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Immunosuppressants Render Flu Vaccination Less Effective in People With Lupus Friday, January 22, 2010 Immunosuppressants Render Flu Vaccination Less Effective in People With LupusStudies 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. Labels: flu
~~~ A Second Flu Shot Might Be More Effective in Some People With Lupus 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. Labels: flu
~~~ A Second Flu Shot Might Be More Effective in Some People With Lupus 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. Labels: flu
~~~ Potential New Indicators of Lupus Being Studied in Children 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. Labels: flu
~~~ People Who Have Both Lupus and Antiphospholipid Syndrome Might Have Higher Risk of Thyroid Disease 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. Labels: flu
~~~ People Who Have Both Lupus and Antiphospholipid Syndrome Might Have Higher Risk of Thyroid Disease 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.
~~~ A Potential New Treatment for Severe Discoid Lupus Thursday, February 05, 2009 Discoid lupus is a form of lupus that affects the skin (cutaneous lupus). In most cases the discoid lupus rash appears on the face, neck, or scalp, though it can also show up on other areas of the skin. Severe discoid lupus may result in scarring. The treatments that are used most often for severe discoid lupus are strong immunosuppressants that may have significant side effects, especially when used over long periods of time. Efalizumab (trade name, Raptiva™) works by interfering with the function of overactive immune cells that are causing disease activity. The researchers in this study wanted to see if Raptiva could be effective in treating discoid lupus.Read more : http://www.lupus.org/webmodules/webarticlesnet/templates/new_empty.aspx?articleid=2141&zoneid=76 Labels: discoid, threatment
~~~ Masa Depan Penderita Lupus Thursday, March 27, 2008 Kompas, 23 maret 2008 - by dr samsuridjal djauziSaya, perempuan (24), baru saja lulus sarjana ekonomi dan sedang mencari pekerjaan. Sewaktu menyelesaikan skripsi, saya mengalami demam lama. Tadinya saya mengira demam tersebut diakibatkan terlalu keras belajar, tetapi setelah beristirahat, demam tetap timbul disertai pegal-pegal di otot. Saya memeriksakan diri ke dokter spesialis penyakit dalam dan dianjurkan menjalani sejumlah pemeriksaan yang biayanya cukup mahal. Hasil tes menunjukkan saya terkena lupus. Saya amat terkejut dan khawatir karena menurut pemahaman saya lupus penyakit yang berbahaya dan tak dapat disembuhkan. Padahal saya baru saja menyelesaikan kuliah dan bersiap bekerja dan berkeluarga. Apakah semua harapan saya akan lenyap begitu saja? Menurut dokter, lupus termasuk penyakit autoimun dan pengobatannya memerlukan waktu lama. Saya harus berkonsultasi dan diperiksa teratur. Sekarang saya menggunakan obat steroid. Karena obat generik, harganya tidaklah mahal. Apalagi sekarang saya cukup meminum obat tersebut dua tablet per hari. Semula karena mengalami anemia saya mendapat obat 12 tablet. Kemudian setelah anemia membaik, penggunaan tablet steroid diturunkan secara bertahap. Saya juga mengalami kebocoran protein melalui ginjal. Untunglah sekarang kebocoran tersebut dapat diatasi dan urine saya sudah kembali normal. Meski sudah dalam kondisi sehat, sekarang saya masih diliputi rasa khawatir. Apakah penyakit lupus dapat disembuhkan? Apa yang dimaksud dengan penyakit autoimun? Mungkinkah saya bekerja dan berkeluarga? Dapatkah penderita lupus berkeluarga? Apakah boleh punya anak dan jika punya anak apakah mereka nanti juga akan terkena lupus? Maaf pertanyaan saya agak banyak karena sedang memikirkan masa depan. Terima kasih atas perhatian Dokter. M di S Dewasa ini kasus lupus semakin meningkat. Mungkin ini disebabkan kesadaran masyarakat yang juga meningkat mengenai penyakit ini dan kemampuan dokter mendiagnosis penyakit lupus menjadi lebih baik. Lupus pada umumnya menyerang perempuan muda. Meski jarang, lupus juga dapat menyerang laki-laki. Memang benar lupus digolongkan ke dalam penyakit autoimun, yaitu penyakit yang timbul akibat zat antibodi di tubuh yang sebenarnya fungsinya melindungi tubuh dari kuman atau sel kanker berubah fungsi menyerang organ tubuh penderita sendiri. Pada lupus, organ tubuh yang dapat diserang antara lain kulit, sendi, jantung, paru, ginjal, otak, sistem pembuluh darah. Jika hanya terbatas pada kulit dan sendi biasanya penyakit lupus ini lebih ringan. Jika mengenai ginjal atau sistem pembuluh darah seperti yang Anda alami, maka penyakit lupus tersebut lebih berat dan disebut lupus sistemik. Pada sistem pembuluh darah akan terjadi anemia hemolitik. Pada keadaan ini sel darah merah mudah pecah. Sedangkan pada ginjal terjadi pengeluaran berlebihan protein melalui ginjal dan dalam waktu lama (sekitar sepuluh tahun) ginjal akan terganggu fungsinya. Keadaan yang sering kita hadapi di Indonesia penderita datang dalam keadaan organ tubuh sudah amat terganggu. Misalnya, anemia amat berat atau gagal ginjal. Upaya untuk mengatasi keadaan organ tubuh yang mengalami kerusakan berat ini tidaklah mudah. Karena itulah pengobatan lupus di negara kita dianggap kurang berhasil. Sebenarnya terapi lupus di Indonesia dan negara maju hampir serupa, tetapi di negara maju penderita lupus berhasil didiagnosis jauh lebih dini sehingga hasil terapi juga lebih baik. Jika di Indonesia kita mampu menemukan lupus pada keadaan dini, maka hasil terapi juga akan lebih baik. Untuk dapat mendiagnosis lupus secara dini, kesadaran masyarakat atas penyakit ini perlu ditingkatkan dan kepedulian dokter terhadap lupus juga harus lebih baik. Umumnya penderita lupus datang ke dokter penyakit dalam dan dokter spesialis kulit karena gejalanya lebih sesuai untuk kedua spesialis tersebut, yaitu demam lama, pegal pada sendi, seriawan mulut, anemia, protein urine, dan lesi kulit muka. Penyakit lupus dapat dikendalikan dengan obat. Artinya kita dapat mengetahui seorang penderita lupus tidak mempunyai gejala dan dalam keadaan sehat dengan obat. Umumnya obat yang digunakan adalah obat jenis steroid, tetapi sekarang tersedia beberapa obat lain untuk mendukung pengobatan lupus. Keadaan tanpa gejala ini disebut remisi dan keadaan remisi ini dapat berlangsung lama. Risiko kekambuhan (relaps) memang ada, tetapi jika dikenali secara dini relaps akan dapat diatasi. Dengan demikian, penderita lupus diharapkan dapat hidup normal. Dia dapat bekerja produktif di masyarakat, menikah, dan mempunyai anak. Umumnya anak dari penderita lupus sehat dan lupus bukan penyakit yang berisiko ditularkan kepada anak. Meski demikian, tidak berarti lupus tak pernah dijumpai pada anak. Meski jarang, lupus juga dapat dijumpai pada anak. Saya merasa ikut gembira karena kerja sama Anda dan dokter berhasil mencapai keadaan lupus remisi. Pertahankanlah keadaan tersebut dengan berobat teratur. Salah satu faktor penting kegagalan terapi lupus adalah penderita menghentikan pengobatan. Mudah-mudahan Anda akan berhasil terus dalam keadaan remisi dan dapat mewujudkan semua cita-cita Anda selama ini. source
~~~ Cardiovascular disease activity in lupus -- even during remission? Wednesday, March 26, 2008 What is the topic?Lupus is a disease that has periods of obvious activity and apparent remission. However, even during what seems like quiet periods when there are no clearcut symptoms, it is possible that changes are occurring below the surface that can cause complications later. What did the researchers hope to learn? Lupus patients are at increased risk for cardiovascular disease (CVD), which involves hardening of the arteries and can lead to heart attacks or strokes later in life. The bone marrow makes special cells that help repair damaged blood vessels (endothelial progenitor cells, EPCs); people with CVD may have fewer of these repair cells in their blood stream, and this may contribute to the damage of the blood vessel walls, increasing the risk for cardiovascular disease. This group of researchers wanted to learn if lupus patients had lower levels of these helper cells, even when they were in remission. Who was studied? Fifteen women with lupus and 15 healthy women of the same age and similar smoking histories were recruited for this study. The lupus patients all were in remission for at least one year, and used low doses of prednisone or hydroxychloroquine alone or in combination with other lupus medications. How was the study conducted? The researchers took blood samples from all of the study participants and measured the EPCs and other cells that help produce them, called hematopoetic stem cells (HSCs). They compared the levels of EPCs and HSCs in the lupus patients and the healthy controls, and they also looked for relationships between the levels of these repair cells and other factors. To see whether the patients were developing CVD, the researchers measured the "stiffness" of the patients’ arteries with tests for blood pressure and blood flow. What did the researchers find? The levels of the EPC and HSC repair cells were lower in the lupus patients than in the controls. There was no correlation between the levels of these cells and measures of active lupus such as anti-dsDNA antibodies or antiphospholipid antibodies. Prednisone use did not appear to affect the number of the EPCs or HSCs, but hydroxychloroquine use did -- higher doses of this medication were associated with increased numbers of EPCs. Also, lupus patients who used hydroxychloroquine tended to have lower stiffness scores for their arteries than other lupus patients, which