Nov. 04, 2010

Lupus Antibodies Related to Persistent Disease Activity and Heart Disease

Antibodies to apolipoprotein A-I, high-density lipoprotein, and C-reactive protein are associated with disease activity in patients with systemic lupus erythematosus.
O’Neill SG, Giles I, Lambrianides A, Manson J, D’Cruz D, Schrieber L, March LM, Latchman DS, Isenberg DA, and Rahman A. (2010).  Arthritis & Rheumatism 62: 845-854. 

What is the topic?
People with lupus are at increased risk for developing heart disease. It is known that lupus patients make antibodies (immune proteins) that could interfere with some of the proteins that control cholesterol. Since unregulated cholesterol is a risk factor for heart disease, it is possible that these particular antibodies might increase the risk for this in lupus patients. 

What did the researchers hope to learn?
The researchers hoped to learn whether antibodies to cholesterol regulators are associated with disease activity or heart disease in people with lupus. The antibodies studied are called anti-apolipoprotein A-I (anti-Apo A-I), anti-high-density lipoprotein (anti-HDL), and anti-C-reactive protein (anti-CRP). 

Who was studied?
81 people with lupus volunteered for this study at University College, London. 34 people without lupus were also studied.

How was the study conducted?
The following information was looked at: whether the patients had mostly high or low disease activity over a two-year period, whether or not they had a flare, whether they developed lupus nephritis (inflammation of the kidney), and whether they had evidence of heart disease within the past year.  

What did the researchers find?
Levels of anti-Apo A-I and anti-HDL were highest in people with mostly high lupus disease activity compared to those with persistently low disease activity. These antibodies were even lower in healthy people. 

One antibody, anti-Apo A-I, seemed to be significantly increased after a flare. 

Among those with newly diagnosed nephritis, levels of anti-dsDNA seemed to be associated with those of anti-HDL and anti-Apo A-I. 

Levels of anti-Apo A-I, anti-HDL, and anti-CRP were significantly higher in people with lupus who had heart disease within the past year as compared to healthy people. 

What were the limitations of the study?
Most of the patients included in the part of the study in which anti-HDL was looked at before and after a flare started out with high levels of this antibody, which may have made it harder to see changes caused by a flare. Disease activity measurements were only available for half of the people with lupus who had heart disease within the past year, thus limiting the amount of information that could be used. Lastly, many of the people with lupus who had heart disease within the past year either smoked or had high blood pressure, which may have unknown effects on the outcome of this study.  

What do the results mean for you?
Persistently high lupus disease activity may lead to increased levels of antibodies that interfere with control of cholesterol levels, possibly increasing the risk for heart disease in people with lupus. Details of these relationships need further study.


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