IL22 in Egyptian SLE patients,could it reflect disease activity,skin or renal involvement or is it only an expensive ESR?

Aim of the work

To analyze the level of interleukin 22 (IL-22) in sera of systemic lupus erythematosus (SLE) patients and to associate its level to disease activity, skin involvement and lupus nephritis.

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.     

Mean platelet volume is a marker of inflammation but not a marker of disease activity in children with juvenile SLE

Aim of the workTo study the mean platelet volume (MPV) in children with juvenile-onset SLE (Jo-SLE), and whether MPV can be used as a biologic marker for disease activity or flare.Patients and methodsTwenty-nine patients from the rheumatology outpatient clinic, Pediatric Cairo University Hospitals and age 36 and gender matched healthy controls were included in the study. The MPV was determined within 4 h of blood sampling in all study populations. Recent routine laboratory investigations for Jo-SLE patients were obtained. Disease activity was estimated using SLE disease activity index (SLEDAI).Results29 Jo-SLE patients had a mean age of 12.8 ± 2.9 years and disease duration of 3.5 ± 3 year. The most frequent clinical manifestations were photosensitivity, malar rash, followed by arthritis and serositis. The MPV in Jo-SLE patients was 8.2 ± 2.1 femtoliters (fL) compared with 5.6 ± 0.9 fL in healthy controls (p < 0.001). There was no significant difference between MPV in 18 active patients (8.3 ± 2.1 fL) compared to 11 patients with inactive disease (8.1 ± 2.5 fL). Furthermore, there were no significant correlations between the MPV and SLEDAI score (r = −0.19, p = 0.33), or between MPV and other disease parameters routinely used to estimate disease activity or flare.ConclusionResults of the present study confirm the association between MPV and inflammation, but do not support the use of MPV as an indicator for monitoring disease activity or flare in juvenile SLE. Further longitudinal studies with larger numbers of patients are warranted to unveil the possibility of using MPV as a biologic marker of disease activity.     

Th1/Th2 cytokines in patients with systemic lupus erythematosus: is tumor necrosis factor alpha protective?

OBJECTIVES: To determine the circulating levels of Th1 and Th2 cytokines in patients with systemic lupus erythematosus (SLE) and to elucidate their association with disease activity and autoimmune response. METHODS: We included 52 patients and 25 healthy controls. Serum levels of tumor necrosis factor (TNF) alpha, interferon (IFN) gamma, interleukin (IL)-12p70, IL-10, and IL-4, as well as anti-DNA, -Ro, -La, -RNP, and -Sm antibodies were determined by enzyme-linked immunosorbent assay. Disease activity was recorded according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and classified as very active (SLEDAI > or = 13), moderately active (SLEDAI: 3-12), or inactive (SLEDAI < or = 2). RESULTS: The mean age of the patients was 34.2 +/- 12.6 years, and the mean duration of disease was 4.9 +/- 7.6 years. Twelve patients (23%), 20 patients (34.5%), and 20 patients (34.5%) had highly, moderately, and inactive SLE, respectively. Levels of IFN-gamma, TNF-alpha, and IL-12 were significantly higher in patients than in healthy controls (P <.03), as well as the IL-12/IL-10, IL-12/IL-4, IFN/IL-10, IFN/IL-4, TNF/IL-10, and TNF/IL-4 ratios (P <.01), suggesting a major participation of Th1 over Th2 cytokines. Nevertheless, a direct correlation between Th1 (IFN-gamma and TNF-alpha) and Th2 (IL-4 and IL-10) cytokines was observed in patients (r >.5, P <.01), indicating a mutual Th1-Th2 participation. TNF-alpha levels and the TNF/IL-10 ratio were higher in patients with inactive disease compared with patients with very active disease and controls (P <.04). IL-12 levels and IL-12/IL-4, as well as IL-12/IL-10, ratios were higher in patients with very active disease than in those with inactive SLE and controls (P <.01). IL-10 levels were associated with anti-DNA, anti-Ro, and anti-La response (P <.01). CONCLUSION: Our results suggest that TNF-alpha could be a protective factor in SLE patients, whereas IL-12p70 participates in disease activity and IL-10 influences the autoimmune response (autoantibody production).     

