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Background: Systemic lupus erythematosus (SLE) is currently the most prevalent autoimmune disorder worldwide. A previous study reported the frequency of sarcopenia in patients with chronic inflammation and found a higher rate of sarcopenia in patients with SLE than in control. A preview study found that exercises management given to SLE patients can reduce fatigue and increase vitality., Objective: The objective of this study is to understand the relationship between sarcopenia and SLE from Physical Medicine and Rehabilitation (PM&R) standpoint and its intervention., Methods: Using the PubMed computer-aided search engine specific keywords: "sarcopenia" AND "Systemic lupus erythematosus" OR "lupus" OR "SLE" OR "physical medicine and rehabilitation" OR "rehabilitation" OR "physical therapy" OR "exercises" OR "physical activity" OR "training" OR "nutrition" OR "OR "diet.", Results: Exercise rehabilitation can increase energy level, cardiovascular fitness, functional status, and physical capabilities of muscle strength and are safe to be performed by patients with SLE. Resistance training has been shown to improve muscle strength and size, increase mitochondrial content, and reduce oxidative stress. Resistance exercise impacts sarcopenia through several mechanisms in the muscular and neuromotor levels. Aerobic exercises are also beneficial for skeletal muscles to increase mitochondrial bioenergy, improve insulin sensitivity, and reduce oxidative stresses. Nutritional interventions such as protein, amino acids, essential fatty acids, and vitamin D produce biological effects that will enhance the physiological adaptation of exercise., Conclusion: Intervention for maintaining muscle function in the prevention and management of sarcopenia in SLE and its complications is a combination of resistance training and nutritional intake through adequate protein intake., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Incidence of ANCA antibodies in patients with systemic lupus erythematosus (SLE) is described in 24-31 %, but they are not related to the distribution and severity of organ involvement in SLE; the routine monitoring is not recommended. Overlap syndrome of systemic lupus erythematosus and ANCA associated vasculitis (AAV) is rare. The difficult diagnosis and treatment of this syndrome is described in this case report of the patient with SLE and severe kidney involvement resulting from AAV.

Background/aim: Avascular necrosis (AVN) is the death of bone due to compromise of blood flow. The etiology of AVN is multifactorial; corticosteroid usage is the second most significant factor after trauma, and systemic lupus erythematosus (SLE) is the most common underlying disease. The objective of this study was to assess the factors of AVN in SLE patients., Materials and Methods: The study included 127 patients with SLE who fulfilled 1997 American College of Rheumatology (ACR) revised criteria. Demographic data, age at SLE diagnosis, disease duration, disease activity, body mass index, clinical findings, antiphospholipid syndrome, steroid usage, dose and duration, comorbid diseases, and smoking history were recorded., Results: AVN was found in 11 of 127 (8.7%) SLE patients. Hyperlipidemia (P < 0.001), cushingoid body habitus (P < 0.001), and proteinuria (P = 0.013) were found at higher rates in the AVN group. All of the 11 AVN cases had osteoporosis (P < 0.02). In multivariate regression analysis, daily steroid usage was the only factor for development of AVN in SLE., Conclusion: The hypothesis of our study was that an alternate day steroid regimen may decrease AVN frequency in SLE patients., Competing Interests: None declared, (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background: The relationship between SLE and traditional risk factors for cardiovascular events was evaluated., Methods: The data regarding sixty patients with SLE and 30 healthy controls (age and sex matched) were gathered using SLEDAI forms. Venous blood (10mL) from all the participants was examined for hs-CRP, homocysteine, VCAM1, CBC, anti-DNA antibody, C3, C4, low-density lipoprotein (LDL), cholesterol, FBS and triglyceride. The IMT of carotid arteries was determined bilaterally by ultrasound. Other measurements included insulin levels via Elisa (Linco/Millipore Corp) and the HOMA-IR index for insulin resistance., Results: The mean age (in years) in the test and control groups was 28.8±10.3 (18-52) and 33.8±9.13 (18-48), respectively. The average IMT in the test group was directly related to serum levels of VCAM1 (p<0.001), homocysteine (p<0.001), cholesterol (p<0.009), LDL (p<0.001), TG (p<0.001), and FPG (p=0.004). The association between other risk factors, insulin resistance, carotid IMT and SLEDAI, was