Bacteremia in female Chinese patients with systemic lupus erythematosus: a case-control study

Introduction: Bacteremia is a common complication in systemic lupus erythematosus (SLE) patients, causing high morbidity and mortality. We investigated characteristics, pathogens, and sites of infection using a cohort of 64 female adults from a single university hospital in China. Methodology: SLE patients who had at least one episode of bacteremia (n = 16) were compared with non-bacteremia SLE patients (n = 48) in a case-control fashion, matching for age at SLE diagnosis and time of admission. Demographic characteristics, clinical and laboratory data, and bacteriologic examinations were collected and reviewed. Results: A series of parameters were found to be significantly different between controls and cases at bacteremia diagnosis, including an SLE disease activity index, multiple major organ involvement (> 2), active renal disease, leukocytes, neutrophils, 24-hour urine protein, erythrocyte sedimentation rate (ESR), aspartate aminotransferase (AST), creatinine, hemoglobin, lymphocyte, platelets, and albumin. Eighteen episodes of bacteremia were analyzed, with Escherichia coli and Staphylococcus aureus being the most frequent isolates. Additionally, Listeria monocytogenes, Rhodotorula mucilaginosa, and Salmonella choleraesuis, which were very rare in the general population, were isolated from the bloodstreams of the cases. Apart from bacteremia without focus, respiratory tract, gastrointestinal tract, urinary tract, skin, and soft tissue were the major origins of infection. Conclusions: The present study depicts the nature of a cohort of female Chinese SLE patients with bacteremia, revealing that bacteremia is a critical factor contributing to the aggravation of SLE. Our findings provide useful information regarding the control and prevention of bacteremia in female SLE patients in China.

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Zoster after Cyclophosphamide for Systemic Lupus Erythematosus or Vasculitis: Incidence, Risk Factors, and Effect of Antiviral Prophylaxis

The Journal of Rheumatology ◽

10.3899/jrheum.180310 ◽

2018 ◽

Vol 45 (11) ◽

pp. 1541-1548 ◽

Cited By ~ 4

Author(s):

Camille Garnier ◽

David Ribes ◽

Dominique Chauveau ◽

Antoine Huart ◽

Grégory Pugnet ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Protective Effect ◽

Lupus Erythematosus ◽

Postherpetic Neuralgia ◽

Systemic Vasculitis ◽

Laboratory Data ◽

University Hospital ◽

Systemic Lupus ◽

Cox Models

Objective.To assess the incidence and the risk factors for zoster in patients exposed to intravenous cyclophosphamide (CYC) for systemic vasculitis or systemic lupus erythematosus (SLE), as well as the protective effect of prophylaxis by valacyclovir (VCV).Methods.This retrospective study included all adults treated by intravenous CYC for SLE or systemic vasculitis between 2011 and 2015 at Toulouse University Hospital, France. Zoster occurrence was recorded using medical chart review, laboratory data, and patient interviews. Univariate Cox models were computed to assess the risk factors for zoster and the protective effect of prophylaxis by VCV.Results.The cohort consisted of 110 patients (81 systemic vasculitis and 29 SLE). During a mean followup of 3.4 years after CYC initiation, 10 cases of zoster occurred, leading to an overall incidence of 27.9/1000 patient-years (95% CI 15.2–50.6); it was 59.4/1000 patients (95% CI 27.5–123.6) during the year after CYC initiation. Four patients experienced persistent postherpetic neuralgia. Probable risk factors were lymphopenia < 500/µl at CYC initiation (HR 5.11, 95% CI 0.94–27.93) and female sex (HR 4.36, 95% CI 0.51–37.31). The incidence was higher in patients with SLE (HR as compared with systemic vasculitis patients = 2.68, 95% CI 0.54–13.26). None of the 19 patients exposed to VCV during the followup developed zoster.Conclusion.The incidence of zoster is high in systemic vasculitis and in patients with SLE exposed to intravenous CYC. CYC may favor postherpetic neuralgia. Prophylaxis by VCV should be considered, particularly in cases of lymphopenia < 500/µl at CYC initiation and during the year after.

