Environmental exposures interact with genetic factors has been thought to influence susceptibility of systemic lupus erythematosus (SLE) development. To evaluate the effects of environmental exposures on SLE, we conducted a population-based cohort study across Jiangsu Province, China, to examine the associations between the living environment including air and water pollution, population density, economic income level, etc. and the prevalence and mortality of hospitalized SLE (h-SLE) patients. A total of 2231 h-SLE patients were retrieved from a longitudinal SLE database collected by the Jiangsu Lupus Collaborative Group from 1999 to 2009. The results showed that: It existed regional differences on the prevalence of h-SLE patients in 96 administrative districts; The distribution of NO2 air concentration monitored by atmospheric remote sensors showed that three of the ultra-high-prevalence districts were located in the concentrated chemical industry emission area; h-SLE patient prevalence was positively correlated with the excessive levels of nitrogen in drinking water; The positive ratio of pericarditis and proteinuria was positively correlated with the prevalence of h-SLE patients and pollution not only induced a high h-SLE patient prevalence but also a higher mortality rate, which might be attributed to NOx pollution in the air and drinking water. In summary, our data suggested that NOx in air and drinking water may be one of the important predispositions of SLE, especially for patients with renal involvement.

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) occurs up to 75% of adult SLE patients, and is one of the major causes of death in SLE patients. Cognitive dysfunction is a typical clinical feature of NPSLE, which seriously affects the quality of life of patients. Dyslipidemia and thyroid disease, which were prevalent in SLE patients, both related to the neuropsychiatric disturbances, including significant psychiatric and cognitive disturbance. This study aimed to investigate whether cognitive dysfunction in patients with systemic lupus erythematosus (SLE) was related to the expression of serum thyroid hormone and lipoproteins.Methods: A total of 121 patients with SLE and 65 healthy controls (HCs) at Nanjing Drum Tower Hospital completed a cognitive function test, then 81 SLE patients were divided into high cognition (n=33) group and low cognition group (n=48). The differences in clinical and laboratory tests and the correlations between IgG, IgM, albumin, T3, and T4 levels and cognitive function were analyzed. The enzyme-linked immunosorbent assay was used to determine the serum levels of 4 lipoproteins (APOE, APOA1, IGF-1, and IGFBP7) in 81 patients.Results: Patients with SLE were less educated with abnormal cognitive function compared with HCs. The levels of albumin, T3 (P < 0.05), and T4 decreased in low-cognition patients, while D-dimer, anti-dsDNA antibody, and IgM levels increased. The serum IgG and IgM levels showed a significant negative correlation with partial cognitive function. The serum T3 and T4 levels positively correlated with cognition. The expression of APOE, APOA1, IGF-1, and IGFBP7 showed no difference between the high- and low-cognition groups. However, the serum APOE level negatively correlated with Line Orientation, APOA1 positively correlated with Coding, and IGFBP7 negatively correlated with Graphic copy (P < 0.05), and IGF-1 had no correlation with any cognitive functions.Conclusions: Thyroid hormones (T3 and T4) and lipoproteins (APOE, APOA1, and IGFBP7) were associated with cognitive dysfunction in SLE. Whether T3 and T4 can be used in clinical practice as the biomarkers of cognitive dysfunction in SLE needs further exploration.

Objective Patients with autoimmune diseases often present with olfactory impairment. The aim of the study was to assess the olfactory functions of patients with primary Sjögren’s syndrome, and to correlate these findings with their disease activity.Methods Fifty-two patients with primary SS and 52 sex- and age- matched healthy control subjects were included. All of them underwent clinical and laboratory examination. Olfactory functions were evaluated using olfactory function assessment by computerized testing including the three stages of smell: threshold, identification and memory of the different odors. Results All the olfactory scores (olfactory threshold, identification and memory) in patients with pSS were significantly decreased than the control group (all P<0.01). Patients had higher proportion of anosmia (13.5% vs 0%) and hyposmia (19.2% vs 11.5%) than controls (χ2 =10.526, P <0.01). Multivariable regression analysis revealed that ESSDAI and the symptoms of dryness, fatigue and limb pain had negative influence on olfactory function (adjusted R2=0.381, 0.387, 0.513 and 0.614, respectively). ESSPRI showed significantly negative association with olfactory threshold, identification, memory and total scores. Olfactory identification and memory scores were decreased in pSS patients with thyroid dysfunction or hypocomplementemia (P<0.05). Smell threshold scores were decreased in pSS patients with anti-SSA antibody or anti-nuclear antibody compared with those without those autoantibodies (P<0.01). Conclusion Our findings indicate that olfactory functions are impaired in pSS patients. There was close correlation between olfactory dysfunction with disease severity and immunological abnormalities. Immune and systemic inflammation dysregulation might play a role in the mechanism of this defect.