Anti-dsDNA titre in female systemic lupus erythematosus patients: relation to disease manifestations, damage and antiphospholipid antibodies

Lupus ◽  
2018 ◽  
Vol 27 (7) ◽  
pp. 1081-1087 ◽  
Author(s):  
T A Gheita ◽  
N M Abaza ◽  
N Hammam ◽  
A A A Mohamed ◽  
I I El-Gazzar ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Damage Index ◽  
Disease Activity Index ◽  
Protective Role ◽  
Systemic Lupus ◽  
American College Of Rheumatology ◽  
Neuropsychiatric Manifestations ◽  
Musculoskeletal Manifestations

Background Attempts are ongoing to unveil unresolved queries about anti-double-stranded deoxyribonucleic acid (anti-dsDNA), their precise pathogenic effects and to what extent blocking them would be a useful therapeutic goal. Objectives The aim of the present study was to determine the anti-dsDNA antibodies titre in systemic lupus erythematosus (SLE) patients and investigate their relation to the disease characteristics, activity, damage and antiphospholipid autoantibodies (aPL). Methods Seventy female SLE patients and 35 age- and sex-matched controls were included. The anti-dsDNA level and aPL were measured. Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) were assessed. Results The mean age of the patients was 27.5 ± 5.1 years, disease duration 7.7 ± 5.4 years, and SLEDAI and SLICC/ACR-DI scores were 6.8 ± 8.04 and 1.2 ± 1.3, respectively. Anti-dsDNA was positive in 61.4% of the patients and the titre (133.2 ± 100.5 IU/ml) was significantly higher compared to controls (22.03 ± 17.2 IU/ml) ( p < 0.0001). The anti-dsDNA level was significantly increased in those with musculoskeletal manifestations ( p = 0.007) and positive anti-β2 glycoprotein (anti-β2GP) ( p = 0.037) and decreased in those with neuropsychiatric manifestations ( p = 0.004) and those receiving cyclophosphamide (CYC) ( p = 0.013). The anti-dsDNA level tended to be higher in active patients. The anti-dsDNA titre significantly correlated with the erythrocyte sedimentation rate ( p = 0.001), anticardiolipin IgG and IgA antibodies ( p = 0.008) and anti-β2GP IgG ( p = 0.03) and IgA ( p = 0.002) and inversely with the total leucocytic count ( p < 0.0001) and SLICC/ACR-DI ( p = 0.001). Conclusion Anti-dsDNA is remarkably increased in SLE patients especially those with musculoskeletal manifestations and aPL. A protective role seems likely in those with neuropsychiatric manifestations and those receiving CYC and may form a shield against disease tissue damage.

scholarly journals Bacteremia in Systemic Lupus Erythematosus in Patients from a Spanish Registry: Risk Factors, Clinical and Microbiological Characteristics, and Outcomes

2019 ◽  
Vol 47 (2) ◽  
pp. 234-240 ◽  
Author(s):  
Iñigo Rúa-Figueroa ◽  
Francisco J. López-Longo ◽  
Víctor Del Campo ◽  
María Galindo-Izquierdo ◽  
Esther Uriarte ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Damage Index ◽  
Disease Activity Index ◽  
Systemic Lupus ◽  
American College Of Rheumatology ◽  
Microbiological Characteristics ◽  
Elevated Creatinine

