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Lupus flare

Alexis Mathian, Suzanne Mouries-Martin, Karim Dorgham, Hervé Devilliers, Laura Barnabei, Elyès Ben Salah, Fleur Cohen-Aubart, Laura Garrido Castillo, Julien Haroche, Miguel Hie, Marc Pineton de Chambrun, Makoto Miyara, Delphine Sterlin, Micheline Pha, Du Lê Thi Huong, Frédéric Rieux-Laucat, Flore Rozenberg, Guy Gorochov, Zahir Amoura
OBJECTIVES: No simple or standardized assay is available to quantify interferon-α (IFNα) in routine clinical practice. Single-molecule-array (Simoa) digital enzyme-linked immunosorbent assay (ELISA) technology enables direct IFNα quantification at fg/mL concentrations. This study was undertaken to assess IFNα digital ELISA diagnostic performances to monitor systemic lupus erythematosus (SLE) activity. METHODS: IFNα concentrations in serum samples from 150 consecutive SLE patients in a cross-sectional study were determined with digital ELISA and a functional biological activity assay (bioassay)...
December 3, 2018: Arthritis & Rheumatology
Bruce Richardson
Systemic lupus erythematosus flares when genetically predisposed people encounter environmental agents that cause oxidative stress, such as infections and sunlight. How these modify the immune system to initiate flares is unclear. Drug induced lupus models demonstrate that CD4+ T cells epigenetically altered with DNA methylation inhibitors cause lupus in animal models, and similar T cells are found in patients with active lupus. How infections and sun exposure inhibit T cell DNA methylation is unclear. DNA methylation patterns are replicated each time a cell divides in a process that requires DNA methyltransferase one (Dnmt1), which is upregulated as cells enter mitosis, as well as the methyl donor S-adenosylmethionine, created from dietary sources...
November 30, 2018: Clinical Immunology: the Official Journal of the Clinical Immunology Society
Kimberly R Middleton, Steffany Haaz Moonaz, Sarfaraz A Hasni, Miriam Magaña López, Gladys Tataw-Ayuketah, Nicole Farmer, Gwenyth R Wallen
Systemic lupus erythematosus (SLE) is an autoimmune disease associated with widespread inflammation and tissue damage. It is more common and severe among Blacks, Hispanics, and Asians; with higher incidence in women. While the goals of medical treatment are to prevent flares and reduce organ damage, up to 50% of patients perceive their health to be suboptimal with unaddressed needs including fatigue and pain. Recent SLE treatment guidelines focus on improving quality of life. Yoga has shown improvements in quality-of-life and fatigue in various diagnoses...
December 2018: Complementary Therapies in Medicine
Sophia L Ryan, Shamik Bhattacharyya
Connective tissue disorders are now understood to include autoimmune and genetic diseases affecting organs, blood vessels, and surrounding fascia. Many of these diseases predominantly affect women in childbearing years and are associated with neurologic complications. Pregnancy can affect disease activity (such as flares of systemic lupus erythematosus), and the diseases can affect pregnancy outcome (such as increased risk of preterm labor). We review the neurologic complications and changes with pregnancy for systemic lupus erythematosus, Sjögren syndrome, idiopathic inflammatory myopathy, and Marfan syndrome...
February 2019: Neurologic Clinics
Sajal Ajmani, Harshit Singh, Saurabh Chaturvedi, Ravi Mishra, Mohit Kumar Rai, Avinash Jain, Durga Prasanna Misra, Vikas Agarwal
Bacterial and opportunistic infections are a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis owing to treatment with immunosuppressants. Commonly used laboratory tests are unreliable in differentiating infection from active disease patients. Fc receptor (FcγR1 or CD64) expression on neutrophils and soluble TREM-1 (triggering receptor expressed on monocytes) are potential biomarkers of bacterial infections...
November 16, 2018: Clinical Rheumatology
Hironari Hanaoka, Harunobu Iida, Tomofumi Kiyokawa, Yukiko Takakuwa, Kimito Kawahata
AIM: To assess for any additive value of hydroxychloroquine (HCQ) in Japanese patients with systemic lupus erythematosus (SLE) depending on calcineurin inhibitors (CNIs). METHODS: We retrospectively evaluated patients with SLE who visited our hospital from 2015 to 2016 and were taking prednisolone (PSL) at <20 mg/d and one immunosuppressant (IS). Patients were divided into two groups depending on HCQ use and the groups were compared for changes in SLE Disease Activity Index (SLEDAI), prednisolone (PSL) dose, and cumulative flare rate between patients who were treated and not treated with CNI...
