scholarly journals P171 Factors determining sleep quality in SLE

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Rosalie Magro ◽  
Liberato Camilleri ◽  
Andrew A Borg
Keyword(s):  
Sleep Quality ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Functional Disability ◽  
Activity Index ◽  
Depression Scale ◽  
Disease Activity Index ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Cross Sectional

Abstract Background Poor sleep quality is common in systemic lupus erythematosus (SLE) and could contribute to fatigue, which is regarded as one of the most disabling symptoms in SLE. The Pittsburgh sleep quality index (PSQI) is a validated self-administered questionnaire that measures sleep quality over the previous month. The aim of this study was to analyse the relationship of sleep quality, measured by PSQI, with several variables including depression, anxiety, pain, disease activity, fatigue and functional disability in patients with SLE. A further aim was to establish the prevalence of poor sleep quality in SLE. Methods A cohort cross-sectional study was carried out including 92 SLE patients who fulfilled the SLICC classification criteria for SLE and who provided informed consent for participation. The patients were interviewed, and they were asked to fill in questionnaires including PSQI, Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS) for pain and modified Health Assessment Questionnaire (mHAQ). Blood and urine tests enabled the calculation of SLE disease activity index-2K (SLEDAI-2K). The study was approved by the University Research Ethics Committee. Results 92.4% of the cohort studied were females, and the mean age was 46.9 years (range 19-79 years). 55.4% were noted to have poor quality sleep (PSQI >5), and the median PSQI was 6 (range 0-18). Sleep quality measured by PSQI, had a significant correlation with SLEDAI-2K (R = 0.254, p = 0.014), VAS pain (R = 0.515, p < 0.001), HADS-D (R = 0.605, p < 0.001), HADS-A (R = 0.375, p < 0.001), estimated glomerular filtration rate (eGFR) (R=-0.211, p = 0.044), FSS (R = 0.551, p < 0.001) and mHAQ (R = 0.559, p < 0.001). ANCOVA analysis showed that PSQI was significantly dependant on VAS pain (p < 0.001), HADS-D (p < 0.001) and eGFR (p = 0.003). Conclusion Poor sleep quality is highly prevalent in SLE patients. This study has shown that the strongest predictive factors for poor sleep quality are pain, depression and impaired renal function. Since poor sleep quality is significantly related to fatigue and functional disability, its identification and management is important for patients’ wellbeing. Disclosures R. Magro None. L. Camilleri None. A.A. Borg None.

scholarly journals Characterisation of Patients with Systemic Lupus Erythematosus in Malta: A Population Based Cohort Cross-Sectional Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Rosalie Magro ◽  
Andrew A. Borg
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Significant Positive Correlation ◽  
Functional Disability ◽  
Unmet Needs ◽  
Depression Scale ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Positive Correlation

Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disorder. The aim of this study was to characterise the SLE patients living in Malta in order to estimate the prevalence and incidence of SLE and characterise the clinical presentation as well as identify any unmet needs. 107 SLE patients who fulfilled SLICC classification criteria were identified. These were invited to participate in the study by means of an interview, blood and urine tests, and filling of the following questionnaires: Fatigue Severity Scale (FSS), visual analogue scale (VAS) for fatigue, Hospital Anxiety and Depression Scale (HADS), VAS for pain, Pittsburgh Sleep Quality Index (PSQI), and modified Health Assessment Questionnaire (mHAQ). The estimated prevalence of SLE in Malta is 29.3 patients per 100,000 and the estimated incidence is 1.48 per 100,000 per year. 93.5% of SLE patients were female, and the mean age at diagnosis was 33.1 years. 60.8% were overweight or obese and body mass index (BMI) had a significant positive correlation with daily dose of prednisolone (R=0.177, p=0.046). 20.7% and 3.3% had a moderate and high disease activity, respectively, as measured by SLEDAI-2K. Disease activity had a significant positive correlation with functional disability measured by mHAQ (R=0.417, p<0.001). 56.5% had an abnormal level of fatigue (FSS >3.7) and 57.6% had a high level of anxiety (HADS ≥8). This study has identified a number of unmet needs of SLE patients, including obesity, uncontrolled disease activity, fatigue, and anxiety.

