Access: Lupus Research -- Lupus Complications
Research Summaries from 2012
Metabolic Syndrome Among Patients With Lupus
Metabolic syndrome is characterized by increased waist circumference and elevations in cholesterol, fats in the blood, blood pressure, and/or fasting blood sugar levels. Metabolic syndrome is marked by increased risk of cardiovascular diseases, so its incidence among people with lupus can indicate risk of cardiovascular disease in lupus patients. The results of this study indicate that metabolic syndrome is somewhat common among people with lupus and that specific factors related to lupus and its treatments significantly increase its risk. In addition, lupus patients from specific minority groups are at especially increased risk of developing metabolic syndrome.
New American College of Rheumatology Guidelines for Lupus Nephritis
Lupus-related inflammation of the kidney, or lupus nephritis, is one of the most serious complications of systemic lupus erythematosus. About half of people with lupus will develop lupus nephritis within a decade of a lupus diagnosis. In 1999, the American College of Rheumatology (ACR) released guidelines for the management of lupus nephritis. Since that time, new treatments for and insights about lupus nephritis have emerged. To update the ACR guidelines for the management of lupus nephritis, a team of lupus experts from around the country collaborated with the ACR. The researchers utilized extensive literature searches and expert opinions to develop the updated guidelines. Based on these efforts, the researchers developed new and specific treatment guidelines for the different classes of lupus nephritis, based on disease severity utilizing criteria set forth by the International Society of Nephrology (ISN)/Renal Pathology Society (RPS). It should be noted that these ACR-endorsed guidelines are provided as guidance, but are considered voluntary.
Increased Lupus-Related Risk of Work Loss
Having lupus is known to negatively affect specific aspects of work life. In general, the following are associated with work loss among people with lupus: lower levels of education, minority race/ethnicity, advanced age, longer disease duration, higher disease activity, and cognitive involvement. However, the extent to which specific manifestations of lupus (such as brain or skin involvement) are related to losing a job is largely unknown. The results of this study indicate that lupus patients having thrombotic (blood clot-related) events experience significant drops in employment within 12 months of the event. Lupus patients having musculoskeletal or neuropsychiatric events also experience a significant reduction in employment over time (although this reduction is less severe and occurs less rapidly than in the case of blot-clot related events). The results have the potential to guide aspects of lupus care that physicians should follow in patients over time and may guide strategies to improve work-related outcomes among people with lupus.
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Reduced Bone Density in Newly Diagnosed Children with Lupus
Sun avoidance, vitamin D deficiency, and steroid treatments are associated with thinning of the bones, or "osteoporosis." Children with lupus may be especially susceptible to osteoporosis because they are often being treated with steroids at a time when most of their initial bone development is still taking place. It would be useful for children with lupus (as well as their family members) to know whether they may be experiencing osteoporosis early on in their disease course due to steroid treatments or other factors. The results of this study highlight risk factors for developing osteoporosis, as well as the relative importance of lupus disease mechanisms and steroid treatments in the likelihood of a child newly diagnosed with lupus developing osteoporosis.
First Ever Study of Cholesterol-Lowering Drugs in Children With Lupus
Adults with lupus are at increased risk for developing cardiovascular disease as compared to the general population. Increased levels of blood cholesterol can result in atherosclerosis, or hardening of the arteries, which is itself a risk factor for cardiovascular disease. Previous studies indicate that subclinical atherosclerosis may be present in children with lupus. Since atherosclerosis is now known to begin in childhood, even in healthy people, the risk of developing atherosclerosis and cardiovascular disease has become a growing concern for the health of children with lupus. This study examined the safety and efficacy of atorvastatin (Lipitor®), a cholesterol-lowering drug, in children with lupus over a three-year period. The results suggest that lipid-lowering drugs like atorvastatin can safely and effectively reduce cholesterol levels in children with lupus. However, the effects of this treatment regimen do not warrant administration of lipid-lowering drugs to all children with lupus and future studies may indicate specific subpopulations that could benefit most.
Optimizing Assessment of Heart Disease Risk in People with Lupus
Lupus is associated with an increased risk for developing cardiovascular disease. Previous studies indicate that this increased risk cannot be fully accounted for by traditional risk factors, such as high cholesterol or blood pressure. Heart disease risk is typically assessed based on, at least in part, measurement of blood pressure and cholesterol levels at a certain point in time for a person of a given sex and age. However, recent studies suggest that cholesterol and blood pressure can vary considerably over time in people with lupus. This study examined whether heart disease risk could be better predicted in people with lupus when multiple measures of cholesterol and blood pressure were taken over time. The results suggest that traditional methods of blood pressure assessment (such as single-point-in-time measures) tend to underestimate its potential role in the development of heart disease and do not predict heart disease-related outcomes in people with lupus. Potential strategies to better assess heart disease risk in people with lupus are discussed.
Research Summaries from 2011
Reduced Growth and Delayed Puberty in Children with Lupus
Children with lupus often face unique challenges because their disease can be more severe and may require more aggressive treatments. Lupus or its treatments may have lasting biological effects. However, little is known about growth and development in children with lupus. The researchers examined possible impairments in growth, such as height, among children with lupus of varying ages and also depending on how long they have had lupus. Possible effects of steroid treatments on height were also specifically examined.
