Lupus Academy Roadshow Meeting: Abstract Book

The Lupus Academy is committed to continuing the development of high quality educational programmes, focused on providing insightful and clinically relevant content through both live meetings and eLearning environments. With this, we aim will support you as you strive to provide best-in-class patient care and improve patient outcomes in lupus. This Roadshow Meeting is CME accredited by the Paraguayan Society of Rheumatology and aims to provide latest insights into advances in global research and clinical practice in lupus and allied diseases. The scientific component of this programme, developed by our Steering Committee of 12 international experts in lupus, is designed to create a highly interactive forum through which we can all develop a logical approach to the management of lupus worldwide. This meeting will give you the opportunity to meet like-minded clinicians and scientists and, through the sharing of clinical and scientific experience, develop your knowledge in this complex and multidisciplinary therapeutic area. We sincerely hope that this meeting will provide you with new ideas for your clinical work, enriched enthusiasm for collaborative research, and fruitful discussions with your colleagues who care for patients with lupus.CONACYT - Consejo Nacional de Ciencias y TecnologíaPROCIENCI

Advanced and convencional magnetic resonance imaging in neuropsychiatric lupus.

Neuropsychiatric lupus is a major diagnostic challenge, and a main cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Magnetic resonance imaging (MRI) is, by far, the main tool for assessing the brain in this disease. Conventional and advanced MRI techniques are used to help establishing the diagnosis, to rule out alternative diagnoses, and recently, to monitor the evolution of the disease. This review explores the neuroimaging findings in SLE, including the recent advances in new MRI methods

Síndrome antifosfolipídico catastrófico

El término síndrome antifosfolipídico (SAF) “catastrófico” fue introducido para definir una forma grave y rápidamente evolutiva de SAF que conduce a insuficiencia multiorgánica. Los pacientes con SAF catastrófico tienen en común: a) evidencia clínica de afectación orgánica múltiple (3 o más órganos); b) evidencia anatomopatológica de la oclusión de múltiples vasos de pequeño calibre (aunque algunos pacientes presentan también trombosis de los vasos de gran calibre) y c) confirmación de la presencia de anticuerpos antifosfolipídicos (AAF), generalmente a títulos elevados. Aunque representan menos del 1% de todos los pacientes con SAF, generalmente se encuentran en una situación médica urgente que requiere un seguimiento clínico exhaustivo y un tratamiento precoz y enérgicoThe term anti-phospholipid syndrome (APS) “catastrophic” was introduced to define a serious and rapidly progressive form of APS which leads to multi-organ failure. Patients with catastrophic APS have in common: a) a clinical evidence of multiple organ involvement (3 or more organs); b) pathological evidence of occlusion of multiple small vessels (although some patients have also thrombosis of large vessels) and c) confirmation of the presence of anti-phospholipid antibodies (APAs), usually at high titers. Although they represent less than 1% of all patients with APS, they usually found in an urgent medical situation that requires a thorough clinical monitoring and an early and vigorous treatmentCuenc

Antigens and antibodies of the antiphospholipid syndrome as new allies in the pathogenesis of COVID-19 coagulopathy

High prevalence of both criteria and extra-criteria antiphospholipid antibodies (aPL) has been reported in COVID-19 patients. However, the differences in aPL prevalence decreased when an age-matched control group was included. The association of aPL with thrombotic events in COVID-19 is very heterogeneous. This could be influenced by the fact that most of the studies carried out were conducted on small populations enriched with elderly patients in which aPL was measured only at a single point and they were performed with non-standardized assays. The few studies that confirmed aPL in a second measurement showed that aPL levels hardly changed, with the exception of the lupus anticoagulant that commonly reduced. COVID-19 coagulopathy is an aPL-independent phenomenon closely associated with the onset of the disease. Thrombosis occurs later in patients with aPL presence, which is likely an additional prothrombotic factor. B2-glycoprotein deficiency (mainly aPL antigen caused both by low production and consumption) is very common during the SARS-CoV2 infection and has been associated with a greater predisposition to COVID-19 complications. This could be a new prothrombotic mechanism that may be caused by the blockage of its physiological functions, the anticoagulant state being the most important

