Lupus Science & Medicine最新文献

{"title":"Potential causal effect of SLE on osteoporosis, and the mediation effect: a Mendelian randomisation study.","authors":"Zhaoqing Wang, Jiaxuan Yang, Qingya Shi, Bojie Liu, Ying Liang, Yangzhong Zhou, Guanqiao Li","doi":"10.1136/lupus-2025-001735","DOIUrl":"10.1136/lupus-2025-001735","url":null,"abstract":"<p><strong>Objective: </strong>This study uses Mendelian randomisation (MR) to investigate the causal link between SLE and osteoporosis across different ethnic groups.</p><p><strong>Methods: </strong>Genetic variants associated with SLE were identified from publicly available genome-wide association studies in European and East Asian populations. Two-sample MR (TSMR) analysis and meta-analysis with inverse variance weighting (IVW) assessed their effects on bone mineral density (BMD) and fracture risk. Multivariable MR (MVMR) analysis in East Asians adjusted for potential mediators, and two-step mediation analysis evaluated mediation effects of independent covariates.</p><p><strong>Results: </strong>A meta-analysis of IVW results from TSMR in East Asian populations revealed a significant positive genetic association of SLE with osteoporosis (OR=1.023, CI 1.007 to 1.040, p<0.01). A similar, although weaker, association was observed in the European population (OR=1.001, CI 1.000 to 1.001, p<0.01). Furthermore, SLE was identified as a risk factor for reduced BMD in both East Asian (β=-0.0690, p<0.05) and European (β=-0.0109, p<0.05) populations, and for fracture risk in European (OR=1.002, p<0.05) populations, while no significant association was observed in the East Asian population (OR=1.010, p=0.705). MVMR analysis of East Asian data assessed mediation effects and found that the SLE-osteoporosis association was nullified after adjusting for cardiovascular disease and health status. Mediation analysis identified low-density lipoprotein cholesterol (LDL-C) and anti-inflammatory medication use as independent mediators, with mediation effects of 0.1170 and 0.0510, respectively. No significant heterogeneity or pleiotropy was detected.</p><p><strong>Conclusions: </strong>SLE appears to be a causal risk factor for osteoporosis. LDL-C and anti-inflammatory medication use mediate this relationship, suggesting the importance of managing these factors in patients with SLE to reduce osteoporosis risk.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199826","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":"Risk of preterm delivery and early pregnancy hydroxychloroquine use from a Californian lupus cohort.","authors":"Amadeia Rector, Emily F Liu, Maurice Druzin, Michael H Weisman, Eliza Chakravarty, Miranda Cantu, Gary M Shaw, Daniel Z Kuo, Monique M Hedderson, Julia F Simard","doi":"10.1136/lupus-2025-001654","DOIUrl":"10.1136/lupus-2025-001654","url":null,"abstract":"<p><strong>Objective: </strong>Pregnant patients with systemic lupus erythematosus (SLE) have 2-3 times higher risk of preterm delivery (PTD). Hydroxychloroquine (HCQ) is recommended during pregnancy and may reduce PTD risk. This study investigates whether early pregnancy HCQ-use reduces PTD risk in a diverse SLE cohort.</p><p><strong>Methods: </strong>We included singleton pregnancies reaching ≥20 weeks' gestation (2011-2020) among patients with SLE aged 18-50 receiving care at Kaiser Permanente Northern California. HCQ exposure was defined as ≥2 prescriptions filled from 3 months before the last menstrual period through the first trimester. PTD was defined as delivery <37 weeks and continuously as gestational weeks for time-to-delivery analyses. Propensity scores (PS) based on demographics, comorbidities and medication use were calculated to address confounding. Risk ratios (RR) and HRs, including 95% CIs, were estimated using PS-adjusted Poisson regression with robust SEs and Cox regression, stratified by parity. To investigate effect modification, we stratified by prepregnancy comorbidities and pregnancy corticosteroid use.