Decreased serum levels of TGF-ß1 are associated with renal damage in female patients with systemic lupus erythematosus.

INTRODUCTION: Transforming growth factor ß1 (TGF-ß1) has a large role in the control of autoimmunity. TGF-ß1 production by lymphocytes is reduced in systemic lupus erythematosus (SLE). Decreased levels of TGF-ß1 might associate to disease susceptibility, activity and organ damage in SLE. However, the correlation between TGF-ß1 levels and severity of renal damage in SLE has not been examined. METHODS: The present study was undertaken to assess the serum levels of total and active TGF-ß1 in 150 female patients with SLE and 31 healthy women. Simple and multiple regression analyses between TGF-ß1 levels and the diseases-related variables were performed in patients with SLE. RESULTS: Serum levels of both total and active TGF-ß1 were significantly reduced in patients with SLE compared with levels in healthy controls (p < 0.01). Total TGF-ß1 levels correlated positively with white blood cell, platelet counts, calculated glomerular filtration rate (GFR), and active TGF-ß1 level, and inversely with erythrocyte sedimentation rate (ESR). In multiple regression analysis, ESR and platelet counts remained determinants of total TGF-ß1. Total TGF-ß1 levels were lower in patients with high disease activity (SLEDAI > 10) and severe organ damage (SLICC > 3). Significantly lower levels of total TGF-ß1 were found in patients with severe renal damage, i.e. lower TGF-ß1 in patients with 24-h urine protein over 3.5 g than in those with below 3.5 g (p < 0.05); lower TGF-ß1 in patients with GFR less than 50 ml/min than in those with over 50 ml/min (p < 0.05). In contrast, active TGF-ß1 only correlated with platelet counts. There was no association between renal damage and the levels of active TGF-ß1. CONCLUSION: This study demonstrates significantly reduced serum levels of both total and active TGF-ß1 in women with SLE compared with healthy women. Total TGF-ß1 levels are correlated negatively with ESR and positively with blood platelets. Total TGF-ß1 levels were lower in SLE patients with high disease activity and severe organ damage. Importantly, the severity of the renal damage was associated with decreased serum levels of total TGF-ß1, suggesting that TGF-ß1 might be involved in pathogenesis of renal damage caused by lupus nephritis.

Health-related quality of life in systemic lupus erythematosus and its association with disease and work disability.

OBJECTIVES: To determine the health-related quality of life (HRQOL) and its relationship to disease variables, vertebral fractures, and employment status in female patients with systemic lupus erythematosus (SLE). METHODS: HRQOL was assessed with the Swedish version of the Medical Outcomes Study (MOS) 36-Item Short Form Survey (SF-36) in female patients (n=163) and in age- and sex-matched controls (n=1045). Associations between the SF-36 score and demographics, disease variables, prevalent vertebral fractures, and employment status were analysed. RESULTS: The SLE patients, aged 20 to 82 years, scored significantly lower than the controls on all SF-36 subscales. Patients with vertebral fractures were older, had greater disease damage, and lower physical functioning (PF) than patients without fractures. Of the SLE patients of working age (n=142), 54% worked full or part time. These patients scored their HRQOL significantly higher (better) than patients not working. Being able to work was significantly associated with low age and high scores in PF and role physical (RP): the area under the receiver operating characteristic (ROC) curve for these variables was 0.82, confidence interval 0.75-0.89. CONCLUSIONS: HRQOL is substantially lower in SLE than in the general population but working ability indicates better health. We encourage further research regarding the effects on HRQOL by preventive actions taken against work disability in SLE.

Prevalence and risk factors of osteoporosis in female SLE patients-extended report.

OBJECTIVES: To determine the frequency of osteoporosis and possible risk factors of low bone mineral density (BMD) in women with systemic lupus erythematous (SLE) in western Sweden. In addition, to evaluate if adequate anti-osteoporotic treatment was provided. METHODS: BMD was measured at radius, lumbar spine and hip by dual X-ray absorptiometry (DXA). An 'expected' control BMD was calculated for each patient. Simple and multiple linear regression analyses were performed to determine associations between BMD and demographic and disease-related variables. RESULTS: One hundred and sixty-three women were included. Median age was 47 (20-82) yrs, 89 (55%) were post-menopausal and 85 (52%) were taking glucocorticosteroids. BMD was significantly reduced in all measured sites compared with expected BMD. Thirty-seven (23%), 18 (11%) and 6 (4%) of the patients were osteoporotic in at least one, two and three or more measured locations. Bisphosphonates were used by 23 (27%) of patients taking glucocorticosteroids and 13 (35%) with osteoporosis. High age and low weight or BMI were associated with low BMD in all measured sites. In total hip, high SLICC/American Collage of Rheumatology (ACR), ESR and 'combinations of DMARD' were additional markers of low BMD. High S-creatinine was associated with low BMD in lumbal spine whereas high S-creatinine and CRP were markers in radius. CONCLUSION: Women with SLE are at greater risk of osteoporosis compared with controls and few are treated adequately. Factors associated with low BMD in SLE are high age and low weight but also markers of inflammation, impaired kidney function and disease damage, however glucocorticosteroids were not associated.