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Journal of Autoimmunity Apr 2023Finkelstein-Seidlmayer vasculitis, also called acute hemorrhagic edema of young children or infantile immunoglobulin A vasculitis, is habitually a benign skin-limited...
Finkelstein-Seidlmayer vasculitis, also called acute hemorrhagic edema of young children or infantile immunoglobulin A vasculitis, is habitually a benign skin-limited small vessel leukocytoclastic vasculitis that mainly affects infants 24 months or less of age. Since this disease is commonly triggered by an infection, an immune-mediated origin has been postulated. To better appreciate the possible underlying immune mechanism of this vasculitis, we addressed circulating autoimmune markers and vascular immune deposits in patients contained in the Acute Hemorrhagic Edema BIbliographic Database, which incorporates all original reports on Finkelstein-Seidlmayer vasculitis. A test for at least one circulating autoimmune marker or a vascular immune deposit was performed in 243 cases. Subunits of complement system C4 resulted pathologically reduced in 4.7% and C3 in 1.4%, rheumatoid factor was detected in 6.1%, and antinuclear antibodies in 1.9% of cases. Antineutrophil cytoplasmic antibodies were never demonstrated. Immunofluorescence studies were performed on 125 skin biopsy specimens and resulted positive for complement subunits in 46%, fibrinogen in 45%, immunoglobulin A in 25%, immunoglobulin M in 24%, immunoglobulin G in 13%, and immunoglobulin E in 4.2% of cases. Infants testing positive for vascular immunoglobulin A deposits did not present a higher prevalence of systemic involvement or recurrences, nor a longer disease duration. In conclusion, we detected a very low prevalence of circulating autoimmune marker positivity in Finkelstein-Seidlmayer patients. Available immunofluorescence data support the notion that immune factors play a relevant role in this vasculitis. Furthermore, vascular immunoglobulin A deposits seem not to play a crucial role in this disease.
Topics: Child; Infant; Humans; Child, Preschool; Vasculitis; Vasculitis, Leukocytoclastic, Cutaneous; Immunoglobulin A; Immunoglobulin G; Hemorrhage; Edema
PubMed: 36822150
DOI: 10.1016/j.jaut.2023.103002 -
Medicine Dec 2022To evaluate the efficacy and safety of total glucosides of paeony in the treatment of systemic lupus erythematosus (SLE). (Meta-Analysis)
Meta-Analysis
BACKGROUND
To evaluate the efficacy and safety of total glucosides of paeony in the treatment of systemic lupus erythematosus (SLE).
METHODS
From the creation of the database to July 2021, multiple databases were searched for randomized controlled trials of treating SLE with total glucosides of paeony (TGP) combining chemical medicine. After screening, quality evaluation and data extraction, the included studies were analyzed by Revman5.3 software.
RESULTS
A total of 11 studies were included, including 836 patients (treatment group 417, control group 419). Meta analysis showed that on the basis of routine treatment, TGP could further improve the treatment effective rate (OR = 4.19, 95% CI: 2.21 to 7.95, Z = 4.38, P < .0001), reduced SLE Disease Activity Index (SLEDAI) (MD = -1.70, 95%CI: -2.51 to -0.89, Z = 4.11, P < .0001) and erythrocyte sedimentation rate (MD = -7.04, 95%CI: -8.48 to -5.59, Z = 9.53, P < .00001), reduced the level of immunoglobulin A (IgA) (MD = -0.60, 95%CI: -0.82 to -0.37, Z = 5.24, P < .00001), immunoglobulin G (IgG) (MD = -2.97, 95%CI: -3.72 to -2.23, Z = 7.82, P < .00001), and immunoglobulin M (IgM) (MD = -0.36, 95%CI: -0.45 to -0.27, Z = 7.54, P < .00001), increased the level of complement C3 (MD = 0.34, 95%CI: 0.30 to 0.39, Z = 14.40, P < .00001) and complement C4 (MD = 0.07, 95%CI: 0.06 to 0.08, Z = 10.08, P < .00001), and decreased the recurrence (OR = 0.31, 95%CI: 0.16 to 0.61, Z = 3.39, P = .0007), and there was no significant difference in the incidence of adverse reactions (OR = 0.93, 95%CI: 0.45 to 1.91, Z = 0.20, P = .84).
