SLEDAI Score Research Articles

Characterization of T-bet expressing B cells in lupus patients indicates a putative prognostic and therapeutic value of these cells for the disease.

To investigate whether T-bet+ B cells, as well as age-associated B cells/ABCs (CD19+CD21-CD11c+T-bet+) and double-negative B cells/DN (CD19+IgD-CD27- CXCR5-T-bet+), serve as prognostic and/or therapeutic tools for systemic lupus erythematosus (SLE) in humans. Flow cytometry was used for enumerating T-bet+ B cells and ABCs/DN subsets, found in the peripheral blood of 10 healthy donors and 22 active SLE patients. Whole blood assay cultures, combined with in vitro pharmacological treatments, were performed to evaluate the effects of hydroxychloroquine, anifrolumab and fasudil (a ROCK kinase inhibitor) on T-bet+ B cells' percentage. Moreover, previously published single-cell RNA sequencing (scRNA-seq) data were used in a meta-analysis to allow characterization of genes and pathways associated with the biology of T-bet in B cells. T-bet+ B cells displayed an expansion in SLE patients [1.47 (1.9 - 0.7) vs 10.85 (37.4 - 3.6)]. Similarly, both ABCs and DN were found to be expanded. Interestingly, percentages of T-bet+ B cells positively correlated with patients' SLEDAI scores (rs=0.55, p=0.007). Cell culture experiments conducted, revealed that all three agents tested can deplete T-bet+ B cells (without affecting the cell viability of lymphocytes, T cells and B cells). According to bioinformatics analyses, T-bet is highly expressed in two B cell clusters with pathogenic characteristics for SLE (designated as atypical memory B cells and activated naïve B cells). These clusters can be targeted for therapeutic interventions. T-bet+ B cells can serve as a putative prognostic biomarker of lupus severity. Circumstantial data suggest that these cells may promote disease pathogenesis and may represent a novel therapeutic target.

Steroid-induced diabetes in lupus nephritis patients: Classic risk factors or a different type of diabetes?

Glucocorticoids are frequently employed in systemic lupus erythematosus (SLE) patients and play a critical role in the induction therapy of lupus nephritis (LN), despite their many side effects, including steroid-induced diabetes (SID). Information regarding SID in SLE patients is quite scant. The aim of this study was to determine risk factors associated with the development of SID in patients with LN. A nested case-control study was conducted. We included patients with biopsy-proven LN, who received induction treatment with steroids. Out of the total of 358 patients, 35 (9.7%) developed SID. Patients with SID had more metabolic risk factors, including the metabolic score for insulin resistance (METS-IR); more factors related with lupus activity, with higher SLEDAI and SLICC-DI scores; and lower cumulative pre-induction steroid dose. A higher percentage of patients who developed SID received steroid pulses and a lower percentage received antimalarials. After logistic regression, the variables significantly associated with the development of SID were the SLEDAI index (OR 1.25 [95% CI 1.04-1.50], p 0.01), SLICC-DI (OR 4.93 [95% CI 2.14-11.3], p < 0.001), METS-IR (OR 1.17 [95% CI 1.04-1.32], p 0.009), delta METS-IR at 6months (OR 1.20 [95% CI 1.03-1.39], p 0.01), and the use of antimalarials (OR 0.14, [95% CI 0.02-0.85], p 0.03). After propensity score matching, METS-IR remained a significant predictor of SID. Patients with METS-IR >36.8 were at higher risk (OR: 2.83, 95% CI: 1.09-7.36, p = 0.034). In conclusion, SDI development in patients receiving induction therapy for LN is associated with both classic metabolic risk factors and SLE-specific factors, and antimalarial use could be associated with a protective effect. Rheumatologists should be aware of this potential complication, in order to implement appropriate management strategies.

The Relationship Between Fibromyalgianess and Clinical Features, Disease Activity in Patients With Systemic Lupus Erythematosus.

