Lupus最新文献

{"title":"Shrinking lung syndrome in systemic lupus erythematosus: Insights from a case series and a systematic review of the past decade.","authors":"Tuane Queiroz Frota, Lysiane Maria Adeodato Ramos Fontenelle, Carlos Ewerton Maia Rodrigues","doi":"10.1177/09612033261435924","DOIUrl":"10.1177/09612033261435924","url":null,"abstract":"<p><p>AimsShrinking lung syndrome (SLS) is a rare pulmonary manifestation of systemic lupus erythematosus (SLE) and affects approximately 0.5-1% of patients. This systematic review aimed to summarize the clinical features, imaging findings, therapeutic strategies, and outcomes of SLS in patients with SLE.MethodsThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 2015 and 2025 were identified using the terms \"shrinking lung syndrome\" AND \"systemic lupus erythematosus.\" Clinical characteristics, imaging findings, pulmonary function tests, treatments, and outcomes were analyzed.ResultsA total of 52 cases were included, comprising 44 cases from the literature and 8 from a single-center case series. The mean age was 31.5 ± 7.5 years in our cohort and 38.6 years in the literature, with a marked female predominance. All patients had a prior diagnosis of SLE. Dyspnea was present in all the patients, followed by pleuritic chest pain and dry cough. The most common imaging finding was reduced lung volume with elevated diaphragmatic domes, which was observed in all the patients in our cohort and in 77.2% of the reported cases, followed by basal atelectasis. Diaphragmatic ultrasonography, performed in half of our patients, demonstrated reduced diaphragmatic excursion. Pulmonary function tests consistently revealed a restrictive ventilatory pattern with reduced diffusing capacity for carbon monoxide (DLCO). Immunosuppressive therapy as a corticosteroid-sparing strategy was used in all patients from our cohort and was the most frequently reported treatment in the literature, with rituximab being the most commonly used agent. Improvement in pulmonary function occurred in 62.5% of our patients and 50% of the reported patients, whereas stabilization was observed in approximately one-quarter of the patients. Two cases of clinical worsening, including one death, were reported.ConclusionSLS represents a potentially severe and underrecognized pulmonary complication of SLE. Despite the lack of standardized therapy, early diagnosis and timely initiation of immunosuppressive treatment beyond corticosteroids are critical for improving clinical outcomes, as evidenced by improvement in pulmonary function tests in approximately 52% of patients and the availability of effective steroid-sparing options. Prospective studies are needed to establish standardized treatment strategies.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"722-732"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone microarchitecture impairment in juvenile systemic lupus erythematosus patients: A comparative study.","authors":"Beatriz D P Rosa, Erica M Barbosa, Melissa Mariti Fraga, Jade D Fernandez, Marcelo M Pinheiro, Maria T Terreri","doi":"10.1177/09612033261436510","DOIUrl":"10.1177/09612033261436510","url":null,"abstract":"<p><p><b>Background:</b> Juvenile Systemic Lupus Erythematosus (jSLE) is a multisystem inflammatory disease associated with bone loss. However, some patients experience fractures prior to the impairment of bone mineral density (BMD), suggesting that other bone microarchitectural properties, including the Trabecular Bone Score (TBS), may contribute to an increased risk of fragility fractures. <b>Purpose:</b> To assess TBS values in patients diagnosed with jSLE; to compare them with data from an age- and sex-matched sample of healthy individuals; to associate TBS with BMD values; and to evaluate the correlation between TBS and clinical risk factors, fractures, and BMD. <b>Research Design:</b> An observational, analytical, retrospective study. <b>Study Sample:</b> Patients with jSLE aged between 5 and 19 years. <b>Data Collection:</b> Clinical data and BMD values obtained by DXA between 2017 and 2022 at a quaternary care center were analysed. The BMD and TBS data were compared with existing published data from healthy Brazilian children and adolescents after age and sex matching. <b>Results:</b> Ninety-four examinations from 50 jSLE patients were analysed. Twenty-one (22.3%) examinations showed significantly lower