Is it useful to measure serum ferritin level in systemic lupus erythematosus patients?

BackgroundSerum ferritin is elevated due to various conditions as inflammation and malignancy and could be up regulated in systemic lupus erythematosus (SLE).Aim of workTo evaluate serum ferritin level in SLE patients and correlate it with different clinical and laboratory parameters as well as disease activity.Patients and methodsThe study was carried out on 46 SLE patients and 20 matched controls. SLE Disease Activity Index (SLEDAI) was assessed and patients subdivided into severe (SLEDAI ≥ 11) and mild to moderate (SLEDAI < 11) activity. Serum ferritin, iron and total iron binding capacity (TIBC) levels were assessed.ResultsThey were 40 females and 6 males with a mean age of 36.7 ± 10.3 years and disease duration of 4.9 ± 2.3 years. Serum ferritin was significantly higher in patients than controls (163.5 ± 27.8 vs. 47.1 ± 10.6 ng/ml, p = 0.009). In patients, serum iron (49.2 ± 4.5 mg/dl) and TIBC (284.2 ± 80.8 mg/dl) were comparable with those in controls. Serum ferritin was significantly higher in patients with severe (220.9 ± 50.7 ng/ml) than those with mild-moderate activity (122.9 ± 29.7 ng/ml; p < 0.001). Serum ferritin was significantly higher in patients with anemia (p < 0.001) and thrombocytopenia (p = 0.03) and lower in those with leucopenia (p < 0.001) compared to those without. Ferritin significantly correlated only with hemoglobin (r = 0.5, p = 0.02), platelet count (r = 0.65, p = 0.03) and inversely with leucocytic count (r = −0.08, p = 0.006).ConclusionSerum ferritin is elevated significantly in SLE patients especially those with severe activity. A remarkable difference in serum ferritin levels in patients with hematological manifestations was found making it a potentially useful inflammatory marker for disease activity in patients with blood dyscrasia.     

Influence of +299G>A and +62G˃A resistin gene promoter variants on cardiovascular risk in Egyptian women with systemic lupus erythematosus

BackgroundCardiovascular diseases (CVDs) are major causes of morbidity and mortality in systemic lupus erythematosus (SLE) patients. Resistin is an inflammatory adipocytokine associated with insulin resistance and an increased risk of CVD.Aim of the workTo study the possible role of resistin (RETN) +299A>G and +62G?A gene polymorphisms in the development of CVDs among Egyptian SLE patients and their impact on cardio metabolic risk and disease activity.Patients and methods+299A>G and +62G?A genes polymorphisms were assessed in 140 patients and 100 controls by polymerase chain reaction (PCR). The carotid intima-media thickness (CIMT) was measured. SLE disease activity index (SLEDAI) was assessed. Serum resistin, homeostasis model assessments (HOMA-IR and HOMA-β), fibrinogen and homocysteine were measured.ResultsThe mean age of patients was 31.1 ± 7.6 years and disease duration 5.4 ± 2.5 years. Serum resistin was significantly increased in patients (4.9 ± 0.2 ng/ml) compared to control (3.02 ± 0.9 ng/ml) (p < 0.001). Serum resistin significantly correlated with uric acid (p < 0.001), homocysteine (p < 0.001), fibrinogen (<0.001) and SLEDAI (p < 0.001). AA genotypes and A allele +299G>A were significantly higher in patients than control (37.9% vs 10% and 63.6% vs 33.5%; p < 0.001). Serum resistin, CIMT, uric acid, fibrinogen and homocysteine was significantly higher in +299G>A GA and AA patients compared to GG (p < 0.001) and HOMA-β decreased (p < 0.001). HOMA-β, fibrinogen and uric acid were independently correlated with resistin (p < 0.001).ConclusionResistin +299G/A gene polymorphisms especially the AA genotype and A allele may play an important role in pathogenesis and activity of SLE as well as susceptibility to develop CVD in Egyptian population.     

