Systemic Lupus Erythematosus Patients Research Articles

Diagnostic and prognostic value of quantitative cardiac magnetic resonance imaging biomarkers in systemic lupus erythematosus: a systematic review and meta-analysis.

The aim of this study was to compare CMR imaging biomarkers between SLE patients and matched controls. Electronic databases were systematically searched from inception until November 2023. All studies reporting CMR imaging data in SLE patients were included. PRISMA guidelines were followed, and risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. CMR findings of SLE patients were compared to that of matched controls. Clinical features associated with CMR biomarkers were collected in a qualitative analysis. A total of 64 studies were included in the systematic review pooling 3304 individuals including 1870 SLE patients. Of these, 19 case-control studies were included in the comparative meta-analysis (1576 individuals, including 884 SLE patients). Compared to controls, left ventricular (LV) ejection fraction (62% vs. 64%, p = 0.001) and indexed end-diastolic volume (77 vs. 72 mL/m2, p = 0.006) were significantly altered in SLE patients. Late gadolinium enhancement (LGE) extent was higher in SLE patients (LGE mass/total LV mass: 3.5% vs. 1.1%, p = 0.009). Native T1 and T2 relaxation times were significantly higher in SLE patients (native T1 [1.5 T]: 1005 vs. 982 ms, p = 0.02; native T1 [3 T]: 1267 vs. 1140 ms, p < 0.001; T2 [all fields]: 58 vs. 51 ms, p < 0.001). Three studies found an association between disease activity and increased T2 relaxation times. Two studies identified an association between clinical outcomes and CMR parameters. While CMR-assessed ventricular function and volumes only slightly differed in SLE patients when compared to controls, myocardial tissue characterization parameters were significantly modified and associated with disease activity. Question What are the diagnostic and prognostic values of cardiac magnetic resonance (CMR) quantitative parameters in systemic lupus erythematosus (SLE) patients? Findings Myocardial tissue characterization parameters are significantly altered in SLE patients and associated with disease activity. Clinical relevance CMR imaging demonstrates subclinical cardiac alterations in systemic lupus erythematosus patients. Additional studies are required to further demonstrate the prognostic value of CMR in SLE.

Evaluation of cardiac function using echocardiography in childhood-onset systemic lupus erythematosus patients treated with hydroxychloroquine.

This study aimed to evaluate the effects of hydroxychloroquine on cardiac functions and left ventricular mass in patients with childhood-onset systemic lupus erythematosus (cSLE). Fifty patients with cSLE undergoing treatment with hydroxychloroquine underwent echocardiographic evaluation. All patients exhibited negative disease activity markers and were clinically in remission. The median duration of hydroxychloroquine exposure was 7.1 (5.2-9.5) years, with a median cumulative dose of 784.8 (509.5-3437.6) grams. No correlation was identified between the parameters of left ventricular ejection fraction, left ventricular mass index and geometry, and cumulative hydroxychloroquine dose (p = 0.245, p = 0.094, p = 0.146, respectively). Furthermore, no significant correlation was identified between the cumulative dose of hydroxychloroquine and diastolic cardiac parameters (all p > 0.05). A comparison of the patients who received a cumulative dose of hydroxychloroquine below the median dose (the low-dose group) with those who received a higher dose (the high-dose group) revealed no significant differences in the echocardiographic parameters (all p > 0.05). The findings of this study indicate that chronic hydroxychloroquine use in patients with cSLE does not result in adverse changes in left ventricular mass or impairment of cardiac functions. However, these patients should undergo regular evaluation to monitor for the potential development of cardiotoxicity.

Retinal microvascular changes in systemic lupus erythematosus assessed by optical coherence tomography angiography

PurposeTo assess the retinal microvasculature of Systemic Lupus Erythematosus (SLE) patients using Optical Coherence Tomography Angiography (OCTA).MethodsTwenty adult SLE patients without disease activity and no ocular manifestations were recruited and cross-sectionally assessed. A demographically similar cohort of healthy subjects was used for comparison. The main outcome is vascular density (VD). As secondary outcomes, foveal avascular zone (FAZ) parameters, total vessel length (TVL), vessel length density (VLD), vessel diameter and tortuosity, branchpoint density (BD) and fractal dimension (FD) were evaluated.ResultsForty eyes of 40 women (20 SLE patients and 20 healthy subjects) were enrolled with a mean ± SD age of 36.7 ± 9.9 years. In both the superficial and deep capillary plexuses, SLE patients presented significantly lower VD and TVL values, mean vessel diameter and FD (all p < 0.005). No significant differences were found in FAZ values. A negative correlation was found between age and FAZ parameters and between age and TVL, VLD and FD in the superficial capillary plexus (all p < 0.05).ConclusionsThis study supports the evidence of subclinical retinal microvascular changes in adult SLE patients, providing a more comprehensive characterization of vascular changes. We found vessel diameter and length and FD are decreased in SLE.Trial registrationNCT05863689, 2023-10-19.

