Serum interleukin-18 levels in patients with systemic lupus erythematosus: Relation with disease activity and lupus nephritis

Aim of the workTo further investigate the possible role of IL-18 in the pathogenesis of systemic lupus erythematosus (SLE) and development of lupus nephritis (LN), and to explore its relationship with pathological classes of LN, degree of acute renal activity and chronic damage.Patients and methodsForty-one SLE patients with LN, thirty-one lupus non-nephritis patients and fifteen age and sex matched healthy controls were enrolled in this study. SLE patients were subjected to disease activity assessment by SLEDAI, renal disease activity assessment by the Systemic Lupus International Collaborating Clinics (SLICC) Renal Activity Score, laboratory investigations including measurement of serum interleukin-18 using Enzyme Linked Immunosorbent Assay. Renal biopsy was obtained from LN patients and pathological classification was made according to World Health Organization (WHO) criteria. Analysis of activity and chronicity indices was done on these biopsy specimens.ResultsSerum levels of IL-18 were significantly higher in patients with LN than lupus non-nephritis patients and healthy controls (p < 0.001). There were significant correlations between IL-18 and SLEDAI (p = 0.002), proteinuria (p = 0.027), renal activity score (p = 0.003) and activity index (p = 0.039) in patients with LN. There was no significant difference in the serum levels of IL-18 between WHO classes of LN.ConclusionIL-18 appears to have a pathogenic role in the development of SLE and plays a crucial role in triggering inflammation in LN. Serum IL-18 levels could be a useful biomarker to assess the activity of renal disease in SLE.     

Transferrina y ceruloplasmina en orina de pacientes con lupus eritematoso sistémico. ¿Son útiles para diferenciar pacientes con nefritis lúpica?

Background and objectiveDiagnosis of lupus nephritis (LN) is usually based on renal biopsy, which is an invasive technique that involves multiple risks. Therefore, different biomarkers have emerged as alternatives for the diagnosis of LN. Nonetheless, studies regarding urinary biomarkers in Latin American patients are limited. The objective of this study was to assess the diagnostic value of urinary transferrin and ceruloplasmin to differentiate patients who have renal involvement from those who do not.Materials and methodsSystemic lupus erythematosus (SLE) patients that met the revised American College of Rheumatology (ACR) classification criteria were recruited. Patients with another autoimmune disease, active infection (urinary tract or systemic infection), renal replacement therapy, human immunodeficiency virus infection or pregnancy were excluded. A urine sample was collected from each patient. LN was diagnosed according to ACR criteria. The activity and chronicity of LN were measured using the Austin indices. Urinary transferrin and ceruloplasmin levels were measured using commercial enzyme-linked immunosorbent assay (ELISA) kits. Mann-Whitney U test and Student's t-test were used to compare data. Spearman's rank correlation was used to determine associations. Lastly, receiver operating characteristic (ROC) curves were created.ResultsThe study involved 120 SLE patients. In all, 85% were female, 76% mestizo, the mean age was 32.8 ± 12.1 years and mean systemic lupus erythematosus disease activity index (SLEDAI) was 8.4 ± 8.9; 64% had renal involvement. Urinary levels of the two biomarkers were significantly higher in patients with LN compared to those without LN. Similarly, urinary levels of both biomarkers were significantly higher in patients with active LN compared to those with inactive LN. Furthermore, urinary transferrin levels were significantly higher in Afro-Latin American patients. On the other hand, urinary transferrin levels correlated with SLEDAI and proteinuria, and transferrin and ceruloplasmin levels correlated with each other. The diagnostic value of ROC curves for these urinary biomarkers for LN were good.ConclusionsIn our cohort of SLE patients, we found that transferrin and ceruloplasmin were potential biomarkers for LN, and can even differentiate active LN.     

