Previous reports proposed that the IgM anti-dsDNA antibody is protective for lupus nephritis. In this cross-sectional study, we aimed to compare clinical features of systemic lupus erythematosus (SLE) patients positive for IgG anti-dsDNA alone with those presenting both IgG and IgM anti-dsDNA. Anti-dsDNA antibodies, urinary examination and complement levels were assessed in the day of appointment. IgG and IgM anti-dsDNA antibodies were detected by indirect immunofluorescence. Fifty-eight SLE patients (93.1% female, 81% European-derived, mean age 42.8±14.7 years, mean duration of disease 10.9±8 years) positive for IgG anti-dsDNA entered the study. Of those, 15 were also positive for the IgM anti-dsDNA isotype. The group with both isotypes showed significant less frequency of active nephritis (sediment changes and proteinuria) when compared to patients with IgG anti-dsDNA alone (6.7% versus 34.9%, p=0.046). These data suggest a nephroprotective role for IgM anti-dsDNA and a distinct biologic behavior for this isotype in SLE.
Background Systemic lupus erythematosus (SLE) is an autoimmune disease, where renal involvement is common, being a determinant for bad prognostic. Lupus nephritis is generally associated to the presence of anti-dsDNA. The IgM isotype of this autoantibody, unlike the IgG isotype, seems to be nephroprotector. Objectives To study the influence of isotypes IgG and IgM anti-dsDNA antibodies on clinical and laboratory manifestations of SLE. Methods We conducted a cross-sectional study with 137 patients with SLE, in which we explored the presence of isotypes IgG and IgM anti-dsDNA antibodies. The research of anti-dsDNA was performed by indirect immunofluorescence with Crithidia luciliae (CLIF). Results Fifty-eight (42%) patients had IgG anti-dsDNA reagent and were selected for the study of the IgM isotype. The group of patients who had anti-dsDNA IgG alone (n=43) compared with the group who had concomitant isotypes IgG and IgM (n=15), showed a higher frequency of active urine sediment (34.9% versus 6.7%, p=0.046). Analysis of the median distribution of IgG/IgM anti-dsDNA ratio, according to the presence or absence of clinical and laboratory features, showed a trend of the IgG/IgM ratio be greater in the presence of arthritis and leukopenia/lymphopenia [4 (2-8)versus 1 (1-2), p=0.070 and 4 (3-8) versus 1 (1-4), p=0.066, respectively]. Conclusions Our study showed that the concomitance of the isotypes IgM and IgG anti-dsDNA inhibited the effect of the isotype IgG isolated in association with active urinary sediment. Future studies are needed to clarify the role of anti-dsDNA isotypes in SLE. References Bootsma, H., et al., The predictive value of fluctuations in IgM and IgG class anti-dsDNA antibodies for relapses in systemic lupus erythematosus. A prospective long-term observation. Ann Rheum Dis, 1997. 56(11):661-6. Witte, T., et al., IgM anti-dsDNA antibodies in systemic lupus erythematosus: negative association with nephritis. SLE Study Group. Rheumatol Int, 1998. 18(3):85-91. Forger, F., et al., Clinical significance of anti-dsDNA antibody isotypes: IgG/IgM ratio of anti-dsDNA antibodies as a prognostic marker for lupus nephritis. Lupus, 2004. 13(1):36-44. Munoz, L.E., et al. Predictive value of anti-dsDNA autoantibodies: importance of the assay. Autoimmun Rev, 2008. 7(8):594-7. Atta, A.M., et al., Anti-dsDNA antibodies in Brazilian patients of mainly African descent with systemic lupus erythematosus: lack of association with lupus nephritis. Clin Rheumatol, 2009. 28(6):693-7. Disclosure of Interest None Declared
Background Wireless vital parameter continuous monitoring (WVPCM) is compared to regular nurse monitoring in order to provide data on the clinical and economic impact of critically ill patients (CIPs) in Internal Medicine Units (IMU). Study Design Pilot prospective randomized controlled open-label multi-center study with WIN@Hospital wearable wireless system creating alerts on portable devices (ipad). Experimental Arm: CIPs with MEWS (Modified Early Warning Score) ≥3 and/or NEWS (National Early Warning Score) ≥5 at admission underwent WCPCM over the first 72 h. Active Comparator: CIPs with MEWS ≥3 and/or NEWS ≥5 at admission undergoing regular nurse monitoring. Method Primary outcomes: Reduction of major complications (MC) from 15% to 5%. Secondary outcomes: One day reduction in length of stay (LOS); reduced nurse monitoring time; accurate patient stratification and definition of end stage disease. Results Preliminary results: Enrolled 145 and evaluable 125 patients (51 M/74 F), mean age 80.5 years, Comorbidity: Cumulative Illness Rating Scale CIRS-CI: 4, CIRS SI: 1.8. About 38% scored a BRASS (Blaylock Risk Assessment Screening Score) ≥20 indicating need for discharge planning requiring step-down care. More than 50% of patients present IIA index >3 indicating high dependency from nursing assistance. Nurses saved a minimum of 49,6 minutes to a maximum of 58,1 minutes on time spent monitoring each patient per day. A trend towards reduction of major complications in the experimental group appears to be seen (31% versus 45%). Decrease in re-admissions (7% versus 11%) and mortality (7.3% versus 23.9%) has been observed. Arrhythmic and ischemic complications detection doubled in the experimental arm. More than 30% of the patients meet the criteria defining end stage disease. Conclusion WVPCM, detecting early deterioration in CIPs, may facilitate timely response in at-risk patients, increasing safety and reducing costs. Telemedicine Network Funding Acknowledgement Type of funding source: None
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