How to predict the prognosis in juvenile-onset SLE?

Abstract

Systemic lupus erythematosus (SLE) is a heterogeneous chronic autoimmune inflammatory disorder that results from widespread immune complex deposition and secondary tissue injury, but its pathogenesis is complex [1]. Juvenile-onset SLE (JSLE), which develops before the age of 18 years and accounts for approximately 20% of all SLE cases, tends to have high disease activities with higher morbidity and mortality rates and require long-term immunosuppressive medications as compared with adult-onset SLE [2]. The main causes of death are renal dysfunction, malignant diseases, and cardiovascular disease (CVD). Owing to the recent improvement in its treatment, fulminant SLE incidence has been decreasing, and premature atherosclerosis greatly influences its mortality. However, to my knowledge, no guidelines have been established for monitoring or managing CVD in patients with SLE or JSLE. Patients at high risk of CVDmust be identified, as not all patients with SLE have an equal risk of CVD. Considering the future CVD risk in patients with JSLE and less traditional risk factors, clinicians should use a biomarker or biomarker panel that could easily identify patients. Some clinical studies reported several risk factors of CVD events, such as older age, male sex, dyslipidaemia, hypertension, renal disease, metabolic syndrome, disease duration, and high disease activity, which could be divided into traditional and SLE-specific factors [3]. In this issue of EBioMedicine, Robinson and co-workers identified a novel risk marker, apolipoprotein B (apoB)-to-apoA1 ratio, from an investigation integrating metabolomics, transcriptome, immune profiles, and clinical data of patients with JSLE. They verified its usefulness by conducting longterm observational clinical cohort studies and comparing clinical information between adult patients with SLE and mouse atherosclerotic models [4]. ApoB and apoA1 are major apolipoproteins involved in lipid transport and the pathogenic processes and complications of atherosclerosis. These are the major protein components in very-low-, intermediate-, and low-density lipoproteins, with one protein per particle, and in high-density lipoprotein particles, respectively [5].