</p><p><strong>Results: </strong>Among 399 pregnancies in 324 patients, 21% were preterm. The PS-adjusted RR was 1.08 (95% CI 0.52 to 2.23) and 0.88 (95% CI 0.50 to 1.57) for nulliparous and multiparous pregnancies exposed to HCQ, respectively. The PS-adjusted HRs were similar, and results remained consistent across analyses stratified by potential effect modifiers.</p><p><strong>Conclusions: </strong>Although periconceptional HCQ-use was not associated with reduced PTD nor appreciably altered gestational age at delivery, we found no increased risks for these specific adverse outcomes. Consistent with other work, we found potentially protective associations in subsets stratified by parity. However, we had limited statistical power to test this.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199852","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":"Characterisation of systemic lupus erythematosus associated with immune checkpoint inhibitors: a pharmacovigilance study using FAERS database.","authors":"Lan Zhen, Hong Chen, Wuyuan Pan, Jianrong Song, Huan Yi, Hong Zhou","doi":"10.1136/lupus-2025-001653","DOIUrl":"10.1136/lupus-2025-001653","url":null,"abstract":"<p><strong>Objectives: </strong>SLE associated with immune checkpoint inhibitors (ICIs) is rare, and a comprehensive profile of ICI-induced SLE remains poorly characterised. This study aimed to explore the potential association between ICIs and SLE and characterise clinical features.</p><p><strong>Methods: </strong>We extracted adverse event reports of patients with cancer with SLE from the FAERS (US Food and Drug Administration Adverse Event Reporting System) database (Q1 2011-Q4 2024). A disproportionality analysis was conducted using the reporting OR (ROR) and the information component, with adjusted ROR calculated via logistic regression to control for confounders.</p><p><strong>Results: </strong>146 066 ICI-related adverse events cases from patients with cancer were identified. Among these, 209 (median (IQR) age 63 (55.3-71.7) years; 106 (51%) female) cases of SLEs were reported. Our analysis detected significant positive signals for SLE associated with ICIs overall, particularly for anti-programmed cell death protein 1 (PD-1) and anti-programmed death-ligand 1 therapy. Eight positive signals of SLEs were identified, predominantly cutaneous lupus and SLE. The risk of ICI-related SLEs was significantly higher in females than in males. However, age and chemotherapy were not significant risk factors for the incidence of ICI-related SLEs. The risk was higher with anti-PD-1 therapy compared with other ICI therapies. Patients with lung cancer, melanoma or breast cancer appeared to be at higher risk. Most patients experienced serious outcomes, with a mortality rate of 4.31% (nine cases).</p><p><strong>Conclusion: </strong>This first pharmacovigilance study identified a significant association between ICI use and SLEs, suggesting ICIs may constitute a novel class of drug-induced SLE triggers. Personalised long-term safety monitoring for ICIs is warranted for high-risk patients (eg, females, anti-PD-1 recipients).</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199849","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":"Breastfeeding determinants in Egyptian mothers with systemic lupus erythematosus or rheumatoid arthritis: a retrospective cohort study.","authors":"Omima Ahmed El-Farra, Amal Mohamed Elmesiry, Hager Adel Yehia Abdelfattah, Nermeen Mohammed Elmenayar, Ahmed Adel Abdel Azim, Ahmed Ibrahim Ewais, Gamal Saeed Gamal, Abrar Ghassan Mousa Balousha, Alaa Ali Awad","doi":"10.1136/lupus-2025-001733","DOIUrl":"10.1136/lupus-2025-001733","url":null,"abstract":"<p><strong>Objective: </strong>Breastfeeding prevalence and challenges among women of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) is under-researched especially in the Middle East-North Africa region. This study aimed to assess breastfeeding initiation, duration and predictors of early discontinuation (<6 months post partum) among Egyptian mothers with SLE or RA.</p><p><strong>Methods: </strong>This multicentre retrospective cohort study included 320 pregnancies: 62 SLE (105 pregnancies), 71 RA (110 pregnancies) and 59 healthy mothers (105 pregnancies). Data on pregnancy history, breastfeeding intent, initiation, duration and weaning reasons were collected.