{"title":"Rural-urban disparities in hospitalisation for myocardial infarction in systemic lupus erythematosus in the USA.","authors":"Jasvinder A Singh, Sumanth Chandrupatla","doi":"10.1136/lupus-2025-001516","DOIUrl":"https://doi.org/10.1136/lupus-2025-001516","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether rural-urban disparities exist in people with SLE for hospitalisation with myocardial infarction (MI).</p><p><strong>Methods: </strong>We used the 2016-2019 US National Inpatient Sample data that contain all hospitalisation data. In people with a diagnosis of SLE, we assessed the multivariable adjusted ORs (aORs) to examine the association of rural patient residence with MI hospitalisation, while adjusting for demographics, payer, income, hospital characteristics and the Deyo-Charlson Comorbidity Index.</p><p><strong>Results: </strong>We found that the crude rates of patients hospitalised with MI per 100 000 area specific SLE hospitalisations were higher in rural versus urban residents with SLE, 2265 versus 1435 (p value<0.001). In the multivariable-adjusted model that accounted for demographics, insurance payer, household income, comorbidities and hospital characteristics including geographical location, we found that rural residence was associated with an aOR of 1.98 (95% CI, 1.71 to 2.29; reference category, urban residence) of MI hospitalisations in people with SLE. Other factors significantly associated with the risk of MI were male sex, Medicaid or private insurance, urban not teaching or urban teaching hospital, Midwest region and a private hospital control, either for profit or not for profit.</p><p><strong>Conclusion: </strong>Rural residence doubled the risk of MI hospitalisation in people with SLE independent of demographics, payer status, social determinants of health and hospital characteristics. Our study highlights the disproportionate effect of rurality on health outcomes in people with SLE within the USA and a clear rural-urban gap disparity. Interventions to reduce this disparity are needed.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027540","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}
Emerson Pena, Leonardo Peterson Dos Santos, Rafaela Cavalheiro do Espírito Santo, Lucas Denardi Dória, Stephanie Pilotti, André Luiz Silveira Mallmann, Daniel Nóbrega de Moraes, Clarice Moura Mata Machado, Cristina Costa Duarte Lanna, Olivio Brito Malheiro, Emanoel Luis da Silveira, Rosa Weiss Telles, Fabiana de Miranda Moura, Andrese Aline Gasparin, Vanessa Hax, Poli Mara Spritzer, Tayane Muniz Fighera, Rafael Mendonça da Silva Chakr, Ricardo Machado Xavier, Odirlei André Monticielo
{"title":"Prevalence of sarcopenia and its association with clinical features and health-related quality of life in Brazilian women with systemic lupus erythematosus.","authors":"Emerson Pena, Leonardo Peterson Dos Santos, Rafaela Cavalheiro do Espírito Santo, Lucas Denardi Dória, Stephanie Pilotti, André Luiz Silveira Mallmann, Daniel Nóbrega de Moraes, Clarice Moura Mata Machado, Cristina Costa Duarte Lanna, Olivio Brito Malheiro, Emanoel Luis da Silveira, Rosa Weiss Telles, Fabiana de Miranda Moura, Andrese Aline Gasparin, Vanessa Hax, Poli Mara Spritzer, Tayane Muniz Fighera, Rafael Mendonça da Silva Chakr, Ricardo Machado Xavier, Odirlei André Monticielo","doi":"10.1136/lupus-2024-001447","DOIUrl":"10.1136/lupus-2024-001447","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the prevalence of sarcopenia and examine its association with clinical features, health-related quality of life (HRQoL), muscle-specific strength and body composition in patients with systemic lupus erythematosus (SLE).</p><p><strong>Methods: </strong>In this cross-sectional multicentre study, women with SLE (18-50 years old) were included. Data collected included clinical features and HRQoL. Muscle strength was assessed using the handgrip test (kg), appendicular skeletal muscle mass index (ASMI, kg/m²) was measured using dual-energy X-ray absorptiometry. Physical performance was assessed using the timed-up-and-go test (TUG, seconds). Sarcopenia was defined by the European Working Group on Sarcopenia in Older People-2 criteria. The muscle-specific strength was evaluated by dividing their arm strength by their lean arm mass. Pearson's or Spearman's correlation coefficients were performed (accepted at p<0.05).</p><p><strong>Results: </strong>Seventy-three SLE women were included, with median (IQR) age and disease duration of 37 (30-44) years old and 10.0 (4.0-16.8) years, respectively. Most of the patients (83.5%) had inactive or low disease activity and 31.0% presented a disease damage index score ≥1. Mean (±SD) handgrip strength, ASMI and muscle-specific strength was 25.58±8.31 kg, 6.62±0.97 kg/m² and 6.6±2.3, respectively. Median TUG was 6.9 (6.1-8.2) s. The prevalence of probable sarcopenia was 11.1%, and sarcopenia was 2.7%. Lower muscle strength, lower muscle-specific strength and lower physical performance, as well as sarcopenia, were correlated with worse HRQoL (p<0.05).