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2.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(4): 619-621, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642246

RESUMO

OBJECTIVE: To explore the serum homocysteine (Hcy) level and its influence factors in systemic lupus erythematosus (SLE) patients. METHODS: 90 SLE patients were included in the study. According to the systemic lupus erythematosus disease activity index (SLEDAI) score, 41 patients were in active stage (> 9 scores), 49 patients were in inactive stage (≤9 scores), while 46 healthy individuals were selected as controls. Total cholesterol (TC), triacylglyceride (TG), serum creatinine (Ser), C-reactive protein (CRP), serum cystatin (cystin c, CysC) and Hcy level were measured. Analysis on the relationship between Hcy level and SLEDAI score, as well as serum indicators was conducted. RESULTS: The levels of Hcy, TG, TC, CRP and CysC in SLE patients were higher than healthy controls (P < 0.05), and the serum level in active SLE patients was higher than inactive SLE patients (P < 0.05). There was no significant difference in Ser level among the active SLE patients, inactive SLE patients and healthy controls (P>0.05). There was a positive correlation between Hcy level and SLEDAI score (r=0.698 3, P < 0.01), as well as CysC (r=0.597 5, P < 0.01). There was no significant correlation between Hcy level and CRP, TC, TG and Ser levels (P>0.05). CONCLUSIONS: The Hcy level in SLE patients was higher than healthy controls. The level of Hcy was positively correlated with the degree of disease activity. The Hcy level and SLEDAI score can be used as indicators to evaluate the activity of SLE.


Assuntos
Homocisteína/sangue , Lúpus Eritematoso Sistêmico/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Colesterol/sangue , Creatinina/sangue , Cistatina C/sangue , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Triglicerídeos/sangue
3.
Med. clín (Ed. impr.) ; 153(6): 225-231, sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-184027

RESUMO

Fundamento y objetivo: Analizar la asociación entre concentraciones de interferón-1alpha (INF1alpha), interleucina 10 (IL-10) y BLyS con la actividad clínica en el lupus eritematoso sistémico (LES). Pacientes y métodos: Estudio observacional transversal de 142 pacientes con LES y 34 controles sanos mediante analítica de sangre y orina y revisión de la historia clínica. La concentración sérica de citocinas se determinó mediante métodos colorimétricos. El análisis bioestadístico se realizó con R (3.3.2). Resultados: El 69% de pacientes mostraron al menos una citocina aumentada. Las tres citocinas están más elevadas en pacientes que en controles (p<0,001, p=0,005 y p=0,043), siendo INF1alpha el más frecuente. Los pacientes fueron categorizados según las concentraciones de las tres citocinas. Encontramos una asociación significativa entre concentraciones elevadas de IL-10/INF1alpha y una mayor actividad clínica según SELENA-SLEDAI (p<0,0001) y, en menor medida, con concentraciones aumentadas de INF1alpha/IL-10/BLyS. Concentraciones elevadas de IL-10/INF1alpha e INF1alpha/IL-10/BLyS se relacionaron con un mayor consumo de C3-C4 (p<0,001 y p=0,001) y títulos elevados de anti-dsDNA (p=0,001 y p=0,002). Concentraciones elevadas de INF1alpha/BLyS se relacionaron con títulos más altos de anti-dsDNA (p=0,004) y positividad ENA (p<0,001). Concentraciones altas de INF1alpha/IL-10/BLyS se relacionaron con la positividad de ANA (p<0,001) y anticuerpos antifosfolípidos (p=0,004). Conclusiones: INF1alpha, IL-10 y BLyS están más elevados en pacientes con LES que en controles sanos. El aumento de IL-10, asociado o no a aumento de BLyS y/o INF1alpha, es la citocina que mejor se ajusta a la actividad clínica del LES medida con métodos clásicos


