The prevalence and risk factors for serositis in patients with systemic lupus erythematosus: a cross-sectional study.

This study aims to estimate the prevalence of serositis and identify risk factors for serositis in a large cohort of systemic lupus erythematosus (SLE) patients. A cross-sectional study was conducted based on the medical records of patients hospitalized with SLE at the First Affiliated Hospital of Anhui Medical University and Anhui Provincial Hospital. Patients were diagnosed with serositis when they presented with symptoms and signs of pleuritis or/and pericarditis. We explored factors associated with the generation and quantity of serositis by using binary and ordinal logistic regression analysis. Among the 1668 lupus patients, 298 have serositis. Active lupus disease, fever (≥38 °C) and high D-dimer were all significantly associated with the generation and quantity of serositis. Male gender was independent significant risk factor for pleuritis but not for pericarditis, while low complement C4 and high erythrocyte sedimentation rate (ESR) were risk factors for pericarditis rather than for pleuritis. The possible prevalence of serositis in patients with SLE was 17.9%. The significant associations of active lupus disease, fever (≥38 °C) and high D-dimer with serositis suggest that higher disease activity and hypercoagulability may both contribute to the generation and development of serositis in SLE. The risk factors for pleuritis and pericarditis in SLE are similar but not identical.

Chronic GvHD-associated serositis and pericarditis.

Serositis is a rare manifestation of chronic GvHD (cGvHD). No risk factors or laboratory changes associated with this syndrome have been recognized to date, and outcomes have not been described in a large series. We searched our institutional database for patients undergoing allogeneic hematopoietic cell transplant identified as having serositis or pericarditis. Laboratory studies from prior to diagnosis, at diagnosis and post diagnosis of serositis, as well as outcomes from invasive procedures were included. Twenty patients met criteria for cGvHD-associated serositis, and all but three patients had a prior diagnosis of cGvHD. Fifteen were male, and the complication occurred in the setting of immunosuppressant taper in 12 cases. Ten patients required invasive interventions, including pericardial window or stripping. A significant increase in blood monocytes and decrease in serum albumin were identified at diagnosis compared with pre-diagnosis. Out of 20 patients, 17 were treated with steroids, with 12 demonstrating a complete response. These data suggest that cGvHD-associated serositis occurs mainly in the setting of treated as opposed to de novo cGvHD and biomarkers associated with the syndrome include a decrease in albumin and an increase in absolute monocyte count. Outcome data from larger series are required to better understand the optimal management of this rare complication.

Seasonal variation in the activity of systemic lupus erythematosus.

OBJECTIVE: To determine whether there is any seasonal variation in the activity of systemic lupus erythematosus (SLE) overall and by individual organs. METHODS: The study group comprised 2102 patients with SLE who were followed in a prospective longitudinal cohort study. In this cohort, 92.3% of the patients were women. The mean ± SD age of the patients was 47.9 ± 13.9 years, 56.3% were white, 37.1% were African American, and 3.1% were Asian. Global disease activity was recorded by the Safety of Estrogens in Lupus Erythematosus National Assessment - Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) and the physician's global assessment. Activity of each organ was also recorded using SLEDAI terms and a visual analog scale (VAS; 0 to 3). RESULTS: There was significant seasonal variation in photosensitive rash (p < 0.0001), which was more frequent in the spring and summer months (p < 0.0001). There was significantly more arthritis activity in spring and summer, as measured by both SELENA-SLEDAI (p = 0.0057) and the joint VAS (p = 0.0047). A decrease in renal activity was found in the summer months compared to the rest of the year (p = 0.0397). Serositis recorded by VAS had higher activity from August to October (p = 0.0392). Anti-dsDNA levels were significantly higher during October and November (p < 0.0001). There was significant seasonal variation in antiphospholipid antibody levels (p < 0.0001) and lupus anticoagulant (p = 0.0003). We found a significant variation in activity through the year in global disease activity as measured by SELENA-SLEDAI (p = 0.048). CONCLUSION: In the Hopkins Lupus Cohort, skin and joint activity is increased during the spring and summer, but other organs have different patterns. These seasonal variations likely reflect environmental factors that influence disease activity, including ultraviolet light and infections.

Serum CA125 elevation is independently associated with serositis in SLE patients.