Objective.To describe the incidence of bacteremia in a large multicentric cohort of patients with systemic lupus erythematosus (SLE) and their clinical characteristics and to identify risk factors.Methods.All bacteremic episodes from the Spanish RELESSER registry were included. Clinical and laboratory characteristics concerning bacteremia and SLE status, as well as comorbidities at the time of infection, were retrospectively collected. A comparison with sex- and age-matched SLE controls without bacteremia was made. A logistic regression was conducted.Results.The study included 114 episodes of bacteremia in 83 patients. The incidence rate was 2.7/1000 patient-years. At the time of bacteremia, the median age was 40.5 (range: 8–90) years, and 88.6% of patients were female. The Safety of Estrogens in Lupus Erythematosus National Assessment–Systemic Lupus Erythematosus Disease Activity Index was 4 [interquartile range (IQR) 8]; 41% had an SLE flare (66% severe); Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was 3 (IQR 4). A comorbidity was recorded in 64% of cases. At the time of bacteremia, 88.6% received corticosteroids (68.6% > 10 mg/day) and 57% immunosuppressors. Gram-negative bacilli, most frequently Escherichia coli (29.8%), caused 52.6% of the episodes. The bacteremia-related mortality was 14% and bacteremia was recurrent in 27.2% of cases. A dose-response relationship was found between corticosteroids and bacteremia risk. In the multivariate analysis, these factors were associated with bacteremia: elevated creatinine (OR 1.31, 95% CI 1.01–1.70; p = 0.045), diabetes (OR 6.01, 95% CI 2.26–15.95; p < 0.001), cancer (OR 5.32, 95% CI 2.23–12.70; p < 0.001), immunosuppressors (OR 6.35, 95% CI 3.42–11.77; p < 0.001), and damage (OR 1.65, 95% CI 1.31–2.09; p < 0.001).Conclusion.Bacteremia occurred mostly in patients with active SLE and was frequently associated with severe flares and corticosteroid use. Recurrence and mortality were high. Immunosuppressors, comorbidities, and disease-related damage were associated with bacteremia.

scholarly journals Fatores Determinantes de Morbilidade nos Doentes com Lúpus Eritematoso Sistémico

2017 ◽  
Vol 30 (5) ◽  
pp. 368
Author(s):  
Margarida Jacinto ◽  
Eliana Silva ◽  
Nuno Riso ◽  
Maria Francisca Moraes-Fontes
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Damage Index ◽  
Disease Activity Index ◽  
Systemic Lupus Erythematosus Disease ◽  
Systemic Lupus ◽  
American College Of Rheumatology

Introduction: Severity in systemic lupus erythematosus may vary from mild to even fatal consequences. There are no biomarkers to predict the disease’s prognosis. The Systemic Lupus International Collaborating Clinics/ Systemic Damage Index defines systemic lupus erythematosus disease severity and is found to predict prognosis.Objective: To test damage determinants in a single-centre systemic lupus erythematosus cohort.Material and Methods: Retrospectively followed systemic lupus erythematosus female patients (defined by the identification of at least four systemic lupus erythematosus American College of Rheumatology criteria – fulfillment 100%, n = 76) over the past five years. Age of onset, ethnicity, disease duration, number of American College of Rheumatology criteria at the end of follow-up, cumulative: renal, neuropsychiatric and articular phenotypes, hypertension, dyslipidaemia, smoking and Systemic Lupus Erythematosus Disease Activity Index 2K were correlated to the presence and degree of irreversible damage (Systemic Lupus International Collaborating Clinics Damage Index). Accumulation of American College of Rheumatology criteria was measured in a sub-group of patients followed from disease onset (within a year of the first symptom ascribed to systemic lupus erythematosus) (n = 39 – 51%); Systemic Lupus Erythematosus Disease Activity Index and Systemic Lupus International Collaborating Clinics Damage Index were performed. Statistical analysis was performed using Chi-square, Wilcoxon Mann-Whitney tests and Spearman correlation rho (Sig. 2-tailed p < 0.05).Results: Systemic Lupus International Collaborating Clinics/Systemic Damage Index > 0 was present in 56.6% and significantly associated to a longer duration, a higher number of American College of Rheumatology criteria and a neuropsychiatric phenotype when compared with those with no damage. The final number of American College of Rheumatology criteria accrued was positively correlated to a higher disease activity over the past five years of follow-up (Spearman´s rho 0.02 and p < 0.05). There was no effect from other features.Discussion and Conclusion: Disease duration and number of American College of Rheumatology criteria predict Systemic Lupus International Collaborating Clinics/ Systemic Damage Index. neuropsychiatric disease has an impact on damage accrual.

