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Lupus flare

Pattarin Tangtanatakul, Siriwan Klinchanhom, Pimpayao Sodsai, Thitima Sutichet, Chutipha Promjeen, Yingyos Avihingsanon, Nattiya Hirankarn
BACKGROUND: The contents of exosomes determine their biological functions and represent a new class of epigenetic modulation of renal cells considering as novel class of biomarker. OBJECTIVE: Our study aims to investigate the expression of microRNAs (miRNA), including miR-10a/b, let-7a, and miR-21, in urinary exosomes isolated from patients with active lupus nephritis (LN) compared to inactive LN. METHODS: The exosomes were obtained from long-term follow up LN patients during active and 4 months after treatment (n = 3)...
August 13, 2018: Asian Pacific Journal of Allergy and Immunology
Vijay Gayam, Amrendra Kumar Mandal, Mazin Khalid, Jaspreet Kaler, Shivani Thapa, Pavani Garlapati, Arshpal Gill, Ragin Alex, Binav Shrestha
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease which can manifest in many different organ systems. Gastrointestinal (GI) involvement is common in SLE, but the symptoms are usually mild. More severe GI complications including acute pancreatitis and peptic ulcer bleeding are rare but represent a significant risk of morbidity and mortality. We present a case of a 25-year-old Hispanic female with a severe SLE flare. The initial presentation included symptoms of hematemesis and epigastric abdominal pain secondary to both gastric ulceration and acute pancreatitis, an atypical presentation of an SLE flare...
August 2018: Gastroenterology Research
Megha Garg, Naaima Mufti, Tara Palmore, Sarfaraz Hasni
Patients with Systemic Lupus Erythematosus (SLE) pose a unique dilemma pertaining to immunization against common pathogens. SLE patients are usually not immunized with vaccines based on the fear of either precipitating infection in this immunosuppressed patient population (with live vaccines) or aggravating autoimmunity and hence lupus flares (with any vaccines). However, elevated vulnerability to infection makes patients with SLE precisely the population that needs protection from vaccine-preventable diseases...
August 10, 2018: Autoimmunity Reviews
Nathalie Costedoat-Chalumeau, Frédéric Houssiau, Peter Izmirly, Véronique Le Guern, Sandra Navarra, Meenakshi Jolly, Guillermo Ruiz-Irastorza, Gabriel Baron, Eric Hachulla, Nancy Agmon-Levin, Yehuda Shoenfeld, Francesca Dall'Ara, Jill Buyon, Christophe Deligny, Ricard Cervera, Estibaliz Lazaro, Holy Bezanahary, Gaëlle Leroux, Nathalie Morel, Jean-François Viallard, Christian Pineau, Lionel Galicier, Ronald Van Vollenhoven, Angela Tincani, Hanh Nguyen, Guillaume Gondran, Noel Zahr, Jacques Pouchot, Jean-Charles Piette, Michelle Petri, David Isenberg
Nonadherence to treatment is a major cause of lupus flares. Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half-life and can be quantified by high-performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ <200 ng/ml or undetectable desethylchloroquine), and self-administered questionnaires (MASRI <80%). Drug levels defined 18.4% of the patients as severely nonadherent. In multivariate analyses, younger age, nonuse of steroids, higher body mass index, and unemployment were associated with nonadherence by drug level...
August 6, 2018: Clinical Pharmacology and Therapeutics
Tarek Carlos Salman-Monte, Irene Carrión-Barberà, Carolina Pérez García, Javier Gimeno Beltrán, Jordi Monfort
Systemic lupus erythematosus (SLE) is an autoimmune disease with a wide clinical expression, and musculoskeletal manifestations are the most frequent manifestations of the disease. Digestive manifestations, however, are less prevalent, appearing in only 2%-30% of the patients. Among these cases, the association of SLE with autoimmune hepatitis (AIH) is considered to be rare, with only a few cases documented in the medical literature. We present the only reported case to date of a patient diagnosed with SLE suffering from a flare with a simultaneous hepatic and muscular inflammatory involvement, both evidenced by biopsy...
January 22, 2018: European Journal of Rheumatology
A Aggarwal, S Phatak, P Srivastava, A Lawrence, V Agarwal, R Misra
Introduction About 10-20% of systemic lupus erythematosus (SLE) patients have onset in childhood and have more severe organ involvement. Survival of juvenile SLE patients is improving worldwide. Long-term data of childhood onset SLE from developing countries is scarce. Methods Clinical and laboratory data at initial presentation and follow-up visits were retrieved from clinic files, hospital information system and personal interviews. Treatment received, complications, flares, outcomes and death were recorded...
