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Cornudella Lema J, Sánchez-González B, Carrión-Barberà I, Vázquez Montes de Oca S, García Pallarols F, Salman-Monte TC. Immune thrombocytopenia in systemic lupus erythematosus: Prevalence, risk factors, and a novel predictive model for risk assessment. Med Clin (Barc) 2024; 162:461-469. [PMID: 38383267 DOI: 10.1016/j.medcli.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Immune thrombocytopenia (ITP) is a potentially severe manifestation of systemic lupus erythematosus (SLE) reported in 7-40% of SLE patients. ITP has been associated with a higher risk of organ damage and mortality. OBJECTIVES To describe which factors are associated with the presence of ITP in SLE patients. METHODS Retrospective case-control study. Cases were defined as SLE patients who had ever developed ITP and were sex- and age-matched with two controls. A predictive model was constructed to identify SLE patients who were at risk of developing ITP. RESULTS ITP prevalence in our SLE cohort was 8.35%. Cases had a higher frequency of hemolytic anemia, while controls had a higher prevalence of arthritis at SLE diagnosis. During SLE progression, cases tested positive for anticardiolipin, anti-β2-glycoprotein 1, and lupus anticoagulant antibodies more frequently. Cases received mycophenolic acid and azathioprine more often than controls and had a higher SLICC/ACR score. The model demonstrated a sensitivity of 87.53%, a positive predictive value of 81.92%, a specificity of 80.50%, area under the curve of 83.92%, a F1 of 83% and an overall accuracy of 83.68%. The variables that best explain the model were hemolytic anemia, arthritis, oral ulcers, Raynaud's phenomenon, low C4, low CH50, anticardiolipin and anti-β2GP1 antibodies. CONCLUSION SLE patients who develop ITP have a distinct phenotype characterized by more hemolytic anemia and less arthritis at SLE onset, and higher prevalence of antiphospholipid syndrome antibodies during SLE progression. This phenotype is associated with heightened organ damage and the need for more intensive therapies and stricter follow-up. Our predictive model has demonstrated an impressive ability to identify SLE patients at risk of developing ITP.
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Affiliation(s)
| | - Blanca Sánchez-González
- Department of Hematology, Hospital del Mar, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Hospital del Mar Autoimmune Diseases and Vasculitis Unit of Excellence Unit Disease, Spain
| | - Irene Carrión-Barberà
- Hospital del Mar Research Institute, Barcelona, Spain; Hospital del Mar Autoimmune Diseases and Vasculitis Unit of Excellence Unit Disease, Spain; Department of Rheumatology, Hospital del Mar, Barcelona, Spain.
| | | | - Francesc García Pallarols
- Department of Hematology, Hospital del Mar, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain
| | - Tarek Carlos Salman-Monte
- Hospital del Mar Research Institute, Barcelona, Spain; Hospital del Mar Autoimmune Diseases and Vasculitis Unit of Excellence Unit Disease, Spain; Department of Rheumatology, Hospital del Mar, Barcelona, Spain
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Wang S, Wang F, Wang X, Zhang Y, Song L. Elevated Creatinine Clearance in Lupus Nephritis patients with Normal Creatinine. Int J Med Sci 2021; 18:1449-1455. [PMID: 33628102 PMCID: PMC7893553 DOI: 10.7150/ijms.51117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/07/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives: The present study aimed to observe the differences in creatinine clearance (Ccr) in systemic lupus erythematosus (SLE) patients with normal serum creatinine at different levels of urinary protein. Method: The present cross-sectional study included 177 SLE patients with normal serum creatinine from Qilu Hospital of Shandong University between January 2010 and April 2020. The following data were collected: blood urea nitrogen (BUN), serum creatinine (Cr), serum total protein, serum albumin, immunoglobulin (Ig) G, IgA, IgM, complement 3, complement 4, anti-ds-DNA antibody, routine urine test, urine protein/creatinine ratio (UPCR) (g/g), and