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Childhood-onset bullous systemic lupus erythematosus

Lupus ◽

10.1177/0961203314544187 ◽

2014 ◽

Vol 23 (13) ◽

pp. 1422-1425 ◽

Cited By ~ 16

Author(s):

D M R Lourenço ◽

R Cunha Gomes ◽

N E Aikawa ◽

L M A Campos ◽

R Romiti ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Activity Index ◽

Severe Disease ◽

Immunosuppressive Drugs ◽

University Hospital ◽

Direct Immunofluorescence ◽

Childhood Onset ◽

Systemic Lupus

Bullous systemic lupus erythematosus has rarely been described in pediatric lupus population and the real prevalence of childhood-onset bullous systemic lupus erythematosus has not been reported. From January 1983 to November 2013, 303 childhood-onset SLE (c-SLE) patients were followed at the Pediatric Rheumatology Unit of the Childreńs Institute of Hospital das Clínicas da Faculdade de Medicina Universidade da Universidade de São Paulo, three of them (1%) diagnosed as childhood-onset bullous systemic lupus erythematosus. All three cases presented tense vesiculobullous lesions unassociated with lupus erythematosus lesions, with the median duration of 60 days (30–60). All patients fulfilled bullous systemic lupus erythematosus criteria. Two had nephritis and serositis and presented specific autoantibodies. The histological pattern demonstrated subepidermal blisters with neutrophils-predominant infiltrates within the upper dermis. Direct immunofluorescence (DIF) showed deposits of IgG and complement along the epidermal basement membrane, in the presence or absence of IgA and/or IgM. A positive indirect immunofluorescence on salt-split skin demonstrating dermal binding was observed in two cases. All of them had moderate/severe disease activity at diagnosis with median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) of 18 (14–24). Two patients received dapsone and one with severe nephritis received immunosuppressive drugs. In conclusion, in the last 30 years the prevalence of bullous lupus in childhood-onset lupus population was low (1%) in our tertiary University Hospital. A diagnosis of SLE should always be considered in children with recurrent tense vesiculobullous lesions with or without systemic manifestations.

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CD40 and CD72 expression and prognostic values among children with systemic lupus erythematosus: a case–control study

Lupus ◽

10.1177/0961203320941931 ◽

2020 ◽

Vol 29 (10) ◽

pp. 1270-1276

Author(s):

Abtisam Asmiyou ◽

Ashraf M Bakr ◽

Doaa A Shahin ◽

Yahya Wahba

Keyword(s):

Systemic Lupus Erythematosus ◽

B Cells ◽

Lupus Erythematosus ◽

Case Control Study ◽

Activity Index ◽

Disease Activity Index ◽

Case Control ◽

Cell Mediated Immunity ◽

Systemic Lupus ◽

Control Study

Systemic lupus erythematosus (SLE) is a chronic disease with proven interactions between immune system components, including both humoral- and cell-mediated immunity, as well as co-stimulatory and inhibitory molecules such as CD40 and CD72. Here, we investigated CD40 and CD72 expression on B cells of SLE children and assessed their prognostic values. We conducted a preliminary case–control study in Mansoura University Children's Hospital, Egypt from September 2018 to January 2020 including 27 SLE children and 27 healthy controls. We assessed cases during initial flare and after remission. Flow cytometry analysis was carried out for all participants for CD40 and CD72 expression of B cells. During flare, SLE cases had statistically significant higher CD40 and lower CD72 expression in comparison with controls ( p < 0.001). After remission, the number of CD40+ B cells significantly decreased ( p < 0.001), while the number of CD72+ B cells significantly increased ( p < 0.001) in comparison with flare. We reported non-significant positive correlations between CD40 expression and SLE Disease Activity Index (SLEDAI; p = 0.347 during flare and p = 0.653 after remission) and negative correlations between CD72 expression and SLEDAI ( p = 0.34 during flare and p = 0.044 after remission). No significant differences were detected between renal histopathology classes with regard to CDs expression on B cells ( p = 0.45 for CD40 and p = 0.63 for CD72). In conclusion, CD40+ B cells and CD72+ B cells could be considered as markers of paediatric SLE flare and remission, respectively.

