Lupus Science & Medicine最新文献

{"title":"Role of repeat kidney biopsy after 6 months of treatment in proliferative lupus nephritis.","authors":"Alexandra Vrabie, Bogdan Obrisca, Bogdan Sorohan, Roxana Jurubita, Camelia Achim, Diana S Zilișteanu, Andreea Andronesi, Gabriela Lupusoru, Elena E Rusu, Raluca Bobeică, Georgia Micu, Sonia Bălănică, Andreea Berechet, Valentin Mocanu, Stefan Lujinschi, Nicu Caceaune, Gener Ismail","doi":"10.1136/lupus-2026-002130","DOIUrl":"10.1136/lupus-2026-002130","url":null,"abstract":"<p><strong>Objective: </strong>To characterise histological response following induction therapy in a real-world cohort of patients with proliferative lupus nephritis (LN) undergoing per-protocol repeat kidney biopsy; to assess the concordance between clinical and histological response and to identify baseline factors associated with changes in activity and chronicity indices.</p><p><strong>Methods: </strong>We conducted a retrospective observational study including 20 adult patients with systemic lupus erythematosus and biopsy-proven proliferative LN who underwent a protocolised repeat kidney biopsy at 6 months (±3 months) after induction therapy. Clinical, laboratory and histopathological data were collected at both biopsy time points. Associations between baseline parameters and histological outcomes were explored.</p><p><strong>Results: </strong>After a median of 7.5 months, proteinuria significantly decreased while estimated glomerular filtration rate and complement levels significantly improved. The histological activity index (AI) decreased significantly, with improvement observed in 90% of patients. Chronicity index (CI) increased in 50% of patients, without reaching statistical significance. At 6 months, 55% of patients achieved primary efficacy renal response, whereas 45% achieved histological response. Notably, discordance between clinical and histological responses was frequent: 45% of clinical responders exhibited persistent histological activity and 33% of histological responders failed to meet clinical response criteria. Lower baseline proteinuria and better baseline renal function were observed among patients with AI improvement. Likewise, patients with an increase in CI had a lower baseline CI and tended to have a better baseline renal function. Histological outcomes did not differ according to the type of immunosuppressive therapy used during induction.</p><p><strong>Conclusions: </strong>In this real-world cohort of proliferative LN, substantial discordance between clinical and histological response was observed following induction therapy. While histological activity improved in most patients, chronic damage progressed in half of the cohort despite favourable clinical evolution. These findings should be interpreted as exploratory and hypothesis-generating rather than as definitive associations and highlight the need for prospective studies to define its role in personalised LN management.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"13 2","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648608","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":"Lupus Nexus: developing a prospective registry, biorepository and data exchange platform to foster global collaborations, accelerate research innovation and advance precision medicine in lupus.","authors":"Teodora P Staeva, Arezou Khosroshahi, Alfred Hyoungju Kim, Devon D Kelly, Mary Jo Fekete, Kechi Anyadike, Alyssa Baloski, Shannon K Barriteau, Amonte Davis, Angela M Mitchell, Nikolay Nepochatov, Grant Roesler, Melissa Rawley-Payne, William Apruzzese, Amanda Charbonneau, Christopher Dowd, Paul R Fortin, Paul Hoover, David R Karp, Fotios Koumpouras, Martin Lewis, Meggan Mackay, Paola Mina-Osorio, Christine Peschken, Jamie Shaw, Dayani Tipple, Zahi Touma, Albert Wang, Ruth Wilson, Stacie Bell, Alison Lee, Marc S Hurlbert, Jean Stimola-Sposaro, Virginia Pascual, Inaki Sanz, Peter Schafer, S Sam Lim","doi":"10.1136/lupus-2026-001977","DOIUrl":"10.1136/lupus-2026-001977","url":null,"abstract":"<p><strong>Introduction: </strong>SLE remains a disease of high unmet medical need. Protean manifestations and the lack of clear understanding of aetiology, pathogenesis and disease subgroups make it difficult to develop and employ targeted therapeutic approaches. Community-wide access to a longitudinal, highly curated patient dataset with linked biospecimens and cellular/molecular data is critical to enable advances and is now provided by Lupus Nexus (LNx). In this study, we describe the development of this unique resource with exemplary patient engagement.