Systemic Lupus Erythromatosus Research Articles

Glomerulonephritis as a renal manifestation in a patient with systemic sclerosis overlapped with anti-neutrophil cytoplasmic antibody-associated vasculitis

Introduction and Importance: Systemic sclerosis (SSc) is a systemic immune disorder that may overlap with other rheumatologic disease; however, overlapping with antineutrophil cytoplasmic antibody-associated vasculitis is rare. Case Presentation: A 28-year-old Syrian male patient with SSc diagnosed according to the American College of Rheumatology/European League against Rheumatism 2013 criteria with a disease duration of 4 years, was admitted to the hospital complaining of palpable purpura in the lower limbs and hemoptysis and later, a rise in creatinine level. Laboratory tests showed high levels of perinuclear antineutrophil cytoplasmic antibodies (p-ANCA). The renal biopsy results were consistent with the diagnosis of glomerulonephritis. He was treated with methylprednisolone, cyclophosphamide, and rituximab, as he was diagnosed with SSc overlapping antineutrophil cytoplasmic antibody-associated vasculitis. Clinical Discussion: SSc most commonly renal manifestations are proliferative vasculopathy leading to scleroderma renal crisis. However, other types of renal involvement were also reported in SSc patients with comorbid autoimmune diseases such as glomerulonephritis and signs of concurrent vasculitis. SSc may overlap with rheumatoid arthritis, systemic lupus erythromatosus, polymyositis/dermatomyositis (PM/DM), and Sjogren Syndrome. Overlapping with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is mentioned in rare cases. The authors reported a rare case of overlapping SSc with antineutrophil cytoplasmic antibody-associated vasculitis with renal involvement. Conclusion: The authors revealed a rare case of overlapping SSc with antineutrophil cytoplasmic antibody-associated vasculitis with renal involvement. In SSc, renal involvement as glomerulonephritis is infrequent and should be detect in other rheumatologic disease such as systemic lupus erythematosus or antineutrophil cytoplasmic antibody-associated vasculitis.

SJÖGREN SENDROMU İLE BAZI GEN POLİMORFİZMLERİ ARASINDAKİ OLASI BAĞLANTILAR

Objective: Sjögren’s syndrome is a complex and widespread autoimmune disease whose pathogenesis is not fully elucidated and environmental and genetic factors affect the development of the disease. In order to reveal the effect of genetic contribution, studies have been conducted on the genes previously shown to play a role in other autoimmune diseases such as systemic lupus erythromatosus. In addition, two GWAS studies were conducted to investigate the role of more genes in the disease by screening the entire genome and the relationship of previously unknown genes with SS was shown. Result and Discussion: Studies are being conducted with spontaneous and genetically modified animal models in order to better reveal the relationship between SS and genes and to reinforce the data obtained from humans. In this study, the relationship between the genes previously studied in other autoimmune diseases and the genes associated with SS in GWAS studies and the possible pathways that may contribute to the pathogenesis of the disease through related genes were investigated.

Study of LRRK2 and Beclin-1: Gene expression as autophagic markers in systemic lupus Erythromatosus in Egyptian populations

Study of LRRK2 and Beclin-1: Gene expression as autophagic markers in systemic lupus Erythromatosus in Egyptian populations

Seasonal variation of lupus nephritis in a cohort of Egyptian patients

IntroductionSystemic lupus erythematosus is an autoimmune multisystem disease; renal affection is one of its most common manifestations. The effect of environmental factors on lupus nephritis flares is not fully understood.MethodsThis is a retrospective study that included 200 patients with lupus nephritis flares. All patients had confirmed diagnosis of lupus nephritis on histopathological examination. Lupus nephritis flares were defined by either (1) nephritic flare: defined as increased proteinuria or serum creatinine concentration; abnormal urinary sediment or a reduction in creatinine clearance, or (2) proteinuria flare defined as persistent increase in proteinuria > 0.5–1.0 g/day after achieving complete remission; doubling to > 1 g/day after achieving partial remission. The time of renal flare (month of the year) was recorded to determine the effect of seasonal variation on lupus nephritis flares.ResultsThe median age for the patients was 33 years (IQR = 13); 92% of patients were females. The median duration of lupus was 7 years (IQR = 6). The median serum creatinine was 1.4 mg/dl, median serum urea level was 32, and median UPCR was 2.4 gm/dl. The highest incidence of flares occurred in June (14%) and July (12.5%) (p = 0.003).ConclusionSeasonal pattern of LN flare was observed in our study in Egyptian cohort of patients, with most flares observed during meteorological summertime. Larger studies are needed to confirm this seasonal pattern.Key Points• Flares of lupus nephritis are common in patients with systemic lupus erythromatosus.• A seasonal pattern of flares of lupus nephritis was observed in our study. This seasonal pattern has been observed by previous studies in variable ethnicities and variable climatic circumstances.