Correlation Between Quantitative Anti-dsDNA Levels with Severity of Proteinuria in Systemic Lupus Erythematosus Patients

ObjectiveTo evaluate the correlation of quantitative anti-dsDNA level with proteinuria levels in patients with lupus nephritis in a tertiary care hospital.Study designIn this prospective cross-sectional study, 76 patients of newly diagnosed SLE coming to Fatima Memorial Hospital were included in the study period between January 2020 to June 2020. Demographic data such as age, gender, lupus manifestations such as serositis, arthritis, mucocutaneous disease, and neuropsychiatric manifestations were recorded. Quantitative anti-dsDNA was measured by enzyme-linked immunosorbent assay and proteinuria was estimated by 24 h urinary protein collection. Data was analyzed by SPSS 23. Association between categorical variables was assessed using chi-square test. For comparison of categorical independent and continuous dependent variable t-test or Mann–Whitney U test was applied.ResultsThe median age of the cohort was 29 (with inter quartile range – IQR – of 13) years. The female gender comprised of 68 (89.4%) of the cohort population. The median anti-dsDNA level was 54.9 (183.6 IQR) IU, and baseline proteinuria of the cohort was 520 mg/dL (1.49 IQR). There was a significant association of anti-dsDNA level with systemic features such as arthritis (p = <0.01), serositis (p = <0.01) and, Raynaud's phenomenon (p = <0.01). NPSLE and mucocutaneous features did not show statistically significant association (p = 0.91 and 0.14 respectively). Baseline anti-dsDNA showed a statistically significant correlation with baseline proteinuria levels (p = <0.01).ConclusionQuantitative anti-dsDNA is directly correlated with nephritis measured as proteinuria, and can be detected even before organ involvement. Hence, it can determine disease course and guide early treatment.     

Evaluation of visfatin in patients with systemic lupus erythematosus: Correlation with disease activity and lupus nephritis

IntroductionRenal involvement affects about 50% of SLE patients accounting for significant morbidity and mortality in these patients. The adipokine “visfatin” acting as a growth factor for B-lymphocyte-precursors, exerts several proinflammatory functions. It was demonstrated as a marker of endothelial dysfunction (ED) in chronic kidney disease (CKD) thus could be a factor linking inflammation in SLE and kidney disease.Aim of the workTo assess serum visfatin level in SLE patients and its correlation to disease activity and lupus nephritis (LN) in these patients.Patients and methodsSerum level of visfatin using enzyme-linked immunosorbent assay (ELISA), chemical and immunological markers of SLE and LN were measured in 40 SLE patients and 40 age and sex matched healthy controls. Disease activity and renal involvement were assessed using SLE Disease Activity Index (SLEDAI) and Renal SLEDAI respectively further dividing patients into active versus inactive and LN versus non-LN respectively. Renal biopsies were taken from LN subgroup and were classified according to the modified WHO classification.ResultsA significantly higher serum visfatin level was found on comparing SLE patients (mean 109 ± 180 ng/ml, median18) with controls (mean 9.4 ± 11 ng/ml, median2.5) with statistically highly significant difference (z = 5.2, P < 0.001). Also there was a statistically significant difference as regards serum visfatin level between active SLE patients (mean 173 ± 111 ng/ml, median 14) and inactive patients (mean 139 ± 88 ng/ml, median 5) (z = 2.1, P < 0.05) as well as between patients with LN (mean 226 ± 180 ng/ml, median18) and patients with no LN (mean 101 ± 140 ng/ml, median 8(2-229)) (z = 2.1, P < 0.05). Visfatin had a highly significant positive correlation with disease duration (r = 0.48, P < 0.001), SLEDAI (r = 0.62, P < 0.001) as well as ESR, CRP and, renal score (r = 0.45, 0.35, and 0.65, respectively) while inverse correlation with estimated GFR (r = ?0.614) and C3 and C4 titre (r = ?0.26, r = ?0.35, respectively) was recorded. Visfatin showed high sensitivity in detecting active SLE and LN 83% and 85%, respectively.ConclusionSerum visfatin is strongly associated with LN in SLE patients and is a promising biomarker for prediction of renal involvement in these patients. It reflects SLE activity specially LN activity namely renal score and GFR decline. Further prospective studies are required to confirm visfatin as a destructive mediator of predictive and prognostic value in active lupus nephritis.     

¿Es la nefritis lúpica un factor pronóstico en el embarazo? Resultados maternos y fetales

BackgroundPregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications.ObjectiveTo evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome.MethodsWe retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated.Results121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had Class IV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P = .041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P = .047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress.ConclusionsPatients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.     

Urinary and tissue monocyte chemoattractant protein1 (MCP1) in lupus nephritis patients

Aim of the work

To assess the role of urinary and tissue monocyte chemoattractant protein-1 (MCP-1) in active lupus nephritis (LN) and to correlate the levels with disease activity and renal status.

