{"title":"Comparative outcome of patients with systemic autoimmune rheumatic disease affected by COVID-19 infection-An Asian perspective.","authors":"Kuo-Tung Tang","doi":"10.1111/1756-185X.15359","DOIUrl":"https://doi.org/10.1111/1756-185X.15359","url":null,"abstract":"","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Concurrent breast cancer and IgG4-related orbital pseudotumor in a man.","authors":"Tuba Yüce Inel, Sadettin Uslu, Meltem Soylev Bajin, Fatos Onen","doi":"10.1111/1756-185X.15362","DOIUrl":"https://doi.org/10.1111/1756-185X.15362","url":null,"abstract":"","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osteoporosis (OP) was long viewed as an inevitable process of aging, due to an imbalance between osteoclast bone resorbing and osteoblast bone formation function, leading to a negative balance in bone remodeling. This leads to low bone mass and increased bone fragility putting the patient at risk for fracture. While this view still holds, a better understanding disclosed that OP can occur at any age, as a comorbidity or a complication of many diseases and treatments. Differentiation, maturation, and function of osteoclasts and osteoblasts are affected by many factors from different morbidities: endocrine, metabolic, mechanical and inflammatory. Inflammatory diseases are often complicated by a generalized bone loss that subsequently leads to OP. Factors such as glucocorticoid treatment, immobilization, malnutrition, and insufficient intake of vitamin D play a role. However, the inflammatory process itself is involved and the resulting bone loss is termed immune-mediated bone loss. Experiments on animals and on humans, in addition to clinical studies, shed light on the role of inflammation in OP.
长期以来，骨质疏松症（OP）一直被视为衰老的必然过程，这是由于破骨细胞骨吸收和成骨细胞骨形成功能失衡，导致骨重塑出现负平衡。这会导致骨量降低和骨脆性增加，使患者面临骨折风险。虽然这种观点仍然有效，但人们对 OP 的进一步了解表明，OP 可发生于任何年龄，是许多疾病和治疗方法的合并症或并发症。破骨细胞和成骨细胞的分化、成熟和功能受到来自不同疾病的多种因素的影响：内分泌、代谢、机械和炎症。炎症性疾病通常会并发全身性骨质流失，进而导致 OP。糖皮质激素治疗、固定、营养不良和维生素 D 摄入量不足等因素都起了作用。然而，炎症过程本身也参与其中，由此导致的骨质流失被称为免疫介导的骨质流失。除临床研究外，动物和人体实验也揭示了炎症在 OP 中的作用。
{"title":"Osteoporosis and inflammation: Cause to effect or comorbidity?","authors":"Majda I Khoury","doi":"10.1111/1756-185X.15357","DOIUrl":"https://doi.org/10.1111/1756-185X.15357","url":null,"abstract":"<p><p>Osteoporosis (OP) was long viewed as an inevitable process of aging, due to an imbalance between osteoclast bone resorbing and osteoblast bone formation function, leading to a negative balance in bone remodeling. This leads to low bone mass and increased bone fragility putting the patient at risk for fracture. While this view still holds, a better understanding disclosed that OP can occur at any age, as a comorbidity or a complication of many diseases and treatments. Differentiation, maturation, and function of osteoclasts and osteoblasts are affected by many factors from different morbidities: endocrine, metabolic, mechanical and inflammatory. Inflammatory diseases are often complicated by a generalized bone loss that subsequently leads to OP. Factors such as glucocorticoid treatment, immobilization, malnutrition, and insufficient intake of vitamin D play a role. However, the inflammatory process itself is involved and the resulting bone loss is termed immune-mediated bone loss. Experiments on animals and on humans, in addition to clinical studies, shed light on the role of inflammation in OP.</p>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adamantiades-Behcet's disease: From the first known descriptions to the era of the biologic agents.","authors":"Ellie Stefanadi, Georgios Dimitrakakis, Inetzi-Angeliki Dimitrakaki, Nikolaos Sakellariou, Sangeeta Punjabi, Christodoulos Stefanadis","doi":"10.1111/1756-185X.15353","DOIUrl":"https://doi.org/10.1111/1756-185X.15353","url":null,"abstract":"","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial: The role of Piezo 1 in osteoarthritis: Implications for pathogenesis and therapy.","authors":"Shangqi Guan, Yifang Mei","doi":"10.1111/1756-185X.15348","DOIUrl":"https://doi.org/10.1111/1756-185X.15348","url":null,"abstract":"","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuan Feng, Jia Chen, Xichao Yang, Jie Liu, Xue Cao, Yan Zhang, Zhenbiao Wu
Objective: Interstitial lung disease (ILD) resulting from connective tissue disease (CTD) greatly undermines people's health. Cyclophosphamide (CYC) is a widely used agent in treating CTD-ILD. We compared the efficacy and safety of oral and intravenous CYC in CTD-ILD treatment.
