Rws Wong

Prognostically distinct clinical patterns of systemic lupus erythematosus identified by cluster analysis

The objective of this study was to evaluate the patterns of clinical manifestations and their mortality in a large cohort of Chinese patients with systemic lupus erythematosus. The cumulative clinical manifestations of a large group of Chinese systemic lupus erythematosus patients who fulfilled at least four American College of Rheumatology criteria for systemic lupus erythematosus were studied. Patients were divided into distinct groups by using the K-mean cluster analysis. Clinical features, prevalence of proliferative lupus nephritis (World Health Organization class III, IV), autoantibody profile, and treatment data were compared and the standardized mortality ratios were calculated for each cluster of patients. There were 1082 patients included in the study (mean age at systemic lupus erythematosus diagnosis 30.5 years; mean systemic lupus erythematosus duration 10.3 years). Three distinct groups of patients were identified. Cluster 1 (n = 347) was characterized predominantly by mucocutaneous manifestations (malar rash, discoid rash, photosensitivity, oral ulcer) and arthritis but having the lowest prevalence of serositis, hematologic manifestations (hemolytic anemia, leukopenia, and thrombocytopenia), and proliferative lupus nephritis. Patients in cluster 2 (n = 409) had mainly renal and hematological manifestations but having the lowest prevalence of mucocutaneous manifestations. Pulmonary and gastrointestinal manifestations were significantly more frequent in cluster 2 than the other clusters. Cluster 3 patients (n = 326) had the most heterogeneous features. Besides having a high prevalence of mucocutaneous manifestations, serositis and hematologic manifestations, renal involvement, and proliferative lupus nephritis was also most prevalent among the three clusters. Patients in cluster 2 had a much higher standardized mortality ratio [standardized mortality ratio 7.23 (6.7—7.7), p < 0.001] than those in cluster 3 [standardized mortality ratio 1.27 (1.1—1.5), p = 0.005] and cluster 1 [standardized mortality ratio 0.95 (0.5—1.7), p = 0.86]. In conclusion, patients with systemic lupus erythematosus could be clustered into prognostically distinct patterns of clinical manifestations. Lupus (2009) 18, 1267—1275.

CD5-positive and CD5-negative plaque-forming cells against poly-L-lysine-treated sheep erythrocytes in patients with systemic lupus erythematosus

While attempting to evaluate CD5+ and CD5- anti-DNA-secreting plaque-forming cells (PFC) in patients with systemic lupus erythematosus (SLE), significant numbers of PFC against control sheep erythrocytes (ShE) treated with poly-L-lysine (PLL) but not further conjugated with single-stranded (ss) or double-stranded (ds) DNA were noted. Numbers of PFC obtained using PLL-ShE, ssDNA-ShE and dsDNA-ShE were not significantly different, all reactivity to DNA apparently being accounted for by binding of antibodies to PLL-treated ShE. Nevertheless, anti-PLL-PFC could be inhibited by soluble dsDNA included in the plaque assay. These findings might be explained by cationic anti-DNA antibodies binding non-specifically to anionic PLL. Control healthy subjects gave few PFC against PLL-ShE, ssDNA-ShE or dsDNA-ShE. Anti-PLL-PFC appeared to be related to disease activity, with higher numbers of both CD5+ and CD5- PFC in patients with clinically active SLE.