Serum BLyS and APRIL as possible indicators of disease activity in pediatric systemic lupus erythematosus and juvenile idiopathic arthritis

Aim of the workTo assess serum levels of B lymphocyte stimulator (BLyS) and a proliferation-inducing ligand (APRIL) to determine their correlations with disease activity in pediatric systemic lupus erythematosus (pSLE) and juvenile idiopathic arthritis (JIA) patients.Patients and methodsTwenty-nine pSLE patients and 33 JIA patients were recruited. SLE disease activity was assessed using the systemic lupus erythematosus disease activity index (SLEDAI), while the juvenile arthritis 27 joint disease activity score (JADAS-27) was calculated for JIA patients. Serum samples were assayed for BLyS and APRIL by the enzyme linked immunosorbent assay (ELISA).ResultsSerum BLyS and APRIL were elevated in both pSLE and JIA patients compared to controls. Serum BLyS levels correlated with both SLE and JIA disease activity (p = 0.042, p = 0.019, respectively) whereas serum APRIL levels correlated positively with JADAS-27 and inversely with SLEDAI (p = 0.001, p = 0.02, respectively). Elevated serum BLyS and APRIL were significantly associated with a lower incidence of nephritis (p = 0.043, p = 0.016, respectively), while elevated serum APRIL significantly associated with negative anti-dsDNA in pSLE patients (p = 0.017). In JIA patients, both serum BLyS and APRIL were significantly associated with the presence of ANA (p = 0.008, p < 0.001, respectively), while high serum APRIL associated with the presence of RF (p = 0.035). APRIL and BLYS levels correlated with each other positively in JIA but inversely in pSLE patients.ConclusionSerum BLyS showed elevated levels that correlated significantly with pSLE and JIA disease activity, accordingly anti-BLyS therapy might be of great benefit to offset disease flare. The inverse correlations observed between APRIL with both BLyS and disease activity in pSLE patients raises the possibility of being a down regulator of the disease process.     

抗核小体抗体与抗C1q抗体在狼疮肾炎血清的表达及其临床意义

目的探讨抗核小体抗体与抗C1q抗体在狼疮肾炎（lupus nephritis，LN）患者血清的表达及其临床意义。方法使用酶联免疫吸附试验（ELISA）对46例LN患者血清进行检测，并与31例无肾炎临床表现的SLE患者作对照。结果LN患者血清中抗核小体抗体与抗C1q抗体浓度及阳性率显著高于SLE对照组（P〈0．01）。抗双链DNA（dsDNA）抗体、抗Sm抗体、抗nRNP抗体、抗心磷脂（aCL）IgG抗体有较高的阳性率，与对照组相比差异有统计学意义（P〈0．05）。将抗核小体抗体、抗C1q抗体、抗dsDNA抗体、抗Sm抗体、抗nRNP抗体和aCLIgG抗体分别引入Logistic回归进行统计分析，结果显示入选的自变量包括抗核小体抗体、抗C1q抗体、抗dsDNA抗体（P〈0．05）。结论在LN患者中，存在着抗核小体抗体、抗C1q抗体的高表达。抗核小体抗体及抗C1q抗体在LN发病中起重要的作用。抗核小体抗体、抗C1q抗体、抗dsDNA抗体是反映SLE患者并发肾脏损害的重要指标，在LN诊断和判定其活动性方面有重要作用。     

Anti-nucleosome antibodies may predict lupus nephritis and severity of disease in systemic lupus erythematosus

Background/ObjectiveDetection of anti-nucleosome antibodies in patients with systemic lupus erythematosus (SLE) has been well established and it is claimed that their presence is associated with disease activity. The objective of this study is to determine the diagnostic value of anti-nucleosome antibodies in the assessment of lupus nephritis and clinically active SLE.MethodsThe anti-nucleosome antibodies were evaluated in the serum of 200 Tunisian SLE patients at disease onset by a sensitive immunodot assay. Serum samples from each patient were also tested for ANA and anti-ds DNA antibody by IIF on Hep 2 cells and Crithidia luciliae respectively. During the follow-up, the patients were regularly monitored for clinical parameters. Global SLE activity was measured by the European Consensus Lupus Activity Measurement (ECLAM).ResultsThe prevalence of anti-nucleosome and anti-dsDNA antibodies was 69% and 63.5% respectively. Anti-nucleosome antibodies were found to be 30.1% positive in SLE patients lacking anti-dsDNA antibody. 79.5% patients had active SLE at the first clinical examination. Anti-nucleosome antibodies were more sensitive than anti-dsDNA antibodies to detect active SLE (78% vs. 71.7%, P =0.19). 52.5% of SLE patients had renal involvement. Among these patients, the rate of anti-nucleosome positivity and anti-dsDNA were 77.1% and 67.6% respectively. The positivity of anti-nucleosome antibodies was significantly higher in patients with renal disease than the subjects without renal disease (P = 0.009). Anti-nucleosome and anti-ds DNA antibodies were significantly correlated with disease activity (P < 0.001 and P < 0.001 respectively).ConclusionAnti-nucleosome antibody reactivity may be a useful marker in the diagnosis and assessment of active SLE.     

