Balancing risks and benefits in the use of hydroxychloroquine and glucocorticoids in systemic lupus erythematosus.

INTRODUCTION: Hydroxychloroquine (HCQ) and glucocorticoids (GCs) constitute the oldest and more used drugs in the treatment of systemic lupus erythematosus (SLE). Despite this long experience, both are still subject to a number of uncertainties, mainly regarding the dose. AREAS COVERED: We review the main mechanisms of action, the clinical and toxic effects of HCQ and GCs and analyze the recommendations for the use of both in guidelines published since 2018. We offer a set of recommendations based on the pharmacology, mechanisms of action and clinical evidence. EXPERT OPINION: HCQ is the backbone therapy for SLE, and a judicious use must be accomplished, using doses that allow a good control of lupus without compromising the safety of treatments very much prolonged over the time. Stable doses of 200 mg/day seem to accomplish both conditions. GCs should be used more judiciously, with methyl-prednisolone pulses as the main therapy for inducing rapid remission and doses ≤5-2.5 mg/day be never exceeded in long-term maintenance treatments.

Burden of lupus activity on health care resources utilization in Buenos Aires, Argentina.

OBJECTIVE: The aim is to analyze health care resource utilization (HCRU) of patients with lupus (SLE) from a health management organization (HMO) in Buenos Aires, Argentina, compared with matched controls and comparing periods of flare, low disease activity, and remission. METHODS: This is a retrospective observational study including all SLE incident cases (ACR 1997/SLICC 2012 criteria) between 2000 and 2020 and 5 matched controls. Clinical data and HCRU (medical and nonmedical consultations, lab and imaging tests performed, emergency room visits, hospitalizations, and drugs prescribed) were obtained from administrative databases and electronic medical records. For each patient with SLE, an activity state was determined in every month of follow-up: flare (BILAG A or 2 BILAG B); low disease activity (LLDAS); remission (DORIS definition); or intermediate activity (not fulfilling any of previous). Incidence rates for each HCRU item and incidence rate ratios between SLE and control patients were and between remission and flare periods were calculated. Multivariate negative binomial logistic regression analyses were performed for identification of variables associated with major resource use. RESULTS: A total of 62 SLE and 310 control patients were included, 88.7% were women, the median age at diagnosis was 46 years, and were followed for more than 8 years. Patients with SLE contributed with 537.2 patient-years (CI 95% 461.1-613.3) and controls with 2761.9 patient-years (CI 95% 2600.9-2922.8). HCRU in patients with SLE was significantly higher than in controls in all items, even in remission periods. Patients with SLE remained 74.4% of the time in remission, 12.1% in LLDAS, 12.2% in intermediate activity, and 1.3% in flare (there were 64 flares in 36 patients). HCRU was significantly higher during flare periods compared with remission periods. Number of flares was independently associated with emergency department consultations, lab tests and X-ray performed, number of drugs prescribed, and hospitalizations. CONCLUSION: Significantly more HCRU was observed in patients with SLE in flare compared to remission periods.

Tripterygium glycosides for safely controlling disease activity in systemic lupus erythematosus: a systematic review with meta-analysis and trial sequential analysis.

Background: Tripterygium glycosides have been used to treat systemic lupus erythematosus (SLE) for a long time, showing the effects of immune regulation. We aimed to evaluate the benefits and risks of Tripterygium Glycosides Tablets (TGT) for patients with SLE. Methods: We searched electronic databases and clinical trial registries for relevant randomized controlled trials (RCTs). We identified eligible RCTs and assessed risk of bias. We conducted a meta-analysis to estimate the pooled effects. The Trial Sequential Analysis (TSA) 0.9.5.10 software was used to verify the reliability of the results. Results: Eight RCTs encompassing 538 patients with SLE were included. TGT combined with conventional treatments (CTs) was superior to CTs alone in reducing lupus activity (MD = -1.66, 95% CI = -2.07 to -1.26, p < 0.00001, low-certainty evidence) and improving overall response rate (ORR) (RR = 1.21, 95% CI = 1.11 to 1.32, p < 0.0001, moderate-certainty evidence). The robustness of the results was confirmed by TSA. Regarding safety, there was no statistical difference in the overall incidence of adverse reactions between the two groups. Conclusion: In patients with SLE, TGT might safely reduce disease activity. However, further high-quality studies are needed to firmly establish the clinical efficacy of TGT. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022300474; Identifier: CRD42022300474.

