Systemic Lupus Erythematosus Patients Research Articles

The Effectiveness of Rituximab in the Treatment of Refractory Manifestations of Patients with Systematic Lupus Erythematous: A Retrospective Study

Background: Rituximab (RTX) is a chimeric antibody that directly targets B cells, which has been suggested as a new treatment option for systemic lupus erythematosus (SLE) resistant to conventional treatments. Objectives: This retrospective study aimed to investigate RTX's effect on treating SLE patients with refractory manifestations. Methods: This study was conducted on SLE patients who were resistant to treatment. The patients demographic characteristics and clinical information were collected from their medical records, and the results were compared before and after RTX therapy. Data were analyzed using SPSS software, and the significance level was less than 0.05 (P < 0.05). Results: Nephritis (26.3%), cutaneous manifestations (23.7%), and arthritis, occasionally secondary to overlap with rheumatoid arthritis (18.4%), were the most common complications that made patients (n = 55) candidates for the RTX biosimilar (Zytax). Ten patients were excluded due to a lack of complete data, and seven patients died immediately after starting Zytax due to disease severity and complications. Improvement in arthritis and cutaneous complications was reported after RTX injection in 57.1% and 44.4% of patients, respectively. Creatinine levels decreased significantly in patients with lupus nephritis after RTX injection compared to before treatment (P = 0.006). Moreover, anti-DNA was significantly different before and after RTX injection (Z = -2.89, P = 0.004). Comparison of C3 (t = 0.63; P = 0.53) and C4 (t = 1.72, P = 0.101) levels before and after RTX injection showed no significant differences. Conclusions: Based on the results, RTX improved nephritis, arthritis, and cutaneous complications in lupus patients.

Periodontitis Treatment by Scaling and Root Planing with Antimicrobial and Anti-Inflammatory Solutions in a Patient with Systemic Lupus Erythematosus

Introduction: Systemic Lupus Erythematosus is a chronic autoimmune disease of unknown cause in which patients regularly consume immunosuppressants, causing a decrease in body fluids of proteins such as mucins, immunoglobulin A and G antibodies, which causes destruction of periodontal tissue. Objective: To report a clinical case on the benefits of scaling and root planing (srp) with solutions based on hypochlorous acid (HOCl) and modified diallyl disulfide oxide (mddo) in the periodontal inflammatory process in a patient with systemic lupus erythematosus patient, tubulointerstitial nephritis and periodontitis. Case presentation: A 32-year-old woman, with systemic lupus erythematosus, tubulointerstitial nephritis and, according to the 2017 global workshop on the classification of periodontal diseases and conditions, was diagnosed with Stage 2 and Grade B periodontitis. Periodontal assessment revealed a high overall dental plaque index, with high-risk plaque being the most prevalent. srp treatment was carried out by quadrants, applying a HOCl solution during periodontal debridement and periodontal pockets were irrigated with mddo solution to disinfect them. Conclusions: The antimicrobial and anti-inflammatory solutions used as adjuvants to srp in this novel periodontal irrigation therapy helped to reduce gingival inflammation and high-risk plaque, which favoured healing of periodontal tissues in a patient with systemic lupus erythematosus.

Serum MASP2 level and MASP2 gene polymorphisms in Egyptian systemic lupus erythematosus patients

Serum MASP2 level and MASP2 gene polymorphisms in Egyptian systemic lupus erythematosus patients

Exploring genetic and immune cell dynamics in systemic lupus erythematosus patients with Epstein-Barr virus infection via machine learning.

Epstein-Barr Virus (EBV) is a widespread virus implicated in various diseases, including Systemic Lupus Erythematosus (SLE). However, the specific genes and pathways altered in SLE patients with EBV infection remain unclear. We aimed to identify key genes and immune cells in SLE patients with EBV infection. The datasets of SLE (GSE50772 and GSE81622) or EBV infection (GSE85599 and GSE45918) were obtained from the Gene Expression Omnibus (GEO) database. Next, differential gene expression (DEGs) analysis were conducted to identify overlapping DEGs and then enrichment analysis was performed. Machine learning was applied to identify key genes. Validation was conducted using ROC curve analysis and expression level verification in test datasets and single-cell RNA sequencing. Immune cell infiltration patterns were analyzed using CIBERSORTx, and clinical data were reviewed for SLE patients. We identified 58 overlapping DEGs enriched in interferon-related pathways. Five overlapping DEGs (IFI27, TXK, RAPGEF6, PIK3IP1, PSENEN) were selected as key genes by machine learning algorithms, with IFI27 showing the highest diagnostic performance. The expression level of IFI27 was found higher in CD4 CTL, CD8 naïve and various B cell subsets of SLE patients with EBV infection. IFI27 showed significant correlation with B intermediate and CD4 CT. Clinical data showed lower CD4 T cell proportions in SLE patients with EBV infection. This study identifies IFI27 as a key gene for SLE patients with EBV infection, influencing CD4 CTL and B cell subtypes. These findings enhance the understanding of the molecular mechanisms linking SLE and EBV infection, providing potential targets for diagnostic and therapeutic strategies.