Factores predictores del desarrollo de nefritis lúpica después del diagnóstico de lupus eritematoso sistémico

ObjectiveTo determine predictive factors for the development of lupus nephritis (LN) at the time of diagnosis of systemic lupus erythematosus (SLE).MethodsA case-control study was carried out in a single centre, 595 patients participated diagnosed with SLE without LN by clinical or laboratory parameters at diagnosis. They were followed for a mean of 6.8 (± 4.5) years, two groups were formed from the data from their records: with NL (cases) and without NL (controls) at the end of the follow-up. Sociodemographic, clinical, serological, immunological variables and albumin/globulin ratio (AGR), calculated as albumin / total protein ? albumin at diagnosis, were compared between both groups. A univariate and multivariate analysis was carried out.Results124 (20.8%) patients had LN during follow-up and 471 (79.2%) did not develop LN. Univariate analysis: variables significantly associated with the development of LN: smoking, oral ulcers, serositis, more than four classification criteria, abrupt onset of SLE, higher SLEDAI score, low AGR, low C3 levels, high anti-titres double stranded DNA (anti-dc DNA), anti-nucleosomes and positivity of immunofluorescence in skin. Multivariate analysis: predictors of developing LN: elevated serum levels of anti-dc DNA (odds ratio [OR]: 15.82; confidence interval [CI]: 1.08-1.22, P < .0001), decrease in C3 fraction (OR: 36.50; CI: 13.52-81.91, P < .0001) and RAG < 1 (OR: 47.58; CI: 11.85-79.17, P < .0001).ConclusionAn AGR below one was the greatest predictor of the appearance of LN, together with low levels of C3 and high levels of anti-dc DNA antibodies; these may contribute to identifying patients at higher risk of presenting LN.     

Comparative study of kidney affection in SLE patients with and without antiphospholipid syndrome

Aim of the workTo evaluate the incidence, clinical associations and outcome of APS nephropathy in SLE patients with 2ry APS.Patients and methodsWe studied 64 female SLE patients with nephritis; 32 of them had 2ry APS (group 1) and the rest without 2ry APS (group 2). Demographic, clinical and serological data were prospectively evaluated. Systemic lupus erythematosus disease activity index (SLEDAI) and Systemic Lupus International Collaboration Clinics/ACR damage index (SLICC) were assessed. Renal duplex, renal ^99mTc-dimercaptosuccinic) scan (DMSA scan) and renal magnetic resonance angiography (MRA) were all used to detect renal vascular affection.ResultsThere were statistically significant differences between the two examined groups regarding damage index (p = 0.000), hypertension (p = 0.02), thrombocytopenia (p = 0.000), ↓LDL (p = 0.008), ↓C3 (p = 0.01) and TMA (p = 0.04). In group 1: MR angiography detected 7 patients with RAS: 5 patients with renal artery thrombosis that showed a significant association with TMA and proteinuria (p = 0.002, p = 0.004: p < 0.001, p = 0.02, respectively). Patients with RAS had ↑DBP, ↑s.creatinine and ↑TGs (p = 0.004, p = 0.005 and p = 0.0003, respectively). Renal DMSA detected 6 patients with cortical scar which showed a significant association with TMA, proteinuria, livedoreticularis and arthritis (p = 0.001, p = 0.01, p = 0.04 and p = 0.03, respectively) those patients had ↑DBP and ↑RI (p = 0.000 and p = 0.006, respectively).ConclusionaPL testing should become a routine investigation in patients evaluated for RAS or renal infarctions especially with hypertension and unexplainable deteriorating renal function. To confirm our results we propose that larger scale, multicentre studies with longer evaluation periods.     

