Systemic Lupus Erythematous Patients Research Articles

Area-Level Predictors of Medication Nonadherence Among US Medicaid Beneficiaries With Lupus: A Multilevel Study.

Adherence to hydroxychloroquine (HCQ) treatment in patients with systemic lupus erythematous (SLE) is suboptimal. Although individual-level factors, including younger age and non-white race/ethnicity, have been implicated, contextual factors have not been explored. The aim of this study was to investigate the effect of contextual factors, including racial composition, socioeconomic status, and the concentration of health care resources, on adherence to HCQ among SLE patients enrolled in Medicaid. We identified SLE patients from 28 states in the US who enrolled in Medicaid (2000-2010) and in whom HCQ treatment was newly initiated (no use for ≥6 months). We required 12 months of continuous enrollment with complete drug dispensing data and measured adherence using the proportion of days covered (PDC). We identified individual-level variables from Medicaid, zip code-level, county-level and state-level sociodemographic variables from the American Community Survey, and health resources from Area Health Resources Files. We used 4-level hierarchical multivariable logistic regression models to examine the odds ratios (ORs) and 95% credible intervals (95% CrIs) of adherence (PDC ≥80%) versus nonadherence. Among 10,268 patients with SLE in whom HCQ treatment was initiated, 15% were adherent to treatment. After we adjusted for individual-level characteristics, we observed lower odds of adherence among patients living in zip code areas with a higher percentage of black individuals (highest tertile OR 0.81 [95% CrI 0.69-0.96] versus lowest tertile). This association persisted after controlling for area-level educational attainment, percent below federal poverty level (FPL), urbanicity, and health care resources. We did not observe statistically significant associations with zip code-level percent Hispanic, percent white, education, or percent below FPL. The odds of adherence were higher in counties with more hospitals (OR 1.30 [95% CrI 1.07-1.58]). Among Medicaid beneficiaries with SLE, we observed significant effects of racial composition and hospital concentration on HCQ adherence. Interventions that acknowledge and address contextual factors should be considered in order to reduce high rates of nonadherence in vulnerable populations.

Epidemiology of Depression in Rheumatoid Arthritis, Systemic Lupus Erythematosus, and Systemic Sclerosis

Background: Depression is a major disabling factor around the world. Most of the mental disorders immediately affect the inner mood and cognitive aspect of individuals. Therefore, hiding the depression can delay the early diagnosis and, consequently, a proper treatment in the patients. Objectives: We designed the study to determine the association between rheumatoid diseases and depression. Methods: This is a descriptive - analytic study which was performed on 354 patients referred to Rheumatology Clinic of Ahvaz, a province in south west of Iran in 2016. Then demographic information, depression, quality of life and social support were completed based on standardized questionnaires filled by the patients. Results: The prevalence of depression in rheumatoid arthritis (RA), systemic lupus erythematous (SLE) and systemic sclerosis (SSc) patients was 61.63%, 73.52% and 60%, respectively. There is a meaningful relationship between depression, age and duration of disease in SSc patients. There is a significant relationship between depression and gender in SLE and RA patients. There is a significant relationship between depression and the degree of education of SLE patients. There is a meaningful relationship between depression and quality of life, social support and corticosteroid consumption. Conclusions: The prevalence of depression is very high in all three diseases, which is equal in terms of quality of life, social support and corticosteroid usage in all three diseases. Psychiatric disorders such as depression are common in rheumatic patients.

B7-H3 modulates endothelial cell angiogenesis through the VEGF cytokine.

