Role of Nail Fold Capillaroscopy as A Method of Early Detection of Atherosclerosis in Systemic Lupus Erythematosus Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hanan Mohamed Farouk ◽  
Rasha Mahmoud Mohamed ◽  
Fatma Mohammad Aboud ◽  
Huda Taha Hussein
Keyword(s):  
Cardiovascular Disease ◽  
Lupus Erythematosus ◽  
Screening Tool ◽  
Intima Media Thickness ◽  
Systemic Lupus Erythematosis ◽  
University Hospitals ◽  
Systemic Lupus ◽  
Highly Sensitive ◽  
Carotid Doppler

Abstract Background The development of atherosclerosis and cardiovascular disease as a consequence Systemic Lupus Erythematosis is a common and dangerous complication in patients with SLE. However, since the prevalence of atherosclerosis and cardiovascular disease is variable and increasing by time, universal screening would imply a large number of unnecessary carotid Doppler. Objective To study the early prediction of atherosclerosis and the cardiovascular risk in SLE patients by Nail fold capillaroscopy and the Intima media thickness of the Carotid artery. Patients and Methods All Patients were subjected to full history taking, full clinical examination, laboratory investigations, carotid Doppler and nail fold capillaroscopy. In this study, we prospectively collected data on 30 consecutive patients referred to Ain Shams University hospitals and The National Research Institute. Results However, nail fold changes was significantly higher in patients with IM thickness changes indicative of atherosclerosis with SLE: it was proved to be highly sensitive and adequately specific in predicting the atherosclerosis in those patients. Conclusion IM thickness and nail fold capillaroscopy could be used as a guiding noninvasive screening tool in patients with SLE to predict the atherosclerosis and CV risk. Nail fold changes is correlated to the atherosclerotic changes happening in SLE patients. These results may lead to a reduction in the number of SLE patients with undiagnosed atherosclerosis and CV risk. Nail fold capillarscopy may also help alleviate the financial and disinfection burdens of radiology units as well as the medical costs associated with atherosclerosis and CV risk. Nail fold capillaroscopy can be used as a screening tool before doing carotid Doppler.

scholarly journals AB0326 USEFULNESS OF THE INTIMA-MEDIA THICKNESS INDEX BY CAROTID DOPPLER IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS OF HOSPITAL DOCENTE PADRE BILLINI, DOMINICAN REPUBLIC

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1188.1-1188
Author(s):  
J. Santana Peralta ◽  
T. Polanco Mora ◽  
A. Cornelio ◽  
Y. Cruz ◽  
E. Rodriguez Bautista ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Lupus Erythematosus ◽  
Intima Media Thickness ◽  
Healthy Controls ◽  
Inclusion Criteria ◽  
Systemic Lupus ◽  
Low Activity ◽  
Carotid Doppler

