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Lundtoft C, Sjöwall C, Rantapää‐Dahlqvist S, Bengtsson AA, Jönsen A, Pucholt P, Wu YL, Lundström E, Eloranta M, Gunnarsson I, Baecklund E, Jonsson R, Hammenfors D, Forsblad‐d'Elia H, Eriksson P, Mandl T, Bucher S, Norheim KB, Auglaend Johnsen SJ, Omdal R, Kvarnström M, Wahren‐Herlenius M, Truedsson L, Nilsson B, Kozyrev SV, Bianchi M, Lindblad‐Toh K, Yu C, Nordmark G, Sandling JK, Svenungsson E, Leonard D, Rönnblom L, Rönnblom L. Strong Association of Combined Genetic Deficiencies in the Classical Complement Pathway With Risk of Systemic Lupus Erythematosus and Primary Sjögren's Syndrome. Arthritis Rheumatol 2022; 74:1842-1850. [PMID: 35729719 PMCID: PMC9828039 DOI: 10.1002/art.42270] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/17/2022] [Accepted: 06/10/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Complete genetic deficiency of the complement component C2 is a strong risk factor for monogenic systemic lupus erythematosus (SLE), but whether heterozygous C2 deficiency adds to the risk of SLE or primary Sjögren's syndrome (SS) has not been studied systematically. This study was undertaken to investigate potential associations of heterozygous C2 deficiency and C4 copy number variation with clinical manifestations in patients with SLE and patients with primary SS. METHODS The presence of the common 28-bp C2 deletion rs9332736 and C4 copy number variation was examined in Scandinavian patients who had received a diagnosis of SLE (n = 958) or primary SS (n = 911) and in 2,262 healthy controls through the use of DNA sequencing. The concentration of complement proteins in plasma and classical complement function were analyzed in a subgroup of SLE patients. RESULTS Heterozygous C2 deficiency-when present in combination with a low C4A copy number-substantially increased the risk of SLE (odds ratio [OR] 10.2 [95% confidence interval (95% CI) 3.5-37.0]) and the risk of primary SS (OR 13.0 [95% CI 4.5-48.4]) when compared to individuals with 2 C4A copies and normal C2. For patients heterozygous for rs9332736 with 1 C4A copy, the median age at diagnosis was 7 years earlier in patients with SLE and 12 years earlier in patients with primary SS when compared to patients with normal C2. Reduced C2 levels in plasma (P = 2 × 10-9 ) and impaired function of the classical complement pathway (P = 0.03) were detected in SLE patients with heterozygous C2 deficiency. Finally, in a primary SS patient homozygous for C2 deficiency, we observed low levels of anti-Scl-70, which suggests a risk of developing systemic sclerosis or potential overlap between primary SS and other systemic autoimmune diseases. CONCLUSION We demonstrate that a genetic pattern involving partial deficiencies of C2 and C4A in the classical complement pathway is a strong risk factor for SLE and for primary SS. Our results emphasize the central role of the complement system in the pathogenesis of both SLE and primary SS.
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Affiliation(s)
- Christian Lundtoft
- Department of Medical Sciences, RheumatologyUppsala UniversityUppsalaSweden,Present address:
Olink Proteomics
| | - Christopher Sjöwall
- Division of Inflammation and Infection, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | | | - Anders A. Bengtsson
- Department of Clinical Sciences Lund, Rheumatology, Lund University, and Skåne University HospitalLundSweden
| | - Andreas Jönsen
- Department of Clinical Sciences Lund, Rheumatology, Lund University, and Skåne University HospitalLundSweden
| | - Pascal Pucholt
- Department of Medical Sciences, RheumatologyUppsala UniversityUppsalaSweden
| | - Yee Ling Wu
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, and the Department of Microbiology and ImmunologyLoyola UniversityChicagoIllinois
| | - Emeli Lundström
- Division of Rheumatology, Department of Medicine SolnaKarolinska Institutet, Karolinska University HospitalStockholmSweden
| | | | - Iva Gunnarsson
- Division of Rheumatology, Department of Medicine SolnaKarolinska Institutet, Karolinska University HospitalStockholmSweden
| | - Eva Baecklund
- Department of Medical Sciences, RheumatologyUppsala UniversityUppsalaSweden
| | - Roland Jonsson
- Broegelmann Research Laboratory, Department of Clinical ScienceUniversity of BergenBergenNorway
| | | | - Helena Forsblad‐d'Elia
- Department of Rheumatology and Inflammation ResearchSahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Per Eriksson
- Division of Inflammation and Infection, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Thomas Mandl
- Division of Rheumatology, Department of Clinical Sciences MalmöLund University, and NovartisMalmöSweden
