood cell count contributed significantly to distinguishing patients. Many SLE manifestations were accompanied by kidney involvement, whereas in a subgroup of patients with high anti-dsDNA antibody titers and low antinuclear antibody titers, kidney involvement was positively and negatively correlated with hemolytic anemia and inflammatory manifestations, respectively.ConclusionAlthough there are various combinations of SLE manifestations, our study revealed that some of them are specific to kidney involvement. SLE profiles extracted from the objective analysis will be useful for categorizing SLE manifestations.

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.

Dyslipidemia is associated with inflammation and organ involvement in systemic lupus erythematosus

IntroductionDisturbed lipid metabolism was observed in systemic lupus erythematosus (SLE) patients. This study aimed to evaluate the relationships between dyslipidemia and visceral organ involvement, disease severity, inflammatory factors, and drug intake in SLE patients.MethodInpatients with SLE (n = 105) and healthy controls (HC) (n = 75) were recruited in this study. Clinical and laboratory data were collected from patient records. The concentrations of tumor necrosis factor receptors superfamily member1A (TNFRSF1A), member1B (TNFRSF1B) and adipokine angiopoietin-like 4 (ANGPTL4) in plasma were measured by ELISA.ResultCompared to HC, serum levels of triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), and apolipoprotein B (ApoB) were significantly increased, while high-density lipoprotein (HDL) and apolipoprotein A1 (ApoA1) were decreased in SLE patients. Patients with higher disease activity and renal damage suffered from more severe dyslipidemia. Renal functional parameters were closely correlated with serum lipid levels. Inflammatory factors were associated with dyslipidemia. The levels of TNFRSF1A and TNFRSF1B were obviously increased and associated with kidney involvement in SLE patients. Patients with high-dose glucocorticoid intake showed more severe dyslipidemia.ConclusionsAttention should be paid to the dyslipidemia of SLE. Dyslipidemia is associated with inflammation and organ involvement in SLE. These findings might provide a new strategy for the treatment of SLE.Key Points• Serum levels of TG, TC, LDL, and ApoB were significantly increased, while HDL and ApoA1 were decreased in SLE patients.• Patients with higher disease activity and renal damage suffered from more severe dyslipidemia. Renal functional parameters and inflammatory factors were closely correlated with serum lipid levels.• Patients with high-dose glucocorticoid intake showed more severe dyslipidemia.• These findings might provide a new strategy for the treatment of SLE.

A cross-sectional study of systemic lupus erythematosus patients complicated with infection

Objectives and Introduction The purpose of this study was to determine the prevalence and influencing factors of systemic lupus erythematosus (SLE) patients complicated with infection having multi-system involvement and to analyze the influencing factors of early CMV and fungal infection. Methods We conducted a cross-sectional study of hospitalized SLE patients complicated with infection. Participants had an average age of 44.80 ± 17.30, with 152 being female (89.94%). Clinical data and laboratory results were collected from medical records. Receiver operating characteristic (ROC) curves were plotted, and sensitivity and specificity were calculated. Results Univariate analysis showed that systemic lupus erythematosus disease activity index-2000 (SLEDAI-2k), red blood cell, platelets, hemoglobin, lymphocytes, IgG, IgM, C3, C4, albumin and globulin were significantly associated with SLE patients with infection complicated with multi-system involvement. After multivariable analysis, the following variables remained significant: Hemoglobin, CD4 lymphocyte, IgM and SM ( p &lt; 0.05). ROC curve analysis showed the areas under the curve of Hb, CD4 count, and IgM for the differential diagnosis of SLE with infection complicated with multisystem involvement being 0.646, 0.627, and 0.610. Then, the sensitivities of 73.3%, 53.3%, and 73.3% were observed with the specificities of 54.1%, 69.7%, and 48.6%, respectively. Conclusions Our results demonstrated that hemoglobin, CD4 lymphocyte value, IgM and anti SM antibody had significant value in monitoring multi-system involvement in SLE patients complicated with infection. Besides, intrinsic lymphatic count disturbances associated with SLE disease can cause infections by opportunistic pathogens such as fungi.

Cutaneous Manifestations of Systemic Lupus Erythematosus: A Descriptive Study from a Tertiary Care Center in Southern India

Abstract Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease that affects multiple systems in the body, including the skin. It is more common in women and usually occurs in the fourth decade of life. The skin is the second most frequently affected organ in SLE, occurring in about 80% of patients. Aim: The purpose of this study was to analyze the clinical and epidemiological characteristics of SLE and evaluate the different patterns of cutaneous involvement in SLE patients. Materials and Methods: Sixty newly diagnosed SLE patients (17 male, 43 female) aged 9–58 years were included in the study. Results: Malar rash was observed in 44 (73.3%) patients, discoid rash in 17 (28.3%) patients, photosensitivity in 38 (63.3%) patients, and oral ulcers in 30 (50%) patients. All these skin lesions were associated with underlying systemic involvement. Conclusion: Our study found that active cutaneous manifestations of SLE were strongly correlated with systemic involvement.