TBS values than controls. TBS was lower in female patients aged 14-16 and 17-19 years compared with their peers (1.381 vs 1.466 and 1.397 vs 1.479, respectively). BMD and TBS were concordant in 80/94 (85.1%) examinations, demonstrating a moderate and positive correlation (<i>p</i> < 0.0001). There was no correlation between TBS and previous fractures, disease duration, high disease activity, cumulative glucocorticoid dose, or the presence of fragility fractures. <b>Conclusion:</b> Patients with jSLE exhibited bone microarchitectural impairment, regardless of previous fragility fractures, disease duration, disease activity, or cumulative glucocorticoid exposure.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"745-752"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147474112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut and oral microbiota characterized in systemic lupus erythematosus patients from India: A pilot study.","authors":"Josna Joseph, Santosh K Patnaik, Dilip Abraham, John Mathew, Jessy Alexander","doi":"10.1177/09612033261432163","DOIUrl":"10.1177/09612033261432163","url":null,"abstract":"<p><p><b>Introduction</b>: Systemic lupus erythematosus (SLE) is a multifaceted autoimmune disorder influenced both intrinsically by immune cell alterations, genetic factors, and the microbiome, as well as extrinsically by environmental factors. <b>Methods</b>: In this pilot study, we investigated the role of various peripheral immune cells (CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺, CD4-/CD8-, NK cells (CD16⁺CD56⁺), and CD19⁺) and the gut and salivary microbiota in patients with SLE, comparing these factors to healthy controls. <b>Results and Discussion</b>: Results showed significant alterations in the proportions of CD4⁺ and CD8⁺ T cells in SLE patients, with an inverse correlation between these subsets. Additionally, the CD4⁺ ratio was found to be elevated in SLE. CD4⁺ T cells were strongly correlated with double-negative T cells, while CD8⁺ T cells correlated with NK cells. Metagenomic shotgun sequencing of fecal and salivary samples revealed a disruption in the microbiome, particularly the taxa <i>Pasteurellaceae</i> and <i>Veillonella</i>, which were altered in both the gut and oral microbiomes of SLE patients. These changes suggest that there may be overlap in the composition and function of these microbial populations across different body sites. Dysbiosis was observed in both the gut and oral microbiomes of individuals with SLE, distinguishing them from healthy controls. <b>Conclusion</b><i>:</i> Our findings highlight specific microbiome alterations in SLE patients and suggest that microbiome composition could serve as a potential exploratory tool for diagnosing and prognosticating the disease in larger, adequately powered cohorts.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"667-677"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency and clinical associations of Epstein-Barr virus molecular detection in systemic lupus erythematosus: A follow-up study.","authors":"Rodrigo Cutrim Gaudio, Alice Ramos-Silva, Katia Lino Baptista, Higor França Lima, Lilian Alves, Ana Patrícia Lemos, Natalia Rodrigues Querido Fortes, Daniele Maia de Jesus Valviesse, Fabiana Rabe Carvalho, Andrea Alice Silva, Jorge Reis Almeida, Thalia Medeiros","doi":"10.1177/09612033261435930","DOIUrl":"10.1177/09612033261435930","url":null,"abstract":"<p><p>BackgroundThe \"viral hypothesis\" as an environmental factor that potentially triggers/modulates autoimmune diseases has been studied. Epstein-Barr virus (EBV) stands out as a relevant agent in the pathogenesis of systemic lupus erythematosus (SLE). Therefore, our aim was to evaluate the frequency of EBV molecular detection and its possible clinical and laboratory associations in a prospective cohort of SLE patients.MethodsAn observational prospective study was conducted and SLE patients were evaluated at two timepoints: baseline and after 6 months of follow-up. Clinical and laboratory data were collected from medical records and disease activity (SLEDAI-2K) and accumulated damage (SLICC-DI) scores were calculated. EBV-DNA was detected by real-time polymerase chain reaction (qPCR).ResultsWe included 104 patients, 93.2% (<i>n</i> = 97) female with a mean age of 42.6 ± 13.45 years-old. At baseline, 39 (37.5%) patients presented detectable EBV-DNA and this frequency significantly