Difference in clinical profile between juvenile onset and adult-onset systemic lupus erythematosus: a meta-analysis

The aim was to systematically review the studies that compared clinical and serological variation between adult-onset systematic lupus erythematosus (aSLE) andjuvenile-onset systematic lupus erythematosus (jSLE). A comprehensive literature search was done, in various available electronic databases for relevant publication that compared juvenile onset SLE and adult onset SLE. The data of adverse clinical features, serological profile and mortality were extracted. Juvenile onset was defined as <18 years and adult onset was defined as >18 years. The methodological quality of study was assessed by Newcastle Ottawa scale (NOS) criteria and R version 3.3.1 was used for analysis and ORs and 95% CIs, were used as statistical parameter. A total of 14,920 patients; (12,230: aSLE, and 2,690: jSLE) were included. Renal involvement especially nephritis was significantly more in j-SLE OR: 2.18, 95% CI: [1.81;2.62]; I2=10.8% whereas musculoskeletal was significant in aSLE O.R: 0.64; C.I: [0.44; 0.93]; I2=83.4%. Seizure and malar rash were significantly higher in J-SLE OR:1.69, CI: [1.31; 2.18]; I2=31.1%,1.43; C.I [1.04; 1.97]; I2=82%, respectively. Raynaud’s phenomenon and pleuritis were significantly higher in adult onset SLE. Anemia and thrombocytopenia were significantly higher in juvenile onset SLE. Anti-ds DNA, anti-histone, and anti-ribosomal-P were more frequent in juvenile-onset SLE while, anti-Ro was more common in adult-onset disease. The cause of mortality was not significantly different in both groups. Renal biopsy of class III and IV combined and class V were significantly more in adult-onset SLE. SLEDAI was higher in j-SLE. Meta-analysis indicated that, regardless of many similar clinical and serological manifestations, there is still some variation between adult-onset SLE and juvenile-onset SLE. Although, SLE disease is continuum from juvenile to adult but disease aggressive in juvenile onset SLE.

Atopic dermatitis and risk of autoimmune diseases: a systematic review and meta-analysis

Background Atopic dermatitis is the most common chronic inflammatory skin disease and presents a major public health burden worldwide. Recent observational studies revealed the potential association between atopic dermatitis with autoimmune disorders. However, there is no meta-analysis of the prevalence or incidence of autoimmune diseases in atopic dermatitis. Therefore, considering the potential clinical implications of these associations, we aimed to assess the risk of autoimmune diseases in patients with atopic dermatitis using this method. Methods PubMed, Embase, and Web of Science were searched from inception to October, 2020. Observational studies which provided estimate effects with 95% CI or raw data were included. The quality of selected studies was evaluated using the Newcastle–Ottawa Scale. Odds ratio and relative risks were pooled using a random effects model and expressed with 95% confidence intervals. Results Fourteen observational studies were included in this systematic review and meta-analysis. The random-effects meta-analysis of case–control and cross-sectional studies showed a significant association of atopic dermatitis with mutiple autoimmune diseases, including alopecia areata, celiac disease, Crohn’s disease, rheumatoid arthritis, systematic lupus erythematosus, ulcerative colitis and vitiligo. Furthermore, pooling of the results of cohort studies showed that patients with atopic dermatitis were more likely to develop these autoimmune diseases. Conclusion Our meta-analysis showed that patients with atopic dermatitis were at higher risk of multiple autoimmune diseases including alopecia areata, celiac disease, Crohn’s disease, rheumatoid arthritis, systematic lupus erythematosus, ulcerative colitis and vitiligo. It is important for early detection of the affected group so that timely management can be initiated. Dermatologists and allergists should be aware of the autoimmune diseases in patients with atopic dermatitis and develop interventions if necessary. Also, limited by the present research, we still require more large-scale studies to further establish the association between atopic dermatitis and autoimmune diseases.