</p><p><strong>Conclusion: </strong>In Brazilian patients with SLE with inactive or low disease activity, the prevalence of sarcopenia was low. However, low muscle strength, low muscle-specific strength and low physical performance were correlated with worse HRQoL, emphasising the need for muscle strength assessments in SLE management.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979005","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}
Ettore Silvagni, Antonio Marangoni, Carlo Garaffoni, Simone Appenzeller, George Bertsias, Antonis Fanouriakis, Matteo Piga, Enrico Fainardi, Greta Carrara, Carlo Alberto Scirè, Marcello Govoni, Alessandra Bortoluzzi
{"title":"Can conventional brain MRI support the attribution process in neuropsychiatric SLE? A multicentre retrospective study.","authors":"Ettore Silvagni, Antonio Marangoni, Carlo Garaffoni, Simone Appenzeller, George Bertsias, Antonis Fanouriakis, Matteo Piga, Enrico Fainardi, Greta Carrara, Carlo Alberto Scirè, Marcello Govoni, Alessandra Bortoluzzi","doi":"10.1136/lupus-2024-001490","DOIUrl":"10.1136/lupus-2024-001490","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to investigate which elementary lesions, identified through conventional brain MRI, correlated with the attribution of neuropsychiatric (NP) manifestations of SLE as determined by clinical judgement (CJ) and a validated attribution algorithm (AA).</p><p><strong>Methods: </strong>We conducted a multicentre, retrospective cohort study of patients with SLE (1999-2018) from four tertiary SLE centres. Patients were assessed using American College of Rheumatology nomenclature and underwent MRI at their first NP event. NP manifestations were attributed to SLE using CJ and the AA. Elementary lesions were classified as follows: large infarcts, parenchymal haemorrhages, subarachnoid haemorrhages, inflammatory-type lesions, myelopathy, T2/fluid-attenuating inversion recovery (FLAIR) hyperintense lesions, lacunes, cerebral atrophy and microbleeds. Statistical analyses were performed using χ<sup>2</sup> and Fisher's exact tests. Univariable and multivariable logistic regression models were performed. A sensitivity analysis was performed using a revised AA, which excluded the item 'presence of abnormal MRI' from the list of favouring factors.</p><p><strong>Results: </strong>Among 154 patients, 88 (57%) had NP events attributed to SLE by CJ and 85 (55%) by AA. MRI was normal in 57/154 (37%) cases, while T2/FLAIR hyperintense lesions were the most frequent findings (71/154, 46%). A normal MRI was more common in non-attributed NP events per CJ and AA (OR 0.42, 95% CI 0.21 to 0.82 and 0.27, 95% CI 0.13 to 0.52, respectively). Cerebral atrophy was more frequent in non-attributed events per CJ (adjusted OR 0.06, 95% CI 0.01 to 0.35), while inflammatory-type lesions were more prevalent in SLE-attributed events according to AA (OR 3.91, 95% CI 1.15 to 18.1), with no significant change in sensitivity analyses.</p><p><strong>Conclusions: </strong>Our study elucidates the role of conventional MRI findings in the attribution process in NPSLE. The presence of selected elementary lesions or, instead, their absence could have a relevant weight in assessing NP events. These findings may assist clinicians in achieving a more accurate attribution of NP manifestations.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027516","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":"Proteomics uncovers ICAM2 (CD102) as a novel serum biomarker of proliferative lupus nephritis.","authors":"Zhengyong Li, Yifang Sun, Yixue Wang, Fengxun Liu, Shaokang Pan, Songwei Li, Zuishuang Guo, Dan Gao, Jinghua Yang, Zhangsuo Liu, Dongwei Liu","doi":"10.1136/lupus-2024-001446","DOIUrl":"https://doi.org/10.1136/lupus-2024-001446","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to identify novel, non-invasive biomarkers for lupus nephritis (LN) through serum proteomics.</p><p><strong>Methods: </strong>Serum proteins were detected in patients with LN and healthy control (HC) groups through liquid chromatography-tandem mass spectrometry. The key networks associated with LN were screened out using Cytoscape software, followed by pathway enrichment analysis. The best candidate biomarkers were selected by machine learning models, further validated in a larger independent cohort. Finally, the expression of these candidate markers was verified in kidney tissue samples, and the mechanism was explored by knocking down the expression of intercellular adhesion molecule 2 (ICAM2) through in vitro cell transfection with siRNA.