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.

Cutaneous vasculitis occurring in the setting of systemic lupus erythematosus: a multicentre cohort study.

OBJECTIVES: To describe the clinical and pathological features of biopsy-proven cutaneous vasculitis (CV) associated with SLE, focusing on diagnosis classification and impact on overall SLE activity. METHODS: Retrospective multicentric cohort study including SLE patients with biopsy-proven CV identified by (i) data from pathology departments of three university hospitals and (ii) a national call for cases. SLE was defined according to 1997 revised ACR and/or 2019 ACR/EULAR criteria. CV diagnosis was confirmed histologically and classified by using the dermatological addendum of the Chapel Hill classification. SLE activity and flare severity at the time of CV diagnosis were assessed independently of vasculitis items with the SELENA-SLEDAI and SELENA-SLEDAI Flare Index. RESULTS: Overall, 39 patients were included; 35 (90%) were female. Cutaneous manifestations included mostly palpable purpura (n = 21; 54%) and urticarial lesions (n = 18; 46%); lower limbs were the most common location (n = 33; 85%). Eleven (28%) patients exhibited extracutaneous vasculitis. A higher prevalence of Sjögren's syndrome (51%) was found compared with SLE patients without CV from the French referral centre group (12%, P < 0.0001) and the Swiss SLE Cohort (11%, P < 0.0001). CV was mostly classified as urticarial vasculitis (n = 14, 36%) and cryoglobulinaemia (n = 13, 33%). Only 2 (5%) patients had no other cause than SLE to explain the CV. Sixty-one percent of patients had inactive SLE. CONCLUSION: SLE-related vasculitis seems very rare and other causes of vasculitis should be ruled out before considering this diagnosis. Moreover, in more than half of patients, CV was not associated with another sign of active SLE.

Relación de la expresión génica de IP-10 con la actividad del lupus eritematoso sistémico / Relationship of IP-10 gene expression to systemic lupus erythematosus activity

Objetivo: Evaluar la expresión génica del gen IP-10 en pacientes con lupus eritematoso sistémico (LES) y su posible relación con la actividad de la enfermedad. Pacientes y métodos: El estudio incluyó 120 pacientes diagnosticados con LES y 30 controles sanos. Se investigó la expresión génica relativa de IP-10 con el método fold change, la cual fue correlacionada con el nivel de actividad lúpica evaluado con el instrumento SLEDAI 2-K. Resultados: Se encontraron diferentes niveles en la expresión génica de IP-10 relacionada con la actividad lúpica (p =<0,001). Estos fueron mayores en los pacientes con actividad grave respecto a aquellos sin actividad, baja y moderada. El incremento en la expresión génica del grupo con actividad grave fue significativo con un fold change de tres. Conclusión: El incremento significativo en la expresión génica relativa IP-10 puede ser un marcador de actividad lúpica grave.(AU)

Objectives: To evaluate IP-10 gene expression in patients with SLE, and its possible relationship with disease activity. Patients and methods: This study included 120 patients diagnosed with SLE and 30 healthy controls. The relative gene expression of IP-10 was investigated with the Fold Change method, which was correlated with the level of lupus activity evaluated with the SLEDAI 2-K instrument. Results: Different levels of gene expression were found according to the SLE activity (p =<0.001). IP-10 gene expression levels were higher in patients with severe activity than in those with no activity, low activity, and moderate activity. The increase in gene expression in the severe activity group was significant with a Fold Change of 3. Conclusion: The significant increase in relative gene expression IP-10 may be a marker of severe lupus activity.(AU)

Relationship of IP-10 gene expression to systemic lupus erythematosus activity.