</p><p><strong>Results: </strong>Exclusive breastfeeding was lowest in SLE (29.9%) vs RA (50.6%) and controls (60%, p<0.001). Continuation beyond 6 months was significantly lower in SLE (36.2%) and RA (33.6%) vs controls (81%, p<0.001). Postpartum depression independently predicted discontinuation in SLE (adjusted OR (aOR)=0.06, 95% CI 0.01 to 0.6) and RA (aOR=0.34, 95% CI 0.13 to 0.9). Multivariable generalised estimating equation confirmed SLE reduced breastfeeding odds versus controls (aOR=0.41, p=0.040).</p><p><strong>Conclusion: </strong>Breastfeeding is significantly less prevalent among Egyptian mothers with SLE and RA when compared with control group. Targeted educational programme and support may help improve breastfeeding rates in SLE/RA mothers.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131169","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":"Towards a minimal core dataset for systemic lupus erythematosus studies.","authors":"Stephen McDonald, Jialin Teng, Chengde Yang, Michelle Barraclough, Graciela S Alarcon, Anca D Askanase, Sasha Bernatsky, Ann Elaine Clarke, Nathalie Costedoat-Chalumeau, Qiang Fu, Dafna D Gladman, John G Hanly, Alexandra C Legge, David Isenberg, Kenneth Kalunian, Diane L Kamen, Michelle A Petri, Anisur Rahman, Chuanyin Sun, Ting Li, Murray Urowitz, Alexandre Voskuyl, Daniel J Wallace, Juan Zhang, Ian N Bruce","doi":"10.1136/lupus-2025-001595","DOIUrl":"10.1136/lupus-2025-001595","url":null,"abstract":"<p><strong>Objective: </strong>SLE is a complex, heterogenous autoimmune disease. SLE researchers do not always collect the same data, making comparative studies difficult. We aimed to ascertain what variables SLE clinical researchers commonly collect for SLE research. Our ultimate goal is to generate a minimal core dataset for future SLE studies.</p><p><strong>Methods: </strong>In 2020, we designed and distributed a questionnaire to members of the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) as well as additional active research centres in China. Our survey included 26 questions about the types of data that are routinely collected for research. Variables collected by ≥75% of participating respondents were used as a threshold for inclusion.</p><p><strong>Results: </strong>18 of 36 invited respondents replied (8 from USA/Canada, 5 from China and 5 from Europe). Many key variables in the domains of sociodemographics, SLE specific, comorbidities, baseline haematology/biochemistry/immunology and treatment data were collected by ≥75% respondents including the 1997 American College of Rheumatology (ACR) Classification Criteria (83%), SLE Disease Activity Index-2000 (82%), current treatment (100%), drug name, dose, frequency and start date (75-100%) and complement C3/4 (94%). A range of other items was collected by 50-<75% of respondents including SLICC 2012 Criteria (67%), SLICC/ACR Damage Index (68%) and Short Form Health Survey-36 (53%). Less than 50% of respondents collect certain items including European Alliance of Associations for Rheumatology/ACR 2019 criteria (33%), British Isles Lupus Assessment Group scores (12%) and pneumococcal vaccine status (39%).</p><p><strong>Conclusions: </strong>The frequency with which an initial set of variables is collected in SLE cohorts globally was identified and can form the basis from which to develop a core minimum dataset for SLE. Further refinement and common definitions will be needed to finalise a minimal core dataset suitable for widespread use.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131207","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":"TSPO PET/MR in neuropsychiatric lupus: neuroinflammatory metabolic signatures and diagnostic biomarkers.","authors":"Jing Huang, Jiyuan Wang, Bixiao Cui, Li Su, Hongwei Yang, Yu Liu, Hongxing Wang, Jie Lu","doi":"10.1136/lupus-2025-001643","DOIUrl":"10.1136/lupus-2025-001643","url":null,"abstract":"<p><strong>Background: </strong>Neuropsychiatric SLE (NPSLE) is a clinically challenging subset of SLE, marked by heterogeneous central nervous system involvement. Diagnosis relies on clinical symptoms and exclusionary criteria, lacking objective biomarker.