Estimation of Serum Adenosine Deaminase-2 (ADA2) as One of the Non- Invasive Diagnostic Marker of Pleural Effusion in Systemic Lupus Erythromatosus

Background: Systemic Lupus Erythromatosus (SLE) is an autoimmune disorder which disturbs the normal life of human due to involvement of different vital organs like bones, lungs, heart & kidney etc. A pleural effusion is one of the most common complications associated with lung involvement in young female patients with SLE. Pleural fluid examination is the main method for diagnosis, but lack of trained people and limited resources necessitate evaluating the non-invasive cheap method. Objective: To estimate the serum ADA2 level as one of non invasive marker for the diagnostic tool of pleural effusion in SLE Methodology: There were 29 female cases of SLE diagnosed in different remote areas of Pakistan divided into two groups: group-I contained 16 diagnosed cases of SLE without pulmonary involvement, and group-II contained 13 diagnosed cases of SLE with pleural effusion. The serum ADA2 level was estimated by using the ELISA method by using sandwich technology in conjunction with the ELISA method. In order to conduct the statistical analysis of the data, SPSS version 22 was used to apply an independent Student t-test. Results: The mean serum ADA2 of group-I was 15.1 ± 2.14 U/L while mean value of serum ADA2 of group-II was 11.13 ± 1.76 U/L. There was statistical (p<0.05) decreased level of serum ADA2 in patients of group-II patients with compared the patients of group-I patients. Conclusion: Serum ADA2 level in the serum may be one of diagnostic marker for the diagnosis of pleural effusion in the patients of SLE Keywords: SLE , Pleural Effusion, ADA Enzyme, ADA2,

Effect of training on health outcome including fatigue, depression and quality of life in patients with systemic lupus erythromatosus

BackgroundSystemic lupus erythematosus is an inflammatory condition that causes significant tissue damage and inflammation, and is more common in women. Despite the fact that medical treatment seeks to prevent flare-ups and organ damage, up to 50% of patients believe their wellbeing is suboptimal due to unmet needs like exhaustion and pain. The aim of the new systemic lupus erythematosus treatment guidelines is to improve people's quality of life. In people with systemic lupus erythematosus, fatigue is associated with reduced health, exercise capacity, muscle strength, and impairment. The aim of the study is to compare the effects of strengthening exercise on fatigue, depression, and quality of life in patients with systemic lupus erythematosus compared to the control sedentary group. This study included 20 patients with systemic lupus erythematosus from the department of internal medicine, compared to 25 control patients. Both groups had been treated with strengthening exercises for three months. Self-rating depression scale, quality of life questioner, fatigue severity scale, 6 min’ walk test, 2 min step test and body mass index (BMI). All parameters were measured before and after 3 months of treatment.ResultsAnalysis of data showed that systemic lupus erythematosus has more depression and fatigue than sedentary control. After exercises, both groups have a significant difference between pre and post treatment, but still have a difference between both groups. Both groups have a significant difference between pre and post treatment in 6-min walk test, 2-min step test, and quality of life measured by SF-36. No significant difference was found between both groups pre and post treatment in BMI, although each group has a significant difference between pre and post treatment BMI.ConclusionsExercises are very important in the management of systemic lupus erythematosus. They help to decrease fatigue, depression, and improve quality of life.

The Association between Silent Mating Type Information Regulator 2 Homolog 1 (SIRT1) Gene Polymorphism and Systemic Lupus Erythromatosis (SLE)