| | - Sara Bucher
- Department of Rheumatology, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Katrine B. Norheim
- Department of Rheumatology, Stavanger University Hospital, Stavanger, Norway, and the Institute of Clinical Science, University of BergenBergenNorway
| | | | - Roald Omdal
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway, and the Department of RheumatologyStavanger University HospitalStavangerNorway
| | - Marika Kvarnström
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden, and the Academic Specialist Center, Center for Rheumatology, Stockholm Health ServicesStockholmSweden
| | - Marie Wahren‐Herlenius
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden, and Broegelmann Research Laboratory, Department of Clinical Science, University of BergenBergenNorway
| | - Lennart Truedsson
- Department of Microbiology, Immunology, and GlycobiologyLund University HospitalLundSweden
| | - Bo Nilsson
- Department of Immunology, Genetics, and PathologyUppsala UniversityUppsalaSweden
| | - Sergey V. Kozyrev
- Science for Life Laboratory, Department of Medical Biochemistry and MicrobiologyUppsala UniversityUppsalaSweden
| | - Matteo Bianchi
- Science for Life Laboratory, Department of Medical Biochemistry and MicrobiologyUppsala UniversityUppsalaSweden
| | - Kerstin Lindblad‐Toh
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden, and Broad Institute of MIT and HarvardCambridgeMassachusetts
| | | | - Chack‐Yung Yu
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's HospitalColumbusOhio
| | - Gunnel Nordmark
- Department of Medical Sciences, RheumatologyUppsala UniversityUppsalaSweden
| | | | - Elisabet Svenungsson
- Division of Rheumatology, Department of Medicine SolnaKarolinska Institutet, Karolinska University HospitalStockholmSweden
| | - Dag Leonard
- Department of Medical Sciences, RheumatologyUppsala UniversityUppsalaSweden
| | - Lars Rönnblom
- Department of Medical Sciences, RheumatologyUppsala UniversityUppsalaSweden
| | - Lars Rönnblom
- Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden
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Lundtoft C, Pucholt P, Martin M, Bianchi M, Lundström E, Eloranta ML, Sandling JK, Sjöwall C, Jönsen A, Gunnarsson I, Rantapää-Dahlqvist S, Bengtsson AA, Leonard D, Baecklund E, Jonsson R, Hammenfors D, Forsblad-d'Elia H, Eriksson P, Mandl T, Magnusson Bucher S, Norheim KB, Auglaend Johnsen SJ, Omdal R, Kvarnström M, Wahren-Herlenius M, Notarnicola A, Andersson H, Molberg Ø, Diederichsen LP, Almlöf J, Syvänen AC, Kozyrev SV, Lindblad-Toh K, Nilsson B, Blom AM, Lundberg IE, Nordmark G, Diaz-Gallo LM, Svenungsson E, Rönnblom L. Complement C4 Copy Number Variation is Linked to SSA/Ro and SSB/La Autoantibodies in Systemic Inflammatory Autoimmune Diseases. Arthritis Rheumatol 2022; 74:1440-1450. [PMID: 35315244 PMCID: PMC9543510 DOI: 10.1002/art.42122] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/20/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Copy number variation of the C4 complement components, C4A and C4B, has been associated with systemic inflammatory autoimmune diseases. This study was undertaken to investigate whether C4 copy number variation is connected to the autoimmune repertoire in systemic lupus erythematosus (SLE), primary Sjögren's syndrome (SS), or myositis. METHODS Using targeted DNA sequencing, we determined the copy number and genetic variants of C4 in 2,290 well-characterized Scandinavian patients with SLE, primary SS, or myositis and 1,251 healthy controls. RESULTS A prominent relationship was observed between C4A copy number and the presence of SSA/SSB autoantibodies, which was shared between the 3 diseases. The strongest association was detected in patients with autoantibodies against both SSA and SSB and 0 C4A copies when compared to healthy controls (odds ratio [OR] 18.0 [95% confidence interval (95% CI) 10.2-33.3]), whereas a weaker association was seen in patients without SSA/SSB autoantibodies (OR 3.1 [95% CI 1.7-5.5]). The copy number of C4 correlated positively with C4 plasma levels. Further, a common loss-of-function variant in C4A leading to reduced plasma C4 was more prevalent in SLE patients with a low copy number of C4A. Functionally, we showed that absence of C4A reduced the individuals' capacity to deposit C4b on immune complexes. CONCLUSION We show that a low C4A copy number is more strongly associated with the autoantibody repertoire than with the clinically defined disease entities. These findings may have implications for understanding the etiopathogenetic mechanisms of systemic inflammatory autoimmune diseases and for patient stratification when taking the genetic profile into account.