the researchers took as a sign that their blood vessels were staying healthier than others. All of these findings led the researchers to conclude that for some lupus patients, the ability to repair damaged blood vessels may be impaired, even if the patients are in remission and on medication, and it might be that continuing to take hydroxychloroquine even when otherwise well could help to protect the arteries from future risk. What were the limitations of the study? The size of the study population was very small, which makes it difficult for these preliminary findings to be thought of as proven. The researchers didn’t examine past use of medications, which may have had an impact on the lupus patients’ status when the study was conducted. Also, the lupus patients as a group had more traditional CVD risk factors than the controls, such as higher cholesterol, and it is possible that these other risk factors could have been affecting the levels of EPCs rather than lupus -- as could other things going on in the blood vessels and elsewhere they didn’t account for. What do the results mean for you? This study suggests the possibility that lupus might be contributing to future blood vessel damage even when there is no visible sign of the disease. At the same time, it suggests that finding a way to boost levels of EPCs and the HSCs might help prevent CVD from occurring in some lupus patients. It also offered further evidence suggesting that hydroxychloroquine might be useful in preventing CVD in lupus patients. It would be helpful to have a "before and after" study to see whether hydroxychloroquine raises EPCs in patients after it is given, compared to what is found in the same patients before it is given. source Labels: blood vessle damage, cardiovascular disease, CVD, endothelial progenitor cells, Haematopoietic, SLE
~~~ Risk Factors for Pneumonia What is the topic? Pneumonia is the most common form of lung disease in lupus patients. The first defense against pneumonia is a person’s immune system, which is called to action and directed by a number of genes. What did the researchers hope to learn? The researchers for this study wanted to see if they could identify specific risk factors for pneumonia among lupus patients. Were older patients at greater risk? African Americans more than Caucasians? Did it matter how long a person had lupus, or what medications they had taken? Along with these variables, the researchers were particularly interested in examining how very small differences in the structure of several genes involved in the body’s immune system might increase a lupus patient’s chances of getting pneumonia. Who was studied? The researchers analyzed clinical and genetic information on 282 patients (251 women, 31 men) who were part of the Lupus Genetics Project of the University of California, San Francisco. Nearly half (45 percent) were Caucasian, and other ethnic groups represented were Hispanic (18.4 percent), African American (11.7 percent), Asian/Pacific Islander (19.5 percent), and Other/mixed ethnicity (5.3 percent). Of the 282 patients studied, 42 were identified as having had pneumonia sometime after they were diagnosed with lupus. How was the study conducted? The researchers compared the patients in the study who had pneumonia with those who did not; the factors they compared were sex, ethnicity, socioeconomic status, age at lupus diagnosis, duration of disease, lupus medications, renal disease, and low white blood cell count (leucopenia). They also looked at small inherited differences in three genes that have previously been associated with high rates of infection. The researchers used complex statistical techniques to weigh the impact of the different factors on the rate of pneumonia. What did the researchers find? Being male, having had lupus nephritis or leucopenia, and treatment with immunosuppressive drugs were all associated with a higher risk for getting pneumonia, but the strongest association was a specific variation in a gene that plays a role in the production of a molecule called tumor necrosis factor (TNF). TNF helps cells recognize and defend themselves against foreign bacteria, including the bacteria that cause pneumonia, so any change in the genes that promote TNF may affect the body’s ability to fight off the infection. The researchers did not find evidence linking variations in the other two genes they studied with higher risk for pneumonia. What were the limitations of the study? This study relied on data that had already been provided to the Lupus Genetics Project, so the researchers were limited in the categories of information they could examine. They weren’t able to consider such potentially important factors as patient’s immunization histories, the doses of their steroid or immunosuppressant medicines, which increase the risk for infections. Also, they may not have identified all of the patients who had pneumonia owing to incomplete records. The relatively small size of the study population also meant that they may not have had as much genetic variation as they might have needed for important distinctions to show up. What do the results mean for you? This research does identify some important risk factors that need to be studied more thoroughly. If, as their findings suggest, specific variations in the TNF gene they studied -- or perhaps another gene yet to be identified -- can be shown to raise a lupus patient’s chances of getting pneumonia, doctors could use this information and recommend a number of measures -- such as pneumonia vaccines or antibiotics -- to help prevent some of these infections in those patients at risk. source Labels: genetic, male, pneumonia, SLE
~~~ As Teenage Girls with Lupus Mature What is the topic? Women with lupus may have problems with their menstrual cycle, such as increased blood flow, irregular periods, missed periods and even premature ovarian failure (POF) which means that women go into menopause earlier than normal. Early menopause is often the result of treatments for lupus, in particular the immunosuppressant cyclophosphamide (CYC). What did the researchers hope to learn? Almost all of the studies about menstrual problems in lupus have been on adult women. This study wanted to see if adolescent females with juvenile lupus were also at risk for these kinds of problems, and if there were any differences in their symptoms from those of older women with lupus. Who was studied? Three-hundred fifteen adolescent girls with lupus from 12 different medical centers in Brazil were studied for this research. All were over 10 years old and had reached puberty, having had at least one menstrual period. Thirty-five of these patients had episodes of missed periods. How was the study conducted? The researchers reviewed patients’ records and medical histories for all of the patients in the study: how old patients were when they were diagnosed with lupus, how long they had been diagnosed, how old they were when they had their first period, their lupus symptoms, and the medications they had taken. If the patients had missed periods, the researchers noted when it developed and how long it lasted. They compared the information for those patients who had missed periods with those who didn’t, to see if there were any differences. They also took blood samples from each of the patients to study the levels of different hormones. What did the researchers find? The researchers found several significant differences between the patients who had missed periods and those who did not. Patients who had missed periods tended to be younger (average age 15.04 years-old versus 17.8 ), had their lupus diagnosis for shorter periods of time (3.2 years versus 6.1), and were closer in age to their first period (3.4 years into puberty versus 6.7). They also had more serious lupus disease activity when they started missing their periods and were more likely to have kidney involvement. Unlike the studies on adults, the researchers found no relationship between cyclophospamide therapy and missed periods in the juvenile patients. Also, none of the juvenile patients in this study had premature ovarian failure. This is not a surprising finding, since cyclophosphamide kills eggs, and younger women have many more eggs to spare than older women. What were the limitations of the study? This study focused only on the patients’ adolescent years: there is no way to know if some of the patients who didn’t have menstrual problems during those years might not develop these symptoms later in life. Also, this study was done by looking at past records of patients, so the research could only be based on information that had already been obtained; there may have been other questions the researchers would have addressed if they were examining the patients at the time the symptoms occurred. The researchers did not divide the study patients by ethnicity: there may be important differences in how these menstrual problems occur depending on ethnic background. For all of these reasons, more studies will be needed to understand how lupus affects younger women. What do the results mean for you? Lupus patients in their teens—and their parents and health care team—should be aware that menstrual abnormalities can occur. However, this research confirms some earlier studies which suggest that cyclophosphamide is less likely to put younger patients into menopause than older women. Even when adolescent lupus patients had missed periods, their ovaries continued to function later on; that might relieve a younger patient of some worry about their chances to become pregnant later in life. source Labels: Brazil, girl, JSLE, juvenile, SLE, teenage