the SLE disease activity index. The estimated Ccr was calculated according to the Cockcroft formula. Results: 123 patients were with positive urinary protein (Lupus Nephritis, LN group) and 54 patients were with negative urinary protein (Non-LN group). Compared with the Non-LN group, the LN group had higher BUN (5.76±3.22 vs. 4.78±1.58, P=0.007) and Cr (62.36±19.53 vs. 54.83±11.09, P=0.001). There was a strong correlation between the UPCR and the semi-quantitative determination of urine protein in LN patients (r=0.9583, P=0.0417). The serum creatinine levels were significantly higher in patients with urine protein 3+ (72.97±25.16) or massive proteinuria (62.32±19.66) than the other groups. Patients with urinary protein ± exhibited a significantly elevated Ccr when compared to patients with urinary protein 3+ (130.6±44.15 vs. 110.5±33.50, P=0.02), and patients with UPCR<0.15 g/g had higher Ccr than other groups and showed significantly increased Ccr compared with patients with UPCR≥0.15 g/g (132.44±21.02 vs. 115.14±35.89, P=0.007). Conclusions: Early renal function impairment may be present in LN patients. The kidneys of LN patients with urinary protein ± or UPCR<0.15 g/g are in a state of hyperfunction.
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Affiliation(s)
- Sheng Wang
- Department of Rheumatology, Qilu Hospital of Shandong University, Ji'nan 250012, Shandong, China
| | - Fang Wang
- Department of Rheumatology, Qilu Hospital of Shandong University, Ji'nan 250012, Shandong, China
| | - Xiao Wang
- Department of Rheumatology, Qilu Hospital of Shandong University, Ji'nan 250012, Shandong, China
| | - Yuxian Zhang
- Department of Rheumatology, Qilu Hospital of Shandong University, Ji'nan 250012, Shandong, China
| | - Lijun Song
- Department of Rheumatology, Qilu Hospital of Shandong University, Ji'nan 250012, Shandong, China
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Mao YM, Shi PL, Wu L, Hu YQ, He YS, Xiang K, Tao JH, Pan HF, Wu GC. Prevalence and influential factors of thrombocytopaenia in systemic lupus erythematosus patients: a retrospective analysis of 3140 cases in a Chinese population. Lupus 2020; 29:743-750. [DOI: 10.1177/0961203320922301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The present study aimed to investigate the prevalence and influential factors of thrombocytopaenia in systemic lupus erythematosus (SLE) patients among the Chinese population in order to provide evidence for improving the treatment and nursing of SLE patients. Methods A retrospective analysis of 3140 SLE patients admitted to two large tertiary hospitals was conducted in Anhui, China, from 2011 to 2018. In addition, the influential factors related to SLE with thrombocytopaenia were analysed through univariate and multivariate analysis. Results A total of 804 SLE patients had thrombocytopaenia (25.6%). The top 5 clinical manifestations of SLE inpatients were proteinuria (51.0%), lupus nephritis (45.9%), new rash (38.4%), haematuria (36.7%) and pyuria (32.2%). The incidence of neurological manifestations, oral mucosal ulceration, pleurisy, pericarditis, hyperglycaemia, leucocytopaenia, urinary casts, haematuria, pyuria and high disease activity in the thrombocytopaenia group were higher than those in the non-thrombocytopaenia group ( p < 0.05). Multivariate analysis showed age (odds ratio (OR) = 1.009, p = 0.005), neurological manifestations (OR = 1.373, p = 0.048), pericarditis (OR = 1.394, p = 0.048), hyperglycaemia (OR = 1.717, p < 0.001), leucocytopaenia (OR = 2.551, p < 0.001), haematuria (OR = 1.582, p < 0.001), serum C3 level <0.85 g/L (OR = 1.525, p = 0.001), serum C4 concentration <0.10 g/L (OR = 1.287, p = 0.020), serum CRP concentration <8 ng/L (OR = 1.314, p = 0.005), prothrombin time >15.30 seconds (OR = 1.479, p = 0.032), activated partial thromboplatin time >45 seconds (OR = 1.924, p < 0.001) and thrombin time >21 seconds (OR = 1.629, p = 0.015) were associated with thrombocytopaenia. Conclusion Thrombocytopaenia has a high prevalence in SLE patients and is related to some baseline, clinical and laboratory characteristics, affecting multiple organs and systems.
