Lupus最新文献

Background: Anti-phospholipid syndrome (APS) is systemic autoimmune disorder defined as presence of anti-phospholipid antibodies with multiple obstetric complications. miR-146a-5P and miR-155-5P regulate APS and its associated inflammatory cytokines. Purpose: Our aim is to study expression levels of miR-146a-5p, miR-155-5p and pro-inflammatory cytokine interleukin-8 (IL-8) among pregnant females having APS. Research design: It is a case-control study. Data Collection and Analysis: Case group consisted of 50 pregnant women having APS. Control group consisted of 50 healthy pregnant women. Expression levels of miR-146a-5p and miR-155-5p were determined by quantitative reverse transcription polymerase chain reaction method (qPCR). IL-8 levels were determined using enzyme-linked immunosorbent assay (ELISA). Results: miR-146a-5p (mean ± SD), p value (confidence interval (CI)) among APS group versus Control group = (0.95 ± 0.7) versus (0.27 ± 0.4); 0.01 (0.44-0.90). miR-146a-5p had area under curve (AUC) of 0.813, sensitivity 66% & specificity 86%. miR-155-5p (mean ± SD); p value (CI) among APS group versus Control group = (0.57 ± 1.0) versus (0.48 ± 0.7); 0.60 (-0.25-0.43). miR-155-5p had (AUC) of 0.582, sensitivity 92% & specificity 40%. (mean ± SD); P value (CI) of IL-8 in APS group versus control group = (6.11 ± 1.2) versus (5.19 ± 0.5); CI(-0.36- 0.52), p < .001. Conclusion: miR-146a-5p significantly higher among APS group. IL-8 significantly more predominates among APS group. Alterations in miRNA expression are involved in thrombosis associated pregnancy complications.

ObjectiveTo assess the effect of antimalarials (AMs) on overall damage and on its most frequently affected domains, as measured by the Systemic Lupus International Collaborating Clinics Damage Index (SDI) in patients from the GLADEL cohort.MethodsNew damage was defined as a ≥1 point increase in SDI since cohort entry. AMs users were those who received AMs for at least 6 months after entering the cohort. AMs users and non-users were matched for age, sex, ethnicity, and baseline SDI using stratified random sampling. Two comparisons were carried out: patients with and without new damage, and AM users versus non-users. Propensity score matching was used to determine the effect of AM use on the most frequently affected damage domains.ResultsA total of 850 patients were included; 419 (49.3%) were AM users and 431 (50.7%) non-users. During a median follow-up of 48.5 (IQR 19.3, 69.0) months, 472 (55.5%) developed damage. The most affected domains were skin (18.4%), renal (14.6%), neuropsychiatric (10.8%), musculoskeletal (6.9%), and cardiovascular (4.5%). AMs use was associated with a lower proportion of patients accruing damage at follow-up (170 [40.6%] vs 208 [48.3%]; p = .028). AMs were protective against overall damage (HR 0.7, 95% CI [0.5-0.9]; p = .002), renal (HR 0.4, 95% CI [0.3-0.6]; p < .001), and neuropsychiatric damage (HR 0.5, 95% CI [0.3-0.9]; p = .022).ConclusionAM use is independently associated with a lower probability of overall, renal, and neuropsychiatric damage accrual. These findings support early and sustained AM treatment in lupus patients, unless contraindicated.

BackgroundLimited information is available on the effect of systemic lupus erythematosus (SLE) on outcomes, and healthcare resource utilization and expenditures. Such evidence can help improve care for patients with SLE.ObjectivesWe examined the associations between SLE and clinical and psychosocial outcomes, healthcare resource utilization, and direct healthcare expenditures.MethodsWe conducted a retrospective US population-based cross-sectional study using the US 2017-2022 Medical Expenditure Panel Survey data. We identified patients with SLE as those who both self-reported SLE diagnosis and either reported SLE-related medication use and/or visited a rheumatologist in the survey year. We matched eight patients without SLE to each patient with SLE on survey year, age, and sex, to create a reference cohort. The outcomes we assessed included clinical outcomes, psychosocial outcomes, healthcare resource utilization, and direct healthcare expenditures. We conducted appropriate multivariable regressions to examine the associations between SLE and each outcome.ResultsPatients with SLE had significantly lower mean physical component summary (PCS) scores than those without SLE by almost five points (p < .0001). Patients with SLE reported higher odds of pain interference with activities (adjusted odds ratio (AOR) = 1.998, 95% confidence interval (CI):1.372-2.909), fair to poor physical health status (AOR = 3.141, 95% CI: 1.993-4.949), cognitive limitations (AOR = 2.665, 95% CI: 1.465-4.849), functional limitations (AOR = 2.594, 95% CI: 1.646-4.089), social limitations (AOR = 2.227, 95% CI: 1.437-3.451), and psychological distress (AOR = 2.023, 95% CI: 1.447-2.827). Likewise, patients with SLE had higher adjusted rates of outpatient visits (adjusted annualized event rate ratio (AAERR) = 2.603, p < .05), office-based visits (AAERR = 1.447, p < .05), and emergency room visits (AAERR = 1.518, p < .05). Regarding healthcare expenditures, those with SLE had significantly higher average annual healthcare expenditures than those without SLE ($18,566 vs $9,366, p < .0001), and the findings were consistent across each healthcare resource component. In the adjusted analyses, average annual healthcare expenditures for individuals with SLE were significantly higher than those without SLE ($13,664 vs $11,781, p < .05).ConclusionPoor physical HRQoL, increased cognitive and functional limitations, and psychological distress are common among patients with SLE. Healthcare professionals across different disciplines should address these issues during visits and provide appropriate support and resources for patients with SLE. We also found higher healthcare resource utilization and higher healthcare expenditures among patients with SLE than their non-SLE counterparts.