Fibromyalgia (FM) is a chronic syndrome characterised by widespread pain, fatigue, and symptoms such as sleep disturbances, cognitive impairment, and mood disorders. FM prevalence is notably higher among systemic lupus erythematosus (SLE) patients compared with the general population, often leading to diagnostic challenges. Misinterpreting FM as SLE activity can result in overtreatment. This study aimed to evaluate fibromyalgianess and its relationship with the clinical and immunological characteristics of SLE patients using comprehensive scoring methods for better diagnostic accuracy. This cross-sectional study included 50 SLE patients meeting the 2019 EULAR/ACR classification criteria. Patients with coexisting autoimmune diseases or severe systemic conditions were excluded. Clinical data, SLEDAI scores, and fibromyalgianess severity were assessed using the Polysymptomatic Distress Scale (PSDS). Patients were categorised into groups based on fibromyalgia diagnostic criteria: widespread pain and SLE-FM. Statistical analysis was performed using SPSS, with p<0.05 considered significant. Among 50 patients (45 female, 5 male; mean age 42.04±12.5), 24% had fibromyalgianess, and 18% experienced widespread pain. Female patients exhibited significantly higher PSDS scores (p<0.05). While NSAID use was associated with increased PSDS scores (p<0.001), no significant relationship was found between fibromyalgianess and SLEDAI scores or organ involvement. Fibromyalgianess in SLE patients primarily reflects heightened pain sensitivity and symptom severity rather than disease activity. Incorporating fibromyalgianess assessment into routine SLE management may prevent diagnostic and therapeutic pitfalls and improve treatment outcomes. Multidisciplinary approaches, including pharmacological and non-pharmacological strategies, are essential for effective care.

Clinical Characteristics, Microbiological and Risk Factors of Infections in Patients With Systemic Lupus Erythematosus.

To determine risk factors, clinical and microbiological characteristics of infections in a single-center systemic lupus erythematosus (SLE) cohort. All hospital patients in The First Affiliated Hospital of Zhengzhou University from 2019 to 2021 who meet ≥4 ACR-97 SLE criteria were identified. Patients with infection and without infection were included with a ratio of 1:2. 687 SLE patients were identified and 224 patients with infection and 448 patients without infection were included. The most common microorganisms in the infection group were Escherichia coli, Herpes zoster and Aspergillus, respectively. In the cox regression analysis, nephritis (OR 1.785; 95% CI: 1.156-2.756), diabetes(OR 6.507; 95% CI: 2.692-15.725), CD4+ T cell (OR 1.003; 95% CI: 1.002-1.004), prednisone>10 mg/day (OR 1.879; 95% CI: 1.112-3.175), immunosuppressants (OR 0.465; 95% CI: 0.310-0.697) and SLEDAI score (OR 0.866; 95% CI: 0.837-0.896) were risk factors associated with infection. Bacteria was the most common infection in SLE patients with the respiratory tract being the most common site. Nephritis, diabetes, SLEDAI score were associated with infection. Monitoring CD4+ T cell can predict the infection incidence. Prednisone (>10 mg/day) and immunosuppressants increase the occurrence of infection.

Exploring Patient Activation and Compliance in Patients with Different Rheumatological Disorders.

Purpose: This study aimed to assess patient activation using patient activation measure 13 (PAM-13) in systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), and axial spondyloarthritis (axSPA). Patients and methods: A cross-sectional study was conducted involving patients with three rheumatological conditions (SLE, PsA, and axSPA). Patients were contacted either at the clinic or through social media platforms. Data, including demographics, PAM 13, Arabic compliance questionnaire for rheumatology (ACQR), and disease-related activity scores, were collected electronically. The analyses included Chi-squared tests, linear regression, and binary logistic regression. Results: Overall, 418 patients were recruited (SLE = 323, PsA = 65, and axSPA = 30), with a mean (±SD) age of 42 ± 11 years and a female predominance (88%). PAM-13 scores did not significantly differ between the rheumatological disorders. Patients with axSPA showed significantly higher compliance than those with SLE or PsA (p = 0.012). In regression models, patients with PsA were more likely to be in activation level 1, with an OR of 2.890 (95% CI: 1.044-8.000, p = 0.0041), whereas patients with axSPA were more likely to be in activation level 4, with an OR of 2.460 (95% CI: 1.122-5.393, p = 0.025). The SLEDAI score was inversely related to the PAM-13 score (Pearson's correlation coefficient = -0.221, p < 0.001). Conclusions: This study explored the levels of activation and medication compliance in different rheumatological conditions. Larger studies are needed to confirm these findings and explore the challenges and opportunities for improving compliance and activation.

Systemic lupus erythematosus-specific CD14+IFITM3+ monocyte: Implications for disease activity and progression.

