{"title":"Vitamin D receptor expression level in patients with SLE and its relationship with vitamin D status, disease course and bone mineral density.","authors":"Sergii Shevchuk, Tetiana Malovana, Liubov Marynych, Liudmyla Denyshchych","doi":"10.1136/lupus-2025-001730","DOIUrl":"10.1136/lupus-2025-001730","url":null,"abstract":"<p><strong>Objective: </strong>To determine vitamin D receptor (VDR) blood serum concentrations in patients with SLE and to assess the relationship with vitamin D status, disease course, bone turnover markers levels and bone mineral density (BMD).</p><p><strong>Methods: </strong>The cross-sectional study involved 99 patients with SLE and 30 controls. We assessed VDR, vitamin D, C-reactive protein (CRP), interleukin (IL) 6, osteocalcin (OC), C-terminal telopeptide of type I collagen (CTX) concentrations, and erythrocyte sedimentation rate (ESR) in study subjects. Dual-energy X-ray absorptiometry was also performed.</p><p><strong>Results: </strong>Mean VDR levels in patients with SLE and in the control group were 12.78±0.61 ng/mL and 23.12±0.61 ng/mL, accordingly (p<0.01). 77.8% patients with SLE had low VDR concentrations and only 22.2% patients presented relatively normal or high levels. Low VDR levels in patients with SLE were associated with age (p=0.054, r=-0.22). The study did not reveal a relationship between VDR level and sex, disease duration, body mass index (BMI) and cumulative glucocorticoid (GC) dose. No association was found between VDR level and a diagnosed lupus nephritis, creatinine concentration and glomerular filtration rate. The correlation analysis confirmed the association of low VDR level with high disease activity, namely with elevated CRP (r=-0.22), IL-6 (r=-0.21) levels, SLE Disease Activity Index 2000 variant (r=-0.20). VDR concentration was closely associated with vitamin D supply. The average level of vitamin D in patients with low VDR was 33.55% lower than in the group with a relatively normal vitamin concentration (p=0.0001, r=0.47). We revealed a proportional increase of CTX concentration associated with VDR decrease (p<0.05, r=-0.27). No significant difference in average Z-score, T-score and BMD between the groups of patients with SLE with low and relatively normal VDR levels (p>0.05) was found.</p><p><strong>Conclusion: </strong>Low VDR concentration is a common phenomenon in patients with SLE associated with age, high disease activity, vitamin D supply and serum CTX concentration. VDR concentration had no significant association with sex, disease duration, cumulative GC dose, BMI, a diagnosed lupus nephritis, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, OC level and BMD.</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/PMC12443211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081120","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":"Cortical changes in women with systemic lupus erythematosus with mild cognitive impairment: a voxel-based morphometry and surface-based morphometry study.","authors":"Minghuang Mo, Yifan Yang, Shuang Liu, Ru Bai, Shu Li, Ruotong Zhao, Xinyu Xu, Yuqi Cheng, Jian Xu","doi":"10.1136/lupus-2025-001523","DOIUrl":"10.1136/lupus-2025-001523","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to reveal the morphological changes of grey matter (GM) in women systemic lupus erythematosus (wSLE) patients with mild cognitive impairment (MCI) with normal conventional MRI.</p><p><strong>Methods: </strong>The differences in brain morphological indicators among wSLE with MCI, wSLE without MCI and women healthy control (wHC) group were calculated and compared by voxel-based morphometry and surface-based morphometry. The GM volume (GMV), cortical thickness (CT), indicators of cortical complexity, including fractal dimension (FD), gyration index (GI), sulcus depth, the relationship between brain morphological indicators and clinical features, were analysed.</p><p><strong>Results: </strong>In comparison to wSLE patients without MCI (n=36), wSLE with MCI (n=26) demonstrated a significant decrease in FD of the left lateral orbitofrontal gyrus. When compared with the wHC group (n=36), both wSLE patients with MCI and wSLE without MCI group exhibited a reduction in GMV in the medial of right superior frontal gyrus, a thinning of CT in the left paracentral and postcentral gyrus as well as in the right pars triangularis gyrus and superior frontal gyrus. Within the wSLE group, Mini-Mental State Examination scores were positively correlated with GMV in the middle of right superior frontal gyrus and with the FD of the left lateral orbitofrontal gyrus.</p><p><strong>Conclusion: </strong>WSLE patients with MCI have brain morphological changes such as reduced GMV, thinning CT, reduced FD and increased GI. Cortical morphological changes may be involved in the pathological process of MCI in wSLE patients.