Role of syndecan-1 (CD138) in Egyptian systemic lupus erythematosus patients with lupus nephritis: Relation to disease activity

BackgroundSyndecan-1, a transmemebrane heparan-sulfate glycoprotein, is predominantly expressed by plasma cells and is readily shed and released under certain pathologic conditions and remains biologically active to plasma cells behaviour.Aim of the workTo assess the level of syndecan-1 in relation to lupus nephritis (LN) and systemic lupus erythematosus (SLE) activity.Patients and methodsThe study included 60 SLE patients subgrouped according to the presence of LN and activity. SLE disease activity index (SLEDAI) was assessed. Serum syndecan-1 level was measured.ResultsThe patients mean age was 25.9 ± 8.6 years, they were 54 females and 6 males with a disease duration of 3.8 ± 3.4 years. There was a significant difference in the level of syndecan-1 between healthy control (46.3 ± 12.2 ng/ml) and SLE patients whether they were with active LN (150.2 ± 31.1 ng/ml) (p < 0.001), extrarenal flare (86.9 ± 16.7 ng/ml) (p < 0.001) or inactive (79.1 ± 19.8 ng/ml) (p < 0.003). Syndecan-1 was significantly higher in patients with active LN compared to those with extrarenal flare and inactive disease (p < 0.001 and p < 0.001 respectively). Serum syndecan-1 level was significantly higher in patients with arthralgia, arthritis, pleurisy and pericarditis) (all p < 0.001). There was a significant correlation between syndecan-1 level and 24 h urinary proteins (r = 0.8, p < 0.0001), and inversely with the complement (C3: r = −0.54, p < 0.0001 and C4: r = −0.48, p < 0.0001). There was a significant correlation between syndecan-1 and SLEDAI (r = 0.68, p < 0.001).ConclusionSerum syndecan-1 is significantly high in active LN patients and can be a useful tool for diagnosis of active nephritis. It correlates with disease activity, consumed complement and proteinuria. It was significantly related to the presence of musculoskeletal manifestations and serositis.     

Noninvasive evaluation of gastric emptying and gastric wall thickness in SLE patients

Objective: The objective of this study is to evaluate the gastric emptying in patients with systemic lupus erythematosus (SLE) with gastrointestinal involvement using three-dimensional (3D) ultrasonography.

Methods: The gastric emptying times at 25% (T1), 50% (T2), and 75% (T3) of SLE patients with gastrointestinal involvement (n?=?40) and healthy controls (n?=?80) were evaluated and compared. In addition, the correlations among the gastric wall thickness, SLE disease activity index (SLEDAI), and upper gastrointestinal symptoms were calculated.

Results: The gastric wall thickness was correlated with the SLEDAI (r?=?0.928, p?<?0.001) and the upper gastrointestinal symptom index (r?=?0.848, p?<?0.001). The emptying times T1, T2, and T3 of the SLE patients were 17.08?±?2.65?min (mean?±?standard deviation), 39.85?±?6.54?min, and 83.58?±?7.12?min, respectively. For healthy controls, they were 19.65?±?5.39?min, 41.08?±?7.51?min, and 70.34?±?8.03?min. The T1 of the SLE patients was shorter (p?<?0.01), while the T3 was longer (p?<?0.001). Moreover, T3 in the SLE group had the best correlation with the upper gastrointestinal symptom index (r?=?0.553, p?<?0.001). T1 in the SLE group was anti-correlated with early satiety (r?=??0.366, p?<?0.05).

Conclusions: Combining the emptying times T1 and T3, as well as the gastric wall thickness, the SLEDAI and the upper gastrointestinal symptoms index can provide accurate clinical diagnosis of SLE with gastric involvement.     

Critically ill systemic lupus erythematosus patients referred to the intensive care unit of Fayoum University Hospital: Frequency,complications and outcome

Aim of the work

To determine the frequency of critical complications of systemic lupus erythematosus (SLE) admitted to the intensive care unit (ICU), study the risk factors and outcome.

Serum ferritin,transferrin and metabolic syndrome are risk factors for subclinical atherosclerosis in Egyptian women with systemic lupus erythematosus (SLE)

Aim of the work

This work aimed to measure serum ferritin and transferrin levels and to study the presence of metabolic syndrome (MetS) in Egyptian systemic lupus erythematosus (SLE) females and to correlate them with disease activity, damage, clinical status and subclinical atherosclerosis.

