Lupus最新文献

ObjectivesTo compare the efficacy of tacrolimus (TAC) plus glucocorticoids (GCs) with that of TAC plus mycophenolate mofetil (MMF) and GCs for the induction of remission in proliferative lupus nephritis (LN).MethodsThis multicentre cohort study, designed as a target trial emulation, included patients with biopsy-proven proliferative LN who received TAC-based induction therapy. Patients were classified into the TAC + GC and TAC + MMF + GC groups. The primary outcome was total renal response at 12 months, which was defined as a complete or partial renal response. To address baseline imbalances between the groups, inverse probability of treatment weighting (IPTW) was applied. Binary logistic regression was used to estimate the odds ratio (OR) for the renal response.ResultsIn total, 115 patients (48 with TAC + GC and 67 with TAC + MMF + GC) were included in the study. A 12-month total renal response was achieved in 16 (33.3%) patients in the TAC + GC group and 40 (59.7%) patients in the TAC + MMF + GC group (p = .009). After IPTW adjustment, the TAC + MMF + GC group showed significantly higher 12-month total renal response (IPTW-adjusted OR 2.84 [1.31-6.35]). Adverse drug reactions occurred in 7 patients in the TAC + GC group and 11 patients in the TAC + MMF + GC group.ConclusionsIn patients with proliferative LN, TAC + MMF + GC therapy was associated with a significantly higher 12-month renal response than TAC + GC. These findings support TAC + MMF + GC as the preferred TAC-based induction regimen for proliferative LN.

Childhood-onset systemic lupus erythematosus (cSLE) often presents with aggressive manifestations that may not respond to standard immunosuppressive therapy. We describe two paediatric cSLE cases with severe life-threatening complications-autoimmune hemolytic anemia in one patient and macrophage activation syndrome with acute respiratory distress syndrome in the other-successfully managed with Eculizumab as adjunctive treatment. Both patients demonstrated rapid stabilization after Eculizumab initiation and showed favorable outcomes at their latest follow-up. These cases highlight the potential role of complement inhibition in select cSLE complications and suggest that Eculizumab may serve as a rescue therapy beyond its established use in thrombotic microangiopathy. Further studies are needed to better define its optimal use and target patient population.

ObjectivesTo investigate the impact of time to diagnosis on damage accrual in thrombotic antiphospholipid syndrome (APS).MethodsRetrospective cohort study including 252 patients with thrombotic APS (Sydney criteria). Time to diagnosis was defined as the period from the first thrombosis to diagnosis (diagnostic delay ≥12 months). Recurrent events occurred during antithrombotic therapy. Damage was assessed using the damage index for APS (DIAPS). Risk factors for diagnosis and treatment delay (≥12 months) were assessed. Cox regression analysis was used to determine predictors of damage (DIAPS ≥1) and severe damage (DIAPS ≥ 3). Significance was set as α < 0.05.ResultsMost patients were female (76.7%) with primary APS (71.8%) and a median age at onset of 40.5 (28-51) years. The median time to diagnosis was 12 months (≥12 months, 53.6%). Damage and severe damage affected 75.4% and 21.0% of patients, respectively. Diagnosis delay was associated with higher cumulative thrombotic events, recurrent thrombosis and anticoagulation delay (all p < .001). Secondary APS (HR 2.65, 95% CI 1.52-4.62) and recurrent thrombosis (HR 2.66, 95% CI 1.52-4.66) predicted severe damage but not damage. Diagnosis delay did not predict damage but predicted severe damage (HR 2.99, 95% CI 1.25-7.16), even after multivariate analysis (aHR 3.18, 95% CI 1.24-8.12).ConclusionIn thrombotic APS, diagnosis delay is associated with increased number of thrombotic events and recurrent thrombosis, and is an independent predictor of severe organ damage.

