Lupus Science & Medicine最新文献

{"title":"Corneal confocal microscopy: a novel biomarker of small fibre neuropathy in SLE.","authors":"Miral H Gharib, Georgios Ponirakis, Soha O M Dafaalla, Hoda Gad, Einas Elgassim, Hadeel B Zaghloul, Adnan Khan, Ioannis N Petropoulos, Gulfidan Bitirgen, Samar Al Emadi, Rayaz A Malik","doi":"10.1136/lupus-2025-001645","DOIUrl":"https://doi.org/10.1136/lupus-2025-001645","url":null,"abstract":"<p><strong>Objective: </strong>Small fibre neuropathy (SFN) is an under-recognised complication of SLE that contributes to chronic pain and reduced quality of life. We assessed the utility of corneal confocal microscopy (CCM) for identifying small fibre damage in SLE in relation to disease activity, neuropathic pain and quality of life.</p><p><strong>Methods: </strong>Participants with SLE and healthy controls underwent CCM to quantify corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL), corneal nerve fibre tortuosity (CNFT), inferior whorl length (IWL), Douleur Neuropathique 4 (DN4) Score, vibration perception threshold (VPT) and sudomotor function.</p><p><strong>Results: </strong>Participants with SLE (n=59; age 38.6±9.6 years; mean Systemic Lupus Erythematosus Disease Activity Index Score 3.4±4.2) had significantly lower CNBD (41.5±21.3 vs 72.1±29.4 branches/mm², p=0.0001) and CNFL (18.5±4.3 vs 24.2±4.4 mm/mm², p=0.0001) but comparable CNFD (31.7±7.1 and 34.0±6.9 fibres/mm², respectively, p=0.25), CNFT (15.0±4.0 and 14.3±3.1, respectively, p=0.55), and IWL (38.5±8.0 and 35.6±5.9 mm/mm², respectively, p=0.16) compared with healthy controls (n=17). Patients with SLE had a DN4 Score of 3.5±2.5 and elevated VPT (4.1±3.3 vs 2.8±0.7 V, p<0.01) but comparable sudomotor function of the hands and feet (p=0.28-0.42). Active SLE was associated with a lower CNBD/CNFD ratio (p<0.05). Patients with SLE associated with sustained neuropathic pain (17.2%) had significantly lower CNFD, CNFL and IWL than those with transient (p<0.05-0.0001) and recurrent (p<0.05-0.01) pain but comparable VPT (p=0.27) and sudomotor function (p=0.14). Reduced CNFL was associated with bodily pain, affecting quality of life (p<0.05).</p><p><strong>Conclusion: </strong>This study demonstrates that CCM detects peripheral neurodegeneration in patients with SLE, which relates to disease activity, sustained neuropathic pain and quality of life. CCM may serve as a rapid non-invasive neuroimaging technique to identify SFN in SLE.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HDAC3 knockdown inhibits ferroptosis via upregulating Nrf2 to alleviate renal interstitial fibrosis in lupus nephritis.","authors":"Tianli Shi, Zhen Luo, Wenjuan Lei","doi":"10.1136/lupus-2025-001666","DOIUrl":"https://doi.org/10.1136/lupus-2025-001666","url":null,"abstract":"<p><strong>Background: </strong>Lupus nephritis (LN) is the most serious complication of SLE. Interstitial fibrosis is the dominant pathological change of renal injury in LN. Enhanced histone deacetylase 3 (HDAC3) positively correlates with renal interstitial fibrosis (RIF). Our study objective was to explore the accurate role and mechanism of HDAC3 in the RIF of LN.</p><p><strong>Methods: </strong>To knock down HDAC3, Murphy Roths large (MRL)/wt and MRL/MpJ-Faslpr/J (MRL/lpr mice were injected with lentiviral short hairpin RNAs. Human renal proximal tubular epithelial cells (HK-2 cells) were treated with serum from patients with LN to establish an LN cell model. Renal histopathological change was assessed by H&E, Masson and Sirius red staining. Cell viability was determined using Cell Counting Kit-8 (CCK-8) kits. Inflammation cytokine determination was conducted employing ELISA assays. Protein expression was detected by western blot, and immunohistochemical and immunofluorescence staining. Gene densities were analysed by quantitative real-time PCR assays. Co-immunoprecipitation analysis validated the interactions of nuclear factor erythroid 2-related factor 2 (Nrf2) and Kelch-like ECH-associated protein 1 (Keap1).</p><p><strong>Results: </strong>HDAC3 levels were increased in the serum and kidney tissues of patients with SLE and LN, and the LN group posted the highest level. HDAC3 knockdown ameliorated RIF, oxidative stress, inflammation and ferroptosis in kidney tissues of MRL/lpr mice. Moreover, HDAC3 inhibition repressed the inflammatory and oxidative reactions, fibrosis and ferroptosis in LN-serum-induced HK-2 cells. Further, HDAC3 knockdown could inhibit the Keap1-Nrf2 interaction to trigger Nrf2 activation.</p><p><strong>Conclusion: </strong>HDAC3 inhibition relieved RIF, oxidative stress, inflammation and ferroptosis by upregulating Nrf2 in the mice and cell models of LN.