Management Of Systemic Lupus Erythematosus Research Articles

The Therapeutic Effects of Probiotic on Systemic Lupus Erythematosus in Lupus Mice Models: A Systematic Review.

Increasing evidence suggests the beneficial immunomodulatory effects of probiotics can reduce inflammation in systemic lupus erythematosus (SLE). However, there is no summary of the existing evidence available. This study aims to investigate the therapeutic effects of probiotics on SLE in a lupus mouse model by examining various markers, including inflammatory cytokines, Treg cells, disease activity, and gut microbiota. A systematic search was conducted using three databases (Web of Science, PubMed, and Scopus) to identify animal studies that reported the therapeutic benefits of probiotics against SLE. Data extracted from the selected articles were qualitatively synthesized. The SYRCLE risk of bias tool was used to evaluate the risk of bias. Out of a total of 3205 articles, 12 met the inclusion criteria. Probiotic strains, quantities, and routes of administration varied among the studies. The treatment ranged from 8 to 47weeks. Probiotic strains such as L. fermentum CECT5716, L. casei B255, L. reuteri DSM 17509, L. plantarum LP299v, and L. acidophilus can significantly reduce pro-inflammatory cytokines (TNF-α, IL-12, IL-6, IL-1β, IL-17, and IFN-γ) levels while increasing anti-inflammatory IL-10 and Treg cells. Probiotics also delay the production of autoantibodies, thus prolonging the remission period, decreasing flare frequency, and delaying disease progression. Furthermore, probiotic administration prevents gut dysbiosis, increases intestinal stability, and prevents pathogen colonization. In conclusion, probiotics can be considered a new alternative therapeutic approach for the management of SLE. Further clinical studies are required to investigate and validate the safety and effectiveness of probiotics in humans.

#1720 Insights from sodium-glucose transport 2 (SGLT2) inhibitors treatment in patients with systemic lupus erythematosus

Abstract Background and Aims Kidney involvement is common among patients with systemic lupus erythematosus (SLE) and it is an important cause of morbidity and mortality among this population. Recently, the EULAR 2023 update of the recommendations for the management of SLE advised considering the use of sodium-glucose transport 2 inhibitors (SGLT2i) as kidney protective agents in patients with chronic kidney disease with reduced glomerular filtration rate (GFR). Aims: To assess clinical characteristics and outcomes of Israeli patients with SLE treated with SLGT2i. Method This retrospective study, conducted between 2014–2023, included adult patients with SLE diagnosed for at least 12 months. Patients receiving SGLT2i for a duration of three months or longer were compared with a control group consisting of patients who were not treated with these agents. Associated variables were assessed including disease-related characteristics, kidney-related factors, and comorbidities such as diabetes and heart failure. Clinical outcomes including severe infections, hospitalizations, and all-cause mortality were recorded. Repeated measures analysis model was applied to compare the estimated GFR (eGFR) at different time points (before diagnosis, at diagnosis, and at the last follow-up), among the SGLT2i-treated patients and controls. Protein to creatinine ratio was compared before starting treatment with SGLT2i and on treatment at the last follow-up. Results A total of 165 consecutive patients were included in this analysis, with a mean follow-up from SLE diagnosis of 15.6 ± 11.8 years. Of them, 7 were treated chronically with SGLT2i and had available data. While age at SLE diagnosis was comparable between the two groups (29.8 ± 12.2 years in the SGLT2i group and 32.6 ± 14.3 years in controls, p = 0.6), SGLT2i treated patients were significantly older at last follow-up (62.1 ± 13.5 years vs. 47.3 ± 16.3 years, p = 0.019), and as a consequence, the duration of follow-up since SLE diagnosis was longer among them (26.2 ± 11 years vs. 15.3 ± 11.7 years in the controls, p = 0.04). Diabetes was diagnosed in 16 out of 165 patients (9.7%), and 5 out of 7 patients treated with SGLTi were diabetic (71.4% vs. 7.0% in controls, p < 0.01). Heart failure was diagnosed in 7.3% of the cohort, and was more prevalent among the SGLTi group (28.6% vs 6.3% in controls, p = 0.03). Only 26.6% of patients with diabetes and 16.7% of patients with heart failure were treated with SGLTi. On repeated measures analysis, eGFR decreased significantly during the study period (p = 0.043, Fig. 1). The decline in eGFR throughout the study period was comparable between the groups. Protein to creatinine ratio decreased significantly in the SGLTi-treated patients after starting treatment (1516 ± 1685 mg/g before treatment vs. 611 ± 875 mg/g after treatment, p = 0.05). The prevalence of severe infections requiring hospitalization was comparable between groups (28.6% in SGLTi vs 29.9% in controls, p = 0.9). Hospitalizations for SLE exacerbations, as well as hospitalization for cardiovascular events, were similarly comparable between groups (28.6% vs, 28.5%, p = 0.9 and 14.3% vs. 15.3%, p = 0.9; respectively). During the study period, 10 patients developed end-stage kidney disease and 11 patients died, with no significant difference between groups. Conclusion While the SGLT2i-treated patients were older and had higher rates of comorbidities such as diabetes, chronic kidney disease, and heart failure, a similar rate of kidney function decline was observed in both SGLT2i-treated patients and controls. Additionally, a comparable rate of severe infections was found in both groups of patients. This relatively small cohort could support the use of these kidney and heart protective agents in patients with SLE and kidney involvement. A special consideration should be given to patients with comorbid diabetes and heart failure.