Identification of RNA uridylation subtypes, and the prognostic and therapeutic value of RNA uridylation in systemic lupus erythematosus

The uridylation of 3′-RNA-a major process in epitranscriptomics- is catalyzed by terminal uridylyl transferases (TUTases), which are involved in multiple diseases and the immune response. Nonetheless, the role of TUTases in systemic lupus erythematosus (SLE) remains unknown. Here we identified increased level of MTPAP and ZCCHC6 and decreased level of PAPD5 and ZCCHC11 in SLE patients from Gene Expression Omnibus (GEO) GSE50772, GSE65391, and GSE121239. The random forest model was applied to screen 4 TUTase candidates (MTPAP, ZCCHC6, PAPD5, and ZCCHC11) to predict the susceptibility of SLE. A nomogram was constructed based on the 4 selected TUTase regulators. Decision curve analysis indicated that patients could benefit from the nomogram. Moreover, based on the 4 differentially expressed genes, individuals with SLE were divided into three patterns (Cluster A-C) using the consensus clustering method. Cluster B was enriched in adaptive immune cells, with the lowest TCE signature expression, manifesting a higher Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) than that in Cluster A and C. whereas, Cluster C was enriched in innate immune cells, with the highest T-cell exhaustion (TCE) signature expression, manifesting lower SLEDAI than that in Cluster B. Clinically, lupus nephritis (LN) patients manifested increased expression of MTPAP and ZCCHC6 and decreased expression of PAPD5 and ZCCHC11 in PBMCs using Quantitative Polymerase Chain Reaction (q-PCR). Immunohistochemistry (IHC) illustrated higher level of ZCCHC6 in the kidneys of LN patients than that in NC. In summary, TUTases could predict the occurrence of SLE and stratify patients based on their immune characteristics, eventually predicting the disease activity and guiding immune therapy.

Belimumab 10 years later: how drug positioning has changed.

We analysed the change in the positioning of belimumab (BLM) in systemic lupus erythematosus (SLE) treatment in the first decade of real-life use, by providing data about patients treated by this biological drug in the Sapienza Lupus Cohort. We evaluated SLE patients treated by BLM according to the current clinical practice. Data of each patient were collected, focusing on previous and concomitant treatments. Finally, the drug retention rate was assessed. Since August 2013, 138 SLE patients started BLM (M/F 7/131; median age 49years, IQR 13.25; median disease duration 214months, IQR 180). To evaluate the change in BLM positioning, we divided patients according to the date of starting treatment as below: patients treated from 2013 to 2018 (period 1) and those treated since 2019 to date (period 2). Indeed, the median number of previous immunosuppressant drugs was significantly higher in patients treated in period 1 [3 (IQR 1.25) versus 1 (IQR 1.75), p = 0.0002]. Furthermore, 15.9% of patients treated in period 2 were not previously treated by immunosuppressant drugs, compared with 5.2% in period 1 (p = 0.01). Finally, the 24-month drug survival was significantly higher in patients previously treated with ≤ 1 immunosuppressant drug in comparison with those treated with ≥ 2 drugs (69.1% versus 43.4%, p = 0.0097, HR 0.49; 95% CI 0.27-0.88). Our data clearly described the progressive anticipation of BLM prescription in the first 10years of clinical practice, underlining as choosing earlier biological agents could positively influence the drug retention rate.

Screening and validating genes associated with cuproptosis in systemic lupus erythematosus by expression profiling combined with machine learning.