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Administration of belimumab prior to standard immunosuppression in patients with early active lupus hinders accrual of new EULAR/ACR criteria within the first 12 months of treatment.","authors":"Mariele Gatto, Claudio Cruciani, Elisa Bellis, Pietro Francesco Gavino Pilo, Massimo Radin, Luca Iaccarino, Daniela Rossi, Dario Roccatello, Annamaria Iagnocco, Andrea Doria, Savino Sciascia","doi":"10.1136/lupus-2025-001662","DOIUrl":"https://doi.org/10.1136/lupus-2025-001662","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of early belimumab administration on disease progression in patients with early active SLE.</p><p><strong>Methods: </strong>This multicentre observational study included patients with early active SLE, defined as being diagnosed ≤12 months from enrolment in the study, displaying ≤2 clinical European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) 2019 criteria, without major organ involvement but with active serology. Patients were receiving glucocorticoids and hydroxychloroquine as standard of care (SoC) and either belimumab (BEL group) or standard immunosuppression (SoC group). Patients were followed up for 12 months, and accrual of new EULAR/ACR criteria served as a marker of disease progression. Kaplan-Meier survival analysis and log-rank tests were applied to assess differences in criteria-free survival between groups, while Cox regression compared the lag time to criteria accrual.</p><p><strong>Results: </strong>69 patients were included (BEL=33 and SoC=36). Patients receiving early BEL accrued fewer events per 100 patient-years compared with SoC (2.78 vs 12.12, p=0.035). Criteria-free survival was longer in the BEL group (log-rank p=0.04), with a mean time-to-event of 11.8±1.07 months versus 10.3±3.33 months in the SoC group (Cox regression, p=0.027). Early BEL was associated with a sixfold higher likelihood of achieving glucocorticoid (GC) discontinuation at 12 months as compared with patients on hydroxychloroquine (HCQ) and GC alone (OR 6.67, p=0.0014).</p><p><strong>Conclusions: </strong>Early administration of BEL in active SLE significantly delays disease progression and promotes GC withdrawal. These findings are more striking when limiting SoC to HCQ and GC and underscore the potential of early biologic intervention to modify disease course. Further validation in larger, prospective studies is warranted.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does social support reduce bodily pain among African American women with SLE? Findings from a randomised controlled trial.","authors":"Jerik Leung, Everette P Keller, Paul Nietert, Tomika Caldwell, Clara L Dismuke-Greer, Hetlena Johnson, Edith Williams","doi":"10.1136/lupus-2025-001712","DOIUrl":"10.1136/lupus-2025-001712","url":null,"abstract":"<p><strong>Objective: </strong>Peer mentoring has been shown to be an effective intervention for chronic conditions with evidence to suggest that it might improve health-related bodily pain among African American women living with systemic lupus erythematosus (SLE). However, there is a lack of evidence to describe the intervention impact when adjusting for self-management of SLE. The present work aims to determine whether greater patient activation is associated with greater reductions in pain overall and within intervention groups.</p><p><strong>Methods: </strong>Data were used from the Peer Approaches to Lupus Self-Management study, a randomised controlled trial designed to determine the efficacy of peer mentorship in African American women with SLE. A total of 274 participants were randomised to an intervention (mentorship) or control (non-mentorship) arms. Data were collected on self-reported Lupus Quality of Life questionnaire for bodily pain and Patient Activation Measure (PAM). Linear mixed models and multivariable linear mixed models were fit to assess the intervention and impact of PAM on bodily pain over time.</p><p><strong>Results: </strong>Increased patient activation was significantly associated with greater reductions in bodily pain (b=-0.13, p=0.019); however, there was no significant difference in intervention group over the study period between the intervention and control groups CONCLUSION: Patient self-management can have a significant effect on bodily pain for SLE patients. Future work aims to consider strategies which address patient activation as a mechanism for reducing pain and improving quality of life.</p><p><strong>Trial registration number: </strong>NCT03734055.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12542739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and prognostic factors in adult macrophage activation syndrome: an observational study in a Chinese cohort.","authors":"Yuanyuan Pei, Xiao Han, Fengtao Yang, Xi Wang, Lingjie Cao, Ranran Yao, Renge Liang, Wenfeng Huang, Jihong Zhu, Yin Su","doi":"10.1136/lupus-2025-001620","DOIUrl":"10.1136/lupus-2025-001620","url":null,"abstract":"<p><strong>Objective: </strong>Macrophage activation syndrome (MAS), a subtype of secondary haemophagocytic lymphohistiocytosis (HLH), is a rare and life-threatening complication of rheumatoid diseases. However, the prognostic factors in adult MAS patients are still not fully elucidated, which need further investigation.