Treatment Of Systemic Lupus Erythematosus Patients Research Articles

Ovarian function in patients with systemic lupus erythematosus: Pathogenesis, drug application and prospective therapies

Ovarian function in patients with systemic lupus erythematosus: Pathogenesis, drug application and prospective therapies

Antiphospholipid Antibodies Are Major Risk Factors for Non-Thrombotic Cardiac Complications in Systemic Lupus Erythematosus.

In systemic lupus erythematosus (SLE), cardiovascular complications are among the leading causes of death. Cardiovascular risk in SLE is even higher in the presence of antiphospholipid antibodies or secondary antiphospholipid syndrome (APS). The aim of this retrospective, single-center study was to investigate the occurrence of antiphospholipid antibodies and non-thrombotic cardiac manifestations in 369 SLE patients. We also assessed the clinical and laboratory characteristics of the patients to reveal the risk factors for cardiac manifestations. Patients were divided into two groups based on the presence of antiphospholipid antibodies (APA); 258 (69.9%) patients were APA positive, and 111 (30.1%) patients were APA negative. Mitral and tricuspid insufficiency, aortic stenosis and pulmonary arterial hypertension were more common in APA-positive patients. Anticardiolipin IgG showed the strongest correlation with any non-thrombotic cardiac manifestations. Based on our results, the adjusted global antiphospholipid syndrome score (aGAPSS) above 8.5 is predictive of valvulopathies and ischemic heart disease, while aGAPSS above 9.5 is predictive of cardiomyopathies. The presence of antiphospholipid antibodies may affect the development of cardiac manifestations in SLE. Periodic cardiological and echocardiographic screening of patients without cardiac complaints, as well as regular monitoring of antiphospholipid antibodies, have great importance during the treatment of SLE patients.

2022 Chinese guideline for the management of pregnancy and reproduction in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE), a prevalent autoimmune disease predominantly affecting women of childbearing age, presents ongoing challenges despite notable advances in diagnosis and treatment. Although survival rates for SLE patients have significantly improved, pregnancy continues to pose a considerable obstacle. Addressing this critical need for enhanced reproductive and prenatal care, there is a pressing imperative to establish standardized protocols for peri-gestational monitoring and treatment in SLE patients. This guideline is jointly sponsored by the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), the Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR), and the Chinese Research Committee of Pregnancy and Reproduction in Autoimmune Rheumatic Diseases (CHOPARD). Thirteen pertinent clinical questions have been generated through several rounds of rigorous clinical and methodological expert discussions and selections for a comprehensive understanding of key aspects in this domain. Guided by thorough examination of research evidence and expert perspectives, the formulated recommendations aim to optimize pregnancy success rates, reduce maternal and infant mortality rates, and ultimately enhance the overall well-being of SLE patients.

Glucocorticoid Receptors and Disease Activity in Systemic Lupus Erythematosus Patients

Glucocorticoids (GC) have been widely used to treat patients with systemic lupus erythematosus (SLE). However, GC-insensitivity remains a major barrier in achieving remission. Therefore, understanding its mechanism is crucial to enhance the efficacy of GC treatment. Our study aimed to explore the association of the nuclear receptor subfamily 3 group C member 1 (NR3C1) gene, which encodes GC receptors GRα and GRβ, the histone deacetylase2 (HDAC2), the histone acetyltransferase-1 (HAT1), and the interleukin- 23 receptor (IL-23R), with the response to treatment in SLE patients. Methods: Quantitative real-time PCR (qPCR) was used to determine the expression levels of NR3C1 isoforms, HDAC2, HAT1, and IL23R in peripheral blood mononuclear cells (PBMC) from 30 SLE patients and 6 healthy controls (HC). Immunohistochemical (IHC) staining was used to analyze the protein expression level of GRα in 19 SLE patients’ 8 controls renal biopsies. Results: GRα mRNA expression level was associated with SLE disease (p=0.018) and correlated with the SLEDAI score (p=0,038). HDAC2 was up-regulated in patients during remission phase compared to active phase (p=0.015). The IL23R mRNA expression was associated with anemia (p=0.037) and lymphopenia (p=0.028). It was up-regulated in treated patients with the combination of hydroxychloroquine, cyclophosphamide, and methylprednisolone (p=0,028) compared to other treatments. Tubular GRα expression showed a positive correlation with the chronicity index (rs=0.607, p=0.016). Conclusion: The GRα may be involved in the pathogenesis of SLE. It appears that HDAC2 contributes to the remission phase in SLE. IL23R expression could be affected by treatments in SLE patients.