</p><p><strong>Purpose: </strong>To investigate metabolic patterns of intracerebral lesions and identify diagnostic biomarkers for NPSLE using translocator protein (TSPO) positron emission tomography (PET)/magnetic resonance (MR).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 19 patients with NPSLE and 10 patients with non-NPSLE, who underwent [¹⁸F] DPA-714 PET/MRI. Diagnoses of SLE and NPSLE followed American College of Rheumatology (ACR) classification and Systemic Lupus International Collaborating Clinics (SLICC) Model B criteria. T2-weighted MRI lesions served as regions of interest (ROI), coregistered to PET for cross-modality quantitative analysis. The maximum uptake (SUVmax) and mean uptake (SUVmean) of brain lesions for each patient was measured. Group differences in SUVmax and SUVmean were compared. Clinical associations were conducted using Pearson correlation, and differentiation between non-NPSLE and NPSLE was performed by logistic regression analysis.</p><p><strong>Results: </strong>SUVmax was significantly higher in the NPSLE group than in the non-NPSLE group (p<0.01), while there was no significant difference in SUVmean (p>0.05). SUVmax was correlated with clinical assessment scores (SLICC/ACR: r=0.43, p=0.02; modified Rankin Scale: r=0.41, p=0.04; SLE Disease Activity Index: r=0.41, p=0.03), and no significant correlation was found for SUVmean. In logistic regression analysis, only the model based on SUVmax alone was significant (p=0.01). In ROC analysis, the area under the curve (AUC) of SUVmax (0.83) was higher than that of SUVmean (0.68), and Model 4 (SUVmax+SUVmean + Interaction) showed the best diagnostic performance (AUC=0.94).</p><p><strong>Conclusions: </strong>Patients with NPSLE and non-NPSLE showed distinct TSPO uptake in brain lesions, indicating different pathophysiology. TSPO PET/MR may serve as a potential imaging biomarker for differentiating NPSLE, providing insights for clinical diagnosis and mechanistic stratification in SLE.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081018","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":"Frequency-dependent and temporal variability of low-frequency fluctuations in patients with primary Sjögren's syndrome.","authors":"Chunfeng Hu, Luoyu Wang, Xiuhong Ge, Zhijiang Han, Xiaofang Zhang, Xinyun Du, Yushan Shang, Huijun Cao, Chengcheng Gao, Peiying Wei, Jiao Huang","doi":"10.1136/lupus-2025-001655","DOIUrl":"10.1136/lupus-2025-001655","url":null,"abstract":"<p><strong>Objectives: </strong>The central nervous system is a significant extraglandular target in primary Sjögren's syndrome (pSS), often characterised by cognitive deficits. However, the underlying mechanisms remain elusive. This study aims to investigate the alterations in amplitude of low-frequency fluctuations (ALFF) in patients with pSS and to explore whether it exhibits frequency dependence and temporal variability, attempting to explore its mechanism.</p><p><strong>Methods: </strong>The study comprised 68 patients with pSS and 69 healthy controls, all of whom underwent resting-state functional MRI and neuropsychological assessments. The ALFF method was used to ascertain whether frequency-dependent alterations occur within the slow-5 (0.01-0.027 Hz) and slow-4 (0.027-0.073 Hz) frequency bands. Additionally, dynamic ALFF (dALFF) analysis was conducted to explore the temporal variability. Ultimately, the correlation between the abnormal brain regions and neuropsychological assessments was elucidated.</p><p><strong>Results: </strong>The right fusiform gyrus of patients with pSS shows abnormalities in ALFF and its two sub-bands, while the left precentral gyrus and right middle frontal gyrus exhibited abnormal increase limited to the slow-5 frequency band. dALFF showed an abnormal activity in the left supplementary motor area in patients with pSS. Additionally, the differential brain regions identified by the slow-5 frequency band of ALFF correlated with certain neuropsychological scales.