Association of Polymorphisms in C-Reactive Protein (CRP) Promoter -821 A>G, -390 C>A/T, and Plasma Interferon-α (IFN-α) with Plasma CRP Level in Javanese Systemic Lupus Erythematosus (SLE) Patients.

BACKGROUND: As an acute-phase reactant, CRP is needed to clear apoptotic cells and immune complexes in SLE. This unresponsive CRP may be caused by genetic variation and abundant IFN-α that might inhibit CRP secretion. This study aims to analyze the association of single nucleotide polymorphisms (SNP) in CRP promoter and plasma IFN-α with CRP level in Javanese SLE patients. We also analyzed the association of these SNPs with SLE. METHODS: Forty SLE and 40 spondyloarthritis (as control) patients were included. SLE subjects underwent routine laboratory test, CRP level, serum IFN-α, and DNA sequencing to detect SNPs in CRP promoter. The control group only underwent DNA sequencing. RESULTS: The median age of SLE patients was 31.5 years. The median SLAM score was 8.5. The median age of the control group was 39 years. The average CRP was 5.19 SD 2.69 mg/L, median plasma IFN-α was 46.02 pg/ml. There was no significant difference of SNPs in CRP -821 (rs2794521) or -390 (rs3091244) between SLE and control. New SNP was found in CRP -456 A>G in 5 SLE patients, but none in controls. This SNP would increase SLE risk 2.143 times. There was a moderate negative correlation between IFN-α level and plasma CRP. Linear regression only showed IFN-α level (not either SNP) correlated with serum CRP. CONCLUSION: Plasma IFN-α correlated with CRP level. There was no association of SNPs in CRP -821, -390, and -456 with CRP level. SNP CRP -456 A>G would increase the risk of SLE with an odds ratio of 2.143.

The Coexistence of Systemic Lupus Erythematosus and Psoriasis: Is It Possible?

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with various clinical disorders and frequent exacerbations. Psoriasis vulgaris is a common skin disorder which affect 1-3% of general populations. The pathophysiology regarding the coexistence of these diseases is not fully understood. Therapeutic challenges arise since the treatment one of these diseases may aggravate the other. We reported two cases of SLE with psoriasis vulgaris with clinical manifestations as recurrent erythroderma with photosensitivity. Improvement in clinical condition was observed after treating the patients with methylprednisolone combined with methotrexate. The coexistence SLE and psoriasis are considered very rare. The presence of this overlap syndrome may precede one another or occur simultaneously and is closely related with the presence of anti-Ro/SSA. Thus, it raises new challenge regarding its relationships, diagnosis, therapeutic, and management.

Acute Appendicitis in a Patient with Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a chronic excacerbative autoimmune disease with wide clinical spectrum. Gastrointestinal manifestasion is a frequent clinical manifestasion seen in SLE. Management with glucocorticoid and non-steroid anti-inflammatory drugs (NSAID) can mask the gastrointestinal symptoms in patient with SLE. One of the etiologies of gastrointestinal manifestations in SLE is acute appendicitis. Patients with acute appendicitis usually have abdominal pain as its chief complaint. The pathophysiology of acute appendicitis can occur primarily from SLE and secondary from other causes eg: infection, inflammation, etc. When a SLE patient has acute appendicitis as its initial assessment, determining its etiology is pivotal to give comprehensive management and preventing life-threatening complications.