nonexistent. Mean insulin and insulin resistance levels in all the participants were 0.43±2.06 µU/mL and 0.09±0.44, respectively. There was no significant difference between the test and control groups regarding serum insulin and insulin resistance levels (p=0.42 and p=0.9, respectively). None of the risk factors, such as hsCRP, VCAM1, or homocysteine, were shown to be related to insulin resistance (p=0.6, p=0.6, p=0.09, respectively)., Conclusion: Our findings did not show an increase in the prevalence of atherosclerosis in patients with SLE. There was no association between IMT and insulin resistance. However, the former was associated with FPG, total cholesterol, LDL, TG, homocystein and VCAM1., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Systemic Lupus Erythematosus (SLE) is a polysystem autoimmune disease that adversely affects human health. Various organs can be affected, including the kidney or brain. Traditional treatment methods for SLE primarily rely on glucocorticoids and immunosuppressors. Unfortunately, these therapeutic agents cannot prevent a high recurrence rate after SLE remission. Therefore, novel therapeutic targets are urgently required., Methods: A systematic search of the published literature regarding the abnormal structure and function of mitochondria in SLE and therapies targeting mitochondria was performed in several databases., Results: Accumulating evidence indicates that mitochondrial dysfunction plays important roles in the pathogenesis of SLE, including influencing mitochondrial DNA damage, mitochondrial dynamics change, abnormal mitochondrial biogenesis and energy metabolism, mitophagy, oxidative stress, inflammatory reactions, apoptosis and NETosis. Further investigation of mitochondrial pathophysiological roles will result in further clarification of SLE. Specific lupus-induced organ damage also exhibits characteristic mitochondrial changes., Conclusion: This review aimed to summarize the current research on the role of mitochondrial dysfunction in SLE, which will necessarily provide potential novel therapeutic targets for SLE., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Purpose: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with marked disparities in prevalence and disease severity among different ethnic groups. The purpose of this study is to characterize a Latin American cohort and identify genetic risk factors for developing SLE and its end-organ manifestations in this Latin Hispanic cohort., Methods: A total of 201 SLE cases and 205 non-diseased controls were recruited in the Dominican Republic (DR). Cases were defined according to the 1997 revised American College of Rheumatology criteria for the classification of SLE. Genomic DNA was prepared from whole blood and applied to genotyping analyses for 42 single nucleotide polymorphisms (SNPs) that have been implicated in autoimmune diseases, including SLE, in other ethnic populations. Data were analyzed by Fisher's Exact Probability Test., Results: In this cohort, SNP rs9271366 (tag SNP for HLA-DRB1*15:01) confers the highest risk for SLE among the 13 MHC gene alleles that display association with SLE (p = 8.748E-10; OR = 3.5). Among the 26 non-MHC gene alleles analyzed, SNP rs2476601 in PTPN22 gene confers the highest risk for SLE (p = 0.0001; OR = 5.6). ITGAM, TNFSF4, TNIP1, STAT4, CARD11, BLK, and TNXB gene alleles were confirmed as SLE-susceptible alleles in the DR cohort. However, IRF5 and TNFAIP3 gene alleles, established risk factors for SLE in populations of European and Asian ancestry, are not significantly associated with SLE in this cohort. We also defined a novel HLA-DRA haplotype that confers an increased risk for lupus nephritis (LN) and alleles in HLA-DRA2 and TNFSF4 genes as genetic risk factors for developing neuropsychiatric (NP) SLE., Conclusion: Our data suggest that the Latin American population shares some common genetic risk factors for SLE as other populations, but also has distinct risk gene alleles that contribute to SLE susceptibility and development of LN and NPSLE. This is the first study focusing on genetic risk factors for SLE in the DR, a Latin American population that has never been characterized before., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background and Objective: Systemic lupus erythematosus (SLE) is a diverse autoimmune disorder, evoked in response to self-immune system that leads to immune complex depositions and organ damage. The exact mechanism of SLE pathogenesis is still unclear but certain genetic and environmental factors have been suggested that could influence its pathogenesis., Discussion: The modulation in B- and T- cell responses and genetic variations could lead to abnormal lymphocyte functions and the production of antibodies against the indigenous proteins and the immune complex depositions., Conclusion: The present review highlights the various causatives of SLE, particularly the genetic alteration in B- and T-cell-related proteins. We have also delineated some of the available therapeutic strategies for the treatment of SLE., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

