bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and laboratory features of patients of Vietnamese descent with systemic lupus erythematosus
Authors: Phan J C , Bush T M , Donald F , Ward M 
Published: November 2003

The prevalence rate and disease manifestations of systemic lupus erythematosus (SLE) have been noted to vary among different ethnic groups. There has been no description in the English literature of SLE in the Vietnamese population. This is the first report, which details the clinical and laboratory features as well as an estimation of the prevalence of SLE in patients with a Vietnamese ancestry living in the United States. We performed a retrospective chart review of clinical and laboratory features of patients of Vietnamese descent with SLE. The case finding was performed by a review of the rheumatology clinic records at two large teaching hospitals in Santa Clara County searching for patients with SLE with a Vietnamese surname. In addition, we recruited patients by contacting all of the rheumatologists practicing in the county. Twenty-three patients of Vietnamese descent were identified with SLE in Santa Clara County. The estimated prevalence of SLE in the patients of Vietnamese descent was 42 cases per 100 000 persons. Eighty-seven per cent of the cases were born in Vietnam. The clinical and laboratory features of SLE were similar to prior published reviews except for a relatively high prevalence of anti-RNP antibody (54%). The patients with anti-RNP antibody exhibited features of overlap syndrome. There was a high rate of exposure to tuberculosis (TB). Fifty-eight per cent of patients had a positive purified protein derivative (PPD) skin test and 27% of patients had a history of clinical TB. Forty-four per cent of patients had evidence of hepatitis B exposure. The prevalence of SLE in the Vietnamese population in Santa Clara County is similar to that of other Asian populations. There was a relatively high prevalence of anti-RNP antibody in our patient group which was associated with overlap features. As expected in an immigrant population from Southeast Asia, there was a high rate of prior exposure to tuberculosis and hepatitis B. Clinicians should diligently screen for these infections and appropriately prophylaxe and treat patients.
Systemic lupus erythematosus (SLE) and hair treatment: a large community based case-control study
Authors: Hardy C J , Palmer B P , Muir K R , Powell R J 
Published: November 2003

Objective: To investigate the association of hair treatment, including permanent and non-permanent dyes, bleach, highlights and lowlights on the development of systemic lupus erythematosus (SLE). Methods: 150 SLE patients and 300 controls from Nottingham, UK were interviewed in a casecontrol study. Controls were matched to cases for gender and year of birth. All patients met at least four of the American Rheumatology Association criteria for SLE. Controls were randomly selected from the Nottingham Family Health Services Authority register. Information was collected via an interview-administered questionnaire concerning demographic variables and hair treatment. Results: For hair treatment no significant associations were observed between ever using permanent colouring, non-permanent colouring, bleach or lowlights, and disease. Nevertheless a significant association (OR 0.55, 95% CI 0.31–0.95) was observed between ‘ever having’ used highlights and disease with cases having used highlights less frequently than their healthy counterparts. No significant differences were observed in duration of usage of hair bleach, permanent colouring, non-permanent colouring, highlights and lowlights between cases and controls. Conclusions: Hair treatment or duration of hair treatment usage is not significant in the aetiology of SLE. Although patients with SLE were less likely in this study to have highlights than controls, for all other hair treatments no differences were observed.
Risk factors for hypercreatinemia in patients with systemic lupus erythematosus
Authors: Rzany B , Coresh J , Whelton P K , Petri M 
Published: November 2003

