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Vincent FB, Kandane-Rathnayake R, Hoi AY, Slavin L, Godsell JD, Kitching AR, Harris J, Nelson CL, Jenkins AJ, Chrysostomou A, Hibbs ML, Kerr PG, Rischmueller M, Mackay F, Morand EF. Urinary B-cell-activating factor of the tumour necrosis factor family (BAFF) in systemic lupus erythematosus. Lupus 2018; 27:2029-2040. [PMID: 30301439 DOI: 10.1177/0961203318804885] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION We examined the clinical relevance of urinary concentrations of B-cell-activating factor of the tumour necrosis factor family (BAFF) and a proliferation-inducing ligand (APRIL) in systemic lupus erythematosus (SLE). METHODS We quantified urinary BAFF (uBAFF) by enzyme-linked immunosorbent assay in 85 SLE, 28 primary Sjögren syndrome (pSS), 40 immunoglobulin A nephropathy (IgAN) patients and 36 healthy controls (HCs). Urinary APRIL (uAPRIL) and monocyte chemoattractant protein 1 (uMCP-1) were also quantified. Overall and renal SLE disease activity were assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000. RESULTS uBAFF was detected in 12% (10/85) of SLE patients, but was undetectable in HCs, IgAN and pSS patients. uBAFF was detectable in 28% (5/18) of SLE patients with active nephritis vs 5/67 (7%) of those without ( p = 0.03), and uBAFF was significantly higher in active renal patients ( p = 0.02) and more likely to be detected in patients with persistently active renal disease. In comparison, uAPRIL and uMCP-1 were detected in 32% (25/77) and 46% (22/48) of SLE patients, respectively. While no difference in proportion of samples with detectable uAPRIL was observed between SLE, HCs and IgAN patients, both uAPRIL and uMCP-1 were significantly detectable in higher proportions of patients with active renal disease. CONCLUSIONS uBAFF was detectable in a small but a significant proportion of SLE patients but not in other groups tested, and was higher in SLE patients with active renal disease.
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Affiliation(s)
- F B Vincent
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
| | - R Kandane-Rathnayake
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
| | - A Y Hoi
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
| | - L Slavin
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
| | - J D Godsell
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
| | - A R Kitching
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia.,2 Department of Nephrology, Monash Health, and Monash University, Clayton, Victoria, Australia
| | - J Harris
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
| | - C L Nelson
- 3 Western Health, Department of Nephrology, St Albans, Victoria, Australia.,4 The Department of Medicine, Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - A J Jenkins
- 5 National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - A Chrysostomou
- 6 The Renal Unit, The Alfred Hospital, Prahran, Victoria, Australia
| | - M L Hibbs
- 7 Department of Immunology and Pathology, Monash University, Central Clinical School, Melbourne, Victoria, Australia
| | - P G Kerr
- 2 Department of Nephrology, Monash Health, and Monash University, Clayton, Victoria, Australia
| | - M Rischmueller
- 8 Rheumatology Department, The Queen Elizabeth Hospital, and Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - F Mackay
- 7 Department of Immunology and Pathology, Monash University, Central Clinical School, Melbourne, Victoria, Australia.,9 Department of Microbiology and Immunology, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - E F Morand
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
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Golder V, Ooi JJY, Antony AS, Ko T, Morton S, Kandane-Rathnayake R, Morand EF, Hoi AY. Discordance of patient and physician health status concerns in systemic lupus erythematosus. Lupus 2017; 27:501-506. [PMID: 28764617 DOI: 10.1177/0961203317722412] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives To compare the health status concerns of patients with systemic lupus erythematosus (SLE) and of their physicians. Methods Cross-sectional questionnaire study of SLE patients and their treating physicians at a tertiary disease-specific outpatient clinic. Patients and physicians completed a questionnaire regarding their concern about specific disease manifestations and impact on quality of life. For each item, degree of concern was rated on a five-point Likert scale and summarized as median (interquartile range). Ratings between patients and physicians were compared using Mann-Whitney U tests. Results A total of 84 patients and 21 physicians participated. Patients' predominant concerns centred on function and fatigue, whereas physicians' concerns focused on SLE-related organ complications. Of the 10 highest ranked patient concerns, only two were common to the 10 highest ranked physician concerns, while physicians rated seven significantly differently; all 10 highest ranked physician concerns were rated significantly lower by patients. The three highest ranked patient concerns (fatigue, pain and feeling worn out) were routinely assessed by 47.6%, 42.9% and 9.5% of physicians, respectively. Conclusion There was significant discordance between SLE patient and physician health status concerns. Items which were ranked highly by patients were not assessed consistently by physicians, highlighting a significant gap in healthcare communication.