B7-H3 is a cell surface molecule in the immunoglobulin superfamily that has been shown to perform both immunological and non-immunological functions. It has also been found that vascular endothelial growth factor (VEGF) is an important molecule in the modulation of endothelial cell behavior. In this study, we analyzed the serum expression of B7-H3 in 113 rheumatoid arthritis and systemic lupus erythematous patients using the ELISA and found a positive correlation between B7-H3 and VEGF. Next, we investigated the involvement of B7-H3 in angiogenesis using human umbilical vein endothelial cells (HUVECs) with transient knockdown of B7-H3 and an in vivo Matrigel model. Data from the in vitro experiments showed that B7-H3 increased cell proliferation, migration, and tube formation, and correlated with the expression of VEGF. Furthermore, B7-H3 affected the formation of functional vascular networks in Matrigel plugs, which were dissected from mice injected with different HUVECs. Our data suggest that B7-H3 promotes angiogenesis through the enhancement of VEGF secretion. This is the first study proposing a significant role for B7-H3 in the promotion of angiogenesis and may provide further understanding of this gene's biological function.

The Predictive Value of Autoantibody Spectrum on Organ Damage in Patients With Systemic Lupus Erythematosus.

This study aims to investigate the positive detection rate and predictive value of autoantibodies, including anti-double stranded deoxyribonucleic acid (anti-dsDNA) antibodies, anti-histone antibodies (AHAs), anti-ribosomal (anti-Rib) P antibodies, anti-Smith (anti-Sm) antibodies, anti-U1 ribonucleoprotein (anti-U1RNP) antibodies, anti-Sjögren's syndrome type A antibodies and anti-Sjögren's syndrome type B antibodies, on organ damage in patients with systemic lupus erythematous (SLE). A total of 225 patients with SLE (37 males, 188 females; mean age 37.4±15.9 years; range, 7 to 80 years) were evaluated retrospectively. Statistical analysis was performed to obtain the positive detection rate of autoantibodies and to investigate the predictive value. There were statistically significant differences of positive anti-dsDNA antibodies in renal damage, photosensitization, hematological abnormalities and serositis (p<0.05) and a statistically significant difference of positive AHAs in photosensitization (p<0.05). There was statistically significant difference of positive anti-U1RNP antibodies in renal damage (p<0.05). There were also statistically significant differences of positive anti-Smith antibodies in renal damage, arthritis, photosensitization, oral ulcers, hematological abnormalities and serositis (p<0.05) and of positive anti-Rib antibodies in renal damage, arthritis, photosensitization, malar rash, hematological abnormalities and serositis (p<0.05). However, there were no statistically significant differences of positive anti-Sjögren's syndrome type B antibodies and anti-Sjögren's syndrome type A antibodies in renal damage, arthritis, malar rash, neuropsychiatric disorders, hematological abnormalities and serositis (p>0.05). Autoantibody spectrum is an important serological basis for SLE diagnosis. There are differences in the autoantibodies distribution of SLE patients with different organ damage, suggesting a certain clinical value for prediction of organ damage in SLE.

Assessing the relative impact of lupus nephritis on mortality in a population-based systemic lupus erythematosus cohort.

There is limited knowledge on the relative impact of lupus nephritis (LN) on morbidity and mortality in population-based systemic lupus erythematous (SLE) cohorts. Here, the primary aim was to compare mortality rates between patients with and without LN in a population-based SLE cohort. The study cohort included all SLE patients resident in the city of Oslo during 1999-2008. Follow-up time was median 14 (0-15) years. Presence of LN was defined according to the 1987 American College of Rheumatology classification criteria for SLE. LN class was determined by renal biopsy. Data on kidney function, including presence of end-stage renal disease (ESRD), were obtained from patient charts. Standardized mortality ratios (SMRs) were estimated by comparing deaths in the SLE cohort with age- and gender-matched population controls. We found that 98/325 SLE patients (30%) developed LN, 92% of whom had occurrence within the first five years from disease onset. Incidence rate of ESRD was 2.3 per 1000 patient-years. A total of 56 deaths occurred during the study period, corresponding to an overall SMR in the SLE cohort of 2.1 (95% confidence interval (CI) 1.2-3.4). Estimated SMR for LN patients was 3.8 (95% CI 2.1-6.2), and for SLE patients without LN it was 1.7 (95% CI 0.9-2.7). In this population-based SLE cohort, we found that LN was associated with increased morbidity and mortality, whereas SLE patients who did not develop LN had good overall prognoses regarding survival.

