Summary
We focussed on evaluating the protective effect of lycopene and resveratrol on post‐thaw bull sperm and oxidative stress parameters. Nine ejaculates for each bull were used in the study. Each ...ejaculate, splitted into three equal aliquots and diluted at 37 °C with base extenders containing lycopene (1 × 10−3 g ml−1) and resveratrol (1 mm), and no antioxidant (control), was cooled to 5 °C and then frozen. Frozen straws were thawed in a water bath for evaluation. The supplementation of the semen extender with lycopene and resveratrol increased the percentages of post‐thawed computer‐assisted sperm analysis (CASA) motility (55.8 ± 3.8 and 61.9 ± 4.0%) and progressive motility (38 ± 2.4 and 37 ± 8.8), compared with the controls (50.7 ± 2.65 and 33.3 ± 3.74%, respectively, P < 0.05). Resveratrol provided a higher ALH (4.3 ± 0.1), in comparison with the control (3.9 ± 0.3, P < 0.05). The supplementation of the semen extender with lycopene and resveratrol produced a higher mitochondrial activity (24.6 ± 2.9 and 30.1 ± 6.5% respectively), compared with that of the control (11.8 ± 9.5%, P < 0.05). It was determined that both antioxidants resulted in a lower percentage of sperm with damaged DNA than that of the control (P < 0.05). Sperm motion characteristics except for ALH, acrosome integrity, sperm viability and oxidative stress parameters were not affected by the adding of lycopene and resveratrol.
Background
In systemic sclerosis (SSc), studies showed that permenant organ damage may exist very early in the disease course.
Objectives
To reveal the differences between diffuse cutaneous and ...limited cutaneous SSc (dcSSc and lcSSc) patients regarding the progress of disease related organ damage over time.
Methods
Medical records of consecutive 210 patients(91.9% women) who fulfilled SSc classification criteria and had a follow-up period of at least 12 months were retrospectively evaluated. ‘Scleroderma Clinical Trials Consortium Damage Index‘ score* was calculated initially and after a follow-up period of 101±70 months in dcSSc and lcSSc patients.
Results
In dcSSc; joint contractures, low BMI/weight loss, and dependence on oxygen, ILD with>20% extent on HRCT and FVC<70% were more frequent at follow-up, total damage scores were higher at baseline and follow-up (3.1±2.8 vs 1.9±2.5,p=0.004 and 9.7±5.9 vs 5.8±4.6,p<0.000) (Table 1, Figure1). In dcSSc; presence of puffy fingers was associated with initial respiratory damage (OR:3.88,p=0.008) and ILD with musculoskeletal-skin damage at follow-up (OR=3.547, p=0.02). In lcSSc; follow-up period of >5 years was associated with musculoskeletal-skin damage (OR=10.17,p=0.002), presence of skin thickening proximal to the MCP with peripheral vascular damage (OR=8.48,p=0.000 and OR=2.87,p=0.047), presence of anti-Scl70 with respiratory damage (OR=4.84, p=0.008), presence of ILD, DU and follow-up period of >5 years with GIS damage(OR=2.48,p=0.001, OR=1.79,p=0.029 and OR=5.77,p=0.000) at follow-up. In lcSSc, the presence of DU and ILD were associated factors with moderate damage (6-12 points)(OR=2.41,p=0.000 and OR=1.94,p=0.006), telangiectasias and PAH with high damage (≥13 points) (OR=2.42,p=0.041 and OR=2.87,p=0.004) at follow-up. Of the patients 4.3%(n=9) died during follow-up; cardiovascular damage (baseline and follow-up) was associated with mortality (5.5% vs.55.6%, p<0.000, and 15.4% vs.55.6%, p=0.009).
Conclusion
In SSc patients, the frequency and severity of organ damage were increased in both cutaneous subtypes during 8 years of follow-up. Presence of ILD, DU, telangiectasia and PAH and long duration of follow-up period were prominent factors associated with damage. Cardiovascular damage was found to be associated with mortality. The identification of risk groups in different cutaneous subtypes of SSc and early efficacious treatment strategies could improve survival.
Reference
1Ferdowsi N, et al. Ann Rheum Dis. 2019;78:807-816.
Table 1.