November 8, 2018: International Journal of Rheumatic Diseases
Sonya J Wolf, Shannon N Estadt, Johann E Gudjonsson, J Michelle Kahlenberg
Ultraviolet (UV) light is an important environmental trigger for systemic lupus erythematosus (SLE) patients, yet the mechanisms by which UV light impacts disease are not fully known. This review covers evidence in both human and murine systems for the impacts of UV light on DNA damage, apoptosis, autoantigen exposure, cytokine production, inflammatory cell recruitment, and systemic flare induction. In addition, the role of the circadian clock is discussed. Evidence is compared in healthy individuals and SLE patients as well as in wild-type and lupus-prone mice...
2018: Frontiers in Immunology
Josef Symon Salgado Concha, Victoria P Werth
Several patterns of hair loss can occur in lupus erythematosus (LE). Alopecias which show histological characteristics of LE are LE-specific, and include discoid LE (DLE), diffuse or patchy hair loss in acute LE, subacute cutaneous LE, and rarely tumid LE. Lupus hair in SLE is a poorly characterised entity and may be a form of telogen effluvium. Alopecia areata can coexist with LE and may mimic DLE. Non-lupus alopecias such as telogen effluvium and anagen effluvium have a myriad of causes which include disease flares, drugs and stress in the setting of LE...
2018: Lupus Science & Medicine
Fabien B Vincent, Laura Slavin, Alberta Y Hoi, Arthur Richard Kitching, Fabienne Mackay, James Harris, Rangi Kandane-Rathnayake, Eric F Morand
Objective: To characterise the clinical relevance of urinary macrophage migration inhibitory factor (uMIF) concentrations in patients with systemic lupus erythematosus (SLE). Methods: MIF, adjusted for urine creatinine, was quantified by ELISA in urine samples from 64 prospectively recruited patients with SLE. Serum MIF and urinary monocyte chemoattractant protein 1 (uMCP-1) were quantified by ELISA in a subset of patients (n = 39). Disease activity was assessed using the SLE Disease Activity Index-2000 (SLEDAI-2K) score...
2018: Lupus Science & Medicine
E M D Smith, A Eleuteri, B Goilav, L Lewandowski, A Phuti, T Rubinstein, D Wahezi, C A Jones, S D Marks, R Corkhill, C Pilkington, K Tullus, C Putterman, C Scott, A C Fisher, M W Beresford
BACKGROUND: A urine 'biomarker panel' comprising alpha-1-acid-glycoprotein, ceruloplasmin, transferrin and lipocalin-like-prostaglandin-D synthase performs to an 'excellent' level for lupus nephritis identification in children cross-sectionally. The aim of this study was to assess if this biomarker panel predicts lupus nephritis flare/remission longitudinally. METHODS: The novel urinary biomarker panel was quantified by enzyme linked immunoabsorbant assay in participants of the United Kingdom Juvenile Systemic Lupus Erythematosus (UK JSLE) Cohort Study, the Einstein Lupus Cohort, and the South African Paediatric Lupus Cohort...
November 2, 2018: Clinical Immunology: the Official Journal of the Clinical Immunology Society
Rita Quelhas da Costa, M Elena Aguirre-Alastuey, David A Isenberg, Amanda M Saracino
Importance: Cutaneous lupus erythematosus (CLE) can be severe and treatment resistant. B-cell depletion therapy (BCDT) with rituximab is well recognized in organ involvement in systemic lupus erythematosus (SLE), but its efficacy in cutaneous manifestations is less well established. Objective: To evaluate the outcomes of BCDT in CLE and its clinical subtypes in the setting of associated SLE. Design, Setting, and Participants: This single-center, retrospective, cohort study was performed at the adult tertiary referral Rheumatology Department of University College London Hospital, London, United Kingdom, from January 1, 2000, through March 31, 2016, with 12-month follow-up completed on March 31, 2017...
October 31, 2018: JAMA Dermatology
Estephania Pignaton Naseri, Fernanda Garanhani Surita, Anderson Borovac-Pinheiro, Marília Santos, Simone Appenzeller, Lilian Tereza Lavras Costallat
OBJECTIVE:  To evaluate the effects of pregnancy in systemic lupus erythematosus (SLE) patients. METHODS:  The present article is a retrospective cohort study. Data were collected from medical records of pregnant women with SLE from January 2002 to December 2012 at Universidade Estadual de Campinas, in the city of Campinas, state of São Paulo, Brazil. Systemic lupus erythematosus and disease activity were defined according to the American College of Rheumatology and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) criteria respectively...
October 2018: Revista Brasileira de Ginecologia e Obstetrícia
Vanessa Ocampo-Piraquive, Ivana Nieto-Aristizábal, Carlos A Cañas, Gabriel J Tobón
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by organ damage, flare-remission pattern, and increased mortality when compared with the general population. SLE mortality depends on epidemiological, sociodemographic, genetic, and clinical factors. Mortality causes have been mainly grouped in disease activity, infections, and cardiovascular complications. Lupus nephritis and neuropsychiatric lupus are the main manifestations associated to mortality. Bacterial infection remains an important cause of death, and cardiovascular mortality is almost double when compared to age - and sex-matched comparisons...