</p><p><strong>Methods and analysis: </strong>LNx, developed with guidance from over 100 partners, includes a prospective, longitudinal observational study, the Lupus Landmark Study (LLS), that will enrol up to 3500 adults living with lupus into four cohorts and will follow them over 5 years. The registry data comprises medical information, clinician-reported and patient-reported outcomes while the biorepository includes whole blood, urine, saliva, stool and tissue which are available to the research community for a broad range of analyses. Importantly, since all raw data from the biospecimen analyses will be deposited in LNx, it will amass a deep and comprehensive dataset over time. As of 25 March 2026, there are 705 enrolled participants (13.3% new onset, 27.4% extrarenal flare, 23.3% active lupus nephritis and 35% prevalent cases, with 37.6% black, 38% white and 12.6% Asian/Pacific Islander patients). Over 15 400 unique samples have been collected and specific analyses are underway.All data and samples from LNx are available via its Data Repository Exchange and Analytics platforM (DREAM). Importantly, a dedicated patient portal within DREAM enables participants to view their study data, connect with others and learn about the research emerging from projects using LNx.</p><p><strong>Trial registration number: </strong>NCT05934149.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"13 2","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604488","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":"Targeting type I interferon in lupus autoimmune haemolytic anaemia: first report with anifrolumab.","authors":"Fulvia Ceccarelli, Rossella De Angelis, Francesca Bottazzi, Danila Madonna, Melania Alessia Coscia, Noemi Italiano, Emanuela Praino, Emanuela Sabatini, Leonardo Santo, Lorenzo Cavagna, Fabrizio Conti","doi":"10.1136/lupus-2026-002063","DOIUrl":"10.1136/lupus-2026-002063","url":null,"abstract":"<p><strong>Objective: </strong>Autoimmune haemolytic anaemia (AIHA) occurs in approximately 5-10% of patients with SLE and it is traditionally associated with higher disease activity, increased damage accrual and reduced survival. SLE management recommendations partially address disease-related haematological manifestations without specific indication for AIHA treatment. Indeed, therapeutic approaches are prevalently extrapolated from the haematology field. In the present report, we aimed at describing a case series of patients with SLE and AIHA successfully treated with anifrolumab (ANF).</p><p><strong>Methods: </strong>We described patients with SLE treated by ANF with active AIHA at the drug initiation. Clinical and laboratory data were reported in a standardised electronic form, including laboratory evidence of haemolysis. Overall disease activity was assessed by using the SLE Disease Activity Index 2000 (SLEDAI-2k). We collected patients data at baseline (T0), after 1 month (T1) and every 3 months thereafter.</p><p><strong>Results: </strong>We included seven patients (6F/1M, median age 61 years (IQR 33), median disease duration 48 months (IQR 72)). All the patients had a positive direct Coombs test and laboratory evidence of active haemolysis at ANF starting. During treatment, we observed a progressive increase in haemoglobin (Hb) levels, with a statistically significant difference compared with baseline after 3 months of treatment (p=0.02). In parallel we registered the increase in RBC count, without the need to perform RBC transfusions after ANF starting. Overall disease activity significantly improved during the follow-up, with significant reduction of mean SLEDAI-2k values after 6 months of treatment (p=0.01).</p><p><strong>Conclusion: </strong>In the present case-series study, we provide the first report about the benefit of ANF in the treatment of SLE-related AIHA, a rare but potentially severe manifestation associated with increased morbidity and mortality. In our cohort, ANF treatment was associated with a rapid and sustained increase in Hb levels, evident already at 1 month and progressively improving up to 6 months.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"13 2","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604571","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 falls, recurrent falls and osteoporotic fractures in SLE patients with comorbid fibromyalgia: a propensity score-matched cohort study using the TriNetX Network.","authors":"Wan-Yun Hsu, Li-Yun Tsai, Ching-Yi Lai, Jun-Peng Chen, Chung-Mao Kao, Yen-Ju Chen, I-Chieh Chen, Yi-Ming Chen","doi":"10.1136/lupus-2026-002188","DOIUrl":"10.1136/lupus-2026-002188","url":null,"abstract":"<p><strong>Objective: </strong>Fibromyalgia (FM) frequently co-occurs with SLE, but its independent contribution to musculoskeletal risk is unclear. We aimed to determine whether comorbid FM is independently associated with the risk of falls, recurrent falls, thoracolumbar vertebral fractures and osteoporotic fractures in patients with SLE.