Management of systemic lupus erythematosus: a systematic literature review informing the 2023 update of the EULAR recommendations

ObjectivesTo analyse the new evidence (2018–2022) for the management of systemic lupus erythematosus (SLE) to inform the 2023 update of the European League Against Rheumatism (EULAR) recommendations.MethodsSystematic literature reviews were...

State of the art: the treatment of systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with dysregulated cells in the immune system. The disease affects organs like kidneys, nervous system, joints, and skin. To manage SLE effectively, novel treatments targeting immune system components have been developed. This review investigates the therapeutic potential of existing targeted therapies and explores future innovative approaches for well tolerated, personalized treatment. SLE treatment involves cytokine targets and specific immunologic pathways, with even small molecules involved. The advanced therapeutic options in SLE management give clinicians more tools to control disease activity according to personalized medicine.

Saudi National Clinical Practice Guidelines for Management of Adult Systemic Lupus Erythematosus.

To provide evidence-based clinical practice recommendations for managing Systemic Lupus Erythematosus (SLE) in Saudi Arabia. This EULAR-adapted national guideline in which a multidisciplinary task force utilized the modified Delphi method to develop 31 clinical key questions. A systematic literature review was conducted to update the evidence since the EULAR publication. After reaching a consensus agreement, two rounds of voting and group discussion were conducted to generate consolidated recommendations/statements. A significant number of patients in Saudi Arabia experience delays in accessing rheumatologists, highlighting the significance of timely referral to SLE specialists or rheumatologists to ensure accurate diagnosis and prompt treatment. The primary goal of Glucocorticoid (GC) therapy in SLE patients is to establish disease control with a minimum dose and duration. Steroid-sparing agent utilization facilitates steroid-sparing goals. Hydroxychloroquine is recommended for all SLE patients, though physicians must carefully monitor toxicity and prioritize regular medication adherence assessment. SLE management during pregnancy starts from preconception time by assessing disease activity, major organ involvement, hypercoagulability status, and concomitant diseases that may negatively impact maternal and fetal outcomes. Multidisciplinary care with close monitoring may optimize both maternal and fetal outcomes. For patients with antiphospholipid antibodies, low-dose aspirin prophylaxis is recommended. Also, Long-term anticoagulant medications are fundamental to prevent secondary antiphospholipid syndrome due to high thrombosis recurrence. This Saudi National Clinical Practice guidelines for SLE management provide evidence-based recommendations and guidance for healthcare providers in Saudi Arabia who are managing patients with SLE. These guidelines will help to standardize healthcare service, improve provider education, and perhaps lead to better treatment outcomes for SLE patients.

Rituximab treatment in resistant lupusnephritis: A single-center prospective study.

Lupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus (SLE) and failure to respond to traditional immunosuppression increases morbidity and mortality. Rituximab has been considered a novel therapeutic option for the management of SLE. We conducted a single-center, prospective, observational study from July 2018 to June 2019 to evaluate the effectiveness of rituximab in patients with resistant LN. Resistant LN was defined as the failure to respond to conventional immunosuppressive therapy including both cyclophosphamide and mycophenolate mofetil. All adult patients (>18 years) with biopsy-proven class III/IV LN were included in the study. Four doses of intravenous rituximab (375 mg/m2) on 0, 1, 2, 3 weeks were administered. Patients were followed for 6months, and the rates of complete renal response (CRR), partial renal response (PRR), or no renal response (NRR) were measured. The change in baseline 24-hour urine protein, mean serum creatinine levels, and mean serum CD-19 levels at 24 weeks were also measured. Six months after rituximab therapy, total sustained renal response (CRR+PRR) was observed in 52% cases of resistant LN (CRR was achieved in 24% of patients and PRR in 28%, respectively). Rituximab was associated with a significant decline in the 24-hour urine protein, even in non-responders. However, the improvement in eGFR and serum creatinine was not statistically significant. The mean absolute CD-19 count was significantly low in responders compared to the non-responder group. Rituximab is a safe and effective therapeutic strategy for patients with resistant LN.

P089 Comprehensive comparison of current guidelines in the management of Systemic Lupus Erythematosus in children, with a focus on Lupus Nephritis

Abstract Background/Aims Lupus nephritis (LN) is a common complication of systemic lupus erythematosus (SLE); LN affects 50-60% of those with a diagnosis of childhood-SLE (cSLE). Currently one set of paediatric recommendations exists for the diagnosis and treatment of LN, published by the Single Hub and Access point for Paediatric Rheumatology in Europe (SHARE). This paper compares SHARE recommendations against two current sets of adult guidelines, published by the British Society of Rheumatology (BSR) and the European Alliance of associations for Rheumatology (EULAR). This paper aims to identify similarities and differences between the three sets of guidelines, and to evaluate the evidence base used to formulate them. Methods Paediatric SHARE recommendations were recorded within a spreadsheet. The recommendations were separated into recommendations for diagnosis and recommendations for treatment. The BSR paper was then examined for equivalent guidelines. The evidence level was recorded for each guideline. In the second phase, the EULAR 2019 guidelines were assessed for corresponding guidelines to the SHARE recommendations. EULAR levels of evidence were recorded. A Likert score of similarity (0-10) was assigned to each trio of guidelines (the trio consisting of one each from SHARE, BSR and EULAR). If a comparable guideline couldn’t be found in either the BSR or EULAR papers, this is made clear in the table. Results When comparing six diagnostic SHARE recommendations for paediatric LN with equivalent BSR and EULAR guidelines, the Likert similarity score ranged between 0-9. Only 50% of the 20 treatment SHARE recommendations had a Likert score ≥5 with their equivalent BSR and EULAR guidelines. Three SHARE treatment recommendations had no comparable guidelines, these are clearly identified in the results tables. All SHARE recommendations were based on level 3 or 4 evidence. Level 3 evidence comes from descriptive studies, whilst level 4 evidence comes from expert opinion and is considered the lowest level of evidence. Conclusion The quantity of differences noted in this paper leads to questioning whether transitional guidelines should be developed for care of young adults with LN to ensure safe transition as they move from paediatric to adult medical care. LN is a chronic condition that will impact a child’s entire life. Optimising care from as early in life as possible and continuing this into the future is essential to maximising quality of life and reducing adverse outcomes associated with renal involvement. Disclosure J.A. Day: None. M.W. Beresford: None.

Notch1 hyperactivity drives ubiquitination of NOX2 and dysfunction of CD8+ regulatory T cells in patients with systemic lupus erythematosus.