Circulating Levels of Low-Density Granulocytes and Cell-Free DNA as Predictors of Cardiovascular Disease and Bone Deterioration in SLE Patients.

The present work evaluates the predictive value of low-density granulocytes (LDGs) for the development of cardiovascular disease (CVD) and/or bone deterioration (BD) in a 6-year prospective study in systemic lupus erythematosus (SLE). Considering the high SLE-LDG capacity to form neutrophil extracellular traps (NETs), circulating levels of total cell-free DNA (cirDNA) and relative amounts of mitochondrial and nuclear DNA (mtDNA and nDNA, respectively) were tested as LDG-associated biomarkers to identify SLE patients at risk of CVD and BD. The frequency of total blood LDGs, as well as the CD16negCD14neg (nLDG) and CD16posCD14low (pLDG) subsets, was quantified by flow cytometry in 33 controls and 144 SLE patients. Total cirDNA and relative amounts of mitochondrial (mtDNA) and nuclear (nDNA) cell-free DNA were measured by fluorometry or qPCR in plasma from a subgroup of 117 patients and 23 controls at enrolment. Our findings showed increased blood levels of SLE-nLDGs at enrolment associated with prospective CVD development (pCVD) and the presence of BD, thus revealing LDG expansion as a predictor of both comorbidities in SLE progression. The amounts of the different types of circulating DNA analyzed were increased in patients, especially those presenting with traditional CV risk factors or subclinical atheromatosis. Similar to nLDGs, the nDNA concentration could predict the development of pCVD in SLE, supporting the quantification of cirDNA levels as a surrogate marker of LDGs in clinical practice.

Asymptomatic multifocal avascular necrosis, a commonly overlooked finding in patients with systemic lupus erythematosus

BackgroundIn patients with Systemic lupus erythematosus (SLE), osteonecrosis of various joints is a debilitating complication associated with the disease and its treatment, in which a considerable proportion of osteonecrosis may be asymptomatic. Recognizing the crucial role of early and timely detection, as well as appropriate management of asymptomatic osteonecrosis, in preventing joint destruction, we conducted a study to evaluate the prevalence of asymptomatic osteonecrosis in SLE patients who have already been diagnosed with symptomatic osteonecrosis. Additionally, we aimed to examine the relationship between proposed risk factors of osteonecrosis and the development of asymptomatic osteonecrosis.MethodsIn this cross-sectional study, Patients with recently diagnosed symptomatic osteonecrosis of at least one joint were selected by reviewing data from the digital medical record system of the Rheumatology Research Center. The patients underwent three-phase Single Photon Emission Computed Tomography (SPECT) bone scintigraphy to screen for other asymptomatic osteonecrotic joints. MRI was subsequently performed on the asymptomatic osteonecrotic sites for further diagnostic confirmation. The study evaluated the prevalence of asymptomatic osteonecrosis, the extent of joint involvement, the specific locations of osteonecrosis, the most commonly affected joints, and the risk factors for asymptomatic osteonecrosis.ResultsEight out of the 17 patients (47%) who participated in our research were found to have asymptomatic osteonecrosis. The most commonly affected joint without symptoms was the left knee (25%), while the most frequently affected joint with symptoms was the left hip (23.07%). The only statistically significant difference observed between patients with and without asymptomatic osteonecrosis in this study was the age at which the disease first appeared (p = 0.046) and this age was higher among patients with asymptomatic osteonecrosis.ConclusionsOur research provides further evidence of the high incidence of asymptomatic osteonecrosis in individuals with SLE due to the nature of the disease and the frequent use of high-dose corticosteroids. It underscores the importance of early detection through whole-body SPECT bone scintigraphy and MRI, as well as prompt intervention in order to avert the incapacitating effects of osteonecrosis.