The Association Between Disease Activity and Duration in Systemic Sclerosis

2010 ◽  
Vol 37 (11) ◽  
pp. 2299-2306 ◽  
Author(s):  
JENNIFER G. WALKER ◽  
RUSSELL J. STEELE ◽  
MIREILLE SCHNITZER ◽  
SUZANNE TAILLEFER ◽  
MURRAY BARON ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Disease Activity ◽  
Disease Duration ◽  
Activity Index ◽  
Disease Onset ◽  
Depression Scale ◽  
Disease Activity Index ◽  
Cross Sectional ◽  
Diffuse Disease ◽  
Patient Reported

Objective.The absence of a standardized disease activity index has been an important barrier in systemic sclerosis (SSc) research. We applied the newly derived Valentini Scleroderma Disease Activity Index (SDAI) among our cohort of patients with SSc to document changes in disease activity over time and to assess possible differences in activity between limited and diffuse disease.Methods.Cross-sectional study of a national cohort of patients enrolled in the Canadian Scleroderma Research Group Registry. Disease activity was measured using the SDAI. Depression scores were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D).Results.A total of 326 out of 639 patients had complete datasets at the time of this analysis; 87% were female, of mean age 55.6 years, with mean disease duration 14.1 years. SDAI declined steeply in the first 5 years after disease onset and patients with diffuse disease had 42% higher SDAI scores than patients with limited disease with the same disease duration and depression scores (standardized relative risk 1.42, 95% CI 1.21, 1.65). Patients with higher CES-D scores had higher SDAI scores relative to patients with the same disease duration and disease subset (standardized RR 1.22, 95% CI 1.14, 1.31). Among the 10 components that make up the SDAI, only skin score (standardized OR 0.59, 95% CI 0.43, 0.82) and patient-reported change in skin (standardized OR 0.64, 95% CI 0.45, 0.92) decreased with increasing disease duration. High skin scores (standardized OR 32.2, 95% CI 15.8, 72.0) were more likely and scleredema (standardized OR 0.58, 95% CI 0.37, 0.92) was less likely to be present in patients with diffuse disease. High depression scores were associated with positive responses for patient-reported changes in skin and cardiopulmonary function.Conclusion.Disease activity declined with time and patients with diffuse disease had consistently higher SDAI scores. Depression was found to be associated with higher patient activity scores and strongly associated with patient self-response questions. The role of depression should be carefully considered in future applications of the SDAI, particularly as several components of the score rely upon patient recall.

scholarly journals Mean Platelet Volume (MPV) as an indicator of  disease activity and severity in lupus

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 126 ◽  
Author(s):  
Abidullah Khan ◽  
Iqbal Haider ◽  
Maimoona Ayub ◽  
Salman Khan
Keyword(s):  
Disease Activity ◽  
Lupus Erythematosus ◽  
Mean Platelet Volume ◽  
Activity Index ◽  
Disease Activity Index ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Strong Positive Correlation ◽  
Platelet Volume ◽  
Cross Sectional