Interferon-inducible transmembrane (IFITM) family members (IFITM1, IFITM2, IFITM3) are extensively expressed in T cells and are involved in adaptive immunity. However, little is known about the expression of IFITM1, IFITM2 and IFITM3 in monocytes and their roles in systemic lupus erythematosus (SLE). Our study has shown that the expression of IFITM1, IFITM2, and IFITM3 in peripheral blood mononuclear cells (PBMCs) of SLE patients was dysregulated, and the expression of IFITM3 in SLE was significantly higher than that of healthy controls. Besides, the percentage of CD14+IFITM3+ monocyte in the peripheral circulation of SLE patients was significantly increased, which was significantly correlated with inflammatory and immune indexes (ESR, CRP, PLT, urine-β2M, and urine mALB) of SLE. Most importantly, the percentage of CD14+IFITM3+ monocyte was positively associated with the SLEDAI score, suggesting it predictive role in SLE disease activity. In summary, we have found that IFITM3 may serve as a SLE-specific marker and the dysregulation of CD14+IFITM3+ monocyte may affect the disease activity and progression of SLE.

Effect of tacrolimus with mycophenolate mofetil or cyclophosphamide on the renal response in systemic lupus erythematosus patients

ObjectiveThis study aimed to determine the therapeutic efficacy of tacrolimus (TAC) with mycophenolate mofetil (MMF) or cyclophosphamide (CYC) on the renal response in systemic lupus erythematosus (SLE) patients.MethodsA retrospective cohort study based on medical data was conducted among SLE patients who took at least one of the following medicines in 2010–2021: TAC, MMF and CYC. The odds ratio (OR) and 95% confidence interval (CI) were calculated, and the synergistic interaction was estimated using logistic regression models.ResultsAmong 793 SLE patients, 27.9% patients (221 cases) achieved CR after at least 3 months. The TAC use was positively associated with CR with an adjusted OR (95% CI) of 2.82 (1.89, 4.22) overall and in subgroups of SLE patients with SLEDAI scores > 12, moderate or severe urinary protein and comorbidities. The dose-response effect on CR was also observed at TAC doses greater than 4 mg/d and more than 180 days, with adjusted ORs (95% CIs) of 5.65 (2.35, 13.55) and 3.60 (2.02, 6.41), respectively. Moreover, the combined effect of TAC with MMF or CYC was better than that of monotherapy, there was significant synergistic interactions with adjusted ORs (95% CIs) of 2.43 (1.20, 4.92) and 3.14 (1.49, 6.64), respectively, and similar results were observed for the combination of different doses of TAC with MMF or CYC.ConclusionTAC can effectively alleviate the condition of patients with SLE and may interact with MMF or CYC, which suggests that the combination therapy of TAC with MMF or CYC may produce greater benefits for patients with SLE.Trial registrationThis is a purely observational study that does not require registration.

The effect of circulating cytokines on the risk of systemic lupus erythematosus: Mendelian randomization and observational study.

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder, the etiology of which involves the alterations in circulating cytokine levels. However, the cause-and-effect relationships and in-depth clinical relevance of them remain to be systematically investigated. We conducted a two-sample Mendelian randomization (MR) study to assess the causality of circulating cytokine levels and SLE and found that genetically determined elevated CTACK and IL-18 were associated with an increased risk of SLE, whereas a higher level of GRO-a was associated with decreased risk. Furthermore, we performed an observational study to further reveal the association between 27 cytokines and the severity measured by SLEDAI score, as well as lupus nephritis (LN), of SLE. We identified six cytokines (MCP1, MIP1β, CTACK, IP10, HGF, IL18, IL13) that were identified as associated with the clinical severity of SLE, and five cytokines, especially IL18, were related with LN and may have good diagnostic value. Moreover, we also predicted four compounds that might have good binding activities with IL18. The evidence supported a potential causal role of circulating cytokines on the risk of SLE. Targeting IL18 might be a meaningful strategy for the prevention or treatment of SLE, especially in LN patients.

The value of renal color Doppler ultrasound as an objective tool in the diagnosis of renal affection in SLE patients

BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disease with diverse manifestations, which resembles a clinical challenge to be managed. Lupus nephritis is a life-threatening condition as about 10% of patients develop chronic kidney disease.Aim of the workTo assess the role of resistive index (RI) as a noninvasive parameter in detecting renal affection in SLE patients.ResultsA case–control study included 3 matched groups: 30 patients, 15 SLE with no renal affection, and 15 SLE lupus nephritis patients, who were selected, diagnosed according to ACR criteria 2019 for SLE, beside 15 age- and gender-matched healthy controls without any risk factors of chronic diseases. Written informed consent was obtained from all the three groups, and the study was approved by ethical committee. There was a statistically significant increase in both SLEDAI and renal SLEDAI scores, serum BUN, creatinine, urinary pus cells, RBCs, casts and proteins, 24-h urinary proteins, and protein/creatinine ratio beside a statistically significant increase in both right and left resistive indices in the group of lupus nephritis than the other group. There was highly statistically significant difference between SLE without nephritis and SLE with nephritis regarding renal echogenicity. There was statistically significant positive correlation between average RI and SLEDAI, rSLEDAI, serum creatinine, BUN, 24-h urinary proteins, protein/creatinine ratio, and renal echogenicity. Relation between renal echogenicity and demographic, laboratory, and clinical data was highly statistically significant with rSLEDAI, serum creatinine, BUN, 24-h urinary proteins, and P/C ratio. Our study highlighted that the best cutoff point of Rt average RI to detect SLE with nephritis group was found > 0.68 with sensitivity of 86.7% and specificity of 100.0%, while the best cutoff point of left average RI to detect SLE with nephritis group was found > 0.7 with sensitivity of 80.0% and specificity of 100.0%.ConclusionRenal RI is a noninvasive technique that can be used for detection renal disease activity in SLE patients, together with renal parenchymal echogenicity by grayscale US.

ACHIEVING BETTER QUALITY OF LIFE THROUGH THE PROVISION OF SUPPLEMENTS, MEDICAL AIDS, AND COUNSELLING OF SLE PEDIATRIC PATIENTS AT RSSA MALANG

Introduction: Systemic lupus erythematosus (SLE) in children can interfere with their growth and social functioning and the treatment process is often hampered by low compliance and the unmet secondary needs of the patient. The aim of this community service activity is to improve the quality of life of patients by fulfilling their secondary needs and providing free consultation and education. Methods: This community service was carried out by educating and provide free consultation for 38 SLE pediatric patients accompanied by their parents directly at RSSA, monthly for 6 months, and we emphasise topics on management and healthy lifestyle for SLE patients. We also make this opportunity as a means of monitoring patient's condition which includes disease activity through SLEDAI Score, clinical symptoms, and psychosocial support, and we complete it by providing vitamin D supplements, sunblock, and wheelchairs. Results: All the subjects in this community service were 100% girls and 50% of them had active SLE status with various clinical manifestations. 79% of patients never took vitamin D supplements and all patients did not use sunblock. There were 3 patients with neurological disorders who needed a wheelchair. We provide their secondary needs to maximize the standard therapy we have been doing. After 6 months, there was a decrease in the number of patients who missed monthly controls, and a decrease in patients SLEDAI Score indicating that their lupus activity was appropriately controlled. Conclusion: Although rarely considered, the fulfillment of secondary needs in SLE patients such as vitamin D, sunblock, and wheelchairs for patients with mobility problems is very meaningful to them, which can optimize the main therapy given and make patients routinely attend monthly controls, because they find it helpful in terms of mobility. In addition, they do not need to buy vitamin D and sunblock themselves.

Circulatory microRNAs and proinflammatory cytokines as predictors of lupus nephritis.

Lupus nephritis (LN) is one of the most prevalent severe organ manifestations of systemic lupus erythematosus (SLE), impacting 70% of SLE patients. MicroRNAs (miRNAs), are small non-coding RNA molecules which influence the expression of approximately one-third of human genes after the process of transcription. Dysregulation of miRNAs was documented in numerous disorders, including SLE and LN. Cytokines are the orchestrators of the immune response in autoimmune diseases. Our study aims to explore the variation in the levels of circulating miRNAs and proinflammatory cytokines as potential diagnostic biomarkers among LN and SLE patients without LN in comparison to controls. The study involved 20 LN patients, 20 SLE patients without LN, and 10 healthy controls. Serum levels of IL-12 and IL-21 in addition to miR-124, miR-146a, miR-199a, and miR-21 were assessed using the enzyme-linked immunosorbent assay (ELISA) for cytokines and quantitative real-time PCR for miRNAs. A significant downregulation in miR-124 (p<0.001) and a significant overexpression of miR-146a (p=0.005) were found in SLE patients without LN in comparison to controls. In comparison to SLE patients without LN and the control group, miR-199a, miR-21, and miR-146a were significantly upregulated in LN patients (p=<0.001) with high diagnostic values of these miRNAs in discriminating LN from SLE patients without LN according to Receiver operating curve (ROC) analysis. Logistic regression analysis revealed that only miR-199a is an independent predictor of LN (OR 1.69; 95% CI: 1.1-2.6). The expression of miR-124 was reduced in LN patients in comparison to the control but increased in LN patients in comparison to SLE patients without LN. However, there was no statistically significant difference in either scenario. In comparison to both SLE patients without LN and controls, LN patients exhibited the highest serum levels of IL-12 and IL-21, with no statistically significant difference. Regression analysis revealed that only miR-146a was associated with creatinine levels and SLEDAI score (p= 0.009 and 0.03, respectively), while miR-124 was associated with hemoglobin level (p=0.03). MiR-199a is an independent predictor for LN and might be used as a diagnostic biomarker for this disease. MiR-146a might play an important role in LN pathophysiology.