Serum fatty acid profiles in systemic lupus erythematosus and patient reported outcomes: The Michigan Lupus Epidemiology &amp; Surveillance (MILES) Program

IntroductionDespite progress in systemic lupus erythematosus (SLE) treatment, challenges persist in medication adherence due to side effects and costs. Precision nutrition, particularly adjusting fatty acid intake, offers a cost-effective strategy for enhancing SLE management. Prior research, including our own, indicates that increased consumption of omega-3 polyunsaturated fatty acids (PUFAs) correlates with improved outcomes in SLE patients. Here we build upon these findings by investigating associations between serum fatty acids—grouped as PUFAs, monounsaturated fatty acids (MUFAs), and saturated fatty acids (SFAs)—and lupus activity, pain, and sleep disturbance.MethodsUsing data from 418 participants with SLE in the Michigan Lupus Epidemiology and Surveillance (MILES) Cohort, we examined associations between serum levels of 25 fatty acids determined by GC-MS and patient-reported outcomes. Disease activity, pain, and sleep quality were assessed using standardized questionnaires. Generalized additive models and partial residual plots were utilized to examine the linearity of fatty acid effects. Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO), followed by multiple linear regression adjusting for sociodemographic factors.ResultsFindings indicated favorable associations between ω-3 PUFAs—and, to a lesser extent, ω-6 PUFAs—and patient-reported outcomes, while MUFAs and SFAs showed unfavorable associations. Docosahexaenoic acid (DHA), an omega-3 PUFA, exhibited the most robust favorable associations across all outcomes. Additionally, the omega-3 α-linolenic acid (ALA) was linked to reduced pain, whereas eicosapentaenoic acid (EPA), another omega-3, was associated with worsened disease activity and pain. Among omega-6 PUFAs, dihomo-γ-linolenic acid (DGLA) was favorably associated with disease activity, while the omega-9 PUFA Mead acid was linked to increased pain.DiscussionThese findings underscore the prospect that increased tissue levels of long-chain omega-3 PUFAs, particularly DHA, are favorably associated with SLE outcomes. Although further research is needed to establish causal relationships, existing evidence supports the role of omega-3 PUFAs in managing cardiovascular and chronic kidney disease, common SLE comorbidities. Most study participants exhibited low omega-3 PUFA status, suggesting substantial potential for improvement through targeted dietary interventions and supplementation. This study supports a potential role for precision nutrition in comprehensive SLE management, considering the impact of PUFAs, SFAs and MUFAs.

The diagnostic and predictive potential of lncRNA CASC2 targeting miR-155 in systemic lupus erythematosus patients with nephritis complication

Lupus nephritis (LN) is a serious problem that results from systemic lupus erythematosus (SLE) complications. Recent studies have highlighted that non-coding RNA (ncRNA) dysregulation is a notable feature in patients with SLE. As a result, this research was designed to investigate lncRNA CASC2 and miR-155 levels as non-invasive diagnostic biomarkers in SLE patients, including those with and without nephritis, and to investigate their effectiveness in assessing disease severity and predicting LN. Our study included 60 patients with SLE who were subclassified into (30 non-LN and 30 LN groups), along with 30 control subjects. Quantification of lncRNA CASC2 and miR-155 in serum samples from the Egyptian population was carried out with real-time polymerase chain reaction (RT-PCR). The disease activity index (SLEDAI) for SLE was evaluated, and the analysis of the receiver operating characteristic (ROC) curve was implemented. Increased levels of lncRNA CASC2 were observed in SLE patients compared to healthy controls, with even higher levels observed in the LN group versus the non-LN patients’ group. Conversely, miR-155 was noted to be down-regulated in SLE patients relative to controls, and its levels were lower in the LN group relative to the non-LN patients’ group. The elevated expression of lncRNA CASC2 and reduced expression of miR-155 were both correlated to the severity of the disease. The current study illustrated that both lncRNA CASC2 and miR-155 could act as valuable non-invasive diagnostic biomarkers for SLE and predicting LN among SLE patients, as well as their abilities to detect the disease severity and progression.

Association of Anti-Smith, Anti-Ro, and Anti-ribonucleoprotein Combination With Accelerated Development of Lupus Nephritis in Systemic Lupus Erythematosus Patients in Saudi Arabia.

