Objective To describe the disease characteristics of osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE) who experiencing prolonged glucocorticoid (GC) exposure. Methods Between January 2016 and June 2019, 449 SLE patients meeting the criteria were recruited from multiple centers. Hip MRI examinations were performed during screening and regular follow-up to determine the occurrence of ONFH. The cohort was divided into ONFH and non-ONFH groups, and the differences in demographic baseline characteristics, general clinical characteristics, GC medication information, combined medication, and hip clinical features were compared and comprehensively described. ResultsThe age at SLE diagnosis was 29.8 (23.2, 40.9) years, with 93.1% (418 cases) being female. The duration of GC exposure was 5.3 (2.0, 10.5) years, and the cumulative incidence of SLE-ONFH was 9.1%. Significant differences (P<0.05) between ONFH and non-ONFH groups were observed in the following clinical characteristics: ① Demographic baseline characteristics: ONFH group had a higher proportion of patients with body mass index (BMI)<20 kg/m2 compared to non-ONFH group. ② General clinical characteristics: ONFH group showed a higher proportion of patients with cutaneous and renal manifestations, positive antiphospholipid antibodies (aPLs) and anticardiolipin antibodies, severe SLE patients [baseline SLE Disease Activity Index 2000 (SLEDAI-2K) score ≥15], and secondary hypertension. Fasting blood glucose in ONFH group was also higher. ③ GC medication information: ONFH group had higher initial intravenous GC exposure rates, duration, cumulative doses, higher cumulative GC doses in the first month and the first 3 months, higher average daily doses in the first 3 months, and higher proportions of average daily doses ≥15.0 mg/d and ≥30.0 mg/d, as well as higher full-course average daily doses and proportion of full-course daily doses ≥30.0 mg/d compared to non-ONFH group. ④ Combined medications: ONFH group had a significantly higher rate of antiplatelet drug use than non-ONFH group. ⑤ Hip clinical features: ONFH group had a higher proportion of hip discomfort or pain and a higher incidence of hip joint effusion before MRI screening than non-ONFH group. Conclusion The incidence of ONFH after GC exposure in China’s SLE population remains high (9.1%), with short-term (first 3 months), medium-to-high dose (average daily dose ≥15 mg/d) GC being closely associated with ONFH. Severe SLE, low BMI, certain clinical phenotypes, positive aPLs, and secondary hypertension may also be related to ONFH.
【摘要】 目的 检测B细胞成熟抗原（BCMA）mRNA在系统性红斑狼疮（SLE）患者外周血单个核细胞（PBMC）的表达水平，探讨BCMA在SLE发病中的意义。 方法 纳入2006年1-11月收治的36例SLE患者，同期17例健康志愿者作为对照组，采用半定量RT-PCR法检测外周血单个核细胞中BCMA mRNA的表达，并与SLE疾病活动指数（SLEDAI）进行相关性分析。 结果 SLE患者组BCMA mRNA表达水平（0.598±0.230）均明显高于正常对照组（0.411±0.309）（Plt;0.05）。SLE患者BCMA mRNA表达水平与SLEDAI评分无相关性（P=0.590）。 结论 SLE患者BCMA mRNA表达水平的增高，可能在SLE的发病机制中具有一定的作用。【Abstract】 Objective To detect the mRNA expression of B-cell maturation antigen (BCMA) in peripheral blood mononuclear cells (PBMC) in patients with systemic lupus erythematosus (SLE), and explore the role of BCMA in the pathogenesis of SLE. Methods From January 2006 to November 2006 the expression of BCMA mRNA in PBMC of 36 patients with SLE and 17 normal controls were measured by half-quantitative RT-PCR. The linear correlation between the expression of BCMA mRNA and SLE disease activity index (SLEDAI) was assessed. Results The level of BCMA mRNA (0.598±0.230) in PBMC significantly increased in SLE patients compared with that in the normal controls (0.411±0.309) (Plt;0.05). The expression of BCMA mRNA in SLE patients showed no correlation with SLEDAI score (P=0.590). Conclusion The results suggest that the expression of BCMA mRNA might play an important role in the pathogenesis of SLE.
ObjectiveSystemic lupus erythematosus (SLE) patients from a SLE family with homogeneity can provide experimental basis for individualized diagnosis and treatment by studying the characteristics of laboratory tests and symptoms. MethodsLaboratory tests were analyzed for three SLE patients in the family, and set up the screen model by three laboratory tests (anitnuclear antibody positive, rheumatoid factor positive and IgE positive, ANA+RF+IgE+). All SLE cases were screened from latest four years as SLE subtype patients (named "similar family SLE patients"), then the family laboratory tests and clinical characteristics were analyzed. ResultsA total of 55 patients (6.27%) were screened as similar family SLE patients from individual SLE patients according to model from 877 cases. The laboratory tests of similar family SLE patients including creatinine, WBC, CRP were significant lower than other SLE patients (P < 0.05), but significant higher for the IgG, positive rate of anti-SSA and anti-SSB (P < 0.05), and the alopecia and skin rashes were more common in similar family SLE patients than other SLE patients. ConclusionsThe ANA+RF+IgE+ SLE patients are of lower inflammatory state and kidney involvement; Clinical symptom is priority to alopecia and skin rashes.