Does anti-DNA positivity increase the incidence of secondary antiphospholipid syndrome in lupus patients?

Aim of the workTo detect the incidence of secondary antiphospholipid syndrome (APS) among Systemic lupus erythematosus (SLE) patients with positive anti-DNA antibodies.Patients and methodsWe studied 342 SLE patients; Group I: anti-DNA positive SLE patients (n = 208) and Group II: anti-DNA negative SLE patients (n = 134), with a female to male ratio of 9.39:1 and a mean age of 27.49 ± 7.94 years and disease duration of 5.74 ± 3.97 years. Full history taking, thorough clinical examination, laboratory and relevant radiological investigations were performed. Disease activity was assessed using systemic lupus erythematosus disease activity index (SLEDAI). Anti-dsDNA tests were carried out by indirect Immunofluorescence (IF) technique. Anti cardiolipin antibodies (IgG and IgM) and Anti-β₂ glycoprotein-I antibody of IgG and/or IgM isotype were detected by ELISA.ResultsThe clinical manifestations, disease activity and laboratory investigations of the SLE patients varied according to the anti-DNA antibodies. Thirty-six patients (17.3%) had secondary APS in those with positive anti-DNA antibodies while only16 (11.9%) had secondary APS in those with negative anti-DNA antibodies, with no significant differences between both groups.ConclusionApparent higher incidence of secondary APS was detected in anti-DNA positive SLE patients. The non significant differences between both groups may suggest that anti-DNA positivity cannot be considered as the only predictor of secondary APS and further studies may be needed to detect other factors which may increase the incidence of APS in SLE patients.     

Prevalence and impact of chronic hepatitis C virus infection on the clinical manifestations and disease activity among patients suffering from systemic lupus erythematosus

Aim of the workTo study the prevalence of anti-HCV antibodies among patients suffering from systemic lupus erythematosus (SLE) as well as to determine the impact of chronic HCV infection on the clinical manifestations and disease activity.Patients and methodsNinety-eight consecutive SLE patients presented to the rheumatology department, Cairo University Hospitals were included in the study. All patients were screened for anti-HCV antibodies using a 3rd generation enzyme-linked immune-sorbent assay (ELISA). Patients with positive anti-HCV were tested for the presence of HCV-RNA by polymerase chain reaction (PCR). Patients were classified into two groups; HCV/SLE and non-HCV/SLE according to the presence or absence of anti-HCV antibodies.ResultsTwenty/98 patients (20.4%) were positive for HCV antibody. Eight/98 patients (8.2%) had active viremia. SLE patients with positive anti-HCV antibodies tend to be older in age and having a longer SLE duration than non-HCV/SLE Patients. HCV/SLE patients had significantly lower mucocutaneous manifestations (p < 0.05) and higher cardiac manifestations and fundus abnormalities (p < 0.04, p < 0.01 respectively) than non-HCV/SLE patients. There was no statistical difference between the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score between both groups. Patients with HCV/SLE were less frequently on oral steroids than patients with non-HCV/SLE.ConclusionHCV antibodies and active HCV viremia were found in 20.4% and 8.2% respectively among SLE patients. SLE with positive anti-HCV antibodies tend to be older in age and having longer SLE disease duration, lower mucocutaneous and higher cardiac manifestations and fundus abnormalities. Concomitant chronic HCV infection has no adverse impact on SLEDAI.     

Neutrophil to lymphocyte and platelet to lymphocyte ratios in systemic lupus erythematosus: Relation with disease activity and lupus nephritis

ObjectivesTo investigate the role of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as activity markers in systemic lupus erythematosus (SLE) without nephritis and lupus nephritis (LN) patients.Patients and methodsThis study included 60 SLE patients with LN, 60 SLE patients without renal involvement and 30 healthy controls. We analyzed correlations between NLR and PLR and both disease activity and renal affection.ResultsThe NLR of SLE patients was much higher than those of the controls. Both ratios showed significantly increased values in SLE patients with active disease. NLR and PLR were positively correlated with SLEDAI, ESR, and CRP and negatively correlated with C4. SLE patients with LN had higher levels of NLR than those without nephritis. NLR showed positive correlations with BUN, serum urea, serum creatinine and 24 h urinary protein. We found NLR to be related to anti-ds-DNA level and renal biopsy classes. While PLR was related only to anti ds-DNA. The best NLR to predict SLE active disease was 2.2 and the best PLR cut-off value was 132.9.ConclusionNLR and PLR are useful inflammatory markers to evaluate disease activity in SLE patients. Also, NLR could reflect renal involvement in SLE patients and is associated with the different classes of its histological staging.     