Clinical characteristics and health related quality of life (HRQoL) in Egyptian patients with systemic lupus erythematosus

Aim of the work

To study the clinical characteristics and health related quality of life (HRQoL) in systemic lupus erythematosus patients.

Serum pentraxin 3 levels in rheumatoid arthritis patients and its association with disease activity

Aim of the workThis work aimed to evaluate serum pentraxin 3 (PTX3) levels in rheumatoid arthritis (RA) patients and to study the association with the disease activity.Patients and methodsSixty RA patients and 26 matched controls were included. In patients, clinical examination was performed and disease activity score (DAS28) assessed. Serum PTX3, rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured.ResultsThe mean age of the patients was 54.9 ± 11.7 years, and the median (Min–Max) of disease duration was 24 (3.96–60) months and 91.7% were females. The mean DAS28 was 4.16 ± 1.77, the ESR was 38.6 ± 23.03 mm/1st h, CRP was 14.9 ± 8.6 mg/l, RF was 49.6 ± 28.1 IU/ml and the median anti-CCP was 375. Serum PTX3 level was significantly higher in RA patients (2.82 ± 0.48 pg/ml) compared to controls (2.56 ± 0.29 pg/ml) (p = 0.003). There was a significant difference in serum PTX3 level according to the disease activity: remission (2.49 ± 0.16 pg/ml), low (2.61 ± 0.33 pg/ml), moderate (2.90 ± 0.53 pg/ml) and high (3.01 ± 0.51 pg/ml) (p = 0.016). There was a significant correlation between serum PTX3 level with disease activity (r = 0.39, p = 0.002) and CRP (r = 0.49, p < 0.001). There was no significant correlation between serum PTX3 level and the RF (r = 0.25, p = 0.054), anti-CCP (r = 0.18, p = 0.17) and ESR (r = 0.09, p = 0.51). PTX3 and CRP showed a good sensitivity and specificity in predicting RA disease (p = 0.006 and p < 0.001, respectively).ConclusionPTX3 can be considered as a marker of a positive acute phase response and may serve as a potential novel biomarker for detecting RA activity.     

Evaluation of red blood cell distribution width in patients with psoriatic arthritis

Aim of the workTo evaluate the red blood cell distribution width (RDW) values in psoriatic arthritis (PsA) patients and to study the relationship between these values and disease activation.Patients and methodsForty seven patients with PsA and 56 age- and sex matched healthy controls were included in this study. Laboratory test results of both groups were retrospectively collected from medical records; these included levels for white blood cell count, hemoglobin, platelet, RDW, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Disease activity score (DAS28) was used to evaluate disease activity.ResultsThe study comprised 47 PsA patients (32 females and 15 males) (F:M 2.1:1) with a mean age of 39.2 ± 9.9 (20–54) years and mean disease duration was 3.3 ± 1.94 (1–8) years. 39 (83%) patients were receiving monotherapy, 8 (17%) were receiving combined therapy. The RDW values were significantly higher when comparing active disease period (16 ± 3.9) of PsA patients versus inactive disease period (14.2 ± 1.04) and controls (14.03 ± 1.2) (p < 0.001). Otherwise, no significant differences were found when comparing inactive disease period of PsA patients versus controls (p = 0.18). RDW values of active disease period of PsA patients significantly correlated with ESR (r = 0.57, p < 0.001), CRP (r = 0.4, p = 0.006) and DAS28 (r = 0.42, p = 0.003).ConclusionsIncreased RDW is associated with active disease period of PsA patients. RDW seems to be a surrogate marker of the inflammation, like CRP and ESR. It is included in the complete blood count thus its measurement does not need any additional costs. RDW may be a potential marker to evaluate disease activity of PsA.     

