Lupus最新文献

{"title":"SLE inflammatory musculoskeletal abnormalities, confirmed by MRI, show a specific profile with a worse health-related quality of life.","authors":"Patricia Corzo, Anna Agustí Claramunt, Ivan Garcia-Duitama, Irene Carrión-Barberá, Salvatore Marsico, Xavier Duran Jordà, Jordi Monfort Faure, Tarek-Carlos Salman-Monte","doi":"10.1177/09612033241301515","DOIUrl":"10.1177/09612033241301515","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if there is a clinicodemographic or serological profile associated with MRI-confirmed inflammatory musculoskeletal abnormalities in SLE patients. To investigate the relationship between these alterations and HRQoL.</p><p><strong>Methods: </strong>patients with SLE from our previous study in whom a wrist and hand MRI with contrast was performed were included. Sociodemographic, clinical, therapeutic, serological data and PROs were collected and correlated with MRI findings.</p><p><strong>Results: </strong>83 patients were analysed. Erosions and synovitis were more common in older patients (55 ± 12.61 vs 45.06 ± 12.18 years, <i>p</i> .001, 52.78 ± 12.99 vs 44.95 ± 12.49 years, <i>p</i> .011). Synovitis was less frequent in patients with nephritis (6.7% vs 24.3%, <i>p</i> .031). Treatment received showed some associations: patients with bone edema received more methotrexate (25% vs 6.3%, <i>p</i> .033), those with erosions and peritendonitis received less mycophenolic acid (5.6% vs 22.9%, <i>p</i> .034; 0% vs 12.8%, <i>p</i> .026). Peritendonitis correlated with higher SLEDAI-2K (7 ± 2.45 vs 3.64 ± 3.34, <i>p</i> .018).</p><p><strong>Worse haq: </strong>Patients with synovitis, tenosynovitis, peritendonitis and bone edema reported higher pain (6.03 ± 2.57 vs 4.26 ± 2.49, <i>p</i> .005; 6.56 ± 1.95 vs 4.76 ± 2.75, <i>p</i> .017; 8.80 ± 1.30 vs 4.95 ± 2.55, <i>p</i> .001; 6.47 ± 2.62 vs 4.83 ± 2.58, <i>p</i> .026, respectively). Patients with synovitis reported higher fatigue numerical values (2.32 ± 0.82 vs 1.91 ± 0.84, <i>p</i> .035), with tenosynovitis worse FSS-9 (61.50 ± 1.73 vs 45.70 ± 16.80, <i>p</i> .015), and with both synovitis and peritendonitis worse HAQ (1.14 ± 0.69 vs 0.75 ± 0.65, <i>p</i> .031; 1.69 ± 0.07 vs 0.90 ± 0.69, <i>p</i> .018).</p><p><strong>Conclusion: </strong>SLE patients with confirmed musculoskeletal alterations on MRI were generally older, less likely to have lupus nephritis, and received different treatments. They reported a worse HRQoL in terms of pain, fatigue and functional disability.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"10-17"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676166","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":"The problem of pain in systemic lupus erythematosus: A comprehensive analysis of pain distribution using the CHOIR body map and PROMIS measures.","authors":"Tiffany En Jiang, Sean Mackey, Beth D Darnall, Julia F Simard, Titilola Falasinnu","doi":"10.1177/09612033241301176","DOIUrl":"10.1177/09612033241301176","url":null,"abstract":"<p><strong>Background: </strong>Our study investigates the associations between pain distribution, biopsychosocial factors, and Patient-Reported Outcomes Measurement Information System (PROMIS) measures in patients with systemic lupus erythematosus (SLE). Employing self-reported pain body maps, we aim to characterize the distribution of pain and its impact on biopsychosocial measures.</p><p><strong>Methods: </strong>We retrospectively analyzed the electronic health records (EHR) of 332 adult patients with SLE attending pain clinics at an academic medical center. The study included demographics, pain distribution assessed via self-reported body maps, and PROMIS assessments of biopsychosocial experiences. We used linear regression models adjusted for age and sex to investigate associations between pain distribution and PROMIS outcomes.</p><p><strong>Results: </strong>Men, on average, indicated pain in 3.2 regions, whereas women reported pain in 5.6 regions. Women predominantly highlighted the hip, buttock, and leg region, whereas men primarily emphasized the shoulder and arm region. We found a positive correlation between pain widespreadness and worse PROMIS measures, including pain interference, behavior, fatigue, depression, anxiety, sleep disturbance, and social isolation. Additionally, widespread pain was associated with lower physical function, emotional support, and satisfaction in roles and activities. Female patients reported higher levels of pain and PROMIS measures compared to males.