Renal insufficiency is one of the most severe outcomes of systemic lupus erythematosus (SLE). The aim of this study was to identify baseline predictors of the development of renal insufficiency in a cohort of patients with SLE. 281 patients from the The Hopkins Lupus Cohort (HLC) enrolled between 1987–1994 were followed for the occurrence of renal insufficiency, defined as a serum creatinine 1.6 mg/dl for men and 1.4 mg/dl for women. Over a mean (±s.d.) of 3.3±2.1 y of follow up, 46 (16%) of the 281 patients developed renal insufficiency. Using a multivariate Cox proportional hazard model, we found the risk of renal insufficiency associated with younger (0–19 y) or older (40 y) age at baseline (relative risk (95% CI) 5.1 (1.4, 18.8) and 4.1 (2.1, 8.2)) and longer duration of SLE before referral to the cohort (RR 1.25 [1.05, 1.5] for every five years). Additional predictive variables were borderline elevation of serum creatinine at baseline (RR 3.1 (1.4, 6.6) for a serum creatinine 1.4–1.5 mg/dl for men and 1.2–1.3 mg/dl for women), and mean proteinuria (RR 3.6 (1.8, 7.4) for trace–3 + and 10.6 (3.8, 30.0) for 3 + (urine dipstick level)). Socioeconomic status, race, autoantibodies and complement were not significantly associated with the risk of renal insufficiency. This study supports early referral of SLE patients to rheumatologists and emphasizes the importance of early signs of renal involvement as predictors of later renal insufficiency in SLE patients.
Immunisation of patients with systemic lupus erythematosus: the current state of play
Authors: Ioannou Yiannis , Isenberg David A 
Published: November 2003

Concerns regarding the safety and efficacy of immunisation in patients with SLE have persisted for over 50 y and indeed infection remains a leading cause of morbidity and mortality in these patients. There have been many anecdotal reports in the literature linking vaccination with either induction or exacerbation of SLE disease. However prospective studies have shown that immunisation with inactivated/killed vaccines is probably safe in patients with SLE. Individuals on immunosuppressive agents and/or high dose steroid (more than 20 mg/d) should not receive live vaccines, as stated in guidelines proposed by the British Society of Rheumatology. The safety of hepatitis B vaccination in patients with SLE is as yet undetermined and a prospective study is required. However until such evidence becomes available the advice of the BSR should be followed and patients with SLE who are at risk of exposure should be vaccinated. It remains uncertain whether the immune response to immunisation is significantly impaired by active disease and/or immunosuppressive treatment and to what extent. Most patients do however seem to mount a satisfactory immune response though this may not be quantitatively and qualitatively the same as healthy controls.
Mycophenolate mofetil for the treatment of systemic lupus erythematosus: an open pilot trial
Authors: Gaubitz Markus , Schorat Annette , Schottel Heiko , Kern Peter , Domschke Wolfram 
Published: November 2003

Objective: To investigate the effectiveness and safety of mycophenolate mofetil in patients with systemic lupus erythematosus who were inadequately controlled with corticosteroids, antimalarials, and other immunosuppresive agents.Methods: Ten patients with systemic lupus erythematosus (SLE) were treated with 1500-2000 mg mycophenolae mofetil (MMF) daily for a median observation time of 11.2 ± 2.4 (8-16) months in an open clinical trial. The effectiveness and safety of treatment were analyzed using an established disease activity score, clinical status, and laboratory parameters.Results: All patients improved under treatment with no or only minor side effects. The disease activity score (SLAM) decreased statistically significantly from a median of 15.6 ± 5.5 to 9.9 ± 4.1 after three months (P < 0.01) and to 8.0 ± 3.3 after six months (P < 0.01). Hematologic parameters did not change significantly whereas a reduction of inflammatory markers was observed. Four patients with SLE-nephritis already treated with cyclophosphamide pulse therapy continuously showed a slight improvement of renal function. Prednisolone dosages could be reduced significantly from a median level of 10.0+ 5.1 mg/d before treatment to 4.6 ±3.5 mg/d after six months (P < 0.01).Conclusion: Mycophenolate mofetil is a promising option in immunosuppressive treatment of patients with moderate and severe systemic lupus erythematosus who did not show a satisfactory response to other immunosuppressives.
A study of 20 SLE patients with intravenous immunoglobulin clinical and serologic response
Authors: Levy Yair , Sherer Yaniv , Ahmed Alaa , Langevitz Pnina , George Jacob , Fabbrizzi Fabrizio , Terryberry Jeff , Meissner Martyna , Lorber Margalit , Peter James B , Shoenfeld Yehuda 
Published: November 2003