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disorder affecting multiple organs. Lupus nephritis (LN), one of its serious complications, is characterized by proteinuria and renal dysfunction. The objective of this study was to evaluate the association between a specific antibody profile (anti-Smith [anti-Sm], anti-Ro, and anti-ribonucleoprotein [anti-RNP]) and the time to develop LN in SLE patients. A retrospective, single-center cohort study was conducted at King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia, and included 128 patients with LN who visited the Rheumatology Clinic between 2014 and 2021. Patients were divided into two groups: a positive serological profile group, which included patients positive for all three antibodies (anti-Sm, anti-Ro, and anti-RNP), and a negative serological profile group (which included patients with at least one negative antibody result). Data on demographics, antibody profiles, time to proteinuria development, and LN classification were analyzed. The time to develop proteinuria from the initial diagnosis of LN to the first detection of proteinuria exceeding 500 mg was categorized into less than 1 year, 1-5 years, 6-10 years, and more than 10 years. Our findings revealed that a substantial proportion (95%) of patients positive for all three antibodies (anti-Sm, anti-Ro, and anti-RNP) had a significantly higher likelihood of developing proteinuria within the first five years of their SLE diagnosis, compared to 89.66% of patients with a negative serological profile. The findings suggest that the presence of anti-Sm, anti-Ro, and anti-RNP antibodies is associated with a higher risk of early LN development, specifically within five years after initial SLE diagnosis. Regular monitoring and proactive management of high-risk patients can reduce the burden of LN and its complications.

Upper arm deep vein thrombosis in a patient with active lupus

Upper extremity deep vein thrombosis (UEDVT) is relatively rare, and much less as an initial presentation of systemic lupus erythematosus (SLE). Primary UEDVT should be considered in individuals with unilateral arm swelling where the brachial, axillary, and subclavian veins are frequently involved. SLE is a chronic autoimmune disease that predominantly affects women of childbearing age and of African descent. Patients present with clinical features ranging from arthritis and arthralgias (over 90% of patients with SLE) to life-threatening hematologic, or central nervous system involvement. Individuals have an increased risk of arterial and/or venous thrombosis where the most important risk factor is the presence of antiphospholipid antibodies. Even within this condition, thrombotic events are typically seen in the legs, and UEDVT remains an unusual presentation. Here, we present a case of a 36-year-old female of African descent with a recent medical history of small joint arthralgia and vaginal bleeding due to uterine fibroids, for which she was prescribed a short course of prednisolone and norethisterone, respectively. She presented with a 2-week history of unilateral swelling in the left arm. Doppler ultrasound and later computed tomography scan with contrast indicated left UEDVT. Further investigations throughout her admission led to the diagnosis of SLE, while antiphospholipid syndrome - a common contributor to thrombosis in SLE - was notably ruled out. The patient was initiated on anticoagulants. The patient went on to later rapidly develop lupus nephritis and started on high-dose prednisolone. Given the high risk of bleeding, the decision to postpone the kidney biopsy was taken. There is limited data available about UEDVT when compared to lower extremity DVT and even fewer studies on SLE patients with thrombosis in the absence of antiphospholipid syndrome. Keeping this in mind, clinicians need to recognize idiopathic UEDVT as a potential early sign of SLE and maintain a high level of suspicion.

Assessment of the Expression Levels of USP27X and DDX3X genes in Systemic Lupus Erythematosus (SLE) Patients

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease influencing numerus tissues in body. Ubiquitin carboxyl-terminal hydrolase 27 (USP27X) is a deubiquitinating enzyme involved in the type I interferons (IFNs) generation, apoptosis and production of proinflammatory mediators. DEAD-box helicase 3 X-linked (DDX3X) is a ribonucleic acid (RNA) helicases and contributes to the generation of type I IFNs, and proinflammatory mediators. Considering the involvement of IFN type I, apoptotic cell death and proinflammatory mediators in the pathogenesis of SLE, the expression levels of USP27X and DDX3X genes were assessed in SLE patients. Methods: Two groups, including SLE patients and healthy subjects, were included in the study and the expression levels of USP27X and DDX3X genes in their peripheral blood mononuclear cells (PBMC) were quantified by the real-time polymerase chain reaction (PCR). Results: The results demonstrated the expression level of DDX3X gene was 5.9-fold higher in the SLE patients compared to the healthy subjects ( P &lt; .01). No significant difference in the expression level of USP27X gene was detected between both groups ( P &gt; .05). Conclusion: A significant elevation in the level of DDX3X gene in SLE patients prepossess the potential involvement of DDX3X in SLE pathogenesis possibly through the induction of proinflammatory mediators. In spite of the potential involvement of USP27X in SLE through the induction of type 1 IFNs, and apoptotic cell death, our finding did not provide evidence in the contribution of USP27X in SLE pathogenesis.

