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1.
Lupus ; 23(4): 360-9, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24449338

ABSTRACT

OBJECTIVE: The objective of this paper is to examine whether smoking is associated with autoantibody production in systemic lupus erythematosus (SLE) patients, unaffected first-degree relatives (FDR) of individuals with SLE--a group at increased risk of developing SLE--or unaffected, unrelated controls. METHODS: Detailed demographic, environmental, clinical, and therapeutic information was collected by questionnaire on 1242 SLE patients, 981 FDRs, and 946 controls in the Lupus Family Registry and Repository; a blood sample was obtained. All sera were tested for multiple lupus autoantibodies by immunofluorescence and luminex bead-based assays. Generalized estimating equations, adjusting for age, gender, and ethnicity and accounting for correlation within families, were used to assess smoking status with the dichotomous outcome variables of positivity for SLE status, positivity of ANA by immunofluorescence (≥1:120), positivity for ≥1 autoantibody by the luminex assay, and positivity for each of the 11 autoantibodies. RESULTS: Current smoking was associated with being positive for ≥1 autoantibody (excluding ANA) (adjusted OR = 1.53, 95% CI 1.04-2.24) in our subjects with SLE. No association was observed in unaffected FDRs or healthy controls. Former smoking was associated with anti-Ro/SS-A60 in our unaffected FDRs. There was an increased association with anti-nRNP A seropositivity, as well as a decreased association with anti-nRNP 68 positivity, in current smokers in SLE subjects. CONCLUSIONS: No clear association between smoking status and individual autoantibodies was detected in SLE patients, unaffected FDRs, nor healthy controls within this collection. The association of smoking with SLE may therefore manifest its risk through mechanisms outside of autoantibody production, at least for the specificities tested.


Subject(s)
Family , Lupus Erythematosus, Systemic/immunology , Smoking/immunology , Adult , Antibodies, Antinuclear/immunology , Autoantibodies/immunology , Case-Control Studies , Female , Fluorescent Antibody Technique , Humans , Male , Middle Aged , Surveys and Questionnaires
2.
Lupus ; 20(12): 1285-92, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21813589

ABSTRACT

UNLABELLED: This study examines the relationship between psychosocial factors, ethnicity, disease activity and quality of life in systemic lupus erythematosus. METHODS: One hundred and twenty-five adult Caucasian and Hispanic lupus patients were recruited from four Southern California medical centers. Linear regression analysis was performed to assess the correlation of ethnicity, socioeconomic factors (age, income), and disease activity (patient and physician reported), as well as psychological (depression, internality, helplessness) variables with quality of life (QOL) as measured by the Short Form (SF)-36. Hierarchical multiple regression analysis was then used to determine the stepwise contribution of the above determinants on the eight domains of the SF-36 questionnaire. RESULTS: Depression negatively correlated with QOL in both Caucasians (r -0.488 to -0.660) and Hispanics (r -0.456 to -0.723). Patient-reported disease activity was moderately related (r -0.456 to -0.698) to seven of the eight SF-36 domains in Hispanics, and none in Caucasians. Physician-reported disease activity, measured by SLEDAI, did not correlate with QOL among Hispanics or Caucasians. When linear and hierarchical regression was used, depression significantly correlated (p < 0.0001) with the majority of the SF-36 domains, except general health, while age had a significant effect in only one domain of the SF-36, physical functioning (p < 0.0001). CONCLUSION: Depression, and not disease activity, appears to have a major influence on quality of life in both Hispanic and Caucasian patients in this lupus cohort.


Subject(s)
Depression/complications , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/psychology , Adult , California , Cohort Studies , Female , Hispanic or Latino , Humans , Linear Models , Lupus Erythematosus, Systemic/physiopathology , Male , Mexican Americans , Middle Aged , Quality of Life , Severity of Illness Index , Socioeconomic Factors , White People
3.
Lupus ; 20(1): 80-4, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20937622

ABSTRACT

Systemic lupus erythematosus (SLE) is an autoimmune disease that can significantly impact both physiological and psychological functioning. In order to examine the relationship between psychological functioning and disease activity in SLE, we administered instruments that collected sociodemographic information and measured indices of disease activity and psychosocial functioning from 125 adult Hispanic and White patients with SLE. Patients were recruited from four healthcare settings in the greater Southern California area. Both cross-sectional and longitudinal relationships between depression and disease activity were evaluated. Cross-sectional findings revealed that depression and ethnicity were independently correlated with self-reported disease activity. Longitudinally, depression alone predicted self-reported disease activity. These data suggest that depression may play a significant role in the health status of SLE patients and serve as an important target for clinical intervention.