August 2, 2018: Lupus
Cristina Pamfil, Zuzanna Makowska, Aurélie De Groof, Gaëlle Tilman, Sepideh Babaei, Christine Galant, Pauline Montigny, Nathalie Demoulin, Michel Jadoul, Selda Aydin, Ralf Lesche, Fiona McDonald, Frédéric A Houssiau, Bernard R Lauwerys
OBJECTIVES: Chronic renal impairment remains a feared complication of lupus nephritis (LN). The present work aimed at identifying mechanisms and markers of disease severity in renal tissue samples from patients with LN. METHODS: We performed high-throughput transcriptomic studies (Illumina HumanHT-12 v4 Expression BeadChip) on archived kidney biopsies from 32 patients with LN and eight controls (pretransplant donors). Histological staging (glomerular and tubular scores) and immunohistochemistry experiments were performed on the same and on a replication set of 37 LN kidney biopsy samples...
July 31, 2018: Annals of the Rheumatic Diseases
Alejandro Vilas-Sueiro, Daniel González-Vilas, Cristina Aguilera, Benigno Monteagudo, Cristina De De Las Heras
Dear Editor, Lupus panniculitis or lupus profundus is a rare inflammatory complication found in patients with systemic lupus erythematosus (SLE), or discoid lupus erythematosus (DLE) (1). When the breast is involved, the term lupus mastitis (LM) is used. This disease involving the breast is rare, and the lesions may precede, coincide with, or occur later than the onset of other lupus lesions. Tissue biopsy is required to confirm the suspected diagnoses of LM. We report a case of a patient with lupus mastitis due to the important differential diagnosis...
December 2017: Acta Dermatovenerologica Croatica: ADC
Simran Kaur Nahal, Carlo Selmi, M Eric Gershwin
Systemic lupus erythematosus (SLE) primarily affects women of childbearing age. One of the major changes in SLE focuses on the timing of a successful pregnancy. In the past, pregnancy was strongly discouraged in SLE, especially in the presence of risk factors such as nephritis, use of immunosuppressive therapies, or positivity of specific autoantibodies such as anti-phospholipids and anti-Ro/SSA, La/SSBA. Thanks to our better knowledge on the disease and management, pregnancy success rates in SLE patients have significantly improved care by the a multidisciplinary team which fosters a successful pregnancy with minimal complications for the mother and fetus when the disease is inactive or in remission...
July 27, 2018: Journal of Autoimmunity
Jorge Romo-Tena, Roberto Reyna-de la Garza, Isaac Bartnicki-Navarrete, Jorge Alcocer-Varela, Diana Gómez-Martin
The primary aim of this study was to assess demographic, clinical, and serological factors associated with remission in systemic lupus erythematosus (SLE). A retrospective cohort study was performed. We examined relevant features in patients with SLE with a follow-up of at least 8 years from active disease (SLE Disease Activity Index-2000 [SLEDAI-2K] ≥6). The primary outcome was to assess various remission states in SLE according to disease activity and treatment. Differences between groups were assessed by Student's t test and chi-square test for continuous and categorical variables, respectively...
July 28, 2018: Clinical Rheumatology
Konstantinos Tselios, Dafna D Gladman, Zahi Touma, Jiandong Su, Nicole Anderson, Murray B Urowitz
BACKGROUND: We recently showed that low disease activity (LDA), defined as a clinical SLEDAI-2K≤2, maintained for 12 months, confers the same risk for damage accrual as complete remission after two years. The aim of the present study was to assess the validity of these findings in the long term (10 years). PATIENTS AND METHODS: The inception patients of the Toronto Lupus Clinic with a minimum follow-up of 10 years and no interval >18 months between consecutive visits were investigated...
July 28, 2018: Arthritis Care & Research
Zakaria Hindi, Mosa Hussein, Abdallah Gad, Abdallah A Khaled, Talal Zahoor
Catastrophic antiphospholipid syndrome is a rare disorder that remains under-recognized causing a high mortality rate even with treatment. Factors such as infections and systemic lupus erythematosus flare play as an inciting event in the thrombotic crisis which underlies catastrophic antiphospholipid syndrome. The use of plasmapheresis has improved the outcome of such cases with a reduction in mortality rate from over 50% to less than 30%, according to some studies. However, the definitive treatment of this disabling and fatal condition remains an area warranting research...
2018: SAGE Open Medical Case Reports
Marcelo De Rosa, Francisco Azzato, Jorge E Toblli, Graciela De Rosa, Federico Fuentes, Haikady N Nagaraja, Ryan Nash, Brad H Rovin
One of the most difficult management issues in lupus nephritis (LN) is the optimal duration of maintenance immunosuppression after patients are in clinical remission. Most patients receive immunosuppression for years, based mainly on expert opinion. Prospective data are unavailable. Complicating this issue are data that patients in clinical remission can still have histologically active LN; however, the implications of this are unknown. To study this, the Lupus Flares and Histological Renal Activity at the end of Treatment study (ClinicalTrial...