</p><p><strong>Results: </strong>Following the serum proteomic screening of LN, a key network of 20 proteins was identified. Machine learning models were used to select ICAM2 (CD102), metalloproteinase inhibitor 1 (TIMP1) and thrombospondin 1 (THSB1) for validation in independent cohorts. ICAM2 exhibited the highest area under the curve (AUC) value in distinguishing LN from HC (AUC=0.92) and was significantly correlated with activity index, proteinuria, albumin and anti-dsDNA antibody levels. Particularly, ICAM2 was significantly elevated in proliferative LN and was associated with specific pathological attributes, outperforming conventional parameters in distinguishing proliferative LN from non-proliferative LN. ICAM2 expression was also elevated in renal tissue samples from patients with proliferative LN. In vitro, knockdown of ICAM2 expression can inhibit the activation of the PI3K/Akt pathway and alleviate the injury of glomerular endothelial cells.</p><p><strong>Conclusion: </strong>ICAM2 (CD102) may serve as a potential serum biomarker for proliferative LN that reflects renal pathology activity, potentially contributing to the progression of LN through the PI3K/Akt pathway.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017967","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":"Correction: Hydroxychloroquine in patients with systemic lupus erythematosus: how much is enough?","authors":"","doi":"10.1136/lupus-2024-001254corr1","DOIUrl":"https://doi.org/10.1136/lupus-2024-001254corr1","url":null,"abstract":"","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971518","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 and immunological differences between primary and autoimmune-associated neuromyelitis optica spectrum disorders: a retrospective study.","authors":"Hung-Cheng Tsai, Yi-Syuan Sun, Wei-Sheng Chen, Wan-Hao Tsai, De-Feng Huang, Ying-Ying Yang, Hsien-Tzung Liao, Chang-Youh Tsai","doi":"10.1136/lupus-2024-001491","DOIUrl":"https://doi.org/10.1136/lupus-2024-001491","url":null,"abstract":"<p><strong>Introduction: </strong>Neuromyelitis optica spectrum disorder (NMOSD) is a rare immune-mediated disease affecting the spinal cord and optic nerves. While NMOSD has been widely studied, limited data exist on the subset associated with autoimmune diseases (AD-NMOSD), particularly in Taiwanese patients. Additionally, relapse and prognostic factors in AD-NMOSD remain unclear.</p><p><strong>Methods: </strong>We retrospectively analysed 71 NMOSD cases diagnosed between 2008 and 2023 at Taipei Veterans General Hospital. Clinical features, laboratory findings, autoimmune comorbidities, imaging and treatments were examined. Patients were stratified by relapse status and the presence of severe sequelae.</p><p><strong>Results: </strong>Among 71 NMOSD cases, 26 (37%) patients had AD-NMOSD. While no significant differences were observed in the number or severity of relapses and sequelae between AD-NMOSD and primary (p)-NMOSD, patients with AD-NMOSD exhibited lower white blood cell counts, haemoglobin, platelet counts, immunoglobulin G and C reactive protein levels. Specific risk factors for relapse in AD-NMOSD included onset age under 50 years, concurrent SLE and a longer duration of SLE before NMOSD presentation. In both AD-NMOSD and p-NMOSD, more relapses were associated with severe neurological sequelae. Although relapse-free survival did not differ significantly between the two groups, patients with AD-NMOSD tended to have a longer period without severe sequelae.</p><p><strong>Discussion: </strong>Taiwanese patients with AD-NMOSD show distinct laboratory characteristics compared with those without autoimmune diseases. Younger age and longer disease duration are key risk factors for relapses, which are linked to more severe neurological sequelae. Despite various treatments, no significant differences were found in relapse rates or sequelae severity, highlighting the need for personalised management strategies.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064167","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":"Langerhans cells infiltration in lymph nodes of patients with systemic lupus erythematosus.","authors":"Jinyi Qian, Lei Li, Jing Lv, Yingjie Jiang, Qianchen Ma, Haoyu Pan, Xiaohan Wei, Zhixia Yang, Shuyi Yu, Yuying Fan, Jialin Teng, Chengde Yang, Aifei Zhang, Yue Yang, Hui Shi","doi":"10.1136/lupus-2024-001474","DOIUrl":"https://doi.org/10.1136/lupus-2024-001474","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to characterise the clinical features and treatment regimens of patients with lupus who have lymphadenopathy (LAP), as well as to investigate the presence and potential implications of Langerhans cells (LCs) infiltration in lymph nodes.