</p><p><strong>Conclusions: </strong>This research indicates that ALFF metrics offer enhanced insights into the alterations of regional brain function in patients with pSS, which exhibits both frequency-dependent and temporal variability characteristics, complementing traditional metrics and enhancing our comprehension of brain function in pSS and suggests that ALFF may emerge as a novel instrument for exploring the underlying neural mechanisms in patients with pSS.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081032","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":"Prevalence and incidence of systemic lupus erythematosus in Thailand based on national health data.","authors":"Patnarin Pongkulkiat, Chingching Foocharoen, Tippawan Onchan, Siraphop Suwannaroj, Ajanee Mahakkanukrauh","doi":"10.1136/lupus-2025-001621","DOIUrl":"10.1136/lupus-2025-001621","url":null,"abstract":"<p><strong>Background: </strong>SLE is an autoimmune disease that varies across ethnic populations and the regions that cause economic burdens, but nationwide epidemiological data for Thailand are lacking.</p><p><strong>Objective: </strong>To estimate the incidence and prevalence of SLE in Thailand between 2017 and 2020.</p><p><strong>Methods: </strong>A retrospective cohort study used the Information and Communication Technology Center, Ministry of Public Health, covering all major healthcare insurance systems (nearly 90% of hospitals, about 80% of the Thai population). Adults (≥18 years) with a primary diagnosis of SLE (International Classification of Diseases 10th Revision code M32) were included. Point and period prevalence (per 100 000 population) and annual incidence rates (per 100 000 person-years) were calculated overall and stratified by year, age, sex and region, with 95% CIs.</p><p><strong>Results: </strong>In 2017, 55 956 prevalent cases were identified among 65 204 797 of the total Thai population, yielding a point prevalence of 85.8/100 000 (95 % CI 85.1 to 86.5). Prevalence was highest in women (152.9 vs 15.9/100 000; female-to-male ratio 9.6:1), in the 40-49 year age group (128.3/100 000) and in the southern region (178.5/100 000). From 2018 to 2020, incident SLE cases numbered 15 403, 16 243 and 15 925, corresponding to annual incidence rates of 23.6, 24.8 and 24.3/100 000 person-years, and the cumulative incidence for the 3 years was 72.7/100 000 person-years (95 % CI 72.0 to 73.4). Incidence peaked at ages 40-49 in 2019 (33.7/100 000) and was consistently highest in the south (60.0, 53.9 and 57.3/100 000 person-years in 2018-2020).</p><p><strong>Conclusions: </strong>SLE is relatively common in Thailand, particularly among women of reproductive age and residents of the southern region. These nationwide data support SLE service planning in Thailand and may guide resource allocation in other Southeast Asian health systems expanding universal coverage.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000913","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":"Advancing treat-to-target in SLE: a pilot study using a clinical decision support system.","authors":"Agner R Parra Sánchez, Koen Vos, Odile van Hall, Irene E M Bultink, Michel Tsang-A-Sjoe, Alexandre Voskuyl, Ronald F van Vollenhoven","doi":"10.1136/lupus-2025-001605","DOIUrl":"https://doi.org/10.1136/lupus-2025-001605","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility, usability and acceptability of implementing a treat-to-target (T2T) strategy supported by a Clinical Decision Support System (CDSS), in routine SLE outpatient care.</p><p><strong>Methods: </strong>A 24-week, non-randomised, multicentre, clustered pilot study was conducted across four rheumatology outpatient centres. Adult patients with SLE were allocated by centre to either a T2T strategy supported by a CDSS (T2T-CDSS) or a routine outpatient care (ROC) group. The CDSS provided evidence-based treatment recommendations based on disease activity measures. Feasibility outcomes included recruitment and retention rates. Usability was assessed with the System Usability Scale (SUS), completed by physicians in the T2T-CDSS group. Acceptability was evaluated using the Treatment Satisfaction Questionnaire (TSQ) and qualitative feedback. Exploratory outcomes included disease activity, remission rates and treatment modifications.