Cordycepin ameliorates autoimmunity by promoting STING degradation via autophagy pathway.

Stimulator of interferon response cGAMP interactor 1 (STING), a central hub protein of cyclic GMP-AMP synthase (cGAS)-STING signalling pathway, has a crucial role in regulating type I interferons (IFNs) production and response. Recent studies indicate that excessive activation of STING is strongly associated with autoimmune diseases, including systemic lupus erythematosus (SLE). Searching immunomodulators that negatively regulate STING might greatly contribute to the suppression of autoimmunity. The peripheral blood mononuclear cells (PBMCs) of SLE patients, Hela cells, L929 cells and bone marrow-derived macrophages (BMDMs) from mice were used as in vitro models. While, Trex1 KO mouse autoimmune disease model was used as in vivo model. After treatment with cordycepin, a nucleoside from Cordyceps mushrooms, type I IFNs production and response were determined by western blotting, real-time polymerase chain reaction (PCR), dual-luciferase assay, enzyme-linked immunosorbent assay (ELISA), haematoxylin-eosin staining and RNA-seq. Cordycepin inhibited type I IFNs production and response in human and murine systems following cGAS-STING signalling activation. Importantly, cordycepin markedly attenuates the autoinflammatory and autoimmune responses in Trex1 KO BMDMs and Trex1 KO mice. Furthermore, cordycepin effectively suppressed the production of type I IFNs and interferon-stimulated genes (ISGs) in the PBMCs of SLE patients. Mechanistically, cordycepin promoted STING degradation via autophagy pathway upon DNA stimulation. This study shows that cordycepin promotes STING autophagic degradation to alleviate autoimmunity upon DNA stimulation. Cordycepin might be a potential therapeutic candidate for alleviating aberrant type I IFNs in autoimmune and autoinflammatory diseases.

Neutrophils-to-lymphocyte and platelet-to-lymphocyte ratio and Systemic Lupus erythematosus activity: a cross-sectional study in Brazilian patients

Background: To identify disease activity in Systemic Lupus Erythematosus (SLE) is important to choose the correct treatment. Neutrophil /Lymphocyte (N/L) and Platelet/ Lymphocyte (P/L) ratio have been considered to reflect inflammatory status in several situations. In this study, we aimed to evaluate the association of N/L and P/L with SLE disease activity. Methods: This is a crosssectional study of 189 SLE patients for disease activity for SLEDAI-2K (SLE Disease activity index), ESR (erythrocyte sedimentation rate), CRP (C reactive protein) and hemogram with N/L and P/L ratio. Results: N/L ratio demonstrated correlation with SLEDAI (rho=0.24; p=0.0009) ESR (rho =0.17; p=0.02) and CRP (rho=0.23; p=0,004); P/L correlated with SLEDAI (rho=0.21; p=0.003), CRP (rho=0.26; p=0.001), ESR (rho=0.23; p=0.003) and levels of anti-dsDNA (rho=0.29; p=0.02) and had a negative correlation with hemoglobin (rho= -0.27; p=0.0001). A cut-off of 2.28 in N/L ratio had sensitivity of 68.6% and specificity of 68.2% for active disease; a cut-off of 124.1 in P/L ratio had sensitivity of 82.9 and specificity of 41.1% for active SLE. Conclusions: N/L and P/L ratio are useful in the evaluation of SLE disease activity.

Neurological involvement in patients with systemic autoimmune rheumatic diseases: a descriptive study in an Egyptian cohort