This study aimed to evaluate the relationship between the level of 25-hydroxyvitamin D [25(OH)D] and systemic lupus erythematosus (SLE). We searched the PUBMED, EMBASE, and Cochrane databases and performed a meta-analysis examining the vitamin D level and/or deficiency in patients with SLE, compared with that in healthy controls. In total, 18 studies consisting of 1,083 patients with SLE and 1,273 controls were included. Vitamin D level was significantly lower in the SLE group than in the control group (standardized mean difference [SMD] = -0.938, 95% CI = -1.352 to -0.524, p = 9.0 × 10-6). Stratification by ethnicity showed a significantly decreased vitamin D level in the SLE group in the European and Arab populations (SMD = -1.485, 95% CI = -2.427 to -0.543, p = 0.002; SMD = -1.067, 95% CI = -1.251 to -0.883, p &lt; 1.0 × 10-8), and an association tendency between decreased vitamin D level and SLE in the Asian population (SMD = -0.874, 95% CI = -2.073 to -0.324, p = 0.153). Subgroup analysis by sample size showed a significantly lower vitamin D level in the SLE group in small- (n ≤ 100) and large-sample (n &gt; 100) populations (SMD = -1.008, 95% CI = -1.672 to -0.344, p = 0.003; SMD = -0.863, 95% CI = -1.444 to -0.293, p = 0.003). Meta-analysis revealed a significant association between SLE and vitamin D deficiency (RR = 2.321, 95% CI = 1.361-3.960, p = 0.002). Stratification by ethnicity showed a significant association between SLE and vitamin D deficiency in European and Arab populations (RR = 2.182, 95% CI = 1.024-4.648, p = 0.043; RR = 4.550, 95% CI = 3.471-5.965, p &lt; 1.0 × 10-8). Our meta-analysis demonstrates that compared with controls, patients with SLE show significantly low serum levels of vitamin D, and that a deficiency of vitamin D is associated with SLE.

Background: Systemic Lupus Erythematosus (SLE) is characterised by increased mortality secondary to Cardiovascular Diseases (CVD). Despite being common in SLE, traditional cardiovascular risk factors cannot entirely justify such increase in CVD-associated mortality. The endothelium is a key regulator of the vascular homeostasis; lupus-associated persistent systemic inflammation may impair endothelium functionality, thus initiating a cascade of events that, in concert with traditional CVD-risk factors, leads to atherosclerosis development and progression. Numerous methods have been used for the in vivo assessment of the endothelial function; among all, Flow- Mediated Dilatation (FMD) has been widely validated in clinical trials. Quantification of the endothelial dysfunction by FMD has been confirmed to be an early predictor of CVD in multiple studies involving both non-CVD and CVD-population and it may therefore represent a likewise efficient biomarker of CVD in SLE., Methods: Research and online content related to endothelial function in SLE is reviewed in this article with special attention to the pathophysiology and therapeutic opportunities., Results: To date, the vast majority of the available data, albeit not all, shows that endotheliumdependent FMD values are lower in SLE patients compared to healthy subjects; further studies, however, will be required in order to confirm the usefulness of the endothelial dysfunction quantification as CVD-predictor in the specific clinical setting of lupus. Notably, FMD variations can also be a sensitive marker for assessing specific therapeutic strategies ability of improving endothelial function in SLE patients., Conclusion: Endothelial function appears to be affected by SLE potentially contributing to the increased cardiovascular risk observed in SLE patients., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disorder, characterized by producing different auto-antibodies and multiorgan involvements. In this study we aimed to investigate the relationship between SLE activity and persistently positive antiphospholipid antibodies., Objective/methods: Fifty-nine lupus patients (55 women and 4 men) who were assessed in two consecutive visits with 6 weeks interval were selected. Patients` clinical and laboratory data and serum antiphospholipid antibodies` values, were collected. Serum anticardiolipin antibodies and lupus anticoagulant were measured in two visits. The correlations between these antibodies with SLEDAI and with major organ involvements were assessed. We found that SLEDAI was significantly higher in persistently positive aPLs patients compared with persistently negative aPLs