</p><p><strong>Methods: </strong>A case-control study was conducted to identify the clinical characteristics of newly diagnosed, treatment-naïve patients with lupus who have LAP. Lymph node biopsies were performed, and LC infiltration was assessed using immunohistochemical staining for S100, CD1a and Langerin.</p><p><strong>Results: </strong>A total of 59 patients with SLE who have LAP (SLE-LAP) were enrolled, with 81 patients with SLE without LAP serving as controls. The SLE-LAP group exhibited significantly higher frequencies of fever (64.4% vs 35.8%, p<0.001), anaemia (71.2% vs 42.0%, p<0.001), serous effusion (27.1% vs 11.1%, p=0.015), myositis (10.2% vs 1.2%, p=0.045) and elevated CRP levels (44.1% vs 22.2%, p=0.006). Moreover, autoantibodies, including anti-Smith (37.3% vs 16.0%, p=0.004), anticardiolipin IgG (27.1% vs 11.1%, p=0.015), IgM (42.4% vs 9.9%, p<0.001) and IgA (8.5% vs 0.0%, p=0.027), were more frequently detected in the LAP group. LC infiltration was confirmed in 29 of the 59 lymph node biopsies (49.2%). Immunohistochemical analysis revealed a scattered (58.6%) or focal (41.4%) distribution of LCs. Patients with LC infiltration predominantly presented with fever (72.4%), anaemia (64.3%), skin rashes (62.1%) and arthritis (62.1%). However, no significant differences in clinical manifestations were observed between LC-positive and LC-negative patients.</p><p><strong>Conclusion: </strong>LC infiltration in the lymph nodes of patients with SLE is relatively common and should be carefully evaluated to prevent misdiagnosis. The role of LCs in the autoimmune response and pathogenesis of SLE warrants further investigation.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031334","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}
Lais Lopes Almeida Gomes, Daniella Forman Faden, Lillian Xie, Shae Chambers, Caroline Stone, Victoria P Werth, Kevin Jon Williams
{"title":"Modern therapy of patients with lupus erythematosus must include appropriate management of their heightened rates of atherosclerotic cardiovascular events: a literature update.","authors":"Lais Lopes Almeida Gomes, Daniella Forman Faden, Lillian Xie, Shae Chambers, Caroline Stone, Victoria P Werth, Kevin Jon Williams","doi":"10.1136/lupus-2024-001160","DOIUrl":"https://doi.org/10.1136/lupus-2024-001160","url":null,"abstract":"<p><p>Atherosclerotic cardiovascular disease (ASCVD) remains the biggest killer of patients with lupus erythematosus (LE) and the general non-autoimmune population. In this literature update on LE and ASCVD, we focused on published work since our earlier review article, meaning from 2021 to the present, with an emphasis on cutaneous LE. Several themes emerged. First, new work shows that patients with lupus still exhibit a high burden of conventional risk factors for ASCVD events. Second, recent studies continue to implicate possible effects of lupus disease activity to worsen rates of ASCVD events beyond predictions from conventional risk factors. Third, new work on estimating the risk of future ASCVD events in patients with lupus supports arterial-wall imaging, inclusion of lupus-specific factors, estimators of ASCVD event risk that take lupus status into account and considering lupus as a diabetes equivalent or even as a diabetes-plus-smoking equivalent in this context. Technologies for arterial-wall imaging continue to improve and will likely play an increasing role in ASCVD assessment and management. Fourth, purported cardiovascular benefits from certain disease-modifying antirheumatic drugs such as antimalarials have become less clear. Fifth, earlier treatment of atherosclerosis, which is a lifelong disease, can be accomplished with diet, exercise, smoking cessation and new classes of safe and effective medications for lipid-lowering and blood pressure control. Benefits on subclinical arterial disease by imaging and on ASCVD events have been reported, supporting the concept that ASCVD is eminently manageable in this autoimmune condition. Sixth, despite the heightened risk for ASCVD events in patients with lupus, available therapeutic approaches remain unused or underused and, accordingly, event rates remain high.Raising awareness among patients and healthcare providers about ASCVD assessment and management in patients with LE is essential. Greater vigilance is needed to prevent ASCVD events in patients with lupus by addressing dyslipidaemias, hypertension, smoking, obesity and physical inactivity.