Background:Systemic lupus erythematosus (SLE) is a multisistemic autoimmune disease. 1There are studies where the increase in the thickness of the intimate/media average in carotid (IMT) is valued, most have shown increase2. Cardiovascular disease is one of the leading causes of morbidity, especially due to its precocity, which occurs in women during the fertile potential, is associated with a higher prevalence of cardiovascular disease (CVD), due to accelerated atherosclerosis3,4,5. Patients with rheumatic diseases have an increased cardiovascular risk due to systemic inflammation and endothelial dysfunction, which promotes accelerated atherosclerosis2. Values below 0.9mm of IMT are considered normal.Objectives:Evaluate the thickness of the intimate/media average in carotid in patients with systemic lupus erythematosus.Methods:Prospective, Observational, cross-sectional study. Carotid Doppler was performed on patients in the outpatient clinic with a diagnosis of SLE from November 2019 to 2020 of the rheumatology service of the Hospital Docente Padre Billini and healthy controls. Inclusion criteria: > 18 years old, SLE diagnosis with ACR 2007 classification criteria, carotid Doppler, measurement of IMT. Controls without disease, matched by sex and age. The data was analyzed with SPSS V23.Results:116 patients with SLE. 95 patients met inclusion criteria;95 healthy controls were included. 97.8% female. Average disease of 6.23 years. 71. 57% (68) use glucocorticoids, antimalarials 70.52% (67), 38.94% (37) mofetil mycophenolate, 20% (19) methotrexate, 11. 57% (11) rituximab, 5.26% (5) azathioprine, 1.05% (1) cyclosporine, 1.05% (1) cyclophosphamide and 0.86% (1) tacrolimus. Dyslipidemia (63.1%) (73), obesity 34.7% (33), high blood pressure 23.1% (22), diabetes 3.44% (4), smokers 0% (0). The carotid doppler with SLE showed 17.89% (17) atheromatous plates, 29.4% (5) calcified plates, Carotid Doppler in healthy controls showed 20% (19) atheromatous plates, 36.84% (7) calcified plates. The activity rate using SLEDAI showed 68.96% (80) without activity, 13.79% (16) low, 11.20% (13) moderate, 6.03% (7) high activity. 78% (75) patients with SLE had increased IMT mean (SD) 2.15mm (0.99). About control 71.57% (68) had an increase of IMT, mean (SD) 1.27mm (1.07) (p-0.046).Conclusion:Our study found that most patients with SLE had IMT increase. The activity ratio of SLE showed that the vast majority of our patients are in low activity. Alterations in IMT were associated with low SLEDAI and glucocorticoid use. There was no significant difference in the intima-media carotid thickness index with respect to the control group. We suggest the realization of Doppler in patients with SLE despite being in low activity for evaluation and monitoring of cardiovascular risk.References:[1]Hernández Muñiz, Y, Guibert Toledano, Z. and Reyes Llerena, G., 2015. Correlation of C Reactive Protein Figures and Atherosclerosis in Patients with Systemic Lupus Erythematosus.[2]Saldarriaga Rivera, L., Ventura Ríos, L., Hernández Díaz, C. and Pineda Villaseñor, C., 2016. Measurement of the thickness of the intimate-half carotid: utility and ultrasound diagnosis of subcline atherosclerosis in rheumatic diseases. Literature review. Rev Col Reum, 23(2), pp.92-101.[3]Telles, R., Lanna, C., Ferreira, G., Souza, A., Navarro, T. and Ribeiro, A., 2008. Carotid atherosclerotic alterations in systemic lupus erythematosus patients treated at a Brazilian university setting. Lupus, 17(2), pp.105-113.[4]Nienhuis, H., by Leeuw, K., Bijzet, J., van Doormaal, J., van Roon, A., Smit, A., Graaff, R., Kallenberg, C. and Bijl, M., 2010. Small artery elasticity is decreased in patients with systemic lupus erythematosus without increased intima media thickness. Arthritis Research & Therapy, 12(5), p.R181.[5]Frerix et al. Arthritis Research & Therapy 2014, 16: R54Disclosure of Interests:None declared

Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review

Lupus ◽  
2017 ◽  
Vol 26 (14) ◽  
pp. 1463-1472 ◽  
Author(s):  
S Fasano ◽  
D P Margiotta ◽  
L Navarini ◽  
L Pierro ◽  
I Pantano ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Cardiovascular Event ◽  
Lupus Erythematosus ◽  
Cardiovascular Events ◽  
Hazard Ratio ◽  
Systemic Lupus ◽  
Increased Risk