BackgroundNeurologic manifestations in the systemic autoimmune rheumatic diseases (SARDs) are protean. They add to the disease burden and could contribute to mortality. Increasing awareness about the neuro-rheumatologic syndromes might help with early diagnosis and effective therapy. Our aim is to survey the clinical and imaging patterns of neurological involvement in Egyptian patients with SARDs.ResultsNeurological involvement is common in Behçet’s disease (BD) (12.7%) and systemic lupus erythematosus (SLE) (6.4%) patients compared with other SARDs. Compared with SLE, neurological involvement in BD tends to develop at an older age (31 ± 7.1 versus 28.3 ± 9.6 years = 0.022) with a greater progression risk (13.8% versus 2.6%, P = 0.003). A higher proportion of SLE patients had abnormal neuroimaging without neurological symptoms (15.7% versus 4.3%, P = 0.026, OR = 4.9, 95%CI 1.1–22.4). SLE patients had a higher frequency of seizures (31.3% versus 6.4%, P < 0.001, OR = 6.7, 95%CI 2.7–16.7) and benign intracranial hypertension (9.6% versus 1.1%, P = 0.009, OR = 9.8, 95%CI 1.2–77.7) but a lower prevalence of quadriplegia due to brain insult (1.7% versus 3.2%, P = 0.045, OR = 0.2, 95%CI 0.04–0.9), dural sinus thrombosis (13% versus 33%, P = 0.001, OR = 0.3, 95%CI 0.2–0.6), brainstem syndrome (0.9% versus 6.4%, P = 0.047, OR = 0.1, 95%CI 0–1.1) and cranial neuropathies (9.6% versus 31.9%, P < 0.001, OR = 0.2, 95%CI 0.1–0.5). Concerning neuroimaging, brain atrophic changes were more common (27.4% versus 9.5%, P = 0.002, OR = 3.6, 95%CI 1.6–8.3) while thrombosis was less prevalent (36.3% versus 53.6%, P = 0.016, OR 0.5, 95%CI = 0.3–0.9) in lupus patients. The cerebral cortex was more commonly affected (20.4 versus 4.8%, P = 0.002, OR = 5.1, 95%CI 1.7–15.4) while dural sinuses (14.2% versus 40.5%, P < 0.001, OR = 0.2, 95%CI 0.1–0.5), basal ganglia (1.8% versus 10.7%, P = 0.010, OR = 0.2, 95%CI 0–0.7), diencephalon (0% versus 13.1%, P < 0.001) and brainstem (1.8% versus 22.6%, P < 0.001, OR = 0.1, 95%CI 0–0.3) were less frequently involved in SLE patients. Concerning other SARDs, cranial neuropathies were the most common neurological presentations. Abnormalities in neuroimaging did not correlate with the patients’ clinical presentations.ConclusionsNeurological presentations associated with SARDs are protean. Neuroimaging abnormalities should be interpreted within the context of the clinical picture and the results of other investigations.

Serum 25-Hydroxyvitamin D Levels and Disease Activity in Patients with Systemic Lupus Erythematosus: An Exploratory Study in Western Mexico

Background and objectives: The correlation between diminished 25-hydroxyvitamin D (25-(OH)D) concentrations and heightened disease activity in systemic lupus erythematosus (SLE) patients remains contentious, as clinical studies have yielded conflicting outcomes—some propose a potential link, while others assert no relationship exists. Nonetheless, all studies report a significant prevalence of low 25-(OH)D levels among SLE patients. This study aimed to assess the frequency of low serum levels of 25-(OH)D in Mexican patients with SLE and to evaluate the correlation between 25-(OH)D deficiency or insufficiency and disease activity levels. Materials and Methods: This retrospective analysis comprised patients admitted to our hospital from November 2022 to October 2023, diagnosed with SLE, and had their serum 25-(OH)D levels tested upon admission. The frequency of low levels of 25-(OH)D was assessed, and clinical and demographic data were gathered to examine potential causes linked to 25-(OH)D deficiency or insufficiency. Results: A total of 61 patients were included, and 87% (n = 53) had low serum 25-(OH)D levels. Patients with 25-(OH)D deficiency (n = 21) were significantly younger (mean 23 vs. 39 years, p = 0.04) and had higher protein levels in 24 h urine protein (1.8 vs. 1.1 g/24 h, p = 0.006) than patients who presented only 25-(OH)D insufficiency, without significant differences in other indicators of disease activity. Conclusions: In this investigation, patients with SLE exhibited a high frequency of low serum levels of 25-(OH)D, consistent with existing literature; however, no significant correlations were identified between 25-(OH)D levels and indicators of disease activity. These findings require validation in subsequent research.