Increased concentration of proatherogenic inflammatory cytokines in systemic lupus erythematosus: relationship to cardiovascular risk factors

OBJECTIVE:. To examine the hypothesis that patients with systemic lupus erythematosus (SLE) have increased concentrations of interleukin-6 (IL-6), IL-8, and monocyte chemoattractant protein-1 (MCP-1) and that these cytokines are associated with coronary risk factors and atherosclerosis. METHODS: Plasma IL-6, MCP-1, and serum IL-8 (pg/ml) concentrations were measured in 74 patients with SLE and in 85 controls. Clinical characteristics, homocysteine, lipids, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and coronary artery calcification as detected by electron beam computed tomography were measured. RESULTS: IL-6 (13.2 +/- 13.8 pg/ml vs 6.7 +/- 3.2 pg/ml, p < 0.001) and MCP-1 (264.2 +/- 581.8 pg/ml vs 131.0 +/- 63.7 pg/ml, p < 0.001) concentrations were higher in patients with lupus than in controls. IL-8 concentrations did not differ between patients and controls (p = 0.86). In patients, IL-6 concentrations were correlated with CRP (p < 0.001), ESR (p < 0.001), SLE disease activity index (SLEDAI, p = 0.003), and body mass index (BMI, p = 0.003). IL-6 concentrations were inversely correlated with HDL cholesterol (p = 0.01). MCP-1 concentrations were correlated with SLEDAI (p = 0.01), ESR (p = 0.04), and triglycerides (p = 0.03). After controlling for age, sex, disease activity, SLICC damage index, smoking status, and systolic blood pressure, IL-6 was associated with coronary calcification (odds ratio, OR = 1.07, p = 0.035). Similar models found no association between MCP-1 or IL-8 with coronary artery calcification. CONCLUSION: Patients with SLE have increased concentrations of IL-6 and MCP-1. These cytokines are associated with increased inflammation, BMI, and adverse lipid profiles. IL-6 is associated with burden of atherosclerosis in SLE.     

Early detection of premature subclinical coronary atherosclerosis in systemic lupus erythematosus patients

ObjectiveTo elucidate early coronary atherosclerotic changes in premenopausal systemic lupus erythematosus (SLE) female patients without clinical cardiovascular manifestation using a 64-slice Multi-detector computed tomography (MDCT) scan to detect coronary calcification and measure coronary calcium score (CCS), and to find out its correlation to some traditional and non-traditional risk factors.MethodologySixty consecutive premenopausal SLE female patients, and sixty age and sex matched healthy subjects without known systemic, immunological, or cardiovascular disease (served as a control group) underwent clinical examination, serological analysis, and 64-slice MDCT-based coronary calcium scoring. All the clinical, serological, and MDCT parameters of the patients were correlated.ResultsCoronary calcification (CC) was seen in 21 patients (35%), the number of atherosclerotic calcified plaques ranged from 0 to 19. Calcium scores ranged from 0 to 843. In contrast to control subjects, SLE patients had significantly higher erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), total cholesterol level, low-density lipoprotein (LDL), immunoglobulin G (IgG) and IgM anti-cardiolipin antibodies, serum intracellular adhesion molecule (sICAM) and E-selectin levels. SLE patients had highly significantly more atherosclerotic plaques (3 ± 0.66 compared to 0.1 ± 0.07, p < 0.001) and higher CCS (59.2 ± 20.3 compared to 2.6 ± 1.85, p < 0.001). Significant positive correlation was found between both number of atherosclerotic plaques and CCS and total cholesterol level, LDL, cumulative prednisone dose, SLE disease activity index (SLEDAI), ESR, CRP, sICAM-1, E-Selectin, and anti-cardiolipin antibodies (p < 0.05 in all).ConclusionPre-menopausal SLE female patients free from clinical atherosclerotic vascular disease have an increased number of atherosclerotic plaques and CCS, which correlate positively with SLEDAI disease activity score, serum CRP, anticardiolipin antibodies, sICAM-1, E-Selectin, LDL level, total cholesterol level, and cumulative prednisone dose. In addition, we conclude that MDCT is a non-invasive, sensitive, reproducible, and reliable tool for accurate measurement of coronary calcification.     

