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Friday, January 22, 2010

Immunosuppressants Render Flu Vaccination Less Effective in People With Lupus
Studies of cell-mediated immune responses to influenza vaccination in systemic lupus erythematosus.

Authors: Holvast A, van Assen S, de Haan A, Huckriede A, Benne CA, Westra J, Palache A, Wilschut J, Kallenberg CG, and Bijl M. (2009).
Arthritis & Rheumatism 60: 2438-2447.

What is the topic?

The immune system fights off the flu in different ways. One way is by making antibodies (immune proteins) that recognize the flu virus and attack it. Another way is by activating certain white blood cells to fight the virus; this is called “cell-mediated immunity.” Both antibodies and cell-mediated immunity play important roles in the body’s normal response to a flu shot. Lupus patients might have decreased antibody responses to the flu shot as compared to healthy people. Since cell-mediated responses to the influenza vaccine also influence how well the vaccine will work, it is important to understand how lupus may affect the body’s cell-mediated response to the vaccine.

What did the researchers hope to learn?The researchers wanted to measure the cell-mediated responses (or responses of certain white blood cells) to a flu vaccine in lupus patients.

Who was studied?

54 lupus patients and 54 healthy people, similar in age and about the same percent of women and men, were studied. Most of the lupus patients had relatively few active symptoms. Pregnant women were not studied.

How was the study conducted?
Lupus patients were randomly picked to either get a flu shot or not. All the healthy people got a flu shot. The flu shot was a "subunit" vaccine, meaning that it had parts of the dead flu virus that help to trigger an immune response but was missing other parts of the virus. Blood samples were taken at the beginning of the study and again 28 days later.

What did the researchers find?

As compared to healthy people, lupus patients had less cell-mediated responses to the flu shot, which may have been influenced by the fact that many of them were taking prednisone and/or azathioprine (Imuran) when they got the shot. Influenza vaccination did not increase lupus disease activity, but minor side effects occurred more frequently in lupus patients than in healthy people.

What were the limitations of the study?

This was a small study. Given that there were not that many patients in the first place, the fact that they were taking a wide variety of medications make it difficult to sort out the results. Finally, more of the lupus patients than the healthy people had gotten a flu shot in the previous year, which could have influenced the results when comparing these two groups.

What do the results mean for you?

It may be that lupus patients have decreases in both antibody and cell-mediated responses to the flu shot as compared to most people. This may make it easier for lupus patients to get the flu and harder to fight it off when they do, especially when taking prednisone or other treatments that suppress the immune system. Appropriate caution to prevent the flu should be taken by all lupus patients, such as avoiding contact with infected people and washing hands frequently, even if the flu shot has already been given.

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Blogged on 6:52 AM

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A Second Flu Shot Might Be More Effective in Some People With Lupus

Effect of a second, booster, influenza vaccination on antibody responses in quiescent systemic lupus erythematosus: an open, prospective, controlled study.

Authors: Holvast A, van Assen S, de Haan A, Huckriede A, Benne CA, Westra J, Palache A, Wilschut J, Kallenberg CG, and Bijl M. (2009). Rheumatology 48: 1294-1299


What is the topic?

One of the ways that the immune system fights off the flu is by making antibodies (immune proteins) that can recognize the flu virus and attack it. The immune system can also make little chemicals called "cytokines" that signal to the white blood cells to make more of these antibodies when there is a virus in the bloodstream. The flu shot is made with dead virus that can help a patient make protecting antibodies but won’t cause the full flu infection to start up. In this way, individuals can be protected in advance before they are exposed to the flu that is "going around" in their community. Some lupus patients make fewer antibodies to the flu shot than most people, and there is some concern that medications for lupus can reduce the response to the flu shot since they can suppress the immune system in other ways. If there was a way to increase these responses, then the flu shot might be more effective for people with lupus.

What did the researchers hope to learn?

The researchers wanted to find out whether a second, "booster" flu shot could increase antibody responses in lupus patients.


Who was studied?

The study included 52 lupus patients and 28 healthy people of about the same age and the same percentage of women and men. The lupus patients were not flaring at the time and thus their lupus symptoms were relatively quiet. Most of them were taking some immune-suppressing treatments. No one in the study had cancer or was taking more than 30 mg/day of prednisone. Most people in both groups had gotten a flu shot the previous year.


How was the study conducted?