~~~ New Tests for Lupus Kidney Disease? What is the topic? The kidneys remove impurities from the blood. If the kidneys are damaged, they can lose their ability to filter out those waste products, and serious health complications can occur. Lupus patients can develop inflammation in their kidneys, which is known as lupus nephritis (LN). Rarely, the LN is so severe that all of the function is lost in the kidneys and the patient would need to go on dialysis until they could get a kidney transplant. What did the researchers hope to learn? The researchers in this study hoped to learn if the presence of specific antibodies in a patient’s blood could be linked to the more severe kinds of kidney disease. In particular they were interested in anti-dsDNA and anti-nucleosome antibodies. Who was studied? The researchers collected information from three different groups of lupus patients in Calgary Canada: 14 LN patients who had received a kidney transplant; 22 patients who had LN stabilized without needing dialysis; and 66 lupus patients without nephritis, to compare with these other groups. The control patients were selected to match the two groups of LN patients as closely as possible in age, sex, and ethnicity. How was the study conducted? The researchers obtained blood samples that had previously been taken from the three groups of patients and stored at a serum bank. They also had access to kidney tissue biopsies for the LN patients (12 of 14 transplant patients, 17 of the 22 other LN patients). They compared the antibody profiles for the three different groups, and also looked to see if particular antibodies were associated with the different degrees of kidney damage that showed up on the biopsies. What did the researchers find? Ninety-six of the 100 patients had antibodies which are associated with lupus, but there was no significant difference in the frequency of most kinds of antibodies in the three groups of LN patients, except for the anti-nucleosome antibodies. Anti-nucleosome antibodies were observed in much higher frequency (79 percent) and at significantly higher levels in the transplant group than in the other LN patients (18 percent) or the controls (9 percent). In addition, the researchers calculated that lupus patients were seven times more likely to develop lupus nephritis if they had anti-nucleosome antibodies present. They felt that these findings provided strong evidence that the presence of anti-nucleosome antibodies could be a reliable test for picking out people at risk for severe lupus nephritis that might lead to the loss of kidney function without aggressive treatments. What were the limitations of the study? There were only 100 patients in this study, so additional research with many more patients will be needed to see if anti-nucleosome antibodies can be used as a good test to predict risk of severe LN. Larger studies will also help researchers see if there are differences in the antibodies in LN in people of different genetic backgrounds. Also, even though 79% of the LN patients who had kidney transplants had anti-nucleosome antibodies, the other 21% of the ESRD patients did not; similarly, there were patients who didn’t develop any lupus nephritis who had anti-nucleosome antibodies in their blood tests: this points out that even when two lupus patients have the same symptoms, different disease activity may be at work—which is why every case of lupus and every lupus patient is unique. What do the results mean for you? Doctors find some blood tests useful to help them manage their individual patients’ care. If, as this research suggests, the presence of anti-nucleosome antibodies can identify those patients with higher risk for serious LN, doctors can use this information to provide early and aggressive therapy in hopes of keeping the disease under control before the patient’s kidneys are badly damaged. source Labels: kidney, lupus neprithis, renal transplantation
~~~ When Platelet Counts are High What is the topic? The spleen is an important organ in both the body’s immune system and its blood circulation. The spleen makes antibodies that protect against infections. It also filters the blood, removing old and damaged red blood cells. In some medical conditions the spleen can be damaged, and this can increase the risk for infections. This is sometimes seen in lupus patients, though this is rare. What did the researchers hope to learn? The researchers wanted to see if there were specific lupus symptoms that showed up more often in patients whose spleens weren’t functioning well. They were particularly interested in lupus patients with an unusually high number of platelets. Platelets are components of blood cells that can stick together to form clots at wounds, and thus help stop the loss of too much blood when an injury occurs. High platelet counts are much less common in lupus patients than low platelet counts. Who was studied? The researchers studied 465 consecutive lupus patients at a rheumatology clinic in Italy. All of the patients -- 387 women and 78 men -- were Caucasian and over 20 years of age. How was the study conducted? Blood samples from each of the patients were tested for antibodies and platelet counts over a period of years. Patients who had high platelet counts in 3 consecutive blood draws taken 3 months apart were further studied with an additional kind of test called a blood smear, which could detect signs of spleen problems. If the blood smear was abnormal, the patients had imaging studies, including ultrasound exams and CT scans to determine whether their spleens were damaged. Twenty patients who did not have high platelet counts also had blood smear tests done in order to compare the results. What did the researchers find? Of the 465 patients studied, 16 women and 1 man were diagnosed with thrombocytosis, and this diagnosis came when their lupus disease was inactive. When the blood smears were done on these patients, three showed signs that their spleen was not functioning properly, and this was confirmed by ultrasound and CT scans. Each of these three patients had antiphospholipid antibodies (aPL), which have been linked to blood clots. One of these three patients developed high platelet counts after previously having abnormally low platelet counts. None of the 20 blood smears from control patients with normal platelet counts showed any indication of spleen problems. To the researchers these findings suggested that when lupus patients have high platelet counts, the damage to the spleen could be caused by blood clots related to antiphospholipid antibodies. They recommended that lupus patients who have high platelet counts should be examined for these antibodies. What were the limitations of the study? While 3 of the 17 patients with high platelet counts were determined to have spleen problems, fourteen others did not. So most people with high platelet counts do not have problems in the spleen. Also, even in those three patients, there was no way to determine if the spleen problems occurred before or after the patients developed high platelet counts. What do the results mean for you? The spleen plays a very important role in fighting bacterial infections, so even though only a minority of patients with elevated platelet counts have spleen problems, this is the group that should be further tested to see if their spleen is functioning properly. This may be particularly important in lupus patients who had previously been diagnosed with thrombocytopenia (low platelet counts) and then show up with thrombocytosis (high platelet counts). Also, since all three of the patients who had spleen damage had aPL, doctors whose lupus patients have aPL may want to keep an eye out for changes in platelet counts as a sign of potential spleen damage. source Labels: Autosplenectomy, Platelet, Thrombocytosis
~~~ The Many Faces of Cutaneous Lupus Tuesday, March 25, 2008 by Elizabeth Thompson BeckleyRachelle Pamela sought medical attention for a mouth ulcer when she was 19 years old. It took several biopsies, many incorrect conclusions, various treatments, and another eight years before, at age 27, Pamela received the correct diagnosis of discoid lupus erythematosus. Discoid lupus is the most common of the skin diseases that fall under the umbrella of cutaneous lupus. "Cutaneous" means "of the skin." Only about 10 percent of people with discoid lupus go on to develop systemic lupus, but about 80 percent of people with systemic lupus will also have skin problems. Cutaneous lupus can affect the skin in many ways. Rashes, mucosal ulcers (sores in the mucous membranes of the mouth and nose), bumps, and dimpling can be painful or itchy. In some cases, the effects on the skin may result in permanent discoloration, scarring, and hair loss -- aspects of appearance that also can take a toll on the psyche. The various eruptions of cutaneous lupus usually are referred to as lesions. A lesion is an abnormality in tissue or an organ caused by disease or injury. Lesion Lesson There are three types of cutaneous lupus, but not all of them cause scarring. According to David Fiorentino, M.D., Ph.D., assistant professor in the department of dermatology and the department of medicine’s division of immunology and rheumatology at Stanford University School of Medicine in Palo Alto, CA, the main type of scarring is caused by lesions from discoid lupus. Acute cutaneous lupus, which frequently appears as a rash across the nose and face (often called the "butterfly" rash), doesn’t scar, Fiorentino says. Subacute cutaneous lupus doesn’t scar, but can leave white areas where there was a rash and the skin’s pigment has been lost (hypopigmentation) or darker areas where the skin’s pigment has become discolored (hyperpigmentation). "Even though skin problems often are associated with lupus, we can’t always assume the skin rash is related to lupus," Fiorentino says, "but the type of rash can be a signal of how active or inactive the internal lupus is." Further analysis is required to determine an individual’s overall health. Often a biopsy of the affected tissue -- done by taking a tissue sample and examining it under a microscope -- can give more information. For Pamela, now age 40 and an office manager for a trucking company in Concord, CA, aggressive treatment has kept her discoid lupus at bay. She now maintains her skin’s health with a manageable drug regimen of antimalarials and a topical steroid. "I take two pills [chloroquine and quinacrine] in the morning and use a cream [fluocinonide] at night," she says. They’re paid for by insurance, and Pamela reports experiencing no side effects. "That’s the great part," she says. The not-so-great parts are the scarring and discoloration that remain from previous flares, which she describes as "a lot of pits and indented scars" around her lips, chin, ears, and scalp. Treatment Strategies for Skin Fortunately, several effective treatments for cutaneous lupus are available. There also are new drugs in the research pipeline, as well as new techniques for dealing with scars and hair loss. source Labels: Cutaneous Lupus, discoid, skin, ulcer
~~~ Another benefit of hydroxychloroquine? What is the topic? The antimalarial drug hydroxychloroquine—and to a lesser degree a similar but older medication chloroquine—is used in the treatment in lupus. Hydroxychloroquine, also known by its trade name Plaquenil®, is often prescribed for mild to moderate cases of lupus, and may be effective in preventing skin flares and possibly blood clots. Doctors also give hydroxychloroquine to lupus patients who are taking steroids, which helps them use lower doses of steroids. What did the researchers hope to learn? A study recently reported from Spain found that antimalarial drugs not only helped control lupus disease, but patients who took either of these drugs also lived longer than other lupus patients—even when discounting other factors. However, almost all of the patients in that study were Caucasian, so researchers here in the United States wanted to see if lupus patients from other ethnic backgrounds who were treated with hydroxychloroquine also lived longer. Who was studied? Since the early 1990s, the LUMINA (LUpus in MInorities: NAture vs. nurture) study has been tracking a group of lupus patients in the United States of different ethnic backgrounds. At the time this study was conducted, the LUMINA study included information on 218 Hispanics, 220 African Americans, and 170 Caucasian patients; of those 608 patients, 61 had died from various causes. How was the study conducted? The researchers focused on the records of the 61 patients who had died, comparing those who were taking hydroxycholoroquine (17) to those who had not (44). For every one of the deceased patients, they also examined the information for 3 surviving patients who had been diagnosed with lupus for the same amount of time. The researchers looked at demographic factors (such as income, education, and age when diagnosed) and also lupus disease symptoms, medications, lab tests. Using some statistical techniques that allowed them to account for the impact of these different variables, they came up with a way to measure if hydroxychloroquine on its own, independent of other factors, provided a protective effect that kept patients living longer. What did the researchers find? Like the previous study in Spain, the researchers in this LUMINA study found that hydroxychloroquine had a clear effect in terms of the survival of lupus patients. Although this might have been explained by the fact that hydroxychloroquine was used more often in people with less severe disease, they accounted for that in their analysis. By applying statistics, they found that hydroxychloroquine had an independent impact on survival. What were the limitations of the study? Even though the researchers designed their study to account for the effect of factors other than hydroxychloroquine, there may be other features that they didn’t account for that also were influencing the outcomes. Also, the study didn’t indicate if hydroxychloroquine’s protective benefit was the same for Caucasians, African Americans, and Hispanics. What do the results mean for you? Hydroxychloroquine has been shown to be an effective medicine for treating lupus, and previous studies have shown that it is associated with fewer flares of disease. Monitoring for rare complications to the eyes is important, but with such monitoring, this treatment can be used safely for long periods of time for most patients. source Labels: Association of socioeconomic and demographic factors with utilization of rheumatology subspecialty care in systemic lupus erythematosus, hydroxychloroquine, LUMINA, multiethnic, steroid
~~~ Have you seen a rheumatologist lately? What is the topic? Although a number of studies have found that specialty care is associated with improved outcomes, there are reports that certain groups of lupus patients -- especially the elderly and African American women often do not have even annual visits with a rheumatologist. That may contribute, in part, to the more severe manifestations of disease seen in African Americans with lupus. Little is known about the use of rheumatology services by other groups of lupus patients (e.g., younger patients, other ethnic minority group members) or how the use of specialists relates to the type of medical insurance a lupus patient may or may not have. What did the researchers hope to learn? The researchers wanted to examine the socioeconomic and/or demographic factors that might affect lupus patients’ use of rheumatology physician services. The primary outcome was whether or not patients had seen a rheumatologist at least once in the prior 12 months. The researchers also sought to determine what kind of physicians (e.g., family practice physicians, internists, rheumatologists, other specialists) were primarily responsible for managing lupus patients’ care. Who was studied? The participants in this study were already part of the Lupus Outcomes Study (LOS), which has been following nearly 1,000 English-speaking patients with lupus over a number of years. This study included 867 people with lupus, more than 91% of whom were women. The racial/ethnic backgrounds of the study participants, as self-identified by the subjects, were: Caucasian (69%), Hispanic/Latino (11%), African American (8%), Asian/Pacific Islander (10%), and some other race/ethnicity (2%). How was the study conducted? Trained survey workers conducted hour-long telephone interviews with the study participants. They collected data on age, sex, disease status, race/ethnicity, income, education, type of health insurance, and how they had come to participate in the LOS (either through a referral from a rheumatology practice or community outreach). The results were analyzed to weigh the relative impact of different variables. What did the researchers find? The researchers found that older participants, males, and those with lower incomes were less likely to visit a rheumatologist, even after taking other variables into account such as race/ethnicity, health insurance, and disease status. They guessed that this underuse of rheumatology services was probably caused by barriers to accessing care, such as lack of rheumatologists nearby, lack of awareness of rheumatology expertise, less frequent referrals to rheumatologists, or inadequate follow-up by rheumatologists once care is established. The researchers did not find a discrepancy in specialty care use by race/ ethnicity in this study, a finding that contrasted with a prior study that showed African Americans with lupus had significantly fewer rheumatology visits compared with Caucasians. What were the limitations of the study? The participants in this study were not randomly selected, but rather had already been enrolled in the LOS. It is possible that the respondents may have had increased access to care compared to lupus patients in general; in particular, study participants identified as members of ethnic/racial minorities were more likely to have been recruited for the original study from rheumatology practices. Also, the study relied on self-reported medical histories, which are not as reliable as detailed clinical information, and this could have masked important differences about the severity of disease in the different groups. What do the results mean for you? The study results point to the need for greater access to rheumatology specialty care for particular groups of lupus patients. In many patients, lupus symptoms may become less severe as they grow older, and this may account in part for why older lupus patients are less likely to see a rheumatologist. However, this is not true for all patients, and some of these patients may still need the particular expertise of physicians who have special training in the management of lupus. source Labels: demographic, socioeconomic, systemic lupus erythematosus, utilization of rheumatology subspecialty