increased at follow-up to 55.4% (p = .02). EBV detection was correlated with laboratory parameters, such as higher serum creatinine (p = .02), urea (p = .04) and ferritin (p = .04) at baseline. In patients with higher viral load (>1000 copies/mL), there was a slight increase in the median SLEDAI-2K (p = .07). Lastly, an age-adjusted logistic regression analysis indicated that immunosuppression at baseline was significantly associated with EBV-DNA positivity (OR = 2.86; 95%CI = 1.08-7.57; p = .03).ConclusionThe significant increase in EBV positivity during the follow-up of SLE patients may indicate a dynamic variation of viral replication. Moreover, our findings suggest a possible association between EBV, renal manifestations and systemic inflammation in SLE. Finally, we identified that immunosuppression may favor viral replication.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"678-687"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A conceptual model of the patient experience of cutaneous lupus erythematosus.","authors":"Kate Burrows, Ella Brookes, Laurence Lucats, Jane R Wells, Adeebah Adams, Veronika Steinerova, Nidhi Saiwal, Ginchereau Sowell France","doi":"10.1177/09612033261435949","DOIUrl":"10.1177/09612033261435949","url":null,"abstract":"<p><p>BackgroundThere is limited qualitative research on the patient experience of cutaneous lupus erythematosus (CLE), and no fit-for-purpose patient-reported outcome (PRO) instruments are currently available in this population. This study aimed to better characterise the disease experience of CLE, focusing on the most prevalent subtypes, discoid lupus erythematosus (DLE) and sub-acute CLE (SCLE), and to develop a conceptual model depicting the core signs, symptoms, and impacts of the disease.MethodsSemi-structured, concept elicitation interviews were conducted in the United States among 25 patients with CLE (<i>n</i> = 15 DLE; <i>n</i> = 10 SCLE) and three expert clinicians to explore the signs, symptoms, and impacts of CLE. Interviews were audio-recorded and verbatim transcripts were coded and thematically analysed. Concepts reported by ≥ 50% of patients with an average bothersome rating of ≥5/10 were considered salient.ResultsThe most frequently reported signs and symptoms included itch (<i>n</i> = 25/25), skin lesions (<i>n</i> = 24/25), skin sensitivity to light (<i>n</i> = 23/25), skin redness (<i>n</i> = 22/25), skin scaling (<i>n</i> = 20/25), fatigue (<i>n</i> = 21/25), skin crusting, skin pain, joint pain, headaches (<i>n</i> = 19/25, each), and hair loss (<i>n</i> = 18/25). The most frequently reported impacts included limited social functioning (<i>n</i> = 22/25), body image concerns (<i>n</i> = 21/25), affected family/partner relationships (<i>n</i> = 19/25), recreational/leisure activities (<i>n</i> = 18/25), and sleep (<i>n</i> = 16/25). Key signs, symptoms, and impacts reported were generally consistent across SCLE and DLE subtypes, although patients with DLE reported greater scalp involvement and hair loss. The conceptual model summarises the core signs, symptoms, and impacts of CLE, while also highlighting any subtype-specific differences.ConclusionsThis study provides robust patient insights into the signs, symptoms, and impacts of CLE, with skin lesions, itch, skin sensitivity to light, hair loss, and fatigue emerging as most bothersome to patients. Scalp lesions warrant additional consideration due to their potential to cause permanent hair loss and scarring. This conceptual model can be used to identify target concepts for measurement and inform the development and selection of fit-for-purpose PRO instruments.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"688-698"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adoption of multimodal echocardiography in evaluating left ventricular systolic synchrony in patients with systemic lupus erythematosus.","authors":"Rui Liu, Biao Zhu, Lingyuan Zhu, Fangping Bi, Weiqun Li","doi":"10.1177/09612033261415991","DOIUrl":"10.1177/09612033261415991","url":null,"abstract":"<p><p>Objectiveit was to assess the value of multimodal ultrasound imaging technology in assessing left ventricular (LV) systolic (LVS) function in patients with systemic lupus erythematosus (SLE).Methods88 patients with SLE were designated as disease group (DG), and 50 healthy individuals served as control group (CG). Both groups underwent color