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Affiliation(s)
| | | | | | - Matteo Bianchi
- Science for Life Laboratory and Uppsala University, Uppsala, Sweden
| | - Emeli Lundström
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Andreas Jönsen
- Lund University and Skåne University Hospital, Lund, Sweden
| | - Iva Gunnarsson
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | - Roald Omdal
- Stavanger University Hospital, Stavanger, Norway
| | - Marika Kvarnström
- Karolinska Institutet, Karolinska University Hospital, and Stockholm Health Services, Region Stockholm, Stockholm, Sweden
| | - Marie Wahren-Herlenius
- Karolinska Institutet and Karolinska University Hospital Stockholm, Sweden, and University of Bergen, Bergen, Norway
| | | | | | | | - Louise Pyndt Diederichsen
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, and Odense University Hospital, Odense, Denmark
| | - Jonas Almlöf
- Science for Life Laboratory and Uppsala University, Uppsala, Sweden
| | | | - Sergey V Kozyrev
- Science for Life Laboratory and Uppsala University, Uppsala, Sweden
| | - Kerstin Lindblad-Toh
- Science for Life Laboratory and Uppsala University, Uppsala, Sweden, and Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | | | | | | | | | - Ingrid E Lundberg
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Thorlacius GE, Hultin-Rosenberg L, Sandling JK, Bianchi M, Imgenberg-Kreuz J, Pucholt P, Theander E, Kvarnström M, Forsblad-d'Elia H, Bucher SM, Norheim KB, Johnsen SJA, Hammenfors D, Skarstein K, Jonsson MV, Baecklund E, Aqrawi LA, Jensen JL, Palm Ø, Morris AP, Meadows JRS, Rantapää-Dahlqvist S, Mandl T, Eriksson P, Lind L, Omdal R, Jonsson R, Lindblad-Toh K, Rönnblom L, Wahren-Herlenius M, Nordmark G. Genetic and clinical basis for two distinct subtypes of primary Sjögren's syndrome. Rheumatology (Oxford) 2021; 60:837-848. [PMID: 32889544 PMCID: PMC7850528 DOI: 10.1093/rheumatology/keaa367] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/21/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Clinical presentation of primary Sjögren's syndrome (pSS) varies considerably. A shortage of evidence-based objective markers hinders efficient drug development and most clinical trials have failed to reach primary endpoints. METHODS We performed a multicentre study to identify patient subgroups based on clinical, immunological and genetic features. Targeted DNA sequencing of 1853 autoimmune-related loci was performed. After quality control, 918 patients with pSS, 1264 controls and 107 045 single nucleotide variants remained for analysis. Replication was performed in 177 patients with pSS and 7672 controls. RESULTS We found strong signals of association with pSS in the HLA region. Principal component analysis of clinical data distinguished two patient subgroups defined by the presence of SSA/SSB antibodies. We observed an unprecedented high risk of pSS for an association in the HLA-DQA1 locus of odds ratio 6.10 (95% CI: 4.93, 7.54, P=2.2×10-62) in the SSA/SSB-positive subgroup, while absent in the antibody negative group. Three independent signals within the MHC were observed. The two most significant variants in MHC class I and II respectively, identified patients with a higher risk of hypergammaglobulinaemia, leukopenia, anaemia, purpura, major salivary gland swelling and lymphadenopathy. Replication confirmed the association with both MHC class I and II signals confined to SSA/SSB antibody positive pSS. CONCLUSION Two subgroups of patients with pSS with distinct clinical manifestations can be defined by the presence or absence of SSA/SSB antibodies and genetic markers in the HLA locus. These subgroups should be considered in clinical follow-up, drug development and trial outcomes, for the benefit of both subgroups.
