Problem In Systemic Lupus Erythematosus Research Articles

Serum S100A8/A9 concentrations are associated with neuropsychiatric involvement in systemic lupus erythematosus: a cross-sectional study

BackgroundNeuropsychiatric (NP) involvement and fatigue are major problems in systemic lupus erythematosus (SLE). S100A8/A9 is a marker of inflammation and responds to therapy in SLE patients. S100A8/A9 has an immunopathogenic role in various neurological diseases. We investigated S100A8/A9 in relation to NP-involvement and fatigue in SLE.Methods72 consecutive SLE outpatients at a tertiary centre and 26 healthy controls were included in this cross-sectional study. NPSLE was determined by specialists in rheumatology and neurology and defined according to three attribution models: “ACR”, “SLICC A” and “SLICC B”. Cerebral MRI was assessed by a neuroradiologist and neurocognitive testing by a neuropsychologist. The individuals were assessed by scores of pain (VAS), fatigue (VAS and FSS), and depression (MADRS-S). Concentrations of S100A8/A9 in serum and cerebrospinal fluid were measured with ELISA. Statistical calculations were performed using non-parametric methods.ResultsSerum concentrations of S100A8/A9 were higher in SLE patients compared with controls (medians 1230 ng/ml; 790 ng/ml, p = 0.023). The concentrations were higher in NPSLE patients compared with non-NPSLE patients when applying the SLICC A and ACR models, but not significant when applying the SLICC B model (medians 1400 ng/ml; 920 ng/ml, p = 0.011; 1560 ng/ml; 1090 ng/ml, p = 0.050; 1460 ng/ml; 1090 ng/ml, p = 0.083, respectively). No differences of CSF S100A8/A9 concentrations were observed between NPSLE and non-NPSLE patients. SLE patients with depression or cognitive dysfunction as an ACR NPSLE manifestation had higher serum S100A8/A9 concentrations than non-NPSLE patients (median 1460 ng/ml, p = 0.007 and 1380 ng/ml, p = 0.013, respectively). Higher serum S100A8/A9 correlated with higher VAS fatigue (r = 0.31; p = 0.008) and VAS pain (r = 0.27, p = 0.021) in SLE patients. Serum S100A8/A9 was not independently associated with NPSLE when adjusting for scores of fatigue (FSS) and pain (VAS) (OR 1.86, 95% CI 0.93–3.73, p = 0.08).ConclusionsSerum S100A8/A9 concentrations may be associated with NPSLE and fatigue. S100A8/A9 may be of interest in evaluating NPSLE, although further investigations are needed.

Manifestaciones cardiovasculares en pacientes con lupus eritematoso sistémico en una institución de referencia en Cundinamarca, Colombia, durante un periodo de un año

IntroductionCardiovascular disease is a poorly recognized problem in systemic lupus erythematosus (SLE) patients, who may have their disease activity associated with cardiac disease at the time of diagnosis or at a later stage of the course of disease. Manifestations are variable, as all structures of the heart can be affected, and can cause significant morbidity and mortality. ObjectiveThe presentation may vary from subclinical form to advanced stages, which require aggressive immunosuppressive therapy. A description is presented of the frequency of these manifestations in patients with systemic lupus erythematosus attending a reference institution of Cundinamarca, Colombia. MethodsA retrospective study was conducted with the recording of clinical aspects, laboratory tests, and cardiovascular manifestations over a period of one year. ResultsThe study included a total of 45 patients with confirmed diagnosis of SLE, with a mean age of 35 years. Deterioration in functional class and dyspnea occurred more frequently. A positive anti-DNA was more frequent in patients with dyspnea (p=.037) and impaired functional class (p=.023). The lupus anticoagulant is also present in patients with deep venous thrombosis (60 vs. 15%; p=.018), and in patients with heart failure (66 vs. 16%: p=.036). ConclusionCardiovascular symptoms are present in a high percentage of patients with SLE, thus these should be questioned to in order to detect them earlier and avoid cardiovascular complications. It is suggested that some autoantibodies, as anti-DNA, lupus anticoagulant, low plasma complement, and anti-C1q, could also be useful for detecting new cardiovascular events in patients with SLE.

Associated factors and psychotherapy on sleep disturbances in systemic lupus erythematosus

Sleep disturbance is a common problem in systemic lupus erythematosus (SLE) patients. This study was performed to determine the prevalence of sleep disturbance in SLE, the factors that might be associated with sleep disturbance, and the correlation between changes in clinical parameters and sleep quality over time. Fifty-six female SLE patients from a total of 497 SLE patients (11.3%) agreed to join the study. The demographic data were recorded at baseline and the clinical data, the Pittsburgh Sleep Quality Index (PSQI) and other standardized assessment tools, disease activity index, quality of life (QoL), damage index, depression, anxiety and fatigue score, were assessed three times: the first visit was at baseline, the second time was one month later, and the third time was three months after the baseline. Thirty-one of these 56 patients (55.36%) were found to have sleep disturbances. All were females with their mean ± SD age of 37.5 ± 12.3 years, and disease duration at study entry of 8.6 ± 7.3 years. There was no association between sleep disturbances and demographic data, disease activity, clinical symptoms, the presence of autoantibodies and current steroid use. In multiple logistic regression analyses, only moderate to severe depression was the independent determinant of sleep disturbances, p = 0.036. During the three-month observation, with the treatment, the changing of total PSQI score showed a significantly positive correlation with depression, anxiety, pain and QoL. Sleep disturbances in Thai SLE patients were not uncommon but a correctable condition. Depression was strongly associated with sleep disturbances. Awareness of underlying depression as well as sleep disturbances in SLE patients and treating them properly improve QoL in SLE.

