National Lupus Awareness Month
October 2023
Lupus Awareness Month takes place during October in Australia every year. It is an important opportunity to raise awareness of the disease. Building awareness of lupus is essential to improve early diagnosis and treatment of this unpredictable and misunderstood disease, and ensure that people with lupus are aware of the support and resources available to help them manage the disease. Lupus Australia
The four different types of lupus
There are four different types of lupus. Systemic lupus erythematosus (SLE) is the most common type of lupus. If SLE begins in childhood, it is known as childhood-onset SLE or cSLE. Approximately 10-20 percent of SLE cases begin in childhood. Most cases of SLE begin in adulthood, between the ages of 15-44. Lupus that only affects the skin is less common and is called cutaneous lupus erythematosus (CLE). There are three types of CLE – discoid lupus, subacute cutaneous lupus, and acute cutaneous lupus. Neonatal lupus and drug-induced lupus are the least common types of lupus. Lupus Foundation of America
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Treatment
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Articles
Diagnosis
Metabolomics and biomarkers for lupus nephritis – a systematic review
The study of metabolomics associated with lupus nephritis (LN) still needs further investigation concerning metabolic pathways and pathogeny. As the community building the databases for the research and annotation of metabolites grow, the use of serum, urine, and saliva in metabolomic profiling, may become a potential non-invasive method in translational medicine studies. Surgical and experimental pathology 10 September 2023
A prognostic model for systemic lupus erythematosus-associated pulmonary arterial hypertension: CSTAR-PAH cohort study
This new risk stratification model for systemic lupus erythematosus-associated pulmonary arterial hypertension may provide individualized prognostic probability using readily obtained clinical risk factors. External validation is required to demonstrate the accuracy of this model's predictions in diverse patient populations. Respiratory research 9 September 2023
Novel CSF biomarkers for diagnosis and integrated analysis of neuropsychiatric systemic lupus erythematosus: based on antibody profiling
The dual-chips screening strategy demonstrated KLK5, L-selectin, Trappin-2, TCN2, and CST6 as CSF biomarkers for diagnosing neuropsychiatric systemic lupus erythematosus (NPSLE). Arthritis research & therapy 8 September 2023
Searching for a prognostic index in lupus nephritis
The authors have developed a prognostic index of poor renal evolution in patients with lupus nephritis (LN) that combines demographic, clinical, analytical and histopathological factors, easy to use in routine clinical practice and that could be an effective tool in the early detection and management. European journal of medical research 11 January 2023
The impact of normal serum complement levels on the disease classification and clinical characteristics in systemic lupus erythematosus
Patients with normal serum complement (N-com) were less involved in renal manifestation and anti-dsDNA antibody positivity but had a higher incidence of fever than those with H-com, while having no disadvantage in SLE classification processes. Serum complement levels at the initial diagnosis of SLE may not predict prognosis. Advances in rheumatology 27 December 2022 ________________________________________________________________________________
Research
Predictors of severe lupus flare: a prospective follow-up study
Systemic lupus erythematosus (SLE) patients with younger age, history of previous lupus nephritis (LN) or high baseline SLE disease activity index (SLEDAI), may need closer monitoring and follow up. BMC rheumatology 24 May 2023
Comparison of clinical features, disease activity, treatment and outcomes between late-onset and early-onset patients with systemic lupus erythematosus. A sex- and year at diagnosis-matched controlled study
In this sex- and year at diagnosis-matched controlled study, after adjusting for disease duration and baseline clinical variables, the late-onset SLE patients had less renal involvement and received less aggressive treatment, but had a higher mortality rate than the early-onset patients. Advances in Rheumatology 1 May 2023
Dysregulated endothelial cell markers in systemic lupus erythematosus: a systematic review and meta-analysis
The authors provide a complete literature overview for dysregulated endothelial cell (EC) markers in systemic lupus erythematosus (SLE) comprising a wide range of different EC functions. SLE-induced EC marker dysregulation was seen with, but also without, association with disease activity. This study provides some clarity in the eminent complex field of EC markers as biomarkers for SLE. Longitudinal data on EC markers in SLE are now needed to guide us more in unravelling the pathophysiology of premature atherosclerosis and cardiovascular events in SLE patients. Journal of inflammation 16 May 2023
Analysis of cardiovascular complications during delivery admissions among patients with Systemic Lupus Erythematosus, 2004-2019
This study found that SLE was associated with increased risk of complications, including preeclampsia, peripartum cardiomyopathy, heart failure, arrhythmias, AKI, stroke, and VTE during delivery hospitalization and an increased length and cost of hospitalization. JAMA 22 November 2022
Resilience and its associations in children with Systemic Lupus Erythematosus and Juvenile Idiopathic Arthritis
In children with SLE and JIA, resilience is lower than in the general population. Further, our results suggest that interventions to increase resilience may improve the HRQOL of children with rheumatic disease. Ongoing study of the importance of resilience in this population, as well as interventions to increase resilience, will be an important area of future research in children with SLE and JIA. Pediatric rheumatology 7 July 2023
A survival case of visceral disseminated varicella zoster virus infection in a patient with systemic lupus erythematosus
This case highlights the importance of a clinical suspicion of visceral disseminated varicella zoster virus (VZV) infections, and the necessity of immediate administration of acyclovir and reduced doses of immunosuppressant to save patients with systemic lupus erythematosus (SLE). BMC nephrology 8 June 2023