</p><p><strong>Conclusion: </strong>Our findings highlight the multidimensional impact of pain on SLE patients' lives underscoring the need for holistic pain management approaches. The intricate associations between pain distribution and biopsychosocial factors emphasize the importance of considering spatial dimensions of pain in clinical interventions. Further research is warranted to explore effective interventions addressing psychosocial aspects of pain in SLE, aiming to enhance patient symptom management and quality of life.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"47-56"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11663094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710470","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":"Current smoking is related to severe damage in systemic lupus erythematosus patients.","authors":"M A Cosatti, S A Muñoz, M T Tamborenea, M García, A Curti, A Cappuccio, O Rillo, P M Imamura, E Schneeberger, F Dal Pra, M Ballent, M L Cousseau, J Velasco Zamora, V Saurit, S Toloza, M C Danielsen, V I Bellomio, C Graf, S Paira, J Cavallasca, B Pons Estel, J L Cristian Moreno, M Díaz, P Alba, M Verando, G Tate, E Mysler, J Sarano, E E Civit, F Risueño, P Álvarez Sepúlveda, M S Larroude, M F Méndez, A Conforti, D Sohn, C A Helling, S Roverano, S Malm-Green, D Medina Bornachera, A Alvarez, A Eimon, G Pendón, M Mayer, J Marin, C N Pisoni","doi":"10.1177/09612033241301182","DOIUrl":"10.1177/09612033241301182","url":null,"abstract":"<p><strong>Objective: </strong>To assess the relationship between smoking exposure and organ damage accrual measured by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for Systemic Lupus Erythematosus score (SLICC-SDI) in consecutive patients with systemic lupus erythematosus (SLE) from Argentina.</p><p><strong>Methods: </strong>623 consecutive SLE patients (fulfilling ≥4, 1997 ACR criteria) were included in this cross-sectional study. Sociodemographic and disease related variables including SLICC-SDI score and smoking status were collected. Patients currently smoking were considered \"smokers\", and \"non-smokers\" those who never smoked and former smokers. SLICC-SDI was divided into two categories: <3 and ≥3 was defined as severe damage.</p><p><strong>Results: </strong>Six hundred and 23 patients were included in the analysis, 89% women. Eighty-four per cent were non-smokers and 16 % were current smokers 83 percent of patients had SLICC-SDI <3 and 17 % had SLICC-SDI ≥3. Twenty one percent of patients with SLICC-SDI ≥3 and 15% with <3 SLICC-SDI were current smokers (<i>p</i> 0.081). In the multiple regression analysis, current smoking (OR 1.82, CI 95% 1.01-3.31, <i>p</i> 0.046), older age (OR 1.04, CI 95% 1.00-1.05, <i>p</i> 0.034), disease duration (OR 1.03, CI 95% 1.00-1.07, <i>p</i> 0.021) and cyclophosphamide exposure (OR 2.97, CI 95% 1.49-5.88, <i>p</i> 0.002) were related to SLICC-SDI ≥3.</p><p><strong>Conclusion: </strong>In our sample of patients, current smoking, older age, disease duration and cyclophosphamide were related to severe damage (SLICC-SDI ≥3).</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"28-33"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648349","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":"Early subclinical macular disease in asymptomatic patients with primary antiphospholipid syndrome: A quantitative multimodal retinal evaluation.","authors":"Leandro Cabral Zacharias, Taurino Dos Santos Rodrigues Neto, Epitácio Dias da Silva Neto, Mário Luiz Ribeiro Monteiro, Gustavo Guimarães Moreira Balbi, Flávio Signorelli, Alex Haruo Higashi, Eloisa Bonfá, Danieli Castro Oliveira de Andrade","doi":"10.1177/09612033241307895","DOIUrl":"10.1177/09612033241307895","url":null,"abstract":"<p><strong>Purpose: </strong>To perform a quantitative multimodal evaluation in 25 patients with primary antiphospholipid syndrome (PAPS) without ocular complaints and to compare them with 25 healthy individuals.</p><p><strong>Methods: </strong>A structural and functional ophthalmological evaluation using optical coherence tomography angiography (OCTA) and microperimetry (MP) exam in 25 patients with PAPS, followed at a tertiary rheumatology outpatient clinic, was performed. All ophthalmologic manifestations were documented and subsequent statistical analysis was performed for comparative purposes, with significance set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>We included 100 eyes of 50 subjects (25 patients with PAPS without ocular complaints and 25 healthy individuals). Quantitative OCTA assessment revealed significant differences between PAPS patients and controls in both the superficial vascular complex (SVC) and deep vascular complex (DVC) using high-speed protocol, as well as in the SVC in the high-resolution protocol. Analysis of the foveal avascular zone (FAZ) parameters showed a larger area of FAZ in the DVC in PAPS patients using the high-speed method compared to the control group (<i>p</i> = 0.047). In MP quantitative analysis, the PAPS group exhibited lower central (<i>p</i> = 0.041) and global (<i>p</i> < 0.001) retinal sensitivity compared to the control group, along with sectoral differences, except in the inferior sector.