~~~ Particular immune molecules and NPSLE What is the topic? Despite the fact that a significant percentage of lupus patients (estimates run from 14% to 75%) have signs of neurological involvement, doctors still don’t have a single test that can definitely indicate when lupus is affecting the central nervous system (NPSLE). What did the researchers hope to learn? The researchers sought to determine if the presence of particular factors in the spinal fluid (CSF) of lupus patients are associated with NPSLE, which might help determine NPSLE diagnosis. Who was studied? The study had four different groups of subjects who were patients at the same hospital in Mexico City: 42 lupus patients who had symptoms of NPSLE; six lupus patients with septic meningitis; 16 lupus patients with no symptoms of NPSLE; and 25 patients with no autoimmune disease and no neurological manifestations who were undergoing elective surgery. How was the study conducted? All of the patients agreed to participate in the study and to undergo a spinal tap. Six months after hospitalization, a second spinal tap was done on 30 of the 42 NPSLE patients. The researchers compared the CSF samples of the NPSLE patients with those of the other groups They also compared the samples of the NPSLE patients that were taken six months later, after the patients had undergone medical treatment and no longer had any NPSLE symptoms. What did the researchers find? The researchers found increased concentrations of several inflammatory proteins in the CSF of lupus patients during a flare of NPSLE including interleukin 6 (IL-6) and several other proteins. At the six-month follow-up, levels of these inflammatory proteins had decreased significantly, but not completely, and were now similar to lupus patients who did not have NPSLE. What were the limitations of the study?The researchers did not study any group of patients with neurologic symptoms but no autoimmune disease, so it is impossible to determine if the high levels of the compounds they identified were present because of the NPSLE or the general fact that there was neurological involvement. What do the results mean for you? Though further studies are required, this research does suggest a particular blood test that could be useful in determining when lupus involves the nervous system. It also provides an interesting perspective on the different ways lupus can affect tissues and cells depending on where they are located in the body and the functions they perform. source Labels: chemokines, Interleukin-6, neuropsychiatric, NPSLE, systemic lupus erythematosus
~~~ Medication use and infertility in men with lupus What is the topic? Because lupus can affect almost every organ system in the body, men who develop lupus may have concerns about their fertility, especially since the presence of antisperm antibodies has been observed in a significant percentage of lupus patients. What did the researchers hope to learn? The researchers sought to determine the frequency and possible causes of sperm damage in men with lupus. Who was studied? The researchers studied sperm development and sexual function in 35 males diagnosed with lupus and 35 healthy males. How was the study conducted? Each of the study participants underwent an examination by a urologist. Sperm samples were obtained to compare sperm count, shape, and motility (the ability of the sperm to move) between the two groups. The lupus patients also had their sex hormone levels determined, their medical histories collected (including data on the duration and dosages of medications they had taken for lupus), and their sperm samples tested for antisperm antibodies. What did the researchers find? The researchers found a high frequency of sperm abnormalities in men with lupus, including lower sperm counts and reduced sperm mobility. Both of these conditions are linked to male infertility. They also noted that the volume of the testes of the men with lupus was reduced compared to the controls. Their analysis showed, however, that these sperm and testicular abnormalities were not the result of lupus disease activity but stemmed from prolonged use (more than five years) of the immunosuppressant drug cyclophosphamide (CYC, trade name, Cytoxan®). What were the limitations of the study? Though the researchers showed that sperm abnormalities occurred much more frequently in males with lupus, the researchers were unable to predict which patients might become infertile. What do the results mean for you?It is already known that CYC is associated with infertility. This research confirms the possibility of infertility among men with lupus who receive CYC therapy. Men with lupus who must receive this treatment may want to consider freezing sperm samples first. source Labels: Gonad evaluation, infertility, male, systemic lupus erythematosus
~~~ Why Certain Patients Don’t Respond to Steroids: One Possible Explanation Monday, March 17, 2008 What is the topic?Steroid medications are often prescribed for people with lupus or other autoimmune diseases such as rheumatoid arthritis. Although steroids have many undesirable side effects, they work quickly and very well to control lupus. However, for a small percentage of lupus patients, steroids don’t provide relief; these patients are said to be "steroid resistant" (SR), and must take other medicines, most of which are not as rapidly active, to treat their disease flares. What did the researchers hope to learn? The researchers in this study wanted to see if they could find out what makes people steroid resistant. In particular, they were interested in learning about the immune cells of SR individuals, to see how they might be different from the immune cells of people for whom steroids are effective. They performed a study in patients with ulcerative colitis, so it is important to understand that the results may or may not be relevant to lupus patients who are steroid resistant. Previous studies had shown that steroids slow down the reproduction of certain kinds of immune cells called CD4+ T cells. By limiting the number of these cells, steroids help reduce inflammation and other signs of autoimmune disease. But not all CD4+ T cells are the same. Some CD4+ T cells produce large amounts of a protein called CD25; these cells are called CD4+CD25high; others produce none, so they are called CD4+CD25- ("negative"). In between these two extremes is a group that produces an intermediate amount, and those cells are called CD4+CD25int. Who was studied? The researchers obtained blood samples from 23 healthy individuals and 6 patients with ulcerative colitis who had a history of steroid resistance. All of the people in the study were Caucasian, and men outnumbered women by 2 to 1 in both the healthy group and the SR patients. How was the study conducted? Blood samples were taken, and the blood was processed so that the researchers had collections of immune cells to work with. They treated these immune cells with chemical techniques so they would show up under a microscope, and so that it could be determined how much CD25 they had. They also measured how many times the cells divided, which is a measure for their reproduction (more dividing cells are seen in inflammatory states). They then exposed these cells to different doses of a steroid medicine called dexamethasone to see which kinds of cells responded and which did not, and compared the responses from the cells of the healthy individuals and the SR ulcerative colitis patients. What did the researchers find? Very weak doses of dexamethasone had little effect on the reproduction of either the CD4+CD25- T cells or the CD4+CD25int T cells, both of which continued to divide and multiply at the same rate that was seen without any steroids. However, as the researchers increased the doses of dexamethasone to the levels usually given to treat patients, the two different kinds of T-cells responded quite differently. Reproduction of the CD4+CD25- T cells slowed down considerably and was even more limited as the dose was further increased. The CD4+CD25int T cells did not appear to be affected by the dexamethasone and continued to divide and create more cells regardless of the dose of the steroid. When comparing the two groups from whom the samples were obtained, the researchers noted that the percentage of CD4+CD25int T cells was much higher in the SR ulcerative colitis patients than in the healthy subjects. There were some healthy subjects (17%) whose T cells also showed high steroid resistance, which led the researchers to conclude that steroid resistance was not necessarily a function of the disease, but a characteristic of the individual person whether or not they were ill. This may be a benign factor until a person has an illness that would benefit from steroid treatment. What were the limitations of the study? This study was conducted not on lupus patients, but rather on ulcerative colitis patients, which is a different autoimmune disease entirely. These findings may or may not apply to people with lupus who do not respond to treatment, but would certainly be worth studying in lupus patients. Also, the study participants were all Caucasian. This is both an asset and a detriment to the study. It is an asset because ethnic differences in normal steroid responsiveness would not confuse the picture as much (of course all Caucasians are not alike as proven by this study). It is a detriment because it is not yet possible to apply the results to people from other genetic backgrounds. Also, in this study men outnumbered women, which is precisely the opposite of what occurs in lupus. Another limitation is the fact that