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069974","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 determinants of vertebral fractures in a SLE cohort.","authors":"Denise Rotta, Giovanni Adami, Isotta Galvagni, Francesca Pistillo, Angelo Fassio, Davide Gatti, Margherita Zen, Viviana Ravagnani, Federica Maiolini, Jacopo Croce, Alessandro Volpe, Carmela Dartizio, Camilla Benini, Francesca Ruzzon, Ombretta Viapiana, Maurizio Rossini, Giovanni Orsolini","doi":"10.1136/lupus-2025-001508","DOIUrl":"10.1136/lupus-2025-001508","url":null,"abstract":"<p><strong>Objectives: </strong>Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterised by multiorgan involvement. Osteoporosis and fragility fractures, particularly vertebral fractures, are significant, yet often underestimated, comorbidities in patients with SLE. This study aims to evaluate the prevalence of vertebral fractures and their associations with demographic, disease-related and therapy-related factors in patients with SLE.</p><p><strong>Methods: </strong>We conducted a monocentric, cross-sectional study to systematically evaluate bone health using dual-energy X-ray absorptiometry and vertebral fracture assessment (VFA). Associations between vertebral fractures and clinical, laboratory variables were investigated with logistic and linear regressions.</p><p><strong>Results: </strong>One hundred and six patients with SLE were included. The overall prevalence of radiographic vertebral fractures was 21.7%, whereas clinical vertebral fractures were reported in 14.2% of patients. New, previously not diagnosed, radiographic vertebral fractures were detected in 14.2% of all patients with SLE at screening with VFA. Older age, longer disease duration, cumulative glucocorticoid (GC) dose and lower bone mineral density were significantly associated with vertebral fractures. Cumulative GC dose had the strongest association with vertebral fractures. We also found a positive association between the number of vertebral fractures on VFA and cumulative GC dose (β 0.025, p=0.025).</p><p><strong>Conclusions: </strong>Our findings underscore the importance of actively screening for vertebral fractures in patients with SLE, especially those on long-term GC therapy, to prevent underdiagnosis, mitigate the risk of further skeletal damage and facilitate the timely initiation of targeted antiosteoporotic treatments when indicated.</p><p><strong>Trial registration number: </strong>NCT05590390.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069900","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":"Immunogenicity, safety and adverse events of sequential vaccination with a 10-valent pneumococcal conjugate vaccine (PCV10) and PPSV23 compared with PPSV23 alone in systemic lupus erythematosus.","authors":"Rudrarpan Chatterjee, Sai Yasaswini Kommaraju, Shincy Mettingal Ramakrishnan, Kadahalli Lingegowda Ravikumar, Amita Aggarwal","doi":"10.1136/lupus-2025-001551","DOIUrl":"10.1136/lupus-2025-001551","url":null,"abstract":"<p><strong>Background: </strong>SLE has increased risk of invasive pneumococcal disease due to immune dysregulation and immunosuppression. European Alliance of Associations for Rheumatology recommendations suggest sequential vaccination with conjugate vaccine, followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23). However, data on immunogenicity of sequential vaccination in SLE are limited.</p><p><strong>Methods: </strong>Adult patients with SLE (American College of Rheumatology 2019 criteria) with inactive disease, stable immunosuppression for 3 months and prednisolone ≤10 mg/day were included. Sequential arm received 10-valent pneumococcal conjugate vaccine, followed by PPSV23. The second arm received only PPSV23. The two cohorts were recruited independently without randomisation. Antibodies at baseline and 12-14 weeks to pneumococci (serotypes 1, 5, 6B, 14 and 19F) were measured by ELISA and opsonophagocytic assay for functional antibodies. The primary outcome was a twofold increase in 3/5 serotypes. 40 subjects were enrolled in each arm and 15 healthy adults for response to PPSV23.</p><p><strong>Results: </strong>35 completed the study in the PPSV23 arm and 34 in the sequential arm. Baseline parameters were comparable.Response to PPSV23 was poorer in SLE (74.28%) compared with healthy controls (100%). There was no difference in the primary outcome between sequential vaccination (82.35%, 95% CI 68% to 94%) and PPSV23 (74.28%, 95% CI 60% to 89%). All 15 non-responders were on prednisolone. Among responders, only 41/54 (76%) were on prednisolone. There was no difference in other immunosuppressive drugs. Increasing age predicted poor response on multivariable analysis in all serotypes.Major adverse events included one event of Miller Fisher variant of Guillain-Barré syndrome in the sequential arm. Minor adverse events included one each with injection-site pain, migraine, fever and fatigue after conjugate vaccine, and one with fever after PPSV23. Three minor adverse events in the PPSV23 group included one each with injection-site pain, <i>herpes zoster</i>, headache and fever. In the PPSV23 arm, three minor flares were seen, while in the sequential arm, one major flare and one minor flare occurred.</p><p><strong>Interpretation: </strong>Both vaccination strategies are safe with adequate antibody response. In low- and middle-income countries, a single-dose PPSV23 may be adequate if cost negates sequential vaccination.