Chromosomally integrated human herpesvirus 6 in a patient with systemic lupus erythematosus

Sir,Fever is one of the most challenging problems insystemic lupus erythematosus (SLE) and the fol-lowing example may be paradigmatical. A 53-year-old woman diagnosed with SLE (2001: fever,arthritis, subacute cutaneous lupus, anti-dsDNA,ANA and anti-Ro positivity) with ongoing therapywith hydroxychloroquine (200mg/day) and lowdose prednisone (2.5mg/day) in October 2009 pre-sented with fever (up to 38 C) and arthromyalgiasnot responsive to prednisone increase up to25mg/day and broad-spectrum antibiotics treat-ment. When she was admitted to our division(December 2009), we first empirically started withlevoxacin (500mg/day, intravenous (i.v.)).Considering fever persistence, signs of disease activ-ity (anti-dsDNA and direct Coombs’ test positivity,C3 and C4 reduction, leukopenia) and the negativ-ity of procalcitonin

AB1428-HPR Fatigue in patients with quiescent systemic lupus erythematosus: The role of dehydroepiandrosterone sulfate

BackgroundFatigue is a major problem in systemic lupus erythematosus (SLE). In some patient groups, associations between fatigue and low levels of dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) have been found....

Fatigue in patients with systemic lupus erythematosus: the role of dehydroepiandrosterone sulphate

Fatigue is a major problem in systemic lupus erythematosus (SLE), but the physiological substrate of this fatigue is largely unclear. To examine if low levels of dehydroepiandrosterone (DHEA) and its sulphate DHEAS play a role in SLE fatigue, we compared: 1) DHEAS levels and fatigue between 60 female patients with SLE with low disease activity (31 using, 29 not using prednisone) and 60 age-matched healthy women, and 2) fatigue between patients with SLE with low and normal DHEAS levels. Serum DHEAS levels were determined with an Advantage Chemiluminescense System. The Multidimensional Fatigue Inventory (MFI) was used to assess fatigue. Patients were more fatigued (p ≤ 0.001) than healthy women and more often had below-normal DHEAS levels (p < 0.001). Patients using prednisone with low and normal DHEAS levels reported a similar level of fatigue (p ≥ 0.39). Patients with low DHEAS levels not using prednisone reported less fatigue than those with normal DHEAS levels (p ≤ 0.03). Thus, our results indicate that low DHEAS levels in SLE are not - or even inversely - related to fatigue. After our previous finding that DHEA administration does not reduce fatigue, this result further indicates that low serum DHEA(S) levels alone do not offer an explanation for SLE fatigue.

Sleep disturbance in lupus patients

Evaluation of: Chandrasekhara PKS, Jayachandran NV, Rajasekhar L, Thomas J, Narsimulu G: The prevalence and associations of sleep disturbances in patients with systemic lupus erythematosus. Mod. Rheumatol. 19(4), 407–415 (2009). Fatigue is a common problem in systemic lupus erythematosus (SLE), and there is a great interest in the role of sleep disturbances in this regard. In the current study of 50 SLE patients, two-thirds were poor sleepers according to Pittsburgh Sleep Quality Index scores. Despite correlations between sleep disturbance and several factors, SLE disease activity was the only independent determinant of sleep quality. A study limitation was the failure to assess some important factors such as physical activity. Still, these findings underline the importance of sleep disturbance in SLE and its importance as a contributing factor to fatigue.

Central nervous system lupus: a clinical approach to therapy.

Management of central nervous system (CNS) involvement still remains one of the most challenging problems in systemic lupus erythematosus (SLE). The best available evidence for the treatment of CNS lupus is largely based on retrospective series, case reports and expert opinion. Current therapy is empirical and tailored to the individual patient. Symptomatic, immunosuppressive and anticoagulant therapies are the main strategies for the management of CNS lupus. The choice depends on the most probable underlying pathogenic mechanism and the severity of the presenting neuropsychiatric symptoms. Thrombotic and nonthrombotic CNS disease needs to be differentiated and requires different management strategies. However, this is often challenging since many, if not most CNS manifestations, may be due to a combination of different pathogenic mechanisms and multiple CNS events may occur in the individual patient. Patients with mild manifestations may need symptomatic treatment only, whereas more severe acute nonthrombotic CNS manifestations may require pulse intravenous cyclophosphamide. Plasmapheresis may also be added in patients with more severe illness refractory to conventional treatment. Recently, the use of intrathecal methotrexate and dexamethasone has been reported in a small series of patients, with a good outcome in patients with severe CNS manifestations. Anticoagulation is warranted in patients with thrombotic disease, particularly in those with the antiphospholipid syndrome (APS). This article reviews the clinical approach to therapy in patients with CNS lupus.

The central nervous system in systemic lupus erythematosus

Management of central nervous system (CNS) involvement is one of the most challenging problems in systemic lupus erythematosus. This article reviews the spectrum of CNS manifestations present in this disease, their diagnosis and pathogenesis, as well as an approach to their treatment and prognostic implications.

Psychiatric problems in systemic lupus erythematosus.

Four patients with systemic lupus erythematosus (SLE) are described in whom there were major psychiatric complications. Two of these patients had cerebral lupus with psychiatric manifestations of the disease together with other features of disease activity and responding to treatment with high dose steroids. The first of these had had a ten-year history of recurrent episodes of depression before other features of the disease became evident; in the second patient recurrent psychotic episodes occurred after the onset of typical multi-system disease. The third patient had had a minor cerebro-vascular accident four years before other features of SLE became manifest, and cerebral deterioration later on in her life was probably due to hypertensive cerebro-vascular disease secondary to the renal disease of SLE. The fourth patient, a young man, had had recurrent episodes of depression and aggressive behaviour for several years and committed suicide at the age of 33.