Frequency of Some Disease Related Organ Damage Parameters in SSc Patients
Baseline
Last
DAMAGE PARAMETERS
lcSSc (n=160
)
dcSSc (n=50
)
lcSSc (n=160
)
dcSSc (n=50
)
Small joint contractures
12 (7.5)
7 (14)
29 (18)
20 (40)
p=0.004
Large joint contractures
1 (0.6)
2 (4)
7 (4.4)
7 (14)
p=0.025
Digital ulcer
19 (12)
11 (22)
60 (38)
28 (56)
Esophageal dysmotility
13 (8)
3 (6)
44 (28)
17 (34)
Low BMI/ weight loss
7 (4.4)
2 (4)
15 (9)
12 (24)
p=0.015
Refractory GERD
30 (19)
9 (18)
105 (66)
37 (74)
HRCT>20%
28(18)
19 (38)
p=0.005
66 (40)
41(82)
p=0.000
HRCT>20% and FVC<70%
6 (4)
7 (14)
p=0.013
27 (17)
24(48)
p=0.000
Dependence on home oxygen
0 (0)
0 (0)
2 (1.3)
4 (8)
p=0.030
PAH
5 (3.1)
3 (6)
14 (8.8)
5 (10)
Right ventricular dysfunction
0 (0)
0 (0)
7 (4.4)
4 (8)
Myocardial disease
0 (0)
1 (2)
4 (2.5)
4 (8)
Figure 1
: Progress of total damage scores in SSc patients with different cutaneous subtypes
Acknowledgements:
NIL.
Disclosure of Interests
None Declared.
Background:
Infection is a remarkable cause of morbidity and mortality in patients with SLE.
Objectives:
We aimed to determine the clinical course of COVID-19 infection in our patients with SLE and ...the factors affecting this course
Methods:
SLE patients (2012 SLICC criteria) diagnosed with COVID-19 infection by a positive PCR test and/or typical findings of lung involvement in CT (computed tomography) imaging were included. Data regarding cumulative clinical and laboratory characteristics, histopathology results, autoantibody profiles, immunsuppressives and damage (SLICC damage index/
SDI
)) were retrieved from the existing database and revised. SLE Disease Activity Index (
SLEDAI-2K
) was determined at the time of infection.
Results:
Sixteen SLE patients with COVID-19 infection were identified. Most (87.5%) of these patients were female. Seventy % (n=11) had lupus nephritis. Twenty-five % had thrombotic antiphospholipid syndrome.
PCR was positive in 70% (n=11) of the patients. Pulmonary parenchymal findings compatible with COVID-19 were observed in 56% (n=9) of those patients. Regarding complaints upon admission, 50% (n=8) had fever, 44% (n=7) cough, 44% (n=7) dyspnea, 19% (n=3) myalgia, 12.5% (n=2) headache, 12.5% (n=2) nausea /vomiting, 6% (n=1) diarrhea, and 6 % (n=1) had anosmia. Eight patients were hospitalized. Six of these patients needed oxygen therapy via nasal cannula. None needed a follow-up in the intensive care unit. The mean hospitalization duration was 14 ± 5 (8-25) days.
Regarding disease activity at the time of infection, 9 had inactive disease with a SLEDAI-2K score of 0 whilst in 5 patients SLEDA-2K score was ≥4. The mean SLEDAI-2K score at the time of infection was 1.7 ± 2.3 (0-6). System/organwise, 1 patient with chronic thrombocytopenia presented with a worsening platelet count accompanied by serologic activity. This patient was a non-adherent to treatment who had stopped taking mycophenolic acid months before COVID19. Three patients 2 of whom had proliferative nephritis experienced nephritic flares.1 patient who had a history of cutaneous lupus and was in remission presented with oral ulcer, leukopenia and hypocomplementemia during infection. Of 16 patients, 7 had system damage at the time of infection. The mean SDI score of the patients was 1.4±1.8. Comparison of patients with and without damage revealed no significant differences in disease activity, symptoms associated with COVID, in the need for hospitalization, hospitalization duration, and the requirement for oxygen therapy. However,CT findings compatible with COVID19, were more common in patients with damage (87% vs.33%,p=0.04) and their mean CRP levels were higher at diagnosis (65 ± 47 vs.22 ± 48 mg/l;p=0.032).