Doppler ultrasound scanning to obtain conventional 2D echocardiography, 3D echocardiography, and 3D speckle tracking imaging (3D-STI) parameters. Spearman correlation analysis assessed the relationship between 3D-STI parameters and LV ejection fraction, and ROC curves were plotted.ResultsDG exhibited substantial differences versus CG in LV end (LVE)-diastolic volume, stroke volume, cardiac output, LVE-diastolic mass, LVE-systolic mass, and LV shortening fraction (<i>P</i> < 0.05). DG demonstrated greatly inferior values for 3D-STI systolic parameters, including overall LV longitudinal strain, overall LV circumferential strain, overall LV radial strain, and overall LV area strain, to CG (<i>P</i> < 0.05). The LV synchrony analysis revealed that, compared to the CG, the DG showed a significant increase in the peak values of longitudinal, radial, and circumferential strains in the 16th and 12th segments, the peak values of rotational angle in the 12th segment, the time differences between these values and the LV minimum systolic volume time, as well as the time to minimum systolic volume in the 16th segment (Tmsv-16) (<i>p</i> < 0.05). The intraclass correlation coefficient (ICC) for Tmsv-16 was 0.90, and the coefficient of variation (CV) was 4.5%, outperforming other indicators. Furthermore, the DG exhibited significantly higher levels of biomarkers, including brain natriuretic peptide (BNP), creatine kinase MB isoenzyme (CK-MB), anti-cardiac actin antibodies (anti-α-actin), and high-sensitivity C-reactive protein (hs-CRP), compared to the CG (<i>p</i> < 0.05). The diagnostic performance of the 3D-STI systolic parameters was as follows: overall LV longitudinal strain had sensitivity (<i>Sen</i>) of 85.23% and specificity (<i>Spe</i>) of 68%; overall LV circumferential strain had <i>Sen</i> of 90.91% and <i>Spe</i> of 78%.Conclusionmultimodal 2D echocardiography combined with 3D echocardiography parameters offers high <i>Sen</i> in predicting LVS function in patients with SLE.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"753-763"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LUNELORD: A descriptive, prospective study on the demographics, disease characteristics and health-related quality of life of patients with LUpus NEphritis and long-term ORgan damage in rheumatology clinics in the Arabian Gulf.","authors":"Jamal Al-Saleh, Faisal Elbadawi, Rajaie Namas, Mohamed Elarabi, Samar Al-Emadi, Miral H Gharib, Khalid A Alnaqbi, Hiba Khogali, Humaid A Al Wahshi, Sadiq Abdul Baqi, Amjad Alkadi, Suad Hannawi, Samah Allam, Reem Al-Jayyousi, Mohamed Hamouda, Averyan Vasylyev, Evelina Zimovetz, Munther Khamashta","doi":"10.1177/09612033261432164","DOIUrl":"10.1177/09612033261432164","url":null,"abstract":"<p><p>BackgroundLupus nephritis (LN) is a major cause of morbidity and mortality among patients with systemic lupus erythematosus. However, there is a paucity of literature on the clinical characteristics and standard of care of patients in the Arabian Gulf. The LUNELORD study aimed to describe the demographics, clinical characteristics, treatment patterns and health-related quality of life (HRQoL) of patients with LN in the region.MethodsEligible adult patients with LN were enrolled from rheumatology centres in the UAE, Qatar, Oman and Kuwait and followed up for 12 months of routine care. Data were abstracted retrospectively from available medical charts up to 12 months prior to study enrolment, and prospectively from patients' medical charts after each follow-up visit. Patients completed the 36-Item Short Form Health Survey (SF-36) at the baseline and Month 12 visits to assess HRQoL.ResultsIncluded patients (<i>N</i> = 193) were predominantly female (83.9%) and of Arab ethnicity (85.0%), with a mean (standard deviation [SD]) age of 37.2 (10.4) years. Among patients with available data, renal biopsy was performed in 123 (64.4%) patients, and most had ISN/RPS class V (23.4%), IV (22.7%) or III (20.6%) LN. At baseline, the most frequently used medications were hydroxychloroquine (96.4%), prednisolone (78.8%) and mycophenolate mofetil (69.3%). Renal remission was achieved by 123 (63.7%) patients during the follow-up period; end-stage renal disease occurred in 12/177 (6.8%) patients. A significant association was found between reduced anti-double-stranded DNA levels and occurrence of renal remission at Months 3, 6 and 9. Significant improvements from baseline to Month 12 were observed in the mean (SD) general health SF-36 domain score (+9.5 [42.5]; <i>p</i> = 0.002); overall SF-36 and other domain scores remained constant.ConclusionsLUNELORD demonstrated a substantial burden of LN disease among patients and highlighted variable adherence to international management and treatment guidelines among rheumatologists in the Arabian Gulf. These findings emphasise the need for early diagnosis, careful monitoring and effective management to optimise renal outcomes and patient HRQoL, which may be achieved by increasing awareness of, and compliance with, international guidelines.