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Affiliation(s)
- Yan-Mei Mao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, PR China
| | - Pei-Li Shi
- School of Nursing, Anhui Medical University, Anhui, PR China
| | - Li Wu
- School of Nursing, Anhui Medical University, Anhui, PR China
| | - Yu-Qian Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, PR China
| | - Yi-Sheng He
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, PR China
| | - Kun Xiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, PR China
| | - Jin-Hui Tao
- Department of Rheumatology and Immunology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, PR China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, PR China
| | - Guo-Cui Wu
- School of Nursing, Anhui Medical University, Anhui, PR China
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Jing C, Zhang X, Song Z, Zheng Y, Yin Y. Progranulin Mediates Proinflammatory Responses in Systemic Lupus Erythematosus: Implications for the Pathogenesis of Systemic Lupus Erythematosus. J Interferon Cytokine Res 2019; 40:33-42. [PMID: 31804874 DOI: 10.1089/jir.2019.0047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease caused by the disorders of immune regulation but its pathogenesis is poorly understood. Progranulin (PGRN) is an immunomodulatory protein that is upregulated in SLE patients. However, the factors involved in regulating the pathogenesis of SLE by PGRN are largely unknown. We sought to investigate the role and molecular mechanisms of PGRN in SLE to develop a novel therapeutic target. We used an animal model of SLE that was induced in PGRN-deficient and normal wild type (WT) mice using pristane. PGRN concentrations were measured in SLE and the impact of PGRN deficiency was examined by measuring tissue injury and immune responses of T cells (Th1, Th2, Th17, and Treg) and B cells. SLE patients and mice showed elevated PGRN levels. Compared with WT SLE mice, inflammatory cell infiltration, tissue edema, and necrosis were alleviated in PGRN-/- SLE mice and the levels of serum chemistry markers of tissue damage and the presence of anti-double-stranded DNA and anti-ribosomal protein P0 antibodies were all significantly decreased. We further discovered that PGRN deficiency could disturb the immune responses of T cell (Th1, Th2, Th17, and Treg) and B cell responses, leading to the decrease of inflammatory cytokines including interferon-γ and interleukin-17A and increased levels of regulatory B cells. PGRN plays a proinflammatory role in the development of SLE partially through promoting the production of autoantibodies and enhancing Th1 and Th17 cell responses. This may provide new therapeutic options for patients with SLE.
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Affiliation(s)
- Chunmei Jing
- Department of Clinical Laboratory, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Zhang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Zhixin Song
- Department of Clinical Laboratory, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuqiang Zheng
- Department of Clinical Laboratory, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yibing Yin
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, China
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Chen Z, Zhong H, Dong G. Thrombocytopenia as a Prognostic Marker for Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis. Am J Med Sci 2019; 357:461-467. [PMID: 30987767 DOI: 10.1016/j.amjms.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/22/2019] [Accepted: 03/05/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) patients often exhibit hematological abnormalities, but the role of thrombocytopenia on the prognosis of SLE shows inconsistent results. The purpose of this meta-analysis was to confirm the impact of thrombocytopenia on mortality and end organ damage in patients with SLE. MATERIALS AND METHODS Three electronic databases, PubMed, Embase and Cochrane library were systematically searched to identify the eligible studies from inception to November 2017 in order to evaluate the impact of thrombocytopenia on the prognosis of patients with SLE. The summary odds ratios (ORs) and 95% confidence intervals (CIs) were used to measure the impact of thrombocytopenia on mortality and end organ damage based on the random-effects model. RESULTS A total of 8 studies that reported data on 2,158 patients with SLE were included. The summary OR indicated that SLE subjects with thrombocytopenia were significantly associated with an increased risk of mortality (OR: 4.57; 95% CI: 2.28-9.17; P < 0.001) and end-organ damage (OR: 3.31; 95% CI: 1.11-9.86; P = 0.031). Furthermore, the sensitivity analysis indicated stable mortality, while the result for end organ damage was variable. In addition, the patients with thrombocytopenia with disease duration <60 months presented a greater risk for mortality than those with disease duration ≥60.0 months (P = 0.002). CONCLUSIONS Patients with SLE and thrombocytopenia were found to be associated with an increased risk of mortality and end organ damage.