Background Systemic lupus erythematosus is associated with an increased risk of cardiovascular disease. Low-dose aspirin, hydroxychloroquine and statins have been suggested to play a prophylactic role of cardiovascular events. This study is devoted to reviewing the literature on the topic and assessing the effects of these drugs in preventing a first cardiovascular event in a two-centre Italian series. Methods A PubMed search on cardiovascular prevention in systemic lupus erythematosus was performed. Moreover, systemic lupus erythematosus patients admitted to two centres from 2000–2015, who at admission had not experienced any cardiovascular event, were investigated. Aspirin, hydroxychloroquine and statin use, and the occurrence of any cardiovascular event, were recorded at each visit. Kaplan-Meier and Cox regression analyses were performed to evaluate the role of traditional, disease-related cardiovascular risk factors and of each of the three drugs in the occurrence of new cardiovascular events. Results The literature search produced conflicting results. Two hundred and ninety-one systemic lupus erythematosus patients were included in the study and followed for a median of eight years. During follow-up, 16 cardiovascular events occurred. At multivariate analysis, taking aspirin (hazard ratio: 0.24) and hydroxychloroquine for more than five years (hazard ratio: 0.27) reduced, while antiphospholipid antibody positivity (hazard ratio: 4.32) increased, the risk of a first cardiovascular event. No effect of statins emerged. Conclusion Our study confirms an additive role of aspirin and hydroxychloroquine in the primary prophylaxis of cardiovascular events in Italian patients with systemic lupus erythematosus. The lack of any detected effect in previous reports may depend on the design of studies and their short follow-up period.

scholarly journals Young Investigator Award Lecture of the APS Water and Electrolyte Homeostasis Section, 2008: The pathophysiology of hypertension in systemic lupus erythematosus

2009 ◽  
Vol 296 (4) ◽  
pp. R1258-R1267 ◽  
Author(s):  
Michael J. Ryan
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Chronic Inflammation ◽  
Lupus Erythematosus ◽  
Renin Angiotensin System ◽  
Peroxisome Proliferator ◽  
Inflammatory Disorder ◽  
Systemic Lupus ◽  
Peroxisome Proliferator Activated Receptor

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disorder that predominantly affects women during their reproductive years. Although SLE can affect any organ system, the kidneys are prominently involved in the form of immune complex glomerulonephritis. In addition, in women with SLE, risk for the development of cardiovascular disease is dramatically increased. Hypertension is a major risk factor for cardiovascular disease and is highly prevalent in women with SLE. Nevertheless, there has been little exploration of the pathophysiological mechanisms that promote SLE hypertension. This review discusses the role of several mechanisms, with an emphasis on the kidney, in SLE hypertension. These mechanisms include the renin-angiotensin system, endothelin, oxidative stress, sex steroids, metabolic changes, peroxisome proliferator-activated receptor-γ, and, perhaps most importantly, chronic inflammation and cytokines. Growing evidence suggests a link between chronic inflammation and hypertension. Therefore, elucidation of mechanisms that promote SLE hypertension may be of significant value not only for patients with SLE, but also for a better understanding of the basis for essential hypertension.

scholarly journals Protective Effects of Probiotic Consumption in Cardiovascular Disease in Systemic Lupus Erythematosus

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2676 ◽  
Author(s):  
Néstor de la Visitación ◽  
Iñaki Robles-Vera ◽  
Marta Toral ◽  
Juan Duarte
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Gut Microbiota ◽  
Lupus Erythematosus ◽  
Therapeutic Option ◽  
Protective Effects ◽  
Systemic Lupus ◽  
Beneficial Effects ◽  
General Populations

The prevalence of renal and cardiovascular disease (CVD) in patients with systemic lupus erythematosus (SLE) is higher than in general populations. Recently, a causal role of gut microbiota on the development of immune responses in SLE has been described. Probiotic consumption changes the composition of gut microbiota, preventing SLE progression. The aim of this review is to explore the role of the gut microbiota in the development of renal and cardiovascular disease in SLE and how probiotics could be a therapeutic option. Despite strong evidence on the beneficial effects of probiotics in the development of autoimmunity and nephritis in SLE, only a few studies described the protective effects of Lactobacillus in important risk factors for CVD, such as endothelial dysfunction and hypertension in mice. The preventive effects of probiotics in renal and CVD in humans have not been established yet.