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"653-666"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient perspectives on SLE, refractory APS, and biologic drug use during pregnancy.","authors":"Jara van Woerkom, Merlijn Wind, Yoe Kie Onno Teng, Titia Lely, Jamy Pullen, Gerard Jansen, Luis Perez-Garcia, Radboud Dolhain, Maarten Limper, Judith Kooiman","doi":"10.1177/09612033261437466","DOIUrl":"10.1177/09612033261437466","url":null,"abstract":"<p><p>PurposeWomen with Systemic Lupus Erythematosus (SLE) and/or Antiphospholipid Syndrome (APS) have an increased risk of pregnancy complications. This study explored their perspectives on pregnancy, pregnancy complications, and medication use during pregnancy.MethodsIn collaboration with the Dutch National Patient Association for Lupus Erythematosus, an online questionnaire was developed and distributed among female members. The questionnaire presented eight potential pregnancy complication scenarios. Respondents indicated whether they found the standard medication regime sufficient and their willingness to take additional medication. They also assessed which side effects of biological therapies would discourage additional treatment. The survey ran from November 18, 2023, to March 19, 2024.Major findingsOf 71 respondents (mean age 39), 42% had APS, 31% had SLE, and 27% had both. A majority (79%) would endure pregnancy complications, such as SLE flare or pre-eclampsia, if it meant a live-born baby. Willingness to use additional medication varied by scenario (51%-89%) depending on the specific complication at risk. Most side effects associated with the use of biologicals were deemed acceptable by the majority of respondents. However, a slight majority indicated they would refrain from additional medication if it led to an increased risk of infections such as urinary tract infections or pneumonia.ConclusionMost women would accept adverse obstetric outcomes or maternal complications as long as pregnancy results in a live birth. The majority of respondents consistently expressed a desire for additional medication to reduce the risk of complications during pregnancy, regardless of the specific complication at hand.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"699-708"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of cardiovascular morbidities in children and adolescents with lupus nephritis from south India: A cross-sectional analytical study.","authors":"Nithya Ramaswamy, Avinash Anantharaj, Ramesh Ananthakrishnan, Zachariah Bobby, Sudarsan Krishnasamy, Bobbity Deepthi, Sriram Krishnamurthy","doi":"10.1177/09612033261435956","DOIUrl":"10.1177/09612033261435956","url":null,"abstract":"<p><p>BackgroundPremature atherosclerosis and cardiovascular morbidity are known in adults with Systemic Lupus Erythematosus (SLE); however, there is paucity of data in Indian children with lupus nephritis (LN), who may be at higher cardiovascular risk due to ethnic differences.MethodsThis cross-sectional study was conducted at the pediatric nephrology clinic of a referral hospital in south India. Forty children with LN >1 year disease duration and 40 healthy-controls were enrolled. Brachial artery flow-mediated dilatation (FMD), carotid intima medial thickness (cIMT), and echocardiography for left ventricular (LV) mass, LV systolic and diastolic function, and global-longitudinal-strain (GLS) were done.ResultsMean age at SLE and LN diagnosis were 10.07 years and 10.68 years respectively, with median LN disease duration of 3.2 years. Class 3 and Class 4 LN accounted for 67.5% of the cases. Overall, 6 (15%) LN cases had concentric LVH, while 4 (10%) had biplane ejection fraction≤ 55%. Mean resting brachial artery diameter was lower in cases (<i>n</i> = 40) than age