ABSTRACT Background Systemic lupus erythematosus (SLE) is a chronic severe multisystem autoimmune disease that affects multiple organs being characterized by heterogeneous manifestations that may affect the skin, joint, heart, brain, kidney, hematopoietic and central nervous systems. It is characterized by autoantibody production for a variety of self-antigens, but it is specifically associated with anti-double stranded DNA (anti-dsDNA), and immune complex deposition. The Silent Mating Type Information Regulator 2 Homolog 1 (SIRT1) is a NAD-dependent deacetylase enzyme that plays an important role in regulating a variety of cellular processes, such as energy metabolism, cell-cycle progression, apoptosis, aging, immune system regulation and inflammation. Aim of the Work The aim of the present study is to investigate the association of SIRT1 rs3758391 gene polymorphism with SLE and to study its impact on disease progression to lupus nephritis. Subjects and Methods This is a case control study conducted at Ain Shams University Hospital, with a total of 50 participants including 34 patients diagnosed with SLE in addition to 16 age and sex matched individuals serving as a healthy control group. Results The results revealed no significant difference between the SLE patients and the controls as regards CC, CT and TT genotypes, yet there was a statistical significant difference between both groups as regards the C and T alleles. Conclusion The present study highlights that SIRT1 gene rs3753891 does not seem to influence lupus nephritis susceptibility and disease activity as indicated by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scoring. However, T allele may be a risk factor for lupus susceptibility.

ASSESSMENT THE ROLE OF URINE OSTEOPROTEGERIN AS A BIOMARKER IN LUPUS NEPHRITIS

Background: Urinary biomarkers may help in identification and assessment of the activity of lupus nephritis (LN).Urinary osteoprotegerin may reflect renal disease activity better. Objective: To investigate urinary osteoprotegerin level as a potential marker of lupus nephritis activity. Patients and Methods: The study included 90 individuals classified into three equal groups: Group (I): clinically and laboratory free, Group (II): patients without renal involvement (non active renal group) and Group (III): patients with active lupus nephritis. Measurement of the level of urinary osteoprotegerin has been done by ELISA from January 2018 till June 2019. Results: All patients with systemic lupus erythromatosus SLE in group II and III had significant higher levels in urinary Osteoprotegerin compared to the control group (I). Moreover, SLE patients with lupus nephritis activity (Group III) had marked increase in urinary osteoprotegerin more than SLE patients without renal involvement (Group II). The study showed also that, with advance of renal histopathological class in lupus nephritis patients, the urine OPG level showed more increase. Conclusion: Urinary level of osteoprotegerin may be used as a biomarker for early prediction of lupus nephritis. Also, it may be used for monitoring the progression and follow up of lupus nephritis as well as with shifting from one class to another.

Kikuchi Fujimoto as an Initial Presentation of Systemic Lupus Erythromatosis


 
 
 
 Kikuchi-Fujimoto Disease (KFD) is a rare benign, condition of necrotising histiocytic lymphadenitis. In this case report, we discuss a case of 10 year old male patient who presented with a fever, rash and generalised lymphadenopathy that was not attributable to the more common causes. Axillary lymph node biopsy confirmed the diagnosis of KFD. Treatment with prednisolone improved his symptoms but after six months he had recurrence of his symptoms. He was investigated again and finally met diagnostic criteria for SLE. This case report highlights importance of close follow up in a child with KFD.
 
 
 

Role of Direct Immunofluorescence Microscopy in Spectrum of Diffuse Proliferative Glomerulonephritis: A Single-Center Study.

Introduction:Immunofluorescence (IF) microscopy is an essential tool for the analysis of glomerular diseases. In this study, we studied the significance of the IF technique together with light microscopy (LM) and clinical details in the diagnosis of different types of diffuse proliferative glomerulonephritis (GN). We intended to evaluate the spectrum of Diffuse Proliferative Glomerulonephritis (DPGN) in our institute.Materials and Methods:We evaluated a total of 95 kidney biopsies received in the past 10 years. All biopsies were scrutinized by LM and IF techniques. Clinical details were documented in a predesigned form.Results:The predominant clinical presentation in this study was nephrotic syndrome (49.4%) followed by systemic lupus erythromatosus with suspected renal involvement (24.2%). On microscopy, lupus nephritis (LN) was the most common DPGN in the study (35.7%), followed by immunoglobulin (Ig) A nephropathy (25.2%) and postinfectious GN (PIGN) (16.8%). The majority of patients were in the <30 years age group (72.6%), with the average age of patients being 24.4 years. The dominant deposit on IF in LN was C3 and IgG (100%). A high deposit of IgA (100%) in IgA nephropathy and of IgG and C3 (100%) in membranoproliferative GN was seen. PIGN showed dominant positive staining of IgG (92.8%).Conclusion:The predominant clinical presentation was of nephrotic syndrome and on LM LN was the most commonly diagnosed DPGN in this study. Direct IF is vital for classifying DPGN, followed by electron microscopy, which is an essential tool. This article describes a rational evaluation of kidney biopsies with DPGN pattern on LM in a way that guides toward the logical assessment to reach the diagnosis. Using the IF technique and comparing it with LM and clinical details, we evaluated the spectrum DPGN in our center.