Clinical and Serologic Factors Associated with Lupus Pleuritis

2010 ◽  
Vol 37 (4) ◽  
pp. 747-753 ◽  
Author(s):  
SHIKHA MITTOO ◽  
ALLAN C. GELBER ◽  
CAROL A. HITCHON ◽  
EARL D. SILVERMAN ◽  
JANET E. POPE ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Disease Duration ◽  
Activity Index ◽  
Disease Onset ◽  
Damage Index ◽  
Disease Activity Index ◽  
Nuclear Antigen ◽  
Systemic Lupus ◽  
Factors Associated ◽  
American College Of Rheumatology

Objective.Pleuritis is a common manifestation and independent predictor of mortality in systemic lupus erythematosus (SLE). We examined the prevalence of pleuritis and factors associated with pleuritis in a multicenter Canadian SLE cohort.Methods.We studied consecutive adults satisfying the American College of Rheumatology (ACR) classification criteria for SLE who had a completed Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) score, at least 1 evaluable extractable nuclear antigen assay, and either a SLE Disease Activity Index (SLEDAI) or a SLE Activity Measure score. Pleuritis was defined as having pleuritis by satisfying the ACR criteria or the SLEDAI. Factors related to pleuritis were examined using univariate and multivariate logistic regression.Results.In our cohort of 876 patients, 91% were women, 65% Caucasian, mean age (± SD) was 46.8 ± 13.5 years, and disease duration at study entry was 12.1 ± 9.9 years; the prevalence of pleuritis was 34% (n = 296). Notably, greater disease duration (p = 0.002), higher SDI score (p ≤ 0.0001), age at SLE diagnosis (p = 0.009), and anti-Sm (p = 0.002) and anti-RNP (p = 0.002) seropositivity were significantly associated with pleuritis. In multivariate analysis with adjustment for disease duration, age at diagnosis, and SDI score, concomitant seropositivity for RNP and Sm were related to a nearly 2-fold greater prevalence of pleuritis (OR 1.98, 95% CI 1.31–2.82).Conclusion.Pleuritis occurred in one-third of this Canadian cohort. Concomitant Sm and RNP seropositivity, greater cumulative damage, longer disease duration, and younger age at SLE disease onset were related to a higher rate of SLE pleural disease.

scholarly journals Measuring Disease Activity and Damage with Validated Metrics: A Systematic Review on Mortality and Damage in Systemic Lupus Erythematosus

2018 ◽  
Vol 45 (10) ◽  
pp. 1448-1461 ◽  
Author(s):  
Stephanie O. Keeling ◽  
Ben Vandermeer ◽  
Jorge Medina ◽  
Trish Chatterley ◽  
Tatiana Nevskaya ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Damage Index ◽  
Disease Activity Index ◽  
Evaluation Methodology ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Damage Accrual

Objective.To identify the effect of disease activity and damage, measured by validated indices, on mortality and damage accrual, in order to inform upcoming Canadian systemic lupus erythematosus (SLE) recommendations.Methods.Following GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to fill in evidence-to-decision tables to create recommendations for “minimal investigations needed to monitor SLE patients at baseline and subsequent visits,” a systematic literature review was performed. The effect of disease activity and damage, measured by validated metrics, on mortality and damage was systematically reviewed, with metaanalyses performed when available.Results.A title/abstract screen of 5599 articles identified 816 articles for full paper review, with 102 meeting inclusion criteria and 53 with extractable data. Thirty-three articles describing outcomes related to disease activity and 20 articles related to damage were identified. Mortality was associated with higher SLE Disease Activity Index-2000 scores in 6 studies (HR 1.14, 95% CI 1.06–1.22) and higher Systemic Lupus International Collaborating Clinics/ACR Damage Index scores in 6 studies (HR 1.53, 95% CI 1.28–1.83). Higher SLE Activity Measure scores were associated with increased risk of damage in 3 studies (OR 1.06, 95% CI 1.04–1.08). British Isles Lupus Assessment Group was associated with mortality in 1 study with HR of 1.15.Conclusion.Active SLE disease and damage are associated with and predict greater mortality and damage. The use of validated disease activity and damage metrics is important in the assessment of disease activity and damage and will inform upcoming Canadian recommendations for the assessment of SLE.

scholarly journals Intestinal Microbiota and Active Systemic Lupus Erythematosus: protocol for a systematic review

2021 ◽  
Author(s):  
Juliana Rosa Pires Vieira ◽  
Andréa Toledo de Oliveira Rezende ◽  
Marcos Rassi Fernandes ◽  
Nilzio Antônio Silva
Keyword(s):  
Systematic Review ◽  
Systemic Lupus Erythematosus ◽  
Intestinal Microbiota ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Disease Activity Index ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Assessment Development ◽  
American College Of Rheumatology