Patients with systemic lupus erythematosus (SLE) display heightened immune activation and elevated IgG autoantibody levels, indicating compromised regulatory T cell (Tregs) function. Our recent findings pinpoint CD8+ Tregs as crucial regulators within secondary lymphoid organs, operating in a NOX2-dependent mechanism. However, the specific involvement of CD8+ Tregs in SLE pathogenesis and the mechanisms underlying their role remain uncertain. SLE and healthy individuals were enlisted to assess the quantity and efficacy of Tregs. CD8+CD45RA+CCR7+ Tregs were generated ex vivo, and their suppressive capability was gauged by measuring pZAP70 levels in targeted T cells. Notch1 activity was evaluated by examining activated Notch1 and HES1, with manipulation of Notch1 accomplished with Notch inhibitor DAPT, Notch1 shRNA, and Notch1-ICD. To create humanized SLE chimeras, immune-deficient NSG mice were engrafted with PBMCs from SLE patients. We observed a reduced frequency and impaired functionality of CD8+ Tregs in SLE patients. There was a downregulation of NOX2 in CD8+ Tregs from SLE patients, leading to a dysfunction. Mechanistically, the reduction of NOX2 in SLE CD8+ Tregs occurred at a post-translational level rather than at the transcriptional level. SLE CD8+ Tregs exhibited heightened Notch1 activity, resulting in increased expression of STUB1, an E3 ubiquitin ligase that binds to NOX2 and facilitates its ubiquitination. Consequently, restoring NOX2 levels and inhibiting Notch1 activity could alleviate the severity of the disease in humanized SLE chimeras. Notch1 is the cell-intrinsic mechanism underlying NOX2 deficiency and CD8+ Treg dysfunction, serving as a therapeutic target for clinical management of SLE.

Recommendations for physical activity and exercise in persons living with Systemic Lupus Erythematosus (SLE): consensus by an international task force

ObjectiveThis international task force aimed to provide healthcare professionals and persons living with systemic lupus erythematosus (SLE) with consensus-based recommendations for physical activity and exercise in SLE.MethodsBased on evidence from...

Mesenchymal stem cell transplantation may be able to induce immunological tolerance in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a common, potentially fatal autoimmune disease involving a significant inflammatory response. SLE is characterised by failure of self-tolerance and activation of autoreactive lymphocytes, leading to persistent disease. Although current treatments achieve some improvement in patients, some SLE patients are refractory and others relapse after drug withdrawal. The toxicity of current drug regimens, with recurrent infections, together with ongoing inflammation, contribute significantly to the progressive decline in organ function. Therefore, the clinical management of SLE requires more effective and less toxic treatments, ideally inducing complete remission and self-tolerance. In this context, recently developed cell therapies based on mesenchymal stem cells (MSCs) represent a promising and safe strategy in SLE. MSCs inhibit the activation of B cells, prevent the differentiation of CD4⁺ T cells into autoreactive T cells, reprogram macrophages with anti-inflammatory effects and inhibit dendritic cells (DCs), limiting their activity as antigen-presenting cells. In addition, MSCs could induce antigen-specific tolerance by enhancing anergy processes in autoreactive cells - by inhibiting the maturation of antigen-presenting DCs, blocking the T cell receptor (TcR) pathway and secreting inhibitory molecules -, increasing apoptotic activity to eliminate them, and activating regulatory T cells (Tregs) to enhance their proliferation and induction of tolerogenic DCs. Thus, induction of self-tolerance leads to immune balance, keeping inflammation under control and reducing lupus flares.

Autoimmune responses and therapeutic interventions for systemic lupus erythematosus: a comprehensive review.

Systemic Lupus Erythematosus (SLE) or Lupus is a multifactorial autoimmune disease of multiorgan malfunctioning of extremely heterogeneous and unclear etiology that affects multiple organs and physiological systems. Some racial groups and women of childbearing age are more susceptible to SLE pathogenesis. Impressive progress has been made towards a better understanding of different immune components contributing to SLE pathogenesis. Recent investigations have uncovered the detailed mechanisms of inflammatory responses and organ damage. Various environmental factors, pathogens, and toxicants, including ultraviolet light, drugs, viral pathogens, gut microbiome metabolites, and sex hormones trigger the onset of SLE pathogenesis in genetically susceptible individuals and result in the disruption of immune homeostasis of cytokines, macrophages, T cells, and B cells. Diagnosis and clinical investigations of SLE remain challenging due to its clinical heterogeneity and hitherto only a few approved antimalarials, glucocorticoids, immunosuppressants, and some nonsteroidal anti-inflammatory drugs (NSAIDs) are available for treatment. However, the adverse effects of renal and neuropsychiatric lupus and late diagnosis make therapy challenging. Additionally, SLE is also linked to an increased risk of cardiovascular diseases due to inflammatory responses and the risk of infection from immunosuppressive treatment. Due to the diversity of symptoms and treatment-resistant diseases, SLE management remains a challenging issue. Nevertheless, the use of next-generation therapeutics with stem cell and gene therapy may bring better outcomes to SLE treatment in the future. This review highlights the autoimmune responses as well as potential therapeutic interventions for SLE particularly focusing on the recent therapeutic advancements and challenges.