Nonuremiccalciphylaxis - A Systematic Review

Background: Calciphylaxis, also known as calcific uremic arteriolopathy, is a well-described condition in renal transplant and end-stage kidney disease (ESKD) patients; however, little is known about calciphylaxis induced by nonuremic causes. This systematic study aimed to determine the causes, prognosis of nonuremic calciphylaxis, clinical features and laboratory abnormalities. Patients and methods:A comprehensive review of the literature for nonuremic calciphylaxis case reports and case series published between 2016 and 2021 was performed. Cases included satisfied the criteria for a histological diagnosis of nonuremic calciphylaxis in the absence of ESKD, renal transplantation, or acute kidney injury requiring renal replacement therapy. Results: The authors identified 53 cases of nonuremic calciphylaxis (83.14 % women, Caucasian 13.33 %, aged 25 to 83 years). The most prevalent documented associations were of patients having multiple conditions 18 (33.33 %), warfarin-induced (7.4 %), calcium and Vitamin D supplementation (3.7 %), primary hyperparathyroidism (3.7 %), liver disease (3.7 %), Acenocumarol use (3.7 %), Systematic lupus erythematosus (3.7 %), alcoholic cirrhosis (3.7 %), respectively. Conclusion:When investigating skin lesions in patients with sensitive conditions, calciphylaxis must often be addressed in the absence of ESKD or renal transplantation. Obese women with various underlying illnesses such as alcohol intake, smoking, diabetes, liver disease, and so on are more likely to develop nonuremic calciphylaxis (NUC).Calciphylaxis is linked with high mortality; however, sodium thiosulfate (ST) has made clear progress in terms of treatment, yet there are still areas that need to be addressed to describe the effectiveness of ST.

Lupic Outbreak and Covid-19 Pneumonia-Case Report

Coronavirus disease 2019 (COVID-19) is a respiratory infection that can cause mild symptoms or even death, to patients who suffer from it. It affects all population groups without distinction. Systematic Lupus Erythematosus (SLE) is a chronic and fluctuating autoimmune disease. One of the goals of the treatment is to avoid flare-ups and thereby reduce mortality. Their innate alterations in immunity, added to the use of immunosuppressive drugs to control the disease and prevent outbreaks makes them more vulnerable to develop severe symptoms in SARS-CoV-2 infection. We present the case of a patient with SLE infected by SARS-CoV-2 with a lupus flare during hospitalization, entailing a diagnostic and therapeutic challenge.

Potential for Antigen-Specific Tolerizing Immunotherapy in Systematic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic complex systemic autoimmune disease characterized by multiple autoantibodies and clinical manifestations, with the potential to affect nearly every organ. SLE treatments, including corticosteroids and immunosuppressive drugs, have greatly increased survival rates, but there is no curative therapy and SLE management is limited by drug complications and toxicities. There is an obvious clinical need for safe, effective SLE treatments. A promising treatment avenue is to restore immunological tolerance to reduce inflammatory clinical manifestations of SLE. Indeed, recent clinical trials of low-dose IL-2 supplementation in SLE patients showed that in vivo expansion of regulatory T cells (Treg cells) is associated with dramatic but transient improvement in SLE disease markers and clinical manifestations. However, the Treg cells that expanded were short-lived and unstable. Alternatively, antigen-specific tolerance (ASIT) approaches that establish long-lived immunological tolerance could be deployed in the context of SLE. In this review, we discuss the potential benefits and challenges of nanoparticle ASIT approaches to induce prolonged immunological tolerance in SLE.

Clinical Manifestation and Hematologic Interpretation of Pediatric Systematic Lupus Erythematosus at Initial Presentation: 2-Years Observation

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by a spectrum of clinical manifestations, immunological abnormalities, and varied laboratories results. In children, SLE manifestation is particularly more severe, involving more organs. Hematological manifestation has been known as the most common manifestation. The purpose of this study was to describe the clinical manifestations and hematologic interpretation of pediatric SLE at initial presentation.Methods: This retrospective data collection study was conducted at the Department of Child Health Dr. Hasan Sadikin General Hospital Bandung on medical records from a two-year period of 2017–2018. The clinical manifestations were categorized into malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, renal disorders, and neurological disorders. The hematologic interpretations were categorized into anemia, leukopenia, neutropenia, lymphopenia, and thrombocytopenia. Clinical manifestations and hematological interpretations were presented as occurrence percentages and stratified into three age-group of pre-pubertal, peri-pubertal, and post-pubertal.Results: Among 79 pediatric SLE patients (median age 14 years old; IQR 11–16), female gender was predominant. Abnormalities hematologic interpretation occurs in more than half of the patients (83.5%). Malar rash and anemia were the commonest findings among all age groups. Increased occurrence of neuropsychiatric and renal disorders were observed in all age-groups.Conclusions: Malar rash and anemia are important findings among pediatric SLE patients. Furthermore, the occurrences of the neuropsychiatric and renal disorders are also important.