Cell death has long been a focal point in life sciences research, and recently, scientists have discovered a novel form of cell death induced by copper, termed cuproptosis. This paper aimed to identify genes associated with cuproptosis in Systemic Lupus Erythematosus (SLE) through machine learning, combined with single-cell sequencing (scRNA-seq), to screen and validate related genes. The analytical results were then experimentally verified. Two published microarray gene expression datasets (GSE65391 and GSE61635) from SLE and control peripheral blood samples were downloaded from the GEO database. The GSE65391 dataset was used as the training group, while the GSE61635 dataset served as the validation group. Differentially expressed genes (DEGs) from GSE65391 identified 12 differential genes. Nine diagnostic genes, considered potential biomarkers, were selected using the least absolute shrinkage and selection operator (LASSO) and support vector machine recursive feature elimination (SVM-RFE) analysis. The Receiver Operating Characteristic (ROC) curves for both the training and validation groups were used to calculate the Area Under the Curve (AUC) to assess discriminatory properties. CIBERSORT was used to assess the relationship between these diagnostic genes and a reference set of infiltrating immune cells. Single-cell RNA sequencing data (GSE162577) from SLE patients were also obtained from the GEO database and analyzed. Experimental validation of the most important SLE biomarkers was performed. Twelve significantly different cuproptosis-related genes were identified in the GSE65391 training set. Immune cell analysis revealed 12 immune cell types and identified nine signature genes, including PDHB, GLS, DLAT, LIAS, MTF1, DLST, DLD, LIPT1, and FDX1. In the GSE61635 validation set, seven genes were weakly expressed, and two genes were strongly expressed in the treatment group. According to the ROC curves, PDHB and GLS demonstrated significant diagnostic value. Additionally, correlation analysis was conducted on the nine characteristic genes in relation to immune infiltration. The distribution of key genes in immune cells was determined using single-cell RNA sequencing data. Finally, the mRNA expression of the nine diagnostic genes was validated using qPCR.

Clinical significance of serum soluble scavenger receptor CD163 in patients with lupus nephritis.

The soluble CD163 (sCD163) was elevated in systemic lupus erythematosus (SLE) patients. To study whether serum sCD163 could be used to predict the occurrence and prognosis of lupus nephritis (LN). The recruited patients were classified into different groups according to standard identification criteria. The patients with LN. 11 indices were analyzed and compared in SLE and LN patients. Furthermore, the level of serum sCD163 was detected using an enzyme-linked immunosorbent assay. Meanwhile, the receiver operating characteristic analysis was performed to evaluate the prediction effect of sCD163. Additionally, spearman correlation analysis of serum sCD163 with indices was conducted. There were six positive indices and one negative risk factor correlated to LN. sCD163 was elevated in LN patients and could be used to diagnose LN. Importantly, sCD163 was increased in LN patients with a heavy SLE disease activity index. Finally, it was revealed that the level of sCD163 was higher in the LN patients with no response than that with complete or partial response, which also could predict the prognosis of LN. Serum sCD163 was elevated in LN patients than in SLE patients, which could be used to predict the occurrence and prognosis of LN.

Hearing and balance functions in patients with systemic lupus erythematosus

Background Systemic lupus erythematosus (SLE) is a chronic, inflammatory, autoimmune disease, characterized by multiple organ involvement, which is seen more often in young females. Objectives To evaluate the hearing and balance functions in SLE patients. Materials and methods Twenty-four SLE patients, 24 healthy controls underwent pure tone audiometry (0.125–16 kHz), VNG, vestibular evoked myogenic potential (VEMP), and video head impulse test (vHIT). Results A statistically significant difference was determined between the control group and the SLE group at 0.125, 0.25, 0.5, 1.0, 6.0, 8.0, 10, 12, 14, and 16 kHz frequencies. Sensorineural hearing loss was observed in 37.5% of the SLE group. The pursuit test was pathological at the rate of 25% in the SLE group. No response was obtained in six SLE patients in the oVEMP test and four SLE patients in the cVEMP test. The mean posterior SCC VOR gain values were 0.64 ± 0.2 in the SLE group. A significant difference was determined between the groups with respect to posterior SCC VOR gains. Conclusions and significance Our findings show that SLE disease may negatively affect the hearing system and the vestibular system as well. The current study is the first study to comprehensively evaluate SLE patients with VNG, VEMP, and vHIT tests.