CONCLUSION
On the basis of conventional treatment, the combined use of TGP can enhance the clinical efficacy of SLE without increasing the incidence of adverse effects.
Topics: Humans; Glucosides; Paeonia; Lupus Erythematosus, Systemic; Treatment Outcome
PubMed: 36550839
DOI: 10.1097/MD.0000000000032029 -
Seminars in Arthritis and Rheumatism Jun 2015Systemic lupus erythematosus (SLE) is an autoimmune disease that may present manifestations that resemble other diseases. Visceral leishmaniasis (VL) is a parasitic... (Review)
Review
OBJECTIVE
Systemic lupus erythematosus (SLE) is an autoimmune disease that may present manifestations that resemble other diseases. Visceral leishmaniasis (VL) is a parasitic infection whose hallmarks may mimic SLE symptoms. Here, we report a case series and evaluate the published, scientific evidence of the relationship between SLE and VL infection.
METHODS
To assess original studies reporting cases of VL-infected patients presenting manifestations that are capable of leading to inappropriate suspicions of SLE or mimicking an SLE flare, we performed an extensive search in several scientific databases (MEDLINE, LILACS, SciELO, and Scopus). Two authors independently screened all citations and abstracts identified by the search strategy to identify eligible studies. Secondary references were additionally obtained from the selected articles.
RESULTS
The literature search identified 53 eligible studies, but only 17 articles met our criteria. Among these, 10 lupus patients with VL mimicking an SLE flare and 18 cases of VL leading to unappropriated suspicions of SLE were described. The most common manifestations in patients infected with VL were intermittent fever, pancytopenia, visceromegaly, and increased serum level of acute phase reactants. The most frequent autoantibodies were antinuclear antibodies, rheumatoid factor, and direct Coombs' test.
CONCLUSION
In endemic areas for VL, the diagnosis of SLE or its exacerbation may be a clinical dilemma. Hepatosplenomegaly or isolated splenomegaly was identified in the majority of the reported cases where VL occurred, leading to unappropriated suspicions of SLE or mimicking an SLE flare. Furthermore, the lack of response to steroids, the normal levels of complement proteins C3 and C4, and the increased level of transaminases suggest a possible infectious origin.
Topics: Adolescent; Adult; Antibodies, Antinuclear; Coombs Test; Diagnosis, Differential; Female; Fever; Humans; Leishmaniasis, Visceral; Lupus Erythematosus, Systemic; Pancytopenia; Rheumatoid Factor
PubMed: 25704907
DOI: 10.1016/j.semarthrit.2014.12.004 -
Chinese Journal of Integrative Medicine Oct 2021To provide evidence on the efficacy and safety of Chinese herbal medicine (CHM) as interventions for systemic lupus erythematosus (SLE). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To provide evidence on the efficacy and safety of Chinese herbal medicine (CHM) as interventions for systemic lupus erythematosus (SLE).
METHODS
Seven electronic databases, including the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Chinese Biomedical Literature Service System (SinoMed), Wanfang, Embase, and PubMed, were comprehensively searched, from their inception to August 16, 2020, for all randomized controlled trials (RCTs) that focused on CHM used alone or in combination with conventional medicine for SLE. Outcomes were SLE activity index (SLEDAI), traditional Chinese medicine symptom/syndrome score (TCMSS), dosage of glucocorticoids, main serological testing, and incidence of adverse events. Data were extracted and pooled using Review Manager 5.3 software.