Estimation of TNF- α and some immunological parameters in patient with systemic lupus erythematosus

Abstract: Abstract— Systemic Lupus Erythematosus (SLE) is a multifactorial chronic systemic autoimmune disease. It is characterized by a lack of immune tolerance to autoantigens such as nuclear antigens. In this study, 25 individuals diagnosed with SLE had their blood samples drawn, while 25 healthy individuals were used as a control group. The results of this investigation show that the patients' TNF-α levels (106.9 ± 10.8) significantly increased more than 52.86 in the control group. Comparing the immunological parameters of the patients to the healthy group, the study revealed a decrease in the eosinophile, basophile, lymphocyte, and monocyte counts (010 ± 0.003, 0.022 ± 0.004, 1.71 ± 0.66, 0.21 ± 0.047 respectively) and a rise in the neutrophile and immature granulocyte counts (7.43 ± 1.66, 2.68 ± 0.46 respectively) in SLE patient. Keywords— SLE,TNF‑α,immunological parameters

Immune thrombocytopenia in patients with systemic lupus erythematosus.

Immune thrombocytopenia (ITP) is a common hematological manifestation of systemic lupus erythematosus (SLE). The diversity of its clinical features and treatment responses may reveal the complex pathophysiological mechanisms of the disease. To enhance the therapeutic response rate and improve the prognosis for SLE patients with concurrent ITP, while reducing adverse events during the treatment process, it is crucial to accurately identify and apply clinical parameters to predict patients' responses to treatment. In addition to conventional therapeutic approaches such as glucocorticoids, immunosuppressants, and intravenous immunoglobulin (IVIG), a range of emerging therapies are gradually becoming the focus of research. These innovative therapeutic strategies include thrombopoietin receptor agonists (TPO-RAs), targeted therapies against B-cells, and plasma cell-targeted treatments. With a deepening understanding of the role of platelets in immune and inflammatory responses, novel platelet-targeted therapeutic agents in the field of SLE-ITP treatment may demonstrate significant potential. Despite this, to ensure the clinical efficacy and safety of these therapeutic approaches, we must rely on rigorously designed randomized controlled trials (RCTs) for further validation. This article provides a systematic review of the pathogenesis of systemic lupus erythematosus (SLE) complicated by immune thrombocytopenia (ITP) and conducts a comprehensive overview of current treatment strategies. The article also provides an in-depth exploration of the key biomarkers that may influence the therapeutic response in SLE-ITP patients. This comprehensive analysis aims to elucidate the factors that potentially affect the efficacy of treatments and contribute to a more personalized approach to patient care.

Urinary microbiome profiling as a non-invasive tool for identifying biomarkers in systemic lupus erythematosus and lupus nephritis.

Bacteriome alterations have been implicated in the pathogenesis of systemic lupus erythematosus (SLE). However, the relationship between SLE and the urinary microbiome remains underexplored. This study aimed to characterize the urinary microbiome of SLE patients using 16S rRNA sequencing and to investigate its correlations with clinical parameters through integrative analyses. Urine sediment samples were collected from individuals with SLE and lupus nephritis (LN) (n = 20), SLE without LN (n = 22), and healthy controls (HCs) (n = 23). DNA was extracted and subjected to 16S rRNA sequencing to profile the urinary microbiome. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic efficacy of urinary microbiota, while Spearman's correlation analysis was employed to identify links between specific microbial taxa and clinical parameters. Functional predictions of bacterial roles were performed using Picrust2. The urinary microbiota diagnostic model exhibited excellent performance in distinguishing SLE patients from HCs. Spearman's analysis revealed significant correlations between the urinary microbiome and clinical parameters. Specifically, Sphingomonas and Lachnospiraceae genera showed positive correlations with vitamin D levels, cylinderuria, and proteinuria, while Pedobacter, Aquabacterium, Delftia, and Achromobacter displayed negative correlations with proteinuria and albumin-to-creatinine ratio (ACR). Functional predictions indicated that the urinary microbiome might influence immune regulation through modulation of signaling pathways and metabolic processes. Our study is the first to reveal dysbiosis in the urinary microbiome of patients with SLE. Certain bacterial taxa in the urinary microbiome were identified as potential diagnostic biomarkers for SLE. Furthermore, the functional implications of these bacterial communities suggest their involvement in immune modulation, highlighting the potential for further investigation into their roles in SLE pathogenesis and diagnosis.