The flu shot that was used is called a "subunit" vaccine, which means that it has enough pieces of the flu virus to cause antibodies to be made, but may be missing other parts of the flu virus. All of the people participating in this study got at least one flu shot. Four weeks later, the lupus patients, but not the other people, got a second booster flu shot. Antibodies against the flu virus were measured before each shot, and again four weeks after the time of the second shot.


What did the researchers find?

The researchers found that a second flu shot did not increase the overall amounts of flu antibodies if you looked at the whole group of lupus patients compared to healthy people. However, a sub-group of the lupus patients who had not gotten the flu shot in the previous year did show an increased antibody response with the booster vaccination.


Neither the first nor second flu vaccination increased lupus disease activity, but both caused more frequent minor side effects in lupus patients than in healthy people. The kinds of side effects seen in lupus patients were similar after the first and second flu shots.


What were the limitations of the study?

This was a small study. Also, it did not include a group of lupus patients given only one flu shot, which could have been useful to compare to those who got two shots.

What do the results mean for you?

Increased antibody responses to a second, booster flu shot were seen only in lupus patients who had not received a flu shot in the previous year. Therefore, the additional benefit for lupus patients who get a second flu vaccination may be just for those not vaccinated against influenza in the previous year.

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Blogged on 6:50 AM

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A Second Flu Shot Might Be More Effective in Some People With Lupus

Effect of a second, booster, influenza vaccination on antibody responses in quiescent systemic lupus erythematosus: an open, prospective, controlled study.

Authors: Holvast A, van Assen S, de Haan A, Huckriede A, Benne CA, Westra J, Palache A, Wilschut J, Kallenberg CG, and Bijl M. (2009). Rheumatology 48: 1294-1299


What is the topic?

One of the ways that the immune system fights off the flu is by making antibodies (immune proteins) that can recognize the flu virus and attack it. The immune system can also make little chemicals called "cytokines" that signal to the white blood cells to make more of these antibodies when there is a virus in the bloodstream. The flu shot is made with dead virus that can help a patient make protecting antibodies but won’t cause the full flu infection to start up. In this way, individuals can be protected in advance before they are exposed to the flu that is "going around" in their community. Some lupus patients make fewer antibodies to the flu shot than most people, and there is some concern that medications for lupus can reduce the response to the flu shot since they can suppress the immune system in other ways. If there was a way to increase these responses, then the flu shot might be more effective for people with lupus.

What did the researchers hope to learn?

The researchers wanted to find out whether a second, "booster" flu shot could increase antibody responses in lupus patients.


Who was studied?

The study included 52 lupus patients and 28 healthy people of about the same age and the same percentage of women and men. The lupus patients were not flaring at the time and thus their lupus symptoms were relatively quiet. Most of them were taking some immune-suppressing treatments. No one in the study had cancer or was taking more than 30 mg/day of prednisone. Most people in both groups had gotten a flu shot the previous year.


How was the study conducted?

The flu shot that was used is called a "subunit" vaccine, which means that it has enough pieces of the flu virus to cause antibodies to be made, but may be missing other parts of the flu virus. All of the people participating in this study got at least one flu shot. Four weeks later, the lupus patients, but not the other people, got a second booster flu shot. Antibodies against the flu virus were measured before each shot, and again four weeks after the time of the second shot.


What did the researchers find?

The researchers found that a second flu shot did not increase the overall amounts of flu antibodies if you looked at the whole group of lupus patients compared to healthy people. However, a sub-group of the lupus patients who had not gotten the flu shot in the previous year did show an increased antibody response with the booster vaccination.


Neither the first nor second flu vaccination increased lupus disease activity, but both caused more frequent minor side effects in lupus patients than in healthy people. The kinds of side effects seen in lupus patients were similar after the first and second flu shots.


What were the limitations of the study?

This was a small study. Also, it did not include a group of lupus patients given only one flu shot, which could have been useful to compare to those who got two shots.

What do the results mean for you?

Increased antibody responses to a second, booster flu shot were seen only in lupus patients who had not received a flu shot in the previous year. Therefore, the additional benefit for lupus patients who get a second flu vaccination may be just for those not vaccinated against influenza in the previous year.

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Blogged on 6:50 AM

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Potential New Indicators of Lupus Being Studied in Children
Adipokines as novel biomarkers in paediatric systemic lupus erythematosus. (2009).

Authors: Al M, Ng L, Tyrrell P, Bargman J, Bradley T, and Silverman E.Rheumatology 48: 497-501.