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Association of microRNA-34a rs2666433 (A/G) Variant with Systemic Lupus Erythematosus in Female Patients: A Case-Control Study

Journal of Clinical Medicine ◽

10.3390/jcm10215095 ◽

2021 ◽

Vol 10 (21) ◽

pp. 5095

Author(s):

Nesreen M. Ismail ◽

Eman A. Toraih ◽

Mai H. S. Mohammad ◽

Eida M. Alshammari ◽

Manal S. Fawzy

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Activity Index ◽

Laboratory Data ◽

Disease Activity Index ◽

Enrichment Analysis ◽

Systemic Lupus ◽

Allelic Discrimination ◽

Replication Studies

Several microRNAs (miRNAs) are associated with autoimmune disease susceptibility and phenotype, including systemic lupus erythematosus (SLE). We aimed to explore for the first time the role of the miRNA-34a gene (MIR34A) rs2666433A > G variant in SLE risk and severity. A total of 163 adult patients with SLE and matched controls were recruited. Real-Time allelic discrimination PCR was applied for genotyping. Correlation with disease activity and clinic-laboratory data was done. The rs2666433 variant conferred protection against SLE development under heterozygous [A/G vs. G/G; OR = 0.57, 95%CI = 0.34–0.95], homozygous [A/A vs. G/G; OR = 0.52, 95%CI = 0.29–0.94], dominant [A/G + A/A vs. GG; OR = 0.55, 95%CI = 0.35–0.88], and log-additive [OR = 0.71, 95%CI = 0.53–0.95] models. Data stratification by sex revealed a significant association with SLE development in female participants under heterozygous/homozygous models (p-interaction = 0.004). There was no clear demarcation between SLE patients carrying different genotypes regarding the disease activity index or patients stratified according to lupus nephritis. Enrichment analysis confirmed the implication of MIR34A in the SLE pathway by targeting several genes related to SLE etiopathology. In conclusion, although the MIR34A rs2666433 variant conferred protection against developing SLE disease in the study population, it showed no association with disease activity. Replication studies in other populations are warranted.

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Increased Proportion of CD226+ B Cells Is Associated With the Disease Activity and Prognosis of Systemic Lupus Erythematosus

Frontiers in Immunology ◽

10.3389/fimmu.2021.713225 ◽

2021 ◽

Vol 12 ◽

Author(s):

Miki Nakano ◽

Masahiro Ayano ◽

Kazuo Kushimoto ◽

Shotaro Kawano ◽

Kazuhiko Higashioka ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

B Cells ◽

Disease Activity ◽

Lupus Erythematosus ◽

Activity Index ◽

Renal Involvement ◽

Laboratory Data ◽

Clinical Manifestations ◽

Systemic Lupus ◽

Dsdna Antibody

BackgroundCD226, an activating receptor expressed on the surface of natural killer (NK) cells and T cells, is also seen on B cells and CD226 polymorphism is associated with systemic lupus erythematosus (SLE). Because the specific roles of CD226+ B cells in SLE are still unknown, we investigated the association of CD226+ B cells with SLE.MethodsWe measured CD226 expression on B cells and its subsets using flow cytometry in 48 SLE patients and 24 healthy controls (HCs). We assessed the relationships between CD226+ B cells and SLE Disease Activity Index 2000 (SLEDAI-2K), clinical manifestations, laboratory data, and prognosis after 12 months.ResultsThe proportions of CD226+ cells in whole B cells and all its subsets were significantly higher in SLE patients than HCs. In SLE patients, the proportions of CD226+ B cells and CD226+ switched-memory (SM) B cells were significantly correlated with SLEDAI-2K scores and anti-dsDNA antibody titers, and negatively correlated with serum complement levels. Moreover, basal percentages of CD226+ B cells and CD226+ SM B cells were low in patients who were in Lupus Low Disease Activity State after 12 months. In patients with renal involvement, the proportion of CD226+ B cells increased. Additionally, the proportion of CD226+ B cells was higher in patients who were not in complete renal remission after 12 months.ConclusionsIncreased proportion of CD226+ B cells was associated with disease activity and prognosis of SLE. CD226+ B cells may be a useful biomarker for the management of SLE.