Clinical and economic burden of systemic lupus erythematosus in Colombia

Aims Our cost-of-illness (COI) model adopted payer and societal perspectives over five years to measure the economic burden of Systemic Lupus Erythematosus (SLE) in Colombia. Materials and methods A prevalence-based model was constructed to estimate costs and economic consequences for SLE patients in Colombia. The model included four health states: three phenotypes of SLE representing mild, moderate, and severe states and death. The clinical inputs were captured from the published literature and validated by the Delphi panel. Our model measured direct medical and indirect costs, including disease management, transient events, and indirect costs. One-way sensitivity analysis was also performed. Results The number of Colombian SLE patients was 37,498. The number of SLE patients with mild, moderate, and severe phenotypes was 5343, 28757 and 3,397, respectively. SLE-patients with moderate (Colombian pesos; COP 146 billion) and severe phenotypes (COP276 billion) incurred higher costs than those with mild phenotypes (COP2 billion), over 5 years. The total SLE cost in Colombia over five years from the payer and societal perspectives was estimated to be COP 915 billion and 8 trillion, respectively. The costs per patient per year from the payer and societal perspectives were COP 4,881,902 ($3,510) and COP 46,637,054 ($33,528), respectively. Conclusion The burden of SLE in Colombia over five years is substantially high, mainly due to the consequences of economic loss because it affects women and men of working age, in addition to the costs of SLE management and its consequences, such as flares, infection, and organ damage. Our COI indicated that disease management costs among patients with moderate and severe SLE were substantially higher than those among patients with a mild phenotype. Therefore, more attention should be paid to limiting the progression of SLE and the occurrence of flares, with the need for further economic evaluation of novel treatment strategies that help in disease control.

Economic burden of systemic lupus erythematosus in Malaysia

Introduction Our cost-of-illness (COI) model adopted the perspective of both payer and society over a time horizon of 5 years to measure the economic burden of systemic lupus erythematosus (SLE) in Malaysia. Methodology Our COI model utilized a prevalence-based model to estimate the costs and economic consequences of SLE in Malaysia. The clinical parameters were obtained from published literature and validated using the Delphi panel. Direct and indirect medical costs were measured, including disease management, transient events, and indirect costs. One-way sensitivity analysis was also performed. Results The number of target Malaysian patients with SLE in the COI model was 18,121. At diagnosis, the numbers of SLE patients with mild, moderate, and severe phenotypes were 2,582, 13,897, and 1,642, respectively. The total SLE cost in Malaysia over 5 years from both payer and society perspectives was estimated at MYR 678 million and 2 billion, respectively. The results showed a considerable cost burden due to productivity losses resulting from SLE-related morbidity and mortality. Over a 5-year time horizon, the costs per patient per year from the payer and society perspectives were MYR 7,484 ($4766) and 24,281($15,465), respectively. Conclusion Our study demonstrated the substantial economic burden of SLE in Malaysia over a time horizon of 5 years. It affects adults of working age, in addition to the costs of SLE management and its consequences, such as flares, infection, and organ damage. Our COI model indicated that disease management costs among patients with higher disease severity were higher than those among patients with a mild phenotype. Hence, more attetion should be paid to limiting the progression of SLE and the occurrence of flares, with the need for further economic evaluation of novel treatments that could lead to better outcomes.