Background and objective: to analyse the association between interferon-1alpha (INF1alpha), interleukin-10 (IL-10) and BLyS concentrations and clinical activity in systemic lupus erythematosus (SLE). Patients and methods: A cross-sectional, observational study of 142 SLE patients and 34 healthy controls was performed, through a complete blood and urine test and review of their medical history. Serum concentration of INF1alpha, IL-10 and BLyS was determined by colorimetric methods. A biostatistical analysis was performed with R (3.3.2.). Results: 69% of our SLE patients showed at least one cytokine increased. INF1alpha, IL-10 and BLyS are higher in SLE patients than in healthy controls (P<.001, P=.005 and P=.043, respectively), being INF1alpha the most frequent. Patients were categorised according to low or high concentrations of the three cytokines. We found a significant association between increased IL-10/INF1alpha concentrations and a higher clinical activity measured by SELENA-SLEDAI (P<.0001) and, to a lesser extent, an association with increased INF1alpha/IL-10/BLyS concentrations. Elevated levels of IL-10/INF1alpha and INF1alpha/IL-10/BLyS related to increased C3-C4 consumption (P<.001 and P=.001 respectively) and anti-dsDNA titres (P=.001 and P=.002 respectively). Elevated INF1alpha/BLyS related to higher anti-dsDNA titres (P=.004) and ENA positivity (P<.001). Increased levels of INF1alpha/IL-10/BLyS related to positivity of ANAs (P<.001) and APL (P=.004). Conclusions: INF1alpha, IL-10 and BLyS are higher in SLE patients than in healthy controls. Increased IL-10 levels, regardless of whether or not there were also increased levels of BLyS and/or INF1alpha, was the cytokine that best fit with clinical activity in SLE measured with classic methods


Assuntos
Humanos , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/sangue , Interferon Tipo I/sangue , Interleucina-10/sangue , Linfócitos B/metabolismo , Biomarcadores/sangue , Biomarcadores/urina , Estudos Transversais , Lúpus Eritematoso Sistêmico/urina , Colorimetria/métodos , Bioestatística , Anticorpos Antifosfolipídeos , Inquéritos e Questionários , Ensaio de Imunoadsorção Enzimática , Citocinas/sangue , Citocinas/urina
5.
Pan Afr Med J ; 33: 97, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489075

RESUMO

Libman-Sacks endocarditis is a rare cardiac manifestation systemic lupus erythematosus, in which there is a sterile vegetation in the heart valves. There is a significant risk of infective endocarditis. Our patient was a 38 year old woman with persistent fever from two months with inflammatory polyarthralgia, fixed at the wrists and ankles. She was febrile at 39 ° C, had a mitral systolic murmur 2/6 and painful swelling of the wrists and ankles. We have objectified an inflammatory syndrome, blood cultures were negative. The dosage of anti-nuclear antibody was positive with a mottled appearance, as well as anti-DNA antibodies. The Doppler echocardiography had objectified vegetations in the mitral and aortic valves. Clinical, biological and morphological improvements were obtained after antibiotic and corticosteroid combination. We can conclude that Libman-Sacks endocarditis evolution is favorable in the absence of an associated antiphospholipid syndrome (APS). Always fear in all cases a surinfection. The treatment is based on the combination antibiotic-corticosteroid-synthetic antimalarial.


Assuntos
Anticorpos Antinucleares/imunologia , Endocardite/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Corticosteroides/administração & dosagem , Adulto , Antibacterianos/administração & dosagem , Antimaláricos/administração & dosagem , Ecocardiografia Doppler/métodos , Endocardite/etiologia , Endocardite/imunologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/imunologia , Superinfecção/diagnóstico
6.
Clin Exp Rheumatol ; 37(5): 715-722, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31376267

RESUMO

Systemic lupus erythematosus (SLE) is an autoimmune connective-tissue disorder with a wide range of clinical manifestations that predominantly affect women. Many aspects of its pathogenesis are still unclear, and new therapeutic strategies are progressively emerging. Thus, in this review we aim to summarise the most relevant data on SLE that emerged during 2018, following the previous annual review of this series. In particular, the review will focus on new insights in SLE regarding new pathogenetic pathways, new biomarkers, new data on clinical manifestations, clinical outcomes and comorbidities and what has emerged on new drugs and new therapeutic strategies.