</p><p><strong>Methods: </strong>We conducted a propensity score-matched (PSM) retrospective cohort study using the TriNetX US Collaborative Network. Adult SLE patients with comorbid FM (SLE+FM) were matched 1:1 to SLE patients without FM (SLE-only) on demographics, comorbidities, laboratory parameters and 19 medications. A 6 month washout period preceded outcome ascertainment to ensure capture of incident events only. Time-to-event analyses over 5 years for risk of falls, recurrent falls, thoracolumbar vertebral fractures and osteoporotic fractures used Kaplan-Meier curves and Cox proportional hazards regression.</p><p><strong>Results: </strong>After 1:1 PSM, 23 775 matched pairs were retained with substantially improved covariate balance. At 5 years, SLE+FM patients had significantly elevated risks of incident falls (adjusted HR (aHR) 1.38, 95% CI 1.29 to 1.48), recurrent falls (aHR 1.53, 95% CI 1.32 to 1.76), thoracolumbar vertebral fractures (aHR 1.18, 95% CI 1.01 to 1.37) and osteoporotic fractures (aHR 1.14, 95% CI 1.02 to 1.27) compared with the SLE-only group. Associations were directionally consistent at 3 years and across all prespecified subgroups. Kaplan-Meier curves showed early and progressive divergence between cohorts from the start of follow-up.</p><p><strong>Conclusion: </strong>Comorbid FM is significantly and independently associated with increased fall and fracture risk in SLE. These findings support the incorporation of FM evaluation into fall risk assessment, alongside multidisciplinary bone-protective and fall-prevention strategies, in SLE patients with comorbid FM.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"13 2","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604468","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":"Circulating kidney injury molecule-1 as a prognostic biomarker for long-term renal outcomes in lupus nephritis: a retrospective cohort study.","authors":"Keisuke Sako, Yoshitada Toyota, Shiori Nakagawa, Daichi Yomogida, Misaki Yoshida, Akari Takeji, Takahiro Yuasa, Akihiko Koshino, Shunsuke Tsuge, Yuta Yamamura, Megumi Oshima, Satoshi Hara, Kiyoaki Ito, Norihiko Sakai, Miho Shimizu, Takashi Wada, Joseph V Bonventre, Yasunori Iwata","doi":"10.1136/lupus-2026-002067","DOIUrl":"10.1136/lupus-2026-002067","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether circulating kidney injury molecule-1 (KIM-1) predicts long-term renal outcomes in lupus nephritis (LN), including relapse, progression to end-stage kidney disease (ESKD) and mortality.</p><p><strong>Methods: </strong>This retrospective cohort study included 63 Japanese patients with biopsy-confirmed LN who were treated at Kanazawa University Hospital between 1990 and 2022. After excluding 17 patients who did not meet the eligibility criteria, 46 patients were included in the final analysis. Circulating KIM-1 levels were measured in serum samples collected at the time of renal biopsy prior to treatment or additional treatment. Patients were stratified into low-KIM-1 and high-KIM-1 groups using the median value (153 pg/mL) as the cut-off. The primary endpoints were LN relapse, ESKD and all-cause mortality. Survival was analysed using Kaplan-Meier curves and Cox proportional hazards models.</p><p><strong>Results: </strong>During a median follow-up of 127 months, nine patients (20%) experienced relapse, four (9%) developed ESKD and six (13%) died. The high-KIM-1 group had lower baseline renal function, greater proteinuria, a higher frequency of Class IV histology and higher activity index scores. Kaplan-Meier analysis demonstrated significantly lower LN relapse-free (p=0.027; log-rank) and ESKD-free survival (p=0.049) in the high-KIM-1 group. In the multivariable Cox regression analysis, circulating KIM-1 was independently associated with LN relapse (per-IQR HR: 1.92, 95% CI 1.07 to 3.45; p=0.029).</p><p><strong>Conclusion: </strong>Elevated circulating KIM-1 at the time of renal biopsy was associated with adverse long-term renal outcomes in LN and independently associated with relapse, although its incremental predictive value beyond conventional clinical markers was modest. KIM-1 may support early risk stratification and individualised treatment; however, prospective validation in larger cohorts is needed.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"13 2","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13405212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579203","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":"Glucocorticoid exposure and social support deficits as longitudinal predictors of long-term neuropsychiatric damage in SLE: insights from the LUMINA cohort (LXXXIII).","authors":"Mario Felix, Gerald McGwin, Graciela S Alarcon, Lais Osmani, David Felson, Lisa Gale Suter, Evelyn Hsieh","doi":"10.1136/lupus-2026-002074","DOIUrl":"10.1136/lupus-2026-002074","url":null,"abstract":"<p><strong>Objective: </strong>To identify longitudinal predictors of neuropsychiatric damage in SLE and compare predictors of organic versus all neuropsychiatric outcomes.