scholarly journals Azathioprine Treatment in Systemic Lupus Erythematosus: A Double Edged Sword

2020 ◽  
Vol 14 (2) ◽  
Author(s):  
Jia XIA ◽  
Xiao SU ◽  
Wei-wei CHEN ◽  
Li-qun HE
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Oral Ulceration ◽  
Erythrocyte Sedimentation ◽  
Azathioprine Treatment ◽  
Severe Pancytopenia ◽  
Low Dosage

Extremely severe pancytopenia induced by low dosage of azathioprine in systemic lupus erythematosus patients is rare. A 40-year-old Chinese female was diagnosed with systemic lupus erythematosus. She suffered worse erythema, oral ulceration, raised erythrocyte sedimentation rate and high anti-dsDNA in August 2013. Then she was initiated on oral azathioprine 50mg/d and extremely severe pancytopenia was seen in September 2013. She was recovered by a series of treatments. Regular monitoring of blood counts is highly recommended to reduce the possible serious myelosuppression induced by azathioprine.

scholarly journals The ratio of erythrocyte sedimentation rate to C-reactive protein is useful in distinguishing infection from flare in systemic lupus erythematosus patients presenting with fever

Lupus ◽  
2018 ◽  
Vol 27 (7) ◽  
pp. 1123-1129 ◽  
Author(s):  
E Littlejohn ◽  
W Marder ◽  
E Lewis ◽  
S Francis ◽  
J Jackish ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Lupus Erythematosus ◽  
Laboratory Data ◽  
Diagnostic Value ◽  
C Reactive Protein ◽  
Systemic Lupus ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation

Background Both C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can be elevated in systemic lupus erythematosus (SLE) flare and infection, and are therefore of limited utility for distinguishing between the two conditions in febrile SLE patients. Methods A medical records review of hospitalizations (1997–2006) of SLE patients in the Michigan Lupus Cohort was performed. Eligible hospitalizations were those in which patients presented with a temperature of >100.3°F or with subjective fevers as a presenting complaint at admission. Detailed demographic, clinical, and laboratory data were collected. Multivariable logistic regression was used to examine the associations between ESR and CRP and the outcome of flare vs infection, adjusted for confounders. Results Among 557 SLE patients screened, there were 53 eligible hospitalizations (28 flares and 25 infections). Each unit increase in the ratio of ESR:CRP was associated with a 17% increase in the odds of fever being attributable to SLE flare compared to infection (OR 1.17, 95% CI 1.04, 1.31; p = 0.009), when adjusted for white blood cell count, SLE duration, sex, race, and age. ESR and CRP were not individually associated with flare vs infection when modeled with their ratio. Conclusions The ratio of ESR:CRP may provide diagnostic value beyond individual ESR and CRP levels in distinguishing flare vs infection in SLE patients presenting with fever.

scholarly journals The significance of M1/M2 macrophage-like monocytes in children with systemic lupus erythematosus

2019 ◽  
Vol 17 ◽  
pp. 205873921882446
Author(s):  
Xiao-Ling Niu ◽  
Dan Feng ◽  
Sheng Hao ◽  
Xin-Yu Kuang ◽  
Ying Wu ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Sedimentation Rate ◽  
Lupus Erythematosus ◽  
Peripheral Blood ◽  
Absolute Number ◽  
M2 Macrophage ◽  
Systemic Lupus ◽  
Erythrocyte Sedimentation ◽  
M1 Macrophage ◽  
The Absolute

Monocytes/macrophages are important in the development of systemic lupus erythematosus. To research M1 and M2 macrophage-like monocytes in the peripheral blood of children with systemic lupus erythematosus and explore the clinical significance, M1 and M2 macrophage-like monocytes, tumor necrosis factor-α, interleukin-1, interleukin-6, interleukin-10, and interleukin-18 are tested in the peripheral blood of children with systemic lupus erythematosus by flow cytometry. A correlation analysis is made between M1 and M2 macrophage-like monocytes and erythrocyte sedimentation rate and C-reactive protein. As we found, the absolute number and percentage of M1 macrophage-like monocytes (CD163–CD14+) in macrophage-like monocytes (CD14+) in peripheral blood of the severe systemic lupus erythematosus group were higher than those of the control group and the mild–moderate systemic lupus erythematosus group ( F = 28.4, 21.7, 122, 81.7; P < 0.05). But there was no obvious difference between these three groups in terms of the absolute number of M2 macrophage-like monocytes (CD163+CD14+). The absolute number and percentage of M1 macrophage-like monocytes in macrophage-like monocytes had positive correlation with C-reactive protein and erythrocyte sedimentation rate ( r  = 0.46, 0.44, 0.367, 0.47; P < 0.05); whereas, the absolute number and percentage of M2 macrophage-like monocytes in macrophage-like monocytes had negative correlation with CRP and erythrocyte sedimentation rate ( r = –0.47, –0.45, –0.47, –0.32; P < 0.05). Thus, M1 macrophage-like monocytes have effective impact on inflammation in children with systemic lupus erythematosus. M2 macrophage-like monocytes, to a large extent, have the opposite functions compared to M1 macrophage-like monocytes. In children with systemic lupus erythematosus, macrophages play important role in the development of systemic lupus erythematosus and M1 macrophage-like monocytes have functions in active systemic lupus erythematosus and they can induce the inflammation and have correlation with severity of systemic lupus erythematosus.

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