Global epidemiology of systemic lupus erythematosus: a comprehensive systematic analysis and modelling study

Tian, Jiahong; Zhang, Dingyao; Yao, Xu; Huang, Yaqing; Lu, Qianjin

doi:10.1136/ard-2022-223035

Cited by 183 publications

(122 citation statements)

References 29 publications

(53 reference statements)

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“…First, Calado et al (2009)observed that in bone marrow CD34 + cells, androgen and estradiol could stimulate telomerase activity, which plays an important role in maintaining the length of telomeres; moreover, androgen also mediated telomerase activity in both normal peripheral blood lymphocytes. Their findings may indicate a significant difference between males and females in the incidence of SLE (Tian et al, 2022) and AS (Tarannum et al, 2022;Zhang et al, 2022). The antigen presentation process stimulates telomerase in normal B cells and T cells, leading to increased telomerase activity (Igarashi and Sakaguchi, 1997;Hathcock et al, 2005).…”

Section: Potential Mechanismsmentioning

confidence: 98%

Immune-mediated inflammatory diseases and leukocyte telomere length: A Mendelian randomization study

et al. 2023

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Objective: To elucidate the potential causality of leukocyte telomere length (LTL) with immune-mediated inflammatory diseases (IMIDs), we conducted a Mendelian randomization (MR) study.Methods: The genetically predicted causation between LTL and IMIDs was evaluated using a two-sample MR method. We analyzed 16 major IMIDs, which included systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), ulcerative colitis (UC), Crohn’s disease (CD), ankylosing spondylitis (AS), sicca syndrome (SS), rheumatoid arthritis (RA), type 1 diabetes (T1D), primary sclerosing cholangitis (PSC), idiopathic pulmonary fibrosis (IPF), atopic dermatitis (AD), sarcoidosis, hypothyroidism, hyperthyroidism, psoriasis, and childhood asthma. The random-effects inverse-variance weighted (IVW) method was performed as the main analytical approach in MR. Various sensitivity analyses, including MR-Egger, MR robust adjusted profile score (MR-RAPS), weighted median, MR pleiotropy residual sum and outlier (MR-PRESSO) methods, weighted mode, radial plot, and radial regression, were used to guarantee the robustness of the results and detect horizontal pleiotropy. Cochran’s Q value was calculated to check for heterogeneity, and the MR Steiger approach was used to test the causal direction.Results: The MR results indicated significant inverse associations of LTL with risks of psoriasis (OR: 0.77, 95% CI: 0.66–0.89, and p = 3.66 × 10−4), SS (OR: 0.75, CI: 0.58–0.98, and p = 0.03), RA (OR: 0.77, 95% CI: 0.68–0.88, and p = 9.85 × 10−5), hypothyroidism (OR: 0.84, 95% CI: 0.78–0.91, and p = 7,08 × 10−6), hyperthyroidism (OR: 0.60, 95% CI: 0.44–0.83, and p = 1.90 × 10−3), sarcoidosis (OR: 0.67, 95% CI: 0.54–0.83, and p = 2.60 × 10−4), and IPF (OR: 0.41, 95% CI: 0.29–0.58, and p = 4.11 × 10−7) in the FinnGen study. We observed that longer LTL was associated with an increased risk of AS susceptibility (OR: 1.51, 95% CI: 1.18–1.94, and p = 9.66 × 10−4). The results of the IVW method showed no causal relationship between TL and SLE (OR: 0.92, 95% CI: 0.62–1.38, and p = 0.69) in the FinnGen study; however, a significantly positive correlation was shown between LTL and SLE in another larger GWAS (OR: 1.87, 95% CI: 1.37–2.54, and p = 8.01 × 10−5).Conclusion: Our findings reveal that abnormal LTL has the potential to increase the risk of IMIDs. Therefore, it could be treated as a predictor and may provide new potential treatment targets for IMIDs. However, the change of LTL may not be the direct cause of IMIDs. Further studies should aim at the pathogenic mechanism or potential protective effects of LTL in IMIDs.