Hazards of pulse steroid use in a cohort of Egyptian lupus nephritis patients

BackgroundPulse methylprednisolone is a tool for rapid immunosuppression in systemic lupus erythematosus (SLE) patients with life-threatening manifestations.Aim of the workTo assess the effect of the frequent use of high-dose pulse steroids on renal response and to detect any associated hazards in lupus nephritis (LN) patients with a disease duration >3 years.Patients and methodsMedical records of 90 Egyptian LN patients were revised every 6 months for the preceding 3 years. Patients’ examination was followed-up every 6 months for another year. Disease damage and activity (SLEDAI) indices were assessed; criteria for renal response evaluated, relevant laboratory investigations performed, and history of steroid therapy reported.ResultsThe patients mean age was 30.1 ± 8.3 years, 75 were females (83.3%) and 15 males (16.7%), mean SLEDAI was 7.6 ± 6.9 and damage index was 0.38 ± 0.95. All were on treatment with steroids and immunosuppressives. Those receiving frequent pulse-steroids (n = 71) had a significantly higher proteinuria and both significantly correlated throughout the study course (p < 0.001). A higher pulse-steroid dose was associated with poor renal response (p < 0.001). There was a significantly higher damage index in those receiving pulse compared to those not (p < 0.001). The cumulative steroid dose was significantly higher in patients with renal damage (n = 18), with cerebrovascular accident (n = 5) and with avascular necrosis of the hip (n = 8) than those without (p = 0.001, p = 0.047 and p = 0.001).ConclusionRepeated “pulse” steroid was associated with higher renal damage and deleterious effect on central nervous system and bone. The abuse of “pulse” steroid therapy should be avoided.     

A cross-sectional study to assess the association of systemic lupus erythematsous disease activity with levels of high sensitivity C-reactive protein

BackgroundEarlier studies have shown that active systemic lupus erythematosus (SLE), though an inflammation, is not associated with high C-reactive protein (CRP) levels. But a few recent studies have shown that high sensitivity CRP (hsCRP) may be elevated in SLE and is associated with organ damage.ObjectiveTo evaluate the association between hsCRP levels and SLE disease activity index (SLEDAI).MethodsThis cross-sectional study was conducted in 40 SLE patients. The SLEDAI was calculated and the hsCRP level was measured in the serum. Correlation between hsCRP levels and SLEDAI was assessed. Relationship of hsCRP levels with individual components of SLEDAI was also analyzed.ResultsOut of 40 patients, 38 (95%) were female. The mean age was 28.15 years. The mean SLEDAI was 27.4 ± 17.8, indicating that most of the patients had high disease activity. The mean hsCRP levels were 6.64 ± 5.09 mg/L. hsCRP levels and SLEDAI showed strong positive correlation (Pearson's correlation coefficient r = 0.91; p < 0.0001). hsCRP levels were higher in patients with serositis, nephritis, nervous system manifestations and immunological abnormalities.ConclusionhsCRP levels reflect SLE disease activity and are higher in patients with major organ involvement.     

Serum beta2-microglobulin level in systemic lupus erythematosus patients: Relation to disease activity

Aim of the workTo assess the level of β2-microglubulin (β2M) in systemic lupus erythematosus (SLE) patients and its association with disease activity and other disease parameters.Patients and methods40 SLE patients and 22 matched controls were studied. Serum β2M was assessed using enzyme-linked immunosorbent assay (ELISA). SLE Disease Activity Index (SLEDAI) and the damage index were assessed.ResultsThe patients were 36 females and 4 males (F:M 9:1) with a mean age of 28.5 ± 7.9 years and disease duration of 6.7 ± 3.3 years. The SLEDAI was 9.3 ± 5.2 and the damage index 1.83 ± 1.84. The mean level of serum β2M was significantly higher in SLE patients (6.42 ± 2.46 mg/L) than control (2.47 ± 0.4 mg/L) (p < 0.01).The serum level of β2M was significantly higher in patients with nephritis (n = 22) (7.45 ± 2.47 mg/L) compared to those without (n = 18) (5.17 ± 1.82 mg/L)(p = 0.002), And it was similar in those with and without arthritis (7.24 ± 2.3 mg/L vs 5.88 ± 2.4 mg/L (p0.07).The β2M significantly correlated with disease activity (r = 0.86, p 0.001), serum creatinine (r = 0.52, p > 0.001), urea (r = 0.63, p < 0.001), 24 h urinary protein (r = 0.56, p < 0.001), hematuria (r = 0.4, p < 0.01) and pyuria (r = 0.41; p < 0.01), ESR (r = 0.48; p < 0.01) and inversely with hemoglobin level (r = ?0.34; p = 0.03). No significant correlation was found with C-reactive protein or with disease damage. Serum (β2M) significantly predicted nephritis and disease activity (sensitivity 63.6 %, specificity 77.8 %; p < 0.001 and 95 %CI: 0.25–0.41; p < 0.001 respectively).ConclusionSerum β2M is significantly associated with disease activity and lupus nephritis, suggesting that serum β2M may serve as a potential biomarker to monitor the disease activity and predicting lupus nephritis. However its association to disease severity needs further longitudinal studies.     