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Anti-recoverin antibodies indicate fundus abnormalities in systemic lupus erythematosus

Lupus ◽

10.1177/0961203320940780 ◽

2020 ◽

Vol 29 (11) ◽

pp. 1346-1352

Author(s):

Min Li ◽

Gong Cheng ◽

Zongyi Wang ◽

Wen Liu ◽

Yuebo Jin ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Activity Index ◽

Laboratory Data ◽

Complement C3 ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Systemic Lupus ◽

Sledai Score ◽

Dsdna Antibody

Objectives Lupus fundus abnormalities are a sight-threatening complication of systemic lupus erythematosus (SLE) and its pathogenesis remains to be studied. The aim of this study was to assess the clinical characteristics associated with the presence of anti-recoverin antibodies in patients with SLE, especially those with fundus abnormalities. Methods Seventy-six participants were enrolled, including 21 patients with fundus abnormalities (fundus group), 30 patients without fundus abnormalities (non-fundus group) and 25 healthy individuals. Serum anti-recoverin antibody levels were measured using enzyme-linked immunosorbent assay, and clinical and laboratory data were obtained from medical records. Results Compared with the non-fundus group, the fundus group had a higher incidence of hematuria ( p < 0.05). The Systemic Erythematosus Disease Activity Index (SLEDAI) score in the fundus group was significantly higher than the non-fundus group (21.48 ± 8.06 versus 10.80 ± 5.74, p < 0.001). The levels of serum anti-recoverin antibodies in the fundus group were significantly higher than the non-fundus group ( p = 0.029) or the healthy control group ( p = 0.011). Anti-recoverin-negative and -positive patients differed on a number of clinical parameters, including incidence of fever, rash, antinuclear antibody, anti-dsDNA antibody, erythrocyte sedimentation rate, immunoglobulin G, complement C3 and complement C4. The average SLEDAI score of anti-recoverin-positive patients was significantly higher than anti-recoverin-negative patients (17.73 ± 8.11 versus 12.56 ± 8.37, p < 0.05). Conclusions Anti-recoverin antibodies were related to higher disease activities in SLE, especially those with fundus abnormalities, suggesting that anti-recoverin antibodies may play an important role in the pathogenesis of fundus abnormalities in SLE.

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Management of non-renal non-neurologic persistent lupus activity in real world patients from Argentina

Lupus ◽

10.1177/0961203319861687 ◽

2019 ◽

Vol 28 (9) ◽

pp. 1167-1173

Author(s):

M Scolnik ◽

V Scaglioni ◽

G J Pons-Estel ◽

E R Soriano

Keyword(s):