scholarly journals AB0325 FREQUENCY OF ATHEROMATOUS PLAQUES IN CAROTID ARTERIES BY DOPPLER IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS, SANTO DOMINGO, DOMINICAN REPUBLIC

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1187.2-1188
Author(s):  
J. Santana Peralta ◽  
T. Polanco Mora ◽  
A. Cornelio ◽  
Y. Cruz ◽  
E. Rodriguez Bautista ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Inclusion Criteria ◽  
Systemic Lupus ◽  
Atheromatous Plaques ◽  
Low Activity ◽  
Carotid Doppler

Background:Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease. 1 Atherosclerosis is considered an alteration of the arteries by the abnormal deposit of lipids and fibrous tissue. 2 Cardiovascular disease is one of the leading causes of morbidity and mortality, especially due to its precocity, which occurs in women during childbearing age, is associated with a higher prevalence of cardiovascular disease (CVD), due to accelerated atherosclerosis3,4,5. Patients with rheumatic diseases have an increased cardiovascular risk due to systemic inflammation and endothelial dysfunction, which promotes accelerated atherosclerosis2.Objectives:Evaluate the frequency of atheromatous plaques in patients with systemic lupus erythematosus.Methods:Observational, prospective, cross-sectional study. Carotid Doppler was performed on patients with SLE from the external consultation of the rheumatology service from November 2019 to 2020. Inclusion criteria: > 18 years old, diagnosis SLE with the classification criteria ACR 2007, realization of Doppler. Controls: no disease, equated by age and sex. The data was analyzed with SPSS V23.Results:116 patients met inclusion criteria, including 116 female controls. Mean sick time was 6.23 years. 14.65% (17) had atheromaus plates, 29.4% calcified plates (5). 34.7% Dyslipidemia (63.1%) (73), obesity 34.7% (33), high blood pressure 23.1% (22), diabetes 3.44% (4), smokers 0% (0). The activity rate using SLEDAI showed 68.96% (80) without activity, 13.79% (16) low, 11.20% (13) moderate, 6.03% (7) high activity. About control group (116), 19.82% (23) showed atheromatous plates, 39.13% (9) calcified plates.Conclusion:Our study shows that less than a quarter of patients have atheromatous plaques in the carotid Doppler. In relation to LES activity, the vast majority are in low activity. We suggest the realization of Carotid Doppler in patients with low activity SLE for evaluation and monitoring of cardiovascular risk. Our study showed that there is no increased risk of atheroma plaque formation in SLE patients, compared to the general population.References:[1]Hernández Muñiz, Y., Guibert Toledano, Z. and Reyes Llerena, G., 2015. Correlation of C Reactive Protein Figures and Atherosclerosis In Patients with Systemic Lupus Erythematosus.[2]Saldarriaga Rivera, L., Ventura Ríos, L., Hernández Díaz, C. and Pineda Villaseñor, C., 2016. Measurement of the thickness of the intimate-half carotid: utility and ultrasound diagnosis of subcline atherosclerosis in rheumatic diseases. Literature review. Rev Col Reum, 23(2), pp.92-101.[3]Telles, R., Lanna, C., Ferreira, G., Souza, A., Navarro, T. and Ribeiro, A., 2008. Carotid atherosclerotic alterations in systemic lupus erythematosus patients treated at a Brazilian university setting. Lupus, 17(2), pp.105-113.[4]Nienhuis, H., by Leeuw, K., Bijzet, J., van Doormaal, J., van Roon, A., Smit, A., Graaff, R., Kallenberg, C. and Bijl, M., 2010. Small artery elasticity is decreased in patients with systemic lupus erythematosus without increased intima media thickness. Arthritis Research & Therapy, 12(5), p.R181.[5]Frerix et al. Arthritis Research & Therapy 2014, 16: R54.[6]Marta, M., Joan T., Stefano B., Chapt 2 - Assessment of Disease Activity in Systemic Lupus Erythematosus, Systemic Lupus Erythematosus, Mosby, 2007.Disclosure of Interests:None declared

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