Background: Amongst the different clinical and laboratory parameters used to monitor disease activity in systemic lupus erythematosus (SLE), mean platelet volume (MPV) is a novel biomarker. Although MPV has been studied in other rheumatological conditions like rheumatoid arthritis, its role in adult SLE needs to be defined, especially in Pakistan. Methods: The aim of this study was to evaluate the role of MPV as a biomarker of disease activity in SLE. Fifty patients were recruited through a consecutive non-probability sampling technique for this cross-sectional study.  On the basis of their SLE disease activity index (SLEDAI) score of greater or lesser than 5, these 50 participants were divided into two equal groups respectively;25 patients with active SLE, and another 25 participants with stable, inactive lupus. MPV was measured in each group and compared using SPSS version 16. MPV was also correlated with SLEDAI and erythrocyte sedimentation rate (ESR). Independent sample t-test and Spearman’s rho and Pearson’s correlation tests were applied. Sensitivity and specificity of MPV were checked through ROC analysis.    Results: The MPV of patients with active SLE (n=25, mean [M]=7.12, SD=1.01) was numerically lower than those in the inactive-SLE group (n=25, M= 10.12, SD=0.97), and this was statistically significant ( P<0.001). MPV had an inverse relationship with both ESR (r=-0.93, P<0.001) and SLEDAI (rs= -0.89, P<0.001). However, there was a strong positive correlation between ESR and SLEDAI (rs=0.90, P<0.001). For MPV, a cutoff value of less than 8.5fl had a sensitivity of 92% and a specificity of 100% ( P< 0.001).  Conclusions: Higher disease activity in SLE is associated with a correspondingly low MPV.

scholarly journals Mean Platelet Volume (MPV) as an indicator of  disease activity and severity in lupus

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 126 ◽  
Author(s):  
Abidullah Khan ◽  
Iqbal Haider ◽  
Maimoona Ayub ◽  
Salman Khan
Keyword(s):  
Disease Activity ◽  
Lupus Erythematosus ◽  
Mean Platelet Volume ◽  
Activity Index ◽  
Disease Activity Index ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Strong Positive Correlation ◽  
Platelet Volume ◽  
Cross Sectional

Background: Amongst the different clinical and laboratory parameters used to monitor disease activity in systemic lupus erythematosus (SLE), mean platelet volume (MPV) is a novel biomarker. Although MPV has been studied in other rheumatological conditions like rheumatoid arthritis, its role in adult SLE needs to be defined, especially in Pakistan. Methods: The aim of this study was to evaluate the role of MPV as a biomarker of disease activity in SLE. Fifty patients were recruited through a consecutive non-probability sampling technique for this cross-sectional study.  On the basis of their SLE disease activity index (SLEDAI) score of greater or lesser than 5, these 50 participants were divided into two equal groups respectively;25 patients with active SLE, and another 25 participants with stable, inactive lupus. MPV was measured in each group and compared using SPSS version 16. MPV was also correlated with SLEDAI and erythrocyte sedimentation rate (ESR). Independent sample t-test and Pearson’s correlation tests were applied. Sensitivity and specificity of MPV were checked through ROC analysis.   Results: The MPV of patients with active SLE (n=25, mean [M]=7.12, SD=1.01) was numerically lower than those in the inactive-SLE group (n=25, M= 10.12, SD=0.97), and this was statistically significant (P<0.001). MPV had an inverse relationship with both ESR (r=-0.93, P<0.001) and SLEDAI (r= -0.94, P<0.001). However, there was a strong positive correlation between ESR and SLEDAI (r=0.95, P<0.001). For MPV, a cutoff value of less than 8.5fl had a sensitivity of 92% and a specificity of 100% (P< 0.001). Conclusions: Higher disease activity in SLE is associated with a correspondingly low MPV.

scholarly journals Assessment of Mean Platelet Volume in Patients with Systemic Lupus Erythematosus

2018 ◽  
Vol 12 (1) ◽  
pp. 129-138 ◽  
Author(s):  
Lisandra Torres Hartmann ◽  
Ana Paula Alegretti ◽  
Alice Beatriz Mombach Pinheiro Machado ◽  
Eduardo Ferreira Martins ◽  
Rafael Mendonça da Silva Chakr ◽  
...  
Keyword(s):  
Disease Activity ◽  
Lupus Erythematosus ◽  
Mean Platelet Volume ◽  
Activity Index ◽  
Disease Activity Index ◽  
Inactive Disease ◽  
Control Group ◽  
Platelet Volume ◽  
Complement Components ◽  
Cross Sectional

