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Ceccarelli F, Perricone C, Natalucci F, Picciariello L, Olivieri G, Cafaro G, Bartoloni E, Roberto G, Conti F. Organ damage in Systemic Lupus Erythematosus patients: A multifactorial phenomenon. Autoimmun Rev 2023:103374. [PMID: 37301273 DOI: 10.1016/j.autrev.2023.103374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
The prevention of chronic damage, especially in early disease phases, remains an unmet need in the management of Systemic Lupus Erythematous (SLE) patients, despite the application of a so-called treat-to-target strategy. The high proportion of SLE patients developing chronic damage suggests a multifactorial aetiology. Thus, besides disease activity, other factors may contribute to the development of damage. The revision of data published so far underlines that, next to disease activity, it is possible to identify other factors playing a relevant role in damage development and progression. In summary, the presence of antiphospholipid antibodies and drugs used to treat SLE patients, in particular glucocorticoids, is strongly associated with SLE-related damage. Furthermore, recent data suggests the possible role of genetic background in determining the development of specific organ damage, in particular renal and neurological. Nonetheless, demographic factors, such as age, sex and disease duration could exert a role along with the presence of comorbidities. The contribution of different factors in determining damage development suggests the need for new outcomes to assess a comprehensive disease control including not only the assessment of disease activity, but also the evaluation of chronic damage development.
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Affiliation(s)
- Fulvia Ceccarelli
- Lupus Clinic, Division of Rheumatology, Department of Internal Clinical Sciences, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
| | - Francesco Natalucci
- Lupus Clinic, Division of Rheumatology, Department of Internal Clinical Sciences, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Licia Picciariello
- Lupus Clinic, Division of Rheumatology, Department of Internal Clinical Sciences, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulio Olivieri
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gerli Roberto
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabrizio Conti
- Lupus Clinic, Division of Rheumatology, Department of Internal Clinical Sciences, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Antiphospholipid antibodies, steroid dose, arterial hypertension, relapses, and late-onset predict organ damage in a population of Colombian patients with systemic lupus erythematosus. Clin Rheumatol 2017; 37:949-954. [DOI: 10.1007/s10067-017-3927-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/24/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
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Taraborelli M, Cavazzana I, Martinazzi N, Lazzaroni MG, Fredi M, Andreoli L, Franceschini F, Tincani A. Organ damage accrual and distribution in systemic lupus erythematosus patients followed-up for more than 10 years. Lupus 2017; 26:1197-1204. [PMID: 28420047 DOI: 10.1177/0961203317693096] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective The aim of this study was to determine the prevalence, predictors and progression of organ damage in a monocentric cohort of systemic lupus erythematosus patients with a long follow-up. Organ damage was assessed by the Systemic Lupus International Collaborating Clinics Damage Index one year after diagnosis and every five years. Disease activity was measured by the systemic lupus erythematosus disease activity index (SLEDAI)-2K at the beginning of the follow-up. Univariate and multivariable analyses were used to detect items associated with damage. A total of 511 systemic lupus erythematosus patients (92% females, 95% Caucasian), prospectively followed from 1972 to 2014, were included. Results After a mean disease duration of 16 years (SD: 9.5) and a mean follow-up of 12.9 years (SD: 8.8), 354 patients (69.3%) had accrued some damage: 49.7% developed mild/moderate damage, while 19.5% showed severe damage. Damage was evident in 40% of 511 patients one year after diagnosis, and its prevalence linearly increased over time. Longer disease duration, higher SLEDAI, severe Raynaud's, chronic alopecia and cerebral ischaemia were significantly associated with organ damage. No associations between damage and autoantibodies, including anti-dsDNA, anti-Sm or antiphospholipid antibodies, were observed. Anyway, antiphospholipid syndrome and anticardiolipin antibodies predicted the development of neuropsychiatric damage. The ocular, musculoskeletal and neuropsychiatric systems were the most frequently damaged organs, with a linear increase during follow-up. Conclusion A high rate of moderate and severe damage has been detected early in a wide cohort of young lupus patients, with a linear trend of increase over time. Disease activity and long duration of disease predict damage, while antiphospholipid antibodies play a role in determining neuropsychiatric damage.