IntroductionBlack patients with systemic lupus erythematosus (SLE) have lower medication adherence than White patients, contributing to worse health outcomes. However, racial differences in reasons for nonadherence and beliefs about medications are not well understood.MethodsWe conducted a cross-sectional analysis of Black and White patients with SLE who completed the Beliefs about Medicines Questionnaire and the SLE-specific Domains of Subjective Extent of Nonadherence survey. We compared scores by race and by adherence level within each racial group.ResultsAmong 123 patients (52% Black, 48% White), adherence was lower in Black patients (44% vs 64%, p = .02). Black patients reported greater concerns about SLE medications and medication overuse and harm than White patients. Nonadherent Black patients reported weaker beliefs in SLE medication necessity and greater concerns about medication overuse and harm than adherent Black patients. Reasons for nonadherence reported by Black patients but not White patients included feeling well (45%), concerns about future fertility (14%), and doubts about their doctors and medicines (8%).ConclusionNonadherence among Black patients was uniquely associated with stronger concerns about medication overuse and harm and weaker beliefs that SLE medicines were necessary, potentially reflecting medical mistrust that may drive skipping doses when feeling well or when concerns arise. These insights can help clinicians more astutely probe and address each patient's needs to enhance medication adherence and SLE management.

BackgroundLupusPRO is a disease-targeted, patient-reported outcome measure developed for assessing the quality of life in patients with systemic lupus erythematosus. Initially, the questionnaire was validated among U.S. patients of varied ethnic backgrounds and genders. This study aims to carry out a cross-cultural adaptation and validation of the Polish-translated version of LupusPRO.MethodWe administered the Polish version of LupusPRO along with the 36-Item Short Form Health Survey (SF-36) and EQ-5D-5L questionnaire, and the Polish modification of the Hospital Anxiety and Depression Scale (HADS-M). At the same time, we collected demographics and clinical characteristics. Disease activity, damage, and exacerbation were assessed using SELENA-SLEDAI, SLICC/ACR DI and LFA. Furthermore, we tested internal consistency reliability (measured with Cronbach's alpha), test-retest reliability (using r-Pearson correlation coefficient), convergent validity (against corresponding domains of SF-36) and criterion validity (against disease activity, damage and EQ-VAS), and known group validity.ResultsA total of 199 (91% females) patients with SLE with a mean age of 42.6 ± 12.62 years participated in the study. We observed that the mean SELENA-SLEDAI reached 5.3 (±5.9) points, while SLICC/ACR DI was at 1.3 (±2.0) points. The internal consistency reliability of LupusPRO domains ranged between 0.737 and 0.925 (except for Lupus Symptoms, Social Support, Coping, and Satisfaction with care). For all domains except Social Support, test-retest reliability exceeded 0.7. Convergent validity with corresponding domains of the SF-36 was good (r > 0.5). All health-related quality of life domains performed well against disease activity and damage measures, establishing its criterion validity. Confirmatory factor analysis showed a satisfactory fit. (± expression of range).ConclusionThe Polish version of LupusPRO has proved to have fair psychometric properties among Polish patients with SLE.

ObjectiveThis study explored whether modulating prefrontal alpha oscillations using transcranial alternating current stimulation (tACS) could alleviate depressive symptoms in individuals with systemic lupus erythematosus (SLE).MethodsOver the course of 5 days, three individuals underwent daily 40-min sessions of 2 mA bifrontal individual alpha frequency tACS (IAF-tACS) while watching a relaxing video. Resting-state 128-channel electroencephalography (EEG) was recorded on Day 1 and Day 5 before each tACS session. Self-reported assessments of depression, anxiety, insomnia, and fatigue were administered on Day 1, Day 5, and at the 2- and 4-week follow-ups.ResultsTwo out of three participants showed a reduction in left prefrontal alpha power after 5 days of IAF-tACS. Only those with this reduction reported short-term improvements in depression, insomnia, anxiety, and well-being.ConclusionThese preliminary results suggest that modulating prefrontal alpha oscillations through tACS may offer a potential approach for alleviating depressive symptoms in individuals with SLE.