The Expression pattern of NK cells in systemic lupus erythematosus patients with different disease activities

Data demonstrated the role of natural killer (NK) cells in systemic lupus erythematosus (SLE). We aimed to determine the immunophenotype and frequency of NK cells and their subsets, CXCR3, CD161 expression in blood and renal tissue of SLE patients with and without lupus nephritis and their relationship with disease activity. The study included 31 SLE patients and 11 controls. Study participants underwent full history and thorough clinical examination. SLE patients underwent routine laboratory investigations. Renal tissue biopsies were taken from patients with lupus nephritis. The frequency of NK cell subsets in blood of patients and controls and renal tissue from patients was performed by flow cytometry. An increase in circulatory CD56bright NK cells and its CD56bright CD16dim subtype was associated with the severity of systemic manifestations in SLE patients. Total CD56bright NK cells and its CD56bright CD16bright subtypes in renal tissues were related to renal damage. We detected decreased CD161 expression on NK cells related to renal damage and severity of systemic manifestations in SLE patients. Decreased expression of CXCR3 on NK cell surface in renal tissues causes misdirected trafficking of NK cells that seems to reduce the severity of lupus nephritis. In conclusion, our results paved the way to understanding the role of NK cells in the pathogenesis of SLE which may represent a future target for immune therapy of SLE. NK and CD56dim subset were decreased in the blood and increased in renal tissue of SLE patients, while the CD56bright subset was increased in blood and decreased in renal tissue reflecting their effects on renal damage and severity of manifestations in SLE.

The Onset of Systemic Lupus Erythematosus Triggers Nucleus Pulposus Cell Pyroptosis to Exacerbate Intervertebral Disc Degeneration.

Systemic lupus erythematosus (SLE) is an autoimmune disorder marked by immune system dysregulation and autoantibodies production, causing widespread inflammation and damage across various body systems. Despite the prevalent back pain in SLE patients, the link between SLE and intervertebral disc (IVD) degeneration, a primary contributor to back pain, remains inadequately understood. This study explored the impact of SLE on IVD degeneration using the MRL/lpr mouse model, which effectively replicates human SLE manifestations. The study utilized MRL/lpr mice to investigate the effects of SLE on IVD degeneration. The mice were evaluated for typical SLE phenotypes and indicators of IVD degeneration, including IVD height, IVD score, tissue integrity, extracellular matrix degradation, and apoptosis of IVD cells. Additionally, the study examined nucleus pulposus (NP) pyroptosis and inflammatory cytokine secretion. Mechanistic analysis focused on the antioxidant pathway, specifically the expression levels of NRF2, HO-1, KEAP1, and the phosphorylation levels of p65. MRL/lpr mice displayed typical SLE phenotypes and exacerbated profiles of IVD degeneration, including reduced IVD height, lower IVD score, significant IVD tissue impairment, extracellular matrix degradation, and increased apoptosis of IVD cells. Notably, SLE stimulated NP pyroptosis and excessive secretion of inflammatory cytokines. Mechanistic analysis indicated that the progression of SLE impedes the antioxidant pathway by downregulating NRF2 and HO-1 expression, upregulating KEAP1, and enhancing phosphorylation levels of p65. Our findings highlight the mechanistic link between SLE and IVD degeneration, suggesting potential therapeutic targets for mitigating back pain in SLE patients.

Type I IFN drives unconventional IL-1β secretion in lupus monocytes

Opsonization of red blood cells that retain mitochondria (Mito+ RBCs), a feature of systemic lupus erythematosus (SLE), triggers type I interferon (IFN) production in macrophages. We report that monocytes (Mos) co-produce IFN and mature interleukin-1β (mIL-1β) upon Mito+ RBC opsonization. IFN expression depended on cyclic GMP-AMP synthase (cGAS) and RIG-I-like receptors' (RLRs) sensing of Mito+ RBC-derived mitochondrial DNA (mtDNA) and mtRNA, respectively. Interleukin-1β (IL-1β) production was initiated by the RLR antiviral signaling adaptor (MAVS) pathway recognition of Mito+ RBC-derived mtRNA. This led to the cytosolic release of Mo mtDNA, which activated the inflammasome. Importantly, mIL-1β secretion was independent of gasdermin D (GSDMD) and pyroptosis but relied on IFN-inducible myxovirus-resistant protein 1 (MxA), which facilitated the incorporation of mIL-1β into a trans-Golgi network (TGN)-mediated secretory pathway. RBC internalization identified a subset of blood Mo expressing IFN-stimulated genes (ISGs) that released mIL-1β and expanded in SLE patients with active disease.