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Affiliation(s)
- M Taraborelli
- 1 Rheumatology and Clinical Immunology Department, Spedali Civili of Brescia, Brescia, Italy
| | - I Cavazzana
- 1 Rheumatology and Clinical Immunology Department, Spedali Civili of Brescia, Brescia, Italy
| | - N Martinazzi
- 2 Rheumatology and Clinical Immunology Department, University of Brescia, Brescia, Italy
| | - M Grazia Lazzaroni
- 2 Rheumatology and Clinical Immunology Department, University of Brescia, Brescia, Italy
| | - M Fredi
- 1 Rheumatology and Clinical Immunology Department, Spedali Civili of Brescia, Brescia, Italy
| | - L Andreoli
- 2 Rheumatology and Clinical Immunology Department, University of Brescia, Brescia, Italy
| | - F Franceschini
- 1 Rheumatology and Clinical Immunology Department, Spedali Civili of Brescia, Brescia, Italy
| | - A Tincani
- 1 Rheumatology and Clinical Immunology Department, Spedali Civili of Brescia, Brescia, Italy.,2 Rheumatology and Clinical Immunology Department, University of Brescia, Brescia, Italy
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Taraborelli M, Leuenberger L, Lazzaroni MG, Martinazzi N, Zhang W, Franceschini F, Salmon J, Tincani A, Erkan D. The contribution of antiphospholipid antibodies to organ damage in systemic lupus erythematosus. Lupus 2016; 25:1365-8. [PMID: 26945023 DOI: 10.1177/0961203316637431] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/12/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The objective of this study was to assess the contribution of clinically significant antiphospholipid antibodies (aPL) to organ damage in systemic lupus erythematosus (SLE). METHODS Patients with disease duration of less than 10 years and at least 5 years of follow-up were identified from two SLE registries. A clinically significant antiphospholipid antibody (aPL) profile was defined as: positive lupus anticoagulant, anticardiolipin IgG/M ≥ 40 G phospholipid units (GPL)/M phospholipid units (MPL), and/or anti-β2-glycoprotein-I IgG/M ≥ 99th percentile on two or more occasions, at least 12 weeks apart. Organ damage was assessed by the Systemic Lupus International Collaborating Clinics Damage Index (SDI). Univariate and multivariate analysis compared SLE patients with and without SDI increase during a 15-year follow-up. RESULTS Among 262 SLE patients, 33% had a clinically significant aPL profile, which was associated with an increased risk of organ damage accrual during a 5-year follow-up in univariate analysis, and during a 15-year follow-up in the multivariate analysis adjusting for age, gender, race, disease duration at registry entry, and time. In the multivariate analysis, older age at diagnosis and male gender were also associated with SDI increase at each time point. CONCLUSION A clinically significant aPL profile is associated with an increased risk of organ damage accrual during a 15-year follow-up in SLE patients.
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Affiliation(s)
- M Taraborelli
- Rheumatology and Clinical Immunology, Spedali Civili and University of Brescia, Brescia, Italy
| | - L Leuenberger
- Rheumatology, Hospital for Special Surgery, New York, United States
| | - M G Lazzaroni
- Rheumatology and Clinical Immunology, Spedali Civili and University of Brescia, Brescia, Italy
| | - N Martinazzi
- Rheumatology and Clinical Immunology, University of Brescia, Brescia, Italy
| | - W Zhang
- Healthcare Research Institute, Hospital for Special Surgery, New York, United States
| | - F Franceschini
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Brescia, Italy
| | - J Salmon
- Rheumatology, Hospital for Special Surgery, New York, United States
| | - A Tincani
- Rheumatology and Clinical Immunology, Spedali Civili and University of Brescia, Brescia, Italy
| | - D Erkan
- Rheumatology, Hospital for Special Surgery, New York, United States
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Gonçalves MJ, Sousa S, Inês LS, Duarte C, Borges J, Silva C, Romão VC, Terroso G, Bernardes M, Cerqueira M, Raposo A, Sequeira G, Barcelos A, Macieira C, Canas da Silva J, Costa L, Pereira da Silva JA, Cunha-Miranda L, Da Silva JAP, Canhão H, Santos MJ. Characterization of damage in Portuguese lupus patients: analysis of a national lupus registry. Lupus 2014; 24:256-62. [DOI: 10.1177/0961203314555172] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Although the survival rate has considerably improved, many patients with systemic lupus erythematosus (SLE) develop irreversible organ damage. Objectives: The objectives of this paper are to characterize cumulative damage in SLE patients and identify variables associated with its presence and severity. Methods: A cross-sectional analysis of SLE patients from the Portuguese Lupus register Reuma.pt/SLE in whom damage assessment using the SLICC/ACR-Disability Index (SDI) was available was performed. Predictor factors for damage, defined as SDI ≥ 1, were determined by logistic regression analyses. A sub-analysis of patients with severe damage (SDI ≥ 3) was also performed. Results: In total, 976 patients were included. SDI was ≥1 in 365 patients, of whom 89 had severe damage. Musculoskeletal (24.4%), neuropsychiatric (24.1%) and ocular (17.2%) domains were the most commonly affected. Older age, longer disease duration, renal involvement, presence of antiphospholipid antibodies and current therapy with steroids were independently associated with SDI ≥ 1. The subpopulation with severe damage had, in addition, a greater interval between the first manifestation attributable to SLE and the clinical diagnosis as well as and more frequently early retirement due to SLE. Conclusions: This large lupus cohort confirmed that demographic and clinical characteristics as well as medication are independently associated with damage. Additionally, premature retirement occurs more often in patients with SDI ≥ 3. Diagnosis delay might contribute to damage accrual.