Cardiovascular Manifestations and Therapy Options for Systemic Lupus Erythematosus: A Systemic Literature Review

Systemic lupus erythematosus (SLE) is an autoimmunemulti-systemic disease; it is a controlled disease but isnot curable. SLE affects different systems in the body,such as cardiac, renal, respiratory, hematology,neurology, and rheumatology. It can cause variousproblems in the heart, lungs, and joints. This Systemicreview researched articles from 3 databases: PubMed,Google Scholar, and PubMed Central in June 2022. Wedid this systemic review using Prisma guidelines. Wecollected this systemic review in the last five years. Freefull articles randomized controlled trial (RCT), systemicreview articles, and English language included. Otherlanguages and articles earlier than 2017. Joanna BriggsInstitute (JBI) checklist, Assessment of MultipleSystemic Reviews 2 (AMSTAR), and Scale for theAssessment of Multiple Systemic Reviews 2 (SANRA)are used to check for quality assessment. In thesystemic review, the initial search generated 516articles. They included 13 in the final selection; six werecase reports, two were systemic reviews, three of themretrospective studies, and two were literature reviews.In this Systemic review, we will focus on the cardiacmanifestations associated with systemic lupuserythematosus and use Hydroxychloroquine to preventthe deterioration of systemic lupus erythematosus anddecrease the incidence rate cardiac problems. Itdiscovered a decrease in the incidence rate of cardiacmanifestations. It found that hydroxychloroquine iseffective in the treatment of systemic lupuserythematosus patients. Not only that, but they foundthat Hydroxychloroquine effectively treats systemiclupus erythematosus patients and limits cardiac riskfactors. We need further studies and research tounderstand the effect of systemic lupus erythematosuson the cardiac system and the effects ofHydroxychloroquine on decreasing the impact ofsystemic lupus erythematosus on the heart.

A Case Report: Korean Medicine Treatment for a Systemic Lupus Erythematosus Patient Persistently Complaining of Fatigue and Chest Tightness

Objective: This study reported the improved symptoms of integrative Korean medicine-based treatment in a patient diagnosed with Systemic Lupus Erythematosus (SLE) who persistently complained of fatigue and chest tightness.Methods: A 51-year-old female SLE patient persistently complaining of fatigue and chest tightness underwent an 18-day treatment with Kracie <i>Shihogayonggolmoryo-tang</i>, Cheongpajeon-H, Gwanjeol-go, acupuncture, pharmacopuncture, cupping therapy, deep tissue meridian hot pack therapy, manual therapy, Interferential Current Therapy, and Extracorporeal Shock Wave Therapy. The Brief Fatigue Inventory (BFI) and Numeric Rating Scale (NRS) for each symptom were measured on admission, at one week, two weeks of hospitalization, and upon discharge. Clinical outcomes were assessed using these two figures.Results: After treatment, there was a reduction in the BFI score (7 to 3). The NRS score of chest tightness with hot flashes decreased from 8 to 5, neck pain lessened from 7 to 5, pain in both ankles diminished from 6 to 4, the cold hypersensitivity of both feet fell from 6 to 4, and heartburn decreased from 5 to 2. In order, the biggest clinical improvement was to heartburn, fatigue, and chest tightness with hot flashes.Conclusion: This case study shows that integrative Korean medicine-based treatment can improve symptoms of a Systemic Lupus Erythematosus patient persistently complaining of fatigue and chest tightness with hot flashes and suggests that <i>Shihogayonggolmoryo-tang</i> may be an effective option for managing and treating SLE patients.

2022 Chinese guideline for the management of pregnancy and reproduction in patients with systemic lupus erythematous

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects women of childbearing age. With the improvement of diagnosis and treatment, the survival rate of SLE patients has improved significantly, but pregnancy is still an important challenge for SLE patients. It is urgent to strengthen the reproductive and pregnancy management of SLE patients and standardize the peri-gestational monitoring and treatment of SLE patients. This guideline is jointly sponsored by the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR), and Chinese Research Committee of pregnancy and reproduction in autoimmune rheumatic diseases (CHOPARD). Guided by clinical problems, after several rounds of clinical and methodological expert demonstration and selection, 13 clinical problems that need to be solved are finally formed, based on evidence-based medical evidence and expert opinions, guideline recommendations are given. The aim is to improve the pregnancy success rate and reduce the maternal and infant mortality rate in SLE patients.