The association between systemic lupus erythematosus (SLE) and early psychiatric background

BackgroundThe etiology of Systemic Lupus Erythematosus (SLE) remains elusive.Research has established links between SLE and various mental health issues, including associations with psychiatric illness, unique symptomatology in SLE, a relationship between stress and disease exacerbation, and improvement in SLE patients after psychiatric and psychological treatment. However, the hypothesis that psychiatric conditions might precede SLE onset by long periods has not been empirically established. This study aims to address this gap. MethodsThis matched cohort study conducted a retrospective analysis using the electronic database of Clalit Health Services (CHS), Israel's largest HMO, comparing 2786 individuals diagnosed with SLE with 8358 non-SLE matched controls. ResultsTwo logistic regression analysis tests revealed significant associations between SLE diagnosis and prior psychiatric conditions.the first (p < 0.001) showed a 120% higher likelihood of psychiatric history among those diagnosed at least 10 years later with SLE compared to controls, and the second (p = 0.008) showed a 61% greater likelihood of a psychiatric history among those diagnosed at least 15 years with SLE. Investigation into the association between specific psychiatric indices and the later development of SLE found significant correlations between an SLE diagnosis and four psychiatric indices 10 years prior: dispensing of antipsychotics, anxiolytics, hypnotics, and sedatives; dispensing of antidepressants, psychostimulants, ADHD agents, and nootropics; diagnosis of mood disorders; and phobic and anxiety disorders. ConclusionsThe increased probability of pre-existing mental health issues preceding SLE onset by extended durations suggests a potential etiological role in SLE development.

Association of BLK and BANK1 gene polymorphisms with systemic lupus erythematous in Egyptian patients

This study examined the genotype, allelic frequencies (polymorphisms) in a sample of Egyptian patients and examined the relationship between disease activity in systemic lupus erythematosus (SLE) and the B lymphoid tyrosine kinase (BLK) and B-cell scaffold protein with ankyrin repeats 1 (BANK1) gene. This case control study involved 70 SLE patients and 40 subjects matched for age and sex as a control group. Clinical data were gathered from each participant, including SLE-related clinical activity indicators. Utilizing the restriction fragment length polymorphism (RFLP)-polymerase chain reaction (PCR), the single nucleotide polymorphisms (SNPs) BLK rs13277113G/A and BANK1 rs10516487G/A were assessed. The most prevalent genotype among the study participants was BLK rs13277113; G/G (57.1%), and BANK rs10516487; GG/ genotype (74.3%). There were no substantial variations in the incidence of genotype and allelic polymorphism between patients and controls (p&gt;0.05). In the studied SLE patients, however, there was no significant association between both alleles (BANK rs10516487 gene alleles, G/G and G/A &amp; BLK rs13277113, G/A, G/G &amp;A/A) and the SLE disease activity score. While there was a significant association between BLK rs13277113 genotype alleles and age. In conclusion, BLK rs13277113 G/A and BANK1 rs10516487 G/A alleles showed no difference between SLE Egyptian patients compared to controls with no link between both genes and SLE disease activity.

Physiological and hormonal changes between postmenopausal rheumatoid arthritis and systemic lupus erythematosus in women

It is thought that sex hormones are playing an actual role in the pathogenesis of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The purpose of this study was to determine the differences of some hematological, hormonal and immunological parameters between the postmenopausal women with rheumatoid arthritis and systemic lupus erythematosus. This study contained 75 postmenopausal women (52-65 years old). They included 25 women diagnosed with rheumatoid arthritis, 25 diagnosed with systemic lupus erythematosus and 25 normal controls. Blood was collected and used to determine complete blood count (CBC) and erythrocyte sedimentation rate (ESR) tests. Serum was separated and used to determine Follicle-stimulating hormone (FSH), Luteinizing Hormone (LH), Prolactin, cortisol, Estrogen, progesterone, testosterone, rheumatoid factor (RF) and Immunoglobulin E (IgE). The results indicated that both patients’ groups had anemia. However, the RA group had leukocytosis, but the SLE group had leukopenia. Moreover, thrombopenia occurred only in SLE patients. Although the levels of FSH and cortisol were significantly higher, the levels of LH, Estrogen and testosterone had significantly dropped in both patient groups. Interestingly, the level of progesterone was higher in the SLE and lower in the RA group. Moreover, the levels of RF, ESR and IgE were significantly increased in both patients’ groups. In conclusion, there were many differences in hematological and hormonal levels between postmenopausal women with rheumatoid arthritis and systemic lupus erythematosus. Such findings need future work to find out the reasons for these differences and how they could be used in future treatment strategies.