BackgroundMounting evidence indicates an increase in systemic lupus erythematosus (SLE) cases in the paediatric population, highlighting childhood-onset SLE (cSLE) as a distinct entity that warrants attention. Thus, we characterized a hospital-based cSLE patient cohort at our centre, including 10 years of observation and an assessment of case distribution across three subperiods.MethodsRetrospective data from 2009 to 2022 were collected from the hospital medical records of SLE patients <18 years at the Department of Child Health at Prof. Ngoerah Hospital in Denpasar. The 2009-2022 population estimation was derived from the Office of Statistic Bureau, Bali Branch. We documented the number across the 2009-2022 period, the incidence per year, the regency of origin, the patients' age and sex, the number of referral cases, and the referrer and referrer diagnosis. The patients were grouped by year of presentation; the subperiods 2009-2014 (1st period), 2015-2017 (2nd period), and 2018-2022 (3rd period) were selected according to changes in financial and facility management across the study period. The distribution of certain characteristics across the subperiods was also assessed.ResultsA single case of cSLE was documented in 2009, followed by a pause in new cases. Subsequently, the incidence slowly increased until 2014. A surge in case numbers was reported from 2015 to 2017. The case incidence peaked in 2019, then began to decline, only to increase again in 2022. Thus, across the 2009-2022 period, the two peaks with the sharpest trend increases occurred between 2009 and 2019. The most common regency of origin was Denpasar in the first period, Badung in the second, and Denpasar in the third. Referrals also originated from other provinces in the third period. The dominant age group in the first period was 6-11 years, while the second and third periods were dominated by those 12-18 years of age, followed by 6-11 years, with a small number <5 years. No differences in the sex ratio were observed across the periods.ConclusioncSLE demonstrates an increasing trend in Bali, underscoring the need for improved facilities for diagnosis, medication, and care at both the acute and long-term disease phases.

ObjectiveTo delineate immunophenotypic alterations associated with newly diagnosed childhood-onset systemic lupus erythematosus (cSLE).MethodsPeripheral blood from 25 newly diagnosed cSLE patients (ND-cSLEs) and 23 healthy controls (HCs) was examined by multiparameter flow cytometry to profile lymphocyte subsets and helper T-cell populations; serum cytokines were quantified by bead-based assays.ResultsCompared with HCs, ND-cSLEs exhibited cytopenias, reduced CD3⁺ and CD4⁺ T cells, a decreased CD4⁺/CD8⁺ ratio, and diminished NK cells. Autoreactive CD21^-CD27^-B cells and plasmablasts were markedly expanded, whereas naïve and memory B-cell compartments contracted. Both CD4⁺ and CD8⁺ T cells demonstrated increased PD-1 and HLA-DR expression, indicating concurrent activation and exhaustion. T peripheral helper cells and CXCR3⁺ Tfh cells were significantly enriched. Elevated serum IL-10, IL-8, and IL-21 levels further characterized the inflammatory milieu.ConclusionsNewly Diagnosed cSLE patients is distinguished by profound remodeling of lymphocyte compartments, expansion of autoreactive and helper subsets, and heightened proinflammatory cytokine production, underscoring potential immunological biomarkers and therapeutic targets.

BackgroundCyclophosphamide (CYC) is a key immunosuppressive agent used for the treatment of systemic lupus erythematosus (SLE) and lupus nephritis (LN). However, its use is often limited by variability in efficacy and toxicity, potentially influenced by genetic polymorphisms. This systematic review and meta-analysis aimed to evaluate the association between the CYP2C19 polymorphism and cyclophosphamide-induced toxicity in SLE and LN patients.MethodsLiterature search was performed using PubMed and Web of Science databases in accordance with PRISMA guidelines. Studies were included if they evaluated cyclophosphamide therapy in SLE or LN patients, assessed genetic polymorphisms, and reported toxicity outcomes. Meta-analysis was performed using inverse variance weighted fixed effect and random effect, publication bias was checked using funnel plot and risk of bias was assessed using ROBINS E tool.ResultsOut of 1,713 identified articles, a total of 5 studies were eligible for meta-analysis which studied CYP2C19*2 genetic Polymorphism and CYC induced toxicity. It showed a significant association with protective effect (OR = 0.28, 95% CI: 0.099-0.845, p = .021). Funnel plots suggested potential publication bias in CYP2C19*2 studies, while the risk of bias assessment revealed some concerns regarding confounding and outcome measurement.DiscussionThis meta-analysis supports the utility of CYP2C19*2 genotyping in predicting CYC induced toxicity in SLE and LN patients. Small sample sizes, confounding factors, and variability in outcome assessment were found to be the key limitations. Larger, multi ethnic studies with standardized toxicity assessments are recommended to validate these findings and explore these pharmacogenetic markers for optimizing CYC therapy.