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Affiliation(s)
| | - Lina Hultin-Rosenberg
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala, Sweden
| | - Johanna K Sandling
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Matteo Bianchi
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala, Sweden
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Juliana Imgenberg-Kreuz
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Pascal Pucholt
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Elke Theander
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | | | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sara Magnusson Bucher
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Katrine B Norheim
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | | | - Daniel Hammenfors
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Kathrine Skarstein
- Department of Clinical Science and Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Malin V Jonsson
- Department of Clinical Science and Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Eva Baecklund
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Lara A Aqrawi
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Janicke Liaaen Jensen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Øyvind Palm
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Andrew P Morris
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - Jennifer R S Meadows
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala, Sweden
| | | | - Thomas Mandl
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Per Eriksson
- Department of Clinical and Experimental Medicine, Rheumatology/Division of Neuro and Inflammation Sciences, Linköping University, Linköping, Sweden
| | - Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Roald Omdal
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Roland Jonsson
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kerstin Lindblad-Toh
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala, Sweden
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lars Rönnblom
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Gunnel Nordmark
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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4
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Tarn JR, Howard-Tripp N, Lendrem DW, Mariette X, Saraux A, Devauchelle-Pensec V, Seror R, Skelton AJ, James K, McMeekin P, Al-Ali S, Hackett KL, Lendrem BC, Hargreaves B, Casement J, Mitchell S, Bowman SJ, Price E, Pease CT, Emery P, Lanyon P, Hunter J, Gupta M, Bombardieri M, Sutcliffe N, Pitzalis C, McLaren J, Cooper A, Regan M, Giles I, Isenberg D, Saravanan V, Coady D, Dasgupta B, McHugh N, Young-Min S, Moots R, Gendi N, Akil M, Griffiths B, Johnsen SJA, Norheim KB, Omdal R, Stocken D, Everett C, Fernandez C, Isaacs JD, Gottenberg JE, Ng WF. Symptom-based stratification of patients with primary Sjögren's syndrome: multi-dimensional characterisation of international observational cohorts and reanalyses of randomised clinical trials. Lancet Rheumatol 2019; 1:e85-e94. [PMID: 38229348 PMCID: PMC7134527 DOI: 10.1016/s2665-9913(19)30042-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Heterogeneity is a major obstacle to developing effective treatments for patients with primary Sjögren's syndrome. We aimed to develop a robust method for stratification, exploiting heterogeneity in patient-reported symptoms, and to relate these differences to pathobiology and therapeutic response. METHODS We did hierarchical cluster analysis using five common symptoms associated with primary Sjögren's syndrome (pain, fatigue, dryness, anxiety, and depression), followed by multinomial logistic regression to identify subgroups in the UK Primary Sjögren's Syndrome Registry (UKPSSR). We assessed clinical and biological differences between these subgroups, including transcriptional differences in peripheral blood. Patients from two independent validation cohorts in Norway and France were used to confirm patient stratification. Data from two phase 3 clinical trials were similarly stratified to assess the differences between subgroups in treatment response to hydroxychloroquine and rituximab. FINDINGS In the UKPSSR cohort (n=608), we identified four subgroups: Low symptom burden (LSB), high symptom burden (HSB), dryness dominant with fatigue (DDF), and pain dominant with fatigue (PDF). Significant differences in peripheral blood lymphocyte counts, anti-SSA and anti-SSB antibody positivity, as well as serum IgG, κ-free light chain, β2-microglobulin, and CXCL13 concentrations were observed between these subgroups, along with differentially expressed transcriptomic modules in peripheral blood. Similar findings were observed in the independent validation cohorts (n=396). Reanalysis of trial data stratifying patients into these subgroups suggested a treatment effect with hydroxychloroquine in the HSB subgroup and with rituximab in the DDF subgroup compared with placebo. INTERPRETATION Stratification on the basis of patient-reported symptoms of patients with primary Sjögren's syndrome revealed distinct pathobiological endotypes with distinct responses to immunomodulatory treatments. Our data have important implications for clinical management, trial design, and therapeutic development. Similar stratification approaches might be useful for patients with other chronic immune-mediated diseases. FUNDING UK Medical Research Council, British Sjogren's Syndrome Association, French Ministry of Health, Arthritis Research UK, Foundation for Research in Rheumatology. VIDEO ABSTRACT.