Objective: To test the clinical response of systemic lupus erythematosus (SLE) patients to intravenous immunoglobulins (IVIg), and whether the clinical response of IVIg treatment in SLE is accompanied by modification of SLE-associated autoantibodies/antibodies (Abs) and complement levels. Methods: Twenty SLE patients were treated with high-dose (2 g/kg) IVIg monthly, in a 5-d schedule. Each patient received between 1-8 treatment courses. They were evaluated for the clinical response, Systemic Lupus Activity Measure (SLAM) score before and after IVIg, levels of antinuclear antibody (ANA), dsDNA (double-stranded DNA), SS-A or SS-B, ENA (extractable nuclear antigens), C3 and C4 levels before and after the treatment, and before and after each treatment course. Results: A beneficial clinical response following IVIg treatment was noted in 17 out of 20 patients (85%). Few clinical manifestations responded more to treatment: arthritis, fever, thrombocytopenia, and neuropsychiatric lupus. In 9 patients evaluated before and after IVIg, mean SLAM score decreased from 19.3 ± 4.7 to 4 ± 2.9 (P < 0.0001). There was a tendency towards abnormal levels of complement and Abs before IVIg courses among the treatment responders compared with the non-responders, and similarly the former tended to have normalization of their abnormal levels more than the latter. These differences were found statistically significant only with respect to C4 and SS-A or SS-B levels before IVIg courses. Conclusion: IVIg has a high response rate among SLE patients. A combination of clinical manifestations, Abs and complement levels may aid in the future in predicting who among SLE patients will benefit more from IVIg treatment.
Central nervous system involvement in systemic lupus erythematosus patients without overt neuropsychiatric manifestations
Authors: Sabbadini M G , Manfredi A A , Bozzolo E , Ferrario L , Rugarli C , Scorza R , Origgi L , Vanoli M , Gambini O , Vanzulli L , Croce D , Campana A , Messa C , Fazio F , Tincani A , Anzola G , Cattaneo R , Padovani A , Gasparotti R , Gerli R , Quartesan R , Piccirilli M , Farsi A , Emmi E , Domeneghetti M , Piccini C , Massacesi L , Pupi A , De Cristoforis M , Danieli M , Candela M , Fraticelli P , Bartolini M , Salvolini U , Danieli G , Passaleva A 
Published: November 2003

Objective: To verify whether features of CNS involvement can be detected in SLE patients without overt neuropsychiatric manifestations. Methods: 114 SLE patients who had never received a diagnosis of neuropsychiatric lupus (never NPSLE) were studied and compared to 65 SLE patients with known neuropsychiatric involvement (NPSLE). The study relied on evaluation of neurocognitive functions by means of a battery of neuropsychological tests, on psychiatric and neuropsychological assessments and on neuroimaging studies (computed tomography, magnetic resonance, single photon emission computed tomography (SPECT)). Results: Clinical features, including disease duration/activity and pharmacological therapy, of never-NPSLE and NPSLE patients were similar. Short-term and long-term memory, visuo-spatial and verbal information processing were similarly compromised in never-NPSLE and in NPSLE patients; only attention was significantly more compromised in NPSLE patients. Psychiatric morbidity was higher than expected in never-NPSLE patients, although less than in the control neuropsychiatric group. Ischemic lesions, multiple small high intensity lesions and cortical atrophy, detected by CT and MR scans, as well as abnormal SPECT were also frequently detected in never NPSLE patients. Interestingly, left parietal and occipital area hypoperfusion by SPECT was significantly more frequent in the patients with impaired visuo-spatial intelligence and short-term memory. Conclusions: Most abnormalities detected by available diagnostic tools and characteristics of neuropsychiatric SLE are also present in non-symptomatic patients. They may derive from an unexpected widespread involvement of the CNS and are not per se sufficient, in the absence of clinical manifestations, for a diagnosis of neuropsychiatric SLE.
Primary Sjögren's syndrome in the elderly: clinical and immunological characteristics
Authors: García-Carrasco M , Cervera R , Rosas J , Ramos-Casals M , Morlá R M , Sisó A , Jimé S , Pallaré L , Font J , Ingelmo M 
Published: November 2003