Circulating B Lymphocyte Subsets in Patients with Systemic Lupus Erythematosus

Background/Objectives: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the abnormal activation of autoreactive T and B cells, autoantibody production, complement activation, and immune-complex deposition, resulting in tissue damage. However, data on immunologic disturbances in SLE, particularly regarding flares, are scarce. Methods: We investigated 35 patients with SLE: 12 (34.3%) with disease exacerbation (SLE disease activity index [SLEDAI] ≥ 5 points) and 23 (65.7%) in remission (SLEDAI &lt; 5 points). All patients met the 2019 EULAR/ACR SLE criteria. Flow cytometry was used to identify B cell subsets, including memory B cells. Results: In the whole patient group, SLEDAI was positively related to the percentage of transitional/regulatory B cells (r = 0.38, p = 0.034). Some lymphocyte subsets correlated with complement levels, e.g., the percentage of naïve and memory B cells showed associations with C3c complement (r = 0.43, p = 0.018 and r = −0.45, p = 0.016, respectively). Furthermore, regarding inflammatory markers, we found associations between C-reactive protein and the percentage of plasmablasts (r = 0.40, p = 0.026) and plasmocytes (r = 0.44, p = 0.017). Finally, the percentage of plasmablasts correlated with SLE duration (r = 0.42, p = 0.016). In the follow-up analysis, during a median observation of 5 years, 5 out of the initially 23 inactive SLE patients developed a disease flare. They were characterized by longer disease duration stated in the beginning compared to patients who remained in remission (p = 0.019). Conclusions: Our study highlights significant associations between various B cell subsets and SLE disease activity. A more personalized approach to indicate patients with SLE at a higher risk of lupus flares is crucial for better management.

COVID-19 Vaccination in Patients With Systemic Lupus Erythematosus: Adverse Events and Rating Agreement of Flares Between Patients and Physicians.

To compare adverse events and flares among different doses and types of COVID-19 vaccines in patients with systemic lupus erythematosus (SLE). All consecutive SLE patients in a lupus cohort, seen between March and October 2022, were invited to join this retrospective study. Inclusion criteria were aged ≥ 20 years and had received at least one dose of COVID-19 vaccine. Data regarding adverse events after vaccination, clinical disease activity and flares within 30 days postvaccination were reviewed. A total of 201 SLE patients received 524 vaccine doses, with 201, 199, and 124 patients received 1, 2, and 3 doses, respectively. The vaccines included inactivated virus vaccine, adenovirus-vectored vaccine, and mRNA vaccines in 183 (35%), 128 (24%), and 213 (41%) doses, respectively. Regardless of the dose and type of vaccine, adverse events occurred in 50%-70% of patients. Pain and swelling at the injection site were common local symptoms, whereas constitutional, neurological, musculoskeletal, and mucocutaneous symptoms were among systemic ones. The majority of these symptoms were mild to moderate. Patients reported they had disease flares after vaccination in 5%-6%, while actual flares determined by physicians occurred in 8%-13% of them, giving fair to moderate rating agreement between patients and physicians (Cohen's kappa: 0.21-0.44). There was no significant difference in mean mSLEDAI-2K between pre- and 30 days postvaccination. Adverse events after vaccination were common, regardless of the dose or type of COVID-19 vaccines, but only a small proportion of patients had severe symptoms. Flares were uncommon. The rating agreement of flares between patients and physicians as fair to moderate.

Association Between Neuropsychiatric Event and Systemic Lupus Erythematosus Clinical Manifestation: A Meta-Analysis.

To uncover the clinical characteristics and investigate the underlying causes of psychiatric manifestations in patients with systemic lupus erythematosus (SLE), including its subset, neuropsychiatric systemic lupus erythematosus (NPSLE). Through comprehensive database searches in PubMed, Embase, Medline, and Cochrane, from their inception to August 2023, the study focused on adult SLE and NPSLE cases. From the selected studies, data were synthesised via a random-effects meta-analysis, encompassing a total of 2,997 subjects across six studies. The findings highlighted differences in medical indicators such as discoid rash, hypertension, mean disease duration, and various autoantibodies between SLE and NPSLE patients, indicating a nuanced approach to treatment is necessary, particularly with NPSLE requiring extended treatment periods. The analysis suggests that the causality behind these manifestations is multifactorial, encompassing mental state, autoantibody profiles, and environmental factors, thus providing valuable insights into the clinical management and understanding of SLE and NPSLE. This study emphasises the complexity of SLE, particularly in its neuropsychiatric manifestations, and underscores the importance of targeted treatment strategies. Key Words: Systemic lupus erythematosus, Neuropsychiatric systemic lupus erythematosus, Neuropsychiatric event, Meta-analysis.