Characterization of systemic lupus erythematosus subtypes using cluster analysis: insights from lymphocyte subpopulations.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, in which lymphocyte subsets were dysregulated. Incorporating lymphocyte subpopulations in cluster analysis offers a pathway for personalized and precise treatment, targeting specific abnormalities for more effective management. We conducted Gaussian clustering analysis on clinical data, serological data, urine test results, and lymphocyte subpopulations for SLE patients hospitalized from September 2008 to December 2019. A total of 1863 SLE patients from Xi'Jing Hospital were included. After excluding those without complete assessments, 1281 patients underwent flow cytometry for lymphocyte subsets. Five SLE clusters emerged: Cluster 1 with severe kidney involvement, high SLEDAI scores, and infection rates, often accompanied by rashes and edema; cluster 2 with high urinary protein but better renal function; cluster 3 with normal lymphocyte count and low positive antibodies; cluster 4 with frequent psychiatric symptoms and pulmonary arterial hypertension (PAH); and cluster 5 with fever, arthritis, hematologic involvement, and high IgG levels despite decreased B cells. All enrolled SLE patients were ultimately categorized into five distinct clinical phenotype groups, with lymphocyte testing being meaningful for patient stratification. This finding shed light on the intricate heterogeneity of SLE, emphasizing the need for a personalized medicine approach. Targeting specific abnormalities in lymphocyte subsets holds promise for more effective and precise management of SLE. Key Points • A comprehensive analysis of SLE patients, including lymphocyte subpopulations, revealed five distinct clusters with varying clinical characteristics, emphasizing the heterogeneity of the disease. • This heterogeneity underscores the need for a personalized medicine approach in SLE management, targeting specific lymphocyte subset abnormalities for more effective and precise treatment.

Outcome and Prognostic Factors of Class V Membranous Nephropathy (Pure and Mixed Form) in a Cohort of Egyptian Patients with Systemic Lupus Erythematosus

Abstract Background Renal disease is a frequent and severe cause of morbidity in systemic lupus erythematosus (SLE). Lupus membranous nephropathy (LMN), which is an uncommon subtype of lupus nephritis, is usually associated with nephrotic syndrome and can have a variable course; some patients maintain stable kidney function or show a slow progression, while others can have renal flares and transformation to more severe proliferative forms eventually leading to ESRD or to life-threatening extrarenal complications, including thrombotic events, cardiovascular disease (CVD), or infections. In many cases, a combination of membranous and proliferative lesions may be seen in renal biopsies. Objective To study the clinical presentation, course, outcome and prognostic factors of class V membranous nephropathy (pure and mixed) in a cohort of Egyptian patients with SLE. Methods This was an observational study which was conducted on ninety six (96) adult Egyptian patients diagnosed with LMN recruited from the outpatient clinic and inpatient department of rheumatology, at Ain Shams university hospitals, during a period of 12 months. Results In this study, the univariate logistic regression analysis shows that (low level of WBCs, low level of hemoglobin, high level creatinne, high level of urine, Protein / Cr ratio, low level of Creatinine clearance) were found significantly associated with poor outcome in patients with mixed type. Also, the multivariate logistic regression analysis shows that the most important factors associated with poor outcome in patients with mixed type was found WBCs level ≤3. WBC of urine analysis&amp;gt;10, that ESR &amp;gt;28, partial remission and SLEDAI score &amp;gt;13 were found significantly associated with poor outcome among patients with pure MLN. Also, the multivariate logistic regression analysis shows that the most important factor associated with poor outcome in patients with pure type was found partial remission. Conclusion The present study can burden the knowledge and shed some light on future prospective studies with larger sample sizes and longer follow up to reassess our findings.