Methods: The retrospectively enrolled CTD-ILD patients were divided into the oral and intravenous CYC groups. The chest high-resolution computed tomography examination, forced vital capacity (FVC), lung carbon monoxide diffusion capacity (Dlco) determinations, and 6 min walk test (6MWT) were performed pre-treatment and at the 3rd, 6th, and 12th months posttreatment. Radiographic ILD severity was assessed using the Warrick score. Krebs Von den Lungen-6, surfactant protein A (SP-A), SP-D, and erythrocyte sedimentation rate (ESR) before and at the 12th month post-treatment were determined. CYC cumulative dose and occurrence of adverse reactions during treatment were recorded.
Results: CYC cumulative dose in the intravenous CYC group was reduced. Compared with oral CYC treatment, intravenous CYC caused decreased Warrick score and increased FVC and 6MWT at the 6th month, and elevated DLco at the 3rd and 6th months posttreatment. SP-A, SP-D and ESR levels in both groups were reduced 12 months posttreatment, with a more evident decrease in the intravenous CYC group. Intravenous CYC had lower total adverse reaction incidence.
Conclusion: Compared with oral CYC, intravenous CYC decreases Warrick score and increases FVC and 6MWT at 6 months posttreatment, and reduces SP-A, SP-D, and ESR levels after 12 months of treatment, which shows low CYC cumulative dose and adverse reaction incidence in treating CTD-ILD.
{"title":"Efficacy and safety of oral versus intravenous cyclophosphamide in treatment of connective tissue disease-related interstitial lung disease.","authors":"Yuan Feng, Jia Chen, Xichao Yang, Jie Liu, Xue Cao, Yan Zhang, Zhenbiao Wu","doi":"10.1111/1756-185X.15354","DOIUrl":"https://doi.org/10.1111/1756-185X.15354","url":null,"abstract":"<p><strong>Objective: </strong>Interstitial lung disease (ILD) resulting from connective tissue disease (CTD) greatly undermines people's health. Cyclophosphamide (CYC) is a widely used agent in treating CTD-ILD. We compared the efficacy and safety of oral and intravenous CYC in CTD-ILD treatment.</p><p><strong>Methods: </strong>The retrospectively enrolled CTD-ILD patients were divided into the oral and intravenous CYC groups. The chest high-resolution computed tomography examination, forced vital capacity (FVC), lung carbon monoxide diffusion capacity (Dlco) determinations, and 6 min walk test (6MWT) were performed pre-treatment and at the 3rd, 6th, and 12th months posttreatment. Radiographic ILD severity was assessed using the Warrick score. Krebs Von den Lungen-6, surfactant protein A (SP-A), SP-D, and erythrocyte sedimentation rate (ESR) before and at the 12th month post-treatment were determined. CYC cumulative dose and occurrence of adverse reactions during treatment were recorded.</p><p><strong>Results: </strong>CYC cumulative dose in the intravenous CYC group was reduced. Compared with oral CYC treatment, intravenous CYC caused decreased Warrick score and increased FVC and 6MWT at the 6th month, and elevated DLco at the 3rd and 6th months posttreatment. SP-A, SP-D and ESR levels in both groups were reduced 12 months posttreatment, with a more evident decrease in the intravenous CYC group. Intravenous CYC had lower total adverse reaction incidence.</p><p><strong>Conclusion: </strong>Compared with oral CYC, intravenous CYC decreases Warrick score and increases FVC and 6MWT at 6 months posttreatment, and reduces SP-A, SP-D, and ESR levels after 12 months of treatment, which shows low CYC cumulative dose and adverse reaction incidence in treating CTD-ILD.