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Affiliation(s)
- Jessica R Tarn
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nadia Howard-Tripp
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dennis W Lendrem
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Xavier Mariette
- Université Paris-Sud, AP-HP Université Paris-Saclay, Hôpital Bicêtre, Department of Rheumatology, INSERM UMR1184, Le Kremlin-Bicêtre, France
| | - Alain Saraux
- Lymphocytes B et auto-immunité, Inserm U1227, University of Brest, Brest, France; Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Valerie Devauchelle-Pensec
- Lymphocytes B et auto-immunité, Inserm U1227, University of Brest, Brest, France; Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Raphaele Seror
- Université Paris-Sud, AP-HP Université Paris-Saclay, Hôpital Bicêtre, Department of Rheumatology, INSERM UMR1184, Le Kremlin-Bicêtre, France
| | - Andrew J Skelton
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine James
- Interdisciplinary Computing & Complex BioSystems Research Group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Peter McMeekin
- Faculty of Health and Life Science, Northumbria University, Newcastle upon Tyne, UK
| | - Shereen Al-Ali
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Department of Pathological Analyses, College of Science, University of Basrah, Basrah, Iraq
| | - Katie L Hackett
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Faculty of Health and Life Science, Northumbria University, Newcastle upon Tyne, UK
| | - B Clare Lendrem
- National Institute for Health Research Newcastle In Vitro Diagnostics Co-operative, NewcastleUniversity, Newcastle upon Tyne, UK
| | - Ben Hargreaves
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John Casement
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sheryl Mitchell
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Colin T Pease
- Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust Leeds, Leeds, UK
| | - Paul Emery
- Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust Leeds, Leeds, UK
| | - Peter Lanyon
- Nottingham University Hospitals NHS Trust, Rheumatology, Derby Road, Nottingham, UK
| | | | | | - Michele Bombardieri
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | | | - Costantino Pitzalis
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | | | | | - Marian Regan
- University Hospitals of Derby and Burton, Derby, UK
| | - Ian Giles
- Centre for Rheumatology, University College London, London, UK
| | - David Isenberg
- Centre for Rheumatology, University College London, London, UK
| | | | - David Coady
- City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | - Bhaskar Dasgupta
- Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
| | - Neil McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | | | - Robert Moots
- University Hospital Aintree, University of Liverpool, Liverpool, UK
| | - Nagui Gendi
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
| | - Mohammed Akil
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Bridget Griffiths
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Deborah Stocken
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Colin Everett
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Catherine Fernandez
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - John D Isaacs
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Centre de Référence National Pour les Maladies Auto-Immunes Systémiques Rares, CNRS, Strasbourg, France; Institut de Biologie Moléculaire et Cellulaire, Immunopathologie et Chimie Thérapeutique, Université de Strasbourg, Strasbourg, France
| | - Wan-Fai Ng
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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Vikse J, Gøransson LG, Norheim KB. Systemic capillary leak syndrome following bosentan treatment in a patient with systemic sclerosis. Scand J Rheumatol 2019; 48:426-427. [PMID: 31012372 DOI: 10.1080/03009742.2019.1584641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J Vikse
- Clinical Immunology Unit, Stavanger University Hospital , Stavanger , Norway
| | - L G Gøransson
- Department of Nephrology, Stavanger University Hospital , Stavanger , Norway.,Clinical institute 1, University of Bergen , Bergen , Norway
| | - K B Norheim
- Clinical Immunology Unit, Stavanger University Hospital , Stavanger , Norway
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Hammonds SK, Lauvsnes MB, Dalen I, Beyer MK, Kurz KD, Greve OJ, Norheim KB, Omdal R. No structural cerebral MRI changes related to fatigue in patients with primary Sjögren's syndrome. Rheumatol Adv Pract 2017; 1:rkx007. [PMID: 31431945 PMCID: PMC6649952 DOI: 10.1093/rap/rkx007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/27/2017] [Indexed: 12/19/2022] Open
Abstract
Objective Whether or not chronic fatigue is reflected in structural changes in the brain is a matter of debate. Primary SS (pSS) is characterized by dryness of the mouth and eyes, migrating muscle and joint pain and prominent fatigue. We aimed to investigate whether the severity of fatigue in pSS was associated with cerebral MRI findings. Methods Fatigue was measured with the fatigue visual analog scale in 65 patients with pSS. Global grey matter (GM) and white matter volumes were estimated from magnetic resonance T1 images, and associations between fatigue and brain volumes were assessed in regression models. Voxel-based morphometric analyses of GM were performed to investigate possible associations between fatigue and GM volume changes in particular brain regions. Results The fatigue scores in the patient group were spread across a wide range. Global volume analyses showed no significant effect of GM volumes and white matter volumes on fatigue. Voxel-wise analyses of GM did not identify any particular brain region associated with fatigue. Conclusion Fatigue is a dominant phenomenon in pSS patients but is not reflected in structural abnormalities in the brain as visualized by conventional MRI. Our findings support the hypothesis of fatigue as a physiological phenomenon that does not lead to vascular changes or neuronal or glial death or damage.