Noninvasive diagnostic value of urinary mir-663a in pediatric lupus nephritis

Abstract Background and objectives Lupus nephritis (LN) is a severe clinical manifestation seen in individuals with systemic lupus erythematous (SLE). It has a poor long-term prognosis in pediatric patients with high morbidity and mortality rates. MicroRNAs (miRNAs) are noncoding small RNAs that act as epigenetic modulators, regulating gene expression, and modulating the understanding of mechanisms and pathogenesis of human diseases. Depending on bioinformatics analysis, we aimed to investigate urinary expression of miR-663a in LN among SLE children and discriminate between proteinuria of LN versus chronic renal disease without SLE. Methods The urinary miR-663a expression levels were estimated in cellular pellets from 15 SLE patients, 15 SLE and biopsy-proven active LN patients, 15 chronic kidney disease (CKD) patients rather than LN and 15 healthy controls. Results LN patients had significantly higher urinary miR-663a expression levels compared to other groups (p &lt; 0.0001). Urinary miR-663a at a cutoff of 8.61 had a diagnostic value of 93.3% for LN among pediatric SLE with 100% specificity (p &lt; 0.0001). Moreover, miR-663a was upregulated in advanced grades and LN classes V, IV, and III compared to class II. Furthermore, miR-663a was positively correlated with the duration of SLE, activity index, chronicity index, urinary protein, anti-dsDNA, and SLEDAI score, and negatively correlated with serum complement C3 (p &lt; 0.05). Conclusion miR-663a could be related to the pathogenesis of kidney damage in LN; that could provide a specific noninvasive diagnostic and follow -up tool for LN patients.

Clinical outcomes in lupus nephritis patients treated with belimumab in real-life setting: a retrospective comparative study in China.

The use of belimumab in treating lupus nephritis (LN) patients in China is still in its early stages. This retrospective comparative study aims to delineate the disease activity, associated therapies, clinical outcomes, and adverse events among LN patients treated with belimumab, reflecting real-world experience in southeastern China. From May 2020 to December 2023, 54 LN patients treated with belimumab and 42 LN patients treated with conventional therapy were enrolled. All patients had a follow-up period of more than 3 months. The general information, presenting clinical and laboratory data, and outcomes were collected and compared. At 3 months of belimumab treatment, compared to baseline, there was a decrease in proteinuria from 74.1% to 64.8% (p<0.001), a reduction in hematuria from 59.3% to 37.0% (p=0.008), and an increase in partial or complete renal response from 53.7% to 75.9% (p<0.001). The median SLEDAI score decreased from 10 to 5 (p<0.001), and the proportion of patients achieving low lupus disease activity state (LLDAS) increased from 11.11% to 16.67% (p<0.001) by the 3-month evaluation. Notably, there were significant reductions in oral corticosteroid dosages, with a median decrease from 30 to 17.5 mg/day (p<0.001) by 3 months, and the proportion of patients requiring >5 mg/day of steroids decreased from 88.89% at baseline to 79.07% at six months (p<0.001). Compared to the conventional therapy group, the belimumab group experienced a significant reduction in median steroid dosage and increased the proportion of patients achieving remission or LLDAS. The incidence of treatment-emergent adverse events (TEAEs) was significantly lower in the belimumab group (29.6% vs 52.4%, p=0.024). These findings support the potential of belimumab to improve renal and serological parameters, reduce disease activity, lessen corticosteroid dependence, and decrease the risk of TEAEs, demonstrating its safety and efficacy as an adjunct therapy in LN management.

Exploring the role of Life Essential 8 in patients diagnosed with systemic lupus erythematosus and rheumatoid arthritis