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Affiliation(s)
- V Golder
- 1 School of Clinical Sciences, Monash University, Australia.,2 Department of Rheumatology, Monash Health, Clayton, Australia
| | - J J Y Ooi
- 1 School of Clinical Sciences, Monash University, Australia.,3 Alfred Health, Melbourne, Australia
| | - A S Antony
- 2 Department of Rheumatology, Monash Health, Clayton, Australia
| | - T Ko
- 2 Department of Rheumatology, Monash Health, Clayton, Australia
| | - S Morton
- 2 Department of Rheumatology, Monash Health, Clayton, Australia
| | | | - E F Morand
- 1 School of Clinical Sciences, Monash University, Australia.,2 Department of Rheumatology, Monash Health, Clayton, Australia
| | - A Y Hoi
- 1 School of Clinical Sciences, Monash University, Australia.,2 Department of Rheumatology, Monash Health, Clayton, Australia
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Antony A, Kandane-Rathnayake RK, Ko T, Boulos D, Hoi AY, Jolly M, Morand EF. Validation of the Lupus Impact Tracker in an Australian patient cohort. Lupus 2016; 26:98-105. [PMID: 27516435 DOI: 10.1177/0961203316664593] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 07/25/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this article is to validate the Lupus Impact Tracker (LIT), a disease-specific patient-reported outcome (PRO) tool, in systemic lupus erythematosus (SLE) patients in a multi-ethnic Australian cohort. METHODS Patients attending the Monash Lupus Clinic were asked to complete the LIT, a 10-item PRO. Psychometric testing assessing criterion validity, construct validity, test-retest reliability (TRT) and internal consistency reliability (ICR) were performed. We compared the LIT scores across patient characteristics, and correlations between LIT scores and SLEDAI-2k, PGA, and SLICC-SDI were examined. RESULTS LIT data were obtained from 73 patients. Patients were 84% female with a median age of 41 years, and 34% were Asian. The cohort had mild-moderate disease activity with a median (IQR) Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2k) of 4 (IQR 2-6). The median LIT score was 32.5 (IQR 17.5-50). LIT demonstrated criterion validity against SLEDAI-2k and SDI. Construct validity assessed by confirmatory factor analysis demonstrated an excellent fit (Goodness of fit index 0.95, Comparative Fit Index 1, Root Mean Square Error of Approximation <0.0001). The LIT demonstrated TRT with an overall intraclass correlation coefficient of 0.986 (95% CI 0.968-0.995). ICR was demonstrated with a Cronbach's alpha of 0.838. Patients with disability, low socioeconomic status, or higher disease activity had significantly worse LIT scores. CONCLUSION The LIT demonstrated properties consistent with its being valid in this population. Lower socioeconomic status appears to have a significant impact on patient-reported health-related quality of life in SLE.
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Affiliation(s)
- A Antony
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - R K Kandane-Rathnayake
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - T Ko
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - D Boulos
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - A Y Hoi
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - M Jolly
- Rush University Medical Centre, Chicago, IL, USA
| | - E F Morand
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Connelly K, Morand EF, Hoi AY. Asian ethnicity in systemic lupus erythematosus: an Australian perspective. Intern Med J 2014; 43:618-24. [PMID: 23279565 DOI: 10.1111/imj.12070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 12/03/2012] [Indexed: 01/09/2023]
Abstract
Ethnic differences in both disease susceptibility and expression have been noted in systemic lupus erythematosus (SLE). This review focuses on the evidence of disparities between SLE patients of Asian and Caucasian descent, the two predominant ethnic groups affected by SLE in the Australian context. While epidemiological studies suggest higher rates of SLE among Asian patients, multi-ethnic cohort studies have allowed direct comparison of disease characteristics between different ethnic groups. Such studies suggest that Asians are affected by more severe SLE across several disease parameters, including increased renal involvement, autoantibody positivity, disease activity and damage accumulation. As delineation of these disparities becomes clearer, uncovering the biological basis of such differences poses a significant opportunity to progress understanding of SLE pathogenesis. Understanding ethnic variation in disease provides a platform for an individualised approach to risk assessment, monitoring and management of SLE.
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Affiliation(s)
- K Connelly
- Department of Medicine, Monash University, Australia
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Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with protean manifestations. We here present a case of unexplained diarrhoea and abdominal pain in a patient with SLE. Investigations revealed dilatation of stomach, small bowel and colonic wall, biliary and pancreatic ducts, renal collecting systems and ureters as well as thoracic aorta and major pulmonary arteries, as manifestations of a smooth muscle myopathy that was responsive to immunosuppressive therapy with cyclosporin A.
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Affiliation(s)
- G S Ngian
- Monash Centre of Inflammatory Diseases, Monash Medical Centre, Melbourne, Victoria, Australia.
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