OBJECTIVES: To evaluate IP-10 gene expression in patients with SLE, and its possible relationship with disease activity. PATIENTS AND METHODS: This study included 120 patients diagnosed with SLE and 30 healthy controls. The relative gene expression of IP-10 was investigated with the Fold Change method, which was correlated with the level of lupus activity evaluated with the SLEDAI 2-K instrument. RESULTS: Different levels of gene expression were found according to the SLE activity (P = <.001). IP-10 gene expression levels were higher in patients with severe activity than in those with no activity, low activity, and moderate activity. The increase in gene expression in the severe activity group was significant with a Fold Change of 3 CONCLUSION: The significant increase in relative gene expression IP-10 may be a marker of severe lupus activity.

Validation and adaptation of the Spanish version of the systemic lupus activity questionnaire (S-SLAQ) in an Argentinean population.

OBJECTIVES: To validate the systemic lupus activity questionnaire (SLAQ) in Spanish language. METHODS: The SLAQ questionnaire was translated and adapted in Spanish. Consecutive SLE patients from 8 centers in Argentina were included. A rheumatologist completed a Systemic Lupus Activity Measure (SLAM), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K, and a physician's assessment. Reliability was assessed by internal consistency (Cronbach's alpha), stability by test-retest reliability (intraclass correlation coefficient), and construct validity by evaluating the correlation with clinically relevant scores. Sensitivity and specificity for clinically significant disease activity (SLEDAI ≥6) of different S-SLAQ cut-off points were evaluated. RESULTS: We included 97 patients ((93% female, mean age: 40 years (SD14.7)). Internal consistency was excellent (Cronbach's alpha = 0.84, p < 0.001), and the intraclass correlation coefficient was 0.95 (p < 0.001). Mean score of S-SLAQ was 8.2 (SD 7.31). Correlation of S-SLAQ was moderate with Patient NRS (r= 0.63 p< 0.001), weak with SLAM-no lab (r = 0.42, p <0.001) and SLAM (r = 0.38, p < 0.0001), and very weak with SLEDAI-2K (r = 0.15, p =0.1394). Using the S-SLAQ cutoff of five points, the sensitivity was 72.2% and specificity was 37.9%, for clinically significant disease activity. CONCLUSIONS: The S-SLAQ showed good validity and reliability. A good correlation, similar to the original instrument, was observed with patient´s global disease activity. No correlation was found between S-SLAQ and gold standard disease activity measures like SLEDAI-2K and SLAM. The S-SLAQ cutoff point of 5 showed a good sensitivity to identify the active SLE population and therefore could be an appropriate screening instrument for disease activity in clinical and epidemiological studies.

Relationship of IP-10 gene expression to systemic lupus erythematosus activity. / Relación de la expresión génica de IP-10 con la actividad del lupus eritematoso sistémico.

OBJECTIVES: To evaluate IP-10 gene expression in patients with SLE, and its possible relationship with disease activity. PATIENTS AND METHODS: This study included 120 patients diagnosed with SLE and 30 healthy controls. The relative gene expression of IP-10 was investigated with the Fold Change method, which was correlated with the level of lupus activity evaluated with the SLEDAI 2-K instrument. RESULTS: Different levels of gene expression were found according to the SLE activity (p =<0.001). IP-10 gene expression levels were higher in patients with severe activity than in those with no activity, low activity, and moderate activity. The increase in gene expression in the severe activity group was significant with a Fold Change of 3. CONCLUSION: The significant increase in relative gene expression IP-10 may be a marker of severe lupus activity.

Anti-IFNαR Mabs for the treatment of systemic lupus erythematosus.