Subject(s)
Depressive Disorder/psychology , Lupus Erythematosus, Systemic/physiopathology , Lupus Erythematosus, Systemic/psychology , Severity of Illness Index , Adult , California , Cross-Sectional Studies , Ethnicity/psychology , Female , Humans , Male , Middle Aged , Self Concept
4.
Lupus ; 19(2): 119-29, 2010 Feb.
Article in English | MEDLINE | ID: mdl-19946032

ABSTRACT

Although males with systemic lupus erythematosus (SLE) represent 4-22% of all SLE patients, it may not be appropriate that these cases should be subordinated to females with SLE in terms of most health-related issues. Over the past few decades, some distinctive features of male lupus have been observed with regard to genetic and environmental aspects of sex differences, clinical features, and outcome. In addition, recent insights into sex disparities in this disease have brought forth a few plausible and novel pathogenetic hypotheses. This review discusses these findings and sex disparities in SLE that appear to be especially noteworthy and pertinent to our understanding of male SLE.


Subject(s)
Lupus Erythematosus, Systemic/physiopathology , Animals , Clinical Trials as Topic , Female , Genetic Predisposition to Disease , Humans , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/epidemiology , Male , Sex Factors
5.
Lupus ; 18(6): 516-21, 2009 May.
Article in English | MEDLINE | ID: mdl-19395453

ABSTRACT

In this study, the clinical course and change in extra-renal manifestations of patients with SLE taking mycophenolate mofetil (MMF) were evaluated. The charts of 75 consecutively identified patients on MMF from a single practice were reviewed for demographics, dates of SLE diagnosis, initiation, indication or discontinuation of MMF and other medications. British Isles Lupus Assessment Group (BILAG) organ system data were identified for 3 months prior to MMF and then for the subsequent 5 years. BILAG scores for each organ system and an overall score were calculated for intervals of 6 months. The mean age of 75 subjects was 35.8 years with SLE mean disease duration of 99.2 months. Indications for starting MMF were renal (70.7%), musculoskeletal (10.6%), mucocutaneous (9.3%), cardiorespiratory (5.3%), haematologic (4%), vasculitic (2.7%), neurologic (1.3%) and other (18.7%). The mean duration of treatment was 3.3 years; 22 discontinuations occurred. Overall, there was a >50% improvement in composite BILAG scores for 49.3% (37/75) of patients in the first year of treatment and in 20% (15/75) of patients who were still on MMF at >or=5 years. Most flares occurred at second and third year of treatment. The general and renal systems have the most improvement and clinical remissions; the musculoskeletal, mucocutaneous and haematological systems have the most recurrences. Approximately, 50% and 20% of patients taking MMF showed improvement in overall lupus disease activity at both 1 and 5 years, respectively. When evaluating organ system subsets separately, MMF improved disease activity in the first year, but had little effect in preventing new organ-specific flares, with most flares taking place in second and third year of treatment.


Subject(s)
Heart Diseases/prevention & control , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Musculoskeletal Diseases/prevention & control , Mycophenolic Acid/analogs & derivatives , Respiratory Tract Diseases/prevention & control , Vasculitis/prevention & control , Adolescent , Adult , Aged , Anti-Inflammatory Agents, Non-Steroidal , California/epidemiology , Child , Female , Follow-Up Studies , Heart Diseases/epidemiology , Heart Diseases/etiology , Humans , Immunosuppressive Agents/administration & dosage , Incidence , Lupus Erythematosus, Systemic/complications , Male , Middle Aged , Musculoskeletal Diseases/epidemiology , Musculoskeletal Diseases/etiology , Mycophenolic Acid/administration & dosage , Mycophenolic Acid/therapeutic use , Respiratory Tract Diseases/epidemiology , Respiratory Tract Diseases/etiology , Retrospective Studies , Time Factors , Treatment Outcome , Vasculitis/epidemiology , Vasculitis/etiology , Young Adult
6.
Ann Rheum Dis ; 67(5): 710-2, 2008 May.
Article in English | MEDLINE | ID: mdl-18079191

ABSTRACT

OBJECTIVE: The purpose of this study was to examine the safety and efficacy of anti-tumour necrosis factor (TNF) agents (etanercept, infliximab and adalimumab) in HIV-positive patients with rheumatic diseases refractory to standard therapy. METHODS: Patients were treated with anti-TNF blocker with rheumatic diseases refractory to disease modifying antirheumatic drugs who had a CD4 count of >200 mm3 and an HIV viral load of <60 000 copies/mm3 and no active concurrent infections. Changes in CD4 counts, HIV viral loads, or other adverse effects while on anti-TNF agents and clinical response were monitored for 28.1 (SD 20.9) months (range 2.5-55). RESULTS: Eight HIV-positive patients were treated with anti-TNF blockers (two patients with rheumatoid arthritis, three with psoriatic arthritis, one with undifferentiated spondyloarthritis, one with reactive arthritis and one with ankylosing spondylitis). No significant clinical adverse effect was attributed to this treatment in any patient. CD4 counts and HIV viral load levels remained stable in all patients. Three patients on etanercept therapy and two patients on infliximab had sustained clinical improvement in their rheumatic diseases. CONCLUSIONS: This retrospective series of eight patients suggests that treatment with anti-TNF-alpha therapy is a viable alternative in HIV patients without advanced disease with associated rheumatic diseases refractory to standard therapy.