The economic burden of systemic lupus erythematosus in Taiwan

Background Our cost-of-illness (COI) model adopted both payer and societal perspectives over a time horizon of 5 years to measure the economic burden of systemic lupus erythematosus (SLE) in Taiwan. Methodology A prevalence-based model was established to estimate the economic consequences of SLE after diagnosis in Taiwan. The model included four health states: (i) the three phenotypes representing mild, moderate, and severe SLE, and (ii) death. The inputs were obtained from a literature review of all the clinical trials and validated using a Delphi panel. The Delphi panel’s insights included commonly used treatment strategies for patients with SLE within the Taiwanese healthcare system. The costs mentioned in this model are disease management, monitoring, transient event, and indirect costs. One-way sensitivity analyses were conducted to assess the model uncertainty. Results The number of patients with SLE in our COI model was 20,189. At diagnosis, the number of SLE patients with mild, moderate, and severe phenotypes was 5,916, 12,255, and 2019, respectively. The total SLE cost in Taiwan over 5 years from both payer and societal perspectives was estimated at TWD 3.9 and 47 billion, respectively. The costs per patient per year from the payer and societal perspective were TWD 38,775 ($2,758) and TWD 466,119 ($33,152), respectively. Conclusion The findings demonstrated that the burden of SLE in Taiwan over a time horizon of 5 years is substantially high, mainly due to the consequences of economic loss as it affects women and men during their working age, in addition to the costs of SLE management and its consequences, such as flares, infection, and organ damage. Therefore, more attention should be paid to limiting the progression of SLE and the occurrence of flares, and further economic evaluations are necessary to assess novel treatment strategies that could control the disease.

Systemic lupus erythematosus: one year in review 2024.

Systemic lupus erythematosus (SLE) is classically regarded as the landmark of systemic autoimmune diseases, characterised by protean, multi-systemic manifestations and a highly variable clinical course.Over the last years, both clinical and translational clinical research efforts led to significant steps forward in management and treatment of SLE. However, numerous aspects of SLE, from pathogenesis to treatment, still remain challenging, and several unmet needs persist for both patients and physicians. Following the previous annual reviews of this series, herewith, we aim to report the most relevant new updates on SLE, issued in 2023. In particular, we focused on biomarkers, clinical aspects and outcomes, comorbidities, as well as new treatment targets and real-world evidence.

The Problem of Pain in Lupus: Epidemiological Profiles of Patients Attending Multidisciplinary Pain Clinics

Patients with systemic lupus erythematosus (SLE) bear a significant burden of pain. We aimed to identify factors that distinguish patients with SLE referred to comprehensive pain clinics and those who are not. Characterizing this patient population will identify unmet needs in SLE management and inform efforts to improve pain care in rheumatology. Among patients with SLE with ≥2 rheumatology clinic visits in a large hospital system from 1998 to 2023 (n = 1319), we examined factors that distinguished those who had at least one visit to multidisciplinary pain clinics (n = 77, 5.8%) from those who did not have any visits (n = 1242, 94.2%) with a focus on biopsychosocial and socioeconomic characteristics. We extracted demographic data and ICD-9/ICD-10 codes from the EHR. Patients with SLE attending the pain clinics exhibited characteristics including average older age (mean age ± SD: 54.1 ± 17.9 vs. 48.4 ± 19.9), a higher likelihood of relying on public health insurance (50.7% vs. 34.2%), and a greater representation of Black patients (9.1% vs. 4.4%) compared to SLE patients not seen in pain clinics. Nearly all patients seen at the pain clinics presented with at least one chronic overlapping pain condition (96.1% vs. 58.6%), demonstrated a higher likelihood of having a mental health diagnosis (76.7% vs. 42.4%), and exhibited a greater number of comorbidities (mean ± SD: 6.0 ± 3.0 vs. 2.9 ± 2.6) compared to those not attending the pain clinic. We found notable sociodemographic and clinical differences between these patient populations. Patients presenting with multiple comorbidities might benefit from further pain screening and referral to pain clinics to provide comprehensive care, and earlier referral could mitigate the development and progression of multimorbidities.