INTRODUCTION: The type 1 interferon pathway is known to play a role in the immunopathology of systemic lupus erythematosus (SLE). As a result, biologic agents targeting this pathway have been developed and are currently being investigated in clinical trials. AREAS COVERED: We review the biologic agents which have been developed to antagonize type I interferons in SLE. We focus on anifrolumab, a type I interferon receptor antagonist, and consider the complexities of defining efficacy in SLE clinical trials. EXPERT OPINION: Anifrolumab shows promise as an addition to the SLE therapeutic armamentarium. Despite discordant results between its two phase III studies, there is a convincing suggestion of benefit in both trials to encourage the view that this approach might be effective. Data acquired thus far look particularly useful for cutaneous disease. We await data on its effect on renal, pulmonary, cardiac, and central nervous system involvement, on patient reported outcomes, and its safety and efficacy with long-term use.

Evaluation of serum presepsin, procalcitonin, copeptin, and high-sensitivity C-reactive protein for differentiating bacterial infection from disease activity in Egyptian patients with systemic lupus erythematosus.

OBJECTIVES: Several biological markers have been studied for the differentiation of infection from disease activity in systemic lupus erythematosus (SLE) patients with discrepant results. We aimed to evaluate the role of serum presepsin, hs-CRP, procalcitonin (PCT), and copeptin (CPP) in differentiating bacterial infections from disease activity in SLE patients. METHODS: This study is a cross-sectional observational study in which 94 Egyptian patients were recruited from June 2017 to January 2018. Our patients were divided into two groups: group (1) included 48 patients with active SLE hospitalized with any sort of lupus activity and group (2) included 46 patients with active SLE admitted with a proven bacterial infection. Hs-CRP, presepsin, PCT, and CPP were measured using enzyme-linked immune sorbent assay technique. RESULTS: Hs-CRP, presepsin, PCT, and CPP were highly significantly higher among group (2) patients compared to group (1) patients (p < 0.001). Serum presepsin expressed higher specificity than hs-CRP (87.5% vs 60.4%) but the same sensitivity (80.4%) in the detection of bacterial infection in SLE patients. Serum PCT expressed higher specificity than hs-CRP (100% vs 60.4%) but lower sensitivity (73.9% vs 80.4%). Serum CPP expressed higher specificity than hs-CRP (65.9% vs 60.4%) but lower sensitivity (65.9% vs 80.4%). CONCLUSION: Our study suggests that increased serum levels of hs-CRP, presepsin and PCT levels are useful in differentiating bacterial infections from disease activity in SLE patients. Serum CPP could be used as an adjunct with more specific inflammatory biomarkers in making better diagnostic judgments. KEY POINTS: • The increased serum levels of hs-CRP, presepsin and PCT levels are useful in differentiating bacterial infections from disease activity in SLE patients. • Serum Presepsin expressed higher specificity than hs-CRP but the same sensitivity in the detection of bacterial infection in SLE patients. • Serum CPP expressed higher specificity than hs-CRP but lower sensitivity.

Hospitalización en lupus eritematoso sistémico: causas, actividad lúpica y evolución / Hospitalization in systemic lupus erythematosus: causes, lupus activity and evolution

Resumen: ANTECEDENTES: el lupus eritematoso sistémico es una enfermedad autoinmunitaria de origen multifactorial en la que se afectan múltiples órganos. OBJETIVO: establecer las principales características de los pacientes con lupus eritematoso sistémico tratados en el servicio de Medicina Interna, las causas de ingreso, el grado de actividad de la enfermedad y la evolución posterior a su ingreso al hospital. MATERIAL Y MÉTODO: estudio descriptivo y retrospectivo de pacientes con diagnóstico de lupus eritematoso sistémico, ingresados durante el periodo del 1 de enero de 2013 al 30 de junio de 2016 en el servicio de Medicina Interna del Hospital Escuela Universitario de Tegucigalpa, Honduras. RESULTADOS: se estudiaron 78 pacientes del sexo femenino y 5 masculinos, con relación aproximada de 16:1; el promedio de ingresos hospitalarios por paciente fue de 1.19. Se encontró un índice MEX-SLEDAI promedio de actividad al ingreso de 7.5 ± 4.6 puntos. El promedio de estancia hospitalaria fue de 12.4 ± 11.7 días, en 61% de los casos la duración de la hospitalización fue mayor de 7 días, en este grupo se encontró un valor promedio de actividad lúpica de 8.5 ± 4.4 puntos. La causa más frecuente de ingreso hospitalario fue la actividad de la enfermedad 58%, seguida de procesos infecciosos 24%. CONCLUSIONES: el lupus eritematoso sistémico se diagnostica comúnmente en pacientes jóvenes principalmente del sexo femenino; sin embargo, cuando afecta a pacientes masculinos, la actividad de la enfermedad suele ser más severa. La actividad lúpica fue la principal causa de ingreso.