Assuntos
Biomarcadores , Lúpus Eritematoso Sistêmico , Autoimunidade , Biomarcadores/metabolismo , Comorbidade , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/terapia , Masculino , Prognóstico , Fatores de Risco
7.
Medicine (Baltimore) ; 98(35): e16830, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464908

RESUMO

RATIONALE: Amyloidosis accounts for 2% of head and neck tumors. Amyloidosis that develops in the head and neck region is localized amyloidosis. Multifocal amyloidosis in the head and neck region is extremely rare. PATIENT CONCERNS: The patient presented to the clinic of otolaryngology with nasal obstruction, anosmia and left neck mass for several months. DIAGNOSIS: A left nasopharynx tumor was revealed under nasopharyngeal scope. Eosinophilic, proteinaceous material was revealed under a pathology scope in the nasopharynx tissue and neck tumor. Congo red staining demonstrated pale congophilic amorphous material with apple-green birefringence under cross-polarized light, and multifocal amyloidosis was diagnosed. Amyloidosis secondary to systemic lupus erythematosus (SLE) was confirmed after a series of investigations. INTERVENTIONS: The patient underwent local excision for multifocal amyloidosis without following management. To control underlying SLE, the patient accepted steroid pulse therapy and immunosuppressants. The patient eventually achieved disease remission. OUTCOMES: During the 6 months of follow-up in the outpatient department of otolaryngology and rheumatology, complications, recurrence of nasopharyngeal amyloidosis, and SLE flare-up were not observed. LESSONS: Head and neck amyloidosis involving the nasopharynx is a rare presentation of this disease. Head and neck multifocal amyloidosis should be taken as a hint of systemic disease. In head and neck amyloidosis, a comprehensive survey should be performed to clarify the underlying disease predisposing to amyloidosis and organ involvement.


Assuntos
Amiloidose/etiologia , Neoplasias de Cabeça e Pescoço/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico , Adulto , Amiloidose/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/cirurgia , Indução de Remissão , Esteroides/uso terapêutico , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(28): e16397, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305448

RESUMO

RATIONALE: Vasculitis is one of the common pathological hallmarks of systemic lupus erythematosus (SLE). Vascular lesions in SLE commonly involve medium- and small-sized vessels. Rarely, vasculitis in SLE may involve large vessels such as the aorta leading to life-threatening complications. Reported cases of large vessel lesions in SLE included aortic aneurysm and aortic dissection. PATIENT CONCERNS: Here, we report a 52-year-old Chinese woman with SLE, who was stable on oral glucocorticoid, but showed sudden intractable hypertension and heavy proteinuria before we found aorta coarctation in her computed tomography (CT) scan of the aorta. DIAGNOSES: This patient's large vascular lesions were likely secondary and not a primary manifestation of lupus activity. INTERVENTIONS AND OUTCOMES: After endovascular stent graft repair of the abdominal aorta, her hypertension and proteinuria were controlled. LESSONS: In the context of reported cases of large vessel lesions in SLE, our case further supports the significance of having a wide differential for vascular lesions in SLE, especially when an SLE patient presents sudden hypertension and heavy proteinuria. This case also demonstrates that vascular lesions in SLE may lead to serious, potentially fatal consequences.