</p>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Chronic kidney disease in patients with lupus nephritis-Important but underrecognized.","authors":"Selene T Y Teoh, Desmond Y H Yap, Tak Mao Chan","doi":"10.1111/1756-185X.15361","DOIUrl":"https://doi.org/10.1111/1756-185X.15361","url":null,"abstract":"","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The aim of this commentary is to discuss the Cochrane Review “Exercise therapy for treatment of acute non-specific low back pain”<span><sup>1</sup></span> by IJzelenberg et al., (This summary is based on a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2023, Issue 8, Art. No.: CD009365. DOI:10.1002/14651858.CD009365.pub2. (see www.cochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review) published by Cochrane Back and Neck Group. This Cochrane Corner is produced in agreement with <i>International Journal of Rheumatic Diseases</i> by Cochrane Rehabilitation with views (The views expressed in the summary with commentary are those of the Cochrane Corner authors (different than the original Cochrane Review authors) and do not represent the Cochrane Library or Wiley) of the review summary authors in the “implications for practice” section.</p><p>Low back pain (LBP) is a common condition that affects a significant proportion of the population, leading to considerable pain and disability.<span><sup>2</sup></span> LBP refers to pain, muscle tension, or stiffness situated between the costal margin and the inferior gluteal folds, which may include referred leg pain (sciatica). Acute nonspecific LBP means LBP episodes lasting up to 6 weeks, which were not caused by known underlying conditions, such as infection, cancer, broken bones, or pregnancy.<span><sup>3</sup></span> Exercise therapy, a widely used conservative treatment, involves active interventions to enhance physical fitness, flexibility, stability, coordination, and muscle strength, but its efficacy in this context remains uncertain.<span><sup>4</sup></span> It may target specific muscles (e.g., transversus abdominus and multifidus) or broader muscle groups (trunk, abdomen, and back). Programs vary in intensity, frequency, duration, and setting. While commonly used, the efficacy of exercise therapy for acute nonspecific LBP remains uncertain.<span><sup>1</sup></span> Understanding its impact can guide clinical practice and improve patient outcomes.</p><p>Wilhelmina IJzelenberg, Teddy Oosterhuis, Jill A Hayden, Bart W Koes, Maurits W van Tulder, Sidney M Rubinstein, Annemarie de Zoete, 2023.</p><p>The implications of this Cochrane Review for rheumatology practice are nuanced due to very uncertain evidence about the effect of exercise therapy in reducing pain or improving functional status compared with placebo, no treatment, or other conservative approaches in people with acute, nonspecific LBP. Given this uncertainty and considering that acute LBP often improves spontaneously without any intervention, the necessity of exercise therapy for this population may be questioned. This contrasts with chronic LBP, where the natural progression differs, and exercise therapy may have a more cl
本评论旨在讨论 IJzelenberg 等人撰写的 Cochrane 综述 "运动疗法治疗急性非特异性腰背痛 "1 （本摘要基于 Cochrane 系统综述数据库 2023 年第 8 期发表的 Cochrane 综述，文章编号：CD009365）。编号：CD009365。DOI:10.1002/14651858.CD009365.pub2.(信息见 www.cochranelibrary.com）。Cochrane 评论会随着新证据的出现和对反馈意见的回应而定期更新，Cochrane 系统性评论数据库（Cochrane Database of Systematic Reviews）的最新版本应参阅 Cochrane Back and Neck Group 出版的《Cochrane 评论》。本 Cochrane Corner 是 Cochrane 康复中心与《国际风湿病学杂志》（International Journal of Rheumatic Diseases）合作编写的，在 "对实践的影响 "部分中包含了综述摘要作者的观点（综述摘要中的观点与评论是 Cochrane Corner 作者（不同于 Cochrane 综述原作者）的观点，不代表 Cochrane 图书馆或 Wiley）。2 腰背痛是指位于肋缘和臀下皱襞之间的疼痛、肌肉紧张或僵硬，其中可能包括移行性腿部疼痛（坐骨神经痛）。急性非特异性枸杞痛是指枸杞痛发作持续时间不超过 6 周，且不是由感染、癌症、骨折或妊娠等已知的潜在疾病引起。训练计划的强度、频率、持续时间和设置各不相同。运动疗法虽然常用，但对急性非特异性腰痛的疗效仍不确定1。Wilhelmina IJzelenberg, Teddy Oosterhuis, Jill A Hayden, Bart W Koes, Maurits W van Tulder, Sidney M Rubinstein, Annemarie de Zoete, 2023.与安慰剂、不治疗或其他保守疗法相比，运动疗法对急性非特异性腰背痛患者减轻疼痛或改善功能状态的效果尚不确定，因此本文献综述对风湿病学实践的影响是微妙的。鉴于这种不确定性，并考虑到急性椎管内疼痛通常会在没有任何干预措施的情况下自发改善，对这一人群进行运动疗法的必要性可能会受到质疑。这与慢性枸杞痛形成鲜明对比，慢性枸杞痛的自然进展不同，运动疗法可能具有更明确的作用。5 Cashin 等人的另一篇综述表明，与安慰剂、常规护理或候诊对照组相比，运动对慢性腰椎间盘突出症患者的疼痛和残疾有小幅、短期的缓解作用。6 值得注意的是，Cashin 等人的综述和指南等其他大多数综述和指南都侧重于慢性腰椎间盘突出症，而慢性腰椎间盘突出症的病情及其管理有很大不同。因此，慢性腰椎间盘突出症的研究结果和建议是否能直接应用于急性腰椎间盘突出症病例仍不确定。风湿免疫科医生在推荐治疗方案时应考虑这些研究结果，重点关注针对个体预后因素和患者偏好的个性化方法。这些证据强调了患者教育、共同决策以及考虑急性腰椎间盘突出症自然病史的重要性。医生应探索其他循证干预措施，并考虑成本效益。虽然运动疗法仍可在多模式治疗方法中发挥作用，但其有限的疗效凸显了定期监测和重新评估治疗计划的必要性。正如 Oliveira 等人（2018 年）所强调的那样，临床指南也与这一区别相一致，推荐对慢性 LBP 进行运动疗法，但不推荐对急性病例进行运动疗法。7 风湿病学家应随时了解正在进行的研究，并准备好在出现新证据时调整其实践。两位作者均认可手稿的最终版本，并对其内容负责。