Risk factors for osteonecrosis severity among Egyptian systemic lupus erythematosus patients: Magnetic resonance imaging (MRI) staging

Aim of the workTo determine the risk factors of bilateral and severe (advanced) osteonecrosis femoral head (ONFH) as assessed by magnetic resonance imaging (MRI) staging in Egyptian SLE patients.Patients and methodsSixty SLE patients were studied and subdivided into two groups according to the presence or absence of symptomatic osteonecrosis. Full medical history, musculoskeletal examination, laboratory and serologic tests were done to all patients. SLE disease activity index (SLEDAI), systemic lupus international collaboration clinics damage index (SLICC/DI), health assessment questionairre (HAQ) disability index and the visual analogue scale (VAS-pain) were assessed. 30 patients with symptomatic ONFH were identified and staged by MRI according to Ficat and Arlet classification. Dual energy x-ray absorptiometry (DEXA) scan was performed.ResultsThe mean age at-onset of patients with ONFH was significantly lower than those without (20.7 ± 5.9 vs 30.4 ± 7.9 years; p < 0.0001) with comparable genders (F:M 29:1 vs 26:4; p = 0.16). SLEDAI, SLICC/DI, HAQ were significantly increased (p = 0.001 each) and DEXA reduced (p = 0.02) in those with ONFH. Predictors of ONFH severity included the presence of serositis (p = 0.005), arthritis (p = 0.02), gastrointestinal (GI) manifestations (p = 0.005), cardiac involvement (p = 0.049), diabetes (p = 0.01), elevated creatinine (0.008), urine sediments (p = 0.006), VAS-pain (p = 0.005), steroids (p = 0.015) and absence of hydroxychloroquine (HCQ) intake (p = 0.045). Risk factors of bilateral ONFH were the presence of serositis, nephritis, increased SLICC/DI and increased VAS-pain (p = 0.02, p = 0.03, p = 0.009 and p = 0.008, respectively).ConclusionNephritis, serositis, GI involvement, arthritis, steroids are key predictors for advanced ONFH while HCQ was protective. Risk factors for bilateral ONFH were serositis, nephritis, increased damage-index and VAS-pain.     

Assessment of vascular endothelial growth factor in systemic lupus erythematosus patients with anti-phospholipid syndrome

Aim of the work: The aim of the present study was to assess the serum vascular endothelial growth factor (VEGF) in systemic lupus erythematosus (SLE) patients with and without antiphospholipid syndrome (APS). Relation of the VEGF to the clinical characteristics and laboratory investigations were well thought out. Patients and methods: The study included 84 female SLE patients; 37 with APS and 47 without as well as 33 matched control. Disease activity was estimated using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and damage index evaluated. Serum VEGF level was quantified using ELISA. Results: The mean age of the SLE patients was 29.03?±?5.4?years with disease duration of 5.2?±?3.1?years. The VEGF was signficantly higher in the SLE patients (417.1?±?410.4?pg/ml) compared to the control (76.5?±?33.01?pg/ml) (p?<?0.0001) and was comparable between those with and without APS. VEGF was signficantly higher in those with a positive anti-ds DNA (n?=?53) (471.8?±?431.7?pg/ml) compared to those with a negative test (223.9?±?234.8?pg/ml) (p?=?0.005). The serum VEGF level signficantly correlatied with the SLEDAI (r?=?0.34, p?=?0.001) and steroid dose (r?=?0.27, p?=?0.02). On regression analysis, VEGF was not a signficant predictor of disease activity (p?=?0.46). A cut off value of 126?pg/ml showed a good sensitivity (72%) and specificity (60%) predicting anti-dsDNA positivity (p?=?0.02). Conclusion: Serum VEGF was remarkably increased in SLE patients with no special relation to APS and may be considered a potential marker of disease activity. Further insights on its relation with anti-ds DNA and genotypic expression in SLE are warranted.