</p><p><strong>Results: </strong>Of 91 screened patients, 38 were enrolled (recruitment rate 42%) and 35 completed the study (retention rate 92%). The SUS score for the CDSS was 73.8, indicating good usability. Global satisfaction scores on the TSQ were stable over time and comparable between groups. Remission was achieved at least once by 61% (11/18) of patients in the T2T-CDSS group and 59% (10/17) in the ROC group. Both treatment intensifications and de-escalations occurred more frequently in the T2T-CDSS group compared with ROC (83% vs 47%). Treatment intensifications were observed in 61% of patients in the T2T-CDSS group vs 29% in the ROC group. Treatment de-escalation, represented by glucocorticoid tapering, occurred in 39% of T2T-CDSS patients compared with 18% in ROC. No statistically significant differences were observed between groups in disease activity outcomes or remission rates.</p><p><strong>Conclusions: </strong>Implementation of a T2T strategy supported by a CDSS in SLE outpatient care was feasible, usable and acceptable to patients and physicians. Although qualitative feedback revealed important implementation barriers that should be addressed in future trials, the intervention facilitated proactive, target-driven treatment adjustments without compromising patient satisfaction and shows promise for implementing goal-directed therapy in SLE management.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959601","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":"Anti-ribosomal-P protein antibodies and systemic lupus erythematosus (SLE): in a cross-sectional study of Danish adult patients with SLE, no significant association is found between anti-ribosomal-P and neuropsychiatric SLE.","authors":"Sabine Lerke Kamstrup, Nanna Surlemont Schmidt, Henrik Zachar Langkilde, Anna Christine Nilsson, Anne Voss","doi":"10.1136/lupus-2025-001550","DOIUrl":"10.1136/lupus-2025-001550","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective was to assess the prevalence of anti-ribosomal-P protein antibodies (anti-Rib-P) in a well-characterised Danish adult SLE cohort. Secondary objectives included (1) assessing any association between anti-Rib-P and neuropsychiatric SLE (NPSLE), (2) assessing any association between anti-Rib-P and characteristics of Danish patients with SLE and (3) assessing potential associations between selected autoantibodies and NPSLE.</p><p><strong>Method: </strong>This cross-sectional study included 198 Danish patients with SLE from a population-based cohort. Patients meet the American College of Rheumatology's 1997 revised classification criteria for SLE and were 18 years of age or older. Anti-Rib-P were detected in serum using fluorescence enzyme immunoassay. ANA patterns were tested using indirect immunofluorescence on HEp-2 cells. Anti-double-stranded DNA antibody was examined by manual ELISA, and antibodies targeting Ro/SSA, La/SSB, Sm, RNP, Scl-70, Jo-1, Centromer B and Histone were examined on a Luminex instrument.</p><p><strong>Results: </strong>We identified 14 (7.1%) patients with anti-Rib-P positive SLE, and 3 anti-Rib-P positive patients were diagnosed with NPSLE (21% of patients with NPSLE). There was no statistically significant association between anti-Rib-P and NPSLE. The mean anti-Rib-P titres in the patients with NPSLE did not differ significantly from patients without NPSLE patients' titres. We observed a significant association between anti-Rib-P positivity and disease activity measured by the SLEDAI-2K (SLE Disease Activity Index 2000) score. A stepwise logistic regression found an association between NPSLE and SLEDAI-2K and SLICC DI (SLE International Collaborating Clinics Damage Index) score.</p><p><strong>Conclusion: </strong>This study could not confirm a role for anti-Rib-P in the identification of NPSLE. On the other hand, anti-Rib-P was associated with SLE disease activity as well as organ damage.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873899","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}