Clinical implications and prognostic significance of thrombocytopenia in Tunisian patients with systemic lupus erythematosus

Jallouli, M.; Frigui, M.; Marzouk, Samar; Snoussi, M.; Kechaou, Meriem; Kaddour, N.; Masmoudi, Hatem; Elloumi, Moez; Bahloul, Z.

doi:10.1177/0961203312438630

Cited by 35 publications

(38 citation statements)

References 29 publications

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“… 4 , 13 In some studies, patients who were thrombocytopenic more frequently exhibited neurological manifestations, kidney disorders, and hematological abnormalities. 5 , 6 , 8 – 10 , 15 , 16 Low complement levels and elevated anti-dsDNA antibody have also been observed among patients with thrombocytopenia. 5 , 15 Furthermore, most previous studies showed that disease activity also correlated with thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

“… 7 In previous studies, the mortality of thrombocytopenic patients with SLE was significantly high. 5 , 6 , 13 , 15 The mortality of thrombocytopenic patients was 24%, which was a significantly higher rate compared with those who were not thrombocytopenic (hazard ratio [HR] = 2.855, P < 0.001). 5 A recent study reported a mortality rate in thrombocytopenic patients of 17.1%, which was significantly different to nonthrombocytopenic patients (HR = 1.79, P = 0.045).…”

Section: Discussionmentioning

confidence: 99%

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Thrombocytopenia in Systemic Lupus Erythematosus

et al. 2016

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The aim of the study was to examine the clinical characteristics and prognosis according to severity of thrombocytopenia and response to treatment for thrombocytopenia in patients with systemic lupus erythematosus (SLE).We retrospectively evaluated 230 SLE patients with thrombocytopenia, and reviewed their clinical data and laboratory findings. Thrombocytopenia was defined as platelet counts under 100,000/mm3, and patients were divided into 3 thrombocytopenia groups according to severity: mild (platelet counts >50,000/mm3), moderate (>20,000/mm3, ≤50,000/mm3), and severe (≤20,000/mm3). Clinical characteristics, treatments, and prognoses were compared among the groups. Furthermore, complete remission of thrombocytopenia was defined as platelet counts >100,000/mm3 after treatment.There was no significant difference in clinical or laboratory findings among the groups according to severity of thrombocytopenia. However, hemorrhagic complications were more frequent in severe thrombocytopenia (P < 0.001) and mortality was also higher (P = 0.001). Complete remission was achieved in 85.2% of patients. The clinical characteristics and modality of treatment did not differ between the patients with and without complete remission. Mortality in patients with complete remission (1.5%) was significantly lower than in those without complete remission (29.4%, P < 0.001). Survival was significantly higher in patients with complete remission from thrombocytopenia (odds ratio = 0.049, 95% confidence interval: 0.013–0.191, P < 0.001).The severity of thrombocytopenia in SLE patients can be a useful independent prognostic factor to predict survival. Moreover, complete remission of thrombocytopenia after treatment is an important prognostic factor. The severity of thrombocytopenia and response to treatment should be closely monitored to predict prognosis in SLE patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thrombocytopenia in Systemic Lupus Erythematosus

et al. 2016

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“…ITP is commonly associated with autoimmune diseases, especially with systemic lupus erythematosus (SLE). The prevalence, clinical characteristics and prognostic impact of ITP in SLE have been well-studied (4,5), providing many insights in clinical management of secondary ITP associated with SLE. Presence of ITP in pSS has been reported by some case reports (6,7).…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Secondary Immune Thrombocytopenia Associated With Primary Sjögren's Syndrome

Yang

Rao

et al. 2020

Front. Med.

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Objective: Clinical characteristics of immune thrombocytopenia (ITP) associated with primary Sjögren's syndrome (pSS) have not been clearly defined. This study aimed to evaluate the prevalence and clinical characteristics of secondary ITP in patients with pSS. Methods: 291 pSS patients in our hospital were retrospectively analyzed. Clinical manifestations and laboratory findings were compared between pSS patients with and without ITP. Results: The prevalence of secondary ITP in pSS patients was 12.03%. Compared to pSS patients without ITP, pSS patients with ITP were younger and had higher disease activity. The prevalence of interstitial lung diseases (ILD) was significantly lower in pSS patients with ITP (30.43 vs. 54.95%; P = 0.029), and it was the same with arthritis (17.14 vs. 3.9.11%; P = 0.014) and dry eye (33.33 vs. 54.17%, P = 0.027) compared with those without ITP. Serum creatinine level was lower in pSS patients with ITP (P = 0.009), while positivity of anti-histone autoantibodies was higher in pSS patients with ITP (P = 0.025). Conclusion: This study is an initial report describing clinical features of ITP in pSS. The lower incidence of ILD and arthritis among pSS patients with ITP indicated potential active roles of platelets in the pathogenesis of fibrosis or inflammatory arthritis, which may open the way for further experimental and clinical work.

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“…While gestational thrombocytopenia does not seem to affect maternal and fetal outcomes in pregnancy [23], in malaria patients thrombocytopenia has been associated with malaria severity and prognosis [24]. On the other hand, in SLE patients the effects are not clear, with conflicting reports suggesting no effect [22] or correlation with worse prognosis [25]. Recent data suggests that the pathogenesis of PM is mediated in part by an inflammation-coagulation cycle involving platelets as one of the key components in this cycle [26].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Genetic Susceptibility to Systemic Lupus Erythematosus on Placental Malaria in Mice

et al. 2013

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Severe malaria, including cerebral malaria (CM) and placental malaria (PM), have been recognized to have many of the features of uncontrolled inflammation. We recently showed that in mice genetic susceptibility to the lethal inflammatory autoimmune disease, systemic lupus erythematosus (SLE), conferred resistance to CM. Protection appeared to be mediated by immune mechanisms that allowed SLE-prone mice, prior to the onset of overt SLE symptoms, to better control their inflammatory response to Plasmodium infection. Here we extend these findings to ask does SLE susceptibility have 1) a cost to reproductive fitness and/or 2) an effect on PM in mice? The rates of conception for WT and SLE susceptible (SLEs) mice were similar as were the number and viability of fetuses in pregnant WT and SLEs mice indicating that SLE susceptibility does not have a reproductive cost. We found that Plasmodium chabaudi AS (Pc) infection disrupted early stages of pregnancy before the placenta was completely formed resulting in massive decidual necrosis 8 days after conception. Pc-infected pregnant SLEs mice had significantly more fetuses (∼1.8 fold) but SLE did not significantly affect fetal viability in infected animals. This was despite the fact that Pc-infected pregnant SLEs mice had more severe symptoms of malaria as compared to Pc-infected pregnant WT mice. Thus, although SLE susceptibility was not protective in PM in mice it also did not have a negative impact on reproductive fitness.

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Clinical implications and prognostic significance of thrombocytopenia in Tunisian patients with systemic lupus erythematosus

Abstract: Our results, concerning North-African SLE patients, confirm the findings of previous studies which suggest that thrombocytopenia correlates with more severe disease and has a negative impact on the survival of lupus patients.

Cited by 35 publications

References 29 publications

Thrombocytopenia in Systemic Lupus Erythematosus

Thrombocytopenia in Systemic Lupus Erythematosus

Clinical Characteristics of Secondary Immune Thrombocytopenia Associated With Primary Sjögren's Syndrome

The Impact of Genetic Susceptibility to Systemic Lupus Erythematosus on Placental Malaria in Mice

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