A single infection with a malaria parasite protects mice from lethal autoimmune glomerulonephritis

Abstract The progression of autoimmune diseases such as Systemic Lupus Erythematous (SLE) can be altered by environmental factors, including parasitic infections. Epidemiological studies have shown a relative absence of SLE in West Africa (areas of endemic malaria), even though SLE is highly prevalent in populations of African descent living outside of Africa. We hypothesize that malaria infections might reduce the incidence of lupus. In the present work, we assess the effect of the non-lethal Plasmodium yoelii 17XNL in a well-characterized animal model of SLE (FcγRIIB−/−). Mice deficient in the inhibitory Fc receptor for IgG (FcγRIIB) develop spontaneous disease driven by the production of anti-nuclear autoantibodies, a broad immune activation, splenomegaly, anemia and lethal glomerulonephritis with a pathology similar to human SLE. We infected FcγRIIB−/− mice at 2 months of age with P. yoelii and followed the progression of autoimmune disease for 5 months. Infection with P. yoelii increased the titer of a broad range of autoantibodies, with concomitant immune-complex deposition and complement fixation in the kidney. While lupus-prone mice succumbed from renal disease detected by protein in urine, malaria-infected lupus-prone mice did not develop proteinuria or lethal disease. Infection with the parasite did not alter tolerance mechanisms leading to lupus but instead prevented end-point tissue pathology. P. yoelii infection seems to inhibit pathogenic leukocyte infiltration without affecting the autoimmune inflammation of glomeruli. These results indicate a possible route for lupus protection that specifically targets renal function, which remains a cause of the substantial morbidity and mortality in SLE patients.

Carotid artery atherosclerosis and ECG changes in patients with systemic lupus erythematosus: relation to disease activity and severity

AimThis study aimed to detect atherosclerotic changes in the carotid arteries of systemic lupus erythematous (SLE) patients as an indicator of cardiovascular risk factors and to correlate the findings with disease severity and activity parameters as well as to study specific ECG changes in these patients to elucidate possible associations between these variables.Patients and methodsThis study included 30 SLE patients who met the Systemic Lupus International Collaborating Clinics (SLICC) criteria (group I), 30 rheumatoid arthritis (RA) patients diagnosed according to the American College of Rheumatology/European league against rheumatism (EULAR) 2010 criteria (group II), and 30 apparently healthy volunteers age and sex matched to the SLE patients’ group (group III). All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity using the Systemic Lupus Erythematous Disease Activity Index (2 K) score and assessment of damage by the SLICC/American College of Rheumatology Damage Index (SDI). Laboratory investigations included: complete blood count, erythrocyte sedimentation rate, lipid profile, immunological profile (antinuclear antibodies, anti-double-stranded DNA antibody, anticardiolipin antibody, and complements C3 and C4). The right common carotid artery was scanned by ultrasound and the average of carotid intima media thickness (CIMT) was calculated (mean of four readings) for all participants participating in the study. ECG was also done for all participants.ResultsThe mean CIMT was higher in RA patients (0.71±0.194 mm) with a nonsignificant difference compared with SLE patients (0.68±0.197 mm) and a high statistically significant difference (P<0.001) compared with healthy controls (0.34±0.09 mm). There was no statistically significant correlation of the mean CIMT (mm) with SLICC damage index (P=0.09) and disease activity score (P>0.05). Abnormal ECG findings were observed in 3/30 SLE patients (10%), 10/30 RA patients (33.3%), and one/30 healthy control (3.3%), with statistically significant difference (P<0.03) among groups. The presence or absence of abnormal ECG findings showed statistically insignificant differences regarding patients’ disease activity and mean CIMT.ConclusionAlthough ECG changes were present in 10% of our SLE patients, association of specific ECG changes could not be confirmed. A greater prevalence of increased CIMT was observed in SLE patients, emphasizing the important role of this disease in the development of premature atherosclerosis which did not correlate with disease activity or severity parameters.