Baseline renal functions predict the effect of canakinumab on regression of proteinuria in patients with familial Mediterranean fever

Introduction and objectivesCanakinumab, an IL-1 blocking drug, decreases the frequency and severity of the attacks and decreases the proteinuria level in colchicine resistant/intolerant familial Mediterranean fever (FMF) patients. However, it is not known whether patients with impaired or preserved renal functions respond differently to IL-1 blocking therapies in terms of proteinuria reduction and progression of kidney dysfunction which was the aim of this study.Materials and methodsAdult FMF subjects with biopsy proven amyloidosis who had 24-h urine protein excretion > 150 mg/day before initiation of canakinumab were divided into two groups as patients with preserved renal function (GFR ≥ 60 mL/min) and patients with impaired renal function (GFR < 60 mL/min). The response in proteinuria and renal functions are compared between two groups in this cross-sectional study.ResultsA total of 18 patients (11 with preserved and 7 with impaired renal function) were included in this study. Although proteinuria levels of both groups were similar at the baseline and at six months after initiation of canakinumab, proteinuria at 12 months was significantly lower for patients with preserved renal function compared to patients with impaired renal function (2462 ± 1760 mg/day vs. 7065 ± 3035 mg/day respectively, p = 0.02). All of the patients with preserved renal function had more than 50% decrease in proteinuria at 12 months compared to baseline values, while none of the patients with impaired renal function had more than 50% decrease in proteinuria.ConclusionsCanakinumab, an IL-1 blocking agent, is not effective in decreasing proteinuria in FMF patients with already impaired renal functions and should be started early in the course of disease to prevent renal impairment.     

Association between anti-Ro 60 kDa (SS-A) autoantibodies and hypocomplementemia in systemic lupus erythematosus patients from Algiers prefectures

BackgroundSystemic lupus erythematosus (SLE) is characterized by a vicious cycle maintaining systemic inflammation. It starts by autoantibody production, immune complex formation and complement activation that contribute to inflammation, tissue damage and further autoantibody production.Aim of the workTo evaluate the association between the auto-antibodies (abs), circulating immune complexes (CIC), and complement activity in SLE patients.Patients and methodsThis study involved 30 female SLE patients analyzed for autoantibodies, complement profile including complement hemolytic 50 (CH50), alternative pathway 50_, factor B, C1q, C2, C3 and C4 as well as C1q-CIC. SLE disease activity was assessed by the SLE Disease Activity Index (SLEDAI).ResultsThe age of patients was 34 ± 12.8 years, disease duration was 5.2 ± 3.2 years and their mean SLEDAI was 9.96 ± 4.2. Anti-SSA, anti-dsDNA, anti-C1q abs, and CIC were detected in 36.7%, 50%, 50% and 30% of patients, respectively. Anti-SSA were higher in patients with lower compared to normal CH₅₀ activity and C3 level (24.7 vs 88.6 U/ml; p = 0.002 and 118.6 ± 25.18 U/ml vs 15.9 ± 7.3; p < 0.0001 respectively) than the other autoantibodies. Increased CIC were higher in patients with lupus nephritis and were associated with anti-SSA, anti-SSB, anti-C1q, anti-Sm and in patients with low CH50 activity. The CIC significantly correlated with anti-C1q (r = 0.69, p < 0.0001), anti-SSA (r = 0.5, p = 0.005) and negatively with CH₅₀ (r = −0.4, p = 0.046).ConclusionsThe current study confirms that the etiopathogenic anti-SSA autoantibodies are the most associated with hypocomplementemia in SLE. This would stimulate future researches for validation of predictive biomarkers earlier than hypocomplementemia which is still the major unmet need in lupus research and patient care.     