ObjectiveTo compare and correlate cardiovascular risk (CVR) factors through ultrasound findings, clinical, and laboratory variables.Methods37 patients underwent ultrasound assessment, with CVR clinical scores applied: Framingham and QRISK-3 (Risk for Increased Cardiovascular Disease in SLE). The SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) assessed systemic lupus erythematosus (SLE) activity.ResultsStatistically significant correlations were observed between the Framingham score, QRISK-3, and carotid artery diameter, with QIMT RF and expected values. Correlation coefficients ranged from 0.45 to 0.84, and p-values from 0.01 to <0.01. In linear regression analysis, variables influencing expected QIMT included QRISK-3, age, statin use, and diabetes mellitus, with p-values from 0.034 to <0.001. For QIMT RF, age and the Framingham score showed influence, with p-values from 0.028 to 0.004. SLEDAI did not significantly impact ultrasonographic parameters.ConclusionCarotid ultrasound was associated with in the subclinical detection of CVR in this cohort, providing complementary data to clinical evaluations.

ObjectivesIn systemic lupus erythematosus (SLE), a serologically active clinically quiescent (SACQ) state is defined as one in which high anti-DNA antibody levels or low complement levels persist, however, disease activity remains stable. Although treatment intensification is not recommended for the SACQ state under the Treat to Target strategy, SACQ has been reported to be a risk factor for flares. The present study aimed to evaluate the efficacy of adding belimumab (BLM) to hydroxychloroquine (HCQ), the standard treatment for SLE, for patients in the SACQ state.MethodsPatients treated with BLM were defined as the exposure group and those who did not were defined as the control group. Propensity score analysis with inverse probability of treatment weighting was used to analyze outcomes. The primary outcome was analyzed using the Kaplan-Meier method to determine time-to-event achievement to reduce prednisolone (PSL) dose to 7.5 mg/day or 5 mg/day. Secondary outcomes were as follows: (1) time to flares, analyzed using the Kaplan-Meier method, and (2) difference in median PSL dose at the last observation, analyzed using the Mann-Whitney U-test.ResultsOf the 146 patients in the SACQ state who received HCQ, 27 were included in the exposure group and 107 in the control group. The primary outcome, time-to-event achievement to reduce PSL dose to 7.5 mg/day and 5 mg/day had an HR value of 1.21 (95% confidence interval (CI) 0.78-1.89, p = 0.396) and 1.19 (95% CI 0.74-1.89, p = 0.471) in the two groups, respectively, with no significant difference between the two groups. No significant differences were observed in other outcomes.ConclusionsAdding BLM to HCQ in patients in the SACQ state did not demonstrate effects in preventing flares or reducing glucocorticoids (GC) dose.

ObjectivesTo clarify risk factors for cytomegalovirus (CMV) reactivation and disease in patients with systemic lupus erythematosus (SLE).MethodsWe reviewed patients with SLE who received remission induction therapy at our institution between May 2010 and October 2022 and enrolled those whose CMV pp65 antigen-positive cell counts were measured within 3 months of admission. Patients with CMV reactivation were divided into CMV disease (with any symptoms or end-organ disease due to CMV reactivation) and asymptomatic CMV reactivation. Risk factors for CMV reactivation and CMV disease were examined.ResultsWe observed CMV reactivation in 64 of 130 patients. Age (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.09-3.78; p = 0.026), albumin (HR, 2.35; 95% CI, 1.09-5.07; p = 0.029), a high Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (HR, 1.73; 95% CI, 1.00-2.98; p = .048), and immunosuppressive drug use (HR, 1.94; 95% CI, 1.12-3.35; p = 0.018) were risk factors for CMV reactivation. CMV reactivation occurred more frequently when two or more risk factors were present. Among the 64 cases of CMV reactivation, 25 with disease had a higher number of CMV pp65 antigen-positive cells (6 vs 2; p = 0.02). The cut-off value for developing organ damage was 12 cells on two slides.ConclusionIn SLE patients, age, albumin, a high SLEDAI, and immunosuppressive drug use were possible risk factors for CMV reactivation. Patients who develop organ damage have high numbers of CMV pp65 antigen-positive cells and are prone to be symptomatic with an antigenemia count >12 per two slides.