The objective of the study was to determine the clinical and immunological characteristics of primary Sjoögren's syndrome (SS) in patients with an older onset of the disease. We included 223 consecutive patients (204 female and 19 male; mean age at onset 53 years; range 15-87 years) visited in our Units. All patients were white and fulfilled four or more of the diagnostic criteria for SS proposed by the European Community Study Group in 1993. Disease onset was determined on the basis of the appearance of symptoms strongly suggestive of SS. In 31 patients the onset of disease occurred after the age of 70 years, and they represent the elderly-onset group described in this report. The remaining 192 patients presented disease onset before the age of 70 years, and they represent the younger-onset group. Of the 31 (14%) patients with elderly onset of primary SS, 26 were female and 5 male, and the disease onset occurred between 70 and 87 years (mean 74 years). The most common extraglandular manifestations were articular involvement (29%), hepatic involvement (20%), peripheral neuropathy (16%) and interstitial pneumopathy (13%). When compared with patients with a younger onset, the prevalences of glandular and extraglandular manifestations and immunological features (cryoglobulinemia, hypocomplementemia and positivity for RF, anti-Ro/SS-A or anti-La/SS-B) were similar in both groups. In conclusion, although primary SS is typically a disease of middle-aged adults, clinicians should note that it may be diagnosed frequently among elderly patients. However, we could not found any notable differences in clinical and immunological characteristics of patients with elderly onset of primary SS.
Integrin signalling defects in T-lymphocytes in systemic lupus erythematosus
Authors: Ng T TC , Collins I E , Kanner S B , Humphries M J , Amft N , Wickremasinghe R G , D'Cruz D , Nye K E , Morrow W JW 
Published: November 2003

Objective: To establish the relationship between T cell responses to integrin coreceptor stimulation and B cell hyperreactivity as measured by pathologic autoantibody production. Methods: Peripheral blood mononuclear cells from 42 patients with SLE according to the American Rheumatism Association criteria were examined for their ability to adhere to plateimmobilised fibronectin. Co-stimulation assays were performed on the same cells using anti-CD3 antibody alone or co-immobilised with an anti-b1-integrin antibody. Proliferative responses were measured by 3[H]thymidine pulsing on day 3 and activation was determined using a commercial protein kinase C assay, the protocol being established by our group in association with Promega. b1-Integrin expression was established by FACS analysis. Results: An impaired PKC response to integrin-mediated activation was found in T-lymphocytes from 6=21 (29%) SLE patients, which correlated significantly with an absence of anti-dsDNA antibody in patient sera, irrespective of prednisolone treatment. Integrin co-stimulation of TcR/CD3-induced proliferation and T cell adhesion to fibronectin were also impaired among 5=21 (24%) and 6=15 (40%) patients studied, respectively. Conclusion: We hypothesise that the integrity of b1-integrin signalling pathways may influence pathological antibody production in SLE by affecting T-lymphocyte activation and interactions between T and Blymphocytes.
Antibodies against lysophosphatidylcholine and oxidized LDL in patients with SLE
Authors: Wu R , Svenungsson E , Gunnarsson I , Andersson B , Lundberg I , Elinder L Schäfer , Frostegård J 
Published: November 2003

Lysophosphatidylcholine (LPC) is present in oxidized low density lipoprotein (oxLDL), which is implicated in atherosclerosis. Antibodies to cardiolipin (aCL) and oxLDL (aoxLDL) have been shown to crossreact. LPC is formed by hydrolysis of phosphatidylcholine (PC) in LDL and cell membranes, induced by phospholipase A2 or by oxidation. We here demonstrate the presence of enhanced antibody levels to LPC in 184 patients with SLE as compared to 85 healthy, age-matched controls. The antibody reactivity to LPC was not specifically related to oxidation of the fatty acid moiety in LPC, since LPC containing only the saturated fatty acid palmitic acid showed equivalent antibody levels as LPC containing unsaturated fatty acids. aPC were significantly lower as compared to aLPC, indicating that hydrolysis of PC at the sn-2 position increases the antigenic potential of the molecule. β-glycoprotein 1 was a cofactor for aCL, but not for aoxLDL or aLPC, and the antigenicity of these compounds is therefore not directly related to β2GP1. There was a close correlation between aoxLDL, aCL and aLPC and both LPC and oxLDL competitively inhibited aCL-binding to CL. LPC, oxLDL and CL thus display a common antigenic site, which could be formed by removal of a fatty acid at the sn-2 position, possibly due to the activity to phospholipase A2 and/or oxidation. This study indicates the potential role of LDL-oxidation and phospholipase A2 in SLE.
A double-blind, placebo-controlled, clinical trial of dehydroepiandrosterone in severe systemic lupus erythematosus
Authors: van Vollenhoven R F , Park J L , Genovese M C , West J P , McGuire J L 
Published: November 2003