patients. A positive correlation between IgG-aCL antibody titer and SLEDAI at first visit (P=0.049) was also seen., Result and Conclusion: The results showed that disease activity in SLE was associated with increased APAs and persistent positive antiphospholipid antibodies may indicate higher lupus disease activity., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Background and Aims: Matrix metalloproteinase-9 (MMP-9) is closely related to the pathogenesis of autoimmune diseases, especially Systemic Lupus Erythematosus (SLE). However, published works about the circulating MMP-9 levels in SLE are contradictory. A meta-analysis was performed to estimate circulating MMP- 9 levels in SLE patients more accurately and explore its related influencing factors., Methods: The related literatures were systematically searched in PubMed, Embase, and The Cochrane Library database (up to 31 January 2018). Pooled Standardized Mean Difference (SMD) and 95% Confidence Interval (CI) of circulating MMP-9 levels were calculated by Stata12.0 software according to fixed-effect or randomeffect model analysis., Results: A total of 638 articles were retrieved, and 12 studies including 730 SLE cases and 759 controls were finally included in the meta-analysis. No significant differences in circulating MMP-9 levels were observed between SLE patients and healthy controls (pooled SMD = -0.209, 95% CI = -0.812 to 0.394). However, subgroup analyses indicated that age<30 years group had higher MMP-9 levels (SMD = 0.991, 95% CI: 0.504 to 1.478) and sample size (n ≥ 60) group had lower MMP-9 levels when compared with controls (SMD = -0.755, 95% CI: - 1.347 to -0.163)., Conclusion: The meta-analysis of current evidence suggests that circulating MMP-9 levels do not differ between SLE patients and healthy controls, however, the results may be affected by age and sample size. Further studies are needed to clarify the relationship between SLE and circulating MMP-9 levels., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Background and Objective: The evidence regarding the association between serum/plasma vitamin D (VitD) concentrations and systemic lupus erythematosus (SLE) is inconsistent. The study was based on relevant results from literatures that were identified and evaluated. The aim of this meta-analysis is to determine circulating VitD in SLE patients and explore influencing factors., Methods: Studies examining VitD levels in SLE patients were identified through targeted searches in the PubMed and EMBASE databases (up to December 2017). Data extracted from eligible studies was synthesized to calculate the standardized mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI). A fixed or a random effects model was applied to calculate the pooled SMDs and ORs depending on heterogeneity across studies., Results: A total of 24 studies, including 6017 patients and 18,417 controls were included. The pooled analysis suggested that VitD levels were significantly lower in SLE patients compared with those in controls [SMD= -0.09, 95%CI= -0.12 to -0.06, P < 0.001]. When the studies were stratified by ethnicity, VitD concentrations were also significantly lower in Asian, Caucasian and African patients. When the studies were stratified by age, gender, VitD level was lower in patients than that in controls. Subgroup analyses stratified by measurement type (expect for radioimmunoassay) also demonstrated consistent results. Moreover, VitD insufficiency was more prevalent in SLE patients than healthy controls [OR=6.57, 95%CI=4.64-9.29]., Conclusion: Compared with healthy controls, SLE patients had lower concentration of VitD. Additionally, the prevalence of VitD insufficiency is more common in SLE patients., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Inhalation of crystalline silica is known to result in silicosis: an irreversible, disabling and potentially fatal occupational lung disease, which is associated with a variety of pulmonary and non-pulmonary complications including autoimmunity. A potential link between silicosis and systemic lupus erythematosus (SLE) is currently recognized only in cases of acute or accelerated silicosis. We report a case of SLE, a disease which usually affects young females, arising in a male former stonemason with simple silicosis. Epidemiological and clinical literature on the association of silica exposure and development of SLE are briefly reviewed. This case report and literature review highlight the link between occupational silica exposure and autoimmune disease including SLE, establishes that even simple silicosis appears linked to development of autoimmunity and emphasizes the importance of an occupational history, especially in male patients who develop SLE., (© The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)