and sex-matched healthy-controls (<i>n</i> = 40) (2.7 mm vs 2.9 mm, <i>p 0.010</i>), although median proportionate change in FMD was comparable [13.84% (8.17%, 20.31%) versus 14.49% (12.21%, 17.24%); <i>p 0.413</i>]. However, proportionate change in FMD <10% was more prevalent in cases vs controls (35% vs 10%, p 0.007). Cardiac assessments showed higher A-wave velocity (69.03 ± 18.0 cm/s vs 58.64 ± 11.93 cm/s, <i>p 0.003</i>) and lower E/A ratio (1.56 ± 0.49 vs 1.80 ± 0.44, <i>p 0.030</i>) in cases vs controls; with elevated medial a' velocity (8.98 ± 2.01 vs 7.94 ± 2.12 cm/s, <i>p 0.030</i>). Pulmonary venous Doppler revealed shorter atrial reversal duration (85.82 ± 18.7 vs 102.25 ± 17.8 ms, <i>p 0.001</i>) and reduced A-wave duration (118.08 ± 19.73 vs 128.67 ± 20.27 ms, <i>p 0.023</i>) among cases. GLS was lower in cases (-21.59 ± 3.06% vs -22.95 ± 2.38%, <i>p 0.030</i>), and median LV mass was higher in cases vs controls (92.7 g vs 72.1 g, <i>p < .001</i>).ConclusionSouth Indian children with LN of >1 year disease duration demonstrate significant cardiovascular comorbidities, including evidence of endothelial dysfunction, as well as LV systolic and diastolic dysfunction.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"733-744"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147458254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond glomeruli in lupus nephritis: Impact of tubulointerstitial inflammation and interstitial fibrosis/tubular atrophy on renal function decline - A systematic review and meta-analysis.","authors":"Kenzo Ogasawara Donato, Akio Ogasawara Donato, Lucas Ferraz Gonçalves, Pedro Maia, Gustavo Garrido, Philippe Quadros, André Nishizima, Laura Mesquita, Adriano Mota, Gabriel Jacob Moreno, Alleh Nogueira, Carlos Antonio Moura","doi":"10.1177/09612033261437467","DOIUrl":"10.1177/09612033261437467","url":null,"abstract":"<p><p>BackgroundTo evaluate the prognostic impact of tubulointerstitial inflammation and interstitial fibrosis/tubular atrophy on renal function decline in patients with lupus nephritis.MethodsThis systematic review and meta-analysis followed PRISMA and Cochrane guidelines and was registered in PROSPERO (CRD420251045672). PubMed, Embase, Web of Science, and Cochrane were searched for studies evaluating the association between tubulointerstitial histopathologic lesions in lupus nephritis and renal outcomes. Risk ratios were pooled using random-effects models. Prespecified subgroup analyses were conducted according to follow-up duration, and sensitivity analyses included leave-one-out testing and restriction to studies defining ≥25% tubulointerstitial involvement. Meta-regression was performed to explore study-level sources of heterogeneity. Risk of bias was assessed using the Newcastle-Ottawa Scale. Analyses were performed in RStudio.ResultsTwenty-one retrospective studies encompassing 3607 adult patients with lupus nephritis were included. Tubulointerstitial inflammation (TII) was associated with an increased risk of renal function decline (RR 2.22; 95% CI 1.75-2.82), as was interstitial fibrosis/tubular atrophy (IFTA) (RR 3.44; 95% CI 2.70-4.38). No significant difference was observed between TII and IFTA regarding renal outcomes (RR 0.78; 95% CI 0.59-1.03). In subgroup analyses stratified by follow-up duration, the association between TII and renal decline was stronger in studies with longer follow-up (>5 years), whereas IFTA conferred a consistently elevated risk across follow-up strata. Sensitivity analyses, including leave-one-out testing, confirmed the robustness of findings. Funnel plot symmetry and Egger's test (<i>p</i> = 0.9074) indicated no evidence of publication bias. Study-level meta-regression suggested that the association between TII and renal decline varied according to the distribution of proliferative glomerular classes, while the association for IFTA was not significantly modified by glomerular pattern.ConclusionThis meta-analysis found that both interstitial fibrosis/tubular atrophy (IFTA) and tubulointerstitial inflammation (TII) are significantly associated with renal function decline in lupus nephritis, suggesting a worse prognosis. These findings highlight the prognostic relevance of tubulointerstitial lesions in lupus nephritis.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"709-721"},"PeriodicalIF":1.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}