scholarly journals More Consistent Antimalarial Intake in First 5 Years of Disease Is Associated with Better Prognosis in Patients with Systemic Lupus Erythematosus

2017 ◽  
Vol 45 (1) ◽  
pp. 90-94 ◽  
Author(s):  
Rattapol Pakchotanon ◽  
Dafna D. Gladman ◽  
Jiandong Su ◽  
Murray B. Urowitz
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Multivariable Analysis ◽  
Damage Index ◽  
Retinal Toxicity ◽  
Systemic Lupus ◽  
Group A ◽  
Group B

Objective.To examine whether more consistent use of antimalarial agents (AM) leads to better results in systemic lupus erythematosus (SLE).Methods.From a longitudinal cohort study, we identified inception patients with a minimum of 5 years of followup. They were divided into 3 groups: patients who took AM > 60% of the time (group A), those who took AM < 60% of the time (group B), and those who did not receive AM (group C) during the first 5 years of followup. Outcomes included increase in Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), flare, achieving low disease activity (LDA), adjusted mean Systemic Lupus Erythematosus Disease Activity Index 2000, cumulative doses of steroids (CMS), and AM-related retinal toxicity. Regression analysis models were constructed to identify predictors of the outcomes.Results.There were 459 patients identified: 236 (51.4%) in group A, 88 (19.2%) in group B, and 135 (29.4%) in group C. The changes in SDI, flare event, and CMS were significantly lower in group A, which more often achieved LDA. Multivariable analysis revealed that the patients in group A had a lower risk of increasing SDI and were more likely to achieve LDA at Year 5 compared to the patients in group C. Patients taking AM had lower CMS over the 5 years of followup. There was only 1 patient with AM-related retinal toxicity in each group.Conclusion.More consistent use of an AM over the first 5 years of SLE is associated with better outcomes.

scholarly journals Circulating Endothelial Cells as a Marker of Vascular Dysfunction in Patients With Systemic Lupus Erythematosus by Real-Time Polymerase Chain Reaction

2011 ◽  
Vol 135 (11) ◽  
pp. 1482-1485 ◽  
Author(s):  
Fadia M. Attia ◽  
Ahmed Maaty ◽  
Fawzy Attia Kalil
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Disease Activity Index ◽  
Systemic Lupus ◽  
Double Stranded Dna ◽  
Group A ◽  
Dna Antibodies ◽  
Group B

Context.—Systemic lupus erythematosus (SLE) is associated with an increased risk of atherosclerosis; endothelial dysfunction represents the first step in its pathogenesis. Objective.—To assess endothelial dysfunction in SLE by circulating endothelial cells (CECs) and to characterize SLE-specific factors that contribute to its appearance. Design.—Case-control study was conducted on 60 subjects, divided into 2 groups: group A (30 patients with SLE) and group B (30 healthy sex- and age-matched controls). Total cholesterol, triglycerides, antinuclear antibodies, anti–double-stranded DNA antibodies, and C3 were determined in all patients. Systemic lupus erythematosus activity was assessed using the SLE Disease Activity Index. Endothelial function was assessed by means of flow-mediated dilation of the brachial artery using B-mode ultrasonography and relative quantification of CD 146 mRNA by real-time polymerase chain reaction. Results.—The group of SLE patients was formed of 20 females and 10 males, with a mean age of 31.16 ± 9.69 years. The values of SLE-specific tests and SLE Disease Activity Index were represented by anti–double-stranded DNA antibodies 160 ± 40.5, C3 68.91 ± 11.91 mg/dL, total cholesterol 188.66 ± 49.63 mg/dL, triglycerides 143.41 ± 46.26 mg/dL, and SLE Disease Activity Index 12.66 ± 3.70. Values for flow-mediated dilation were 8.85% ± 2.02% (group A) and 20.33% ± 6.19% (group B), P &lt; .001, and CECs were 300 ± 40.5 μL−1 blood (group A) and 10 ± 2.5 μL−1 blood (group B). The statistical analysis showed a strong inverse correlation between CECs and SLE Disease Activity Index, a strong correlation between CECs and C3, a strong correlation between CECs and anti–double-stranded DNA antibodies, and a moderate inverse correlation between CECs and total cholesterol. Conclusion.—Endothelial dysfunction is present in SLE patients even in the absence of traditional cardiovascular risk factors due to disease activity.

scholarly journals SAT0232 PERCEPTION OF THE DISEASE IN PATIENTS WITH EARLY SYSTEMIC LUPUS ERYTHEMATOSUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1059.3-1059
Author(s):  
M. Garabajiu ◽  
L. Mazur-Nicorici ◽  
T. Rotaru ◽  
V. Salaru ◽  
S. B. Victoria ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Activity Index ◽  
Damage Index ◽  
Organ Damage ◽  
Systemic Lupus