Abstract: BACKGROUND: Systemic lupus erythematosus SLE is an autoimmune pathology of multifactorial etiology where multiple organ involvement occurs. OBJECTIVE: To establish the main characteristics of patients with systemic lupus erythematosus treated at Internal Medicine service, their causes of entering, degree of disease activity and evolution posterior to hospitalization. MATERIAL AND METHOD: A descriptive and retrospective study of patients diagnosed with systemic lupus erythematosus admitted during the period from January 1st 2013 to June 30 2016 at the Internal Medicine Service of the Hospital Universitario de Tegucigalpa, Honduras. RESULTS: We studied 78 female and 5 male patients, establishing a ratio of approximately 16:1, the average hospital admission per patient was 1.19. We found an average MEX-SLEDAI of activity at the entrance of 7.5 ± 4.6 points. The average hospital stay was 12.4 ± 11.7 days, in 61% of cases duration of more than 7 days was presented, in this group an average value of lupus activity of 8.5 ± 4.4 points was found. The most frequent cause of hospital admission was the activity of the disease 58%, followed by infectious processes 24%. CONCLUSIONS: Systemic lupus erythematosus is commonly diagnosed in young female patients, but when it occurs in male patients, the disease activity is usually more severe. Lupic activity was the main cause of hospitalization.

From BILAG to BILAG-based combined lupus assessment-30 years on.

Disease activity in SLE can be difficult to measure and there is no biomarker that uniformly reflects disease activity. There are various disease activity scores, but there is no gold standard assessment tool. This is a review of the development of the BILAG index from the classic BILAG disease activity index to the BILAG-2004 disease activity index and composite response criteria. The original classic BILAG index was revised and distinguished nine organs/systems. Features that indicated damage, such as avascular necrosis, were excluded. There was improvement in the glossary, scoring system and software. The BILAG-2004 index has been shown to be reliable, valid and sensitive to change. The BILAG-2004 index has been modified for pregnancy and has also been used in paediatrics. The SLE Responder Index (SRI) and the BILAG-based combined lupus assessment (BICLA) are composite responder indices incorporating the BILAG index. Since the initial development of the BILAG index in 1984, major improvements have been made in the measurement of disease activity in lupus. However, the BILAG-2004 index is the only transitional index that grades clinical features as being new, the same, worse or improving and incorporates severity in the scoring.

Socioeconomic status and organ damage in Mexican systemic lupus erythematosus women.

The objective of this cross-sectional study was to determine relationships between socioeconomic status and organ damage in Mexican systemic lupus erythematosus (SLE) patients. Demographic and clinical variables were assessed. Socioeconomic status was evaluated using the Graffar method and monthly household income. Lupus activity and organ damage were measured using the SLE disease activity scale, validated for the Mexican population (Mex-SLEDAI), and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) scale. The 143 Mexican female SLE patients included (mean age 40.1 ± 8.9 years, mean disease duration 8.9 ± 6.3 years) had a mean monthly household income of $ 407.2 ± 326.5. According to the Graffar index, 18.9%, 52.5%, and 28.7% had high/medium-high, medium, and medium-low/low socioeconomic status, respectively. Organ damage was observed in 61 patients (42.7%). Patients with organ damage had lower monthly household incomes ($241.4 ± 152.4 vs. $354.8 ± 288.3) and were more frequently unemployed (57.3% vs. 35.3%; p = 0.01) than those without. Low monthly income was not associated with lupus activity or self-reported health status. In the adjusted multivariate analysis, low monthly income ( < $300) was associated with organ damage. In conclusion, low income may be associated with organ damage in Mexican SLE patients.