the researchers focused only on the T cell populations, which are only a minority of immune cells. Though their findings did seem to indicate a role for CD4+CD25int T cells in promoting steroid resistance, there could still be other factors involved that also contribute. What do the results mean for you? Although their number is small, lupus patients who do not respond to steroid medicines face a number of challenges. Steroids are one of the most immediately effective treatments for lupus flares, despite the fact that they have distressing side effects. So although most patients (and their doctors) prefer to avoid steroids, they are often extremely effective in moderate to severe flares and can even be life-saving. Against that background, this study holds out a possible way for doctors to use blood tests to identify which of their lupus patients may or may not respond as well to steroids, which might lead to more aggressive dosing in emergencies or earlier introduction of other strong immune suppressants. In addition, if researchers can know for sure which factors contribute to steroid resistance, there is the possibility that treatments can be developed to overcome those problems. For those reasons, this study offers hope that more sophisticated approaches can be developed in the future to provide safer and more effective (and individualized) treatments. source Labels: Glucocorticoids, Inflammatory Diseases, research, steroid
~~~ A Clue to Congenital Heart Block What is the topic? Neonatal lupus is a condition that can occur when anti-SSA/Ro antibodies cross the placenta in pregnancy from the mother to her developing baby. Babies born to women who are positive for anti-SSA/Ro antibodies (even women who do not have lupus) are at greater risk for neonatal lupus, although this remains rare. A number of symptoms are seen in infants who are born with neonatal lupus, most commonly skin rashes or liver involvement, which go away over time as the infant’s own immune system develops, and the mother's antibodies are cleared from the baby’s system. Even more rarely, however, there is a potentially life-threatening heart condition that these babies can be born with, called congenital heart block (CHB). It is possible to diagnose this condition in the baby while it is still in the womb (usually in the second trimester of the pregnancy) by picking up an irregular heartbeat using a special kind of sonogram called a fetal echocardiogram. Early CHB may be reversible with treatment, but in the later stages a baby may require a pacemaker at the time of birth. Just because a pregnant woman has anti-SSA/Ro antibodies does not automatically mean that her baby will develop CHB. In fact, the first offspring of only 2 percent of pregnant women who test positive for anti-SSA/Ro develop CHB; furthermore, in those women whose first babies did have CHB, there is only a 20 percent recurrence in future pregnancies. Also, when an anti-SSA/Ro mother has identical twins, more often one will develop CHB and the other will not. All of this evidence suggests that there are other additional factors besides anti-SSA/Ro that determine whether a baby will develop CHB. What did the researchers hope to learn? One important piece in the puzzle for the researchers in this study was the fact that CHB tissue has a lot of scarring; this was surprising because fetal tissue is supposed to heal without permanent scarring. They hoped that they could learn what was causing this scarring, and whether it could shed further light on the development of CHB. Previous work had led them to focus on the possibility that the heart cells were not receiving an adequate supply of oxygen, a condition called hypoxia. Who was studied? Studying changes at the cellular level that may be involved in CHB is especially challenging. Only a very small percentage of the cases of CHB result in the death of the fetus, and when death does occur, it is usually several weeks or more after the irregular heart beat that is characteristic of CHB is first detected. Tissue samples taken at that time may not accurately reflect the changes that brought on the abnormal rhythm. The researchers in this study, however, had access to the hearts of two fetuses that died within days of showing the initial signs of CHB, one during the 20th week of the pregnancy and the other during the 22nd week. Tissue from these two hearts provided a picture of the state of the cells very close in time to the moment when the irregular heart beats were detected. They also had heart tissue from a fetus with no sign of CHB that had died at age 23 weeks. In addition, the researchers obtained samples of cord blood from 67 babies whose mothers were positive for anti-SSA/Ro antibodies; 31 of these babies had CHB, while 36 did not. Cord blood is the baby’s blood that remains in the umbilical cord after the baby is delivered. They also had heart tissue samples from seven other fetuses and both heart and lung tissue samples from three other fetuses. They treated cells from these tissues with chemicals that simulated the conditions that would occur if they did not receive a sufficient supply of oxygen in the womb. Following those treatments, the researchers used other techniques to get the treated cells to replicate over and over, to see if there were any changes after the exposure to low oxygen conditions. How was the study conducted? All of the work was done by examining cells and tissue samples with microscopes. Some of the cells were treated with chemicals to create changes similar to those that might occur under conditions of hypoxia in the womb. The cord blood was analyzed to measure the level of erythropoietin in the cells; because erythropoietin helps cells make use of oxygen, the researchers used increased levels of erythropoietin as a sign that the cells were not otherwise receiving enough oxygen, and therefore hypoxic. What did the researchers find? Examining the heart tissue from the 20- and 22-week-old fetuses with CHB, the researchers found cell types that cause scarring, and it appeared to have developed fairly recently, especially around the area of the heart that is responsible for regulating the heart rhythm. They also found chemicals in the tissue that are produced in reaction to hypoxia. The heart tissue from the 23-week-old fetus without CHB did not exhibit scarring, or signs of hypoxia. The researchers used the heart and heart and lung tissues from the other fetuses to observe how the different tissues responded to hypoxic conditions. The fetal heart tissue showed changes in the activity of the cells, including making proteins associated with scarring. This was not found in the lung tissue, which continued to produce fetal cells that did not promote scarring. Among the chemical changes that followed hypoxia in the heart tissue, the researchers found one compound was released that stimulated the production of cAMP, a chemical which helps to protect cells from producing scar tissue. However, it did not appear that even the higher levels of cAMP could fend off all of the scarring when CHB begins to develop. The researchers noted significant differences in the levels of erythropoietin in the cord blood between infants born with CHD and those without, suggesting that the cells in the CHD infants were struggling, and needing more oxygen. When they began this study, the researchers already had a theory of how CHB develops. They saw CHB resulting from a succession of immune response processes. One of those steps involved changes in heart tissue that would lead to the production of cells that cause scarring. The researchers see the findings of this study as supporting that theory, citing hypoxia as adding to the forces that cause scarring in fetal heart cells. What were the limitations of the study? The researchers for this study discuss some of the limitations of this study in their paper. Though this team of scientists was fortunate to obtain access to hearts of two rare fetuses that died soon after their CHB showed up, tissue samples from many more cases of CHB would need to be analyzed to see if their findings about hypoxia and scarring hold up. What do the results mean for you? Most women with lupus will deliver healthy babies. For the very small number of those with anti-SSA/Ro antibodies who are at risk for their baby developing neonatal lupus, CHB remains a concern, since, although it is rare, it can be life-threatening to the baby. This study offers an interesting perspective on what may be taking place to cause the baby’s abnormal heart rhythm, and contributes one more potentially important link in the progress towards defeating this complicated illness. One biq question revolves around cause and effect: does the hypoxia cause the scarring of the heart tissue, or does the damaged tissue cause the heart to be unable to provide enough oxygen? And when does the damage occur? The change in the heart rhythm that indicates CHB may show up close to the 20th week of pregnancy, but that doesn’t mean the damage hadn’t begun weeks before. Also, the researchers don’t have the answer to why the increased cAMP doesn’t prevent the scarring, since that is one of its functions. Is it too little too late? Perhaps there is some damage to the heart that makes it unresponsive to cAMP. These and other questions will probably remain unresolved for some time, however, because of the difficulty in obtaining enough tissue samples from different cases when CHB is developing. source Labels: cAMP, heart, Human Fetal Cardiac Fibroblasts, Hypoxia, neonatal, pregnancy