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Affiliation(s)
- M J Gonçalves
- Hospital de Santa Maria, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
| | - S Sousa
- Hospital Garcia de Orta, Almada, Portugal
| | - L S Inês
- Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - C Duarte
- Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - J Borges
- Instituto Português de Reumatologia, Lisboa, Portugal
| | - C Silva
- Instituto Português de Reumatologia, Lisboa, Portugal
| | - V C Romão
- Hospital de Santa Maria, Lisboa, Portugal
- Hospital Garcia de Orta, Almada, Portugal
| | - G Terroso
- Hospital de São João, Porto, Portugal
| | | | - M Cerqueira
- Hospital Conde de Bertiandos, Ponte de Lima, Portugal
| | - A Raposo
- Hospital Conde de Bertiandos, Ponte de Lima, Portugal
| | | | | | - C Macieira
- Hospital de Santa Maria, Lisboa, Portugal
| | - J Canas da Silva
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
| | - L Costa
- Hospital de São João, Porto, Portugal
| | | | | | | | - H Canhão
- Hospital de Santa Maria, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
| | - M J Santos
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
- Hospital Garcia de Orta, Almada, Portugal
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Carmona-Fernandes D, Santos MJ, Perpétuo IP, Fonseca JE, Canhão H. Soluble receptor activator of nuclear factor κB ligand/osteoprotegerin ratio is increased in systemic lupus erythematosus patients. Arthritis Res Ther 2011; 13:R175. [PMID: 22027240 PMCID: PMC3308110 DOI: 10.1186/ar3500] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 08/03/2011] [Accepted: 10/25/2011] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) patients have lower bone mineral density and increased fracture risk when compared with healthy individuals, due to distinct factors and mechanisms. Bone remodeling is a tightly orchestrated process dependent on several factors, including the balance between receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG). Our aim was to assess serum OPG and soluble RANKL (sRANKL) levels as well as sRANKL/OPG ratio in female SLE patients and compare it with female controls. METHODS We have evaluated 103 SLE patients and 114 healthy controls, all Caucasian females. All participants underwent a clinical and laboratory evaluation. sRANKL and OPG were quantified in serum by ELISA based methods. sRANKL, OPG and sRANKL/OPG ratio levels were compared between SLE patients and age, sex and race matched healthy controls. For SLE patients, a multivariate analysis was performed, to find the possible predictors of the changes in sRANKL, OPG and sRANKL/OPG ratio levels. RESULTS Although sRANKL levels did not differ between the two groups, serum OPG was lower in SLE patients (P < 0.001). This led to an increased sRANKL/OPG ratio (P = 0.010) in the patients' group.The multivariate analysis was performed considering age and other clinical and laboratorial potential confounders for these variations in the SLE patients group. We have showed that age (P = 0.001) and levels of anti-Sm antibodies (P = 0.016) were independent predictors of sRANKL/OPG ratio variations in SLE patients. No relationship with therapy or disease activity measured by SLEDAI2K was found. CONCLUSIONS These results are suggestive of increased osteoclastic stimuli driven by the SLE disease mechanisms.
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Affiliation(s)
- Diana Carmona-Fernandes
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Edifício Egas Moniz, Av, Prof, Egas Moniz, 1649-028 Lisboa, Portugal
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