Systemic lupus erythematosus and risk of infection

Objective.To compare serious infection risk for systemic lupus erythematosus (SLE) patients starting glucocorticoids (GC), antimalarials (AM), or their combination.Methods.We conducted a new-user, historical cohort study, Kaiser Permanente Northern California, 1997–2013. Cox proportional hazards analysis was used to calculate adjusted HR and 95% CI.Results.The study included 3030 patients with SLE followed an average of 4 years. Compared with patients starting AM without GC (9 infections/1461 patient-yrs), the HR for the risk of infection was 3.9 (95% CI 1.7–9.2) for those starting GC ≤ 15 mg/day without AM (14 infections/252 patient-yrs), while it was 0.0 (0 infections/128 patient-yrs) for those starting the combination. We split the 14 patients with a serious infection and with GC < 15 mg/day into 2 groups: < 7.5 and ≥ 7.5–15 mg/day. The HR for < 7.5 mg/day was 4.6 (95% CI 1.8–11.4) and for ≥ 7.5–15 mg/day, 3.1 (95% CI 1.0–9.7). For patients starting GC > 15 mg/day (reflecting more severe SLE), the risk of infection was nearly the same for the combination of GC and AM (9 infections/135 patient-yrs) and GC alone (41 infections/460 patient-yrs), but the combination users had evidence of more severe disease. Patients with SLE had a 6- to 7-fold greater risk of serious infection than the general population.Conclusion.Our findings suggest that the benefits of AM treatment for SLE may extend to preventing serious infections. Although the study included > 3000 patients, the statistical power to examine GC dosages < 15 mg/day was poor.

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Predictive models of infection in patients with systemic lupus erythematosus: A systematic literature review

Lupus ◽

10.1177/0961203320983462 ◽

2021 ◽

pp. 096120332098346

Author(s):

Mauricio Restrepo-Escobar ◽

Paula A Granda-Carvajal ◽

Daniel C Aguirre ◽

Johanna Hernández-Zapata ◽

Gloria M Vásquez ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Predictive Models ◽

Data Extraction ◽

Risk Of Bias ◽

Therapeutic Interventions ◽

Prognostic Models ◽

Risk Of Infection ◽

Systemic Lupus ◽

Model Studies

Introduction Having reliable predictive models of prognosis/the risk of infection in systemic lupus erythematosus (SLE) patients would allow this problem to be addressed on an individual basis to study and implement possible preventive or therapeutic interventions. Objective To identify and analyze all predictive models of prognosis/the risk of infection in patients with SLE that exist in medical literature. Methods A structured search in PubMed, Embase, and LILACS databases was carried out until May 9, 2020. In addition, a search for abstracts in the American Congress of Rheumatology (ACR) and European League Against Rheumatism (EULAR) annual meetings’ archives published over the past eight years was also conducted. Studies on developing, validating or updating predictive prognostic models carried out in patients with SLE, in which the outcome to be predicted is some type of infection, that were generated in any clinical context and with any time horizon were included. There were no restrictions on language, date, or status of the publication. To carry out the systematic review, the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) guideline recommendations were followed. The PROBAST tool (A Tool to Assess the Risk of Bias and Applicability of Prediction Model Studies) was used to assess the risk of bias and the applicability of each model. Results We identified four models of infection prognosis in patients with SLE. Mostly, there were very few events per candidate predictor. In addition, to construct the models, an initial selection was made based on univariate analyses with no contraction of the estimated coefficients being carried out. This suggests that the proposed models have a high probability of overfitting and being optimistic. Conclusions To date, very few prognostic models have been published on the infection of SLE patients. These models are very heterogeneous and are rated as having a high risk of bias and methodological weaknesses. Despite the widespread recognition of the frequency and severity of infections in SLE patients, there is no reliable predictive prognostic model that facilitates the study and implementation of personalized preventive or therapeutic measures. Protocol registration number: PROSPERO CRD42020171638.