Systematic Literature Review and Meta-analysis of Venous Thromboembolism Events in Systemic Lupus Erythematosus

The objective of this work was to conduct a systematic literature review (SLR) and meta-analysis (MA) to evaluate the relative risk (RR) of venous thromboembolism (VTE) events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), in patients with systemic lupus erythematosus (SLE) compared with patients without SLE, as well as the absolute risk (AR) (measured by incidence proportion) and incidence rate (IR) of VTE events in patients with SLE. The SLR was conducted using Embase, MEDLINE, and MEDLINE In-Process to identify observational studies evaluating the risk of VTE, DVT, and PE events in adult patients with SLE compared with the general population, published January 2000 to September 2020. Random-effects models were used as the primary approach in the MA. Heterogeneity was assessed on the basis of the I2 value. Sensitivity analyses were performed to assess the robustness of results to various conditions, and subgroup analysis was performed for the AR of VTE by antiphospholipid status (aPLs) and antiphospholipid syndrome (APS). Of the 50 publications included for data extraction, 44 contained data for consideration in the MA of any one of the measures of interest (RR, AR, or IR) for VTE, DVT, or PE. The pooled RR indicates statistically significantly higher risk of VTE (RR 4.38, 95% confidence interval 2.63-7.29) in patients with SLE compared with the general population. Considerable heterogeneity was present in nearly all MA (I2 = 75-100%). Moreover, a higher pooled AR of VTE was estimated in patients with SLE with aPLs (n/N = 0.13) and APS (n/N = 0.63) compared with patients with SLE without aPLs/APS (n/N = 0.07). Overall, there was evidence of an increased risk of VTE, DVT, and PE in patients with SLE compared with the general population

Vitamin K-dependent proteins GAS6 and Protein S and TAM receptors in patients of systemic lupus erythematosus: correlation with common genetic variants and disease activity

INTRODUCTION: Growth arrest-specific gene 6 protein (GAS6) and protein S (ProS) are vitamin K-dependent proteins present in plasma with important regulatory functions in systems of response and repair to damage. They interact with receptor tyrosine kinases of the Tyro3, Axl and MerTK receptor tyrosine kinase (TAM) family, involved in apoptotic cell clearance (efferocytosis) and regulation of the innate immunity. TAM-deficient mice show spontaneous lupus-like symptoms. Here we tested the genetic profile and plasma levels of components of the system in patients with systemic lupus erythematosus (SLE), and compare them with a control healthy population. METHODS: Fifty SLE patients and 50 healthy controls with matched age, gender and from the same geographic area were compared. Genetic analysis was performed in GAS6 and the TAM receptor genes on SNPs previously identified. The concentrations of GAS6, total and free ProS, and the soluble forms of the three TAM receptors (sAxl, sMerTK and sTyro3) were measured in plasma from these samples. RESULTS: Plasma concentrations of GAS6 were higher and, total and free ProS were lower in the SLE patients compared to controls, even when patients on oral anticoagulant treatment were discarded. Those parameters correlated with SLE disease activity index (SLEDAI) score, GAS6 being higher in the most severe cases, while free and total ProS were lower. All 3 soluble receptors increased its concentration in plasma of lupus patients. CONCLUSIONS: The present study highlights that the GAS6/ProS-TAM system correlates in several ways with disease activity in SLE. We show here that this correlation is affected by common polymorphisms in the genes of the system. These findings underscore the importance of mechanism of regulatory control of innate immunity in the pathology of SLE

Sarcoidosis or primary Sjögren's syndrome?

Correspondence: SIR, We were interested to read the case report by Melsom and coworkers.' We have been followinl up a patient who presented a similar difficult diagnosis