</p><p><strong>Methods: </strong>We studied 657 patients from the multiethnic Lupus in Minorities: Nature vs Nurture cohort (5944 person-visit observations). Organic neuropsychiatric damage (seizures, cerebrovascular accident, neuropathy, transverse myelitis) and all neuropsychiatric damage (organic plus cognitive impairment/psychosis) were defined using the Systemic Lupus International Collaborating Clinic/American College of Rheumatology Damage Index. Random survival forests with time-varying covariates modelled 173 predictors. Feature importance was assessed by permutation methods and SHapley Additive exPlanations (SHAP).</p><p><strong>Results: </strong>92 patients (14.0%) had organic and 197 (30.0%) had any neuropsychiatric damage; models were trained on incident events (48 and 90, respectively). Random survival forests achieved C-indices of 0.738 (organic) and 0.775 (all neuropsychiatric damage) outperforming Cox regression. For organic damage, glucocorticoid highest ever daily dose was the strongest predictor, followed by social support deficits and retirement status, exceeding disease activity measures. Tangible material support deficits specifically dominated the social support signal. SHAP dependence analysis suggested a model-derived inflection in risk contribution between approximately 40 and 60 mg/day, with current dose contributing approximately 2.8-fold more to model-predicted risk for all neuropsychiatric damage than for organic damage alone (mean |SHAP| 0.022 vs 0.008). For the secondary outcome, physician global assessment, fatigue and pain ranked highest, suggesting distinct predictor profiles for cognitive versus organic outcomes. Social determinants of health contributed independently of clinical severity.</p><p><strong>Conclusions: </strong>In this exploratory analysis, glucocorticoid exposure and tangible social support deficits emerged as leading, potentially modifiable predictors of neuropsychiatric damage in SLE, often outranking disease activity measures, with implications for glucocorticoid stewardship, tangible-support screening and outcome-specific management. External validation in an independent contemporary cohort is required prior to clinical translation.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"13 2","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562489","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":"Harnessing AI and social media to understand real-world patient experiences in SLE.","authors":"Siqi Yang, Carina Hawryluk, James Liu, Niki Eckert, Jessica Otoo, Ernest R Vina, Lixia Yao","doi":"10.1136/lupus-2026-002024","DOIUrl":"10.1136/lupus-2026-002024","url":null,"abstract":"<p><strong>Objective: </strong>To apply large language models (LLMs) to Reddit posts referencing SLE to identify patient-expressed unmet medical needs, symptom experiences and healthcare challenges, demonstrating how artificial intelligence-enabled social media listening complements traditional patient-experience research.</p><p><strong>Methods: </strong>We extracted 4633 posts from 10 SLE-related Reddit communities using the public Reddit Application Programming Interface (October-November 2025). After removing duplicates, promotional content and posts with insufficient information, 2603 posts remained. We developed a thematic codebook through manual review of 300 posts and refined it iteratively. Two state-of-the-art LLMs (Gemini 3.0 and GPT-5.2) were evaluated for automated thematic labelling using per cent agreement, Cohen's κ and performance against a human-annotated reference set (n=100). The best-performing model was then used to quantify theme prevalence across the full dataset, followed by qualitative review of representative narratives.</p><p><strong>Results: </strong>GPT-5.2 demonstrated higher performance (F1=0.844) than Gemini 3.0 (F1=0.811), with substantial intermodel agreement across main themes (mean κ=0.71). Posts reflected multidimensional experiences. The most frequent subtheme was <i>Advice Seeking</i> (84.1%), followed by <i>Emotional Coping</i> (55.6%). Common symptom-related themes included <i>Pain</i> (37.2%), <i>Other Symptom Presentations</i> (37.6%), <i>Fatigue</i> (24.7%) and <i>Acute or Worsening Flares</i> (30.2%). Diagnostic uncertainty was prominent, including testing and results confusion (24.0%) and emotional impact of uncertainty and disease progression (33.0%). Qualitative review highlighted emotional and social burden, reliance on peer communities for advice and shared experiences, and difficulty managing complex treatment regimens.