</p><p><strong>Conclusions: </strong>PAPS patients present lower vascular density and retinal sensitivity compared to the control group, even in patients without paracentral acute middle maculopathy (PAMM). Our findings underscore the significance of ocular evaluation beyond symptomatic assessment in these patients.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"79-87"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807375","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":"The effectiveness of telitacicept in patients with systemic lupus erythematosus: A retrospective, real-world study.","authors":"Yinxiu Hu, Pengyu Wang, Xue Cao, Zhenbiao Wu, Yuan Feng","doi":"10.1177/09612033241311330","DOIUrl":"https://doi.org/10.1177/09612033241311330","url":null,"abstract":"<p><strong>Objective: </strong>Despite some study demonstrated the effectiveness of telitacicept in patients with systemic lupus erythematosus (SLE), a noticeable gap exists in real-world data. This study aimed to examine the effectiveness and safety of telitacicept in patients with SLE in the real-world.</p><p><strong>Method: </strong>This retrospective study enrolled patients with SLE at the Tangdu Hospital from January 2022 to January 2023. These patients were administered telitacicept at 80 mg or 160 mg dosage. The observed outcomes were changes in the SLE Responder Index 4 (SRI-4), disease activity, renal function, and immunological indicators.</p><p><strong>Result: </strong>Sixty-one patients were enrolled, with 60 patients completed the 24-week follow-up, and 30 completed the 52-week. The SRI-4 response rates at 4, 12, 24, and 52 weeks were 52.5%, 67.2%, 75.4%, and 80.0%, respectively. No statistically differences were observed in the SRI-4 response rates between the 80 mg and 160 mg doses at any of the time points (all <i>p</i> > 0.05). By 52 weeks, the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index scores were significant decreased from baseline (<i>p</i> < 0.001), and complement 3 and 4 levels (<i>p</i> = 0.001), albumin levels (<i>p</i> = 0.004), and the overall change in glucocorticoid dosage (<i>p</i> < 0.001) were all significantly increased, with all showing significant changes over time (<i>p</i> < 0.001). During the study, 3 (4.9%) patients experienced infection, and 1 (1.6%) developed an allergy at the injection site.</p><p><strong>Conclusion: </strong>Telitacicept exhibited a highly effective and favorable safety in patients with SLE, with improved renal and hematological manifestations and facilitated a reduction in glucocorticoid medication usage.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"9612033241311330"},"PeriodicalIF":1.9,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882201","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":"Systemic lupus erythematosus is a risk factor for having multiple subtypes of cutaneous lupus erythematosus.","authors":"Grace Lu, Larry Steven Brown, Benjamin F Chong","doi":"10.1177/09612033241311335","DOIUrl":"https://doi.org/10.1177/09612033241311335","url":null,"abstract":"<p><strong>Background: </strong>Patients with cutaneous lupus erythematosus (CLE) can present with one or multiple different subtypes of CLE. There is limited understanding of the prevalence and associated risk factors for having multiple CLE subtype diagnoses.</p><p><strong>Objective: </strong>This study characterized the frequency and risk factors for having multiple CLE subtypes.</p><p><strong>Methods: </strong>This was a cross-sectional study of 319 patients with CLE enrolled in the University of Texas Southwestern Cutaneous Lupus Registry seen in outpatient dermatology clinics at the University of Texas Southwestern Medical Center and Parkland Health from January 1, 2009 to December 31, 2021. Demographic and clinical information was collected from each subject and compared using univariate and multivariable logistic regression analyses.</p><p><strong>Results: </strong>59 subjects (18.5%) were diagnosed with two or more CLE subtypes. Univariate analyses identified statistically significant differences in rates of systemic lupus erythematosus (SLE) diagnosis, history of positive anti-nuclear antibody, arthritis, renal disorder, and serositis in patients with multiple CLE subtype diagnoses. In the multivariable analysis, SLE diagnosis was found to be statistically significant.</p><p><strong>Conclusions: </strong>Our study showed that almost one out of five CLE patients have multiple CLE subtypes, with SLE diagnosis being a significant risk factor. Clinicians can monitor CLE patients for developing multiple subtypes and account for systemic manifestations and laboratory abnormalities associated with SLE.