{"title":"Is exercise therapy effective for the treatment of acute nonspecific low back pain? A Cochrane Review summary with commentary","authors":"Ayesha Afridi, Farooq Azam Rathore","doi":"10.1111/1756-185X.15352","DOIUrl":"https://doi.org/10.1111/1756-185X.15352","url":null,"abstract":"<p>The aim of this commentary is to discuss the Cochrane Review “Exercise therapy for treatment of acute non-specific low back pain”<span><sup>1</sup></span> by IJzelenberg et al., (This summary is based on a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2023, Issue 8, Art. No.: CD009365. DOI:10.1002/14651858.CD009365.pub2. (see www.cochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review) published by Cochrane Back and Neck Group. This Cochrane Corner is produced in agreement with <i>International Journal of Rheumatic Diseases</i> by Cochrane Rehabilitation with views (The views expressed in the summary with commentary are those of the Cochrane Corner authors (different than the original Cochrane Review authors) and do not represent the Cochrane Library or Wiley) of the review summary authors in the “implications for practice” section.</p><p>Low back pain (LBP) is a common condition that affects a significant proportion of the population, leading to considerable pain and disability.<span><sup>2</sup></span> LBP refers to pain, muscle tension, or stiffness situated between the costal margin and the inferior gluteal folds, which may include referred leg pain (sciatica). Acute nonspecific LBP means LBP episodes lasting up to 6 weeks, which were not caused by known underlying conditions, such as infection, cancer, broken bones, or pregnancy.<span><sup>3</sup></span> Exercise therapy, a widely used conservative treatment, involves active interventions to enhance physical fitness, flexibility, stability, coordination, and muscle strength, but its efficacy in this context remains uncertain.<span><sup>4</sup></span> It may target specific muscles (e.g., transversus abdominus and multifidus) or broader muscle groups (trunk, abdomen, and back). Programs vary in intensity, frequency, duration, and setting. While commonly used, the efficacy of exercise therapy for acute nonspecific LBP remains uncertain.<span><sup>1</sup></span> Understanding its impact can guide clinical practice and improve patient outcomes.</p><p>Wilhelmina IJzelenberg, Teddy Oosterhuis, Jill A Hayden, Bart W Koes, Maurits W van Tulder, Sidney M Rubinstein, Annemarie de Zoete, 2023.</p><p>The implications of this Cochrane Review for rheumatology practice are nuanced due to very uncertain evidence about the effect of exercise therapy in reducing pain or improving functional status compared with placebo, no treatment, or other conservative approaches in people with acute, nonspecific LBP. Given this uncertainty and considering that acute LBP often improves spontaneously without any intervention, the necessity of exercise therapy for this population may be questioned. This contrasts with chronic LBP, where the natural progression differs, and exercise therapy may have a more cl","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1756-185X.15352","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Young-Eun Kim, Jin-Myung Kim, Soo Min Ahn, Ji Seon Oh, Yong-Gil Kim, Chang-Keun Lee, Bin Yoo, Sung Shin, Seokchan Hong
Background
Clinical manifestations and risk factors associated with systemic lupus erythematosus (SLE) flares, including recurrent lupus nephritis (LN), in patients with LN who undergo kidney transplantation have been unclear.
