Lupus nephritis (LN), a common manifestation of systemic lupus erythematosus (SLE), accounts for significant morbidity and mortality in SLE patients. Since the available standard therapies and biologic agents for LN are yet to achieve the desired response and have considerable secondary effects, stem cell therapy has now emerged as a new approach. This therapy involves the transplantation of hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs). Our current review will highlight the progress of stem cell therapy for LN, along with the challenges encountered and the future direction of this approach.

Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by diverse clinical manifestations and a broad spectrum of disease course and prognosis. Often presenting over an extended period, delays in diagnosis can significantly influence patient management and survival, particularly when faced with rare complications such as digestive system manifestations. This case report uniquely highlights the diagnostic and therapeutic challenges posed by severe abdominal pain in a young woman suspected of SLE, with a symptom often masked by steroid therapy or immunosuppression. The diagnostic journey, which led to the identification of SLE as the cause of abdominal pain, involved differentiating SLE from various abdominal pathologies including abdominal vasculitis, gastrointestinal syndrome, antiphospholipid antibody syndrome, pancreatitis, urinary tract infections, and obstetric-gynecological abnormalities. This case underlines the critical need for accurate, timely diagnosis, and targeted therapy in managing SLE, emphasizing the potential implications of such complexities on patient outcomes.

A B S T R A C TBackground. Systemic lupus erythematosus (SLE) is a chronic autoimmunedisease which has a variety of clinical phenotypes with a complex clinical course.The clinical phenotypes are highly variable which can be characterized by acuteattacks, active periods, controllable or remission. Mean platelet volume (MPV) is astraightforward accessible indicator of platelet activity and is associated withsystemic inflammation. The routine usage of MPV as markers for disease activityin SLE remains problematic. Early detection of disease progression is pivotal in themanagement of SLE for obtaining better outcomes. Objective. The study aimed toconfirm that the measurement of the disease severity in patients with SLE usingMex-SLEDAI has a negative correlation with the decrease of MPV value. Methods.This cross-sectional analytic descriptive study was conducted using secondary datafrom the medical records of patients with SLE older than 18 years of age who werenot taking antiplatelets in the Internal Medicine policlinic of Dr. Sardjito GeneralHospital in 2018. Patients with a previous history of cardiovascular andcerebrovascular events, malignancies, receiving a treatment for infections,including sepsis, chronic infections (i.e. tuberculosis, cytomegalovirus, herpessimplex, herpes zoster), HIV, hepatitis B or hepatitis C, and incomplete data ofmedical record were excluded. The correlation between SLEDAI Mex and MPVvalues was evaluated using the Spearman's correlation test. Results. Sixty-sevensubjects (65 women, 2 men) aged 34 ± 11 years were recruited in the study. Themedian duration of diagnosis was 38,2 ± 45,7 months. Arthritis, skin rash andphotosensitivity were identified in 81,1%, 53,7%, and 46,3% of patients,respectively. The Mex-SLEDAI score ranged from 0 to 16. The average of MPV valueis 9.73 ± 1.21 fL. A significant correlation between MPV and SLEDAI Mex wasobserved (p = 0.03 (p <0.05), r = -0.255). Conclusion. The more severe SLE diseaseactivity (based on the Mex-SLEDAI scoring), the more negative correlation with theMPV value.

Background Knee osteoarthritis is more frequently found in women than men. Osteoarthritis pathophysiology is based on inflammatory and degenerative process. The role of inflammation in osteoarthritic pain is varied time over time among patients. Pain perception is different between men and women. Pain in osteoarthritis patients is not only caused by inflammatory process, but also from neurogenic and psychogenic process. Objectives The objectives of this study were to recognize the difference of COX-2 expression by monocytes of synovial fluid and pain perception between men and women with knee osteoarthritis. Methods This was a cross-sectional study. Eighty patients with knee osteoarthritis based on American College of Rheumatology (ACR) criteria, from Rheumatology Clinic of Sardjito Hospital, whose age more than 50 years old and agreed to participate, were selected. Subjects underwent washing period by not consuming anti-inflammatory drugs for a week. Synovial fluids were aspirated from more painful knee. Dried smear preparations were made, and stained using immunocytochemistry method. COX-2 expressions by synovial fluid monocytes were classified into 4 grades, based on monocyte cytoplasm color. Pale monocyte cytoplasm which didn't express COX-2 were scored 0, light brown monocyte cytoplasm which expressed small amount of COX-2 were scored 1, brown monocyte cytoplasm which expressed medium amount of COX-2 were scored 2, and dark brown cytoplasm which expressed large amount of COX-2 were scored 3. The individual mean scores of COX-2 expressions were calculated from the average of 100 monocytes. Knee joint pain was assessed using Visual Analogue Scale (VAS), 0 – 100 mm score. Statistical analysis was done by Duta Wacana Christian University Statistic Center. Results There were 27 men and 53 women. Body mass index, age, and time suffering from osteoarthritis, were not different between groups. The mean ± SD of COX-2 expression scores were 1.95±0.36 in men and 1.80±0.38 in women. COX-2 expression scores were significantly higher (p=0.038) in men (median (IQR), 2.14 (0.63)) compared to women (median (IQR), 1.81 (0.62)). VAS scores were significantly higher (p=0.035) in women (mean ± SD: 56.52±22.67 mm) than men (mean ± SD: 44.33±26.43 mm). Conclusions In patients with knee osteoarthritis, women had more severe pain despite lower COX-2 enzyme expressed by synovial fluid monocytes than men. References Elboim-Gabyzon M, Rozen N, Laufer Y. Gender differences in pain perception and functional ability in subjects with knee osteoarthritis. ISRN Orthopedics. 2012;413105. doi: 10.5402/2012/43105. Neogi T, Frey-Law L, Scholz J, Niu J, Arendt-Nielsen L, Woolf C. Nevitt M, Bradley L, Felson DT. Sensitivity and sensitisation in relation to pain severity in knee osteoarthritis: trait or state? Ann Rheum Dis. 2013. doi: 10.1136/annrheumdis-2013-204191 (Abstract). Tonelli SM, Rakel BA, Cooper NA, Angstom WL, Sluka KA. Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activi...