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Affiliation(s)
- Solveig K Hammonds
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger.,Department of Research, Stavanger University Hospital, Stavanger
| | - Maria B Lauvsnes
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger
| | - Ingvild Dalen
- Department of Research, Stavanger University Hospital, Stavanger
| | - Mona K Beyer
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo.,Department of Life Sciences and Health, Oslo and Akershus University College of Applied Sciences, Oslo
| | - Kathinka D Kurz
- Department of Radiology, Stavanger University Hospital, Stavanger.,Department of Electrical and Computer Engineering, University of Stavanger, Stavanger
| | - Ole J Greve
- Department of Radiology, Stavanger University Hospital, Stavanger
| | - Katrine B Norheim
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger
| | - Roald Omdal
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger.,Faculty of Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
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Grimstad T, Norheim KB, Kvaløy JT, Isaksen K, Leitao K, Carlsen A, Karlsen LN, Aabakken L, Omdal R. Conventional treatment regimens for ulcerative colitis alleviate fatigue - an observational cohort study. Scand J Gastroenterol 2016; 51:1213-9. [PMID: 27310658 DOI: 10.1080/00365521.2016.1195869] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the course of fatigue in a conventional inflammatory bowel disease treatment setting. MATERIALS AND METHODS Eighty-two patients with newly diagnosed ulcerative colitis were included in an observational cohort study and received conventional non-biological drug treatment for 3 months. Colonoscopy was performed at diagnosis and after 3 months, disease activity was assessed by Mayo score and measurements of serum C-reactive protein (CRP) and fecal calprotectin levels. Fatigue was evaluated using the fatigue visual analog scale (fVAS). Mood was assessed with the hospital anxiety and depression scale (HADS). Associations between fVAS scores and time; age; CRP, fecal calprotectin, hemoglobin, and ferritin levels; and Mayo scores, Mayo endoscopic scores, and HADS depression subscale (HADS-D) scores were explored. RESULTS Median fVAS scores decreased, as did Mayo scores and CRP and fecal calprotectin concentrations. HADS-D scores remained unchanged, whereas hemoglobin levels increased after 3 months. Increased fVAS scores were associated with higher ferritin, Mayo and HADS-D scores. There were no associations between fVAS scores and CRP, fecal calprotectin, or Mayo endoscopic scores. Colonic disease distribution did not influence fatigue significantly. CONCLUSIONS Disease activity and fatigue improved after 3 months of conventional ulcerative colitis treatment. Over time, more severe fatigue was associated with more ulcerative colitis symptoms, but not with objective disease activity markers or colonic disease distribution. A clinical setting of standard treatment regimens and medical attention may alleviate fatigue in IBD patients.