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Affiliation(s)
- Zhixian Chen
- Department of Rheumatology and Immunology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Department of Rheumatism, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Han Zhong
- Department of Rheumatology and Immunology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guangfu Dong
- Department of Rheumatology and Immunology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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Li J, Pan Z, Liu H, Ding F, Shu Q, Li X. Retrospective analysis of the risk of hemorrhage associated with moderate and severe thrombocytopenia of 173 patients with systemic lupus erythematosus. Medicine (Baltimore) 2018; 97:e11356. [PMID: 29979417 PMCID: PMC6076144 DOI: 10.1097/md.0000000000011356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The aim of the study was to observe the risk of hemorrhage from moderate and severe thrombocytopenia in systemic lupus erythematosus (SLE).A retrospective analysis was undertaken of cases admitted to Qilu Hospital, China. Blood platelet counts (BPCs) of ≤20 × 10/L represent severe thrombocytopenia, and a BPC of 21 to 50 × 10/L indicates moderate thrombocytopenia. A comparison was made from the perspective of severity with a view to determine the influence of thrombocytopenia on the risk of hemorrhage and the results.Moderate and severe thrombocytopenia occurred in 173 cases, accounting for 15.2% of the total hospitalized patients with SLE with a male to female ratio of 1:23.7. The average age of those patients was 34.8 ± 14.6 years. In the group of severe thrombocytopenia, patients without visceral involvement had a mean age of onset of 31.4 ± 14.2 years with a median of 28.0 years compared with 37.8 ± 14.8 years with a median of 38.5 years for patients with visceral involvement; this difference was statistically significant (P = .034). Seventy-one (76.3%) of 93 patients with severe thrombocytopenia and 20 (25.0%) of 80 patients with moderate thrombocytopenia developed hemorrhagic conditions of various grades, the difference between both were markedly statistically significant. Twenty-three patients with SLE died. Nine deaths were due to a hemorrhage caused by thrombocytopenia, while more were caused by infection.Severe thrombocytopenia is a significant adverse prognostic factor of SLE. SLE with the main manifestation of thrombocytopenia tends to make younger visceral organ owners suffer.
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Esteves GCX, Gormezano NWS, Pereira OL, Kern D, Silva CA, Pereira RMR, Kozu KT, Bonfá E, Aikawa NE. Distinct clinical correlates of immune thrombocytopenic purpura at diagnosis of childhood-onset and adult SLE. Mod Rheumatol 2017; 28:649-653. [PMID: 29067848 DOI: 10.1080/14397595.2017.1386836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To compare clinical and laboratorial features between childhood-onset systemic lupus erythematosus (cSLE) and adult SLE (aSLE) at concomitant diagnosis of immune thrombocytopenic purpura (ITP). METHODS This study evaluated 56 cSLE and 73 aSLE patients regularly followed at Pediatric and Rheumatology Divisions of the same University hospital with ITP (platelets count <100,000/mm3 in the absence of other causes) at lupus onset. RESULTS Median current age was 11.6 and 27.3 years in cSLE and aSLE, respectively. cSLE had a higher frequency of ITP compared to aSLE (17% vs. 4%, p < .0001) and the former group had more hemorrhagic manifestations (36% vs. 16%, p = .0143). Constitutional symptoms and reticuloendothelial manifestations (p < .05), as well as pericarditis (25% vs. 10%, p = .029) and central nervous system (CNS) involvement (30% vs. 14%, p = .029) were more common in cSLE. Conversely, in aSLE, ITP was solely associated with cutaneous and articular involvements (p < .05). Concerning treatment, intravenous methylprednisolone, intravenous immunoglobulin, blood transfusion and platelets transfusion were more frequently used in the cSLE population (p < .05). CONCLUSION ITP at cSLE has distinct features compared to aSLE with a more severe presentation characterized by concomitant constitutional/reticuloendothelial manifestations, CNS involvement and hemorrhagic manifestation. These findings reinforce the need for a more aggressive treatment in this age group.