Predictors of flare-related inpatient or emergency department stay in systemic lupus erythematosus: A real-world analysis of Medicaid claims in the United States.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation. Medical management of SLE is based on reducing inflammation and tissue damage in the affected organs; however, medications used to treat SLE have been found to contribute to additional organ damage. Therefore, finding new ways to predict and prevent flares that require an inpatient (IP) stay or emergency department (ED) visit is critical for reducing the clinical and economic burden in patients with SLE. To identify risk factors of SLE flares requiring an IP/ED visit among a Medicaid-insured population with SLE. This retrospective study included patients from the Merative MarketScan Medicaid database (2013-2019). To capture patients at all stages of their SLE journey, all SLE claims for a patient were captured, and the index date was randomly selected among those claims that were at least 12 months after the first evidence of SLE. Patients were required to be continuously enrolled 1-year pre-index (year 1) and post-index (year 2). Demographics, clinical characteristics, and health care use and costs were measured in year 1, and flares requiring an IP/ED visit were identified in year 2 using the Garris algorithm. Multivariable logistic regression and classification and regression tree (CART) modeling were used to identify year 1 predictors and combination of factors, respectively, associated with flares-related IP/ED visits. Of the 8,083 patients included in the study, 37.6% of patients (n = 3,039) had a flare. Logistic regression identified ED visits in year 1 as one of the strongest predictors of flares-related IP/ED visits in year 2 (odds ratio = 2.19 [95% CI = 1.93-2.49]). SLE treatment progression to biologics (0.54 [0.42-0.70]) was the strongest predictor of decreased odds. Other strong predictors included other neurological disorders (1.63 [1.43-1.87]), Black race (1.49 [1.32-1.68]), chronic kidney disease/renal failure (1.35 [1.10-1.66]), and opioid use (1.30 [1.17-1.45]). CART modeling identified patients with an ED visit, an IP admission, and a diagnosis of Elixhauser Comorbidity Index-defined other neurological disorders in year 1 as having the highest probability of a flare-related IP/ED visit in year 2 (probability = 0.708), whereas patients without an ED visit had the lowest probability (probability = 0.185). Patients with the highest risk of a flare that required an IP/ED visit were those with a prior ED visit, IP admission, and other neurological disorders. Modeling also identified patients with prior opioid use, Black patients, and patients without SLE medications as subgroups with a high risk of a flare requiring an IP/ED visit.

Immunology: what's new in 2023

Systemic lupus erythematosus (SLE) is a complex autoimmune disease affecting various organs and characterized by profound immune disturbances. Monoclonal antibodies such as anifrolumab, targeting type I interferon, and belimumab, targeting a cytokine that activates B-cells and plasmocytes, have shown efficacy in SLE. Voclosporine, a novel calcineurin inhibitor, improves renal outcomes when combined with standard immunosuppression in lupus nephritis. Other approaches like obinutuzumab and CAR-T cells offer hope for refractory patients. These advances diversify SLE management, though their long-term efficacy remains to be established. It is crucial to emphasize basic measures in patients with SLE, including smoking cessation, sun protection, and early use of hydroxychloroquine.

A case report on systemic lupus erythematosus

The abstract encapsulates the complex landscape of systemic lupus erythematosus (SLE), an autoimmune disease impacting multiple organ systems, characterized by immunosuppression and immunomodulation. SLE is recognized as a quintessential connective tissue disorder arising from immune system dysfunction and an overabundance of diverse autoantibodies. Clinical manifestations of SLE encompass nonspecific constitutional symptoms, including fever, exhaustion, anorexia, weight loss, and arthralgias. Additionally, signs of generalized inflammation like hepatosplenomegaly and lymphadenopathy may manifest at disease onset or during flare-ups. The adaptive immune response in SLE is underpinned by the critical role of B lymphocytes in generating autoantibodies, presenting autoantigens, and activating autoreactive T cells. Treatment strategies for SLE primarily involve biologics and therapeutic options approved by the FDA for refractory cutaneous, articular, and renal disease. Belimumab, infliximab, rituximab, abatacept, and tocilizumab represent some of these approved medications. The management of SLE during remission emphasizes the cautious use of prednisone to mitigate flare-ups, considering potential adverse psychiatric effects associated with steroid medication.[14]

Challenges in the diagnosis and management of SLE in India

Management of Systemic lupus erythematosus is challenging due to its varied manifestations, relapses and problems associated with immunosuppressive therapy. This challenge is compounded in resource limited countries due to additional factors such as poor access to health care, limited income, out of pocket expenses for medical care and lack of financial independence of women. In the current review some of these issues have been highlighted in context of India, the most populous country of the world with current annual per capita income of around 2000 dollars.