The impact of curcumin supplementation on systemic lupus erythematosus and lupus nephritis: A systematic review.

OBJECTIVE: Curcumin is the active ingredient in the curry spice turmeric. It has anti-inflammatory properties due to the inhibition of transcription factors and inflammatory mediators such as nuclear factor-κß (NF-κß), cyclooxygenase-2 (COX2), lipoxygenase (LOX), tumor necrosis factoralpha (TNF-alpha), and interleukin-1 (IL-1) and 6 (IL-6). This review examines the literature regarding the efficacy of curcumin on systemic lupus erythematosus disease activity. METHODS: A search was conducted following guidelines in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) using the PubMed, Google Scholar, Scopus, and MEDLINE electronic databases to retrieve relevant studies assessing the impact of curcumin supplementation on SLE. RESULTS: The initial search yielded three double-blind, placebo-controlled, randomized clinical trials, three human in vitro studies, and seven mouse-model studies. In human trials, curcumin decreased 24-h and spot proteinuria, but the trials were small, ranging from 14 to 39 patients, with varied curcumin doses and different study durations ranging from 4 to 12 weeks. There was no change in C3, dsDNA, or the Systemic Lupus Erythematosus Disease Activity (SLEDAI) scores even in the longer trials. The mouse-model trials yielded more data. NF-κß activation was suppressed along with inducible nitric oxide synthase (NOS) species expression when 1 mg/kg/day of curcumin was administered for 14 weeks, leading to significant decreases in dsDNA, proteinuria, renal inflammation, and IgG subclasses. Another study suggested that curcumin reduced B cell-activating factor (BAFF) when used for up to 8 weeks at 50 mg/kg/day. A reduction in pro-inflammatory Th1 and Th17 percentages, IL-6 and anti-nuclear antibody (ANA) levels were reported. The doses used in the murine models were much higher than those used in human trials, with 12.5 mg-200 mg/kg/day used for over 16 weeks; highlighting that the optimal time for an immunological effect to be observed may require 12-16 weeks of curcumin use. CONCLUSION: Despite the wide use of curcumin in everyday life, its molecular and anti-inflammatory use has only been partially explored. Current data show a potential benefit on disease activity. Still, no uniform dose can be advised because long-duration, large-scale randomized trials using defined dosing are needed in different subsets of SLE, including lupus nephritis patients.

The effect of Omega-3 fatty acid supplementation in systemic lupus erythematosus patients: A systematic review.

OBJECTIVE: Many rheumatologists are inundated with questions about what "natural remedies" and "anti-autoimmune diets" exist for decreasing Systemic Lupus Erythematosus (SLE) disease activity. Over the last three decades, there has been an abundance of data from several different trials about omega-3 fatty acids sourced from fish oil, but the findings have been contradictory. This review seeks to present this data so that evidence-based recommendations can be given to patients, supporting the use of an adjuvant regimen with their present immunosuppression. METHODS: A literature search was conducted using the PubMed, Google Scholar, MEDLINE, and Scopus electronic databases to retrieve relevant articles for this review. Trials conducted on human subjects with SLE with full publications in English were included from 1 January 1980 to 1 April 2021. The impact of fish oil-derived omega-3 fatty acid supplementation on specific clinical features, the innate and adaptive immune response, biomarkers, and disease activity measures were assessed. The initial search yielded 7519 articles, but only 13 met our criteria and were eligible for this review. RESULTS: Data from thirteen articles were assessed. Ten trials assessed disease activity as an outcome, with eight trials demonstrating an improvement in patients in the omega-3 fatty acid group as assessed by a validated clinical tool or individual patient criteria. There was a significant improvement in Systemic Lupus Activity Measure-Revised (SLAM-R) scores at week 12 (p = .009) and week 24 (p < .001). Additionally, a reduction of urinary 8-isoprostane, a non-invasive marker of disease activity, was observed. There was no treatment benefit seen with respect to renal parameters such as serum creatinine or 24-hour urine protein; or systemic parameters such as C3, C4, or anti-double stranded DNA (anti-dsDNA) levels regardless of the dose of the omega-3 LUPUS fatty acids or duration of the trial. CONCLUSION: While there is conflicting evidence about the benefits of omega-3 fatty acid supplementation on SLE disease activity, specific measures have demonstrated benefits. Current data show that there is a potential benefit on disease activity as demonstrated by SLAM-R, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and British Isles Lupus Assessment Group (BILAG) scores and plasma membrane arachidonic acid composition and urinary 8-isoprostane levels, with minimal adverse events.

Chronic Tenosynovitis due to Mycobacteria kansasii in an Immunocompetent Host.

We report a case of a healthy 56-year-old male who presented with chronic swelling and erythema in his right hand. He had a prior chemical exposure several years ago and subsequent exposure to freshwater, fish tank, and soil. Laboratory data showed a slightly elevated CRP. An MRI was consistent with suggestive of flexor tenosynovitis. He underwent surgical debridement and was diagnosed with Mycobacterium kansasii. He was treated with clarithromycin, rifampin, and isoniazid, but subsequent susceptibility testing revealed resistance to isoniazid. Isoniazid was switched to ethambutol, but further susceptibility testing also suggested resistance to ethambutol. Antimicrobial therapy was stopped at 6 months due to clinical recovery, and the patient is currently doing well as of 6 months postdiscontinuation of therapy.

Intra-articular, bursa, and tendon sheath injections: a survey of practice patterns among members of the American College of Rheumatology.

OBJECTIVE: The objective of this study was to survey members of the American College of Rheumatology (ACR) regarding intra-articular and soft tissue (musculoskeletal [MSK]) injections and to determine if injection techniques vary depending on type of practice and years of experience. METHODS: A survey was e-mailed to the members of the ACR to obtain demographics of the respondents, MSK injection practices, and adverse events seen. RESULTS: The most common indications for MSK injections were rheumatoid arthritis, osteoarthritis, and bursitis. Written consent and time-out procedures were more common in academic/government practices when compared with private practice. There was variation in the type of corticosteroid used. The most common preparations were methylprednisolone actetate (45.0%), triamcinolone acetonide (26.1%), triamcinolone hexacetonide (22.1%). This survey showed good agreement on the dosage of corticosteroid for MSK injections; however, as years of experience increased, clinicians were more likely to prescribe lower doses for shoulder and knee injections. CONCLUSIONS: In this survey of ACR members, we found self-reported differences in the type of corticosteroid used for MSK injections. There was general agreement on frequency of injections, but more experienced practitioners reported using lower doses of corticosteroid.

Atypical presentation of West Nile virus in a newly diagnosed human immunodeficiency virus patient in New York City.

Central nervous system manifestations of West Nile virus (WNV) infection include meningitis, encephalitis, and poliomyelitis-like syndrome. We describe a 44-year-old man with no past medical history who presented with a meningoencephalitic syndrome and spastic paralysis bilaterally in the upper and lower extremities, hyperreflexia, and myoclonus and was ultimately diagnosed as being infected with HIV and WNV.