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Affiliation(s)
| | - Natali Weniger Spelling Gormezano
- a Division of Rheumatology , Faculdade de Medicina da Universidade de São Paulo (USP) , São Paulo , SP , Brazil.,b Pediatric Rheumatology Unit , Faculdade de Medicina da Universidade de São Paulo (USP) , São Paulo , SP , Brazil
| | - Oriany L Pereira
- a Division of Rheumatology , Faculdade de Medicina da Universidade de São Paulo (USP) , São Paulo , SP , Brazil
| | - David Kern
- a Division of Rheumatology , Faculdade de Medicina da Universidade de São Paulo (USP) , São Paulo , SP , Brazil
| | - Clovis Almeida Silva
- a Division of Rheumatology , Faculdade de Medicina da Universidade de São Paulo (USP) , São Paulo , SP , Brazil.,b Pediatric Rheumatology Unit , Faculdade de Medicina da Universidade de São Paulo (USP) , São Paulo , SP , Brazil
| | | | - Katia Tomie Kozu
- b Pediatric Rheumatology Unit , Faculdade de Medicina da Universidade de São Paulo (USP) , São Paulo , SP , Brazil
| | - Eloisa Bonfá
- a Division of Rheumatology , Faculdade de Medicina da Universidade de São Paulo (USP) , São Paulo , SP , Brazil
| | - Nadia Emi Aikawa
- a Division of Rheumatology , Faculdade de Medicina da Universidade de São Paulo (USP) , São Paulo , SP , Brazil.,b Pediatric Rheumatology Unit , Faculdade de Medicina da Universidade de São Paulo (USP) , São Paulo , SP , Brazil
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Cieslinski JZ, Skare TL, Nisihara R, De Messias-Reason IJ, Utiyama SRR. Mannose-binding lectin serum levels in patients with systemic lupus erythematosus: association with thrombocytopaenia and seizure. Lupus 2017; 27:372-379. [PMID: 28786770 DOI: 10.1177/0961203317722846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The complement system contributes to the pathogenesis of systemic lupus erythematosus (SLE). Mannose-binding lectin (MBL) is a key molecule of the lectin pathway of complement and seems to be related to the clinical manifestations of this disease. We evaluated the serum levels of MBL and its relationship with disease onset and clinical findings in SLE patients. Serum samples were analysed in 195 patients and 145 healthy controls from southern Brazil. Patients with high MBL levels (above 2000 ng/ml) showed a significant increase in the frequency of thrombocytopaenia ( p = 0.007; OR = 2.71; 95% CI = 1.32-5.55); and seizures ( p = 0.034; OR = 2.61; 95% CI = 1.07-6.37). A positive correlation between disease activity and MBL levels (>2000 ng/ml; p = 0.031, rho = 0.279) as well as of MBL concentration with accumulated organ damage ( p = 0.021; rho = 0.232) was observed. Our results suggest a role for MBL in the development of clinical manifestations such as thrombocytopaenia and seizures in SLE patients. These findings corroborate the participation of the lectin pathway of complement in the pathophysiologic mechanisms underlying clinical manifestations of SLE.