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11979607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989108","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":"Application of machine learning in assessing disease activity in SLE.","authors":"Yun Wang, Peihong Yuan, Wei Wei, Rujia Chen, Ting Wang, Renren Ouyang, Feng Wang, Hongyan Hou, Shiji Wu","doi":"10.1136/lupus-2024-001456","DOIUrl":"https://doi.org/10.1136/lupus-2024-001456","url":null,"abstract":"<p><strong>Objective: </strong>SLE is a chronic autoimmune disease with immune complex deposition in various organs, causing inflammation. The Systemic Lupus Erythematosus Disease Activity Index 2000 assesses disease severity but is subjective. This study aimed to construct a machine learning model based on objective laboratory indicators to assess SLE disease activity.</p><p><strong>Methods: </strong>A retrospective study was conducted on 319 patients with SLE, collecting their clinical characteristics and laboratory indicators as model-building indicators. Multiple machine learning algorithms were employed to construct models for assessing SLE disease activity.</p><p><strong>Results: </strong>The patients were divided into two cohorts, cohort 1 used as the training set to build the machine learning models and cohort 2 for external validation. Six laboratory indicators, including anti-dsDNA (IFT), quantitative anti-dsDNA, neutrophils, globulin, proteinuria and NK cells, were selected to construct the SLE disease activity evaluation model. The XGBoost model demonstrated superior performance in distinguishing active SLE, with an area under the receiver operating characteristic curve of 0.934, accuracy of 0.925, sensitivity of 0.969, specificity of 0.750 and F1 score of 0.954.</p><p><strong>Conclusions: </strong>This pioneering machine learning model, using objective laboratory indicators, enhances clinical feasibility and provides a novel method for assessing SLE disease activity, that may enable timely evaluation of SLE activity, facilitating preparation for treatment and prognosis.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11979605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027515","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}
Yuswanto Setyawan, Hani Susianti, Nur Samsu, Loeki Enggar Fitri
{"title":"Comparison of TLR4, NF-κB and IRF3 expression in kidney tissue between lupus nephritis (LN) and systemic lupus erythematosus (SLE): a pristane-induced lupus mice model study.","authors":"Yuswanto Setyawan, Hani Susianti, Nur Samsu, Loeki Enggar Fitri","doi":"10.1136/lupus-2024-001445","DOIUrl":"10.1136/lupus-2024-001445","url":null,"abstract":"<p><strong>Introduction and purpose: </strong>Lupus nephritis (LN) is a major cause of morbidity and mortality in patients with SLE, a complex autoimmune disease characterised by loss of tolerance to self-nuclear antigens. Toll-like receptor 4 (TLR4), the first line of defence in the innate immune system, has been linked to the pathogenesis of autoimmune diseases and LN by activating nuclear factor-κB (NF-κB) or interferon regulatory transcription factor 3 (IRF3). Local expression of those biomarkers in pristane-induced lupus mice is still unknown. Therefore, this study aimed to prove the role of TLR4, NF-κB and IRF3 in pristane-induced lupus mice.</p><p><strong>Subjects and methods: </strong>The study subjects were female Balb/c pristane-induced lupus mice model, 8-12 weeks of age, n=30, divided into two groups, nephritis (LN group) and non-nephritis (SLE group). The control group were age-matched healthy female Balb/c mice, n=11. All mice were euthanised at weeks 16. Kidney tissue was taken for histopathology examination and TLR4, NF-κB, IRF3 immunofluorescence assay. The diagnosis of LN was based on proteinuria and histopathology examination according to the ISN/RPS 2004 classification of LN. Statistical analysis was performed using IBM SPSS Statistics V.25. P value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>There were significant differences in the expressions of TLR4, NF-κB and IRF3 among the LN, SLE and healthy control groups (p=0.000), with the highest expression found in the LN group for all markers. The linear regression between TLR4 and NF-κB resulted in p value=0.000; R<sup>2</sup>=0.817; β=0.904. Linear regression between TLR4 and IRF3 showed p value=0.000; R<sup>2</sup>=0.896; β=0.947, which means TLR4 had an 81.7% effect on NF-κB and 89.6% on IRF3 expression.</p><p><strong>Conclusion: </strong>TLR4, NF-κB and IRF3 expression were increased in lupus, with the highest expression found in the LN group, suggesting that these biomarkers may be responsible for the development of nephritis in SLE, with TLR4 likely playing a dominant role in this pathway. Increased expression of these biomarkers in lupus without nephritis may indicate progression towards nephritis, which still needs to be proven with further research.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811743","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}