Association of preterm outcome with maternal systemic lupus erythematosus: a retrospective cohort study
Born to mothers with SLE may not increase the risk of major premature morbidities, but the hematologic profile of SLE preterm infants may be different from preterm infants born to women without SLE. The outcome of SLE preterm infants is associated with maternal SLE status and may benefit from maternal aspirin administration. Italian journal of pediatrics 1 April 2023
Risk factors for subsequent lupus nephritis in patients with juvenile-onset systemic lupus erythematosus: a retrospective cohort study
Persistently high elevated average anti-double-stranded DNA (dsDNA) antibody and erythrocyte sedimentation rate (ESR) levels during the follow-up period were risk factors for subsequent Lupus nephritis (LN) in patients with jSLE. Pediatric rheumatology 24 March 2023
Pregnancy outcomes in patients receiving assisted reproductive therapy with systemic lupus erythematosus: a multi-center retrospective study
The safety and efficacy of assisted reproductive therapy (ART) is assured in lupus patients with stable disease. Maternal and fetal adverse pregnancy outcomes (APOs) are comparable with planned pregnancy, with a relatively high incidence of premature delivery, gestational diabetes mellitus (GDM), and low-birth-weight (LBW) infants. Arthritis research & therapy 25 January 2023
Investigating the role of health information technology in the control and management of Systemic Lupus Erythematosus (SLE): a systematic review
The findings showed that health information technology (HIT) can improve the management and control of lupus and facilitate self-efficacy, self-care, and self-management in patients. The axes and data elements identified in this study can be the basis for developing and implementing efficient HIT-based systems to improve, control, and manage lupus. BMC medical informatics and decision making 8 October 2022
A cross-sectional study on the association of anxiety and depression with the disease activity of systemic lupus erythematosus
SLE disease activity is positively associated with the severity of depression and anxiety. Those patients whose Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores are greater than 8.5 are more likely to suffer from mental disorders which require additional attention to them. BMC psychiatry 8 September 2022
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Treatment
Hydroxychloroquine dose per ophthalmology guidelines and the risk of Systemic Lupus Erythematosus flares
In this case-crossover study within a contemporary SLE cohort, hydroxychloroquine dosing of 5 mg/kg per day or less, in accordance with current ophthalmology and rheumatology guidelines, was associated with a higher risk of lupus flares, including moderate or severe flares. Furthermore, the dose trend analysis also suggested an apparent threshold near 5 mg/kg per day. A recent study demonstrated that a higher risk of lupus flares was associated with any dose reduction, irrespective of the specific dose. Together, these findings suggest reduced efficacy of lower hydroxychloroquine dosing for lupus disease activity, particularly around doses of 5 mg/kg per day or less. JAMA 16 September 2022
Trial of Anti-BDCA2 Antibody Litifilimab for Systemic Lupus Erythematosus
In a phase 2 trial involving participants with SLE, litifilimab was associated with a greater reduction from baseline in the number of swollen and tender joints than placebo over a period of 24 weeks. Longer and larger trials are required to determine the safety and efficacy of litifilimab for the treatment of SLE. NEJM 8 September 2023
Successful treatment of lupus anticoagulant hypoprothrombinemia syndrome with rituximab
Lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS) is a rare acquired bleeding disorder secondary to development of antibodies against prothrombin protein, in the presence of antiphospholipid antibodies. The authors describe the case of a 13-year-old girl who presented with severe menorrhagia and symptomatic anemia. Labs indicated anemia, thrombocytopenia, elevated PT and aPTT, high-titer inhibitor on mixing studies, positive ANA and anti-dsDNA antibodies, along with a triple-positive antiphospholipid antibody panel. Given additional systemic manifestations, systemic lupus erythematosus was diagnosed. High dose steroids and hydroxychloroquine subsequently started. Her clinical course was complicated by femoral deep venous thrombosis and post renal biopsy retroperitoneal hematoma. Further workup revealed low prothrombin level and the diagnosis of lupus anticoagulant hypoprothrombinemia syndrome. In view of suboptimal response to initial immunosuppressive therapy, rituximab was added to her regimen, leading to an improvement in clinical symptoms and resolution of hypoprothrombinemia. She remains recurrence free 5 years from the event. Thrombosis Journal 17 July 2923
Cognitive dysfunction in patients with childhood-onset systemic lupus erythematosus may impact treatment
In this study, the frequency of cognitive dysfunction (CD) in childhood-onset systemic lupus erythematosus (cSLE) patients was as high as that in the adult SLE population. CD can significantly impact the response of cSLE patients to treatment, justifying preventive measures in the care of this population. Advances in rheumatology 24 April 2023
The influence of intrathecal injection of methotrexate and dexamethasone on neuropsychiatric systemic lupus erythematosus (NPSLE): a retrospective cohort study of 386 patients with NPSLE
Intrathecal treatment of methotrexate and dexamethasone was associated with a more favorable prognosis of NPSLE and may serve as a valuable additional therapy for NPSLE patients, especially for those with elevated levels of protein in cerebrospinal fluid. Arthritis research & therapy 28 March 2023
Association of low-dose glucocorticoid use and infection occurrence in systemic lupus erythematosus patients: a prospective cohort study
These results suggested that the use of 5.0–7.5 mg prednisolone (PSL) or equivalent could pose an infection risk in SLE patients. This finding indicates that PSL dose should be reduced to as low as possible in SLE patients to avoid infection. Arthritis research & therapy 28 July 2022
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