Assuntos
Coartação Aórtica/etiologia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Pessoa de Meia-Idade
10.
Pan Afr Med J ; 32: 181, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312295

RESUMO

Introduction: The term anti-nuclear antibody (ANA) is used to define a large group of autoantibodies which specifically bind to nuclear elements. Although healthy individuals may also have ANA positivity, the measurement of ANA is generally used in the diagnosis of autoimmune disorders. However, various studies have shown that ANA testing may be overused, especially in pediatrics clinics. Our aim was to investigate the reasons for antinuclear antibody (ANA) testing in the general pediatrics and pediatric rheumatology clinics of our hospital and to determine whether ANA testing was ordered appropriately by evaluating chief complaints and the ultimate diagnoses of these cases. Methods: The medical records of pediatric patients in whom ANA testing was performed between January 2014 and June 2016 were retrospectively evaluated. Subjects were grouped according to the indication for ANA testing and ANA titers. Results: ANA tests were ordered in a total of 409 patients during the study period, with 113 positive ANA results. The ANA test was ordered mostly due to joint pain (50% of the study population). There was an increased likelihood of autoimmune rheumatic diseases (ARDs) with higher ANA titer. The positive predictive value of an ANA test was 16% for any connective tissue disease and 13% for lupus in the pediatric setting. Conclusion: in the current study, more than one-fourth of the subjects were found to have ANA positivity, while only 15% were ultimately diagnosed with ARDs. Our findings underline the importance of an increased awareness of correct indications for ANA testing.


Assuntos
Anticorpos Antinucleares/sangue , Doenças Autoimunes/diagnóstico , Doenças do Tecido Conjuntivo/diagnóstico , Doenças Reumáticas/diagnóstico , Adolescente , Instituições de Assistência Ambulatorial , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/imunologia , Criança , Pré-Escolar , Doenças do Tecido Conjuntivo/epidemiologia , Doenças do Tecido Conjuntivo/imunologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/imunologia , Turquia/epidemiologia
11.
J Clin Neurosci ; 67: 261-263, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31278051

RESUMO

A case of progressive multifocal leukoencephalopathy (PML) occurring on low dose immunosuppression for systemic lupus erythematosus (SLE) and Sjogren's syndrome (SS) is presented. Neurologic changes in patients with SLE or SS should not be assumed to be a disease manifestation. Importantly, serious opportunistic infections such as PML can occur in minimally immunosuppressed rheumatic patients. Early diagnosis, facilitated by scrutiny of MRI findings, should trigger measures to reconstitute immunity in an otherwise fatal disease.


Assuntos
Leucoencefalopatia Multifocal Progressiva/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Síndrome de Sjogren/diagnóstico , Diagnóstico Precoce , Feminino , Humanos , Leucoencefalopatia Multifocal Progressiva/complicações , Leucoencefalopatia Multifocal Progressiva/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Síndrome de Sjogren/complicações , Síndrome de Sjogren/diagnóstico por imagem
12.
J Assoc Physicians India ; 67(3): 95-97, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31304722

RESUMO

Lupus myelopathy is a relatively uncommon manifestation of SLE. Atypical presentation of this rare entity with neuropathic itch has never been reported. We report a young girl who presented with predominant symptom of refractory pruritus which after clinical localization and imaging was detected to have long segment patchy myelitis. Detailed evaluation led to a diagnosis of lupus myelopathy and the patient responded to immunosuppressive therapy with significant clinical and radiological improvement. Maintaining a high level of suspicion for neurological cause in a patient with refractory localized itching resistant to regular antiallergic treatment is important in the right clinical setting.


Assuntos
Lúpus Eritematoso Sistêmico/diagnóstico , Mielite/diagnóstico , Prurido/diagnóstico , Feminino , Humanos , Imunossupressão , Imagem por Ressonância Magnética , Doenças da Medula Espinal
13.
Z Rheumatol ; 78(10): 979-986, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31346705

