Advances in the management of systemic lupus erythematosus

Abstract

Systemic lupus erythematosus (SLE) is a severe multisystem autoimmune disease that can cause injury in almost every body system. While considered a classic example of autoimmunity, it is still relatively poorly understood. Treatment with immunosuppressive agents is challenging, as many agents are relatively non-specific, and the underlying disease is characterized by unpredictable flares and remissions. This State of The Art Review provides a comprehensive current summary of systemic lupus erythematosus based on recent literature. In basic and translational science, this summary includes the current state of genetics, epigenetics, differences by ancestry, and updates about the molecular and immunological pathogenesis of systemic lupus erythematosus. In clinical science, the summary includes updates in diagnosis and classification, clinical features and subphenotypes, and current guidelines and strategies for treatment. The paper also provides a comprehensive review of the large number of recent clinical trials in systemic lupus erythematosus. Current knowns and unknowns are presented, and potential directions for the future are suggested. Improved knowledge of immunological pathogenesis and the molecular differences that exist between patients should help to personalize treatment, minimize side effects, and achieve better outcomes in this difficult disease.

Genetically predicted associations between circulating cytokines and autoimmune diseases: a bidirectional two-sample Mendelian randomization

“…For example, new drugs for MS treatment, such as Bruton’s tyrosine kinase inhibitors (BTKi) and several candidate neuroprotective compounds, have achieved some success in phase II clinical trials ( 65 ), but their effectiveness remains to be fully evaluated. Treatment options for SLE include non-steroidal anti-inflammatory drugs, antimalarials, corticosteroids, immunosuppressants, and biologics ( 66 ). Despite the approval of new treatments, the prognosis for SLE patients remains poor ( 67 – 70 ).…”

Inflammation and arrhythmogenesis: a narrative review of the complex relationship

“…In addition, RA can raise the risk of heart failure and coronary artery disease by causing atherosclerosis, or the accumulation of plaque in the arteries [39]. Another autoimmune condition that can impact several organs, such as the skin, kidneys, lungs, and heart, is systemic lupus erythematosus (SLE) [40]. Heart muscle, pericardium, blood arteries, and heart valves can all become inflamed and damaged as a result of SLE [40].…”

“…Another autoimmune condition that can impact several organs, such as the skin, kidneys, lungs, and heart, is systemic lupus erythematosus (SLE) [40]. Heart muscle, pericardium, blood arteries, and heart valves can all become inflamed and damaged as a result of SLE [40]. Anti-phospholipid syndrome, a disorder that makes blood clot more readily, and an increased risk of heart attack and stroke can also be brought on by SLE [40].…”

Double-Negative T (DNT) Cells in Patients with Systemic Lupus Erythematosus

“…Among them, (lupus) nephritis is the most relevant complication from a prognostic point of view. Such a protean clinical picture is also associated with a large and variable production of autoantibodies; however, double-stranded DNA (anti-dsDNA) antibodies are the most specific for SLE, have a pathogenic relevance, and also correlate with disease activity [9,10]. Accordingly, the immunological background of SLE is very complex, and the main immunopathogenic mechanisms include efferocytosis defects (namely a reduced clearance of self-antigens, especially through complement factors, of which some patients have been shown to be deficient in), apoptosis defects (which also contribute to the loss of B-cell self-tolerance), and the inappropriate activation of type I interferon (which can sustain chronic inflammation and, thus, further compromises self-tolerance) [11][12][13][14].…”