Primary Healthcare Practitioners' Knowledge, Attitude, and Practice Toward Systemic Lupus Erythematosus in the Qassim Region, Saudi Arabia.

Objective The study aims to evaluate the primary healthcare practitioner's (PHCP) knowledge, attitude, and practice toward systemic lupus erythematosus (SLE) and to explore the difficulties of early referral to specialized clinics. Method This is a cross-sectional study conducted between February and March 2022 targeting the PHCP among the primary healthcare centers in Qassim, Saudi Arabia. The study was conducted among 203 participants who enrolled via a cluster random sampling technique depending on the survey. Qualitative categorical variables are expressed as frequencies and percentages, while continuous variables are reported as means and standard deviations (SD). The one-way analysis of variance (ANOVA) test and the independent T-test have been used to explore the relationship between participants' knowledge scores and their socio-demographic characteristics. A P-value ≤0.05 was considered statistically significant. Result The study found that only 4.4% of participating PHCPs had good knowledge related to SLE, while 45.8% of them had fair knowledge, and nearly half of them (49.8%) had poor knowledge. It was noted that GPs who specialized in family medicine or saw more than 40 patients each week had comparably better knowledge than others, which was statistically significant (p<0.05). The difficulty in diagnosing SLE patients was mentioned by 48.3% of the PHCPs. Family medicine consultants (p<0.001), those who worked in a tertiary care facility for more than six months (p<0.001) and those who worked in a rheumatology department (p<0.05), reported considerably better levels of comfort when treating SLE patients. Conclusion This study found that included participants' understanding of SLE, its diagnosis, and management was inadequate. Coordination between rheumatologists and experts from many disciplines at the primary, secondary, and tertiary levels of care is critical for overcoming ambiguities and obstacles in the diagnosis and therapy of SLE patients.

Immunometabolic alterations in lupus: where do they come from and where do we go from there?

Systemic lupus erythematosus (SLE) is an autoimmune disease in which the overactivation of the immune system has been associated with metabolic alterations. Targeting the altered immunometabolism has been proposed to treat SLE patients based on theirresults obtained and mouse models of the disease. Here, we review the recent literature to discuss the possible origins of the alterations in the metabolism of immune cells in lupus, the dominant role of mitochondrial defects, technological advances that may move the field forward, as well as how targeting lupus immunometabolism may have therapeutic potential.

Clinical characteristics of SLE patients infected with Epstein-Barr virus and potential associated risk factors.

To investigate the clinical features and potential associated risk factors of Epstein-Barr virus (EBV) DNA positivity in systemic lupus erythematosus (SLE) patients. A total of 121 newly diagnosed SLE patients who had never used immunosuppressive drugs (treatment-naïve) and 191 previously treated SLE patients from January 2017 to January 2020 were enrolled in this study. And 115 age- and sex-matched non-rheumatic disease controls were also included. A significantly higher incidence of EBV DNA positivity and higher viral DNA copies in peripheral blood mononuclear cells were observed among treatment-naïve and previously treated SLE patients compared with controls. The positivity rate of EBV DNA was further increased in previously treated SLE patients compared with that in treatment-naïve patients. EBV DNA-positive treatment-naïve SLE patients presented lower incidence of hemolytic anemia and more affected organ number than EBV DNA-negative patients. EBV DNA-positive treated SLE patients showed older age, longer immunosuppressive duration, higher IgG level, and higher Th/Ts ratio than EBV DNA-negative patients. Patients responding well to treatment with decreased SLE disease activity index scores had a transformation of EBV DNA from positive to negative in treated SLE patients. Multivariate logistic regression analysis showed that older age, higher IgG level, and longer immunosuppressive duration were associated risk factors for EBV DNA positivity in SLE patients, while higher TNF-α level was a protective factor. Older age, higher IgG level, and longer immunosuppressive duration are associated with the positivity of EBV DNA in SLE patients. A seroconversion of EBV DNA indicates an association between EBV positivity and therapy response, while larger number cases are needed to confirm. Key Points • Older age, higher IgG level, and longer immunosuppressive duration are associated with EBV DNA positivity in SLE patients. • A seroconversion of EBV DNA might be an indicator to reflect the SLE therapy -response.