All patients received similar treatment for COVID-19 except active patients who required high dose steroids (2 with active renal, 1 with thrombocytopenia and 1 with oral ulcer, leukopenia and hypocomplementemia).The patient with thrombocytopenia also received intravenous immunoglobulin and 1 with cutaneous active disease received tocilizumab as she developed macrophage activation syndrome. Six patients (37.5%) had received rituximab (RTX) in the last 6 months before COVID. No significant difference, in terms of hospitalization and need for oxygen therapy due to COVID19 was found between patients who had received RTX vs who had not. No hypogammaglobulinemia was detected in patients who received RTX despite lower levels of IgG (998 ± 184 vs 1481± 51 mg/dl, p=0.02)
Conclusion:
Although half of the patients in our series of COVID19 infected SLE patients required hospitalization, there were no mortalities. More patients with damage (none pulmonary) displayed CT findings compatible with COVID19 and further follow up will reveal whether they will suffer from fibrotic lung disease. Patients can experience disease flares during COVID. But it is also important to consider that some manifestations such as thrombocytopenia may also be a sign of severe infection. Immunosupressive agents may not have a negative impact on the course of infection.
*the first two authors contributed equally
Disclosure of Interests:
None declared.
PurposeTo evaluate the topographic, tomographic, and densitometric properties of patients with pellucid marginal degeneration (PMD) and inferior keratoconus.Patients and methodsRetrospective, ...comparative case series. Forty-seven eyes of 32 patients with crab claw patterns were identified from 2751 patients with corneal ectasia. They were divided into two groups, inferior keratoconus and PMD, based on clinical findings. The topographic, tomographic, and densitometric measurements were analyzed.ResultsPMD was detected in 11 eyes of eight patients (mean age 50.2±11.1 years), and inferior keratoconus was detected in 36 eyes of 24 patients (mean age 34.7±10.1 years). The control group consisted of 40 patients (33.1±4.6 years). The thinnest corneal point and maximum anterior and posterior elevation points were located lower in the PMD than in the inferior keratoconus (P<0.01). In the PMD, all deviation indices were higher than the controls (P<0.01), whereas the deviation indices, except Dt (P=0.960), were lower than the inferior keratoconus (P<0.01). The densitometry values of PMD were significantly higher than those of the controls in all zones and layers (P<0.01) and significantly higher than the densitometry values of inferior keratoconus in the 6-10 and 10-12 mm zones (P<0.05).ConclusionThere is a higher probability of a patient with crab claw pattern on the topography of having inferior keratoconus than having PMD. Therefore, analyzing only the anterior corneal surface is not sufficient in differential diagnosis. Tomographic and densitometric evaluations may facilitate the differential diagnosis.
Background:
Retinol binding protein 4 (RBP4) is a plasma retinol transporter that transports retinol from liver to periphery. RBP4 has been studied as a biomarker in metabolic and neoplastic ...conditions, however its association with inflammation is not clear. Serum amyloid A (SAA), another retinol binding protein, has been known as a sensitive biomarker of inflammation in familial Mediterranean fever (FMF) and other autoinflammatory disorders. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and SAA are commonly used as acute phase reactants, but they are not successful in differentiating non-infectious inflammatory conditions from infections.
Objectives:
We aimed to evaluate the potential of serum RBP4 as a biomarker of acute phase response and to determine its performance in differentiation of inflammation of patients with FMF and AA amyloidosis from infections.
Methods:
A total of 169 participants in 5 groups, consisting of FMF (n = 60), FMF with AA amyloidosis (n = 58), non-FMF AA amyloidosis (n = 23), infections (n = 10, 3 pneumonia, 3 sepsis, 1 pyelonephritis, 1 fungal infection, 1 cellulitis, 1 disseminated zoster), and healthy controls (HC) (n = 18), were included and evaluated cross sectionally. Hemogram and serum CRP, ESR, SAA, ferritin, creatinine, AST, ALT, albumin levels were recorded from the patient charts. FMF and FMF + amyloidosis patients were evaluated during attack-free period. Serum RBP4 levels were investigated by ELISA (Elabscience, USA). Mean values and relative changes compared to healthy controls were evaluated for SAA, CRP, RBP4 levels in all groups.
Results:
Serum RBP4 level was found to be higher in FMF group compared to the patients with infection (p = 0.002) and HC (p <0.001) as well as in patients with amyloidosis. Compared to HC, 47%, 28% and 27% increase was observed in mean RBP4 levels in FMF, FMF + amyloidosis and non-FMF amyloidosis patients, despite no significant change in patients with infections. However, CRP and SAA elevations were much more prominent in patients with infections (58 and 134 times, respectively) compared to the patients with FMF (13 and 35 times, respectively), FMF + amyloidosis and non-FMF amyloidosis (Table 1). There was no significant difference in RBP4 levels between FMF, FMF-amyloidosis and non-FMF amyloidosis groups. CRP, ESR, ferritin and SAA levels were higher in the infection group compared to HCs.