Impact of an Education Program on Self-Care Agency and Self-Rated Abilities among Patients with Systemic Lupus Erythromatosis

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease with potential variety and severity of manifestations and unpredictable course present challenges and repercussions in all arenas of life. The aim of the current study was to evaluate the impact of education program on self-care agency and self-Rated abilities among patients with systemic lupus erythromatosis at Mansoura university hospital. A quasi experimental research design was utilized. Setting, the study was conducted at Rheumatology and Immunology outpatient clinic at Mansoura University Hospital, Egypt. A purposeful sample consisting of all patients with Systemic Lupus Erythematosus (SLE) without any organ damage who registered at the rheumatology and immunology unit during the period of the beginning of August 2019 to end of December 2019. Three tools were used in data collection; a structured interviewing questionnaire, Self -Rated Abilities for Health Practices Scale (SRAHP), and Exercise Self Care Agency scale. Results, revealed that one third of studied subjects fall in age group from 30-40 years old, most of them were female and more than half of them were married in addition to more than two fourth of patients had disease for more than 4 years. Related to educational program there were positive impact on self-rated abilities for health practices and self-care agency after implementation of the education program. Conclusion Application of the education program through Self-care interventions has positive impact on improving self-care agency (SCA) and self-rated abilities for health practices that permitting patients to integrate mutually social support and self-care activities. Recommendation; Continuous education programs for patient with systemic lupus erythematosus in order to improve their health status, independence and self-care activities, and replication and expanded studies are also needed.

Mechanistic Paradigms of Natural Plant Metabolites as Remedial Candidates for Systemic Lupus Erythromatosus.

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder involving a dysregulated immune response which ultimately leads to multiple organ failure. Several immunological and cellular checkpoints are available as drug targets. However, the available chemosynthetic drugs such as non-steroidal anti-inflammatory drugs and corticosteroids provide limited therapy with extreme toxicities. Moreover, the disease heterogeneity in SLE is very difficult to manage by a single drug component. Hence, it is imperative to utilize the holistic capabilities of natural plant products as immunomodulators and intracellular signaling regulators, thereby providing an auxiliary option of treatment. Additionally, the herbal drugs also serve as symptomatic relief providers, thereby serving as a prophylactic remedy in case of cerebrovascular, hepatic, nephropathological, hematological, cardiopulmonary, mucocutaneous and musculoskeletal manifestations of SLE. The present review attempts to showcase the current state of knowledge regarding the utility of plant-derived phyto-metabolites with their probable mechanistic roles in treating SLE, by means of targeting the signaling cascade, proinflammatory cytokine production and B–T cell co-stimulation. It is hoped that further preclinical and clinical studies will be embarked upon in order to understand the underlying therapeutic and mechanistic aspects of these medicinal herbs.

Evaluation of Risk of Premalignant and Malignant Changes of the Cervix in Systemic lupus Erythromatosis Patients

Introduction: Cervical cancer is the second most common malignancy among women all over the world and a leading cause of death in females. There are known risk factors in this regard including immunosuppression condition like SLE. Screening of women could decrease the incidence of cervical cancer dramatically by detection of early premalignant changes in the tissue. There was significant debate as female with SLE did in fact have an increased risk of cancer compared to the general population. Our study was conducted to determine the prevalence of abnormal cervical smear and colposcopy finding in patients with SLE. Patients and methods: Our study was carried out on 128 participants (64 SLE patients and 64 apparently healthy individuals as a control group). Patients were recruited from Rheumatology, Obstetrics and Gynecology Department of Armed Forces Hospitals of South Region. Gazan, KSA. The study was explained to all patients and informed consent was obtained before enrollment in the study. All patients underwent thorough complete history taking, clinical evaluation, local and bimanual examination, speculum examination with pap smear intake, colposcopy examination to whom have abnormal pap smear patients with suspicious area, multiple biopsies where be taken for histopathologic examination. Results: The results of our study demonstrated that, there is a significant association between cervical cancer and SLE patients (p=0.034). There is a significant association between ASCUS (Atypical squamous cells of undetermined significance) with younger age of marriage (p=0.019) and shorter duration of SLE (0.014). There is a significant association between cervical cancer with coital bleeding and history of cervical lesion (p=0.003). There is a high significant association between cervical cancer (especially ASCUS and CIN II) with passive smoking. Other examined parameters did not show any significant association (p&gt;0.05).

Structural Retinal Assessment Using Optical Coherence Tomography and Fundus Fluorescein Angiography in Systemic Lupus Erythematosus Patients.