Introduction: The Mean Platelet Volume (MPV) is a platelet activation biomarker that has been recently correlated with disease activity in SLE. We aimed to evaluate the MPV in patients with SLE comparing it with healthy individuals, to study the correlation between MPV and SLE Disease Activity Index (SLEDAI) in SLE patients and to analyze possible correlation between MPV and Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), and complement components C3 and C4. Methods: This is a cross-sectional study in which 81 patients with SLE according to the American College of Rheumatology (ACR) diagnostic classification criteria and 58 healthy controls were included. Active disease was defined as SLEDAI>0. Results: Patients with active SLE had decreased MPV when compared to inactive disease group (10.0±0.7fL vs. 10.7±1.0fL, p=0.005, respectively) and when compared to control group (10.9±1.0fL, p<0.001). Our study found a weak negative correlation between the SLEDAI and the MPV (r=-0.29, p=0.009). There was no correlation between MPV and CRP, ESR, C3 and C4. Also, no correlation between SLEDAI and CRP, ESR, C3 and C4 was found. Conclusion: MPV decreases in patients with active SLE and is inversely correlated with SLEDAI.

Antineutrophil Cytoplasmic Antibody in Lupus Nephritis: Correlation with Clinicopathological Characteristics and Disease Activity

2020 ◽  
Vol 16 ◽  
Author(s):  
Dina Said ◽  
Nearmeen Mohammed Rashad ◽  
Nora Said Abdelrahmanc ◽  
Ghada Aboelsaud Dawaa
Keyword(s):  
Lupus Nephritis ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Rapidly Progressive Glomerulonephritis ◽  
Disease Activity Index ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Class Iv

Background:: Lupus nephritis (LN) represents 40%–50% of all systemic lupus erythematosus (SLE) patients, and rapidly progressive glomerulonephritis is associated with significant morbidity and mortality. Antineutrophil cytoplasmic antibody (ANCA) might be involved in the pathogenesis of LN. Objective:: We evaluated the role of myeloperoxidase (MPO)-ANCA, proteinase 3 (PR3)-ANCA, and anti-glomerular basement membrane autoantibodies (anti-GBM autoAb) for the diagnosis of LN. Methods:: In this cross-sectional study, 95 SLE patients were divided into 2 subgroups: LN group (n = 60) and non-LN group (n = 35). For further analysis, we subclassified the LN group into ANCA-positive (n = 16) and ANCA-negative (n = 44) LN patients. The entire Non-LN group was ANCA-negative. The SLE disease activity index (SLEDAI) was reported for each patient. Determination of MPO-ANCA, PR3-ANCA, and anti-GBM autoAb was performed using a novel multiplex bead-based technology in all patients. Data analyses were done using SPSS, version 20. Approval was obtained from the institutional review board of Zagazig University (ZU-IRB#6000). Results:: Of 95 patients with SLE, 16 patients (16.84%) had ANCA-positive LN, all of which were MPO-ANCA. There was a positive correlation between MPO-ANCA and SLEDAI, as well as with class IV LN. Receiver operating characteristic analyses revealed that the sensitivity and specificity of MPO-ANCA were 81.3% and 99.8%, respectively, in discriminating LN from systemic lupus without nephritis. Conclusion:: MPO-ANCA level was significantly correlated with SLEDAI, inflammatory markers, kidney function tests, and LN class IV.

scholarly journals Depression Symptoms and Sleep Quality during COVID-19 Outbreak in Iran: A National Cross-Sectional Study

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Samaneh Torkian ◽  
Elham Akhlaghi ◽  
Vahid Khosravi ◽  
Reza Etesami ◽  
Ali Ahmadi ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Economic Status ◽  
Depression Scale ◽  
World Health ◽  
Depression Symptoms ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Cross Sectional ◽  
History Of ◽  
History Of Depression