Systemic Lupus Erythematosus and Cardiovascular Disease: A Mendelian Randomization Study.

BackgroundPrevious studies have shown that patients with systemic lupus erythematosus (SLE) tend to have a higher risk of cardiovascular disease (CVD), but the potential causal relationship between genetic susceptibility to SLE and CVD risk is not clear. This study systematically investigated the potential association between genetically determined SLE and the risk of CVD.MethodsThe genetic tools were obtained from genome-wide association studies of SLE and CVD, with no overlap between their participating populations. Mendelian randomization (MR) analysis was performed using inverse variance weighting as the primary method. Simultaneously, a series of repeated analyses, sensitivity analyses, and instrumental variable strength evaluations were performed to verify the reliability of our results.ResultsMR analysis showed that genetic susceptibility to SLE was associated with a higher risk of heart failure (OR=1.025, 95% CI [1.009-1.041], P=0.002), ischemic stroke (OR=1.020, 95% CI [1.005-1.034], P=0.009), and venous thromboembolism (OR=1.001, 95% CI [1.000-1.002], P=0.014). However, genetic susceptibility to SLE was negatively correlated with the risk of type 2 diabetes (OR=0.968, 95% CI [0.947-0.990], P=0.004). Sensitivity analysis found no evidence of horizontal pleiotropy or heterogeneity.ConclusionOur MR study explored the causal role of SLE in the etiology of CVD, which would help improve our understanding of the basic disease mechanisms of SLE and provide comprehensive CVD assessment and treatment for SLE patients.

P240 Predictors and prognostic factors influencing outcomes of anti-CD20 monoclonal antibodies in systemic lupus erythematosus: a systematic review update

Abstract Background/Aims Anti-CD20 monoclonal antibodies (MAb) are used to deplete B cells in autoimmune and haematological disease. Rituximab (RTX) failed to meet its primary endpoint in two Phase III trials for systemic lupus erythematosus (SLE) but is commonly used for the treatment of patients with severe or refractory disease. outcomes including clinical response and adverse effects are highly variable. Alternative anti-CD20 MAbs such as Ofatumumab, have been suggested as a potentially effective alternative treatment for those patients who fail treatment with RTX. We aimed to provide an update of a systematic review of predictive and prognostic factors of anti-CD20 MAb treatment in SLE patients. Methods A systematic literature search was undertaken and included adult and paediatric randomised controlled trials (RCTs) and cohort studies. Articles included in the previous systematic review were excluded. Methodological quality was assessed for RCTs using the Cochrane Collaboration Risk of Bias (RoB2) tool for RCTs and the Quality In Prognosis Studies Tool (QUIPS) for cohort studies. The quality of evidence (QoE) was assessed as high, moderate, low or very low using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach for RCTs and the 2013 adaptation for prognostic factor research. The quality of subgroup analysis for predictors of differential treatment response was also evaluated. A narrative synthesis of the evidence from included studies was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Sixteen studies from an initial 849 results were included. There were two post-hoc analyses of RCTs of RTX, one RCT of ocrelizumab in lupus nephritis and 13 cohort studies examining RTX treatment. Outcomes assessed included global clinical, cutaneous, haematological and renal response, treatment failure, relapse and adverse effects. The overall QoE was assessed as low and very-low for all studies and was limited by significant heterogeneity of inclusion criteria, assessment tools, outcomes assessed and definitions of response and failure. Studies also often included small numbers of participants and failed to account for confounders and multiple subgroup analyses of differing outcomes. Novel biomarkers, such as S100 proteins, anti-vimentin and anti-drug antibodies showed some evidence of prognostic value but QoE was limited due to moderate to high risk of bias, early phase of investigation and imprecision of results. Conclusion Since 2015, there has been little progress in the identification and confirmation of prognostic or predictive factors to guide outcome in lupus patients treated with anti-CD20 therapy. Further work is required to support those factors which appear to demonstrate prognostic potential. PROSPERO registration number: CRD42020220339 Disclosure M. Rodziewicz: Grants/research support; M.R. is supported by the NW England MRC Fellowship in Clinical Pharmacology and Therapeutics, which is funded by the MRC, Riche, Eli Lily UCB, Novartis and the Universities of Manchester and Liverpool. S. Dyball: Grants/research support; S.D. is supported by the NW England MRC Fellowship in Clinical Pharmacology and Therapeutics, which is funded by the MRC, Roche, Eli Lily UCB, Novartis and the Universities of Manchester and Liverpool. C. Mendoza-Pinto: None. P. Munguia-Realpozo: None. I.N. Bruce: Grants/research support; I.N.B. has received grants from GlaxoSmithKline and Sanofi Genzyme. Other; I.N.B. has received consultancy and speaker fees to his institution from GlaxoSmithKline, UCB, BMS, Eli Lily, Aurinia, AstraZeneca and Merck Serono. B. Parker: None.