Background:Systemic lupus erythematosus is an autoimmune disease with a major impact on patient’s quality of life.Objectives:To evaluate patient’s attitude toward early disease and factors that influence it.Methods:Performed case-control study included SLE patients that fulfilled SLICC, 2012 classification criteria. The research included two groups of patients: early SLE – 1stgroup (disease duration ≤24 months) and non-early SLE – 2ndgroup control (disease duration >24 months). The pattern of the disease activity was assessed by patient global assessment (PGA), Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and Systemic Lupus Activity Measure (SLAM), for SLE activity, SLICC/ACR Damage Index (DI) for disease irreversible changes and SF-8 for the Quality of Life (QoL).Results:A total of 101 SLE patients with 34 in the 1stgroup (early SLE) and 67 in the 2ndgroup (non-early SLE) was analyzed. The disease activity showed high disease activity in both groups by SLEDAI (7,02±4,16 and 6,26±4,43 points, p>0,05) and SLAM (7,47±4,40 and 7,31±4,10 points, p>0,05) such as (46,97±19,39 vs 47,98±22,41 points). The QoL was appreciated as low, by both components (mental and physical), in groups. The damage index was higher in the 2nd group (0,23±0,43 and 1,07±1,29, p<0,001), which can be explained by the development of irreversible changes with the increase of disease duration.The PGA in early SLE was influenced by subjective symptoms contained in SLAM index (r=0,48, p<0,05), such as fatigue and depression, and the level of the quality of life (r=0,65, p<0,001). Meantime, PGA in patients with longer disease duration (>2 years), was influenced by the presence of organ damage by SLICC/ACR DI (0,23, p<0,05) and objective findings of the disease activity contained in SLEDAI (r=0,33, p<0,005) and SLAM (0,44, p<0,001).Conclusion:The disease recognition in patients with early SLE was determined by subjective and psycho-emotional signs, while in patients with longer disease duration it was influenced by organ damage and complications.References:no referencesDisclosure of Interests:None declared

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.

Distinct Subtypes of Microparticle-containing Immune Complexes Are Associated with Disease Activity, Damage, and Carotid Intima-media Thickness in Systemic Lupus Erythematosus

2016 ◽  
Vol 43 (11) ◽  
pp. 2019-2025 ◽  
Author(s):  
Paul R. Fortin ◽  
Nathalie Cloutier ◽  
Vincent Bissonnette ◽  
Ellie Aghdassi ◽  
Lihi Eder ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Immune Complexes ◽  
Activity Index ◽  
Damage Index ◽  
Intima Media Thickness ◽  
Vascular Damage ◽  
Systemic Lupus ◽  
Media Thickness

Objective.Microparticles (MP) are small extracellular vesicles present in body fluids. MP originate from different cellular lineages, principally from platelets in blood, and may expose phosphatidylserine (PS). In systemic lupus erythematosus (SLE), MP harbor immunoglobulin G (IgG), thereby forming MP-containing immune complexes (mpIC). We aimed to verify an association between SLE disease activity, damage, and surrogate markers of atherosclerosis and MP harboring IgG, taking into account the platelet origin and PS exposure of MP.Methods.MP expressing surface IgG, platelet antigen (CD41+), and PS were quantified using flow cytometry in plasma of 191 women with SLE. Carotid ultrasounds (US) were available in 113 patients. Spearman correlation analysis was used to analyze whether levels of MP were associated with the following outcomes: SLE Disease Activity Index 2000 (SLEDAI-2K), Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), and carotid US plaques and intima-media thickness (CIMT) as surrogates for vascular damage.Results.We found CD41+ MP harboring IgG present in SLE. A positive correlation was found between SLEDAI-2K and levels of CD41+ MP harboring IgG and exposing (p = 0.027) and non-exposing PS (p = 0.001). Conversely, SDI (p = 0.024) and CIMT (p = 0.016) correlated with concentrations of CD41− MP harboring IgG and exposing PS. Associations were independent of low-density lipoprotein cholesterol level, body mass index, and antimalarial drug use.Conclusion.Different subtypes of mpIC are produced in SLE and are associated with distinct clinical characteristics such as disease activity and vascular damage. The assessment of MP subtypes might serve for the design of predictive markers of disease activity and vascular damage in patients.

scholarly journals Circulating mitochondrial DNA copy numbers represent a sensitive marker for diagnosis and monitoring of disease activity in systemic lupus erythematosus

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e002010
Author(s):  
Stavros Giaglis ◽  
Douglas Daoudlarian ◽  
Reinhard E Voll ◽  
Diego Kyburz ◽  
Nils Venhoff ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Multivariable Analysis ◽  
Systemic Lupus ◽  
Mt Dna ◽  
Cell Free Dna ◽  
Free Dna ◽  
Copy Numbers

