جستجوی مقالات مرتبط با کلیدواژه "systemic lupuserythematosus" در نشریات گروه "پزشکی"

To report a case of multiple bilateral retinal pigment epithelial detachments(PEDs) in a woman with systemic lupus erythematosus(SLE).

Case Report.

A 28-year-old female with mild blurred bilateral vision in both eyes (OU) without pain or any other symptom was admitted to the hospital due to worsening renal function and uncontrolled high blood pressure (HBP). Best-corrected visual acuity (BCVA) was 20/30 and 20/40, right and left eyes, respectively. She had SLE, glucose‑6‑phosphate dehydrogenase deficiency, and immune thrombocytopenic purpura. BP was over 150/90 mmHg for more than 1.5 years, and she used corticosteroids at varying doses for more than 4 years. During hospitalization, she was taking prednisone 60 mg daily as ClassIV lupus nephritis was diagnosed. On fundoscopy, she had a lacy retinal pattern, remarkably on the macula in OU. Spectral-domain optical coherence tomography revealed multiple bilateral serous PEDs and pachychoroid. Angiofluoresceinography displayed multiple pooling hyperfluorescence areas. Six months afterward, while she was on prednisolone 10 mg daily, and antihypertensive medications, BCVA was improved to 20/25 OU. Nevertheless, she had no retinal or choroidal changes. Her findings could be related to SLE choroidopathy, central serous chorioretinopathy-like disease, and/or hypertensive choroidopathy.

Ocular involvement affects nearly one‑third of SLE patients. The findings are variable and can include nearly any part of the eyeball. Multiple bilateral PEDs have been described in the literature; however, in this case, it is probably multifactorial and not only related to SLE.

Fatigue and decreased activities of daily living (ADL) are important problems in patients with systemic lupus erythematosus (SLE) and reduce their quality of life.

This study was conducted to examine the effect of fatigue and activity management education (FAME) program on fatigue severity and ADL in patients with SLE.

A quasi-experimental study was conducted on 40 patients with SLE. The patients were selected consecutively and randomly allocated into an intervention (n = 20) and a control group (n = 20). The control group was treated as usual. However, in addition to the usual treatment, the intervention group received the FAME program. Data collection was done before and 8 weeks after the intervention using the Swedish Occupational Fatigue Inventory-20 (SOFI20) questionnaire, the daily physical activity questionnaire, and a demographic characteristics form. Descriptive statistics, independent- and paired-samples t tests, and analysis of covariance were used to analyze the data.

The two groups were homogenous in terms of demographic characteristics (P > 0.05) unless their job (P = 0.002). The mean baseline fatigue and ADL scores were significantly different between the two groups(P< 0.0001).Hence, analysis of covariancewas used to control the confounding effect of the aforementioned variable. Then, significant differences were found between the two groupsrespecting the mean fatigue (P < 0.0001) and mean ADL (P = 0.009) after the intervention.

Considering the effectiveness of the FAME program in reducing fatigue and increasing ADL in patients with SLE, nurses are recommended to use similar programs in the care for these patients and help them improve their own fatigue and ADL.

Elevated levels of interleukin 17A (IL-17A) have been found in systemic lupus erythematosus (SLE). Forkhead box protein P3 (FOXP3) activates T-regulation lymphocytes and is a master regulator of cell function. The cytotoxic T-lymphocyte-associated protein 4 (CTLA4) gene plays a similar role. We investigated the role of the expression of these genes in SLE patients with and without nephritis.

The present study was a case-controlled trial including 49 patients with SLE and 26 healthy controls. Gene expressions of IL-17A, FOXP3, and CTLA4 were measured by quantitative Real- Time PCR. The relation between lupus nephritis disease activity and IL-17A, FOXP3, and CTLA4 gene expression was evaluated.

IL-17A, FOXP3, and CTLA4 expression in T-cells were significantly higher in SLE patients than controls (P< .0001). When comparing the nephritis group and non- nephritis group with the control group, the expression of the mentioned genes was also higher (P < .05). There was no significant difference regarding IL- 17A, FOXP3, and CTLA4 genes expression in the nephritis group and non- nephritis group (P > .05). Nonetheless, there was a low expression of FOXP3 and IL-17A in patients with the higher stages of nephritis (P < .05).

Our findings showed that elevated IL-17A, FOXP3, and CTLA4 expression significantly correlate with SLE pathophysiology. This study provides new insight into the function of IL-17A, FOXP3, and CTLA4 in a disease setting. Heterogeneity of SLE patients is reflected in the multiple abnormalities found in the immune system. Finding such variations can provide targets for better manipulation of the immune system.

Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematous (SLE). With no specific clinical or laboratory manifestation to predict response to treatment, this study was aimed to provide a panel of predictive biomarkers of response before initiation of treatment.

Liquid chromatography tandem mass spectrometry (LCMS/MS) analysis was performed on plasma and urine samples of 11 patients with biopsy proven proliferative LN at the time of biopsy. Unsupervised principal component analysis (PCA), orthogonal projection to latent structures discriminant analysis (OPLS-DA), gene ontology annotation and protein mapping were performed on 326 proteins in plasma and 1381 proteins in urine samples.

Samples of eight patients achieved complete remission and three reached partial remission were analyzed. The mean 24- hour protein excretion was 3259 mg/d and the mean eGFR was 87.73 cc/min. OPLS-DA analysis of plasma samples showed a clear discrimination for complete and partial remission patients. Twenty plasma proteins and ten urine proteins with the highest fold changes and AUCs were selected as candidate biomarkers (IGHV1-18, PI16, IGHD, C3, FCER2, EPS8L2, CTTN, BLVRB). This plasma and urine biomarker panel is involved in oxidative stress, acute inflammation, reduction in regulatory T cells, complement pathway consumption, and proximal tubule bicarbonate reclamation.

Our suggested panel of plasma and urine biomarkers can precisely discriminate patients with possibility of complete response to treatment. It seems that the higher indices of inflammation will associate with better chance of achieving complete remission.

Immune Thrombocytopenia (ITP) is an autoimmune disease in which platelet destruction causes thrombocytopenia. Due to the known steroid toxicities, alternative agents have been evaluated for the treatment of these patients. We aimed to review the literature and find evidences regarding the potential benefits of hydroxychloroquine (HCQ) as a steroid‑sparing agent in the treatment of ITP. We searched English language articles within Web of Science, PubMed, and Scopus. Cohorts, clinical trials, case reports, conference papers, and letters were included. We excluded papers which either focused on administration of HCQ for non‑ITP conditions or studies on other treatment modalities for ITP. In total, 54 ITP cases with either primary or systemic lupus erythematosus (SLE)‑associated ITP were included in four studies (SLE‑associated ITP; n = 23). All patients have received corticosteroids previously and >90% received other agents with HCQ concomitantly. Overall response was achieved in more than 60% of patients. Sustained response in 18 (33.3%) patients was associated with no treatment or HCQ alone. One of the studies reported a significantly better response in patients with definite SLE compared to those with positive antinuclear antibody and no definite SLE. Similarly, another study found a nonsignificant trend toward better long‑term response in patients with definite SLE compared to incomplete SLE. The included articles reported the efficacy of the HCQ with acceptable safety. Available data regarding the use of HCQ for this indication are spare and more studies are needed in ITP with different severity. It seems that HCQ can be considered as an option in the treatment of SLE‑associated ITP, and although promising, currently, the place of HCQ in the treatment of ITP continues to evolve.