ObjectiveThe dysfunction of interleukin-7 receptor alpha (IL-7Rα), which is encoded by the IL7RA gene, has been implicated in the development of systemic lupus erythematosus (SLE). This study aimed to investigate the relationship between two specific single-nucleotide polymorphisms (SNPs) in the IL7RA gene-rs6897932 (C>T) and rs987106 (A>T)-and the risk of developing SLE.MethodsBlood samples were obtained from 105 Iranian individuals diagnosed with SLE and 105 healthy Iranian controls. The genotyping of these SNPs was carried out using the high-resolution melting (HRM) technique.ResultsAnalysis using a dominant model revealed that the combined frequencies of the CT and TT genotypes for rs6897932 were associated with a decreased risk of SLE (P = .009). Additionally, the T allele was found to be significantly less frequent in the patient cohort compared to the healthy controls (P = .005). Among laboratory parameters, C-reactive protein (CRP) levels were the only significant difference observed between patients with the CC genotype and those with CT or TT genotypes (P = .007). In contrast, an assessment of various inheritance models for rs987106 did not indicate any significant association with SLE risk (P > .05), nor was there a statistically significant difference in the frequency of the T allele between the two groups (P = .434). However, the TT genotype of rs987106 was significantly correlated with elevated serum levels of anti-dsDNA antibodies and creatinine, as well as an increased number of patients displaying renal involvement.ConclusionThe findings suggest that the T allele of rs6897932 in the IL7RA may provide a protective effect against the development of SLE. Although no significant association was found between rs987106 and SLE risk, it may still contribute to the disease's etiopathology, particularly concerning renal complications.

BackgroundSystemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects women of childbearing age and has been reported to cause sexual dysfunction in women. However, there are few qualitative studies to delve deeper into the impact of changing sexuality in women with SLE on themselves and their intimate relationships.ObjectiveTo assess the current sexual status and changes in sexual thoughts, attitudes, behavior, and psychology of female SLE patients to provide targeted health guidance.MethodsA phenomenological research method was used to select 18 female SLE patients from the Department of Rheumatology and Immunology of a tertiary hospital in Hefei City, Anhui Province, to conduct semi-structured in-depth interviews, and the data were analyzed using the Colaizzi seven-step analysis method and the Nvivo11Plus software.ResultsThe analysis of the interview data summarized 3 themes and 12 sub-themes, which were changes in sexual life and relationship (change in sexual physiology, change in sexual psychology, couples face changes in their relationships), multiple factors affecting sexual life and relationships (effect of disease, effect of age, effect of emotions, effect of economic, effect of medication, effect of body image), coping strategies for sexuality changes (avoidance and neglect, communication and acceptance, compromise and submission).ConclusionFemale SLE patients in this study experienced sexual physiological distress and positive or negative psychological experiences, and healthcare professionals should strengthen their attention to patients' sexuality issues and provide targeted professional guidance to patients to improve their quality of life.

BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disorder marked by inflammation and immune dysregulation. Environmental factors like viral infections may contribute to disease onset. Cytomegalovirus (CMV), a beta-herpesvirus capable of immune evasion, has been proposed as a trigger in SLE pathogenesis, though studies show conflicting results.Materials and MethodsA literature search of PubMed, Scopus, Embase, Web of Science, and ScienceDirect identified eligible reports examining CMV prevalence and SLE association. Studies were selected using predefined criteria. Data were analyzed using Comprehensive Meta-Analysis (CMA) v4 software. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Heterogeneity and publication bias were evaluated using Tau square, Cochrane's Q, I² statistics, funnel plots, and Egger's regression test. Sensitivity analyses determined robustness.ResultsTwelve case-control studies comprising 1267 SLE patients and 1417 healthy controls were included. In the healthy control group, antibodies against CMV, specifically IgG (0.728) and IgA (0.641), were more prevalent than CMV DNA (0.095) and IgM (0.051). CMV DNA (OR: 9.727, 95% CI = 1.136 to 83.260, p = .038) and CMV IgM (OR: 2.630, 95% CI: 1.665 to 4.155, p = .000) were significantly more prevalent in SLE patients than in controls, suggesting a possible role for active or recent CMV infection in SLE development. Sensitivity analyses demonstrated overall consistency of findings; however, the association for CMV DNA showed variability across studies and should be interpreted with caution.ConclusionThis meta-analysis shows a link between CMV infection and SLE, suggesting CMV may be an environmental risk factor in SLE pathogenesis. Further research is needed to understand mechanisms and evaluate antiviral strategies.