</p><p><strong>Conclusion: </strong>LLM-enabled social media listening offers a scalable method for synthesising large volumes of unstructured patient narratives, providing timely insights into lived experiences and unmet needs among individuals discussing lupus online. Findings align with established qualitative literature while highlighting persistent gaps in patient education, communication and care coordination. This analytical framework can be extended to other disease areas to support patient-centred care, measurement development and evidence generation relevant to therapeutic and health outcomes research.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"13 2","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549228","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 clinical associations of cerebral atrophy in systemic lupus erythematosus.","authors":"Woon Shen Teo, Choung Min Ng, Lydia Say Lee Pok, Farhana Fadzli, Kartini Rahmat, Jasmin Raja","doi":"10.1136/lupus-2026-002005","DOIUrl":"10.1136/lupus-2026-002005","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the prevalence of cerebral atrophy in a multi-ethnic systemic lupus erythematosus (SLE) cohort and to identify its associated clinical factors.</p><p><strong>Methods: </strong>In this cross-sectional study (2024-2025), adults fulfilling the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for SLE at University Malaya Medical Centre were recruited. Demographic, clinical, serological, vascular and treatment data were collected. Disease activity and cumulative damage were assessed using the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Non-contrast CT brain scans were performed with cerebral atrophy graded using the validated Global Cortical Atrophy (GCA) score. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA). Fisher's exact test and χ² test were used to test the association between two categorical variables where appropriate, while group differences were tested using the Mann-Whitney U test. Univariable and multivariable logistic regression analyses were considered to identify variables that were significantly associated with cerebral atrophy.</p><p><strong>Results: </strong>Seventy patients (92.9% female; median age 40 (IQR 31.75-50.25) years; median disease duration 12 (IQR 4-19) years were included. Cerebral atrophy was present in 52.9%, predominantly mild (75.7%). From univariate comparisons, patients with cerebral atrophy were significantly older in age, had longer disease duration, lower education, higher SDI and poorer MoCA scores. Multivariable analysis showed that older age (OR 1.10 per year, 95% CI 1.04 to 1.18) and neuropsychiatric SLE (NPSLE) (OR 4.58, 95% CI 1.05 to 24.07) contributed to increased odds of cerebral atrophy, while higher educational attainment was linked with reduced odds of cerebral atrophy (OR 0.22, 95% CI 0.06 to 1.03).</p><p><strong>Conclusions: </strong>Cerebral atrophy is common in SLE and independently associated with age, education, NPSLE and cognitive impairment, reflecting neuroinflammatory and neurodegenerative mechanisms. These findings underscore the importance of cognitive screening and targeted monitoring of high-risk patients.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"13 2","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536350","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 belimumab on the utility of serological markers for assessing systemic lupus erythematosus activity.","authors":"Víctor Moreno-Torres, Ana Royuela, Guillem Policarpo-Torres, Diana Paredes Ruiz, María Calabuig, Isabel Sánchez Berná, Olga Capdevila Pons, Augustín Colodro, José Salvador García-Morillo, Lucio Pallarés, Luis Trapiella, Adela Marin Ballvé, Cristina Lavilla-Olleros, Jose Luis Callejas-Rubio, Fernando Tornero, Sandra Parra, Ignasi Rodríguez-Pintó, Julia Barbado Ajo, Ismael Calero-Paniagua, Esther Rubio, Ana Argibay, José M Gómez-Verdú, Jesús Miguel López-Dupla, Carlos Jorge Ripper, Angel Robles-Marhuenda, Eva Calvo-Begueria, Eva Fonseca, Andrés González-García, Kima López-Aldabe, Begoña Frutos-Pérez, Robert Hurtado-García, Ana Ponce, Gabriela Artinyan, Angel Pedro Crisolino Pozas, Borja De Miguel-Campo, Joaquín Pousibet, Gerard Espinosa","doi":"10.1136/lupus-2026-001980","DOIUrl":"10.1136/lupus-2026-001980","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the dynamics of C3, C4 and anti-dsDNA antibody levels and their association with clinical activity and flares in patients with systemic lupus erythematosus (SLE) treated with belimumab (BEL).</p><p><strong>Methods: </strong>Retrospective longitudinal cohort study from the BELILES-GEAS registry. Serological markers were assessed at the time of SLE diagnosis, at baseline, at each follow-up visit (months 3, 6, 12, 18, and 24 after treatment initiation) and during disease flares.