NLR、NC3R评估系统性红斑狼疮疾病活动度分析

目的：系统性红斑狼疮(SLE)易反复发作,评估疾病活动度对治疗具有重要的意义,本文研究中性粒细胞与淋巴细胞比值(NLR)、中性粒细胞与C3补体与的比值(NC3R)与活动性SLE的相关性。方法：纳入189例SLE患者,91例RA患者,79例健康体检人群;测定实验室指标,比较NLR、NC3R及实验室指标的差异,并评价其与SLE活动度的相关性。结果：3组间NC3R、NLR具有差异性(P＜0.01)。SLE活动度评分与NC3R(R=0.449 P＜0.01)和NLR(R=0.267 P＜0.01)具有相关性。当NC3R的cut-off值为5.85,诊断活动度SLE的灵敏度为0.529、特异性0.937;NLR的cut-off值为3.14,灵敏度为0.423,特异性为0.873。结论：NC3R、NLR可以作为评估SLE疾病活动度的辅助指标,并指导SLE的治疗。     

203例系统性红斑狼疮疾病活动指数(SLEDAI)对治疗方案选择与评估价值的回顾性分析

目的研究分析系统性红斑狼疮疾病的活动指数(SLEDAI)对临床治疗方案的选择和评估价值.方法对每一例SLE患者入院前10d内和经激素和免疫抑制剂治疗2年后活动性进行评价.结果 SLEDAI评分≤9分,纯激素治疗即可取得预期的疗效,如加用环磷酰胺(CTX)冲击治疗将会导致治疗过度;SLEDAI评分10-19分,激素加用CTX为合理的治疗方案,单用激素或给予强化治疗可导致治疗不足或治疗过度;SLEDAI评分≥20分,应给予强化治疗,不然将因治疗不足而导致病情恶化.结论 SLEDAI是评价SLE活动性的较好指标,对临床治疗有较好的指导作用,提示对不同器官及系统受累的患者宜选择不同的治疗方案.     

Acute Abdominal Pain in Patients with Systemic Lupus Erythematosus

Background  Patients with Systemic Lupus Erythematosus (SLE) that present with acute abdominal pain (AAP) represent a challenge for the general surgeon. The purpose of this study was to identify the major causes of AAP among these patients and to define the role of disease activity scores and the APACHE II score in identifying patients with an increased perioperative risk. Methods  We conducted a prospective study of patients admitted to the ER with AAP and SLE in an 11-year period. Demographic, diagnostic, and treatment data were recorded. Systemic lupus erythematosus disease activity index (SLEDAI), systemic lupus international collaboration clinics damage index (SLICC/DI), and APACHE II Score were analyzed. The main outcome variables were morbidity and mortality within 30 days of admission. Results  Seventy-three patients were included. Ninety-three percent were female. Most common causes of AAP were: pancreatitis (29%), intestinal ischemia (16%), gallbladder disease (15%), and appendicitis (14%). Most causes of AAP in patients with LES were not related to the disease. APACHE II score > 12 was statistically associated with the diagnosis of intestinal ischemia compared to other causes. No relationship was observed between SLEDAI and outcome. Furthermore, this index did not have impact on diagnosis or decision making. Overall morbidity was 57% and overall mortality 11%. On multivariate analysis, only APACHE II > 12 was associated with mortality (P = 0.0001). Conclusion  This is one of the largest series of AAP and SLE. Most common causes of AAP were pancreatitis and intestinal ischemia. APACHE II score in patients with intestinal ischemia was higher than those with serositis; further studies are needed to examine whether this score may help to differentiate these ethiologies when CT findings are inconclusive. APACHE II score was the most important factor associated with mortality. Furthermore, a prompt diagnosis and an appropriate surgical management are essential in order to improve patient outcome.     