July 20, 2018: Kidney International
Qianwen Li, Haijing Wu, Wei Liao, Ming Zhao, Vera Chan, Linfeng Li, Min Zheng, Genhui Chen, Jianzhong Zhang, Chak-Sing Lau, Qianjin Lu
Lupus erythematosus (LE) is an autoimmune disease with a broad clinical spectrum ranging from cutaneous lesions to severe systemic manifestations. The pathogenesis of the disease and the immunological mechanisms for the heterogeneities in lupus remain unclear. The LE-specific cutaneous manifestations are generally divided into three categories: acute cutaneous LE (ACLE), subacute cutaneous LE (SCLE) and chronic cutaneous lupus erythematosus (CCLE). Clinically, lupus patients with skin lesions can be divided into two subsets based on the organs involved: cutaneous LE, such as DLE and SCLE, which appears only as a skin manifestation, and systemic lupus erythematosus (SLE), e...
July 11, 2018: Journal of Autoimmunity
Chi Chiu Mok, Eric T Bro, Ling Yin Ho, Ravinder J Singh, Paul J Jannetto
The aim of this study is to evaluate the relationship between baseline serum 25-hydroxyvitamin D3 levels and SLE activity/flares over time. This is a longitudinal study of 276 patients who fulfilled ≥ 4 ACR criteria for SLE and recruited in the year 2011. Serum samples were collected at baseline and assayed for 25-hydroxyvitamin D3 at the end of a mean follow-up of 32.5 months. Participants were stratified into three groups according to baseline 25-hydroxyvitamin D3 levels: group I (< 15 ng/ml, deficiency), group II (15-30 ng/ml, insufficiency), and group III (> 30 ng/ml, adequate)...
July 16, 2018: Clinical Rheumatology
E Nasonov, S Soloviev, J E Davidson, A Lila, G Togizbayev, R Ivanova, Ch Baimukhamedov, Zh Omarbekova, O Iaremenko, A Gnylorybov, S Shevchuk, A Vasylyev, J Makarova, L Tariq
OBJECTIVES: To evaluate healthcare resource (HR) consumption associated with Systemic Lupus Erythematosus (SLE) management in adult patients with active autoantibody positive disease in the Russian Federation, Republic of Kazakhstan, and Ukraine. METHODS: The ESSENCE was a retrospective, observational study, and included data on patients' clinical characteristics and SLE-related HR use (laboratory, biopsy, imaging tests, medications, visits to specialists, outpatient visits, hospitalizations) during 2010 from the 12 specialized rheumatologic centers...
July 25, 2018: Journal of Medical Economics
Jaiben George, Kesavan P Sankaramangalam, Aditi Sinha, Pankaj Hari, Amit K Dinda, Arvind Bagga
OBJECTIVE: To evaluate the incidence of flares and treatment resistance in children with lupus nephritis and their association with renal outcomes. METHODS: We retrospectively reviewed the case records of 34 children treated for lupus nephritis (Class II-IV) at a single center. Patients were followed for a minimum of five years to evaluate treatment response, onset of flares, and renal survival. Regression analyses were performed to identify the factors associated with treatment refractoriness, incidence of flares and renal survival...
June 15, 2018: Indian Pediatrics
D J Go, J Y Lee, M J Kang, E Y Lee, E B Lee, E C Yi, Y W Song
Lupus nephritis (LN) is a major complication of systemic lupus erythematosus (SLE). Conventional biomarkers for assessing renal disease activity are imperfect in predicting clinical outcomes associated with LN. The aim of this study is to identify urinary protein biomarkers that reliably reflect the disease activity or predict clinical outcomes. A quantitative proteomic analysis was performed to identify protein biomarker candidates that can differentiate between SLE patients with and without LN. Selected biomarker candidates were further verified by enzyme-linked immunosorbent assay using urine samples from a larger cohort of SLE patients ( n = 121) to investigate their predictive values for LN activity measure...
January 1, 2018: Lupus
Christine Anastasiou, Olivia Dulai, Amrutha Baskaran, James Proudfoot, Samuel Verhaegen, Kenneth Kalunian
Objectives: To describe how immunosuppressant use and hospitalisation patterns for SLE have evolved by comparing admission statistics at one academic centre between 2005 and 2013. Methods: We identified admissions for SLE and for all hospitalised patients by using the hospital electronic database. For adult patients with SLE, a comprehensive chart review was conducted to identify primary indications for hospitalisation, in-hospital mortality, mean length of stay and immunosuppressant use...
2018: Lupus Science & Medicine
Daniel Toro-Domínguez, Jordi Martorell-Marugán, Daniel Goldman, Michelle Petri, Pedro Carmona-Sáez, Marta E Alarcón-Riquelme
OBJECTIVES: The highly heterogeneous clinical presentation of lupus is characterized by the unpredictable appearance of flares of disease activity and important organ damage. Attempts to stratify lupus patients have been limited to clinical information, leading to unsuccessful clinical trials and controversial research results. Our aim was to develop and validate a robust method to stratify patients with lupus according to longitudinal disease activity and whole-genome gene expression data in order to establish subgroups of patients who share disease progression mechanisms...
June 25, 2018: Arthritis & Rheumatology
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