Ocular manifestations in systemic lupus erythematosus (SLE) can be the presenting symptom of the disease or a sight-threatening complication. To detect different structural retinal changes in patients with SLE who had no ophthalmological symptoms and investigate the relationship between different retinal changes and the disease activity assessed by the Systemic Lupus Erythromatosus Disease Activity Index score. A descriptive pilot study from January 2016 to January 2017. Fifty-two eyes of 26 patients diagnosed to have SLE were examined using visual acuity assessment, fundus examination, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA). Fundus fluorescein angiography showed different changes in the form of venular occlusion and optic nerve leakage. There were also degenerative changes in the form of alternating hyperfluorescent and hypofluorescent areas outside the arcades as well as peripapillary areas and capillary dropout. Optical coherence tomography detected signs of degenerative thinning, incomplete posterior vitreous detachment, and epiretinal membrane. A significant correlation was found between SLE activity and the changes detected by FFA (p = 0.017). However, there was no significant correlation between disease activity and changes detected by OCT. Optical coherence tomography changes were significantly correlated with the duration of hydroxychloroquine use of more than 5 years (p = 0.032). There was no correlation between FFA or OCT changes and proteinuria or antiphospholipid antibodies. Fundus fluorescein angiography is more sensitive in detecting early subclinical retinal changes in patients with SLE, which correlates with disease activity, whereas OCT is more sensitive in detecting changes resulting from hydroxychloroquine use.

Study of connective tissue disease-associated pulmonary hypertension

BackgroundScreening for pulmonary arterial hypertension (PAH), a leading cause of death in systemic sclerosis, facilitates earlier treatment. The aim of this work was to study connective tissue disease (CTD)-associated PAH guided by ‘DETECT’ algorithm.Patients and methodsThis study was a prospective cross-sectional study conducted on 30 patients with CTDs, including 16 cases with systemic sclerosis, nine cases with systemic lupus erythromatosis, and five cases with rheumatoid arthritis.ResultsAccording to right heart catheterization finding, estimated total sensitivity and specificity of step 1 and step 2 in diagnosis of PAH among all cases were 80 and 64%, respectively.ConclusionThe novel, evidence-based DETECT algorithm for PAH detection in CTDs is a sensitive, noninvasive tool and addresses resource usage.

Effect of biological agents on B-lymphocyte subpopulations in patients with systemic lupus erythematosus

Objective : to evaluate the effect of different biological agents (BAs), including rituximab (RTM) and belimumab (BLM) combination therapy, on B-lymphocyte subpopulations during a follow-up of patients with systemic lupus erythematosus (SLE). Patients and methods . The investigation enrolled 64 patients with a verified diagnosis of SLE with high and moderate disease activities according to the Systemic Lupus Erythromatosus Disease Activity Index (SLEDAI)-2K scores; 47patients of them took RTM, 10 used BLM, and 7 received RTM + BLM combination therapy. Peripheral blood B-lymphocyte subpopulations were measured by multicolor flow cytofluorom-etry, using a panel of monoclonal antibodies to B-lymphocyte surface membrane markers. The results were assessed using the SLEDAI-2K scores and the British Isles Lupus Assessment Group (BILAG) index. Results and discussion . RTM therapy led to a marked decrease in major B-lymphocyte populations, the residual cells being naXve B-cells and different memory B cell populations, the percentage of which depended on the degree of depletion after a RTM cycle. Incomplete B-lymphocyte depletion was associated with the large baseline numbers of plasma cells (PCs) (&gt;0.2%). One year after initiation of therapy, the percentage ratio of B-lymphocyte subpopulations returned almost completely to baseline values, except the whole memory B-cellpopulation. BLM therapy resulted in a decrease in PCs and plasmablasts (PBs) to the point of their complete depletion. There were reductions in total CD19+ B-lym-phocytes and naive B lymphocytes. The use of the combination of BAs permitted the monitoring of the total B-lymphocyte population; its slower recovery was seen in patients with its complete depletion after a rituximab cycle. The therapy promoted maintenance of low concentrations of PCs and PBs, total memory B-cell and naive B-cell populations. Conclusion. In patients with SLE, all the three therapy with BAs demonstrated a good efficiency manifested by a decrease in clinical and laboratory disease activity. The found time course of changes in B-lymphocyte subpopulations can be used for the selection of therapy and for the evaluation of its efficacy.