Subject(s)
Antirheumatic Agents/therapeutic use , HIV Seropositivity/complications , Rheumatic Diseases/virology , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adalimumab , Adult , Anti-HIV Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Antiretroviral Therapy, Highly Active , Arthritis, Psoriatic/drug therapy , Arthritis, Psoriatic/virology , Arthritis, Reactive/drug therapy , Arthritis, Reactive/virology , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/virology , CD4 Lymphocyte Count , Etanercept , Female , Follow-Up Studies , HIV Seropositivity/drug therapy , HIV Seropositivity/immunology , Humans , Immunoglobulin G/therapeutic use , Infliximab , Male , Middle Aged , Receptors, Tumor Necrosis Factor/therapeutic use , Retrospective Studies , Rheumatic Diseases/drug therapy , Rheumatic Diseases/immunology , Spondylitis, Ankylosing/drug therapy , Spondylitis, Ankylosing/virology , Treatment Outcome , Viral Load
7.
Lupus ; 16(6): 436-43, 2007.
Article in English | MEDLINE | ID: mdl-17664235

ABSTRACT

A variety of neuropsychiatric findings may complicate systemic lupus erythematosus (SLE) and pose diagnostic and therapeutic dilemmas. We describe the clinical and radiographic features of posterior reversible encephalopathy syndrome (PRES) and distinguish PRES from other conditions seen in SLE. Patient charts and magnetic resonance imaging (MRI) findings of four patients with SLE on immunosuppressive therapy with acute or subacute neurologic changes initially suggesting cerebritis or stroke were reviewed. The English language literature was reviewed using the Medline databases from 1996-2006 for other reports of PRES with SLE. Literature review yielded 26 other SLE cases reported with PRES. SLE patients with PRES were more commonly on immunosuppressive drugs, had episodes of relative hypertension, and had renal involvement. Characteristic findings are seen on MRI, which differentiate PRES from other CNS complications of SLE. Clinical and radiographic resolution of abnormalities within 1-4 weeks is typically seen. PRES has been increasingly recognized. Reversible changes are found on brain MRI accompanied by sometimes dramatic signs and symptoms. The therapeutic implications for separating PRES from stroke or cerebritis are important. We propose that PRES should be considered in the differential diagnosis in SLE patients with new-onset neurologic signs and symptoms.


Subject(s)
Brain Diseases/chemically induced , Immunosuppressive Agents/adverse effects , Lupus Erythematosus, Systemic/drug therapy , Adult , Brain Diseases/diagnosis , Brain Diseases/physiopathology , Female , Humans , Hypertension/etiology , Immunosuppressive Agents/therapeutic use , Kidney Diseases/etiology , Lupus Erythematosus, Systemic/complications , Magnetic Resonance Imaging , Male , Middle Aged , Remission, Spontaneous , Syndrome
8.
Lupus ; 16(1): 52-5, 2007.
Article in English | MEDLINE | ID: mdl-17283586

ABSTRACT

The success rates for pregnancies in women with systemic lupus erythematosus (SLE) have improved over the years: however, pregnancy for women with active, serious, organ-threatening lupus continues to be a challenge. Preeclampsia and HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome may complicate pregnancy especially in the setting of advanced maternal age, underlying SLE and chronic renal disease. We report the pregnancy course and outcome for a 35-year old woman with active lupus nephritis at the time of conception who developed severe preeclampsia and HELLP syndrome. The infant was delivered at 26-5/7 weeks gestation, which, associated with intrauterine growth retardation, led to a birth weight of only 470 g. We have reviewed the relevant literature for similar cases of prematurity, very low birth weight, and preeclampsia in the setting of underlying lupus in Medline between 1986 and 2006. This report represents the lowest birth weight pregnancy survival in a lupus patient and the first case of a survival in the second trimester with preeclampsia and HELLP syndrome.


Subject(s)
Fetal Growth Retardation/etiology , Infant, Very Low Birth Weight , Lupus Erythematosus, Systemic , Placental Insufficiency/etiology , Pregnancy Complications , Adult , Anemia, Hemolytic , Birth Weight , Cesarean Section , Female , Fetal Distress/surgery , Gestational Age , Humans , Infant, Newborn , Infarction , Lupus Nephritis , Maternal Age , Placenta/blood supply , Pre-Eclampsia , Pregnancy , Pregnancy Complications, Hematologic , Pregnancy, High-Risk , Survivors , Syndrome , Thrombocytopenia
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