RESUMO

BACKGROUND: In Germany, the numbers of patients with spondylarthritides (SpA) and rheumatoid arthritis (RA) have increased. This rise was possibly promoted by the introduction of new classification criteria (CC) that enable an earlier recognition and the inclusion of less severe cases. The study explores how the new CC for axial SpA (axSpA) are incorporated into the clinical practice, compared with the CC for RA and systemic lupus erythematosus (SLE). In addition, the study investigated whether the new entity of non-radiographic axSpA (nr-axSpA) is accepted and used in Germany. MATERIAL AND METHODS: In 2016, an online survey was performed among all rheumatologists registered in the German Society of Rheumatology (DGRh). In addition, 150 rheumatologists were invited to the survey at the national meeting of the DGRh in 2016. RESULTS: Among 119 participating rheumatologists, 99% were familiar with the new CC for SpA and 82% applied them in practice (RA 99% and 80%, SLE 50% and 56%). 78% differentiated between radiographic and nr-axSpA and 80% believed that a significant proportion of patients with nr-axSpA will never develop radiographic changes. 91% agreed that the new CC facilitated an earlier treatment start and 58% that the CC enabled more patients to receive biologicals. 50% shared the opinion that the criterion "chronic back pain" could lead to the classification of too many patients as having axSpA. It deemed possible to 65% that patients with nr-axSpA would be treated with biologicals in whom the diagnosis of axSpA could not be confirmed later on. 81% voted against the initiation of TNF inhibitors in nr-axSpA patients with normal CRP levels and normal MRI. 67% interpreted the MRI themselves and 30% stated that the MRI is evaluated according to validated standards by the radiologists. Among all axSpA criteria, HLA B27 and inflammatory back pain received the highest significance and the response to NSAID the lowest. CONCLUSION: The new CC and the entity of nr-axSpA are accepted by German rheumatologists. A relevant proportion saw weaknesses of the new CC in the differentiation between nr-axSpA and non-specific chronic back pain. In practise, the interpretation of the CC with respect to the start of biologics is relatively strict, especially in cases with normal CRP and MRI. A ranking of axSpA criteria is commonly applied, although this was not initially intended in the CC.


Assuntos
Artrite Reumatoide , Lúpus Eritematoso Sistêmico , Espondilartrite , Espondilite Anquilosante , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/terapia , Alemanha , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/terapia , Reumatologistas , Espondilartrite/diagnóstico , Espondilartrite/terapia , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/terapia
14.
Autoimmun Rev ; 18(9): 102359, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31323362

RESUMO

OBJECTIVE: The aim of this study is to compare the frequency of remission, according to DORIS definitions, of inception patients from two European SLE cohorts, with a special focus on the differences between the therapeutic schemes of both Units. METHODS: Inception patients enrolled after 2000 from the longitudinal Cruces Lupus Cohort (CC) and Bordeaux Lupus Cohort (BC) were included. The main endpoint was the achievement of clinical remission on treatment (ClinROnT). ClinROnT was assessed yearly from the 1st until the 5th year following the diagnosis of SLE. RESULTS: 173 patients, 92 CC and 81 BC, were studied. The clinical presentation of both cohorts was similar, with no significant differences in the mean SLEDAI score at diagnosis (6.6 vs. 8.1, p = 0.06). Patients from CC were treated more frequently with hydroxychloroquine (mean 57 vs. 43 months), methotrexate (24% vs. 11%) and pulse methyl-prednisolone (42% vs. 26%), and received lower doses of oral prednisone (average dose during the follow up 2.3 vs. 7.2 mg/d, p < 0.001). Patients in CC were more likely to achieve ClinROnT at year one, 84% vs. 43% (p < 0.001). Prolonged ClinROnT during the 5 years of follow up was more frequent in CC: 70% vs. 28%, p < 0.001. Patients in CC were also more likely to achieve ClinROnT after controlling for baseline SLEDAI (adjusted HR 1.69, 95%CI 1.21-2.35) and for the presenting clinical manifestations (adjusted HR 1.72, 95% CI 1.2-2.4). CONCLUSION: Prolonged ClinROnT was achievable by using a therapeutic regime consisting of lower doses of oral prednisone and maximizing the use of hydroxychloroquine, pulse methyl-prednisolone and methotrexate.