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Affiliation(s)
- J Z Cieslinski
- 1 Laboratory of Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - T L Skare
- 2 Rheumatology Clinic, Evangelical University Hospital of Curitiba, Curitiba, Brazil
| | - R Nisihara
- 1 Laboratory of Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil.,3 Department of Medicine, Positivo University, Curitiba, Brazil
| | - I J De Messias-Reason
- 1 Laboratory of Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - S R R Utiyama
- 1 Laboratory of Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil.,4 Department of Clinical Analysis, Federal University of Paraná, Curitiba, Brazil
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Li Y, Feng X. Efficacy and safety of tacrolimus in systemic lupus erythematosus patients with refractory thrombocytopenia: a retrospective study. Lupus 2017; 27:60-65. [PMID: 28566017 DOI: 10.1177/0961203317711011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective We evaluated the efficacy and safety of tacrolimus in systemic lupus erythematosus patients with refractory thrombocytopenia. Methods We retrospectively reviewed the data for 20 systemic lupus erythematosus patients with refractory thrombocytopenia and treated with tacrolimus during the period January 2013 to January 2015. In addition to glucocorticoids, all patients were treated with tacrolimus, 1 mg taken twice daily. The clinical effect of tacrolimus treatment in patients was evaluated by analysis of platelet counts at baseline and after one, three and six months of tacrolimus treatment. Levels of anti-double-stranded DNA antibodies and complement C3, C4 were determined individually. Results After one month of tacrolimus treatment, three patients (15%) did not respond, three patients (15%) achieved a complete response and the other 14 patients (75%) achieved a partial response. After three months of tacrolimus treatment, the platelet counts of all patients were significantly improved. A partial response was seen in 14 patients (75%) and the complete response rate increased to 25% (five patients). After six months, all patients attained partial response or complete response without relapse, and the rate of complete response increased to 75%. Compared to pretreatment, anti-double-stranded DNA antibody levels and the disease activity index score were markedly decreased after tacrolimus treatment. The levels of serum C3 and C4 were increased significantly ( P < 0.05). Conclusions Our survey revealed that a six-month course of tacrolimus is a safe and effective treatment for systemic lupus erythematosus patients with refractory thrombocytopenia.
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Affiliation(s)
- Y Li
- Department of Physiology, Jinzhou Medical University, Jinzhou, P.R. China
| | - X Feng
- Department of Rheumatology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, P.R. China
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Up-regulated Complement 3 Production by Toll-like receptor 9/ Transforming Growth Factor-Beta 1/Complement 3 Pathway in Whole Blood Cells of Lupus Thrombocytopenia. Arch Rheumatol 2017; 32:275-283. [PMID: 29901007 DOI: 10.5606/archrheumatol.2017.6279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/18/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to assess the complement 3 (C3) expressions in whole blood cells and verify a pathway toll-like receptor 9 (TLR9)/ transforming growth factor-beta 1 (TGF-β1)/C3 for C3 regulation in mediating thrombocytopenia (TCP) in patients with systemic lupus erythematosus (SLE). Patients and methods The study included 63 newly diagnosed SLE patients (2 males, 61 females; mean age 39.5 years; range 15 to 67 years). Whole blood messenger ribonucleic acid expression for C3, TLR9 and TGF-β1 were measured by quantitative reverse transcription real-time polymerase chain reaction in SLE patients with TCP (n=38) and age- and sex-matched SLE patients without TCP (n=25) at baseline and in 10 SLE patients with TCP after four weeks of treatment. Whole blood cells from SLE patients with TCP were cultured in the presence of TLR9 ligand cytosine-phosphate- guanine, recombinant human TGF-β1, TGF-β receptor inhibitor/activin receptor-like kinase inhibitor SB431542. TGF-β1 and C3 levels in whole blood cells cultures were determined by quantitative reverse transcription real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Results Whole blood cells from SLE patients with TCP displayed an enhanced gene expression for C3, TLR9 and TGF-β1 compared with that of SLE patients without TCP (p<0.01 for C3, p<0.05 for TLR9 and TGF-β1). SLE patients with TCP had decreased plasma levels of C3 suggesting excessive consumption. In whole blood cell culture, engagement of TLR9 led to the increased gene expression of C3. Furthermore, TGF-β1 inhibitor abolished TLR9 stimulation on C3 gene expression. Conclusion These results suggest that blood cells are the source of extra-hepatic synthesis of C3 in SLE patients with TCP and this synthesis of C3 was up-regulated by TLR9 via induction of TGF-β1. Thus TLR9/TGF-β1/C3 pathway might be in operation mediating lupus thrombocytopenia.