Table 1.
Demographic features and laboratory findings of the participants
Variables
FMF
(n=60)
FMF- Amyloidosis
(n=58)
Non-FMF-AA Amyloidosis
(n=23)
Infection
(n=10)
Healthy control
(n=18)
Female/Male
46/14
33/25
8/15
3/7
8/10
Age (SD)*
38±13
(18-74)
43±11
(21-69)
53±13
65±15
33±9
Creatinine (mg/dL)*
0,8±0,2
1,7±1,7
2,0±1,6
1,7±1,0
0,7±0,2
Albumin(mg/dL)*
4,7±0,4
4,3±0,6
3,3±0,9
3,0±0,9
4,8±0,2
Ferritin (ng/mL)*
70±94
245±315
139±168
554±38
83±72
RBP4 (ng/mL)*
772±183
671±214
666±256
512±204
524±117
RBP4 (median
)
770
(434-1142)
653
(227-1259)
645
(331-1214)
487
(226-876)
498
(566-738)
CRP (mg/L)*
16±47,1
12,8±32,8
25,7±36,4
69±36,8
1,2±1,2
SAA (mg/dL)*
10,3±31,4
5,0±13,9
7,1±14,1
40,2±18,5
0,3±0,1
ESR*
15±13
19±16
41±29
45±42
7±5
Relative RBP4 increase
1,47±0,35
1,28±0,41
1,27±0,49
0,98±0,39
Relative CRP increase
13,4±39,2
10,6±27,3
21,4±30,3
57,7±30,6
Relative SAA increase
34,5±104,8
16,0±45,7
23,7±47,1
133,9±61,7
*mean, RBP4 (Retinol Binding Protein 4), C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), Serum Amyloid A (SAA).
Conclusion:
This preliminary study showed that RBP4 levels may be increased about 1.5 times in FMF and to lesser extent in AA amyloidosis patients despite no significant change during acute phase response of different infections. Patients with infections show strong CRP and SAA response, and the differential response of RBP4 in FMF patients warrants further analysis in larger group of patients with different clinical characteristics.
Disclosure of Interests:
None declared
Background/Purpose
Patients with systemic lupus erythematosus (SLE) have increased rates of cardiovascular disease (CVD) that are one of the major causes of mortality. The aim of this study was to ...determine the frequencies of metabolic syndrome (MetS) and CVD in SLE patients and investigate the link between these and clinical features of SLE.
Methods
A total of 311 SLE patients were consecutively assessed for cumulative organ damage (SDI/SLICC scores), history of CVD and MetS as defined by the National Cholesterol Educational Program Adult Treatment Panel III (NCEP ATP III). Clinical data of SLE patients were collected from the records.
Results
The mean age of the patients was 40.2 ± 13.4 years and 89% were female. The frequencies of CVD and MetS were 15.2% and 19%, respectively. In this SLE cohort increased age, cumulative damage, disease duration and CVD were associated with MetS. CVD was associated with disease duration, cumulative damage, pericarditis, hematologic involvement, lymphopenia, thrombocytopenia, neurological involvement and antiphospholipid antibody (aPL) positivity. Hydroxychloroquine (HCQ) use was found as a protective factor for CVD.
Conclusion
In SLE patients, MetS was associated with CVD and both increased with disease duration. Patients who developed MetS and/or CVD had increased cumulative organ damage. Certain clinical features of SLE and the presence of aPL were also associated with CVD. There was a significant protective effect of HCQ from CVD. The prevention of MetS and long-term use of HCQ may be beneficial in improving the prognosis of SLE.
Background:
Positron emission tomography (PET/CT) has gained importance in the diagnosis and assessment of large vessel vasculitis (LVV) recently.
Objectives:
We aimed to investigate the diagnostic ...importance and clinical significance of PET/CT findings in giant cell arteritis (GCA).
Methods:
Data of the patients who underwent PET/CT to investigate large vessel involvement and who had at least 6 months of follow-up with a clinical diagnosis of GCA were retrospectively evaluated. PET/CT images were assessed by an experienced nuclear medicine specialist, regions of interest were drawn for major vascular territories and standardized maximum uptake values (SUVmax) of these areas were recorded.