Auditory disorders in patients with systemic lupus erythematosus: Relation to clinical parameters

Aim of the workTo evaluate the hearing disorders in SLE patients with particular regard to their frequency and relationship to disease duration and activity.Patients and methodsTwenty female SLE patients were enrolled in the study. Assessment of disease activity was done using the SLE disease activity index (SLEDAI). Another 20 otologically healthy subjects of matched age and sex served as controls. Auditory assessment was performed and included otoscopic examination, pure tone audiometry (PTA), acoustic immittance testing and speech audiometry.ResultsThe PTA was abnormal in 13 (65%) patients; 4 had tinnitus and 1 vertigo. The PTA results showed a highly significant statistical difference from the control (p < 0.001). Otoscopic examination, acoustic immittance testing and speech audiometry of all patients were normal. A significant difference was found in the age at disease onset between those with and without abnormal PTA (p = 0.023). Moreover, there was a significantly lower hearing level (right ear) at 12,000 Hz in juvenile-onset (N = 6) (20.83 ± 3.76 db) compared to adult-onset cases (32.5 ± 15.66 db) (p = 0.02). No significant difference was present in the audiovestibular manifestations (p = 0.114), clinical, laboratory parameters or disease activity between those with or without hearing loss. However, hearing levels were significantly lower in those with lupus nephritis and those receiving hydroxychloroquine.ConclusionPure tone audiometry revealed SNHL in 65% of SLE patients. Absence of audiovestibular manifestations does not exclude inner ear affection. Age at disease onset is remarkably associated with hearing loss in SLE. Lupus nephritis and hydroxychloroquine use are associated with lower hearing levels and possible early hearing loss.     

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.     

Sleep disturbance in female patients with systemic lupus erythematosus and its relation to disease parameters

Aim of the workTo assess the prevalence of sleep disturbance in female patients with systemic lupus erythematosus (SLE) and to evaluate the correlation between sleep disturbance and some disease parameters.Patients and MethodsThe Pittsburgh Sleep Quality Index (PSQI) was used to investigate the sleeping habits of 30 female patients with SLE and of 30 healthy age and sex-matched controls. Depressed mood was assessed using the Center for Epidemiological Studies Depression scale (CES-D), functional disability was assessed with the Health Assessment Questionnaire (HAQ) and pain severity was assessed using the visual analogue scale (VAS). Disease activity was measured using the SLE disease activity index (SLEDAI). Disease severity and cumulative damage were measured using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage (SLICC/ACR DI).ResultsThe mean global scores for the PSQI were significantly different between cases and controls (8.47 ± 3.53 versus 5.10 ± 3.66, p = 0.000) indicating poor sleep quality for these patients compared to healthy controls, and 76.7% (23 patients) were poor sleepers. Sleep disturbances were correlated with disease duration (p = 0.001), functional disability (p = 0.001), SLEDAI (p = 0.000), pain severity (p = 0.002), organ damage (p = 0.000) and depressed mood (p = 0.000). However, with multivariate linear regression analysis SLEDAI and SLICC/ACR were the only significant predictors associated with higher level of PSQI.ConclusionSleep disturbances are prevalent among female SLE patients, with multiple factors contributing to it, but disease activity and cumulative disease damage were the only predictors of sleep quality. Assessment and management of sleep disturbances should be part of the routine care of SLE patients.     

Lymphopenia and systemic lupus erythematosus,a preliminary study: Correlation with clinical manifestations,disease activity and damage indices

IntroductionSystemic lupus erythematosus (SLE) is an autoimmune disease characterized by excessive autoantibody production against ‘self’ antigens and immunocomplex formation, resulting in frequent widespread inflammatory damage to target multiple organ systems.Aim of workTo determine the association of lymphopenia with the clinical manifestations, serologic abnormalities, disease activity and disease damage as well as drug intake in SLE patients.Patients and methodsThe present study was carried out on forty-five SLE female patients fulfilling the American College of Rheumatology (ACR) revised criteria for the diagnosis of SLE. They were divided into two groups according to the lymphocytes’ count: Group-I: thirty patients with lymphopenia (<1500/mm³) and group-II: fifteen patients without lymphopenia (⩾1500/mm³). Ten healthy age matched females (group-III) taken as a control group. Patients and control groups were recruited from the Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University Hospitals. Disease activity was assessed using the SLE Disease Activity Index (SLEDAI). Disease damage was assessed with Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) damage index.ResultsLymphopenia in patients with SLE was found to be associated with lupus nephritis (p = 0.023), leucopenia (p = 0.004), increased disease activity index (p = 0.03) and increased organ damage index (p = 0.02), and was not associated with other clinical lupus manifestations, serological abnormalities or with the drug intake (p > 0.05).ConclusionLymphopenia in SLE was associated with lupus nephritis, leucopenia and increased both disease activity and organ damage indices.