Methods
Kidney transplant recipients with LN from January 1995 to December 2021 were included in this study. A disease flare was defined as either an increase in the non-renal SLE disease activity index score or the presence of biopsy-proven recurrent LN.
Results
Among a total of 93 patients with LN who underwent kidney transplantation, 11 patients (11.8%) experienced SLE flares during a median follow-up period of 76.9 months (IQR, 43.0–122.4). The most common clinical manifestations of SLE flares were recurrent LN (4/11, 36.4%) and hematologic manifestations (4/11, 36.4%). Patients who had flares had significantly higher anti-double-stranded DNA (anti-dsDNA) antibody titers both before and after transplantation. Furthermore, an increased anti-dsDNA antibody level before transplantation was associated with a high risk of an SLE flare (HR, 1.030; p = .008). Conversely, preemptive transplantation was associated with a lower risk of a flare (HR, 0.617; p = .026). The rate of patient death-censored graft survival was found to be considerably lower in patients with recurrent LN than in those without LN.
Conclusions
Approximately 10% of patients with LN experienced an SLE flare after transplantation, with recurrent LN being the most frequent manifestation. Anti-dsDNA antibody titers before transplantation were significantly related to the risk of an SLE flare. Notably, preemptive transplantation was associated with a reduced risk of flares following transplantation.
{"title":"Lupus flare and recurrent lupus nephritis following kidney transplantation in patients with lupus nephritis","authors":"Young-Eun Kim, Jin-Myung Kim, Soo Min Ahn, Ji Seon Oh, Yong-Gil Kim, Chang-Keun Lee, Bin Yoo, Sung Shin, Seokchan Hong","doi":"10.1111/1756-185X.15349","DOIUrl":"https://doi.org/10.1111/1756-185X.15349","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinical manifestations and risk factors associated with systemic lupus erythematosus (SLE) flares, including recurrent lupus nephritis (LN), in patients with LN who undergo kidney transplantation have been unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Kidney transplant recipients with LN from January 1995 to December 2021 were included in this study. A disease flare was defined as either an increase in the non-renal SLE disease activity index score or the presence of biopsy-proven recurrent LN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among a total of 93 patients with LN who underwent kidney transplantation, 11 patients (11.8%) experienced SLE flares during a median follow-up period of 76.9 months (IQR, 43.0–122.4). The most common clinical manifestations of SLE flares were recurrent LN (4/11, 36.4%) and hematologic manifestations (4/11, 36.4%). Patients who had flares had significantly higher anti-double-stranded DNA (anti-dsDNA) antibody titers both before and after transplantation. Furthermore, an increased anti-dsDNA antibody level before transplantation was associated with a high risk of an SLE flare (HR, 1.030; <i>p</i> = .008). Conversely, preemptive transplantation was associated with a lower risk of a flare (HR, 0.617; <i>p</i> = .026). The rate of patient death-censored graft survival was found to be considerably lower in patients with recurrent LN than in those without LN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Approximately 10% of patients with LN experienced an SLE flare after transplantation, with recurrent LN being the most frequent manifestation. Anti-dsDNA antibody titers before transplantation were significantly related to the risk of an SLE flare. Notably, preemptive transplantation was associated with a reduced risk of flares following transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14330,"journal":{"name":"International Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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