The Prognostic Nutritional Index and Nutritional Risk Index Are Associated with Disease Activity in Patients with Systemic Lupus Erythematosus.

The prognostic nutritional index (PNI), controlling nutritional status (CONUT) score and nutritional risk index (NRI) have been described as useful screening tools for patient prognosis in several diseases. The aim of this study was to examine the relationship between PNI, CONUT and NRI with clinical disease activity and damage in 173 patients with systemic lupus erythematous (SLE). Disease activity was assessed with the SLE disease activity index (SLEDAI-2K), and disease-related organ damage was assessed using the SLICC/ACR damage index (SDI) damage index. PNI and NRI were significantly lower in active SLE patients than in inactive SLE patients (p < 0.001 and p = 0.012, respectively). PNI was inversely correlated with the SLEDAI score (p < 0.001) and NRI positively correlated with SLEDAI and SDI scores (p = 0.027 and p < 0.001). Linear regression analysis adjusting for age, sex and medications showed that PNI was inversely correlated with SLEDAI (β (95% CI) = −0.176 (−0.254, −0.098), p < 0.001) and NRI positively correlated with SLEDAI (β (95% CI) = 0.056 (0.019, 0.093), p = 0.003) and SDI (β (95% CI) = 0.047 (0.031, 0.063), p < 0.001). PNI (odds ratio (OR) 0.884, 95% confidence interval (CI) 0.809–0.967, p = 0.007) and NRI ((OR) 1.067, 95% CI 1.028–1.108, p = 0.001) were independent predictors of active SLE. These findings suggest that PNI and NRI may be useful markers to identify active SLE in clinical practice.

Hsp70 Gene Polymorphisms Are Associated With Disease Susceptibility and HRQOL Improvement in Chinese Han Population With Systemic Lupus Erythematosus.

The aim of this study is to investigate whether heat shock protein 70 (Hsp70) gene polymorphisms are implicated in systemic lupus erythematous (SLE) susceptibility, the efficacy of glucocorticoids (GCs) treatment, and improvement of health-related quality of life. A total of 499 SLE patients and 499 controls were included in a case-control study, and 468 SLE patients treated with GCs for 12 weeks were involved in a follow-up study. Patients who completed the 12-week follow-up were divided into GCs-sensitive and GCs-insensitive group by using the SLE disease activity index. The SF-36 was used to evaluate the health-related quality of life of SLE patients, and genotyping was performed by improved multiplex ligation detection reaction. rs2075800 was associated with SLE susceptibility (adjusted odds ratio [ORadj], 1.437; 95% confidence interval [CI], 1.113-1.855; Padj = 0.005; PBH = 0.020 by dominant model; ORadj, 1.602; 95% CI, 1.072-2.395; Padj = 0.022; PBH = 0.029 by TT vs CC model; ORadj = 1.396; 95% CI = 1.067-1.826; Padj = 0.015; PBH = 0.029 by TC vs CC model). In the follow-up study, rs2075799 was associated with the improvement in mental health (p = 0.004, PBH = 0.044), but we failed to find any association between the efficacy of GCs and Hsp70 gene polymorphisms. Hsp70 gene polymorphisms may be associated with susceptibility to SLE and improvement of mental health in Chinese Han population.

Association of S100B polymorphisms and serum S100B with risk of systemic lupus erythematous in a Chinese population.