</p><p><strong>Methods: </strong>We conducted a retrospective study of adult MAS inpatients between January 2016 and January 2024. In accordance with HLH-2004 criteria, 116 patients were eventually enrolled in this study. Clinical manifestations, laboratory data, treatments and outcomes had been recorded. Influence factors associated with prognosis were analysed using logistic regression models.</p><p><strong>Results: </strong>Seventeen of 116 (14.7%) patients died during hospitalisation. Further multivariate analysis suggested that admission ferritin <1350 ng/mL (OR=5.387, 95% CI 1.203 to 24.127, p=0.034), platelets (PLT) ≤30×10⁹/L (OR=5.387, 95% CI 1.203 to 24.127, p=0.028), alanine aminotransferase (ALT) ≥275 U/L (OR=5.732, 95% CI 1.167 to 28.167, p=0.032), central nervous system (CNS) involvement (OR=11.268, 95% CI 1.353 to 93.851, p=0.025) and procalcitonin (PCT) >0.9 ng/mL (OR=11.224, 95% CI 2.019 to 62.381, p=0.006) were potential prognostic factors for mortality of adult MAS patients.</p><p><strong>Conclusion: </strong>Our results indicated that adult MAS patients with lower ferritin levels at admission, lower PLT counts, elevated ALT, CNS involvement and more active infection were associated with an unfavourable prognosis.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145301733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significant glomerular IgM deposition predicts poorer kidney outcomes in lupus nephritis compared with other forms of immune complex deposits.","authors":"Wang Xiang, Yaoyao Tang, Xiuzhi Jia, Yuewen Lu, Xinxin Zhang, Xiaolei Shi, Jianwen Yu, Hongjian Ye, Zhong Zhong, Jiang Lanping, Xi Xia, Ruihan Tang, Wei Chen","doi":"10.1136/lupus-2025-001708","DOIUrl":"10.1136/lupus-2025-001708","url":null,"abstract":"<p><strong>Objective: </strong>Glomerular immune complex deposition plays a central role in lupus nephritis (LN), but the prognostic relevance of individual immunoglobulin components remains unclear. This study aimed to investigate the clinical impact of glomerular immunoglobulin M (IgM) deposition intensity on patient outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study analysed 952 biopsy-proven LN patients (1996-2019) from the First Affiliated Hospital of Sun Yat-sen University. A semiquantitative scoring system stratified glomerular immunoglobulin G (IgG), immunoglobulin A (IgA), IgM, complement 3 (C3) and complement component 1q (C1q) deposition into low (-/+) and high (++ to ++++) groups. The primary outcome was a composite of doubling of serum creatinine from baseline or the development of end-stage renal disease (ESRD). The secondary outcome was all-cause mortality. A multivariable Cox regression model was used to adjust for baseline clinical and pathological factors.</p><p><strong>Results: </strong>Among the studied immune complexes, only high glomerular IgM deposition was significantly associated with adverse renal outcomes (p=0.025). These patients had higher baseline Systemic Lupus Erythematosus Disease Activity Index scores (SLEDAI) (16 (12-20) vs 15 (12-18), p<0.001), more severe histopathological features (including proliferative glomerulonephritis, endocapillary hypercellularity, leucocyte infiltration and microthrombi), and profound complement activation (lower median serum C3 and complement 4 (C4) levels, both p<0.05). High glomerular IgM deposition also correlated with high IgA (r=0.48) and C3 (r=0.40) deposition (both p<0.01). Multivariable analysis revealed that high glomerular IgM deposition remained an independent predictor of renal progression (adjusted HR=1.485, 95% CI 1.040 to 2.119, p=0.029).</p><p><strong>Conclusion: </strong>High glomerular IgM deposition emerged as an independent prognostic marker for adverse renal outcomes in LN, potentially outperforming other individual immune complexes. These findings highlight the pathogenic significance of IgM in LN and support its value in risk stratification and treatment guidance.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12516977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of rural residence on clinical outcomes in SLE: a systematic review.","authors":"Ryuichi Ohta, Ryu Yoshinori, Chiaki Sano, Kunihiro Ichinose","doi":"10.1136/lupus-2025-001725","DOIUrl":"10.1136/lupus-2025-001725","url":null,"abstract":"<p><strong>Background: </strong>SLE is a chronic autoimmune disease with heterogeneous manifestations and variable outcomes. Geographic factors such as rural residence may influence disease severity, access to care and treatment adherence, yet evidence remains fragmented. This systematic review aimed to evaluate the impact of rurality on clinical outcomes in adults with SLE.