Objective This study employs Mendelian randomization analysis to explore the causal relationship between dietary habits and systemic lupus erythematosus (SLE). MethodsWe obtained data from the MRC-IEU database on five dietary habits as instrumental variables for exposure "never eating dairy products" "never eating eggs or foods containing eggs" "never eating sugar or foods/drinks containing sugar" "never eating wheat products" and "I eat all of the above". Summary data related to SLE were retrieved from the MRC-IEU database for the discovery cohort (designated as MSLE) and from a Finnish database for the validation cohort (recorded as FSLE). Two-sample Mendelian randomization analyses were conducted using inverse variance weighting (IVW), MR-Egger, weighted median, Simple Mode, and Weighted Mode methods to investigate the causal relationship between dietary habits and SLE. The MR-Egger intercept test was performed to assess the presence of horizontal pleiotropy, while the leave-one-out method was employed to verify the stability of the results, with Cochran’s Q test and funnel plots used to evaluate heterogeneity. ResultsMendelian randomization analysis indicated that never eating wheat products increases the risk of developing SLE (IVW: P<0.05). In contrast, there was no significant causal relationship between the consumption of dairy products, eggs or foods containing eggs, or the consumption of all of the above with SLE (IVW: P>0.05). Additionally, there was no significant causal relationship between never sugar or foods/drinks containing sugar and MSLE (IVW: P=0.877), although a potential causal association with FSLE was suggested (IVW: P=0.016). The MR-Egger intercept test indicated no evidence of horizontal pleiotropy (P>0.05). ConclusionNever eating wheat products may be an independent risk factor for SLE. However, the causal relationship between never sugar or foods/drinks containing sugar and SLE remains indeterminate.
Objective To explore the factors influencing 2-month sputum smear conversion (2m-SSC) in patients with systemic lupus erythematosus (SLE) and tuberculosis, and to establish a prediction model for 2m-SSC. Methods The initial and follow-up medical records of inpatients with SLE and sputum smear-positive tuberculosis in West China Hospital of Sichuan University from December 2013 to September 2019 were retrospectively reviewed. Single factor analyses and multivariable Firth’s logistic regression were used to determine the influencing factors of 2m-SSC, and a prediction model for 2m-SSC was established. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated to evaluate the performance of the model. Results A total of 91 patients with SLE and sputum smear-positive tuberculosis were ultimately included, with 8 cases in the non-conversion group and 83 in the conversion group. There were statistically significant differences in white blood cell count, total bilirubin, indirect bilirubin (IBIL), triglyceride, and rheumatoid factor (RF) between the two groups (P<0.05). Serum RF [odds ratio (OR)=2.271, 95% confidence interval (CI) (1.312, 4.350), P=0.003], IBIL [OR=2.363, 95%CI (1.206, 5.045), P=0.013], and glucose [OR=2.058, 95%CI (1.016, 4.280), P=0.045] were identified as risk factors unfavorable to 2m-SSC outcomes. The constructed model (including three variables: RF, IBIL, and glucose) had a good ability in predicting 2m-SSC [AUC=0.893, 95%CI (0.744, 1.000)], with a sensitivity of 87.5% and a specificity of 84.3%. Conclusion This study established a prediction model for 2m-SSC in patients with SLE and tuberculosis, and found the value of serum RF, IBIL, and glucose in predicting 2m-SSC, providing certain guidance for clinicians in treatment decisions.
ObjectiveTo study the perioperative treatment of total hip arthroplasty (THA) for avascular necrosis of the femoral head (ANFH) in systemic lupus erythematosus (SLE) patients. MethodsThe clinical data of 27 patients with SLE and ANFH, who underwent 40 THAs between August 2009 and November 2012 were retrospectively analyzed. There were 5 male and 22 female patients, and the average age of the patients at surgery was 40 years ranging from 21 to 66 years. Fourteen cases had unilateral THA and 13 had bilateral THA. The combined disease included 2 cases of hypertension, 3 chronic bronchitis, 1 autoimmune liver disease and hypohepatia, 2 sicca syndrome, and 2 anemia. ResultsAll the patients were stable peri-operatively. No patient had adrenal crisis. Four complications were noted, including one case of fever reaction (maximum temperature:39.3℃), 1 incision fat liquefaction, 1 pulmonary infection, and 1 early dislocation due to improper exercise on the 12th day after the operation. The patients were followed up for 24 to 53 months, and there was no deep infection, prosthetic loosening, peri-prosthetic fracture or deep vein thrombosis after THA. ConclusionAlthough the incidence of postoperative complication is high in patients with SLE and ANFH undergoing THA, meticulous perioperative management can help these patients get through operation safely, including the use of glucocorticoid and antibiotics, treatment of osteoporosis, and prevention and treatment of complications.