Double risk of interleukin-37 rs3811047 A allele polymorphism with lupus nephritis in an Egyptian population

Aim of the work: To investigate the association of interleukin-37 (IL-37)(rs3811047) polymorphism with lupus nephritis (LN) in systemic lupus erythematosus (SLE) patients. Patients and methods: The case-control study included 206 SLE patients, 97 with LN and 109 without LN, and 240 healthy controls. SLE disease activity index (SLEDAI) was assessed. Genotyping of the IL-37 (rs3811047) polymorphism was done using real time polymerase chain reaction (PCR). A bioinformatic analysis of IL-37 was also performed. Results: The mean ages of SLE patients were 32.82 ± 10.43 years and female: male was 195:11 (F:M 17.7:1). The SLEDAI was significantly higher in the patients with LN (7.9 ± 6.6) compared to those without (1.9 ± 1.8) (p < 0.001). The AA genotype was more frequently represented in patients with LN (21.6%) compared to those without (7.3%) (p = 0.007), and carriers of AA genotype had four times increased susceptibility to acquire LN compared to GG and GA (OR: 4.1). Likewise, the A allele was more represented in patients with LN (43%) than in those without (30%)(p = 0.004), and the carriers of the A allele had nearly two times more risk of developing LN compared to carriers of G allele (OR: 1.79).The AA genotype was associated with LN susceptibility under the recessive genetic model (p = 0.002). Regression analyses revealed that A allele is an independent risk factor of proteinuria (p < 0.001), disease activity (p < 0.001), consumed C3 (p < 0.001) and C4 (0.003). Conclusion: The AA genotype of the IL-37 (rs3811047) SNP contributes to the development of SLE in Egyptian patients with a doubled risk of acquiring LN in carriers of the allele A

Defining Criteria for Disease Activity States in Systemic Juvenile Idiopathic Arthritis Based on the Systemic Juvenile Arthritis Disease Activity Score

Objective. Our objective was to develop and validate cutoff values in the systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10) that distinguish the states of inactive disease (ID), minimal disease activity (MDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with systemic juvenile idiopathic arthritis, based on subjective disease state assessment by the treating pediatric rheumatologist. Methods. The cutoff definition cohort was composed of 400 patients enrolled at 30 pediatric rheumatology centers in 11 countries. Using the subjective physician rating as an external criterion, six methods were applied to identify the cutoffs: mapping, calculation of percentiles of cumulative score distribution, the Youden index, 90% specificity, maximum agreement, and receiver operating characteristic curve analysis. Sixty percent of the patients were assigned to the definition cohort, and 40% were assigned to the validation cohort. Cutoff validation was conducted by assessing discriminative ability. Results. The sJADAS10 cutoffs that separated ID from MDA, MDA from MoDA, and MoDA from HDA were &lt;= 2.9, &lt;= 10, and &gt;20.6, respectively. The cutoffs discriminated strongly among different levels of pain, between patients with and without morning stiffness, and among patients whose parents judged their disease status as remission or persistent activity or flare or were satisfied or not satisfied with current illness outcome. Conclusion. The sJADAS cutoffs revealed good metrologic properties in both definition and validation cohorts and are therefore suitable for use in clinical trials and routine practice