Long-Term Impairments of Functioning in Obese Women with Lupus
Relatively few studies have been conducted about the role and effects of obesity in the lives of people with lupus. Obesity is associated with disability, both in the general population and among people with lupus. Since up to half of people with lupus may be obese, it is important to determine to what extent specific functions (such as walking or climbing stairs) are impaired in people with lupus. Identification of preventable risk factors for disability, such as obesity, has the potential to decrease the negative effects of obesity on functioning in people with lupus.
Lack of Cardiovascular Risk Assessment in a Canadian Population of Lupus Patients
People with lupus have an increased risk of heart disease and stroke due to premature hardening of the arteries. This increased risk is due in part to traditional risk factors and in part due to lupus-specific immune dysfunction. The researchers aimed to evaluate how effectively risk for heart disease was being assessed in a population of lupus patients being cared for in Alberta, Canada.
Research Summaries from 2010
Low Level of Vitamin D Does Not Necessarily Result in Bone Disease in People With Lupus
People with lupus are advised to avoid the sun because the ultraviolet rays can trigger rashes. Some patients experience more widespread flares after sun exposure. However, sun avoidance leads to low levels of vitamin D in the body. Low levels of vitamin D are associated with thinning of the bones, or "osteoporosis." The researchers wanted to know about possible relationships between vitamin D levels in the blood, lupus treatments, and bone mineral density (BMD), a measurement of how thick bones are. The results of this study showed that people with lupus who are treated with steroids are at increased risk of having low levels of vitamin D. Although reduced levels of vitamin D are known to be directly linked to osteoporosis, this study did not show that connection.
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People Who Have Both Lupus and Antiphospholipid Syndrome Might Have Higher Risk of Thyroid Disease
The thyroid is a gland in the neck which helps the body keep order over how food and nutrients are handled and how fast people grow, gain or lose weight, how the heart beats, or how blood pressure and cholesterol levels in the blood respond to these changes. A protein called "thyroid peroxidase" helps to modify other proteins that the thyroid produces that perform all of these functions. Some people make antibodies (immune proteins) against their own thyroid peroxidase (these are called "anti-TPO"). People with anti-TPO sometimes have an underactive thyroid; this causes weight gain, fatigue, and a tendency to feel cold when other people around you do not.
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Research Summaries from 2009
The Thyroid-Lupus Relationship
The thyroid gland makes hormones that act on many functions in the body, from how quickly cells use energy to bone development and nerve cell growth. The thyroid’s production of hormones is regulated by TSH (thyroid-stimulating hormone), which is made in the pituitary gland. Autoimmune thyroid disease occurs when the body makes antibodies to thyroid cells. Different antibodies to the thyroid can have different effects. Some can inhibit the thyroid cells, causing an underactive thyroid (thyroiditis); others can stimulate the thyroid cells, leading to an overactive thyroid (Graves’ disease). Many of the symptoms of autoimmune thyroid disease -- fatigue, muscle pain and weakness, specific antibodies -- are also symptoms of lupus. Several studies have suggested that thyroid disease occurs more often in people with lupus than the general population.
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Research Summaries from 2007
Risk Factors for Pneumonia
Pneumonia is the most common form of lung disease in lupus patients. The researchers for this study wanted to see if they could identify specific risk factors for pneumonia among lupus patients. The researchers found that being male, having had lupus nephritis or leucopenia, and treatment with immunosuppressive drugs were all associated with a higher risk for getting pneumonia, but the strongest association was a specific variation in a gene that plays a role in the production of a molecule called tumor necrosis factor (TNF).
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Low bone density in African American women with lupus
Women with lupus are at risk for osteoporosis and fractures. It is estimated that as many as 25% of pre-menopausal women with lupus may have osteopenia, or low bone mineral density (BMD), an early sign of osteoporosis. The researchers wanted to determine if African American women with lupus, like their Caucasian counterparts, were at risk for low bone density. In this study of 298 women, the researchers found that African American women were much more likely to have low BMD in the lower back (or lumbar spine) than Caucasian women.
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At risk for thrombosis: FXII autoantibodies and the antiphospholipid syndrome
People with lupus who have antiphospholipid antibodies (aPL) are at risk for blood clots, including heart attacks, strokes, clots in the legs, lungs, or other organs, and pregnancy complications. Researchers for this study of 127 patients found antibodies to Factor XII (FXII), a protein that plays a role in preventing blood clots, were present in 40% of the lupus patients as opposed to only 7% of the healthy people.
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Organ Damage in Men with Lupus Appears to Develop Sooner and More Severely
Even though nine of ten people who have lupus are female, when lupus occurs in men, organ damage appears to develop sooner in the course of their disease and more severely. This accelerated development of damage early in the course of their disease contributes to poorer long-term prognosis for males.
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Study Identifies Possible Cause of Low Platelet Count in Lupus
Having a reduced number of platelets is a serious complication of lupus. A large percentage of cases are due to antibodies that bind to at least one of two proteins on the surface of blood platelets. A group of researchers in Tokyo have studies these two types of antibodies and suggest that antibodies to each of the proteins operate in distinctly different ways.
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Research Summaries from 2006
Smoking May Be Related to Increased Risk for Developing Lupus
That exposure to tobacco smoke is hazardous to health is by no means breaking news, but what may come as a surprise is that smoking has been associated with a number of autoimmune diseases, including rheumatoid arthritis, multiple sclerosis, and autoimmune thyroid disease – and may actually increase a person’s susceptibility to lupus. One current idea is that smoking-related damage to the genetic material in a cell (DNA) will lead to the formation of antibodies to double-stranded DNA (dsDNA), which may in turn have a role in the development of lupus.
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