Background: Coronavirus 2019 is a new infectious disease that has been declared by the World Health Organization as a global pandemic. This pandemic may have psychological effects on populations. Objectives: This study aimed to investigate the quality of sleep and depression in the Iranian community during COVID-19 pandemic. Methods: This nationwide cross-sectional web-based study was conducted from April 19 to May 12, 2020 in Iran. The data collection tools were the Pittsburgh Sleep Quality Index and Depression Center for Epidemiologic Studies’ Depression Scale questionnaires. Each province in Iran was assumed as a cluster, and generalized estimating equations models were used to determine the demographic variables that were related to depression symptoms and sleep quality during COVID-19 outbreak Results: In this study, 73.5% and 41.4% of the participants had poor sleep quality and had depression symptoms, respectively. Perceived income, hours spent outdoors, the number of people with COVID-19 that were acquainted with, and a history of depression significantly were related to sleep quality. Also, gender, age, having a child, education level, economic status, and a history of depression were significantly associated with having depression symptoms. Conclusions: Most participants had poor sleep quality, and less than half had depression symptoms during the COVID-19 pandemic. These problems can disturb daily routines, cut social ties, and increase worries and fears of the future. Interventions are necessary to reduce psychological problems for Iran.

Photoprotection awareness and practices among patients with systemic lupus erythematosus and its association with disease activity and severity

Lupus ◽  
2018 ◽  
Vol 27 (8) ◽  
pp. 1287-1295 ◽  
Author(s):  
W D Abdul Kadir ◽  
A Jamil ◽  
S Sazliyana Shaharir ◽  
N Md Nor ◽  
A H Abdul Gafor
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Damage Index ◽  
Disease Activity Index ◽  
Sun Exposure ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Sun Avoidance

Objective The objective of this paper is to determine photoprotection awareness, knowledge, practices, and its relationship with disease activity and damage in patients with systemic lupus erythematosus (SLE). Methods A cross-sectional study was performed. Data were acquired from in-person interviews and medical records. Results A total of 199 (89.6%) females and 23 (10.4%) males were recruited. Median age was 39.00 (interquartile range (IQR) 18) years, disease duration 12.12 (IQR 8) years, Fitzpatrick skin phototype III 119 (53.6%) and IV 81 (36.5%). Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K) was 2.95 (IQR 4) while Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC-ACR DI) was 1.20 (IQR 2). The majority 205 (92.3%) were aware of sun exposure effects on SLE. Photoprotection methods were shade seeking 209 (94.1%), sun avoidance 212 (95.5%), long pants 168 (75.7%), long sleeves 155 (69.8%), sunscreen 116 (52.3%), sunglasses 114 (51.4%) and head cover 103 (46.4%). Significantly higher photoprotection practice scores (PPS) were observed in females, Malays, and individuals with higher education level and internet accessibility. PPS were not significantly correlated with SLICC-ACR DI and SLEDAI-2 K. Independent predictors for good photoprotection practice (GPP) were ethnicity (OR = 3.66, 95% CI 1.78–7.53), awareness (OR = 3.77, 95% CI 1.09–13.08) and cutaneous involvement (OR = 2.43, 95% CI 1.11–5.28). Photoprotection methods and GPP were not predictors for disease activity or damage. Conclusion Photoprotection awareness and knowledge was good. Shade seeking and sun avoidance were the common photoprotection methods practised. The use of sunscreen requires improvement. Photoprotection awareness and cutaneous manifestation were predictors for GPP. Neither photoprotection methods nor GPP were associated with disease activity or damage.

scholarly journals FRI0178 PREDICTIVE FACTORS FOR POOR SLEEP QUALITY IN SYSTEMIC LUPUS ERYTHEMATOSUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 673.2-673
Author(s):  
R. Magro ◽  
L. Camilleri ◽  
A. Borg
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Sleep Quality ◽  
Predictive Factors ◽  
Lupus Erythematosus ◽  
Quality Index ◽  
Functional Disability ◽  
Pittsburgh Sleep Quality Index ◽  
Poor Sleep ◽  
Systemic Lupus ◽  
Poor Sleep Quality