OBJECTIVES: Some studies have reported that serum CA125 level is elevated in SLE patients, and elevated CA125 level may be associated with kidney involvement and disease activity in SLE. However, none of the previous studies controlled confounding variables and the results remained controversial. The present study was aimed to investigate whether elevated serum CA125 level is independently associated with clinical and laboratory features of SLE by excluding various confounders in Chinese patients. METHODS: A total of 156 SLE patients, consisting of 139 women and 17 men, were included in the study. Some clinical and laboratory characteristics of the patients were obtained by medical record review. Serum CA125 levels were measured by electrochemiluminescence immunoassays. RESULTS: Compared with patients with normal CA125, those with elevated CA125 had significantly more serositis (37.5% vs. 1.9%, p<0.001) and lung involvement (37.5% vs. 12%, p=<0.001), higher SLEDAI scores (p<0.007). Furthermore, disease duration was significantly longer in those with elevated CA125. Univariate logistic regression analysis showed that elevated serum CA125 level was closely associated with disease duration (OR, 95%CI:1.005, 1.001-1.010; p=0.014), serositis (OR, 95%CI: 32.258, 6.993-142.857; p<0.001), renal involvement (OR, 95%CI: 2.283, 1.114-4.673; p=0.024), lung involvement (OR, 95%CI: 4.386, 1.927-10.000; p<0.001) and SLEDAI scores (OR, 95%CI: 1.098, 1.027-1.174; p=0.006). After controlling for various confounding variables, serositis and disease duration were the only two clinical variables significantly associated with elevation of serum CA125 level. The best cut-off value for CA125 using the ROC curve was 38 kU/L (sensitivity 85%, specificity 75%) and the area under the ROC curve was 0.777 with 95%CI of 0.685-0.868 (p<0.001). Furthermore, the serum CA125 levels can fall into the normal range again with the improvement of serositis. CONCLUSIONS: Of various clinical and laboratory variables of SLE, only serositis is independently associated with serum CA125 elevation.

Young woman with polyserositis, ovarian cystic mass and increased level of CA-125. Case report of peritoneal and pleural tuberculosis.

A 21-year-old woman was addressed to our department for progressive abdominal swelling, fatigue and fever. The clinical examination, the ultrasound examination and the computed tomography showed the presence of polyserositis (ascites and pleural effusion) and revealed a cystic mass at the level of right ovary. The laboratory work-up showed an increased level of CA-125, suggesting a malignancy. The thoracoscopy with visualization of the pleura revealed disseminated small white spots. The laparoscopic exploration of the pelvis and of the peritoneum also showed the same disseminated lesions and a cystic-like mass at the level of the right ovary which was excised and diagnosed as a benign cyst. At the analysis of the frozen and paraffin sections, the diagnostic of pleural and peritoneal tuberculosis was made and the specific quadruple treatment was started with a good evolution at two months and with the normalization of the CA-125 level. This case report underlines the importance of tuberculosis in the differential diagnosis of patients with polyserositis and increased levels of CA-125.

Role of endotoxin in 6-sulfanilamidoindazole(6SAI)-induced arthritis in rats.

6-Sulfanilamidoindazole (6SAI) induces selflimiting arthritis in rats. Since close relationships exist between arthritis and endotoxin, four experiments were conducted to clarify the relationship between endotoxin and 6SAI-induced arthritis. Endotoxin levels in the plasma from the abdominal aorta and portal vein from rats that had 6SAI (500 mg/kg) administered orally for up to 7 days remained within the control values at day 1 and day 3, and were significantly elevated at day 7. Endotoxin levels in the synovial fluid from the same rats showed no significant change. Ankle swelling and redness in rats treated 11 consecutive days with 6SAI did not ameliorate when coadministered with an anti-endotoxin agent, polymyxin B sulfate. Histopathological examination on the ankles of rats treated orally with non-arthiritogenic sulfonamides including sulfonamide, sulfamethoxazole and sulfadimethoxin (250 and 500 mg/kg/day, each compound) for 2 weeks demonstrated no inflammatory changes, while hyperplasia/hypertrophy of thyroid epithelial cells were frequently observed. When histopathological changes in the ankles from rats coadministered with 6SAI and lipopolysaccharide (LPS, Escherihia coli O55:B5, 50 microg/kg, i.v.) were compared with those in rats treated with 6SAI or LPS alone, the ankles from the 6SAI+LPS treated animals had marked edematous inflammation in the synovium and surrounding connective tissues, whereas the LPS-group had only mild focal infiltration of polymorphonuclear leukocytes in the synovium and the 6SAI-group showed no apparent changes. These results suggest that endotoxin is not a direct cause but a possible acceralating factor of 6SAI-induced arthritis, and that the effects of 6SAI on gut bacteria is not related with the pathogenesis of this model.

Serum ferritin as a serologic marker of activity in systemic lupus erythematosus.

To investigate the relationship between serum ferritin and disease activity in systemic lupus erythematosus (SLE), we enrolled 128 patients with SLE (18 males and 110 females). Twenty-eight patients (2 males and 26 females) with rheumatoid arthritis (RA) served as controls. The SLE patients were subdivided into three groups according to Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores: groups A (0-5), B (6-9), and C (> or =10). We prospectively evaluated 48 SLE patients before and after treatment. Serum ferritin and anti-dsDNA antibody were measured by radioimmunometric assay. C-reactive protein (CRP) was measured quantitatively by immunonephelometry. Complements 3 and 4 (C3 and C4) were measured by nephelometry. Serum levels of ferritin during the more active stage of SLE (group C) exceeded those of RA patients and patients at less active stages of SLE (groups A and B). There were no significant differences between RA patients and groups A and B. Serum ferritin was elevated especially in serositis and hematologic manifestation. In this prospective study, changes in SLEDAI scores before and after treatment correlated significantly with serum ferritin levels and inversely to C3 and C4 levels. We confirm that serum ferritin levels can be a useful marker of disease activity in SLE patients.