Urine Galectin-3 binding protein reflects nephritis activity in systemic lupus erythematosus.

Lupus nephritis (LN) is a major and severe organ involvement in systemic lupus erythematosus (SLE), whose diagnosis and treatment necessitate to perform kidney biopsy, which is an invasive procedure. Non-invasive urine biomarkers are an active area of investigation to support LN diagnosis and management. To investigate the role of urinary galectin-3 binding protein (u-Gal-3BP) as a candidate biomarker of renal disease in biopsy proven LN. Levels of u-Gal-3BP were investigated in a cross-sectional fashion by ELISA in 270 subjects: 86 LN patients, 63 active SLE patients with no kidney involvement, 73 SLE patients with inactive disease and 48 age and sex-matched population-based controls (PBC). Moreover, urine samples were analysed separately by ELISA for additional markers of kidney pathology: neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), kidney injury molecule-1 (KIM-1) and galectin-3 (Gal-3). The concentrations of all studied molecules were normalized to urine creatinine levels. In 10 patients, post-treatment levels of the biomarkers were measured. Normalized u-Gal-3BP levels were higher in LN patients compared to the other groups (p < .0001). Comparing different LN classes, u-Gal-3BP levels were higher among patients with proliferative (class III/IV) and membranous (class V) as compared to mesangial (class II) forms (p = .04). In proliferative forms, u-Gal-3BP levels correlated with the activity index in renal biopsies (r = 0.42, p = .004). Moreover, in a subset of 10 patients with repeated kidney biopsy and urine sampling before and after induction treatment, a significant decrease of u-Gal-3BP was observed (p = .03). Among the other markers, KIM-1 was also able to discriminate LN from the other groups, while NGAL, OPN and Gal-3 could not in this cohort. Given its ability to discriminate LN patients from active non-renal and inactive SLE patients, the observed correlation with the activity index in renal biopsies, and its levels declining following treatment, u-Gal-3BP shows promise as a non-invasive urinary biomarker to help detecting and to monitor renal involvement in SLE patients and should be validated in larger cohorts.

Correlation between neutrophil to lymphocyte and platelet to lymphocyte ratios and renal involvement in systemic lupus erythematosus in Central Vietnam

Background: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with diverse clinical manifestations and relapsing - remitting disease course. Nephritis is a major cause of morbidity and mortality in patients with lupus. Many clinical parameters and laboratory markers can be used to evaluate disease activity and nephritis. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are positively associated with inflammatory disorders. Objectives: To evaluate the correlation between NLR and PLR in peripheral blood and renal involvement in systemic lupus erythematosus. Methods: 63 patients were diagnosed with SLE according to the criteria of the Systemic Lupus International Collaborating Clinics 2012 (SLICC 2012) and were treated at the Internal Medicine Department of Hue University of Medicine and Pharmacy Hospital, Thua Thien Hue province, in central Vietnam, from February 2020 to July 2021. This study included 41 SLE patients with lupus nephritis (LN) and 22 SLE patients without renal involvement. Results: The mean age of the study group was 31.67 ± 12.10. The most common age group was 21-50 years old, accounting for 69.8%. Females accounted for 90.5% and the female-to-male ratio stood at 9.5:1. Clinical and laboratory characteristics: acute cutaneous lupus 50.8%, subacute cutaneous lupus 11.1%, oral ulcers 27%, non - scarring alopecia 47.6%, arthritis 61.9%, pleural or pericardial effusion 30.2%, renal involvement 65.1%, neuropsychiatric damage 4.8%, anemia 81.0%, leukopenia 22.2%, neutropenia 11.1%, lymphopenia 41.3%, thrombocytopenia 15.9%, hemolytic anemia 15.9%, positive ANA antibody 61.9%, positive anti-ds DNA antibody 52.4%. Acute cutaneous lupus and arthritis in SLE patients without the nephritis group were higher than in the LN group (p &lt; 0.05). Anemia, lymphopenia, thrombocytopenia, positive ANA, anti-ds DNA in the LN group were higher than SLE patients without nephritis (p &lt; 0.05). SLE patients with LN had higher levels of NLR than those without nephritis. While PLR had no remarkable difference between these two groups. NLR was positively correlated with CRP, serum creatinine, and 24-hour urinary protein. PLR was positively correlated with the SLEDAI score. The best NLR to predict LN was 4.97 with a sensitivity of 51.2% and a specificity of 95.5% (AUC = 0.742, 95% CI, 0.617 - 0.866, p = 0.002). Conclusion: Most of the clinical manifestations in SLE patients according to SLICC 2012 criteria were lupus nephritis, arthritis, and acute cutaneous lupus. PLR was positively correlated with the SLEDAI score. NLR could predict renal involvement in SLE patients. Keywords: Lupus nephritis, ANA, anti-ds DNA, NLR, PLR.