Reprint of: B cell elimination in systemic lupus erythematosus. Clin. Immunol. 146(2) 90-103.

Systemic lupus erythematosus (SLE) is an autoimmune disorder with a worldwide distribution, potentially life-threatening with considerable morbidity. The elimination of pathogenic B cells has emerged as a rational therapeutic option. Many open label studies have reported encouraging results in which clinical and serological remission have invariably been described, often enabling the reduction of steroid and immunosuppressive treatment. However, the results from randomized controlled studies have been disappointing and several questions remain to be answered. In this review we will focus on results of B cell direct depletion in the treatment of patients with systemic lupus erythematosus.

Manifestaciones renales y neuropsiquiátricas en pacientes con lupus eritematoso sistémico y anticuerpos anti-P ribosomal / Renal and neuropsychiatric manifestations in patients with systemic lupus erythematosus and ribosomal P protein autoantibodies

Los auto anticuerpos contra la proteína P ribosomal (anti-P ribosomales) se presentan en aproximadamente el 15% de los pacientes con lupus eritematoso sistémico (LES). Estos anticuerpos fueron inicialmente asociados con psicosis lúpica y enfermedad neuropsiquiátrica. Posteriormente se reconoció su asociación con alto riesgo de compromiso renal y hepático. Objetivos: evaluar la coexistencia serológica y clínica de anticuerpos anti-P ribosomal y anti-DNA en pacientes con LES con compromiso renal y neuropsiquiátrico. Materiales y métodos: casos: 12 pacientes con lupus neuropsiquiátrico (cambios conductuales 6, depresión 4, alucinaciones 3, alteración cognitiva 2, convulsiones 2 y psicosis 2). Controles: 13 pacientes con actividad por LES sin evidencia de manifestaciones neuropsiquiátricas. Todos los pacientes estuvieron activos para el tiempo de la evaluación. Los anticuerpos anti-P ribosomal fueron determinados por ELISA y los anti-dcDNA por el método de Crithidia luciliae. La función renal fue valorada por medición de creatinina y el compromiso renal con uroanálisis. Resultados: la edad media fue de 39 años, 2 hombres / 23 mujeres. Ocho casos (66,6%) y seis (46,1%) controles tenían compromiso renal. El 20% de los pacientes fueron positivos para anti-P ribosomal (5/25 pacientes: 2 controles y 3 casos). El 36% de los pacientes tenían anticuerpos anti-dsDNA (30,7% controles y 41,6% casos). La presencia de anticuerpo P ribosomal estuvo asociada con anti-dcDNA (p = 0,002) y con nefritis lúpica (p = 0,046), pero no hubo asociación entre el anti-P ribosomal y las manifestaciones neuropsiquiátricas (p = 0,645). Conclusiones: la presencia de anticuerpos anti-P ribosomal está asociada con anti-dcDNA y nefritis lúpica. Este estudio no encontró asociación estadísticamente significante entre anti-P ribosomal y manifestaciones neuropsiquiátricas del LES.