Results:
Twenty-nine consecutive patients (median age 68 (50-83), mean follow-up time 37.1 ± 48.8 (6-242)) were included into the study. All patients were over 50 years old and had erythrocyte sedimentation rate (ESR) over 50 mm/h at the time of imaging. Twenty patients (68.9%) met the ACR 1990 Classification criteria (ACR (+) group). The number of patients who had hypermetabolism in the aorta and its major branches in favour of LVV in PET/CT was 23 (79.3%) (PET-CT (+) group). Thoracic and abdominal aorta involvement were detected in 22 (75.8%) and 16 (55.2%) patients, respectively. There was positive correlation between SUVmax in thoracic and abdominal aorta on PET/CT and ESR at diagnosis (r = 0.63 p = 0.002 and r = 0.77 p <0.001, respectively) and SUVmax in thoracic aorta and CRP (r=0.50 p=0.026). PET/CT (-) patients had more frequent disease flares during the follow-up (4/6 vs. 5/23 p = 0.035 OR = 7.2 (1.01- 51)). Three distinct subgroups were defined by implementing both ACR criteria and PET/CT positivity. Among ACR (+) patients (n=20); comparison of PET/CT (+) (n=14) and PET/CT (-) (n=6) patients did not show any difference in age of diagnosis, presence of polymyalgia rheumatica (PMR), flare rate and damage scores. Among PET/CT (+) patients (n=23), the mean age at diagnosis was higher, PMR and bilateral axillary artery involvement was more frequent in ACR (+) group (n=14) (Table 1).
Conclusion:
PET/CT is increasingly used in the diagnosis and assessment of GCA in our center. The level of FDG uptake of the vessel wall in PET/CT correlates with the acute phase response. Flare was rarely observed in PET/CT (+) patients at diagnosis. Axillary artery involvement detected on PET/CT may be associated with the classical GCA clinic in ACR(+) patients (1). PET/CT (+) patients who does not met ACR criteria seems to have a diverse clinic features like young age and rare presence of PMR. PET/CT findings may be helpful in recognizing subgroups and predicting prognosis of GCA although prospective studies with follow-up scans are warranted.
References:
1Grayson PC, Maksimowicz-McKinnon K, Clark TM, Tomasson G, Cuthbertson D, Carette S, et al. Distribution of arterial lesions in Takayasu’s arteritis and giant cell arteritis. Annals of the rheumatic diseases. 2012;71(8):1329-34.
Table 1.
Comparison of patients who fulfilled and not fulfilled ACR 1990 classification criteria among PET/CT (+) patients.
ACR (+) PET/CT (+)
(n=14)
ACR (-) PET/CT (+)
(n=9)
p
OR (%95 CI)
Age at diagnosis
68,8±4,5
63.3±9,2
0.004
PMR
10
2
0.021
2.5 (1 – 6.1
)
History of flare
4
1
NS
CRP at diagnosis
75,1±30,6
130,8±93,4
0.024
ESR at diagnosis
93,9±28,1
112,5±21,2
NS
Brachiocephalic artery
9
6
NS
Right subclavian
8
5
NS
Lef subclavian
9
5
NS
Right carotid
8
5
NS
Left carotid
9
6
NS
Right axillary
7
0
0.011
2 (1.18 – 3.3
)
Bilateral axillary
6
0
0.022
1.75 (1.1-2.7
)
Thoracic aorta SUVmax (mean)
3,9±1,1
4,6±1,3
NS
Abdominal aorta SUVmax (mean)
4,5±1,2
5,3±1,8
NS
Disclosure of Interests:
None declared
Background:
Recently developed EULAR/ACR classification criteria for systemic lupus erythematosus (SLE) have important differences compared to the 2012 Systemic Lupus International Collaborating ...Clinics (SLICC) SLE classification criteria and the revised 1997 American College of Rheumatology (ACR) criteria: The obligatory entry criterion of antinuclear antibody (ANA) positivity is introduced and a “weighted” approach is used
1
. Sensitivity and specificity of these three criteria have been debated and may vary in different populations and clinical settings.
Objectives:
We aim to compare the performances of three criteria sets/rules in a large cohort of patients and relevant diseased controls from a reference center with dedicated clinics for SLE and other autoimmune/inflammatory connective tissue diseases from Turkey.