The aim of this study was to investigate whether the S100B polymorphisms are associated with systemic lupus erythematous (SLE) in a Chinese population. A total of 313 SLE patients and 396 control subjects were enrolled in the present study. The genotypes of three SNPs (rs9722, rs881827 and rs1051169) in S100B gene were detected by single base extension polymerase chain reaction (SBE-PCR). Serum S100B levels were determined by enzyme-linked immunosorbent assay (ELISA). Rs1051169 was associated with an increased risk of SLE (C vs. G: adjusted OR=1.46, 95% CI, 1.18-1.80, p=0.001; CC vs. GG: adjusted OR=1.99, 95% CI, 1.32-3.02, p=0.001; CC+GC vs. GG: adjusted OR=1.54, 95% CI, 1.13-2.11, p=0.007; CC vs. GC+GG: adjusted OR=1.67, 95% CI, 1.16-2.42, p=0.006). Haplotype analysis showed that the G-G-C haplotype was associated with an increased risk of SLE (OR=1.50, 95% CI, 1.14-1.98, p=0.004). Stratified analyses showed that the rs1051169 polymorphism was associated with an increased risk of neurologic disorder in SLE patients (C vs. G: OR=1.78, 95% CI, 1.22-2.59, p=0.003; GC vs. GG: OR=2.33, 95% CI, 1.14-4.77, P=0.019; CC vs. GG: OR=3.02, 95% CI, 1.39-6.53, p=0.004; CC+GC vs. GG: OR=2.57, 95% CI=1.31-5.04, p=0.005). In addition, SLE patients with neurologic disorder carrying the rs1051169 GC/CC genotypes present a higher serum S100B levels compared with that carrying the GG genotype (p < 0.05). Our results indicate that the rs1051169 polymorphism may be involved in the pathogenesis of SLE.

Clinical Manifestations of Systemic Lupus Erythematous in Children at Dr. Hasan Sadikin General Hospital Bandung, Indonesia

Background : Systemic Lupus Erythematous (SLE) is an autoimmune disease, characterized by production of autoantibodies, leading to damage caused by inflammation, directed toward multiple organs in the body. It is difficult to diagnose due to its mimicry with other diseases. The differential diagnosis of SLE is broad, including infection, malignancy and other inflammatory disorders. It is important to recognize the clinical manifestation of SLE from other possible diseases. Methods : A descriptive study was conducted on 56 SLE patientsfrom the Department of Child Health in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, in which the medical records was collected from 2010 to 2014. A total sampling method was used and incomplete records were excluded. Results : Out of the 56 subjects, 82.1% were female, with female to male ratio was 4.6:1. Most of the subjects (52%) was in the age category of 11 to 15 years old. Hematologic involvement was the most common clinical manifestation based on the diagnostic criteria (83.9%), and fever was the most common chief complaint (41.1%). Conclusions : From this study, fever, rash, and joint pain are the common chief complaints among SLE patients in children with hematologic and renal disorders are also found to occur.

Comparative Study for Pattern of Social Support among Systemic Lupus Erythematous Patients' at Out-patient Clinics, Assiut University Hospital

People with Systemic Lupus Erythematous need for social support more than others due to Systemic Lupus Erythematous' often caused severe and unpredictable symptoms; also can be affected multiple system. The study aimed to determine the pattern of Social support among Systemic Lupus Erythematous patients; also to identify the risk factors among Systemic Lupus Erythematous patients at out-patient clinics, Assiut university hospital. Patients and methods: The study was conducted in Rheumatology clinic at Assiut university hospital. The total sample size was (104); total coverage technique used in this study. Tools: Two tools were used, first tool: A structured interview questionnaire sheet which included two parts; demographic data and questions regarding risk factors and the second tool; it included Social Support Assessment scale. Results: more than half (55.8%) of patients had high level of social support after disease compared to 39.4% of them had moderate and high level of social support before disease also, Sunlight exposure was the most risk factors among Systemic Lupus Erythematous patients. Conclusion: there was statistically significant differences between total score of social support before and after disease (P value=0.001*). Recommendation: Health education about rheumatologic services for community to early detection, diagnosis and treatment.

The down-regulation of hsa_circ_0012919, the sponge for miR-125a-3p, contributes to DNA methylation of CD11a and CD70 in CD4+ T cells of systemic lupus erythematous.

