No abstract

No abstract

BackgroundSystemic Lupus Erythematosus (SLE) is an autoimmune disease, characterized by the production of a wide range of autoantibodies, resulting from polyclonal B cells activation, impaired apoptotic pathways, or idiotypic network dysregulation. The anti-double stranded DNA antibodies (anti-dsDNA) are considered a specific marker for SLE, due to their high frequency, sensitivity and specificity (57.3% and 97.4%, respectively). Moreover, their identification in other pathological conditions and in healthy subjects is very rare (less than 0.5%). These antibodies have been associated with kidney involvement and disease activity, however, a comparison between large cohorts of SLE patients with or without anti-dsDNA is lacking.ObjectivesWe aimed at evaluating the demographic, clinical, and laboratory features of SLE patients according with the anti-dsDNA status.MethodsAccording with the anti-dsDNA status, we identified three groups of patients: Group 1 (persistently positive); Group 2 (positive at diagnosis who became negative); Group 3 (persistently negative). Disease activity was assessed using the European Consensus Lupus Activity Measurement (ECLAM).ResultsWe evaluated 393 SLE patients (Group 1: 62.3%; Group 2: 13.3%; Group 3: 24.4%). The renal involvement was significantly more frequent in those patients who were persistently positive for anti-dsDNA (P=0.001). Conversely, serositis resulted significant more frequent in those persistently negative (P<0.0001). The anti-RNP and the reduction of C4 serum levels were found significantly more frequently in Group 1 and 2 (P=0.04, P=0.005). The anti-dsDNA status did not influence disease activity (ECLAM group 1 vs group 2 vs group 3 =NS). Finally, the therapeutic approach was not different between the groups except for the use of cyclosporine A which was more frequently prescribed in the persistently positive patients (60 patients, 24.5%) compared to Group 2 and 3 [9 (17.3%) and 12 (12.5%) patients, respectively; P=0.01].ConclusionsThe main clinical feature associated with anti-dsDNA positivity is the kidney involvement. Nonetheless, disease activity evaluated with ECLAM, thus with an index which does not include anti-dsDNA evaluation, does not seem to be influenced by the presence of anti-dsDNA.Disclosure of InterestNone declared

No abstract

BackgroundThe fertility in childbearing Systemic Lupus Erythematosus (SLE) patients can be impaired due to several conditions. In particular, treatment with alkylating agents, as cyclophosphamide (CYC), could determine menstrual irregularities and premature ovarian failure (POF). Gonadotropin-releasing hormone analogues (GnRH-a) is one of the preventive strategy suggested by the recently published EULAR recommendations (1). They are characterized by good safety profile and effectiveness in reducing POF rate in patients with malignancies and autoimmune diseases. So far, only few studies have been published focusing on the use of GnRH-a to prevent POF in SLE women receiving CYC treatment.ObjectivesIn the present case-control study, we aimed at evaluating the efficacy of GnRH-a on the ovarian function preservation in SLE patients treated with CYC.MethodsWe enrolled consecutive SLE patients, fulfilled the 1997 ACR revised criteria treated with CYC in the period between 2005 and 2012, receiving GnRH-a (GnRH-a+). As control, SLE patients treated with CYC not receiving GnRH-a (GnRH-a-) were assessed. Clinical and laboratory data were collected in a standardized, computerized and electronically filled form. Ovarian function was assessed by the evaluation of FSH and estradiol level (E2). GnRH-a (triptorelin 3.75 mg/monthly intramuscularly) was prescribed. SLE patients treated with CYC were followed after the treatment every six months during the first year and then annually.ResultsThirty-tree SLE patients treated by CYC were evaluated in the present analysis: 75.7% of patients were treated for lupus nephritis. Among [FC1] these, 18 GnRH-a+ (mean±SD age 29.3±7.6 years; mean±SD disease duration 7.2±4.2 years) and 15 GnRH-a- (mean±SD age 31.0±10.5 years; mean±SD disease duration 6.3±7.4 years). The mean±SD SLEDAI-2K score in GnRH-a+ patients was 10.1±3.7, in GnRH-a- patients 8.3±3.3 (p=NS). Moreover, no differences were identified concerning the duration of CYC treatment (GnRH-a+: 6.1±2.8 months versus GnRH-a- 6.1±2.2 months, p=NS) and follow-up (GnRH-a+: 8.11±2.2 years versus GnRH-a- 9.3±7.2 years, p=NS). The prevalence of POF was significantly higher in GnRH-a- (5 patients, 33.3%) in comparison with GnRH-a+ (2 patients, 11.1%, P=0.0002). A significantly higher mean age at the time of CYC treatment was observed in patients developing POF (37.7±5.9 years) in comparison with those not developing this complication (28.0±8.5 years, p=0.008). Moreover, the use of GnRH-a seems to be protective also in terms of menstrual cycle regularity: the cycle remained regular during treatment in 83.3% of GnRH-a+ and only in 33.3% of GnRH-a- (p=0.003). During the follow-up, 3 patients in the GnRH-a+ group underwent pregnancy, with a good outcome.ConclusionsThe results of the present study showed the protective role of GnRH-a for the preservation of ovarian function in SLE patients treated by CYC. Furthermore, the age resulted the only risk factor associated with POF development.References Andreoli L. et al. Ann Rheum Dis. 2016 Jul 25. Disclosu...