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase and Web of Science for observational studies published up to May 2025 that assessed the association between rural residence and clinical outcomes in SLE. Eligible studies included adult patients with SLE and reported at least one relevant outcome stratified by rurality. Using the Newcastle-Ottawa Scale, data were extracted on study characteristics, definitions of rurality, outcome domains and risk of bias. Due to heterogeneity in study design and outcomes, a narrative synthesis was conducted.</p><p><strong>Results: </strong>Eight studies, including over 34 000 participants from the USA, Greece, China, Egypt, Puerto Rico and Latin America (Grupo Latino Americano de Estudio del Lupus cohort), met inclusion criteria. Definitions of rurality varied widely, encompassing administrative classifications, demographic thresholds and self-reported residence. Rural residence was often associated with delayed diagnosis, higher disease activity, lower physical quality of life, increased hospital readmissions and poorer medication adherence. Survival findings were mixed, and one study found no rural disadvantage where specialised care was available. Methodological quality was generally moderate to high.</p><p><strong>Conclusion: </strong>Across diverse settings, rural SLE populations frequently experience worse outcomes, although this is not universal and appears to be strongly influenced by structural disadvantages rather than geography alone. Standardised definitions of rurality and multidimensional measurement approaches are needed to improve comparability and guide effective interventions. Targeted strategies-such as telemedicine, outreach programmes and policies addressing healthcare access-may help reduce inequities in SLE care.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Programme evaluation of Strategies to Embrace Living with Lupus Fearlessly (SELF): an evidence-based digital programme to build and improve lupus self-management skills.","authors":"Sarah D Gilman, Sara Johnson, Katherine Carpenter, Melissa French, Patricia Castle, S Sam Lim, Charmayne Dunlop-Thomas, Cristina Drenkard, Maria Dall'Era, Emily C Somers, Suzanna Zick, Melicent Miller, Daniel J Wallace, Victoria P Werth, Mary Crimmings","doi":"10.1136/lupus-2025-001580","DOIUrl":"10.1136/lupus-2025-001580","url":null,"abstract":"<p><strong>Objectives: </strong>There is increasing recognition of the need for patient-centred lupus self-management (SM) programmes to improve outcomes. The purpose of this manuscript is to describe the underlying methodology and initial pilot results of Strategies to Embrace Living with Lupus Fearlessly (SELF): an evidence-based digital SM intervention designed for individuals with lupus based on the Transtheoretical Model of Behaviour Change.</p><p><strong>Methods: </strong>We describe pilot testing and initial feasibility and acceptability results of SELF among individuals with lupus. Participants for the 90-day pilot test were recruited through three Centers for Disease Control & Prevention-funded lupus registry sites across the USA and the Lupus Foundation of America's constituency, including a diverse sociodemographic lupus population, using varied sources. Feasibility, acceptability and preliminary impact were assessed using data on enrolment, retention, ease of utilisation and satisfaction with SELF's features, changes in readiness for SM behaviours, impact on patient-reported outcomes (eg, fatigue interference) and user feedback.</p><p><strong>Results: </strong>Nearly 80% of participants had moderate or high skill gaps at programme intake (ie, were in an early stage of change for a key SM skill), underscoring the importance of digital SM programmes like SELF. Among those who completed the programme, almost 60% of participants closed a skill gap by mastering one or more SM skills. Significant effects on patient-provider interactions and fatigue interference were also noted, highlighting a need for future investigation. Qualitative data were mostly positive in terms of feasibility and acceptability, with specific recommendations for future improvement.</p><p><strong>Conclusions: </strong>SELF utilisation and pilot data indicate that SELF is generally feasible and acceptable, particularly among those needing to build lupus SM skills. Future work will explore ways to improve the digital SM intervention and reduce barriers to initial and ongoing engagement.