Lupus最新文献

IntroductionMany patients with SLE struggle to achieve remission despite therapy with multiple drugs, emphasizing the need for effective treatments to improve symptoms, quality of life, and reduce medication burden. The objective of this review was to evaluate the safety and tolerability of combination rituximab and belimumab therapy in SLE.MethodsA systematic review was conducted in accordance with PRISMA standards. Embase, MEDLINE, and Web of Science were searched through June 2025. Studies evaluating safety and tolerability of combination rituximab and belimumab use in adults with SLE were included. For the purposes of this review, "combination therapy" was defined as administration of 1-2 doses of rituximab then initiation of belimumab ≥2 weeks after the last dose of rituximab. Studies evaluating simultaneous rituximab and belimumab therapy and those with no safety or tolerability data were excluded.ResultsSeven studies, comprised of two randomized controlled trials and five non-randomized trials, were included for a total of 185 unique patients. Commonly reported treatment-emergent adverse events (TEAEs) included infection, arthralgia, myalgia, rash, and hypogammaglobulinemia. Seven patients discontinued treatment due to TEAEs.DiscussionThe results of this review provide insight into TEAEs and tolerability of combination rituximab and belimumab therapy. Adverse effects are common on this treatment, and there is potential for serious adverse events. Many of the TEAEs reported in the included studies are also symptoms of uncontrolled SLE, adverse effects of concomitant immunosuppressive medications, or infections commonly seen amongst SLE patients. Ethical and logistical issues make it difficult to eliminate confounding factors and determine whether these adverse effects are truly due to study treatment. Further investigation is needed to compare efficacy to potential drawbacks of this therapy.ConclusionDue to the prevalence and severity of adverse effects associated with this therapy, more research is needed to determine if it is as safe as existing therapies for SLE.

BackgroundPatients with systemic lupus erythematosus (SLE) experience impaired wellbeing and elevated cardiovascular risk. Lifestyle interventions targeting exercise and nutrition may improve overall health outcomes, but evidence in this population remains limited.PurposeThis study aimed to investigate the effects of a newly developed healthy lifestyle intervention, the Living Well with Lupus (LWWL) program, on overall wellbeing in patients with SLE and high cardiovascular risk. Research DesignA 6-month, parallel-group, randomized controlled trial was conducted in São Paulo, Brazil, between August 2020 and March 2023. Participants were randomly assigned to either the LWWL intervention group or a standard care control group. The LWWL program was a goal-setting, behavioral intervention including a home-based exercise program and nutritional counseling. Study SampleEighty adults with SLE and high cardiovascular risk were included. Twelve participants in the LWWL group dropped out due to personal reasons, and six in the control group did not respond to post-intervention assessments.Data Collection and/or AnalysisSecondary outcomes related to wellbeing were assessed, including quality of life (SF-36), fatigue (FACIT), functional capacity, anxiety and depression symptoms, and sleep quality. Between-group comparisons were performed at post-intervention, and complete-case sensitivity analyses were conducted. ResultsSignificant between-group differences were observed for the role physical domain of the SF-36 (EMD [95% CI]: -1.0 [-1.6; -0.4]; p = .01; ES [95% CI]: -1.03 [-1.6; -0.4]) and the FACIT fatigue score (EMD [95% CI]: 7.1 [1.6; 12.6]; p = .01; ES [95% CI]: 1.24 [0.5; 2.0]) in favor of the LWWL group. No significant between-group differences were detected for other variables (p > .05). Sensitivity analyses corroborated these findings and suggested improvements in mood and strength following the program. ConclusionsThe LWWL intervention improved fatigue and the role physical domain of quality of life in SLE patients with high cardiovascular risk. This behavioral lifestyle approach represents a potentially clinically relevant strategy to enhance selected aspects of wellbeing in SLE.

ObjectiveTo assess knowledge of reproductive health (pregnancy and contraception) in systemic lupus erythematosus (SLE) patients with no history of pregnancy.MethodsThis cross-sectional study included SLE patients (aged 18-50 years, menstruating, and never pregnant) who attended Chiang Mai University Hospital between November 2021 and July 2023. They completed a reproductive health knowledge assessment and provided information on their contraceptive use.ResultsOf 204 SLE patients (mean age 30.91 years, 73.76% single, 27.45% with active nephritis, 62.75% on immunosuppressive drugs), 83.82% and 57.53% had adequate knowledge of pregnancy and contraception in SLE patients, respectively. Among 101 patients with sexual experience, 91 (43.96%), currently active, provided their contraceptive practice. Male condoms and withdrawal methods were commonly used. None of the patients used intrauterine devices. Compared to the past, the current use of male condoms and withdrawal has significantly decreased (76.92% to 62.64%, p = .007, and 47.25% to 37.36%, p = .020, respectively), and effective contraceptive methods (oral contraceptive pills and medroxyprogesterone acetate injections) also have significantly declined (19.78% to 2.20%, p < .001, and 8.79% to 4.40%, p = .046, respectively). In contrast, the proportion of entirely no contraceptive used slightly but significantly increased (2.20% to 7.69%, p = .025). There was no difference in contraceptive methods used, frequency of sexual activity, and SLE disease activity between patients who did and did not live with their partners.ConclusionsKnowledge of reproductive health, particularly contraceptive use in SLE patients, remains suboptimum. Formal reproductive health counseling should be carried out in all SLE patients for better contraception planning.