Assuntos
Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Prednisona/administração & dosagem , Administração Oral , Adulto , Estudos de Coortes , Intervalo Livre de Doença , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , França/epidemiologia , Glucocorticoides/administração & dosagem , Humanos , Hidroxicloroquina/administração & dosagem , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Metotrexato/administração & dosagem , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Indução de Remissão , Espanha/epidemiologia , Resultado do Tratamento , Adulto Jovem
16.
Brain Nerve ; 71(5): 459-471, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31088995

RESUMO

Neuropsychiatric manifestations in patients with systemic lupus erythematosus (SLE), termed neuropsychiatric SLE (NPSLE), encompass a wide variety of neurological and psychiatric characteristics. A neuropsychiatric event may precede an SLE diagnosis; therefore, physicians must screen for SLE in patients presenting with neuropsychiatric symptoms, if they are not already diagnosed with this condition. For assessing patients with SLE who present with neuropsychiatric symptoms, it is important to first determine whether the symptoms are caused by SLE (primary NPSLE), whether they are a complication of a therapy, or whether they are caused by other comorbidities. Accurate attribution of neuropsychiatric symptoms is vital for selecting therapeutic interventions.


Assuntos
Lúpus Eritematoso Sistêmico/diagnóstico , Vasculite Associada ao Lúpus do Sistema Nervoso Central/diagnóstico , Transtornos Mentais/diagnóstico , Neurologia , Humanos , Médicos
17.
Lupus ; 28(6): 713-721, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31046570

RESUMO

BACKGROUND: Current non-invasive methods of assessing disease activity in systemic lupus erythematosus (SLE) are of limited sensitivity and specificity. Testing includes acute phase markers, autoantibodies and complement levels. Although measurements of dsDNA antibodies and complement C3/C4 levels are routine, they remain of limited value. Improved blood and urine markers may help in early detection of flare, distinction between flare and chronic damage, and monitoring response to therapy. METHODS: A total of 87 patients with SLE were tested for the following cytokines in serum and urine: monocyte chemoattractant protein 1 (MCP-1), regulated upon activation, normal T cell expressed and secreted (RANTES), soluble tumour necrosis factor receptor 1 (sTNF-R1), interferon-inducible protein 10 (IP-10), monocyte inhibitory protein 1α (MIP-1α) and vascular endothelial growth factor (VEGF). Patients attending the Lupus Unit at St Thomas' Hospital, London, UK were divided into active lupus nephritis (LN), inactive LN and non-renal SLE groups based on their renal pathology and SLE disease activity index (SLEDAI). Cytokine testing was performed using the FIDIS multiplex bead assay. RESULTS: The mean level of serum sTNF-R1 was higher in the active LN group compared with both inactive LN and non-renal SLE groups ( p < 0.001). For urine measurements there were significant differences between active LN and non-renal SLE for VEGF ( p = 0.016), after statistical correction for multiple testing. Both urinary and serum sTNF-R1 and IP-10 levels correlated with SLEDAI scores ( p < 0.001), while serum VEGF correlated weakly with SLEDAI ( p = 0.025). The optimum combination for differentiating active from inactive LN patients was serum VEGF, sTNF-R1, MCP-1 and glomerular filtration rate plus urinary sTNF-R1 and protein-creatinine ratio. CONCLUSION: These results indicate that for active LN, sTNF-R1 could be a useful serum cytokine marker, with potential for VEGF in the urine. This study has confirmed the ability of the multiplex bead technique to detect cytokines in a good analytical range, including very low and high levels, in both serum and urine. Combining serum and urine markers provided additional sensitivity in distinguishing active from inactive LN.


Assuntos
Lúpus Eritematoso Sistêmico/diagnóstico , Nefrite Lúpica/diagnóstico , Receptores Tipo I de Fatores de Necrose Tumoral/sangue , Fator A de Crescimento do Endotélio Vascular/urina , Adulto , Biomarcadores/sangue , Biomarcadores/urina , Quimiocina CCL2/sangue , Quimiocina CCL2/urina , Quimiocina CCL3/sangue , Quimiocina CCL3/urina , Quimiocina CCL5/sangue , Quimiocina CCL5/urina , Quimiocina CXCL10/sangue , Quimiocina CXCL10/urina , Estudos Transversais , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Modelos Logísticos , Londres , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/urina , Nefrite Lúpica/sangue , Nefrite Lúpica/urina , Masculino , Pessoa de Meia-Idade , Receptores Tipo I de Fatores de Necrose Tumoral/urina , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fator A de Crescimento do Endotélio Vascular/sangue
18.
Lupus ; 28(6): 778-782, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31046572