Good prognosis for hospitalized SLE patients with non-related disease

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by widespread organ involvement. Given the scope of modern treatment, there has been a rise in life expectancy and quality with a mean estimated 5-year survival of 82%–90%. Hence, hospitalizations of SLE patients for non-SLE related causes have not been investigated.     

Implications of blood indices in systemic lupus erythematosus patients: Two feasible determinants of disease activity and lupus nephritis

Aim of the workTo investigate whether or not neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) may by indicators of disease activity in systemic lupus erythematosus (SLE) with and without lupus nephritis (LN).Patients and methodsThis research was carried out on 40 adult SLE patients (20 with LN and 20 without) and 20 controls. The NLR and PLR were calculated. The SLE disease activity index (SLEDAI) was assessed.ResultsThe mean age of the patients was 36.2 ± 7.6 years, 38 females and 2 males (F:M 19:1), with a disease duration of4.3 ± 1.2 years. The mean SLEDAI was 15.1 ± 4.7 being significantly higher in those with LN (17.5 ± 3.5) compared to those without (12.6 ± 4.6) (p = 0.001). The mean NLR (6.1 ± 2.1) and PLR (236.6 ± 86.9) were significantly increased in patients compared to the control (2.7 ± 1.2 and 125.2 ± 38.8 respectively) (p < 0.001). The NLR and PLR were both significantly related to the serum creatinine (r = 0.35, p = 0.03 and r = 0.5, p = 0.001) and SLEDAI (r = 0.36, p = 0.03 and r = 0.34, p = 0.03 respectively). NLR can significantly predict activity of SLE at cut off 5.6 with a sensitivity 80%, specificity 65% (p = 0.007) and PLR at cut off 217 with sensitivity 75%, specificity 65% (p = 0.035). The NLR can significantly predict LN at cut off 3.6 (sensitivity 80%, specificity 40%; p = 0.007) and PLR at cut off 186 (sensitivity 70%, specificity 60%; p = 0.035).ConclusionThere is a remarkable link between PLR and NLR with SLEDAI. Thus, both may serve as promising affordable indicators of inflammation in SLE. The notable relation to LN may signal renal involvement in patients with SLE.     

Two systemic lupus erythematosus (SLE) global disease activity indexes--the SLE Disease Activity Index and the Systemic Lupus Activity Measure--demonstrate different correlations with activation of peripheral blood CD4+ T cells

Global disease activity measurement in systemic lupus erythematosus (SLE) patients is important for the clinical estimation and adjustment of therapy. By contrast, immune system activation plays a significant role in disease pathogenesis, with CD4+ lymphocytes acting as central cells in the immune response. We investigated which scale better correlates with immunologic changes in the blood of SLE patients, the SLE Disease Activity Index (SLEDAI) or the Systemic Lupus Activity Measure (SLAM) scale. Samples of peripheral blood were obtained from 45 SLE patients with different disease activity as assessed by the SLEDAI and the SLAM scales on the same day. We assessed the percentage of CD4+ T cells with activation-associated receptors: CD69, CD25int, CD95, HLA-DR, and CD4+ T cells with killing properties containing perforin and granzyme B. Our results indicated that the percentage of CD4+CD69+ and CD4+CD25(int) cells did not correlate with either the SLEDAI or the SLAM scale. Significant and positive correlations were observed between percentages of CD4+CD95+ and CD4+HLA-DR+ lymphocytes and SLE activity, but only when activity was measured using the SLAM scale, not with the SLEDAI scale. The percentage of CD4+perforin+ and CD4+granzyme B+ cells also strongly correlated with disease activity measured only with the SLAM scale. We conclude that the SLAM scale better reflects changes of immune system activity in SLE patients compared with the SLEDAI scale.