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Premenopausal women with systemic lupus erythematosus (SLE) taking prednisone to suppress inflammatory reactions may be more likely to develop osteoporosis. Seventy-four premenopausal SLE patients had X-ray absorptiometry of the lumbar spine and the thigh bone to determine bone mineral density. Results were compared with bone mineral density in a group of 50 healthy premenopausal women volunteering for a screening program for age-related bone loss. Bone mineral density was reduced in both locations in SLE patients. Twelve percent of SLE patients versus no control women had bone mineral densities low enough to be considered osteoporotic. The adverse effect on bone mineral density may be due to the effects of prednisone, lack of menstrual cycles in SLE patients, overactivity of the parathyroid resulting from kidney failure, conscious avoidance of sunshine, or lack of physical activity as a result of painful joints.

Los registros de pacientes son herramientas útiles para evaluar enfermedades poco frecuentes. Nuestro objetivo es presentar el «Registro español de pacientes con lupus eritematoso sistémico» (RELES).

Objective. To evaluate the utility of systemic lupus erythematosus (SLE) initial clinical manifestations and the SLE Disease Activity Index (SLEDAI) for identifying patients who will have a remission.Method. We studied 100 SLE patients (85 females, 15 males) and identified all patients who had remission (defined as at least one continuous year during which lack of disease activity permitted withdrawal of all treatment to suppress general lupus activity of a particular clinical manifestation). Changes in laboratory parameters without clinical activity, thus not requiring treatment, did not invalidate remission. We did not include any patient who had never required treatment. We evaluated the SLEDAI values and the main SLE manifestations at the time of diagnosis of SLE, and also every 3 months during the first year of disease.Results. Twenty-four of the 100 SLE patients achieved remission that occurred a mean of 64 months after the diagnosis. They remained in remission for a mean of 55 months. There were no statistical differences in SLEDAI values and the initial manifestations (including renal and cerebral) between patients who reached remission and those who did not. The patients who have a higher SLEDAI score take longer to achieve remission.Conclusion. SLE patients with severe initial clinical manifestations and higher SLEDAI values may achieve clinical remission.

A loss in bone mass was reported in premenopausal systemic lupus erythematosus (SLE) women, but this problem has not been studied in SLE males. We evaluated bone mineral density (BMD) in SLE males and the relationship between prolactin (PRL) and testosterone with BMD. We also studied the controversial effect of steroid therapy on BMD in these patients. We measured BMD in the lumbar spine and at the hip in 20 SLE men (mean age 37 y) and in the controls (n= 40). We measured PRL and testosterone in serum and saliva. The mean dose of prednisone at the time of study was 11.6 mg; and cumulative dose was 17.6 g. No significative decrease in BMD was detected in SLE males vscontrols; either in the lumbar spine (1.00 ± 0.1 vs1.05 ± 0.1 g/cm2) or in the femoral neck (0.84 ± 0.1 vs0.87 ± 0.1 g/cm2). No patient or control had osteoporosis or fractures. We did not find any relationship between BMD and cumulative dose and baseline dose of corticosteroids. The mean values of PRL and testosterone (serum and salivary) were in the normal range. We did not find any correlation between BMD, PRL and androgens. This study did not show a loss in bone mass in SLE men on corticosteroid therapy.

Some COVID-19 patients evolve to severe lung injury and systemic hyperinflammatory syndrome triggered by both the coronavirus infection and the subsequent host-immune response. Accordingly, the use of immunomodulatory agents has been suggested but still remains controversial. Our working hypothesis is that methylprednisolone pulses and tacrolimus may be an effective and safety drug combination for treating severe COVID-19 patients.