ObjectivesCell-free DNA is involved in the pathogenesis of systemic lupus erythematosus (SLE) but the clinical value of cell-free DNA measurements in SLE is unknown. Our aim was therefore to examine the utility of mitochondrial (mt) DNA and nuclear (n) DNA quantification in SLE.MethodsEDTA plasma was drawn from 103 consecutive patients with SLE and from 56 healthy blood donors. mtDNA and nDNA copy numbers were quantified by PCR from cell-free plasma. Clinical parameters were recorded prospectively.ResultsCirculating mtDNA copy numbers were increased 8.8-fold in the plasma of patients with SLE (median 6.6×107 /mL) compared with controls (median 7.6×106 /mL, p<0.0001). Among all 159 individuals, a cut-off set at 1.8×107 mtDNA copies in a receiver operated curve identified patients with SLE with 87.4% sensitivity and 94.6% specificity; the area under the curve was 0.95 (p<0.0001). mtDNA levels were independent of age or gender, but correlated with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) on multivariable analysis (p=0.004). Conversely, SLEDAI was associated with prednisone dose (p<0.001), anti-double stranded DNA-titres (p=0.003) and mtDNA levels (p=0.005), but not nDNA copy numbers. In 33 patients with SLE with available follow-up, the changes of mtDNA, but not those of nDNA concentrations, robustly correlated with the evolution of the SLEDAI (r=0.55, p=0.001).ConclusionsCirculating mtDNA unlike nDNA molecules are markedly increased in SLE plasma. Regardless of disease activity, circulating mtDNA levels distinguish patients with SLE from healthy controls with high sensitivity and represent an independent marker of SLE activity.

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 Outcomes of 847 childhood-onset systemic lupus erythematosus patients in three age groups

Lupus ◽  
2017 ◽  
Vol 26 (9) ◽  
pp. 996-1001 ◽  
Author(s):  
S R M Lopes ◽  
N W S Gormezano ◽  
R C Gomes ◽  
N E Aikawa ◽  
R M R Pereira ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Mortality Rate ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Early Onset ◽  
Age Groups ◽  
Damage Index ◽  
Concomitant Disease ◽  
Systemic Lupus ◽  
Group A

Objective The objective of this study was to assess outcomes of childhood systemic lupus erythematosus (cSLE) in three different age groups evaluated at last visit: group A early-onset disease (<6 years), group B school age (≥6 and <12 years) and group C adolescent (≥12 and <18 years). Methods An observational cohort study was performed in ten pediatric rheumatology centers, including 847 cSLE patients. Results Group A had 39 (4%), B 395 (47%) and C 413 (49%). Median disease duration was significantly higher in group A compared to groups B and C (8.3 (0.1–23.4) vs 6.2 (0–17) vs 3.3 (0–14.6) years, p < 0.0001). The median Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) (0 (0–9) vs 0 (0–6) vs 0 (0–7), p = 0.065) was comparable in the three groups. Further analysis of organ/system damage revealed that frequencies of neuropsychiatric (21% vs 10% vs 7%, p = 0.007), skin (10% vs 1% vs 3%, p = 0.002) and peripheral vascular involvements (5% vs 3% vs 0.3%, p = 0.008) were more often observed in group A compared to groups B and C. Frequencies of severe cumulative lupus manifestations such as nephritis, thrombocytopenia, and autoimmune hemolytic anemia were similar in all groups ( p > 0.05). Mortality rate was significantly higher in group A compared to groups B and C (15% vs 10% vs 6%, p = 0.028). Out of 69 deaths, 33/69 (48%) occurred within the first two years after diagnosis. Infections accounted for 54/69 (78%) of the deaths and 38/54 (70%) had concomitant disease activity. Conclusions This large multicenter study provided evidence that early-onset cSLE group had distinct outcomes. This group was characterized by higher mortality rate and neuropsychiatric/vascular/skin organ damage in spite of comparable frequencies of severe cumulative lupus manifestations. We also identified that overall death in cSLE patients was an early event mainly attributed to infection associated with disease activity.

scholarly journals Vitamin D Deficiency in Egyptian Systemic Lupus Erythematosus Patients: How Prevalent and Does it Impact Disease Activity?