Summary The ribosomal P protein autoantibodies are present in approximately 15% of patients with Systemic Lupus Erythematosus (SLE). These antibodies were initially associated with lupus psychosis and neuropsychiatric diseases. Posteriorly, they were associated to a higher risk of renal and liver involvement in patients with SLE. Objective: to evaluate the serologic and clinic coexistence of ribosomal P protein autoantibodies and anti-dsDNA in patients with SLE with renal and neuropsychiatric manifestations. Materials and Methods: cases: 12 patients with neuropsychiatric and renal involvement (behavior changes 6, depression 4, hallucinations 3, cognitive impairment 2, seizures 2 and psychosis 2). Controls: 13 patients with active SLE, without evidence of neuropsychiatric manifestations. SLE was active in all patients during the process of evaluations. The anti-ribosomal P protein antibodies were determined by ELISA and the dsDNA antibodies by Crithidia luciliae´s immunofluorescence test. The renal function was evaluated by serum creatinin and urinalyses. Results: the median age was 39 years, 2 men/23 women. 8 cases (66.6%) and 7 controls (53.8 %) have renal involvement. 20% of patients were positive for anti P-ribosomal antibodies (5/25 patients: 2 controls and 3 cases). 36% of patients have anti dsDNA antibodies (30.7% controls and 41.6% cases). The presence of anti-ribosomal P protein antibodies was associated with anti dsDNA antibodies (p = 0.002) and with lupus nephritis (p = 0.046), but no association between ribosomal P protein autoantibodies and neuropsychiatric manifestations was found (p = 0.645). Conclusions: the P-ribosomal antibodies are associated with anti-dsDNA and lupus nephritis. This study did not show statistically significant associations between ribosomal P protein autoantibodies and neuropsychiatric manifestations in patients with SLE.

Levels of erythrocyte complement receptor type 1 in the pathogenesis of systemic lupus erythematosus / 中国免疫学杂志

Objective:To investigate the correlationship between levels of erythrocyte receptor type1(E-CR1) and disease activity and abnormal criteria of immunology in systemic lupus erythematosus (SLE)and to study the E-CR1 levels in pathogenesis of SLE.Methods:The fluorescence intensity in sera from 72 patients with SLE and 20 cases of normal controls was detected by flucytometry.Complement(C3,C4),immunoglobulins(IgG,IgA and IgM),gammaglobulins(?-G),erythrocyte sediment rate(ESR) and blood cell counts,including white blood cell(WBC),red blood cell(RBC),hemoglobin(HGB),hematocrit(HCT),mean corpuscular volume(MCV)and platelet(PLT) were detected at the same time.The scoring instruments of systemic lupus activity measure (SLAM) were used to evaluate disease activity.Results:The E-CR1 levels in patients with SLE were lower significantly than that in normal controls (P

Influence of Fludarabine on lupus activity of BXSB mice / 中国免疫学杂志

Objective:To investigate influence of Fludarabine to lupus activity of lupus mice and the effectiveness and safety of Fludarabine on the treatment of BXSB lupus mice and their possible methanism Methods:Fludarabine of 30 mg/(m 2?d) was injected into BXSB by tail vein,3 days continuously Results of treatment was observed through counting number of peripheral blood WBC Anti ds DNA and anti nuclear antibody in BXSB serum was measured by ELISA Pathologic transformation of kidney or urine protein was measured by immunofluorescence or urine protein test paper after treated by Fludarabine Expression of CD4 +Fas +?CD8 +Fas +?CD45RO + Fas + on T lymphocyte were measured by flowcytometry Results:The number of peripheral blood WBC of BXSB mice began to decline from the third day after treated by Fludarabine The lowest value 〔0 5?0 2)?10 9 L -1 〕of the number of peripheral blood WBC appeared on the seventh day and on the nineteenth day the number of peripheral blood WBC was up to 1 0?10 9 L -1 after treated by Fludarabine The falling of anti ds DNA and anti nuclear antibody in BXSB serum appeared on the fourteenth and twentieth one day after treated by Fludarabine, respectively Reduction of from +～++ turning?kindey immunofluorescence were 72 7% in group of Fludarabine Reduction of protein urine from ++～+++ turning ?～ - appeared on the twentieth one and twentieth eight days Reduction of expression of CD4 +Fas +?CD8 +Fas +?CD45RO + Fas + on T lymphocyte was obvious after treated by Fludarabine Conclusion:Fludarabine can evidently reduce the serum level of anti ds DNA and anti nuclear antibody of BXSB and reduce injury of kidney and formation of protein urine So Fludarabine may have good curative effect to severe SLE Fludarabine can reduce expression of CD4 +Fas +?CD8 +Fas +?CD45RO + Fas + on T lymphocyte,which may be one of methanism of Fludarabine to SLE