Quality of Life in Patients with Systemic Lupus Erythematosus

Introduction: Systemic lupus erythematosus (SLE) is a chronic disease that results in variable and occasionally life-threatening manifestations. persons with SLE may experience a wide range of physical, psychological and social problems that affect quality of life. Aim of the work: Assess quality of life in the patients suffering from systemic lupus erythromatosus. Patients and Methods:The study was conducted on forty patients, with systemic lupus erythematosus [32 females (80%) and 8 males (20%)] and forty healthy adults of matched age and sex, as control group [30 female (80%) and 10 males (20%)]. The patients selected from the rheumatology outpatient clinic of Sohag University hospital. An informed written consent had been taken from all patients. Results: The increase in the disease activity, as assessed bysystemic lupus erythematosus disease activity index (SLEDAI) was significantly associated with more impaired quality of life as assessed by SF-36 and systemic lupus erythematosus quality of life questionnaire (SLEQOL). Conclusion:SLE patients have more significantly impaired quality of life, as assessed by short form-36(SF-36), and systemic lupus erythematosus quality of life questionnaire (SLEQOL) than the controls.

Detection of Urinary CD4TCell in Patients with Lupus Nephritis during Activity and Treatment period

Background: Renal involvement is common in Systemic Lupus Erythromatosis (SLE) and is a significant cause of morbidity and mortality. It is estimated that as many as 90% of patients with SLE will have pathologic evidence of renal involvement on biopsy, but clinically significant nephritis will develop in only 50%. The clinical presentation of lupus nephritis is highly variable, ranging from asymptomatic hematuria and/or proteinuria, to frank nephrotic syndrome, to rapidly progressive glomerulonephritis with loss of renal function. Lupus nephritis typically develops within the first 36 months of the disease, although there are exceptions. Aim of the Work: The aim of this work was to study the level of urinary CD4 T cell and monitor the treatment in lupus nephritis patients. Patients and Methods: The ethical approval was obtained from the hospital ethical research committee and each patient participated in the study signed an informed consent.The present study was conducted on seventy-five female subjects, their age ranged from 20 to 40 years. They were divided into 3 groups a- 25 patients knowns as SLE with lupus nephritis, b- 25 SLE patients without lupus nephritis, c-25 normal control subjects. They were recruited from Physical Medicine, Rheumatology and Rehabilitation department of Sayed Jalal and Al-Hussein Al-Azhar University Hospitals, during the period from October 2013 to October 2017. Results: Urinary CD4 markedly decreased after treatment of lupus nephritis. Conclusion: Urinary CD4 T-cells marker has a valuable role in detecting LN in SLE patients and has a significant correlation with disease activity index. Significant Positive correlation was found between Cd4 t-cell and SLEDAI in before and after treatment.Significant positive correlation was detected with 24hr urine protein, SLEDAI, PGA, while Platelet, ESR and C3 significant and negative correlation in post treatment.Monitoring urinary CD4 T-cells may help to identify treatment responders and treatment failure and enable patient-tailored therapy in the future.

Purtscher-like retinopathy as presenting manifestation of systemic lupus erythromatosus following high-grade fever with myalgia and arthralgia

Purtscher-like retinopathy as presenting manifestation of systemic lupus erythromatosus following high-grade fever with myalgia and arthralgia

Contributing factors and effects on health-related quality of life in patients with systemic lupus erythromatosus complaining of sleep disturbances

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organs and systems. Studies with subjective sleep measures have shown that SLE patients have poor sleep quality. This study evaluates sleep quality and its contributors in women with SLE. Methodology: Sleep quality was assessed in 50 women with SLE using the Pittsburgh Sleep Quality Index (PSQI). Disease activity and cumulative disease damage were assessed with standard indices. Patients answered the hospital anxiety and depression scale and lupus quality of life (QoL). Univariate and multivariate analyses were performed to find contributors of poor sleep quality and association of sleep quality with HRQoL by electrolyte imbalance analysis and brain MRI. Results: Sleep quality was poor in 90% of our SLE patients. Compared with the general population, patients had higher frequency of poor sleep quality than the general population and also higher scores in most of the PSQI components, except sleep latency and daytime dysfunction due to sleepiness. Conclusion: Sleep quality disturbances are common in women with SLE and significantly impair their QoL. Age, disease activity, and anxiety/depression were significant determinants of sleep quality in our study. Psychological factors are major contributors to poor sleep quality in SLE patients, which highlights the need for having a bio psychosocial approach toward the management of sleep problems in these patients. Studies with objective sleep measures, prospective studies, as well as interventional studies, are warranted in this regard.