2016 ◽  
Vol 11 ◽  
pp. IMI.S40035 ◽  
Author(s):  
Nouran M. Abaza ◽  
Reem M. El-Mallah ◽  
Asmaa Shaaban ◽  
Sameh A. Mobasher ◽  
Khaled F. Al-hassanein ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Vitamin D ◽  
Disease Activity ◽  
Vitamin D Deficiency ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Damage Index ◽  
Systemic Lupus ◽  
Vitamin D Levels ◽  
Significant Difference

Background The emerging role of vitamin D in immunology and autoimmune disorders has been a worldwide interest in the last decade. Systemic lupus erythematosus (SLE) patients are particularly at a delicate position predisposing them to suffer from vitamin D deficiency due to the multiple risk factors accompanying the disease. Whether vitamin D deficiency is also involved as a risk factor for developing SLE and affecting its course is a considerable concern. Objectives The objective of this study was to estimate the prevalence of vitamin D deficiency in SLE patients and its relation to disease. MATERIALS AND METHODS: In our observational cross-sectional study, serum levels of vitamin D [25(OH)D] in 60 SLE patients and 30 age- and sex-matched healthy controls were assessed and estimated for deficiency and insufficiency at 10 and 30 ng/mL, respectively. Disease activity was evaluated by SLE disease activity index (SLEDAI), irreversible organ damage by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI), and severity by Severity of Disease Index. Fatigue was measured by visual analog scale. Results Significantly lower levels of 25(OH)D were found in SLE patients (17.6 ± 6.9 ng/mL) in comparison to controls (79.0 ± 28.7 ng/mL), with a statistically high significant difference ( t = -11.2, P < 0.001). High prevalence of vitamin D insufficiency and deficiency was detected as 73.3% and 23.3%, respectively. Vitamin D had a highly significant negative correlation with SLEDAI ( r = -0.495, P < 0.001), SLICC ( r = -0.431, P < 0.05), and fatigue ( r = -0.436, P < 0.05). Conclusion Vitamin D deficiency and insufficiency were found to be prevalent in SLE patients in our study and related to disease activity and fatigue. If needed, routine screening and consequent repletion of vitamin D are recommended in SLE patients. Restoring adequate vitamin D levels in SLE patients should be more explored as a potential yet simple measure to their usual management to improve their condition.

scholarly journals The problem of fatigue in patients with systemic lupus erythematosus according to the data on a Russian RENAISSANCE cohort

2020 ◽  
Vol 14 (4) ◽  
pp. 23-30
Author(s):  
E. A. Aseeva ◽  
S. K. Solovyev ◽  
N. Yu. Nikishina ◽  
G. M. Koilubaeva ◽  
T. A. Lisitsyna ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Damage Index ◽  
Clinical Manifestations ◽  
Common Symptom ◽  
Systemic Lupus ◽  
Wide Range ◽  
Antibody Levels

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a wide range of clinical manifestations. Numerous observations and surveys of patients have shown that the most common symptom of SLE is fatigue complaints in 51 to 90% of patients.Objective: to determine the significance of fatigue in the general health status of RENAISSANCE cohort patients with SLE who were hospitalized in the Clinic, V.A. Nasonova Research Institute of Rheumatology.Patients and methods. The investigation included SLE patients aged 18 years and older who met the 2012 SLICC criteria. The standard examination accepted in the management of patients with SLE was made. Disease activity was determined by SLEDAI-2K; irreversible lesions in various organs were identified using the SLICC damage index. The SF-36 and the LupusQoL questionnaires were used to assess health-related quality of life (HRQOL) and the FACIT-Fatigue scale was applied to measure fatigue.Results and discussion. The investigation enrolled 328 patients, mainly women (91%); the mean age was 34.4±11.5 years; the duration of the disease was 106.3±97.9 months. In this group, moderate and high disease activities (SLEDAI-2K scores of 6–10 and 11–19, respectively) were observed at approximately the same frequency. At the time of inclusion, more than half (56.5%) of the patients already had various irreversible organ lesions. At Visit 1, the FACIT-Fatigue scale showed that fatigue was present in 148 (45%) of the 328 patients. According to the presence of fatigue, the patients were divided into two groups. Group 1 included 148 patients with fatigue; Group 2 consisted of 180 patients without fatigue. The Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and anti-DNA antibody levels were significantly higher in the fatigue group (p=0.01 and p=0.02, respectively); the patients also had decreased HRQOL according to 7 LupusQol domains (p<0.001). The patients with fatigue were significantly more likely to receive intravenous glucocorticoids and rituximab. At 12 months after the start of treatment, the patients with fatigue were found to have a statistically significant reduction in disease activity, as well as normalization of anti-DNA antibody levels, improvements in HRQOL according to the LupusQol domains, and less severity of fatigue according to the FACIT-Fatigue scale.Conclusion. Fatigue was detected in almost half (45–53%) of SLE patients. It is associated with a higher disease activity by SLEDAI-2K and with a high anti-DNA antibody level. The patients with fatigue are observed to have an obvious worsening of HRQOL according to all LupusQol domains.

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