Systemic Lupus Erythematosus ◽

Confidence Interval ◽

Lupus Erythematosus ◽

Activity Index ◽

Disease Activity Index ◽

Interquartile Range ◽

University Hospital ◽

Systemic Lupus ◽

Biologic Treatment ◽

Disease Heterogeneity

Management of systemic lupus erythematosus patients is challenging because of disease heterogeneity. Although treatment of renal nephritis is more standardized, treating non-renal lupus activity remains controversial. Our objective was to identify non-renal, non-neurologic persistent active systemic lupus erythematosus patients in our cohort and described therapeutic behaviors in them. All systemic lupus erythematosus patients (American College of Rheumatology and/or Systemic Lupus Erythematosus International Collaborating Clinics criteria) seen at a university hospital between 2000 and 2017 were included and electronic medical records manually reviewed. Persistent lupus activity was defined as a patient with a Systemic Lupus Erythematosus Disease Activity Index score ≥ 6 (without renal and central nervous system manifestations) despite being on a stable treatment regimen for ≥ 30 days. Stable treatment could include prednisone alone (7.5–40 mg/d) or combined with antimalarial drugs and immunosuppressant therapies. A total of 257 lupus patients were included, 230 females (89.5%, 95% confidence interval 85.1–92.7), mean age at diagnosis 29.9 years (SD 16.4). After a median cohort follow-up of 5.7 years (interquartile range 2.4–10.2), 14 patients (5.4%, 95% confidence interval 3.2–9.0) showed persistent non-renal non neurologic lupus activity, with a median disease duration of 11.3 years (interquartile range 3.6–19.4). At that time, 12/14 (85.7 %, 95% confidence interval 52.6–97.0%) had low complement and 11/14 (78.6 %, 95% confidence interval 46.5–93.9%) had positive antiDNA antibodies. The main reasons for being refractory were mucocutaneous disease (50%, 95% confidence interval 23.5–76.5) and arthritis (42.9%, 95% confidence interval 18.5–71.2). Therapeutic choices after being refractory were: only increasing corticosteroid dose in one patient, starting rituximab in four, belimumab in eight, and in one mycophenolate and rituximab; with good response in all of them. In conclusion, 5.4% of systemic lupus erythematosus patients in our cohort were considered to have non-renal non neurologic persistent lupus activity, with mucocutaneous and arthritis the main manifestations. In total, 92.8% of these patients started a biologic treatment at this point (rituximab or belimumab).

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Combining maintenance therapy with hydroxychloroquine increases LLDAS achievement rates in individuals with stable systemic lupus erythematosus

Lupus ◽

10.1177/09612033211014272 ◽

2021 ◽

pp. 096120332110142

Author(s):

Mai Yoshida ◽

Kentaro Minowa ◽

Hirofumi Amano ◽

Yuki Asai ◽

Ken Yamaji ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Maintenance Therapy ◽

Disease Activity ◽

Lupus Erythematosus ◽

Maintenance Dose ◽

Activity Index ◽

Disease Activity Index ◽

University Hospital ◽

Systemic Lupus ◽

Antibody Titers

Background Hydroxychloroquine (HCQ) has been positioned as an anchor drug for systemic lupus erythematosus (SLE). There is evidence supporting the benefits of HCQ; however, the effect of additional HCQ in maintenance therapy remains unclear. Methods Thirty patients with SLE who visited Juntendo University Hospital were receiving maintenance therapy before HCQ treatment and were able to complete more than 104 weeks of HCQ treatment were analyzed. Anti-DNA antibody titers, IgG and CH50 levels, the maintenance dose of corticosteroids, the SLE disease activity index (SLEDAI), and the achievement of the Lupus Low Disease Activity State (LLDAS) were evaluated at baseline and at 12, 24, 52, and 104 weeks after HCQ initiation. Results We observed improvements in the anti-DNA antibody titers, IgG and CH50 levels, maintenance dose of corticosteroids, and SLEDAI at week 104 relative to baseline. Moreover, the LLDAS achievement rate increased over time from 10% at baseline to 43% and 80% at week 52 and week 104, respectively. Conclusion Two years of continuous HCQ treatment led to improvements in SLE disease activity and corticosteroid dose and an increase in LLDAS achievement, thereby demonstrating the significance of the maintenance dose of HCQ for the management of SLE.