What is the topic?
Since the 1970s, researchers have known that lupus patients are at risk for hardening of the arteries ("atherosclerosis"). Some of this risk may be from the increased inflammation that lupus patients have in the bloodstream over many years, but some of it is from the same reasons that hold true for everybody: especially high blood pressure, high blood sugar, or low levels of "good cholesterol." Taken together, these risk factors are known as "metabolic syndrome," a condition that puts people at high risk for heart disease, diabetes, or both. Some of the medications that lupus patients may take can increase the likelihood that a person will develop metabolic syndrome, especially prednisone.

Cells in the body release specialized chemicals called "cytokines," molecules that carry messages between nearby cells, and some of these messages work specifically to influence body weight and how fast food is burned or whether it turns into fat. If the cytokine messengers are sent out by fat cells, they are called "adipokines." The names of some of these adipokines (fat cell messengers) are leptin, adiponectin, and ghrelin.

What did the researchers hope to learn?
The researchers wanted to find out whether the amount of leptin, adiponectin, or ghrelin in children with lupus might be different than in children without lupus.

Who was studied?
105 children with lupus and 77 healthy children from Toronto, Canada took part in this study. About 20% of the lupus patients were boys and about 80% were girls. The healthy children were a little younger and about 27% of them were boys.

How was the study conducted?
The researchers collected blood samples from the children after they had not eaten overnight. They measured the levels of leptin, adiponectin, and ghrelin (fat cell messengers). It was important to do these studies on blood samples taken from participants who had not eaten for a number of hours, because the nutrients that enter the bloodstream from food can have a big effect on the levels of these fat cell messengers.

What did the researchers find?

The researchers found that children with lupus have more leptin in the blood than healthy children. This was not affected by how severe the lupus disease activity was at the time the blood sample was collected, or by the dose of prednisone being taken.
There was no difference between the groups in the levels of adiponectin or ghrelin. Adiponectin levels were affected by the cholesterol levels in the blood or the dose of prednisone being taken.
What were the limitations of the study?The finding that levels of two possible risk factors for atherosclerosis may be higher in children with lupus could be very important, but does not differentiate whether this results from lupus or its treatments.

The effects of the diet a child was eating over an entire month, their kidney function, or other medications they might have been taking could not be looked at in a study this size, but might have had some impact on the outcome.

What do the results mean for you?
Hardening of the arteries takes a long time to develop, and some studies suggest that some of the risk factors can begin to have an impact in childhood. The finding of these risk factors in children with lupus may begin to explain why some lupus patients develop heart disease relatively early in life and, most importantly, could provide a marker to follow so that preventative measures can begin early.

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Blogged on 6:38 AM

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People Who Have Both Lupus and Antiphospholipid Syndrome Might Have Higher Risk of Thyroid Disease


Antithyroid antibodies in antiphospholipid syndrome: prevalence and clinical associations.
Authors: Mavragani CP, Danielides S, Zintzaras E, Vlachoyiannopoulos PG, and Moutsopoulos HM. (2009).
Lupus 18: 1096-1099.
What is the topic?
The thyroid is a gland in the neck which helps the body keep order over how food and nutrients are handled and how fast people grow, gain or lose weight, how the heart beats, or how blood pressure and cholesterol levels in the blood respond to these changes. A protein called "thyroid peroxidase" helps to modify other proteins that the thyroid produces that perform all of these functions. Some people make antibodies (immune proteins) against their own thyroid peroxidase (these are called "anti-TPO"). People with anti-TPO sometimes have an underactive thyroid; this causes weight gain, fatigue, and a tendency to feel cold when other people around you do not.



The antiphospholipid syndrome is a blood clotting disorder where antibodies are made against proteins that help to control how fast or slowly the blood clots. Many people with lupus have the antiphospholipid syndrome, although it can occur without other features of lupus.



What did the researchers hope to learn?
The researchers wanted to find out if there is a connection between thyroid disease and the antiphospholipid syndrome or lupus.



Who was studied?
75 patients with antiphospholipid syndrome, 75 patients with lupus, and 75 healthy people were studied. 35 of the 75 patients who had antiphospholipid syndrome also had other features of lupus. There was no difference between the groups in terms of age, how long people had been diagnosed, or the ratio of women to men.



How was the study conducted?
Antibodies against the thyroid (anti-TPO) were measured in the blood of all the people participating in the study, and were compared among the different groups.



What did the researchers find?
Anti-TPO antibody was found more often in patients who had both antiphospholipid syndrome and lupus than in healthy people.