RESUMO

In a joint effort, the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) recently proposed new criteria for the classification of systemic lupus erythematosus (SLE) with the overarching goal to identify potential participants for clinical studies. Herein, we present the first independent evaluation of these criteria in comparison with older classification grounds using an adult Scandinavian study population of confirmed SLE cases and individuals with SLE-mimicking conditions. We included 56 confirmed SLE cases meeting the 1982 ACR criteria (ACR-82) and/or the Fries "diagnostic principle" (antinuclear antibodies on at least one occasion plus involvement of at least two defined organ systems) and 55 controls with possible systemic autoimmune disease, including the presence of any SLE-related autoantibody. The proposed EULAR/ACR criteria showed a diagnostic sensitivity of 93% (95% confidence interval (CI), 0.83-0.98) compared with 83% (95% CI, 0.72-0.91) for the updated ACR criteria from 1997. The diagnostic accuracy of all tested classification grounds was fairly similar, achieving approximately 85%. However, the disease specificity of the EULAR/ACR criteria reached only 73% (95% CI, 0.59-0.83), which was comparable with the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria, 75% (95% CI, 0.61-0.85), but clearly lower than for ACR-82, 94% (95% CI, 0.83-0.99). In this first independent evaluation of a limited number of cases, we found comparable results with respect to diagnostic sensitivity, specificity and accuracy regarding the SLICC-12 and the proposed EULAR/ACR classification criteria. However, their specificity for SLE appeared to be lower compared with ACR-82.


Assuntos
Lúpus Eritematoso Sistêmico/classificação , Lúpus Eritematoso Sistêmico/diagnóstico , Reumatologia/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Suécia , Adulto Jovem
19.
Drug Discov Ther ; 13(2): 96-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080209

RESUMO

Oligoarticular arthritis (inflammation of upto 4 joints) has a wide range of infectious and non-infectious etiologies. The aim of our study was to identify the features which could help in the differentiation of infectious from non-infectious arthritis. The study was prospective and observational, and included 100 patients with oligoarticular inflammatory arthritis. The final diagnosis was made using standard diagnostic criteria and the patients were categorized into infectious and non-infectious groups. Among the 100 patients who were recruited, the following final diagnosis were made: peripheral spondyloarthritis (n = 37), axial spondyloarthritis (n = 11), tuberculosis (n = 19), brucellosis (n = 6), septic arthritis (n = 6), gouty arthritis (n = 5), early rheumatoid arthritis (n = 5), non-tubercular mycobacteria (n = 2), SLE (n = 2), post-chikungunya arthritis (n = 2), acute lymphocytic leukaemia (n = 1), pachydermoperiostosis (n = 1), sarcoidosis (n = 1) and juvenile idiopathoic arthritis (n = 1). The patients were categorized into two groups: infectious (33) and non-infectious (60). The presence of monoarthritis, clinically-significant weight loss, hepatomegaly, splenomegaly and erosive arthritis were significantly more common in the infectious group as compared to the non-infectious group.


Assuntos
Artrite Infecciosa/epidemiologia , Artrite/classificação , Doenças não Transmissíveis/epidemiologia , Adolescente , Adulto , Artrite/diagnóstico , Artrite Gotosa/diagnóstico , Artrite Gotosa/epidemiologia , Artrite Infecciosa/diagnóstico , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Brucelose/diagnóstico , Brucelose/epidemiologia , Feminino , Humanos , Índia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sarcoidose/epidemiologia , Espondilartrite/diagnóstico , Espondilartrite/epidemiologia , Centros de Atenção Terciária , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adulto Jovem
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