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Vaccination of Patients with Systemic Lupus Erythematosus

Korean Journal of Medicine ◽

10.3904/kjm.2020.95.3.170 ◽

2020 ◽

Vol 95 (3) ◽

pp. 170-175

Author(s):

Chang-Nam Son ◽

Sang-Hyon Kim

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Hepatitis A ◽

Immunosuppressive Agents ◽

Risk Of Infection ◽

Systemic Lupus ◽

Increased Risk ◽

Inflammatory Autoimmune Disease ◽

Chronic Inflammatory Autoimmune Disease ◽

Lupus Disease Activity

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that affects various organs. SLE patients have an increased risk of infection compared to the general population. Immunosuppressive agents commonly used in SLE increase the risk of infection. Vaccination is a good way to reduce the risk of infection. However, some SLE patients are concerned that vaccination may worsen lupus disease activity or cause side effects. The latest SLE patient vaccination data were reviewed in this study, which focused on the safety, immunogenicity, and efficacy of influenza, pneumococcal, tetanus, hepatitis A, herpes zoster, and human papillomavirus vaccines. Korean immunization recommendations were also compared to those of other countries.

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Case Series of Chronic Inflammatory Rheumatic Disease Patients Infected by Coronavirus Disease 2019 (COVID-19)

Case Reports in Rheumatology ◽

10.1155/2020/8860492 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Wendlassida Joëlle Stéphanie Tiendrébéogo ◽

Fulgence Kaboré ◽

Eric Arnaud Diendéré ◽

Dieu-Donné Ouedraogo

Keyword(s):

Rheumatoid Arthritis ◽

Systemic Lupus Erythematosus ◽

Case Report ◽

Lupus Erythematosus ◽

Case Series ◽

Inflammatory Rheumatic Diseases ◽

Risk Of Infection ◽

Systemic Lupus ◽

Immune Disease ◽

Chronic Inflammatory Rheumatic Diseases

Coronavirus disease 2019 (COVID-19) is a viral infection that appeared in December 2019. The risk of infection seems to be increased in chronic inflammatory rheumatic diseases due to both immune disturbances related to the disease and treatment. In this case report, we describe the clinical features of 5 rheumatic immune disease patients with the concomitant presence of COVID-19. Among these patients, 3 had rheumatoid arthritis and 2 had systemic lupus erythematosus. Patients’ age ranged between 38 and 63 years. Only one patient (SLE) had a severe subtype of COVID-19. All the patients were cured of COVID-19 and were subsequently discharged.

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Organized Intraglomerular Deposits in NZB Mouse Disease

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100066772 ◽

1971 ◽

Vol 29 ◽

pp. 544-545

Author(s):

Francis R. Comerford ◽

Alan S. Cohen

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Antinuclear Antibodies ◽

Human Systemic Lupus Erythematosus ◽

Systemic Lupus ◽

Glomerular Lesion ◽

Ultrastructural Studies ◽

Dense Deposits ◽

Experimental Nephritis ◽

Glomerular Lesions

Mice of the inbred NZB strain develop a spontaneous disease characterized by autoimmune hemolytic anemia, positive lupus erythematosus cell tests and antinuclear antibodies and nephritis. This disease is analogous to human systemic lupus erythematosus. In ultrastructural studies of the glomerular lesion in NZB mice, intraglomerular dense deposits in mesangial, subepithelial and subendothelial locations were described. In common with the findings in many examples of human and experimental nephritis, including many cases of human lupus nephritis, these deposits were amorphous or slightly granular in appearance with no definable substructure.We have recently observed structured deposits in the glomeruli of NZB mice. They were uncommon and were found in older animals with severe glomerular lesions by morphologic criteria. They were seen most commonly as extracellular elements in subendothelial and mesangial regions. The deposits ranged up to 3 microns in greatest dimension and were often adjacent to deposits of lipid-like round particles of 30 to 250 millimicrons in diameter and with amorphous dense deposits.

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