Systemic lupus erythematous (SLE) is an autoimmune disease characterized by the production of autoantibodies directed against various autoantigens. But the expression profiles and functions of circular RNAs (circRNAs) in SLE are still scarce. To explore the roles of circRNA in SLE and its potential diagnostic potential in SLE. SLE patients and healthy control subjects were recruited. CD4+ T cells were isolated, circRNA microarray analysis were used to screen for circRNA candidate in CD4+ T cells. Expression of DNMT1, CD11a and CD70, and methylation level of CD11a and CD70 were detected after transfecting hsa_circ_0012919-targetted siRNA. The network analysis of hsa_circ_0012919 was used by bioinformatics. Luciferase reporter assay and fluorescence in situ hybridization (FISH) assay were used for screening for which miRNAs could bind with hsa_circ_0012919. Twelve circRNAs were up-regulated and two circRNAs were down-regulated in SLE patients group after circRNA microarray analysis. Hsa_circ_0012919 was further confirmed to be significantly different between healthy control and SLE patients (P<0.05) and associated with SLE characters (P<0.05). Down-regulation of hsa_circ_0012919 (i) increased the expression of DNMT1 and reduced the expression of CD70, CD11a, (ii) reversed the DNA hypomethylation of CD11a and CD70 in CD4+ T cells of SLE, but it could be reversed by down-regulation of DNMT1. Hsa_circ_0012919 regulated KLF13 and RANTES by miR-125a Conclusion: Hsa_circ_0012919 could be regarded as a biomarker for SLE and hsa_circ_0012919 was the competitive endogenous RNA (ceRNA) for miR-125a-3p.

Peripheral levels of brain-derived neurotrophic factor and S100B in neuropsychiatric systemic lupus erythematous

The aim of this study was to investigate serum S100B and brain-derived neurotrophic factor (BDNF) in systemic lupus erythematous (SLE) patients, with and without neuropsychiatric (NP) manifestation activity. We assessed 47 SLE patients and 20 selected healthy individuals. Disease activity was assessed according to the SLE disease activity index (SLEDAI). Serum BDNF and S100B were measured by enzyme-linked immunosorbent assay. Serum S100B protein was significantly higher in SLE patients. BDNF levels were significantly decreased in active SLE, when compared with inactive SLE, but not when compared with controls. S100B was clearly higher in the NPSLE group, when compared with the non-NPSLE or control groups. Receiver operating characteristic analysis of S100B revealed an area under the curve of 0.706 that discriminated NPSLE patients with peripheral polyneuropathy. Our findings reinforce the use of serum S100B as a biomarker in SLE, particularly for NPSLE. Moreover, we found a strong association between serum S100B and peripheral neuropathy, indicating a specific utility for this biomarker in SLE that warrants clinical investigation.

Chronic Inflammatory Demyelinating Polyneuropathy in Systemic Lupus Erythematosus: A Rare Entity

Background:Neurological manifestations in Systemic Lupus Erythematous (SLE) varies and commonly affects the Central Nervous System (CNS) rather than the peripheral nervous system. Neuropsychiatric or CNS manifestation can be as high as 24-54%, whereas the peripheral nervous system involvement is lower around 5-27%. Chronic Inflammatory Demyelinating Polyradiculopathy (CIDP) is one of the three commonest peripheral nervous system involvements in SLE patients and results with severe debilitating effects. However, it is rarely reported.Methods:A retrospective review of all SLE patients that were diagnosed with CIDP between 2000 and 2015 was done under follow up at our center that were diagnosed with CIDP between 2000 and 2015. We reviewed their medical records and analyzed their clinical presentation, investigations, treatment instituted, response to therapy and any neurological sequealae.Results:A total of 512 case notes were reviewed. Of these 4 patients presented with CIDP (3 females, 1 male) aged between 26 to 46 years old. Three presented with transverse myelitis and the other one with acute motor and sensory axonal neuropathy. All patients were treated with high dose corticosteroids, three patients received cyclophosphamide whilst the other patient was induced with mycophenolate mofetil. Complete recovery was seen in one patient, two had persistent but improving numbness and the other one had a residual weakness.Conclusion:Peripheral nervous system involvement in SLE can result in serious debilitating effects. Early diagnosis and treatment are crucial in limiting the neurological sequealae.