Abstract BackgroundSystemic Lupus Erythematosus (SLE) is an autoimmune disease, characterized by being multi-systemic and, therefore, reaching various organs and affecting mainly young women. Its pathogenesis comprehends many factors, including the interaction between microbiota and immune system. The aim of this systematic review protocol is to assess the relationship between intestinal microbiota and SLE in activity, highlighting microbiota representative patterns regarding quantity and diversity. MethodsThe systematic review will be carried out using the following databases: Medline via PubMed, Scopus, and EMBASE. Inclusion criteria will be: observational studies (cross-sectional, cohort, and case-control) that analyzed intestinal microbiota composition in patients with SLE, with no restriction of age or sex, which fulfilled the classification criteria of either Systemic Lupus International Collaborating Clinic (SLICC), European League Against Rheumatism (EULAR) or American College of Rheumatology (ACR) and used the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) to classify disease in activity or remission. The Downs & Black Scale will be applied to analyze the risk of bias during study selection and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) will be used to assess the quality of the evidence of the selected studies.DiscussionThis review will identify investigation gaps, for better understanding of aspects related to etiopathogenesis and to the inflammatory process during SLE progression. Systematic review registration PROSPERO registration: CRD42021229322

scholarly journals Hippocampal Atrophy in Systemic Lupus Erythematosus Patients without Major Neuropsychiatric Manifestations

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Shuang Liu ◽  
Yuqi Cheng ◽  
Yueyin Zhao ◽  
Aiyun Lai ◽  
Zhaoping Lv ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Structural Changes ◽  
Activity Index ◽  
Disease Activity Index ◽  
Hippocampal Damage ◽  
Hippocampal Atrophy ◽  
Systemic Lupus ◽  
Neuropsychiatric Manifestations

This study was conducted to explore hippocampal structural changes and their possible associations with clinical characteristics, emotional status, and treatment regimens in patients with systemic lupus erythematosus (SLE) without major neuropsychiatric manifestations (non-NPSLE). Eighty-five non-NPSLE patients with normal conventional magnetic resonance imaging (MRI) and seventy-seven matched healthy control (HC) subjects were recruited. All participants underwent the standard high-resolution volumetric MRI. The bilateral hippocampal volume (HIPV) and hippocampal density (HIPD) were calculated, respectively, for each participant. We found that the bilateral HIPV and HIPD of the SLE patient group were significantly less than those of the HC group. The bilateral HIPV of female patients were significantly less than those of male patients. The SLE disease activity index (SLEDAI) was negatively correlated with the bilateral HIPV and the right HIPD. Urine protein quantity was negatively correlated with the bilateral HIPV and HIPD. Hydroxychloroquine (HCQ) showed a protective effect on right HIPV. In conclusion, we found that the early hippocampal atrophy could occur before obvious neuropsychiatric manifestations and might be associated with SLE disease activity and organ damages. Early detection and intervention of hippocampal damage might prevent the progression to NPSLE. More studies are needed to fully understand the underlying mechanisms of hippocampal atrophy in SLE.

FRI0184 ATTRIBUTION OF NEUROPSYCHIATRIC MANIFESTATIONS TO SYSTEMIC LUPUS ERYTHEMATOSUS IN POLISH COHORT OF PATIENTS WITH THE USE OF THE ITALIAN MODEL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 675.1-676
Author(s):  
K. Pawlak-Bus ◽  
W. Schmidt ◽  
P. Leszczynski
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Disease Onset ◽  
Damage Index ◽  
Physician Global Assessment ◽  
Systemic Lupus ◽  
American College Of Rheumatology ◽  
Italian Model