Identification of Diagnostic Biomarkers in Systemic Lupus Erythematosus Based on Bioinformatics Analysis and Machine Learning.

Systemic lupus erythematosus (SLE) is a complex autoimmune disease that affects several organs and causes variable clinical symptoms. Exploring new insights on genetic factors may help reveal SLE etiology and improve the survival of SLE patients. The current study is designed to identify key genes involved in SLE and develop potential diagnostic biomarkers for SLE in clinical practice. Expression data of all genes of SLE and control samples in GSE65391 and GSE72509 datasets were downloaded from the Gene Expression Omnibus (GEO) database. A total of 11 accurate differentially expressed genes (DEGs) were identified by the “limma” and “RobustRankAggreg” R package. All these genes were functionally associated with several immune-related biological processes and a single KEGG (Kyoto Encyclopedia of Genes and Genome) pathway of necroptosis. The PPI analysis showed that IFI44, IFI44L, EIF2AK2, IFIT3, IFITM3, ZBP1, TRIM22, PRIC285, XAF1, and PARP9 could interact with each other. In addition, the expression patterns of these DEGs were found to be consistent in GSE39088. Moreover, Receiver operating characteristic (ROC) curves analysis indicated that all these DEGs could serve as potential diagnostic biomarkers according to the area under the ROC curve (AUC) values. Furthermore, we constructed the transcription factor (TF)-diagnostic biomarker-microRNA (miRNA) network composed of 278 nodes and 405 edges, and a drug-diagnostic biomarker network consisting of 218 nodes and 459 edges. To investigate the relationship between diagnostic biomarkers and the immune system, we evaluated the immune infiltration landscape of SLE and control samples from GSE6539. Finally, using a variety of machine learning methods, IFI44 was determined to be the optimal diagnostic biomarker of SLE and then verified by quantitative real-time PCR (qRT-PCR) in an independent cohort. Our findings may benefit the diagnosis of patients with SLE and guide in developing novel targeted therapy in treating SLE patients.

Tofacitinib Ameliorates Lupus Through Suppression of T Cell Activation Mediated by TGF-Beta Type I Receptor.

Autoreactive T cells play a crucial role in the pathogenesis of systemic lupus erythematosus (SLE). TGF-β type I receptor (TGFβRI) is pivotal in determining T cell activation. Here, we showed that TGFβRI expression in naïve CD4+ T cells was decreased in SLE patients, especially in those with high disease activity. Moreover, IL-6 was found to downregulate TGFβRI expression through JAK/STAT3 pathway in SLE patients. In vitro, the JAK inhibitor tofacitinib inhibited SLE T cell activating by upregulating TGFβRI expression in a dose-dependent manner. In MRL/lpr mice, tofacitinib treatment ameliorated the clinical indicators and lupus nephritis, as evidenced by reduced plasma anti-dsDNA antibody levels, decreased proteinuria, and lower renal histopathological score. Consistently, tofacitinib enhanced TGFβRI expression and inhibited T cell activation in vivo. TGFβRI inhibitor SB431542 reversed the effects of tofacitinib on T cell activation. Thus, our results have indicated that tofacitinib can suppress T cell activation by upregulating TGFβRI expression, which provides a possible molecular mechanism underlying clinical efficacy of tofacitinib in treating SLE patients.

Therapeutic responses and predictors of low-dose interleukin-2 in systemic lupus erythematosus.