OR8 A novel reactivity pattern with labscreen™ class I single antigen beads and its prevalence among SLE patients

Aim Previously, a distinct class II Luminex-single antigen bead (SAB) pattern was described among patients with systemic lupus erythematous (SLE) and attributed to antibodies targeting denatured antigens. In this study, we identify and describe a novel class I reactivity pattern shared among SLE patients. Methods Routine review of serum samples from transplant patients revealed a recurring pattern of reactivity on class I single antigen bead assays (One Lambda, Inc, lot 10). The pattern included the following beads: HLA-A∗33:03, -A∗36:01, -A∗80:01, -B∗54:01, -B∗53:01, -C∗06:02, -C∗07:02, -C∗18:02, -C∗14:02, -C∗03:03, -C∗03:04, and -C∗15:02. Further investigation was performed to determine the prevalence of this pattern and the specific characteristics of patients in which it occurred. Towards this end, all class I results performed in 2017 on renal transplant candidates/recipients were reviewed retrospectively for the presence of the above pattern. Patient diagnosis and demographic data was obtained from patient laboratory and hospital records. Results In total 5,992 samples from 3,027 patients were reviewed. We observed 105 (1.8%) samples from 58 patients displaying the class I pattern. Twenty-nine percent (n = 17) of these patients had no history of sensitization (e.g. blood transfusion, pregnancy, transplant) and only 29% of samples had distinct antibodies as identified by FlowPRA testing. Of the positive samples, 83% had reactivity against self-antigen involving 1 or more of the alleles in question, with HLA-C∗07:02 being the most common target (45%). Notably, 62% of these patients had a diagnosis of SLE. Conclusions To our knowledge, this is the first description of a distinct class I Luminex-SAB pattern with a prevalence in patients with SLE. This pattern was found in patients with no sensitization history, negative FlowPRA, and/or antibody to self-antigen(s). Epitope analysis failed to reveal a common determinant(s) to explain this pattern of reactivity. Given these findings, this pattern likely represents antibody targeting denatured antigen/unique peptide, molecular mimicry, autoimmunity, or a combination of some/all these factors.

Is fatigue a cause of work disability in systemic lupus erythematosus? Results from a systematic literature review.

Fatigue affects the almost totality of Systemic Lupus Erythematous (SLE) patients impairing physical function and leading to a strong reduction of health-related quality of life (HRQoL). Similarly, SLE patients have an increased rate of work loss and work limitations. The aim of our paper was to systematically assess the relationship between fatigue and work disability in SLE. We performed a systematic review using the terms "fatigue" and "employment", "work disability", "work impairment", "presenteeism" and "absenteeism." 19 studies were identified. Fatigue was involved in the development of work loss. In employed patients, fatigue led to impairment of work productivity and presenteeism with a parallel increase of both direct and indirect health costs. Fatigue also affected parenting and household productivity. An adequate control of fatigue could improve physical and work performance in SLE patients thus reducing rates of work loss.