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Teke HÜ, Cansu DÜ, Korkmaz C. Detailed features of hematological involvement and medication-induced cytopenia in systemic lupus erythematosus patients: single center results of 221 patients. Eur J Rheumatol 2017. [PMID: 28638678 DOI: 10.5152/eurjrheum.2017.160086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) may affect a number of systems, with the hematological system being one of the most common. Our aim is to determine the existence of cytopenia at diagnosis or during follow-up of our SLE patients as well as the associated factors. MATERIAL AND METHODS A cohort of SLE patients that had been followed-up in the Department of Rheumotology from 1998 to 2015 was retrospectively assessed. Clinical and laboratory findings about the patients were recorded. RESULTS Out of 221 patients composing the cohort, cytopenia was already present in 83.3% (n=184) at the time of diagnosis. Anemia was detected in 56.1% (n=124), leukopenia in 28.9% (n=64), lymphopenia in 76% (n=168), neutropenia in 4.5% (n=10), and thrombocytopenia in 17.2% (n=38) of patients. The proportion of patients with cumulative cytopenia was 90% (n=199). Cumulative cytopenia was disease-related in 83.4% (n=166) and medication-related in 16.6% (n=33) of the patients. In cases of drug-induced cytopenia, azathioprine was the most frequently prescribed drug. In patients with cytopenia at the time of diagnosis, erythrocyte sedimentation rates (ESR) were higher, C3 and C4 hypocomplementemia was more prevalent, and they were positive for anti-ds-DNA at a greater proportion (p<0.001, p=0.015, p=0.028, and p=0.019, respectively). Moreover, photosensitivity, renal involvement, and antiphospholipid syndrome (APS) were detected more frequently in patients with cytopenia at the time of diagnosis. There was no difference between the two patient sets in terms of other organ involvement (p>0.05). CONCLUSION The most common hematological disorders in SLE patients are lymphopenia and anemia, and patients must be further examined for APS and renal involvement if they suffer cytopenia.
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Affiliation(s)
- Hava Üsküdar Teke
- Division of Rheumatology Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Döndü Üsküdar Cansu
- Division of Rheumatology Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Cengiz Korkmaz
- Division of Rheumatology Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
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Abdel Galil SM, Edrees AM, Ajeeb AK, Aldoobi GS, El-Boshy M, Hussain W. Prognostic significance of platelet count in SLE patients. Platelets 2016; 28:203-207. [PMID: 27590999 DOI: 10.1080/09537104.2016.1214253] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hematological abnormalities, especially thrombocytopenia (TCP), are highly prevalent among patients with systemic lupus erythematosus (SLE) and at the same time it has been reported as a significant prognostic factor of SLE course. We further investigate the correlation between platelet count and the clinical manifestations and disease activity of SLE, in a cohort of Saudi Arabian female patients. A retrospective analysis was done for the medical records of 100 SLE female patients, selected from all patients diagnosed and treated for SLE at the Rheumatology outpatient clinics in Hera'a General Hospital, Holly Makkah, Saudi Arabia. The data collected from every patient's file included laboratory investigations (complete blood count, platelet parameters, ESR, anti-double-stranded DNA antibody, ANA), clinical manifestations, as well as SLE disease activity index (SLEDAI-2k) scores throughout a period of six sequential follow-up visits. Patients were divided into three groups according to the SLEDAI-2k: mild, moderate, and high-activity group. We found that, out of 100 patients, TCP was the most prevalent hematological abnormality evident in 15%, more than leucopenia (14%) and anemia (2%). TCP was acute in onset and associated with arthritis, neurologic manifestations, and nephritis. Platelet count showed a significant negative correlation with disease activity, in all of the three groups of patients. We concluded that platelet count has a negative correlation with disease activity in SLE patients, whatever the associated manifestations, and it should be considered as a prognostic factor, identifying patients with aggressive disease course.