October 19, 2018: Expert Review of Clinical Immunology
Desmond Yh Yap, Susan Yung, Tak Mao Chan
Immunosuppressive therapies for lupus nephritis (LN) have improved significantly over the past few decades, resulting in growing number of choices for treatment individualization and improved renal and patient outcomes. Corticosteroids combined with mycophenolate or cyclophosphamide induces a satisfactory response in a high proportion of Asian and Caucasian patients, but the rate of improvement varies considerably between patients. Relatively low disease flare rate was observed in Chinese patients receiving low-dose prednisolone and mycophenolate maintenance...
October 2018: Nephrology
Alfred H J Kim, Vibeke Strand, Deepali P Sen, Qiang Fu, Nancy L Mathis, Martin J Schmidt, Robin R Bruchas, Nick R Staten, Paul K Olson, Chad M Stiening, John P Atkinson
OBJECTIVE: To examine correlations between blood levels of complement split product iC3b and serum component C3 with clinically meaningful changes in disease activity in patients with systemic lupus erythematosus (SLE). METHODS: 159 consecutive subjects with American College of Rheumatology or Systemic Lupus International Collaborating Clinics classified SLE were enrolled into CASTLE (Complement Activation Signatures in Systemic Lupus Erythematosus), a prospective observational study...
October 8, 2018: Arthritis & Rheumatology
S Finzel, S Schaffer, M Rizzi, R E Voll
The causes of diseases and disorders of the immune system, which lead to the development of systemic lupus erythematosus (SLE), are not yet completely understood; however, it is known that there are various mechanisms, which can lead to SLE. The development of the disease is based on an underlying genetic disposition but is first triggered by exposure to environmental factors, such as sunburn, viral infections or vitamin D deficiency. Disease flares can also be triggered by environmental factors. Many disease manifestations are caused by pathogenic autoantibodies; hence, B‑cells and plasma cells play a critical role in the pathogenesis of SLE...
November 2018: Zeitschrift Für Rheumatologie
J Barbado, S Tabera, A Sánchez, J García-Sancho
Animal and human studies have suggested the potential of mesenchymal stromal cells (MSCs) to treat systemic lupus erythematosus (SLE). Here, we present the results of compassionate MSC treatments for three SLE patients to provide the proof of concept for a randomized and controlled clinical trial. Three patients of different ethnicities who suffer from chronic SLE, and who presented with class IV active proliferative nephritis confirmed by biopsy, were treated with allogeneic MSCs from healthy donors. Ninety million cells were infused intravenously into each patient during high and very high activity disease flare-ups and follow-up was continued for 9 months...
November 2018: Lupus
Desmond Y H Yap, Colin Tang, Gary C W Chan, Lorraine P Y Kwan, Maggie K M Ma, Maggie M Y Mok, Tak Mao Chan
OBJECTIVE: To expand the limited longterm data on sirolimus treatment in patients with lupus nephritis (LN). Our pilot short-term data suggested efficacy of sirolimus treatment in these patients. METHODS: We retrospectively reviewed 16 class III/IV/V patients with LN who have received prednisolone (PSL) and sirolimus either as initial or maintenance treatment. RESULTS: Sixteen patients received sirolimus treatment (9 because of intolerance to standard immunosuppressants and 7 because of a history of malignancy) for 45...
October 1, 2018: Journal of Rheumatology
Stephen J Balevic, Michael Cohen-Wolkowiez, Amanda M Eudy, Thomas P Green, Laura E Schanberg, Megan E B Clowse
OBJECTIVE: Pregnancies in women with active rheumatic disease often result in poor neonatal outcomes. Hydroxychloroquine (HCQ) reduces disease activity and flares; however, pregnancy causes significant physiologic changes that may alter HCQ levels and lead to therapeutic failure. Therefore, our objective was to evaluate HCQ concentrations during pregnancy and relate levels to outcomes. METHODS: We performed an observational study of pregnant patients with rheumatic disease who were taking HCQ from a single center during 2013-2016...
October 1, 2018: Journal of Rheumatology
Annabel Boeke, Bianca Pullen, Lucas Coppes, Michel Medina, Joseph J Cooper
BACKGROUND: Systemic lupus erythematosus (SLE) is known to cause neuropsychiatric symptoms (NPSLE). While not formally recognized as a syndrome associated with NPSLE, catatonia has frequently been reported. OBJECTIVE: It is important for clinicians to recognize and treat catatonia as a potential manifestation of NPSLE. We present 2 cases of SLE with catatonia and review the cases reported in the literature. METHODS: We performed a PubMed search for reported cases of catatonia in SLE...
June 27, 2018: Psychosomatics
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