What were the limitations of the study?
This was a small study. Sometimes, if a study is too small, there will be a slanting of the outcomes just from a sort of "luck of the draw." These findings are interesting, but larger studies are needed to be more sure about them. This study was also conducted by looking back in time; this is called a "retrospective study." Studies that follow patients forward in time to see what happens to them are more accurate in finding cause and effect; those are called "prospective studies." In a prospective study, you know how many patients move away or stop coming to the clinic during the time you are studying them, and you can try to track them down and find out what happened to them. When you are looking backwards, all you know is information about the people who are left at the end of the time period you are studying them; you are missing a lot of information. Also, in a prospective study, you can decide in advance exactly what information you want to study and make sure you get that information at regular intervals for all the participants. In a retrospective study, you are limited to whatever ended up, without any advanced planning, in the medical chart. Therefore, this current study, being a small, retrospective study, raises an interesting question about the relationship between thyroid antibodies and the antiphospholipid syndrome and lupus, but should be confirmed with a larger, prospective study.



What do the results mean for you?
Patients with both antiphospholipid syndrome and lupus may be at increased risk for having thyroid antibodies. This is important to know because sometimes these antibodies can interfere with the functions of the thyroid gland and there are good treatments for this.

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Blogged on 6:36 AM

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People Who Have Both Lupus and Antiphospholipid Syndrome Might Have Higher Risk of Thyroid Disease


Antithyroid antibodies in antiphospholipid syndrome: prevalence and clinical associations.
Authors: Mavragani CP, Danielides S, Zintzaras E, Vlachoyiannopoulos PG, and Moutsopoulos HM. (2009).
Lupus 18: 1096-1099.
What is the topic?
The thyroid is a gland in the neck which helps the body keep order over how food and nutrients are handled and how fast people grow, gain or lose weight, how the heart beats, or how blood pressure and cholesterol levels in the blood respond to these changes. A protein called "thyroid peroxidase" helps to modify other proteins that the thyroid produces that perform all of these functions. Some people make antibodies (immune proteins) against their own thyroid peroxidase (these are called "anti-TPO"). People with anti-TPO sometimes have an underactive thyroid; this causes weight gain, fatigue, and a tendency to feel cold when other people around you do not.



The antiphospholipid syndrome is a blood clotting disorder where antibodies are made against proteins that help to control how fast or slowly the blood clots. Many people with lupus have the antiphospholipid syndrome, although it can occur without other features of lupus.



What did the researchers hope to learn?
The researchers wanted to find out if there is a connection between thyroid disease and the antiphospholipid syndrome or lupus.



Who was studied?
75 patients with antiphospholipid syndrome, 75 patients with lupus, and 75 healthy people were studied. 35 of the 75 patients who had antiphospholipid syndrome also had other features of lupus. There was no difference between the groups in terms of age, how long people had been diagnosed, or the ratio of women to men.



How was the study conducted?
Antibodies against the thyroid (anti-TPO) were measured in the blood of all the people participating in the study, and were compared among the different groups.



What did the researchers find?
Anti-TPO antibody was found more often in patients who had both antiphospholipid syndrome and lupus than in healthy people.



What were the limitations of the study?
This was a small study. Sometimes, if a study is too small, there will be a slanting of the outcomes just from a sort of "luck of the draw." These findings are interesting, but larger studies are needed to be more sure about them. This study was also conducted by looking back in time; this is called a "retrospective study." Studies that follow patients forward in time to see what happens to them are more accurate in finding cause and effect; those are called "prospective studies." In a prospective study, you know how many patients move away or stop coming to the clinic during the time you are studying them, and you can try to track them down and find out what happened to them. When you are looking backwards, all you know is information about the people who are left at the end of the time period you are studying them; you are missing a lot of information. Also, in a prospective study, you can decide in advance exactly what information you want to study and make sure you get that information at regular intervals for all the participants. In a retrospective study, you are limited to whatever ended up, without any advanced planning, in the medical chart. Therefore, this current study, being a small, retrospective study, raises an interesting question about the relationship between thyroid antibodies and the antiphospholipid syndrome and lupus, but should be confirmed with a larger, prospective study.



What do the results mean for you?
Patients with both antiphospholipid syndrome and lupus may be at increased risk for having thyroid antibodies. This is important to know because sometimes these antibodies can interfere with the functions of the thyroid gland and there are good treatments for this.


Blogged on 6:36 AM

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