Background:Distinguishing primary NPSLE (neuropsychiatric systemic lupus erythematosus) from secondary causes remains challenging (1). Attribution models were developed in order to aim clinicians in correct classification of NPSLE cases (2).Objectives:To investigate the prevalence of primary NPSLE manifestations assigned with Italian model of attribution (2).Methods:We retrospectively assessed clinical details of 164 patients with SLE classified with 2012 SLICC (Systemic Lupus International Collaborating Clinics) classification criteria, 21 were excluded due to incomplete information. Data was gathered with a questionnaire comprising demographics, medical history, laboratory results (concentrations of antibodies against double stranded DNA – anti-dsDNA, complement components C3 and C4), disease activity measured with Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and Physician Global Assessment (PGA) and damage determined with SLICC/ACR (American College of Rheumatology) Damage Index (SDI). Neuropsychiatric manifestations were categorized in accordance with 1999 ACR glossary and attribution of manifestations was performed with the use of Italian model with the score ≥7 out of 10 points enabling assignment to primary NPSLE group (2). Statistical analysis was conducted with Statistica v.13.3 using Mann-Whitney U, chi-square and Fisher exact test.Results:We encountered 155 NP manifestations in our cohort and 52 (34%) were attributed to SLE. Characteristics of the study groups are presented in Table 1. Exact manifestations and their attribution rates are presented on Graph 1. Patients with attributable NPSLE were younger, had earlier disease onset, presented higher disease activity, lower damage accrual without taking NP damage into account and more often had increased anti-dsDNA serum concentration.Table 1.Demographic and laboratory characteristics with disease activity and damage of the study groups, N(%) or mean(±SD).CharacteristicPatients with attributed NPSLE manifestationsPatients without attributed NPSLE manifestationsPatients34 (23.8%)109 (76.2%)Sex, female30 (88.2%)102 (93.6%)Age (years)37.6 (±11.7)44.3 (±13.9)*Age of disease onset (years)32.5 (±11.4)37.6 (±12.6)*Disease duration (years)5.1 (±4.1)6.8 (±5.6)SLEDAI-2K29.2 (±10.7)12.2 (±8.1)*patients with clinically active disease (defined as SLEDAI-2K≥6 in clinical manifestations)34 (100%)93 (85.3%)*SLEDAI-2K without NP manifestations14.8 (±8.4)11.0 (±6.7)*PGA2.1 (±1.0)1.2 (±1.0)*SDI0.5 (±0.8)0.7 (±1.1)SDI without NP damage0.3 (±0.6)0.7 (±1.1)*low C3/C4 complement component concentration in serum21 (61.8%)55 (50.4%)elevated anti-dsDNA autoantibody concentration in serum27 (79.4%)55 (50.4%)*NPSLE – neuropsychiatric systemic lupus erythematosus, SLEDAI-2K – Systemic Lupus Erythematosus Disease Activity Index version 2000, PGA – physician global assessment, SDI – SLICC/ACR (Systemic Lupus International Collaborating Clinics/American College of Rheumatology) Damage Index*p<0,05, Mann-Whitney U, χ2or Fisher’s exact test, as appropriateConclusion:Primary NP manifestations in patients with SLE occur mainly in young patients with high disease activity. Cerebrovascular disease, seizures, psychosis and cranial neuropathy are most frequent primary NPSLE manifestations.References:[1]The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999;42(4):599–608.[2]Bortoluzzi A, Scirè CA, Bombardieri S, Caniatti L, Conti F, De Vita S, et al. Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus. Rheumatol Oxf Engl. 2015;54(5):891–8.Disclosure of Interests:None declared

Abnormality in hippocampal signal intensity predicts atrophy in patients with systemic lupus erythematosus

Lupus ◽  
2016 ◽  
Vol 26 (6) ◽  
pp. 633-639 ◽  
Author(s):  
A T Lapa ◽  
T Pedro ◽  
J Francischinelli ◽  
A C Coan ◽  
L T Lavras Costallat ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Damage Index ◽  
Disease Activity Index ◽  
Hippocampal Volume ◽  
The Body ◽  
Volume Loss ◽  
Systemic Lupus

Objectives To quantify signal abnormalities in the hippocampus (Hsig) of patients with systemic lupus erythematosus (SLE) and to determine if Hsig predict hippocampal atrophy (HA) in SLE. Methods We included all SLE patients and healthy age- and sex-matched individuals with two magnetic resonance imaging (MRI) scans performed with a minimum of 1 year interval. All individuals underwent a standardized neuropsychological evaluation. Individual results were converted into standard scores and compared to normative data. SLE patients were additionally assessed for disease activity (SLE Disease Activity Index (SLEDAI)), damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)), and the presence of antiphospholipid antibodies. MRI was performed on an Elscint 2 T scanner and T1 inversion recovery and T2 coronal images were used for analysis. Volumetric (HV) and signal quantification (Hsig) were determined by standardized protocols. Results We included 54 SLE patients (48 women; mean age 32.2 ± 10.56 years). Hsig were found at study entry in 15 (45.5%) patients. Hsig in the body and tail of non-atrophic hippocampi correlated with progression of volume loss during the follow-up period ( r = 0.8, p < 0.001). The presence of Hsig in the head of atrophic hippocampi correlated with progression of HA ( r = 0.73, p = 0.005) during the same period. No correlation of Hsig and disease activity or prednisone dose was observed. Conclusion HA is frequently observed in SLE patients and volume loss is progressive in a subgroup of patients. The evaluation of Hsig is an easy tool to determine patients that may have progressive hippocampal volume loss and should be followed more closely with MRI and cognitive evaluation.