</p><p><strong>Results: </strong>A total of 371 patients were included, with a median drug exposure of 13.2 months. At baseline, 70.1% of patients were seropositive. SLE Disease Activity Index 2000 (SLEDAI-2K) and cSLEDAI scores and prednisone doses decreased significantly over time, whereas serum C3 and C4 levels, anti-dsDNA positivity and immunosuppressant use remained stable. Among 95 (25.6%) patients who experienced 139 (14.5%) flares, longitudinal analysis adjusted by immunosuppressant use and prednisone dose revealed no association between flare occurrence and low C3 or C4, whereas anti-dsDNA antibody positivity was (C3 OR=1.31, 95% CI 0.82 to 2.09; C4 OR=1.08, 95% CI 0.62 to 1.86, and anti-dsDNA OR=1.81, 95% CI 1.09 to 3.01, respectively). When stratified by flare severity, low C3 levels showed a borderline association with moderate-to-severe flares (OR=1.82, 95% CI 0.99 to 3.31), while no significant associations were observed for C4 or for mild flares. There was no association between serum level of C3 or C4 and cSLEDAI. The flare-discriminative performance of SLEDAI-2K and cSLEDAI was similar (AUC-ROCs 0.779 vs 0.781, p=0.88).</p><p><strong>Conclusion: </strong>In SLE patients treated with BEL, the clinical utility of serological markers appears dissociated from disease activity. While C3 and C4 levels were not clearly related to disease activity or flares, low C3 levels showed a borderline association with moderate-to-severe flares, and anti-dsDNA positivity remained associated with increased flare risk, supporting a clinical assessment-driven approach with complementary use of anti-dsDNA.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"13 2","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536355","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":"Real-world treatment patterns and outcomes in moderate-to-severe SLE: findings from the Spanish SPOCS cohort.","authors":"Nuria Lozano-Rivas, Iñigo Rúa-Figueroa, Mercedes Freire-González, Ana Turrión, Iván Castellvi, Julia Barbado Ajo, Jaime Calvo-Alén, Norberto Ortego-Centeno, Monserrat Díaz-Encarnación, José María Pego-Reigosa, Bo Ding, Marta Galvez-Fernandez, Noemí Bahamontes-Rosa, Ricard Cervera","doi":"10.1136/lupus-2026-002054","DOIUrl":"10.1136/lupus-2026-002054","url":null,"abstract":"<p><strong>Objective: </strong>This analysis describes disease activity, organ damage and health-related quality of life (HRQoL) in patients with active SLE and moderate-to-severe disease activity from the Spanish SLE Prospective Observational Cohort Study (SPOCS) cohort.</p><p><strong>Methods: </strong>SPOCS (NCT03189875) is a multicentre, prospective, observational cohort that followed-up adults with SLE every 6 months for up to 3 years. Disease activity was assessed using SLE Disease Activity Index 2000 (SLEDAI-2K) and Physician Global Assessment. Remission and Lupus Low Disease Activity State (LLDAS) definitions were therapeutic objectives; organ damage by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI); HRQoL by Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Patient Health Questionnaire-8 (PHQ-8) and EuroQol 5-Dimension 5-Level (EQ-5D-5L). Patients were recruited from 18 Spanish sites (2017-2019).</p><p><strong>Results: </strong>99 patients were enrolled. At baseline, median (IQR) SLEDAI-2K was 8 (7-12); 45% of patients had organ damage (mean (SD) SDI 1.1 (1.6)). Remission was achieved by 13% at 6 months and at 24 months; sustained remission occurred in 9%. 24% achieved LLDAS at 6 months and ≤22% thereafter; 8% maintained LLDAS for ≥70% of follow-up. Median SLEDAI-2K declined to 4 at 6 months. New or worsening organ damage occurred in 11%, 8% and 12% of patients at 12, 24 and 36 months, respectively; mean SDI (SD) increased to 1.8 (2.0) by 36 months. Musculoskeletal, cutaneous, neuropsychiatric and renal systems were most frequently involved. HRQoL remained poor: 60%-75% had depressive symptoms (PHQ-8 ≥5), 35%-50% moderate-to-severe depression (PHQ-8 ≥10), mean FACIT-F ≈30 (indicating persistent severe fatigue) and mean EQ-5D-5L index 0.70-0.75. Pain/discomfort affected up to 76% and anxiety/depression up to 66% of participants.</p><p><strong>Conclusions: </strong>In Spanish clinical practice, sustained remission and low disease activity state remain uncommon in moderate-to-severe SLE. Nearly half had organ damage at baseline, with continued accrual and impaired HRQoL. These findings highlight ongoing challenges in achieving lasting disease control and underscore the need for broader adoption of treat-to-target approaches to improve outcomes and prevent irreversible organ damage in this patient population.</p><p><strong>Trial registration number: </strong>NCT03189875.</p>","PeriodicalId":18126,"journal":{"name":"Lupus Science & Medicine","volume":"13 2","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471332","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}