Development and validation of a predictive model for end-stage renal disease in systemic lupus erythematosus patients.

Systemic lupus erythematosus (SLE) affects many populations. This study aims to develop a predictive model and create a nomogram for assessing the risk of end-stage renal disease (ESRD) in patients diagnosed with SLE. Data from electronic health records of SLE patients treated at the Affiliated Hospital of North Sichuan Medical College between 2013 and 2023 were collected. The dataset underwent thorough cleaning and variable assignment procedures. Subsequently, variables were selected using one-way logistic regression and lasso logistic regression methods, followed by multifactorial logistic regression to construct nomograms. The model's performance was assessed using calibration, receiver operating characteristic (ROC), and decision curve analysis (DCA) curves. Statistical significance was set at P < 0.05. The predictive variables for ESRD development in SLE patients included anti-GP210 antibody presence, urinary occult blood, proteinuria, white blood cell count, complement 4 levels, uric acid, creatinine, total protein, globulin, glomerular filtration rate, pH, specific gravity, very low-density lipoprotein, homocysteine, apolipoprotein B, and absolute counts of cytotoxic T cells. The nomogram exhibited a broad predictive range. The ROC area under the curve (AUC) was 0.886 (0.858-0.913) for the training set and 0.840 (0.783-0.897) for the testing set, indicating good model performance. The model demonstrated both applicability and significant clinical benefits. The developed model presents strong predictive capabilities and considerable clinical utility in estimating the risk of ESRD in patients with SLE.

Progressive polyadenylation and m6A modification of Ighg1 mRNA maintain IgG1 antibody homeostasis in antibody-secreting cells

Antigen-specific antibodies are generated by antibody-secreting cells (ASCs). How RNA post-transcriptional modification affects antibody homeostasis remains unclear. Here, we found that mRNA polyadenylations and N6-methyladenosine (m6A) modifications maintain IgG1 antibody production in ASCs. IgG heavy-chain transcripts (Ighg) possessed a long 3' UTR with m6A sites, targeted by the m6A reader YTHDF1. B cell-specific deficiency of YTHDF1 impaired IgG production upon antigen immunization through reducing Ighg1 mRNA abundance in IgG1+ ASCs. Disrupting either the m6A modification of a nuclear-localized splicing intermediate Ighg1 or the nuclear localization of YTHDF1 reduced Ighg1 transcript stability. Single-cell RNA sequencing identified an ASC subset with excessive YTHDF1 expression in systemic lupus erythematosus patients, which was decreased upon therapy with immunosuppressive drugs. In a lupus mouse model, inhibiting YTHDF1-m6A interactions alleviated symptoms. Thus, we highlight a mechanism in ASCs to sustain the homeostasis of IgG antibody transcripts by integrating Ighg1 mRNA polyadenylation and m6A modification.

Utility of pan-immune-inflammation value as a predictor of the prognosis of childhood lupus.

Systemic lupus erythematosus (SLE) is a chronic inflammatory multisystemic disease. Monitoring disease activity thoughtout the disease course is important for effective management and assessment of disease outcome. To assess whether the pan-immune inflammation value (PIIV) at diagnosis could predict organ involvement and disease activity in childhood SLE (cSLE) patients after 12months of disease onst. This is an observational retrospective multicenter study that comprised cSLE patients seen and followed at the participating centers between January 2010 and December 2022. All patients met the EULAR/ACR-19 criteria, were immunosuppressive drug-naïve at the time of SLE diagnosis and had a minimal follow-up period of 12months. The data included clinical and laboratory findings and disease activity using the SLEDAI-2K. Receiver operating characteristic (ROC) curves were employed to determine the optimal cut-off value of PIIV and assess its predictive potential for disease activity, and organ involvement. A total of 125 patients (104 female) with a median age of 16.0 (IQR 5.6) years, a median age at disease onset of 10.9 (IQR 3.0) years, and a median disease duration of 4.8 (IQR 5.3) years were included. The most frequent involved organs at diagnosis were hematological (89.6%), musculoskeletal (68.8%), mucocutaneous (63.2%), and renal (58.4%). However, at a 12-month follow-up visit, the most frequent involved organs were renal (40.0%), hematological (39.2%), musculoskeletal (15.2%), and mucocutaneous (10.4%). The median PIIV at diagnosis was 139 (IQR 229.6), while the median SLEDAI was 12 (IQR 6.5) and 3.5 (IQR 7.0) at diagnosis and 12months, respectively. An optimal PIIV cut-off of 250 was found to be a predicative for disease activity, with a sensitivity of 45% and a specificity of 86%. The study revealed that the PIIV successfully predicted four systems in our cohort of patients. Our work suggests the PIIV might be a reasonable predictor for organ involvement and disease activity in newly diagnosed cSLE, though further research, particularly larger studies, is required to validate these findings, especially regarding organ involvement.