Red blood cell distribution width to estimate lupus activity

Objective The aim of the study was to study red blood cell distribution width (RDW) in systemic lupus erythematous (SLE) patients as a lupus activity marker. Background SLE is a multifactorial systemic autoimmune disease that can affect multiple organs. The general pathogenesis of this disease still needs a better understanding. RDW is a measure of the red blood cell size variation. Patient and methods This prospective study was carried in the Internal Medicine Department, Menoufia University Hospital, from March 2016 to August 2016. Our study included 58 patients with SLE activity, which was measured using the Systemic Lupus Erythematous Disease Activity Index. RDW was measured as one of the parameters of complete blood count. RDW was reported on the Sysmex XT. In this study we excluded any other causes of anemia and other connective tissue diseases. Results The study included 58 SLE patients: 20 systemic lupus patients with high activity and 38 systemic lupus patients with very high activity. RDW was higher in systemic lupus patients with very high activity than in systemic lupus patients with high activity. There was a highly significant correlation between RDW and Systemic Lupus Erythematous Disease Activity Index. There was a highly significant correlation between RDW and erythrocyte sedimentation rate. Conclusion There was statistically higher RDW in lupus patients with very high activity than in those with high activity; therefore, RDW can be used as a lupus activity marker. RDW was associated with the inflammatory process of SLE.

Risk of vascular access thrombosis in patients with systemic lupus erythematosus on hemodialysis.

Anticardiolipin antibody is associated with increased risk of vascular access thrombosis (VAT) in hemodialysis (HD) patients. Systemic lupus erythematous (SLE) patients have a high prevalence of anticardiolipin antibodies, but it is not clear whether these patients are at high risk of developing vascular access thrombosis. Thirty six SLE patients on HD, who had either an arterio-venous (AV) graft or AV fistula as vascular access, and were not on anticoagulation treatment, were retrospectively identified at Henry Ford Hospital. A similar number of patients without SLE, matched for age, sex, race and type of vascular access were selected as a control population. Vascular access thrombosis rate at one year was compared between two groups. Mean age at dialysis was 36+/-10 years in 36 SLE patients (28 females, 8 males) and was 38+/-6.4 years in 36 non-SLE patients (29 females, 7 males). Of all patients, 29/36 (80.5%) SLE and 27/36 (75%) non-SLE patients had AV grafts, whereas the rest had AV fistulas as vascular access (19.5% SLE and 25% non-SLE patients). Out of 36 SLE patients, 24 (66.6%) patients developed VAT at one year as compared to 14 (38.9%) patients in non-SLE group (p<0.05). The odds ratio of VAT in SLE patients was 3.1 (95% CI 1.2-8.2). SLE patients on hemodialysis are more likely to develop vascular access thrombosis as compared to non-SLE patients.

Urinary clusterin—a novel urinary biomarker associated with pediatric lupus renal histopathologic features and renal survival

Lupus nephritis (LN) is a major risk factor for systemic lupus erythematous (SLE)-related morbidity and mortality. With the aim of bypassing renal biopsy, we analyzed urinary biomarkers for their ability to predict renal histopathologic features and end-stage kidney disease (ESKD). Urinary albumin, ß2-microglobulin (B2M), cystatin C, kidney injury molecule-1 (KIM-1), monocyte chemoattractant protein 1 (MCP-1), clusterin, calbindin, interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL), trefoil factor 3 (TFF3), osteopontin, and glutathione S-transferase π (GST-π) levels were measured at time of renal biopsy. Renal histopathologies were carefully reviewed. Urine from 60 pediatric SLE cases with LN, 29 without and 22 healthy controls were collected. Median age at SLE diagnosis was 12.92years (range = 4.27-17.30years) and 10 cases progressed to ESKD during a period of 4.12±2.17years. Urinary albumin and clusterin were significantly elevated (p = 0.035 and 0.048, respectively) in patients with tubulointerstitial renal lesions. Urinary clusterin among all urinary markers, performed best at predicting ESKD with cutoff of 0.61 × 10-4 (AUC = 0.804; p = 0.002). Interestingly, elevation of urinary clusterin likely resulted from local over-expression in tubulointerstitial tissue since the level of serum clusterin was not concomitantly higher (p = 0.424). Urinary biomarkers are emerging as non-invasive indicators for lupus-related renal histopathology and renal outcome prediction in pediatric SLE patients. Urinary clusterin, a newly identified biomarker, is an indicator that shows an association with tubulointerstitial renal lesions and demonstrates the best ability to predict ESKD.