Objective: To determine if dehydroepiandrosterone (DHEA) is beneficial in severe systemic lupus erythematosus (SLE). Methods: A double-blinded, placebo-controlled, randomized clinical trial in 21 patients with severe and active SLE, manifestated primarily by nephritis, serositis or hematological abnormalities. In addition to conventional treatment with corticosteroids +/-immunosuppressives, patients received DHEA 200 mg/d vs placebo for 6 months, followed by a 6-month open label period. The primary outcome was a prospectively defined responder analysis, based on a quantitatively specified improvement of the principal severe lupus manifestation at 6 months. Results: Nineteen patients were available for evaluation at 6 months. Baseline imbalance between the groups was noted, with the DHEA group having greater disease activity at baseline (P < 0.05 by physician's global assessment). Eleven patients were responders: 7/9 patients on DHEA vs 4=10 patients on placebo (P < 0.10). Of the secondary outcomes, mean improvement in SLE disease activity index (SLE-DAI) score was greater in the DHEA group (710.3 3.1 vs 73.9 1.4, P < 0.07). Bone mineral density at the lumbo-sacral spine showed significant reduction in the placebo group, but was maintained in the DHEA group. Conclusion: DHEA therapy, when added to conventional treatment for severe SLE, may at most have a small added benefit with respect to lupus outcomes, but baseline imbalances in the study population limit the generalizability of the results. DHEA appears to have a protective effect with respect to corticosteroid-induced osteopenia in such patients.
Atherosclerosis-related markers in systemic lupus erythematosus patients: The role of humoral immunity in enhanced atherogenesis
Authors: George J , Harats D , Gilburd B , Levy Y , Langevitz P , Shoenfeld Y 
Published: November 2003

Systemic Lupus Erythematosus (SLE) patients experience premature atherosclerosis. A deranged lipid metabolism and use of immunosuppressive medications accounts partially for the accelerated process. The role of autoimmunity in atherosclerosis has recently been highlighted. Autoantigenic determinants thought to play a role in the development of atherosclerosis include: modified lipoproteins, heat shock proteins and β2-glycoprotein I (a target of ‘autoimmune’ anticardiolipin antibodies). In this present work we determined autoimmune markers which may be associated with premature atherosclerotic process found in SLE patients. We have found that antibodies to oxLDL were raised in the sera of lupus patients and cross-reacted with cardiolipin and with β2GPI. OxLDL containing immune-complexes of the IgG and IgM isotypes were both elevated in the SLE patients as compared with healthy controls. Patients with high Lipoprotein (a) concentrations (> 30 mg/dl) had higher levels of IgM oxLDL-containing immune-complexes. IgM but not IgG anti-HSP-65 antibodies were elevated in the lupus patients and levels of oxLDL containing immune-complexes correlated positively with the presence of anti-HSP 65 antibodies. Lysophosphatidylcholine (LPC) is a peroxide-derivative formed during LDL oxidation, was shown to evoke a humoral response in healthy subjects. Antibodies to lysophosphatidylcholine of the IgG but not the IgM isotype were reduced in SLE patients compared with controls, suggesting it may be ‘consumed’ into oxLDL containing immune complexes. Therefore, SLE patients exhibit a humoral autoimmune response towards the antigenic candidates incriminated in the progression of atherosclerosis. These findings may help identify factors that are involved in accelerating atherogenesis in SLE patients.