~~~ Are Increased Levels of Nitric Oxide a Sign of Kidney Damage in Lupus? What is the topic? Lupus disease activity often occurs without any apparent signs or symptoms. This is especially true when lupus affects the kidneys, which is known as lupus nephritis. It is possible for lupus to cause significant kidney damage even before a patient is diagnosed. However, though there may be no visible symptoms, there are chemical changes occurring in the cells and tissues that can be measured. Therefore, a major emphasis among lupus researchers is to find simple laboratory tests can be used to detect otherwise silent lupus disease activity. A laboratory test that can be used in this way is called a biomarker. One potential biomarker that is being investigated is nitric oxide (chemical symbol, NO), since NO is one of the chemicals involved in the body’s immune response. What did the researchers hope to learn? The researchers wanted to see if there was any relation between the level of NO and lupus, and if increased levels of NO were related to lupus nephritis. Who was studied? Eighty-three adult lupus patients and 40 healthy people of similar age and background were recruited for this study. Ninety five percent (95%) of the lupus patients were women; 80% were African American; both percentages were higher than those in the healthy group. The researchers divided the 83 lupus patients into three groups: (1) lupus patients with no history of nephritis; (2) lupus patients with history of nephritis but no active kidney disease; and (3) lupus patients with active kidney disease that required a biopsy (a biopsy involves removing tissue from the kidney and studying it with a microscope and with other special laboratory techniques). Among the 83 lupus patients, 49 either had a history of nephritis or had active nephritis over the course of the study. How was the study conducted? At their first visit, all of the patients had blood samples taken, and these blood samples were tested for levels of nitrates and nitrites, which are indications of nitric oxide production; together the nitrates and nitrites are called NOx. The researchers compared the NOx levels of the lupus patients and the controls. They also did further comparisons of the lupus patients’ NOx levels with other standard laboratory measures used to evaluate lupus, such as the presence of certain antibodies and other immune system agents (called complement) in the blood, or protein in the urine. The lupus patients had regularly scheduled visits every 3 months for at least one year (some were seen for as long as two years). During those visits further blood tests were taken to measure NOx levels at that time, and other tests conducted to evaluate their lupus disease. Patients who had signs of active lupus nephritis had biopsies of their kidneys. Since both smoking tobacco and certain foods can raise the blood levels of NOx, participants in the study agreed not to smoke and to eat only a low-NOx diet 24 hours before each visit. What did the researchers find? As expected, the researchers found that the blood levels of NOx in the lupus patients were significantly higher than those without lupus at the first visit. Furthermore, among the lupus patients, those with active lupus nephritis had higher levels than in the other groups. Also, higher levels of NOx were associated with several of the standard laboratory measurements for lupus, including elevated levels of protein in blood and urine (which are signs of kidney disease) and lowered complement, especially the C3 form of complement. Over time, higher NOx levels were associated with greater lupus disease activity. Turning their attention to the group of patients who had undergone a biopsy for active lupus nephritis, the researchers found that the patients with the highest level of NOx also had the most serious degree of kidney damage. They also looked at how the patients with kidney disease responded to medical treatment; those patients who did not get better (“non-responders”) had higher levels of NOx than those who did respond. There are two reasons why a chemical can be increased in the bloodstream: either the body is making increased amounts, or the body is not efficiently eliminating the chemical which is being made. The researchers did another series of tests to make sure that the NOx levels were a result of higher production and not because the kidneys were less able to remove the NOx compounds from the blood. Those tests showed that it was, indeed, increased production and this appeared to be related to the activity of C3 complement. All of these findings led the researchers to conclude that elevated levels of NOx in the blood could be a potential useful marker for lupus disease activity. They also suggested that any medication that aimed to prevent kidney damage in lupus patients might have to limit the production of NO. However, just because something is a marker for disease activity does not necessarily mean that all effective treatments would have to eliminate it. If NO is triggering something else that damages the kidney, then a treatment aimed at that second thing might be effective for nephritis regardless of the NO level. What were the limitations of the study? The size of the study group -- 83 lupus patients -- was small, especially considering how different the inflammation of lupus can be from one person to the next. Also, nearly 80% of the lupus patients in the study were African Americans; that is a good aspect of the study, since people of African descent may have worse kidney involvement and have previously not been studied well enough. However this does limit the ability to draw conclusions about people with lupus who might be from different genetic backgrounds. There are also some limitations to the measurements used. As the researchers themselves pointed out, lupus activity rises and falls over time, and measurements taken at three-month intervals really may not capture important information during the intervening months. Of less concern, but something that should be noted, the researchers didn’t really measure the levels of NO itself, but used the blood levels of nitrate plus nitrite as indicators of NO production. This measurement seems to be useful, but much more could be learned about the specific chemical changes that are going on and in what way they may impact the kidney. What do the results mean for you? A number of previous studies had pointed to increased NO production as an important factor in lupus, but those studies were "after the fact"; they only looked back at the records of lupus patients to see if there were any associations. This was the first study to examine the relationship going forward, following lupus patients over time, and gathering information about NO levels in the course of their treatment and evaluation. Thus, it adds strength to the notion that NO may be a useful biomarker for lupus disease activity that could help doctors know what is going on when their patients may not have obvious symptoms. Their suggestion that limiting NO production might be important to consider for new medications for lupus nephritis is also very intriguing. Both of these points -- the value of NOx as a biomarker and its role as a target for new medications -- are definitely worthy of further studies. source Labels: kidney, lupus neprithis, Nitric Oxide, research
~~~ Kidneys Affected in 40 Percent of People with Lupus Wednesday, March 05, 2008 March 3, 2008It is estimated that as many as 40 percent of all people with the autoimmune disease lupus, and as many as two-thirds of all children with lupus, will develop kidney complications that require medical evaluation and treatment. Because there are so few symptoms of kidney disease, significant damage to the kidneys can occur before a person is actually diagnosed with lupus. Lupus nephritis is the term used when lupus causes inflammation in the kidneys, making them unable to properly remove waste from the blood or control the amount of fluids in the body. Abnormal levels of waste can build up in the blood, and edema (swelling) can develop. Left untreated, nephritis can lead to scarring and permanent damage to the kidneys and possibly end-stage renal disease (ESRD). People with ESRD need regular filtering of their body’s waste done by a machine (dialysis), or a kidney transplant so that at least one kidney is working properly. This occurrence greatly affects the person’s quality of life and life expectancy. In the early stages of lupus nephritis, there are very few signs that anything is wrong. Often the first symptoms of lupus nephritis are weight gain and puffiness in the feet, ankles, legs, hands, and/or eyelids. This swelling often becomes worse throughout the day. Also, the urine may be foamy or frothy, or have a red color. Diagnosis Often the first signs of lupus nephritis show up in clinical laboratory tests on the urine. That is why a urine test, or urinalysis, is an important screening tool. In addition, certain blood tests can provide information about kidney damage and how well the body is filtering waste. A physician also may order a kidney biopsy in which a tiny piece of tissue from one of the kidneys is removed for testing. Treatments Even though lupus nephritis is among the more serious complications of lupus, there are effective treatments. Prednisone and other corticosteroids are generally prescribed to stop the inflammation. Immunosuppressive drugs may also be used (with or in place of steroid treatments), such as cyclophosphamide (Cytoxan®), azathioprine (Imuran®), cyclosporin A, and mycophenolate mofetil (CellCept®). Medications developed for other illnesses are also being studied as treatments for lupus nephritis, including rituximab (Rituxan®), eculizuimab (Soliris™), and abetimus sodium (Riquent™). source Labels: kidney, lupus neprithis