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Affiliation(s)
- Tore Grimstad
- a Department of Internal Medicine , Stavanger University Hospital , Stavanger , Norway
| | - Katrine B Norheim
- a Department of Internal Medicine , Stavanger University Hospital , Stavanger , Norway
| | - Jan Terje Kvaløy
- b Department of Mathematics and Natural Science , University of Stavanger , Stavanger , Norway ;,c Research Department , Stavanger University Hospital , Stavanger , Norway
| | - Kjetil Isaksen
- a Department of Internal Medicine , Stavanger University Hospital , Stavanger , Norway
| | - Kristian Leitao
- a Department of Internal Medicine , Stavanger University Hospital , Stavanger , Norway
| | - Arne Carlsen
- a Department of Internal Medicine , Stavanger University Hospital , Stavanger , Norway
| | - Lars N Karlsen
- a Department of Internal Medicine , Stavanger University Hospital , Stavanger , Norway
| | - Lars Aabakken
- d Department of Medical Gastroenterology , Rikshospitalet University Hospital , Oslo , Norway
| | - Roald Omdal
- a Department of Internal Medicine , Stavanger University Hospital , Stavanger , Norway ;,e Department of Clinical Science , University of Bergen , Bergen , Norway
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8
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Grimstad T, Norheim KB, Isaksen K, Leitao K, Hetta AK, Carlsen A, Karlsen LN, Skoie IM, Gøransson L, Harboe E, Aabakken L, Omdal R. Fatigue in Newly Diagnosed Inflammatory Bowel Disease. J Crohns Colitis 2015; 9:725-30. [PMID: 25994356 DOI: 10.1093/ecco-jcc/jjv091] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/12/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The present study investigated the prevalence and severity of fatigue in patients with newly diagnosed and untreated ulcerative colitis (UC) and Crohn's disease (CD) and examined relevant disease variables that may influence the severity of fatigue. METHODS Eighty-one patients with inflammatory bowel disease (IBD) (60 with UC and 21 with CD) were assessed for fatigue using two fatigue instruments: the Fatigue Severity Scale (FSS) and a fatigue visual analogue scale (fVAS). Cut-off for fatigue was defined as ≥4 for FSS and ≥50 for fVAS. Results were compared with fatigue scores from age-and gender-matched healthy individuals. Disease activity was assessed by symptom scores using the Mayo score in UC patients and the Harvey-Bradshaw index for CD patients, as well as C-reactive protein (CRP) and faecal calprotectin. RESULTS The prevalence of fatigue based on FSS and fVAS was 47 and 42%, respectively, in UC and 62 and 48% in CD. In multivariate regression models, disease activity markers were not associated with fatigue, while a significant relationship was found with age and depression for both fatigue measures. CONCLUSIONS Close to 50% of patients with IBD reported fatigue at the time of diagnosis. In newly diagnosed patients with active disease, the severity of fatigue was not associated with measures of disease activity.
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Affiliation(s)
- Tore Grimstad
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Katrine B Norheim
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Kjetil Isaksen
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Kristian Leitao
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Anne K Hetta
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Arne Carlsen
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Lars N Karlsen
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Inger Marie Skoie
- Department of Dermatology, Stavanger University, Hospital, Stavanger, Norway
| | - Lasse Gøransson
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Erna Harboe
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Lars Aabakken
- Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Roald Omdal
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway Department of Clinical Medicine, University of Bergen, Bergen, Norway
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9
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Mengshoel AM, Norheim KB, Omdal R. Primary Sjögren's Syndrome: Fatigue Is an Ever-Present, Fluctuating, and Uncontrollable Lack of Energy. Arthritis Care Res (Hoboken) 2014; 66:1227-32. [DOI: 10.1002/acr.22263] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 12/03/2013] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Roald Omdal
- Stavanger University Hospital; Stavanger Norway
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10
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Hanasand M, Omdal R, Norheim KB, Gøransson LG, Brede C, Jonsson G. Improved detection of advanced oxidation protein products in plasma. Clin Chim Acta 2012; 413:901-6. [PMID: 22336637 DOI: 10.1016/j.cca.2012.01.038] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Oxidative stress has been associated with many diseases and can among others be assessed as increased levels of advanced oxidation protein products (AOPP). Current AOPP methods suffer from poor reproducibility and accuracy due to precipitation of lipids in plasma samples. We therefore aimed to develop a robust method in which plasma lipids are solubilized. METHODS Plasma was diluted with citric acid, and AOPP measured as absorbance at 340 nm. The method was optimized and validated, and then used to analyze AOPP levels in plasma from healthy control subjects (HC), and in three patients groups; chronic kidney disease (CKD), primary Sjögren's Syndrome (pSS) and systemic lupus erythematosus (SLE). RESULTS AOPP was detected with improved precision compared to established methods where lipids precipitate. Within- and between days variations were less than 1.4% and 2.2%, respectively. A control chart was established and the long-term reproducibility followed over six months. CONCLUSIONS This improved method detects plasma AOPP with significantly better reproducibility and accuracy compared to previously reported methods. Solubilization of plasma lipids before spectrophotometric measure of AOPP levels is novel. It prevents both loss of lipoproteins due to precipitation and overestimation as a result of light scattering.
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Affiliation(s)
- Marita Hanasand
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Norway
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