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"9612033241311335"},"PeriodicalIF":1.9,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872276","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":"Telitacicept for refractory cystitis associated with severe systemic lupus erythematosus: A case report.","authors":"Gui-Chen Ling, Shan Zhang, Ying-Ao Guo, Shuo Yang, Zhi-Ling Li, Jian-Yong Zhang, Jing-Jing Xie","doi":"10.1177/09612033241309838","DOIUrl":"https://doi.org/10.1177/09612033241309838","url":null,"abstract":"<p><strong>Background: </strong>Lupus cystitis, a severe complication of systemic lupus erythematosus (SLE), presents considerable treatment challenges.</p><p><strong>Purpose: </strong>This case report describes the use of telitacicept in treating severe SLE with lupus cystitis.</p><p><strong>Research design: </strong>A single patient with lupus cystitis.</p><p><strong>Study sample: </strong>A patient with symptoms including frequent urination, urgency, and acute urinary retention.</p><p><strong>Data collection and analysis: </strong>Initial treatments included corticosteroid pulse therapy, immunoglobulin, and cyclophosphamide, which improved laboratory indicators but failed to alleviate symptoms of urinary retention. The patient was then treated with telitacicept.</p><p><strong>Results: </strong>Significant alleviation of urinary retention was observed shortly after incorporating telitacicept into the treatment regimen. The patient's condition remained stable with no relapse during the subsequent 10 months of follow-up.</p><p><strong>Conclusions: </strong>This case highlights the therapeutic potential of telitacicept for SLE patients who are unresponsive to conventional therapies, particularly those with severe manifestations such as lupus cystitis.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"9612033241309838"},"PeriodicalIF":1.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869529","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":"2019 EULAR/ACR classification criteria for SLE score predicts future lupus hospital admission and costs.","authors":"Saurav Suman, Hammad Ali, Connor R Buechler, Heidi C Rogers, W Neal Roberts","doi":"10.1177/09612033241310071","DOIUrl":"https://doi.org/10.1177/09612033241310071","url":null,"abstract":"<p><strong>Objective: </strong>To test the ability of the 2019 EULAR/ACR Classification Criteria for SLE score to predict lupus related hospitalization and overall cost of hospitalization.</p><p><strong>Methods: </strong>217 University of Kentucky patient records that met our preliminary inclusion criteria, 44 patients were selected by a random number generator algorithm for a thorough chart review to collect data needed for calculation of the 2019 EULAR/ACR Classification Criteria for SLE score. Total hospitalization cost was calculated by using hospital adjusted expenses per inpatient day data, which estimates the expense incurred by the hospital to provide services and thus removes the variability of charges and reimbursements introduced by insurance type.</p><p><strong>Results: </strong>Patients with a score of 19 or more had increased risk of hospitalization in at least the 6 months after initial outpatient visit as compared to their counterparts with scores less than 19 [<i>p</i>= .069]. The odds of being hospitalized for lupus among those with initial score ≥19 was 5.71 times higher than for those with score <19. Patients who scored 19 or less at initial visit had a mean hospitalization cost of $14,499, whereas those scored >19 had mean hospitalization cost of $28,725.</p><p><strong>Conclusion: </strong>This study adds to the growing evidence that 2019 EULAR/ACR Classification Criteria score for SLE can be used as a surrogate marker to assess disease severity. The weighted 2019 EULAR/ACR Classification Criteria for SLE score offers a promising tool beyond its primary objective to find true lupus cases for research and clinical trials.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"9612033241310071"},"PeriodicalIF":1.