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Section: Potential Mechanismsmentioning

confidence: 98%

Immune-mediated inflammatory diseases and leukocyte telomere length: A Mendelian randomization study

et al. 2023

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“…In our case, the patient had class V membranous lupus nephritis. He was started on methylprednisolone injections for three days, then switched to oral prednisolone for the flare and started on mycophenolate mofetil [15][16][17][18]. Because our patient did not improve on the initial doses, the doses were increased until he showed symptomatic improvement.…”

Section: Discussionmentioning

confidence: 99%

Overlap Syndrome in a Male Presenting With Progressive Lower Limb Weakness: A Case Report

Dubai¹,

Isa²

2023

Cureus

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Overlap syndrome refers to a large group of inflammatory rheumatic conditions characterized by the coexistence of clinical manifestations that include different organ systems and meet the criteria of more than one rheumatic disease. Overlap syndromes are less common compared with the conditions they encompass, for example, the global prevalence of systemic lupus erythematosus (SLE) is estimated to be 43.7 per 100,000 persons, of which only around 3.4-6.3% present with SLE-myositis overlap. Although rare, overlap syndromes commonly include lupus, rheumatoid arthritis, scleroderma, and myositis. Because overlap syndrome can manifest in several ways and has an unpredictable course, it poses a challenge to multidisciplinary teams that examine and treat patients. Therefore, we must not disregard any signs and symptoms as they might have a huge impact on the progression of the disease and the overall outcome of the treatment. We present a rare case of SLE-myositis overlap syndrome in a 44-year-old male. He initially presented with gradual weakness in the proximal muscles of the bilateral lower limb. This patient was diagnosed as having SLE with positive 5g protein/24 hours, anti-nuclear, low C3, anti-U1RNP, anti-Ro, and anti-La antibodies, as well as membranous lupus nephritis evident by the results of renal biopsy. The diagnosis of myositis was also made according to the history and evaluation of the patient, the high titer of muscle enzymes creatine kinase level, and MRI result. Although the patient tested positive for anti-U1RNP, he did not meet the criteria of mixed connective tissue disease. Eventually, the patient was found to have overlap syndrome. The prevalence of overlap between SLE and myositis is relatively rare and varies from 3.4% to 6.3%. To our knowledge, no study has discussed or reported its prevalence among males.

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“…Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the overactivation of the immune system and the involvement of various organs. The global systemic lupus erythematous (SLE) incidence and newly diagnosed population were estimated to be 5.14 (1.4 to 15.13) per 100,000 person-years and 0.40 million people annually, respectively (1). Mortality from SLE is two to three times higher than that of the general population (2) and was the underlying cause of over 50,000 deaths from 1968 to 2012 (3).…”

Section: Introductionmentioning

confidence: 99%

“…A previous study reported that dysbiosis in the vagina is evident in patients with primary Sjögren's syndrome (PSS) (20), a systemic inflammatory autoimmune disease that shares epidemiological, clinical, pathogenic, and etiological features with SLE (21, 22). In addition, women are more frequently affected by SLE than men (1). Therefore, we questioned whether there might be a distinct vaginal microbiome signature of SLE in women.…”

Section: Introductionmentioning

confidence: 99%

Alterations of the fecal and vaginal microbiomes in patients with systemic lupus erythematosus and their associations with immunological profiles

et al. 2023

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BackgroundExploring the human microbiome in multiple body niches is beneficial for clinicians to determine which microbial dysbiosis should be targeted first. We aimed to study whether both the fecal and vaginal microbiomes are disrupted in SLE patients and whether they are correlated, as well as their associations with immunological features.MethodsA group of 30 SLE patients and 30 BMI-age-matched healthy controls were recruited. Fecal and vaginal samples were collected, the 16S rRNA gene was sequenced to profile microbiomes, and immunological features were examined.ResultsDistinct fecal and vaginal bacterial communities and decreased microbial diversity in feces compared with the vagina were found in SLE patients and controls. Altered bacterial communities were found in the feces and vaginas of patients. Compared with the controls, the SLE group had slightly lower gut bacterial diversity, which was accompanied by significantly higher bacterial diversity in their vaginas. The most predominant bacteria differed between feces and the vagina in all groups. Eleven genera differed in patients’ feces; for example, Gardnerella and Lactobacillus increased, whereas Faecalibacterium decreased. Almost all the 13 genera differed in SLE patients’ vaginas, showing higher abundances except for Lactobacillus. Three genera in feces and 11 genera in the vagina were biomarkers for SLE patients. The distinct immunological features were only associated with patients’ vaginal microbiomes; for example, Escherichia−Shigella was negatively associated with serum C4.ConclusionsAlthough SLE patients had fecal and vaginal dysbiosis, dysbiosis in the vagina was more obvious than that in feces. Additionally, only the vaginal microbiome interacted with patients’ immunological features.

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Global epidemiology of systemic lupus erythematosus: a comprehensive systematic analysis and modelling study

Cited by 183 publications

References 29 publications

Immune-mediated inflammatory diseases and leukocyte telomere length: A Mendelian randomization study

Immune-mediated inflammatory diseases and leukocyte telomere length: A Mendelian randomization study

Overlap Syndrome in a Male Presenting With Progressive Lower Limb Weakness: A Case Report

Alterations of the fecal and vaginal microbiomes in patients with systemic lupus erythematosus and their associations with immunological profiles

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