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Affiliation(s)
- Sahar Mahfouz Abdel Galil
- a Medicine Department, Faculty of Medicine , Umm Alqura University , Makkah , Kingdom of Saudi Arabia.,b Rheumatology and Rehabilitation Department , Faculty of Medicine, Zagazig university , Egypt
| | - Azzahra Mohammed Edrees
- a Medicine Department, Faculty of Medicine , Umm Alqura University , Makkah , Kingdom of Saudi Arabia
| | - Afnan Khaled Ajeeb
- a Medicine Department, Faculty of Medicine , Umm Alqura University , Makkah , Kingdom of Saudi Arabia
| | - Ghadeer Sameer Aldoobi
- a Medicine Department, Faculty of Medicine , Umm Alqura University , Makkah , Kingdom of Saudi Arabia
| | - Mohamed El-Boshy
- c Department of Laboratory Medicine, Faculty of Applied Medical Science , Umm Al-Qura University , Makkah , Kingdom of Saudi Arabia
| | - Waleed Hussain
- d Head of Rheumatology Unit , Hera'a General Hospital , Makkah , Kingdom of Saudi Arabia
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Hsu CY, Chen HJ, Hsu CY, Kao CH. Splenectomy increases the subsequent risk of systemic lupus erythematosus. Rheumatol Int 2015; 36:271-6. [DOI: 10.1007/s00296-015-3388-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/27/2015] [Indexed: 01/24/2023]
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Skare T, Damin R, Hofius R. Prevalence of the American College of Rheumatology hematological classification criteria and associations with serological and clinical variables in 460 systemic lupus erythematosus patients. Rev Bras Hematol Hemoter 2015; 37:115-9. [PMID: 25818822 PMCID: PMC4382578 DOI: 10.1016/j.bjhh.2015.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/24/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To study systemic lupus erythematosus in a Brazilian population using the American College of Rheumatology hematological classification criteria and report associations of the disease with serological and clinical profiles. METHODS This is a retrospective study of 460 systemic lupus erythematosus patients followed in a single rheumatologic center during the last 10 years. Hematological manifestations considered for this study were hemolysis, leukopenia, lymphocytopenia and thrombocytopenia. RESULTS The cumulative prevalences of leukopenia, thrombocytopenia, lymphocytopenia and hemolytic anemia were 29.8%, 21.08%, 17.7% and 8.4%, respectively. A higher percentage of patients with hemolysis had anticardiolipin IgM (p-value=0.002). Those with leukopenia had more lymphopenia (p-value=0.02), psychosis (p-value=0.01), thrombocytopenia (p-value <0.0001) and anti-double stranded DNA antibodies (p-value=0.03). Patients with lymphopenia had more leukopenia (OR=1.8; 95% CI=1.01-3.29) and lupus anticoagulant antibodies (OR=2.2; 95% CI=1.16-4.39) and those with thrombocytopenia had more leukopenia (OR=3.1; 95% CI=1.82-5.44) and antiphospholipid syndrome (OR=3.1; 95% CI=1.28-7.87). CONCLUSION The most common hematological finding was leukopenia and the least common was hemolysis. Associations of low platelet count and hemolysis were found with antiphospholipid syndrome and anticardiolipin IgM positivity, respectively. Leukopenia and lymphocytopenia are correlated and leukopenia is more common in systemic lupus erythematosus patients with psychosis, thrombocytopenia and anti-double stranded DNA.
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Affiliation(s)
- Thelma Skare
- Hospital Universitário Evangélico de Curitiba (HUEC), Curitiba, PR, Brazil.
| | - Renata Damin
- Hospital Universitário Evangélico de Curitiba (HUEC), Curitiba, PR, Brazil
| | - Renata Hofius
- Hospital Universitário Evangélico de Curitiba (HUEC), Curitiba, PR, Brazil
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