ObjectiveTo investigate the distribution of the Life Essential 8 (LE8) score among adult patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and explore its association with disease activity.MethodsA cross-sectional study was conducted to select adult patients with SLE and RA who were treated in the general department of the Second Hospital of Shanxi Medical University between May 2022 and September 2023. Through questionnaires, patients’ diet, sleep, smoking habits, and daily exercise were evaluated. Additionally, blood glucose, blood lipids, inflammatory markers, and other relevant data were collected to assess the LE8 levels of the participants. The data was analyzed using SPSS 26.0. Both univariate and ordered multivariate logistic regression were employed to explore the distribution and influencing factors of the LE8 score among the patients.ResultsA total of 43 adult cases of SLE and 55 RA cases were studied, encompassing 11 males and 87 females with a mean age of 49.12 ± 15.86 years. The LE8 score averaged at 68.82 ± 12.29; specifically, the LE8 behavior score was 60.91 ± 17.78, and the LE8 factor score was 77.05 ± 14.30. The disease activity scores of both conditions showed a negative correlation with LE8. As DAS28 (r = − 0.96, P < 0.05) and SLEDAI (r = − 0.807, P < 0.05) scores increased, the LE8 score decreased. A low SLEDAI score serves as a protective factor for LE8 (OR (95% CI) = 0.07 (0.01, 0.37), P = 0.02). Furthermore, among patients with RA (OR (95% CI) = 0.03 (0.00, 0.22), P = 0.001) and SLE (OR (95% CI) = 0.06 (0.01, 0.35), P = 0.002), individuals boasting higher LE8 scores exhibit a reduced 10-year cardiovascular risk.ConclusionsPatients suffering from RA and SLE often exhibit low LE8 scores, reflecting a concerning cardiovascular health status—particularly in cases of high disease activity. Hence, it is imperative to prioritize the cardiovascular well-being of rheumatic patients.Key Points• Research has revealed that individuals suffering from RA and SLE exhibit lower LE8 scores, potentially attributed to alterations in disease activity• In this study, no statistically significant associations were discerned between inflammatory markers and LE8 scores among patients with RA and SLE. Nevertheless, among SLE patients specifically, a notable correlation was observed between ds-DNA levels and LE8 factor scores.• Enhancing the compliance rate for the LE8 target among patients with RA and SLE could potentially mitigate the cardiovascular risk associated with these conditions.

Tofacitinib therapy in systemic lupus erythematosus with arthritis: a retrospective study.

To estimate the effectiveness and safety of tofacitinib in treating systemic lupus erythematosus (SLE) patients with arthritis. This research was a retrospective cohort study that focused on SLEpatients who had arthritis and were treated with tofacitinib at the Department of Rheumatology and Immunology from January 2020 to January 2022. Clinical outcomes, disease activity, immunological parameters, and adverse events were systematically evaluated pre- and post-treatment at 4, 12, and 24weeks. Twenty-two patients were analyzed. At the 4-week mark, 5 (22.7%) patients were partially relieved, and 17 (77.3%) unalleviated. By the 12-week assessment, CR off corticosteroids was observed in four patients (18.2%), and CR on corticosteroids was seen in six patients (27.3%), with an additional six (27.3%) maintaining partial remission. At 24weeks after treatment, three patients (13.6%) achieved CR off corticosteroids, ten patients (45.5%) achieved CR on corticosteroids, and all patients received remission. Compared to before treatment, The SLEDAI and PGA scores significantly improved. The level of C3 was increased significantly, and the absolute CD3+ T cell count, the 28-tender and the 28-swollen joint count, and the levels of serum IL-6 were significantly decreased at 24weeks after treatment. Tofacitinib demonstrates significant therapeutic potential in SLE patients with arthritis, with a safety profile, and the therapeutic mechanism of tofacitinib may be related to reducing IL-6 expression and inhibiting T cell activation. Key Points • Tofacitinib demonstrates significant therapeutic potential in SLE patients with arthritis • The therapeutic mechanism of tofacitinib may be related to reducing IL-6 expression and inhibiting T cell activation.

Long-term outcomes of childhood-onset systemic lupus erythematosus.

Data on the long-term outcome of patients with childhood-onset Systemic Lupus Erythematosus (cSLE) are scarce. Aims of this study were to describe the long-term outcomes of cSLE and to identify factors associated with the development of damage and persistent disease activity. We conducted a retrospective multicentre study using data from the PEDIALUP registry of the Juvenile Inflammatory Rheumatism (JIR) cohort database. Demographic characteristics, clinical manifestations, laboratory, radiological, histological and treatment data were collected from medical records during follow-up. A total of 138 patients with cSLE, diagnosed between 1971 and 2015, were included. With a median follow-up of 15.4 [9.6-22.4] years, 51% of patients had a SLICC-Damage Index score ≥ 1 at last follow-up with the musculoskeletal, cutaneous, renal, neurological, and cardiovascular damage being the most common manifestations. The proportion of patients with a SLICC-DI score ≥ 1 increased significantly with the duration of the follow-up (p< 0.001). On multivariate analysis, duration of follow-up was associated with increased risk of cumulative damage (OR 1.08, 95% CI 1.01, 1.15, p= 0.035). At the last visit, 34% of patients still had active disease with a SLEDAI score of ≥ 6. On multivariate analysis, Sub-Saharan African ethnicity was associated with 7-fold increased odds of having active disease at the last visit compared with Caucasians (OR 7.44, 95% CI 2.24, 24.74, p= 0.0002). The prevalence of damage remains high in patients with cSLE even when the diagnosis of c-SLE has been made in the recent decades.