Methods:
We reviewed the medical records of SLE patients and diseased controls for clinical and laboratory features relevant to all sets of criteria. Criteria sets/rules were analysed based on sensitivity, positive predictive value, specificity and negative predictive value, using clinical diagnosis with at least 6 months of follow-up as the gold standard. A subgroup analysis was performed in ANA positive patients for both SLE patients and diseased controls. SLE patients that did not fulfil 2012 SLICC criteria and 2019 EULAR/ACR criteria and diseased controls that fulfilled these criteria were evaluated.
Results:
A total of 392 SLE patients and 294 non-SLE diseased controls (48 undifferentiated connective tissue disease, 51 Sjögren’s syndrome, 43 idiopathic inflammatory myopathy, 50 systemic sclerosis, 52 primary antiphospholipid syndrome, 15 rheumatoid arthritis, 15 psoriatic arthritis and 20 ANCA associated vasculitis) were included into the study. Hundred and fourteen patients (16.6%) were ANA negative.
Sensitivity was more than 90% for 2012 SLICC criteria and 2019 EULAR/ACR criteria and positive predictive value was more than 90% for all three criteria (Table 1). Specificity was the highest for 1997 ACR criteria. Negative predictive value was 76.9% for ACR criteria, 88.4% for SLICC criteria and 91.7% for EULAR/ACR criteria.
In only ANA positive patients, sensitivity was 79.6% for 1997 ACR criteria, 92.2% for 2012 SLICC criteria and 96.1% for 2019 EULAR/ACR criteria. Specificity was 92.6% for ACR criteria, 87.8% for SLICC criteria 85.2% for EULAR/ACR criteria.
Eleven clinically diagnosed SLE patients had insufficient number of items for both 2012 SLICC and 2019 EULAR/ACR criteria. Both criteria were fulfilled by 16 diseased controls: 9 with Sjögren’s syndrome, 5 with antiphospholipid syndrome, one with dermatomyositis and one with systemic sclerosis.
Table 1.
Sensitivity, positive predictive value, specificity and negative predictive value of 1997 ACR, 2012 SLICC and 2019 EULAR/ACR classification criteria
SLE (+)
SLE (-)
Sensitivity (%)
Positive Predictive Value (%)
Specificity (%)
Negative Predictive Value (%)
1997 ACR
(+)
308
(-) 84
15
279
78.6
95.4
94.9
76.9
2012 SLICC
(+)
357
(-) 35
26
268
91.1
93.2
91.2
88.4
2019 EULAR/ACR
(+)
368
(-) 24
28
266
93.8
92.9
90.5
91.7
Conclusion:
In this cohort, although all three criteria have sufficient specificity, sensitivity and negative predictive value of 1997 ACR criteria are the lowest. Overall, 2019 EULAR/ACR and 2012 SLICC criteria have a comparable performance, but if only ANA positive cases and controls are analysed, the specificity of both criteria decrease to less than 90%. Some SLE patients with a clinical diagnosis lacked sufficient number of criteria. Mostly, patients with Sjögren’s syndrome or antiphospholipid syndrome are prone to misclassification by both recent criteria.
References:
1Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus.
Ann Rheum Dis
2019;78:1151-1159.
Disclosure of Interests:
None declared
Background:
The rates of hospitalization in patients with SLE is around 10% per year.
1
Objectives:
In this study, we aimed to examine the hospitalization data of patients with SLE in the last 5 ...years at our center and determine the factors that affect hospitalization.
Methods:
Hospitalization data of patients with SLE (2012 SLICC classification) admitted to our rheumatology ward between January 2015 and 2020 were analyzed. Cumulative clinical and laboratory findings were retrieved from the existing SLE database and revised. SLICC SLE damage index (SDI), and the disease activity at admission were determined (SLEDAI-2K).
Results:
Eighty-six % (n=138) of 161 hospitalized patients were female. The mean age of the patients was 38 ± 13 years whilst mean duration of disease was 97.3 ±96.9 months. Thirty-eight% of the patients were hospitalized more than once and the mean number of hospitalizations was 1.8±1.5 The mean hospitalization duration covering all stays for each patient was 25±27 days. Active disease followed by infection and damage-related complications ranked the first three among all causes of hospitalization.