~~~ Early signs of lupus, even before a diagnosis can be made? Friday, October 26, 2007 Clinical criteria for systemic lupus erythematosus precede diagnosis and associated autoantibodies are present before clinical symptomsWhat is the topic? Diagnosing lupus is can sometimes be difficult. Because lupus symptoms may come and go and resemble other illnesses, it may take months or even years before a doctor can sort out what is going on. During this run-up period, most doctors agree, lupus disease activity is probably taking place, and lupus-related antibodies may be present even before symptoms occur. What did the researchers hope to learn? The researchers wanted to find out which symptoms tended to appear early on in most lupus patients and what antibodies might be present before certain clinical symptoms appear. They hoped this kind of analysis might provide clues about lupus disease activity and what course the disease might take even before symptoms are apparent. Who was studied? The researchers selected 130 patients who were diagnosed with lupus while they were in the United States military. Whenever someone joins the military, he or she has a baseline medical examination that includes an in-depth physical examination, medical history, and blood tests. The researchers would be able to use that information to look for signs of lupus and run tests for antibodies that were present before the diagnosis was made. How was the study conducted? Medical records for each of the 130 patients in the study were reviewed, and the researchers collected information about various features of lupus if and when they occurred, and if they appeared before the lupus diagnosis was made, how many months/years before. They also ran antibody tests on the blood samples to see what antibodies might have been present before clinical symptoms appeared. The researchers compared all of this information for patients based on their ethnic background, age when they were diagnosed with lupus, and the time frame separating symptoms’ appearance and diagnosis. What did the researchers find? Of the 130 patients studied, 104 had at least one clinical feature present before the diagnosis was made. Most of these patients (74) had only a single feature. The initial feature varied widely from patient to patient, but the most common early symptom was arthritis. In terms of time, discoid rash and seizures tended to be the earliest findings, occurring nearly two years before the diagnosis was made; interestingly, central nervous system involvement, which was one of the earliest problems to appear in patients in the study, did not commonly appear after the diagnosis. There were also interesting differences across populations. Men were more likely than women to have kidney disease as a first symptom, and Caucasians more likely than African Americans to have early rash on the cheeks and rashes that were made worse in the sun. Of the 104 patients who had clinical symptoms before their diagnosis, antibodies were often detectable before these symptoms. Antinuclear antibodies (ANA) showed up in 81 before the initial symptom. Seventeen patients had rheumatoid factor present when their blood was tested; arthritis developed later in 16 of them. As for anti-dsDNA and anti-C1q antibodies, which have been associated with kidney disease in lupus, 80 patients were positive for anti-dsDNA, and 38 of these patients had kidney disease; in 92 percent of these cases, the anti-dsDNA antibodies were detected prior to or at the same time as the diagnosis of kidney disease. About half of the patients who had anti-C1q antibodies developed kidney disease, but half did not; however, among the 18 anti-C1q patients who did have kidney disease, in 13 cases the antibodies showed up before the kidney disease was diagnosed, on average nearly one and a half years beforehand. What were the limitations of the study? The study was limited by the fact that the researchers had to rely on previously collected data, which had been provided for other purposes rather than specifically to look at lupus symptoms and lupus disease. Therefore, some lupus symptoms (like mouth sores) might not have been recorded because they weren’t really being looked for and they weren’t considered important in the overall health record of the patient at the time. Since the doctors following these patients before they were known to have lupus would not usually have been rheumatologists, there might have been many features of lupus that were simply missed. Also, though the researchers had at least one pre-diagnosis blood sample for each patient in the study, for some that was all they had, and the time intervals between that blood test and the lupus diagnosis varied greatly. For some patients there may have been changes in the antibody profile during that interval that the researchers wouldn’t have known about. What do the results mean for you? This study reinforces the notion that a lot of lupus disease activity may be taking place without patients’ or their doctors’ knowing it, in many cases long before the patient is diagnosed with lupus. However, the presence of certain antibodies may be a sign that later clinical symptoms are likely to appear, and so finding these antibodies early on when a patient has only one or a couple of symptoms may help doctors decide how they manage different patients, both before and after they have enough clinical criteria to determine a patient has lupus. On the other hand, it is also known that many family members of patients with lupus have lupus-related antibodies for many years without ever developing lupus. Some people can have these antibodies detectable temporarily during a viral illness or for unknown reasons, and then they go away. And as people age, they sometimes develop lupus-like antibodies as well, without becoming ill. The development of certain autoantibodies is probably one of several events that have to occur before a person develops lupus.
~~~ New symptom related to neonatal lupus What is the topic? Neonatal lupus erythematosus (NLE) is a rare but serious condition that can occur in newborn babies, and is related to anti-Ro (SSA) and/or anti-La (SSB) antibodies, which can cross the placenta in pregnancy from the mother to the fetus. A number of symptoms are seen in infants with NLE, most commonly a skin rash or liver involvement, both of which go away over time as the infant’s own immune system replaces the mothers circulating antibodies. However, a potentially serious heart condition called congenital heart block also can develop and will require medical attention. Developing babies of women with anti-Ro antibodies need to be monitored in the womb for heart block, though only a small number of pregnancies in women with lupus will result in this serious complication. In addition, some reports point to neurological symptoms that may be present in rare cases of NLE. What did the researchers hope to learn? The researchers sought to determine if infants born with NLE were at greater risk for hydrocephalus, a condition characterized by excess spinal fluid in or around the brain, which in turn contributed to macrocephaly, an enlarged head size. Who was studied? The study followed 87 infants born to selected, high risk women with anti-Ro antibodies and who were seen at the Hospital for Sick Children (HSC) in Toronto. Of the 87 infants studied, 47 were diagnosed as having NLE. How was the study conducted? Each of the 87 infants enrolled in the study was seen at least once in a follow-up visit, and more than 90% were seen more than once. What did the researchers find? The researchers found that the infants born to anti-Ro positive mothers developed hydrocephalus and macrocephaly at higher rates than would be expected. The rate of hydrocephalus was higher in both the group of infants with NLE and those identified as otherwise healthy. The researchers suggest that hydrocephalus be considered a new and independent manifestation of NLE, which may occur in association with other symptoms of NLE or alone. It is also important to point out that four of the five NLE infants who developed hydrocephalus were neurologically healthy, and in all but one of the infants, the abnormalities in head size and fluid volume resolved spontaneously over the course of time after their second birthday. What were the limitations of the study? The results of this study were similar to other investigations that showed an association of macrocephaly with NLE. It would have been better to compare this outcome to babies born to other lupus patients without anti-Ro antibodies and to the babies born to a group of healthy mothers attending this same hospital. Specialist hospitals such as this one could be attracting an overall more high risk group of patients with or without the Ro antibodies. What do the results mean for you? Women with lupus who have anti-Ro antibodies who are pregnant or intend to become pregnant need to be aware of the possibility their baby may develop NLE, which can have serious complications, albeit the serious complications are rare. These women should receive specialist high risk prenatal care and their babies should be monitored after birth by knowledgeable pediatricians.
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