Current investigation of the high prevalence of sexual dysfunction in female patients with systemic lupus erythematosus: a cross-sectional study.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects women of childbearing age and has been reported to cause sexual dysfunction in women. Although there are articles on sexual function in women with SLE, the number of articles is small, and the factors affecting sexual function in women with SLE are controversial. Based on this, this study aimed to investigate the prevalence of sexual dysfunction in Chinese female SLE patients and to explore the factors that influence it. The study design was a cross-sectional study conducted from December 2023 to April 2024 in the Department of Rheumatology and Immunology of a tertiary hospital in Hefei, Anhui Province. A total of 293 female patients diagnosed with SLE were enrolled using face-to-face questionnaires and online questionnaires. The questionnaire consisted of four parts: general information questionnaire, fatigue severity scale (FSS), depression-anxiety-stress scale (DASS-21), and female sexual functioning index (FSFI) scale. A total of 173 (59.04%) patients had sexual dysfunction, including 251 (85.67%) with decreased libido and 186 (63.46%) with difficulty in sexual arousal. There was a correlation between the patients' total FSFI scores and age (p = 0.028), marital satisfaction (p < 0.001), own education level (p = 0.008), partner's education level (p = 0.003), place of residence (p = 0.039), monthly household income (p < 0.001), family financial satisfaction(p < 0.001), menstrual status (p = 0.003), hormone use (p = 0.021),immunosuppressant use (p = 0.042), disease activity (p = 0.016), FSS score (p < 0.001), stress score (p < 0.001), anxiety score (p < 0.001) and depression score (p < 0.001)were correlated. The results of stepwise regression analysis showed that marital satisfaction (b = 2.011, t = 3.797, p < 0.001), monthly household income (b = 0.854, t = 2.316, p = 0.021), menstrual status (b = 1.218, t = 2.350, p = 0.019), fatigue scale score (b = -0.069, t = -2.302, p = 0.022), and depression score (b = -0.117, t = -2.910, p = 0.004) were the influencing factors of FSFI total score, and the difference was statistically significant. The incidence of sexual dysfunction in Chinese female SLE patients is high, and medical personnel should pay more attention to patients' sexual problems, to provide theoretical and practical bases for further prevention, treatment, and care of sexual dysfunction in female SLE patients.

Diagnosis of pulmonary lophomoniasis infection in patient with systemic lupus erythematosus; A case report and literature review.

Over the past 30 years, there has been an increasing number of documented human infections associated with the protozoan Lophomonas, specifically Lophomonas blattarum, which is considered a relatively rare infection. These infections are primarily associated with states of immune suppression, including those resulting from corticosteroid therapy. We report a 61-year-old female patient with a 20-year medical history of Systemic lupus erythematosus (SLE) who was admitted due to persistent respiratory symptoms that were unresponsive to treatment. The patient was receiving immunosuppressive therapy for SLE. Upon hospitalization, computed tomography of the lungs revealed the presence of centrilobular nodules exhibiting tree-in-bud patterns, as well as bronchiectasis, predominantly in the middle and lower lobes. Subsequently, the patient underwent bronchoscopy, during which a BAL sample was obtained. Microscopic analysis of the sample indicated the presence of L. blattarum. Clinicians often focus on the primary symptoms of SLE, but they must also consider the risk of severe respiratory complications like lophomoniasis. This condition is critical to address in the management of SLE patients, who are immunosuppressed due to the disease's nature and its treatment.