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864793","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":"Lupus and SARS-CoV-2: What have we learned after the pandemic?","authors":"Rachele Francese, Massimo Rittà, David Lembo, Manuela Donalisio","doi":"10.1177/09612033241309845","DOIUrl":"https://doi.org/10.1177/09612033241309845","url":null,"abstract":"<p><p>After the end of the COVID-19 public health emergency, we analysed the relationship between Systemic Lupus Erythematosous (SLE) and COVID-19 from the virologist's perspective based on recent findings. SLE and COVID-19 co-morbidity present unique challenges, as individuals with SLE may be at increased risk for severe COVID-19 illness due to immune system abnormalities and ongoing therapies. Effective management of both diseases requires careful monitoring, adherence to vaccination programs, preventive measures and approved and patient-tailored therapies. This review covers various aspects, including the clinical outcome of SLE patients infected by SARS-CoV-2, the impact of this infection on SLE onset or flare-ups and the benefits of vaccination for this population. Furthermore, this review presents the most recent recommendations on clinical management of COVID-19 in rheumatic patients, including those with SLE, discussing the currently available therapeutic options. Finally, we explore the most effective tools for SARS-CoV-2 diagnosis in autoimmune conditions and examine prognostic biomarkers in COVID-19 rheumatic patients with potential implications on their clinical oversight. By adopting a comprehensive approach, we address these complexities from the virologist's perspective, aiming to improve health care for this vulnerable population.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"9612033241309845"},"PeriodicalIF":1.9,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846981","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":"Serious infections and tuberculosis adversely impact outcomes of juvenile onset systemic lupus erythematosus in India.","authors":"Rudrarpan Chatterjee, Sarit Sekhar Pattanaik, Durga P Misra, Vikas Agarwal, Able Lawrence, Ramnath Misra, Amita Aggarwal","doi":"10.1177/09612033241309510","DOIUrl":"https://doi.org/10.1177/09612033241309510","url":null,"abstract":"<p><strong>Background: </strong>Infections are a major cause of morbidity and mortality in juvenile systemic lupus erythematosus (SLE). We assessed the incidence and risk factors for major infections in juvenile SLE.</p><p><strong>Methods: </strong>A retrospective review of 225 patients of juvenile SLE (ACR 1997 criteria) with age <18 years visiting the rheumatology clinic at a single centre between 2000 to 2020 was done from case records and the hospital electronic health records. Serious infection was defined as the need for hospitalization, or infection resulting in disability or death. Cox regression was used to determine factors associated with a serious infection and the effect of serious infection on overall survival.</p><p><strong>Results: </strong>We reviewed 225 children (197 girls, mean age 13.89 ± 3.42 years) with a cumulative follow up of 1153.45 person-years. Eighty serious infections occurred in 63 (28% of the cohort) children at a rate of 69.35 serious infections per 1000 person-years. A second serious infection occurred in 12 children and 5 of them developed three infections.Among the cases with known etiology (78.75% of cases), bacterial infections were most common (<i>N</i> = 33) including <i>S. Aureus</i> (11)<i>, E. Coli</i> (7)<i>, K. Pneumoniae</i> (3)<i>, E. Fecalis</i> (3)<i>, S. Pneumoniae</i> (2)<i>, Acinetobacter spp.</i> (2)<i>, Citrobacter</i> (2)<i>, Salmonella</i> (2) and <i>P. Aeruginosa</i> (1). Twenty six (32.5%) opportunistic infections occurred: <i>Mycobacterium tuberculosis</i> (18), <i>Cytomegalovirus</i> (3), disseminated <i>Herpes zoster</i> (4) and invasive candidiasis (1) with 15 (83.3%) of the tuberculosis cases being extrapulmonary. On multivariate analysis, fever (HR 8.51, 1.17-61.44), gastrointestinal involvement (HR 4.73, 1.13-19.94), current steroid dose (HR 1.36,1.14-1.62), average cumulative steroid dose per year (HR 1.004, 1.002-1.005) and cyclophosphamide (HR 2.22, 1.11-4.46) were associated with serious infection.Hospitalization rates were significantly higher in those with any serious infection (Rate-ratio 2.79, 1.81-3.77) as was damage accrual (SLICC damage index 1.04 vs 0.22). Serious infection-free survival at 1 year and 5 years was 84% (79.1-89.2) and 72% (65.4-79.2). There were 19 deaths with infection attributable mortality in 10 (52.6%). Serious infection predisposed to higher overall mortality with recurrent infections conferring a hazard ratio of 36.02 (8.07-160.62).</p><p><strong>Conclusion: </strong>Serious infections are a major cause of mortality and damage in SLE. Constitutional symptoms, gastrointestinal involvement, current and cumulative steroid dose and cyclophosphamide predict serious infections. TB prophylaxis in patients with SLE should be considered in endemic areas, especially when using high-dose steroid therapy.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"9612033241309510"},"PeriodicalIF":1.9,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142836989","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}