RESULTS
A total of 13 RCTs enrolling 856 participants met our inclusion criteria. Meta-analyses showed that, compared to placebo, CHM had statistically significant effect on reducing SLEDAI score (MD=-1.74, 95% CI: -2.29 to -1.18), diminishing TCMSS (SMD=-0.89, 95% CI: -1.16 to -0.62), decreasing dosage of glucocorticoids (MD=-2.41 mg/d, 95% CI: -3.34 to -1.48), lowering erythrocyte sedimentation rate (MD=-4.78 mm/h, 95% CI: -8.86 to -0.71), and increasing serum complement C4 level (MD=0.03 mg/dL, 95% CI: 0.00 to 0.06). No significant difference was found between CHM and placebo on adverse events.
CONCLUSIONS
CHM provided significant beneficial effect on controlling disease activity and reducing dose of glucocorticoids used among SLE patients. Future advanced designed RCTs for CHM treating moderate to severe SLE with multicenter and longer follow-up are urgently needed.
Topics: Drugs, Chinese Herbal; Humans; Lupus Erythematosus, Systemic; Medicine, Chinese Traditional; Multicenter Studies as Topic; Randomized Controlled Trials as Topic
PubMed: 34319503
DOI: 10.1007/s11655-021-3497-0 -
Clinical Reviews in Allergy & Immunology Dec 2020Diffuse alveolar hemorrhage (DAH) is a rare but potentially deadly manifestation of systemic lupus erythematosus (SLE). The aim of this study was to investigate the... (Meta-Analysis)
Meta-Analysis
Clinical Characteristics and Risk Factors of Diffuse Alveolar Hemorrhage in Systemic Lupus Erythematosus: a Systematic Review and Meta-Analysis Based on Observational Studies.
Diffuse alveolar hemorrhage (DAH) is a rare but potentially deadly manifestation of systemic lupus erythematosus (SLE). The aim of this study was to investigate the clinical characteristics and risk factors of DAH in SLE. A systematic review and meta-analysis of previous observational studies compared the clinical characteristics and risk factors between DAH-SLE and SLE patients without DAH. A total of 5 observational studies were included in this meta-analysis. Compared with the SLE patients without DAH, DAH-SLE patients had a significantly higher incidence of neuropsychiatric events (OR = 4.321, 95% CI (1.686-11.073), P = 0.002, I = 49.2%), nephritis (OR = 3.146, 95% CI (1.663-5.955,), P = 0.000, I = 0.0%), serositis (OR = 6.028, 95% CI (1.418-25.635), P = 0.015, I = 80.3%), dyspnea (OR = 31.241,95% CI (0.202-4833.203), P = 0.181, I = 94.6%), and a significantly lower level of C3 (SMD = - 1.358, 95% CI - 1.685, - 1.031), P = 0.000, I = 98.0%), C4 (SMD = - 1.251, 95% CI (- 1.648, - 0.855), P = 0.000, I = 87.7%), hemoglobin (SMD = - 2.074, 95% CI (- 2.433, - 1.715), P = 0.000, I = 94.2%), and a higher SLEDAI-2K score (SMD = 1.284, 95% CI (0.959, 1.608), P = 0.000, I = 98.2%). However, due to significant heterogeneity, some of these results should be interpreted cautiously. Nevertheless, when the above abnormal indicators are found, especially neuropsychiatric involvement and nephritis, besides the existed diagnostic criteria for DAH in SLE patients, a diagnosis for DAH should be considered and relevant treatment timely initiated. Further prospective multi-center SLE studies with a large cohort of patients and long-term follow-up are needed to clarify further or find out the specific clinical indexes for DAH in SLE patients.
Topics: Biomarkers; Blood Platelets; Complement C3; Complement C4; Diagnosis, Differential; Female; Hemorrhage; Humans; Incidence; Lupus Erythematosus, Systemic; Male; Odds Ratio; Pulmonary Alveoli; Risk Factors; Symptom Assessment
PubMed: 31440948
DOI: 10.1007/s12016-019-08763-8