scholarly journals Systemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies

2018 ◽  
Vol 40 (10) ◽  
pp. 587-592 ◽  
Author(s):  
Estephania Naseri ◽  
Fernanda Surita ◽  
Anderson Borovac-Pinheiro ◽  
Marília Santos ◽  
Simone Appenzeller ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Perinatal Death ◽  
Activity Index ◽  
Disease Activity Index ◽  
Fetal Outcome ◽  
Study Data ◽  
Systemic Lupus ◽  
American College Of Rheumatology

Objective To evaluate the effects of pregnancy in systemic lupus erythematosus (SLE) patients. Methods The present article is a retrospective cohort study. Data were collected from medical records of pregnant women with SLE from January 2002 to December 2012 at Universidade Estadual de Campinas, in the city of Campinas, state of São Paulo, Brazil. Systemic lupus erythematosus and disease activity were defined according to the American College of Rheumatology and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) criteria respectively. The means, standard deviations (SDs), percentages and correlations were performed using the SAS software, version 9.4 (SAS Institute Inc., Cary, NC, US). Results We obtained data from 69 pregnancies in 58 women. During pregnancy, a new flare was observed in 39.2% (n = 27). The manifestations were most common in patients with prior kidney disease, and mainly occurred during the third quarter and the puerperium. Renal activity occurred in 24.6% (n = 17), and serious activity, in 16% (n = 11). Of all deliveries, 75% (n = 48) were by cesarean section. Two maternal deaths occurred (3%). Preterm birth was the main complication in the newborns. The abortion rate was 8.7%. Severe SLEDAI during pregnancy was associated with prematurity (100%) and perinatal death (54%). Conclusion The maternal-fetal outcome is worse in SLE when the women experience a flare during pregnancy. The best maternal-fetal outcomes occur when the disease is in remission for at least 6 months before the pregnancy.

scholarly journals Intestinal microbiota and active systemic lupus erythematosus: a systematic review

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Juliana Rosa Pires Vieira ◽  
Andréa Toledo de Oliveira Rezende ◽  
Marcos Rassi Fernandes ◽  
Nilzio Antonio da Silva
Keyword(s):  
Systematic Review ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Intestinal Microbiota ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Disease Activity Index ◽  
Systemic Lupus ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism

Abstract Background Systemic Lupus Erythematosus (SLE) is an autoimmune disease, characterized by being multi-systemic and, therefore, reaching various organs and affecting mainly young women. Its pathogenesis comprehends many factors, including the interaction between microbiota and immune system. This systematic review assessed the relationship between intestinal microbiota and SLE in activity, highlighting microbiota representative patterns regarding quantity and diversity. Methods This study considered researches carried out in patients with SLE, with no restriction of age or gender, which fulfilled the classification criteria of either Systemic Lupus International Collaborating Clinic (SLICC), American College of Rheumatology (ACR) or European League Against Rheumatism (EULAR) and used the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) to classify disease in activity or remission were included. The search was carried out from October, 2020 to January, 2021 using the following databases: Medline via Pubmed, Scopus, and Embase. Five papers were included with a total of 288 participants with SLE. Results Regarding microbiota in patients with SLE in activity, there was significant increase in the following genera: Lactobacillus, Streptococcus, Megasphaera, Fusobacterium, Veillonella, Oribacterium, Odoribacter, Blautia, and Campylobacter. On the other hand, decrease in Faecalibacterium and Roseburia genera as well as Ruminococcus gnavus species was observed in remission cases, showing differences between the microbiota profile in SLE in activity and in remission. Conclusions Results suggest that dysbiosis may be involved in the disease activity process. Trial registration CRD42021229322.

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