Compared to patients hospitalized for active disease or other reasons, patients hospitalized for infection had a significantly higher number of readmissions (
p<0.05
) and their total duration of hospitalization was longer
(p<0.01
). Duration of disease was significantly shorter in patients hospitalized for active disease compared to patients hospitalized for infection and damage related causes (p<0.05).
The frequency of patients with damage and the mean SDI score was significantly lower in the group with active disease (68% and 1.9 ± 2) compared to patients hospitalized for infection (90% and 2.7±1.6) and other causes (96% and 3±1.7) (p<0.05 for both). Distribution of damage according to organ/systems is presented in Graph 1. Highest frequency of damage was detected in the cardiovascular (30%), followed by neuropsychiatric (26.7%), renal (23%), pulmonary (23%) and musculoskeletal (20.5%) domains. A positive correlation was found between the mean SDI score and duration of hospitalization (r=0.551,
p<0.001
) as well as the number of hospitalizations (r=0.393,
p<0.001
). Regarding disease activity at the time of admission, the mean score of patients hospitalized for active disease was 11.0 ± 6.1 whilst was 3.2 ± 2.8 in patients hospitalized for infection and 2.9 ± 3.3 in patients hospitalized for other reasons (
p<0.001
). Renal active disease was the most common (44%), followed by hematological (34.8%), articular (21.7%) and mucocutaneous (21%) activity. Ten% of the patients all of whom had damage were admitted to intensive care unit (ICU).
Total hospitalization duration
(p=0.012),
mean SDI
(p=0.008),
antiphospholipid syndrome
(p=0.033),
lupus anticoagulant
(p=0.010),
thrombocytopenia
(p=0.015),
serositis
(p=0.034),
pulmonary hypertension
(p=0.021), history of
alveolar haemorrhage
(p<0.001) and
cardiac valve involvement
(p=0.002) were associated with ICU hospitalization.
Conclusion:
Disease activity, infections and damage are the leading causes of hospitalization in patients with SLE. Damage increases the frequency of hospitalizations, prolongs the duration of stay, and increases the need for follow-up in the ICU. Tight control of disease activity with rational use of immunosuppressive treatment is important to reduce damage and hospitalizations.
Graphic 1.
Distribution of damage according to organs/systems in hospitalized patients
References:
1Gu K, Gladman DD, Su J, Urowitz MB. Hospitalizations in patients with systemic lupus erythematosus in an academic health science center. The Journal of rheumatology 2017;44:1173-8.
Disclosure of Interests:
None declared
Objectives
TNF-like weak inducer of apoptosis (TWEAK), monocyte chemoattractant protein-1 (MCP-1) and neutrophil gelatinase-associated lipocalin (NGAL) are proinflammatory cytokines/chemokines that ...are considered as potential biomarkers reflecting disease activity in systemic lupus erythematosus (SLE). In this study, we aimed to investigate the association of serum (s) and urine (u) levels of TWEAK, MCP-1 and NGAL with disease activity in both renal and extra-renal SLE.
Methods
Thirty active patients with SLE (15 renal and 15 extra-renal) were recruited. Thirty-one inactive patients with SLE (16 renal and 15 extra-renal), 14 patients with ANCA-associated vasculitis (AAV) all of whom had active renal involvement and 20 healthy volunteers were selected as control groups. Serum and urine levels of TWEAK, MCP-1 and NGAL were tested using ELISA.
Results
Serum and urine levels of TWEAK and NGAL were significantly higher in the active SLE group compared to the inactive SLE group (sTWEAK p = 0.005; uTWEAK p = 0.026; sNGAL p < 0.001; uNGAL p = 0.002), whilst no significant differences regarding serum and urine MCP-1 levels were observed (p = 0.189 and p = 0.106, respectively). uTWEAK (p = 0.237), sMCP-1 (p = 0.141), uMCP-1 (p = 0.206), sNGAL (p = 0.419) and uNGAL (p = 0.443) levels did not differ between patients with active renal and extra-renal SLE. Serum TWEAK was higher in patients with active renal SLE (p = 0.006). There were no differences between active renal SLE and active renal AAV. Levels of all biomarkers were correlated with the SLE Disease Activity Index.
Conclusion
sTWEAK, uTWEAK, sNGAL and uNGAL are biomarkers showing disease activity in SLE. However, our results implicate that these biomarkers may not be specific for SLE, and can be elevated in patients with active renal involvement of AAV.
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