Background:Poor sleep quality is common in systemic lupus erythematosus (SLE) and could contribute to fatigue, which is regarded as one of the most disabling symptoms in SLE. The Pittsburgh sleep quality index (PSQI) is a validated self-administered questionnaire that measures sleep quality over the previous month.1Objectives:The aim of this study was to analyse the relationship of sleep quality with several variables including depression, anxiety, pain, disease activity, fatigue and functional disability in patients with SLE. A further aim was to establish the prevalence of poor sleep quality in SLE.Methods:A cohort cross-sectional study was carried out including 92 SLE patients who fulfilled the SLICC classification criteria for SLE and who provided informed consent for participation. The patients were interviewed and they were asked to fill in questionnaires including PSQI, Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS) for pain and modified Health Assessment Questionnaire (mHAQ). Blood and urine tests enabled the calculation of SLE disease activity index-2K (SLEDAI-2K). The study was approved by the University Research Ethics Committee.Results:92.4% of the cohort studied were females, and the mean age was 46.9 years (range 19-79 years). 55.4% were noted to have poor quality sleep (PSQI >5), and the median PSQI was 6 (range 0-18). Sleep quality measured by PSQI, had a significant correlation with SLEDAI-2K (R=0.254, p=0.014), VAS pain (R=0.515, p<0.001), HADS-D (R=0.605, p<0.001), HADS-A (R=0.375, p<0.001), estimated glomerular filtration rate (eGFR) (R=-0.211, p=0.044), FSS (R=0.551, p<0.001) and mHAQ (R=0.559, p<0.001). ANCOVA analysis showed that PSQI was significantly dependant on VAS pain (p<0.001), HADS-D (p<0.001) and eGFR (p=0.003).Conclusion:Poor sleep quality is highly prevalent in SLE patients. This study has shown that the strongest predictive factors for poor sleep quality are pain, depression and impaired renal function. Since poor sleep quality is significantly related to fatigue and functional disability, its identification and management is important for patients’ wellbeing.References:[1]Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28: 193 – 213.Disclosure of Interests:None declared

scholarly journals Lupus nephritis is linked to disease-activity associated expansions and immunity to a gut commensal

2019 ◽  
Vol 78 (7) ◽  
pp. 947-956 ◽  
Author(s):  
Doua Azzouz ◽  
Aidana Omarbekova ◽  
Adriana Heguy ◽  
Dominik Schwudke ◽  
Nicolas Gisch ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Disease Activity Index ◽  
Structural Features ◽  
Class Iii ◽  
Discovery Cohort ◽  
Cross Sectional ◽  
Faecal Samples

Background/PurposeTo search for a transmissible agent involved in lupus pathogenesis, we investigated the faecal microbiota of patients with systemic lupus erythematosus (SLE) for candidate pathobiont(s) and evaluated them for special relationships with host immunity.MethodsIn a cross-sectional discovery cohort, matched blood and faecal samples from 61 female patients with SLE were obtained. Faecal 16 S rRNA analyses were performed, and sera profiled for antibacterial and autoantibody responses, with findings validated in two independent lupus cohorts.ResultsCompared with controls, the microbiome in patients with SLE showed decreased species richness diversity, with reductions in taxonomic complexity most pronounced in those with high SLE disease activity index (SLEDAI). Notably, patients with SLE had an overall 5-fold greater representation of Ruminococcus gnavus (RG) of the Lachnospiraceae family, and individual communities also displayed reciprocal contractions of a species with putative protective properties. Gut RG abundance correlated with serum antibodies to only 1/8 RG strains tested. Anti-RG antibodies correlated directly with SLEDAI score and antinative DNA levels, but inversely with C3 and C4. These antibodies were primarily against antigen(s) in an RG strain-restricted pool of cell wall lipoglycans. Novel structural features of these purified lipoglycans were characterised by mass spectrometry and NMR. Highest levels of serum anti-RG strain-restricted antibodies were detected in those with active nephritis (including Class III and IV) in the discovery cohort, with findings validated in two independent cohorts.ConclusionThese findings suggest a novel paradigm in which specific strains of a gut commensal may contribute to the immune pathogenesis of lupus nephritis.

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