Interleukin-2 (IL-2) is effective and well tolerated in patients with systemic lupus erythematosus (SLE). However, patient response to IL-2 therapy varies. Therefore, biomarkers are needed to efficiently identify patients who may respond well to IL-2 treatment. We investigated clinical and immunological biomarkers to predict low-dose IL-2 responses. A pooled post-hoc analysis was performed in SLE patients who received low-dose IL-2 treatment in two clinical trials. Factors predicting responses in clinical and T-cell subset changes were evaluated by logistic regression. Good response (GR) and poor response (PR) were defined according to whether patients achieved or did not achieve an SLE Responder Index-4 (SRI-4), respectively. A good response at 68% was achieved in patients with lower Treg, compared to 0% in patients with higher Treg. In comparison to PR, GR was more strongly associated with low Treg proportions at baseline (12.85±6.07% vs. 9.43±2.82%, p<0.01). There were more patients with skin rash in the GR group than in the PR group (68.75% vs. 30.77%, p=0.042). Multivariate analysis showed that low Treg proportions and skin rash presence were both independently associated with GR to low-dose IL-2 treatment. A nomogram to identify GR probability exhibited a clear discrimination (concordance index, 0.812; 95% confidence interval, 0.64-0.97). Based on the area under the receiver operating characteristic (ROC) curve (AUC) of 0.813, the specificity of a low regulatory T cells (Tregs) proportion (≤13.35%) plus skin rash to predict GR to IL-2 therapy was 100%, with a sensitivity of 68.75%. A low Treg proportion and skin rash indicate GR to low-dose IL-2 treatment in SLE patients.

Analysis of trends and causes of death in SLE patients over a 40-years period in a cohort of patients in the United Kingdom.

Systemic Lupus Erythematosus (SLE) an autoimmune rheumatic disease with a complex pathogenesis, remains potentially life-threatening. SLE patients have increased morbidity and premature mortality compared to non-SLE patients. The five-year survival rate has improved from <50% in the 1950s to >90% in the 1980s. Lupus patients still have a mortality risk three times that of the general population. To provide a detailed analysis of the causes of death, main characteristics and trends in the management of the deceased SLE patients from the lupus clinic at the University College London Hospital (UCLH); during the past four decades. This was a non-interventional, retrospective study based on historical real-world data from paper and electronic records of patients followed up at UCLH. The analysis focused on data collected between 1st January 1978 and 31th December 2018. We collected the: causes of death, duration of disease, key laboratory and clinical parameters and the treatment received. We compared the results from the four decades to ascertain trends in the causes of mortality. All statistical analyses were performed using the Statistical Package for Social Sciences (SPSS), version 22.0. The 95% confidence intervals for the means of data were calculated. 111 SLE patients (15%), died during follow-up. Their median age was 51 years (interquartile range (IQR) = 38-63 years) and the median duration of disease, 15 years (IQR = 8.5-24 years). The main causes of death in the past 40 years were infection (31.7%), cancer (26.7%) and cardiovascular disease (CVD) (21.8%). 93.6% of these patients were immunosupressed. During the 40-year period, there were several therapeutic developments notably the introduction of mycophenolate mofetil (MMF) and rituximab; the latter initially only given to patients when more conventional inmunosupressants had failed, but more recently offered to patients at diagnosis. There was a statistically significant increase in the use of hydroxycloroquine (HCQ), MMF and rituximab. In contrast, the use of Azathioprine (AZA) and steroids, hardly changed over time. This retrospective review shows how epidemiological factors, causes of death and treatment of SLE patients have changed during the last 40 years in the UCLH cohort.

Systemic Lupus Erythematosus: Clinical Updates in Women's Health Care Primary and Preventive Care Review.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease most commonly involving skin, joints, and kidneys. Usually, it presents in women in puberty or early adulthood. This monograph provides an overview of the role of an obstetrician-gynecologist (ob-gyn) in the treatment of SLE patients. An ob-gyn is uniquely placed in the health care continuum throughout the life cycle of a woman. Notably, an ob-gyn often is the first physician to notice SLE-related rash, swollen joints, cytopenias, or proteinuria in a patient and is the first to provide initial management. Obstetrician-gynecologists must be familiar with SLE effects on reproductive issues, such as SLE effects on the choice of birth control, pregnancy outcomes, and the risks of hormone therapy use, as well as the pregnancy effects on the risk of lupus nephritis flares. Human papillomavirus and associated cancer also are of concern in patients with SLE. Providing care to women with SLE is multifaceted; therefore, ob-gyns often will need to liaise with rheumatologists and other specialists.