Late Onset Systemic Lupus Erythematosus: Different Clinical, Serological Presentations and Damage Compared to Adult Lupus in Egypt

Abstract Background Comparing cases of adult onset and late onset systemic lupus erythematous (SLE) reveals significant differences in clinical, serological, disease activity, and damage score. Objective This study aimed to analyze clinical manifestations, laboratory data, serological markers, and prognosis of late-onset SLE (L-SLE) and for comparing with adult- onset SLE. Patients and Methods One hundred fifty individuals with SLE were included in a cross-sectional study conducted at Ain Shams University Hospital divide into Group 1: 100 cases with adult-onset (age of onset ≥ 19 years and below 50 years). Group 2: 50 Patients with L-SLE (age of onset ≥ 50 years). All patients were subjected to medical history, physical examination, disease activity measured by the SLE disease activity index (SLEDAI-2K) and a damage score. Laboratory investigations as complete blood count (CBC), serum creatinine, anticardiolipin antibodies, lupus anticoagulant, protein creatinine ratio, serum complement (C3, C4), anti-dsDNA antibody, and antinuclear antibodies (ANA). Results Mucocutaneous manifestations, frequency of hematuria, proteinuria, urinary cast, consumed C3, positive anti-dsDNA antibodies, anti-cardiolipin antibody and lupus anticoagulant titers had considerably greater rates in-group 1 compared to group 2 (P-value &amp;lt;0.05) while group 2 had significantly more musculoskeletal symptoms (P-value &amp;lt;0.05). The SLEDAI scores of the two groups were equivalent, however the damage index was greater in group 2 (P-value 0.00). Neuropsychiatric, cutaneous, renal, and skin damage were more frequent in group 1, while musculoskeletal, endocrinal, pulmonary, cardiovascular and ocular damage were more frequent in- group 2. Conclusion L-SLE is different from adult onset SLE with more frequent damage.

Patient-reported outcomes and healthcare resource utilization in systemic lupus erythematosus: impact of disease activity

BackgroundLimited real-world data exists on clinical outcomes in systemic lupus erythematosus (SLE) patients by SLE Disease Activity Index 2000 (SLEDAI-2 K), hereafter, SLEDAI. We aimed to examine the association between SLEDAI score and clinical, patient-reported and economic outcomes in patients with SLE.MethodsRheumatologists from the United States of America and Europe provided real-world demographic, clinical, and healthcare resource utilization (HCRU) data for SLE patients. Patients provided self-reported outcome data, capturing their general health status using the EuroQol 5-dimension 3-level questionnaire (EQ-5D-3 L), health-related quality of life using the Functional Assessment of Chronic Illness Therapy (FACIT) and work productivity using the Work Productivity and Activity Impairment questionnaire (WPAI). Low disease activity was defined as SLEDAI score ≤ 4 and ≤ 7.5 mg/day glucocorticoids; patients not meeting these criteria were considered to have “higher” active disease. Data were compared between patients with low and higher disease activity. Logistic regression estimated a propensity score for SLE based on demographic and clinical characteristics. Propensity score matched analyses compared HCRU, patient-reported outcomes, income loss and treatment satisfaction in patients with low disease activity versus higher active disease.ResultsData from 296 physicians reporting on 730 patients (46 low disease activity, 684 higher active disease), and from 377 patients’ self-reported questionnaires (24 low disease activity, 353 higher active disease) were analyzed. Flaring in the previous 12 months was 2.6-fold more common among patients with higher versus low active disease. Equation 5D-3 L utility index was 0.79 and 0.88 and FACIT-Fatigue scores were 34.78 and 39.79 in low versus higher active disease patients, respectively, indicating better health and less fatigue, among patients with low versus higher active disease. Absenteeism, presenteeism, overall work impairment, and total activity impairment were 47.0-, 2.0-, 2.6- and 1.5-fold greater in patients with higher versus low disease activity. In the previous 12 months there were 28% more healthcare consultations and 3.4-fold more patients hospitalized in patients with higher versus low disease activity.ConclusionCompared to SLE patients with higher active disease, patients with low disease activity experienced better health status, lower HCRU, less fatigue, and lower work productivity impairment, with work absenteeism being substantially lower in these patients.