ObjectiveTo analysis the impact of 25(OH)D3 on immune function in patients with Systemic lupus erythematosus (SLE) and elucidate its correlation with immunological indexes.MethodsA total of 158 newly diagnosed SLE patients admitted to the Rheumatology and Immunology Department of the hospital from January 2022 to January 2024 were collected. 25(OH)D3, immunoglobulin IgA, IgG, IgM, complement C3 and C4,CD3⁺T cells, CD4⁺T cells, CD8⁺T cells and CD4⁺/CD8⁺ were detected. Antinuclear antibody (ANA) and ENA antibody spectrum were identified; Clinical data of patients were collected. We separated the SLE group into three groups based on the levels of 25(OH)D3: deficient, insufficient, and sufficient. The clinical symptoms, immunological indexes, and autoantibodies of SLE patients across several groups were compared, and the association between the levels of 25(OH)D3 and immunological indexes was investigated.ResultsThe levels of IgA, IgG, and CD8⁺T lymphocytes in patients with SLE were higher compared to those in the healthy control group. The incidence of lupus nephritis, anemia, and arthritis, as well as the positive rate of anti-Sm antibody, was greater in the 25(OH) D3-deficient group compared to the 25(OH) D3-insufficient and sufficient groups. In individuals with SLE, 25(OH)D3 had a positive cor- relation with C3、while showing a negative correlation with IgG, CD8⁺T cells.Conclusion25(OH)D3 is typically insufficient in patients with SLE. Deficiency of 25(OH)D3 impacts the immune system of patients with SLE; such as lupus nephritis, anemia, and arthritis signify an elevated risk of vitamin D deficiency, requiring clinical consideration.

BackgroundSleep disturbances are common among patients with systemic lupus erythematosus (SLE) and significantly impair quality of life. Despite increasing awareness, determinants of poor sleep in this population remain underexplored.ObjectivesThis study aimed to assess sleep quality in Tunisian SLE patients and identify associated clinical and psychological factors.MethodsA cross-sectional study was conducted at Rabta Hospital in Tunisia from February to May 2023, including 100 SLE patients fulfilling the 2019 EULAR/ACR classification criteria. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Depression, anxiety, fatigue, pain, and quality of life were assessed using validated Arabic versions of the Hospital Anxiety and Depression Scale, Fatigue Severity Scale, Numeric Pain Rating Scale, and Lupus QoL.ResultsPoor sleep quality (PSQI ≥6) was observed in 58% of participants. Univariate analysis revealed associations between poor sleep and older age, family history of SLE, depression, anxiety, fatigue, moderate-to-severe pain, and disease activity. However, multivariate analysis identified emotional health domain as the sole independent predictor of poor sleep (OR = 0.955; p = .03).ConclusionEmotional health emerged as a key determinant of sleep quality among SLE patients in Tunisia. These findings highlight the need for integrated psychosocial interventions to improve both sleep and overall quality of life. Future longitudinal studies are needed to confirm these associations and assess causal relationships.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease often associated with anti-double stranded DNA (anti-dsDNA) antibodies and endothelial dysfunction, yet the mechanisms linking extracellular DNA to vascular injury remain unclear.Methods: We collected clinical samples from SLE patients and healthy controls, cultured human umbilical vein endothelial cells (HUVECs), and applied cell viability assays, ELISA, RT-qPCR, and Western blot to assess endothelial injury and activation pathways. We measured levels of von Willebrand factor (vWF), soluble thrombomodulin (sTM), and E-selectin in patient sera and cell culture supernatants.Results: SLE patients, particularly those positive for anti-dsDNA antibodies, showed significantly higher serum vWF, sTM, and E-selectin compared to controls (P < 0.05). In vitro, exposure of HUVECs to dsDNA induced a dose- and time-dependent reduction in cell viability, with an IC50 of 2.874 μg/ml, and significantly upregulated vWF, sTM, and E-selectin secretion. Mechanistically, dsDNA treatment activated the cGAS-STING-IRF3 signaling pathway, evidenced by increased mRNA and protein expression of cGAS, STING, and IRF3 (P < 0.05), as well as enhanced cytoplasmic cGAS fluorescence intensity in immunofluorescence analysis. These results demonstrate that elevated extracellular dsDNA can directly damage endothelial cells through cGAS-STING-IRF3 pathway activation, mirroring the endothelial injury observed in SLE patients.Conclusion: Our findings suggest that cell-free dsDNA is a potent inducer of endothelial dysfunction, and that targeting the cGAS-STING-IRF3 axis may offer new therapeutic opportunities for SLE and other diseases marked by elevated extracellular DNA.

BackgroundAntiphospholipid syndrome (APS) is the most common acquired hypercoagulable disorder characterized mainly by thrombotic events and obstetric morbidity. Quantifying chronic damage caused by APS is crucial for patient management. The original Damage Index for Thrombotic APS (DIAPS) was developed to address this need, but required updates to improve its comprehensiveness and specificity.ObjectiveTo report the initial content validation process of a new version of the damage index: DIAPSv2.MethodsA modified Delphi panel was conducted in two stages. Stage 1 involved a systematic scoping review of DIAPS studies, with data extracted from questionnaires and confirmed by the leading committee. These questionnaires identified items from the original instrument that needed modification, elimination, or replacement with new candidate items. Stage 2 employed the modified Delphi method over three rounds, considering expert panelists' opinions to select concepts for inclusion in DIAPSv2.ResultsIn Stage 1, evidence supported the validity of the original DIAPS but highlighted missing conditions reflecting chronic damage, such as alveolar hemorrhage and significant bleeding due to anticoagulation therapy. In Stage 2, participants from different working groups reached a consensus to evaluate 41 of the 67 items that the leading committee proposed for accurately measuring chronic damage in APS. A final consensus included 32 items. Definitions of all items were updated according to specialists' input and international recommendations for each domain.ConclusionsA collaborative and multidisciplinary consensus-based approach developed a new version of the damage index, comprising 11 domains and 32 items (an update from 10 domains and 38 items in the original version). DIAPSv2 offers a more specific tool for evaluating irreversible damage in patients with thrombotic APS.