Alteration in gut microbiota is associated with dysregulation of cytokines and glucocorticoid therapy in systemic lupus erythematosus

ABSTRACT A growing corpus of evidence implicates the involvement of the commensal microbiota and immune cytokines in the initiation and progression of systemic lupus erythematosus (SLE). Glucocorticoids have been widely used in the treatment of SLE patients, however, glucocorticoid treatment carries a higher risk of other diseases. Using the 16S rRNA technique, we investigated the differences between the gut microbiota associated with the immune cytokines of SLE and relevant glucocorticoid treatment in a female cohort of 20 healthy control subjects (HC), 17 subjects with SLE (SLE-G), and 20 SLE patients having undergone glucocorticoid treatment (SLE+G). We observed that the diversity and structure of the microbial community in SLE+G patients were significantly changed compared to that of SLE-G patients, whereas the gut microbial community of the SLE+G group showed a similarity with the HC group, which implicate that the shift in the gut microbiome could represent a return to homeostasis. Furthermore, the up-regulations of immune cytokines in SLE-G were identified as closely related to gut dysbiosis, which indicates that the overrepresented genera in SLE patients may play roles in regulating expression level of these immune cytokines. This associated analysis of gut microbiota, glucocorticoid therapy, and immune factors might provide novel and insightful clues revealing the pathogenesis of SLE patients.

AB0392 THE EFFECT OF HYDROXYCHLOROQUINE ON THE RISK FACTORS FOR ATHEROSCLEROSIS DEVELOPMENT

Background:Systemic lupus erythematosus(SLE) patients, especially patients with lupus nephritis have poor vascular endothelial function and increased cardiovascular(CV) mortality.Meanwhile, several studies showed hydroxychloroquine(HCQ) has effect on reduction in lipids and thrombosis(1), but the mechanism is unclear.Objectives:We examined effect of HCQ on adipocytokine expression in SLE patients.Methods:52 SLE patients with low disease activity started with HCQ were analyzed before and 3 months after HCQ treatment. 21 SLE patients has past history of lupus nephritis. Serum S100 proteins and adipocytokines were measured by ELISA, and serum inflammatory ctytokine levels were evaluated by Multiplex assay (TNF-α, IL-6, VEGF-A).Results:Serum adiponectin level was increased significantly 3 months after HCQ treatment compared with those at baseline (mean change 1.35, Figure 1). SLE patients who achieved LLDAS had a greater increase than those who did not. Additionally, the changes of serum adiponectin levels were associated with those of TNF-α, IL-6, VEGF-A and S100A9 protein, which plays an important role of SLE pathogenesis.Figure 1.Serum adiponectin levels at baseline were compared with levels after 3 months of HCQ treatment. Serum adiponectin levels significantly decreasing during HCQ treatment in SLE patients. For statistical analyses *p&lt;0.0001,Pvalue: Wilcoxon signed-rank testConclusion:A HCQ could reduce the risk factors for atherosclerosis along with control of SLE disease activity.

Meta-analysis on the efficacy and safety of immunoadsorption for systemic lupus erythematosus among Chinese population.

To systematically evaluate the efficacy and safety of immunoadsorption (IAS) versus non-IAS for systemic lupus erythematosus (SLE) among Chinese population. A meta-analysis was performed by all the literatures germane to estimate the SLE patients treated with IAS and non-IAS from published randomized controlled trials (RCTs) from 1990 to February 2020. Mean differences (MDs), relative ratios (RRs), and 95% confidence intervals (CIs) were calculated, and the meta-analysis was conducted with Stata 12.0 software. A total of 18 RCTs involving 457 patients were included. The results of meta-analysis demonstrated that the IgG, Scr, Bun, ANA, 24-h urine protein, leptin, and TNF-α of IAS combined with a drug therapy group were lower than that of non-IAS, and the levels of C3 and C4 were higher than that of non-IAS after treatment in terms of laboratory parameters. In terms of adverse reactions, the incidence of fever or chills, low blood pressure, or bleeding risk was higher in the treatment group. However, there was no difference in the incidence of puncture point bleeding, thrombocytopenia, mild rash, death due to severe infection, tightness, palpitation, or chest tightness between the two groups. However, most of the adverse effects could be considered as tolerable after timely treatment. Our results indicate that IAS may be superior to non-IAS in treating SLE patients. However, due to the lower quality of included studies, high quality of multicenter, large sample size, randomized, and double-blind controlled trials are needed to validate the results.