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The Plasma Interleukin (IL)-35 Level and Frequency of Circulating IL-35+ Regulatory B Cells are Decreased in a Cohort of Chinese Patients with New-onset Systemic Lupus Erythematosus

Scientific Reports ◽

10.1038/s41598-019-49748-z ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Zhuang Ye ◽

Yanfang Jiang ◽

Dejun Sun ◽

Wei Zhong ◽

Ling Zhao ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

B Cells ◽

Lupus Erythematosus ◽

Activity Index ◽

Chinese Patients ◽

Regulatory B Cells ◽

Systemic Lupus ◽

Total Blood ◽

Tnf Α ◽

Ifn Γ

Abstract Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease that is associated with the destruction of immune tolerance and activation of B cells. Interleukin (IL)-35 and IL-35-producing (IL-35+) regulatory B cells (Bregs) have been demonstrated to possess immunosuppressive functions, but their roles in the initiation and early development of SLE have not been explored. Here, we measured and compared the frequencies of blood regulatory B cell subsets and the concentrations of plasma IL-35, IL-10, IL-17A, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ in 47 Chinese patients with newly diagnosed SLE and 20 matched healthy controls (HCs). The SLE patients had decreased percentages of IL-35+ B cells and IL-10+ B cells among the total blood B cells as well as decreased concentrations of plasma IL-35. In addition, higher levels of plasma IL-10, IFN-γ, TNF-α, and IL-17 along with higher frequencies of circulating plasma and memory B cells were observed in the SLE patients. The percentage of IL-35+ Bregs and the serum IL-35 level were inversely correlated with the SLE disease activity index and the erythrocyte sedimentation rate (ESR) levels. Our results indicate that IL-35+ Bregs and IL-35 may play protective roles in SLE initiation and progression.

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Prevalence and risk factors for serositis in patients with systemic lupus erythematosus: A case-control study

Lupus ◽

10.1177/09612033211049305 ◽

2021 ◽

pp. 096120332110493

Author(s):

Laura Gimeno-Torres ◽

Irene Carrión-Barberà ◽

Xavier Durán ◽

Eduardo Villegas ◽

Jordi Monfort ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Risk Factor ◽

Lupus Erythematosus ◽

Case Control Study ◽

Clinical Manifestations ◽

Case Control ◽

High Morbidity ◽

Systemic Lupus ◽

Control Study

Background Systemic lupus erythematosus (SLE) is an autoimmune multisystemic disease with a wide variety of clinical manifestations. One of its symptoms, associated to high morbidity, is serositis. Its prevalence ranges between 11% and 54%, and little is known about factors associated to this manifestation. The aim of this study is to determine the prevalence of serositis in SLE patients visited at the outpatient Lupus Unit of the Hospital del Mar and identify risk factors that can be used as predictors of this manifestation. Methods A retrospective case-control study was performed based on the review of 297 medical records of SLE patients. Twenty-eight patients were identified to have suffered serositis (cases) and were age- and sex-matched with 2 controls with SLE without serositis. Results The overall prevalence of serositis in our cohort was 9.42%, being higher in men than in women, 30% versus 7.9% ( p = 0.001, 95% CI: 1.7–42.4%). In 40.7%, it was the first manifestation of the disease. When looking for serositis-associated factors, an association was found with anti-dsDNA antibodies measured by the Crithidia method ( p = 0.016), and different measures of corticosteroids, where cases had required higher maximum doses and more pulses than controls throughout the disease, although this last correlation was lost when adjusting for confounding variables as nephritis and arthritis. Cases also received more mycophenolic acid ( p = 0.021) and, marginally, more belimumab ( p = 0.056). Conclusion The overall prevalence of serositis was 9.42%, being significantly higher in men (30%). Therefore, male gender constitutes a risk factor for serositis, and almost one third of men will develop this manifestation, so greater awareness is required in SLE men. CrithidiaDNA+ was also identified as a risk factor, and it should be determined in all SLE patients. Cases significantly received more corticosteroid pulses and higher maximum doses in relation to other SLE severe manifestations, which could imply a more aggressive form of SLE in patients with serositis.

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