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction model for renal outcomes in Latin American Mestizo patients with pure proliferative lupus nephritis.","authors":"Arturo Villalobos Navarro, Marc Xipell, Estefanía Garduño Hernández, Ricardo Valjalo, Francisco Contreras, Andrea Ruiz de Arechavaleta, Paula Segura, Daniel Miranda, Eduardo Ávila, María José Hidalgo, Juan Daniel Diaz Garcia, Fabiola Pazos Pérez, Diana Valderrama Ávila, María Inés Gil Arredondo, Elena Guillén, Ricard Cervera, Gerard Espinosa, Arturo Pereira, Miquel Blasco, Luis F Quintana","doi":"10.1136/lupus-2025-001649","DOIUrl":"10.1136/lupus-2025-001649","url":null,"abstract":"<p><strong>Objective: </strong>Lupus nephritis (LN) is associated with a poorer prognosis in Latin American populations. However, the contributing risk factors contributing to this remain to be fully elucidated. This study aimed to develop a prognostic model for poor renal outcomes in patients of mestizo descent.</p><p><strong>Methods: </strong>We conducted a multicentre, retrospective analysis including 290 adult mestizo patients with incident, biopsy-proven pure proliferative LN (International Society of Nephrology/Renal Pathology Society (ISN/RPS) class III or IV) from nine Chilean hospitals. Clinical, biological and histological variables were assessed. The primary outcome was a composite of stage IV/V chronic kidney disease, dialysis or death. Predictive variables were selected using multivariable Cox regression, and prognostic scores were derived accordingly. Internal validation was performed via bootstrapping. External validation included 93 Mexican patients, with model performance assessed using Harrel's concordance index.</p><p><strong>Results: </strong>Two baseline factors were independently associated with poor renal outcome: estimated glomerular filtration rate <30 mL/min/m² (HR 3.82, 95% CI 2.15 to 6.78; p<0.001) and histological chronicity index >2 (HR 2.01, 95% CI 1.18 to 3.43; p=0.01). Patients were stratified into three risk categories according to the presence of none (low risk), one (intermediate risk) or both (high risk) of these factors. The likelihood of the primary outcome increased progressively across these groups: high versus intermediate risk (HR 3.22, 95% CI 1.64 to 6.34; p=0.001), and intermediate versus low risk group (HR 2.41, 95% CI 1.35 to 4.30; p=0.003). The three-tier model was replicated in the validation cohort with a concordance index of 79% (95% CI 71% to 87%; p<0.001) between predicted and observed results.</p><p><strong>Conclusions: </strong>Based on two readily available features at the time of diagnosis, the proposed model effectively stratifies Latin American mestizo patients with pure proliferative LN (ISN/RPS class III or IV) into three risk categories for poor renal outcome. This tool may support improved risk-based management in this high-risk population.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dyspigmentation and scarring in cutaneous lupus erythematosus.","authors":"Shae Chambers, Aretha On, Xiwei Yang, Lais Lopes Almeida Gomes, Touraj Khosravi-Hafshejani, Hammad Ali, Rui Feng, Victoria P Werth","doi":"10.1136/lupus-2025-001637","DOIUrl":"10.1136/lupus-2025-001637","url":null,"abstract":"<p><strong>Objective: </strong>No studies have investigated the incidence and correlation of scarring and dyspigmentation across all cutaneous lupus erythematosus (CLE) categories and subtypes. As better characterisation of such symptoms may impact how clinicians document disease damage as well as manage patients' expectations on their disease course, we set out to investigate the relationship between dyspigmentation and scarring in CLE further.</p><p><strong>Methods: </strong>We conducted a cross-sectional review of our IRB-approved CLE database at the University of Pennsylvania. Patients were divided by category and chronic CLE (CCLE) subtype. Dyspigmentation and scarring were quantified using the CLE Disease Area and Severity Index damage score. Data on dyspigmentation and scarring were captured from the patient visit where dyspigmentation was highest.</p><p><strong>Results: </strong>Dyspigmentation and scarring significantly differed between CLE categories and CCLE subtypes. Across categories, CCLE had the highest medians for dyspigmentation and scarring. Across CCLE subtypes, discoid lupus erythematosus (DLE) had the highest medians for dyspigmentation and scarring. Positive correlations for dyspigmentation and scarring were seen in CCLE, DLE and LE panniculitis.</p><p><strong>Conclusions: </strong>Dyspigmentation and scarring correlation differences highlight the importance of accurate assessment and documentation of both elements of damage as well as classification of CLE category and subtype. Our results reflect important differences in the CLE categories and CCLE subtypes which may be helpful for clinicians and patients as they navigate the course of the disease.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}