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023573","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":"Glycosylation of anti-dsDNA IgG correlates with organ involvement in treatment-naïve patients with systemic lupus erythematosus.","authors":"Zhuochao Zhou, Yuhong Liu, Xiaotong Gu, Haowen Zhang, Panan Zhang, Yue Sun, Honglei Liu, Xiaobing Cheng, Yutong Su, Hui Shi, Qiongyi Hu, Huihui Chi, Jianfen Meng, Jinchao Jia, Tingting Liu, Mengyan Wang, Cui Lu, Yunping Cai, Yijun You, Dehao Zhu, Shifang Ren, Jialin Teng, Jingyi Wu, Chengde Yang, Junna Ye","doi":"10.1136/lupus-2025-001665","DOIUrl":"10.1136/lupus-2025-001665","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to leverage machine learning algorithms to explore the relationship between anti-double-stranded DNA (anti-dsDNA) immunoglobulin G (IgG) glycosylation and the degree of organ involvement in patients with SLE.</p><p><strong>Methods and analysis: </strong>We enrolled 86 consecutive treatment-naïve patients with SLE positive for anti-dsDNA antibodies from the Department of Rheumatology and Immunology at Ruijin Hospital, Shanghai, between 2017 and 2019. We quantified and classified the degree of organ involvement in patients with SLE and analysed each glycoform and a combination of glycoforms of purified anti-dsDNA IgG. A random forest classifier and artificial neural network were applied to evaluate the correlation between the levels of glycoform pairs and the degree of organ involvement.</p><p><strong>Results: </strong>Pearson's correlation analysis revealed a strong connection between the involved and uninvolved organs in patients with SLE. Random forest analysis showed that the combination of IgG1Gal and IgG3/4Bis had the highest accuracy (0.7692) and area under the curve (0.8187). In terms of predicting the degree of involvement using an artificial neural network, IgG3/4Bis and IgG1Gal showed the lowest mean squared error (0.0244).</p><p><strong>Conclusions: </strong>Our study showed the effectiveness of combining glycoforms to classify and predict the degree of SLE organ involvement. Different glycoforms were correlated with the involvement degree to various extents, and the combination of anti-dsDNA IgG3/4Bis and IgG1Gal exhibited the best correlation with organ involvement.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959582","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":"Enhancing predictions of subclinical cardiac dysfunction in SLE patients through integrative machine learning analysis.","authors":"Yuhong Liu, Siwei Xie, Zhiming Lin, Changlin Zhao","doi":"10.1136/lupus-2025-001616","DOIUrl":"10.1136/lupus-2025-001616","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the two-dimensional speckle-tracking echocardiography (2D-STE) parameters associated with early impaired left ventricular systolic function in SLE patients and to estimate the potential clinical factors that may trigger and influence left ventricular systolic dysfunction.</p><p><strong>Methods: </strong>This study collected a total of 36 patients admitted to the rheumatology and immunology department of Sun Yat-sen University between January 2020 and December 2021, who were newly diagnosed with SLE and had a Systemic Lupus Erythematosus Disease Activity Index 2000 Score≥4 points. An equal number of healthy controls matched for gender and age were included. All participants underwent routine echocardiography and two-dimensional speckle-tracking echocardiography (2D-STE) examinations. Various clinical data were also collected. Machine learning and regressions were used to estimate potential risk factors for left ventricular systolic dysfunction in SLE patients.</p><p><strong>Results: </strong>Significant differences in 2D-STE parameters were found, including global longitudinal peak systolic strain (GLPS) (p-adjust<0.001), GLPS strain obtained from the apical two-chamber view and GLPS strain obtained from the apical four-chamber view (GLPS-A4C) (p-adjust=0.005), and GLPS strain obtained from the apical long-axis view (GLPS-APLAX) (p-adjust=0.003) between SLE patients and controls. Machine learning models, particularly GLPS-APLAX, showed excellent discrimination ability with an AUC of 0.93 (95% CI: 0.89 to 0.96) and an area under the precision-recall curve of 0.96. Multivariate regression further highlighted the inverse relationship between anti-U1 small nuclear ribonucleoprotein (U1RNP) antibodies and four GLPS-related continuous variable measures, with GLPS, GLPS-A4C and GLPS-APLAX measures having statistically significant effects (eg, GLPS coefficient=-3.71, 95% CI: -5.91 to -1.51, p=0.002).</p><p><strong>Conclusions: </strong>This case-control study revealed that 2D-STE parameters can be used to predict subclinical cardiac dysfunction in SLE patients, and anti-U1RNP antibodies may be an essential predictive clinical factor. Machine learning may further assist in preliminary screening and quantifying left ventricular systolic dysfunction reasons in SLE patients.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"12 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959610","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}
Agner R Parra Sánchez, Koen Vos, Odile van Hall, Irene E M Bultink, Michel Tsang-A-Sjoe, Alexandre Voskuyl, Ronald F van Vollenhoven
{"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}
Sabine Lerke Kamstrup, Nanna Surlemont Schmidt, Henrik Zachar Langkilde, Anna Christine Nilsson, Anne Voss
{"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}