Neuropsychiatric manifestations are present in 30-40% of patients with systemic lupus erythematosus (SLE). Recently, antibodies to aquaporin-4 (termed AQP4-Ab, or NMO-IgG), a water channel protein, were reported to be present in a subset of patients with SLE and neurological involvement. To evaluate the syndrome specificity and prevalence of serum NMO-IgG/anti-AQP4 antibodies in patients with neuropsychiatric systemic lupus erythematosus (NPSLE). Sera of 76 patients with SLE and neurological symptoms, 50 of whom met the ACR case definitions of NPSLE, were tested for AQP4-Ab in an indirect immunofluorescence assay employing HEK293 cells transfected with recombinant human AQP4. Only one of the examined sera was positive for NMO-IgG/AQP4-Ab. This patient suffered from TM, ranging over two vertebral segments on spinal MRI. None of the 75 NPSLE without TM was found to be seropositive for NMO-IgG/AQP4-Ab. NMO-IgG/AQP4-Ab in NPSLE were present only in a patient with TM and were not detectable in NPSLE patients with other neurological manifestations. Testing for NMO-IgG/AQP4-Ab positivity should be considered in patients presenting with SLE and TM. Non-longitudinally extensive lesions do no not exclude NMO-IgG/AQP4-Ab in patients presenting with SLE and TM.
- MeSH
- akvaporin 4 analýza krev MeSH
- biologické markery analýza krev MeSH
- fluorescenční protilátková technika nepřímá MeSH
- HEK293 buňky MeSH
- imunoglobulin G analýza krev MeSH
- komorbidita MeSH
- lidé MeSH
- prevalence MeSH
- rekombinantní proteiny MeSH
- séroepidemiologické studie MeSH
- transverzální myelitida diagnóza epidemiologie imunologie MeSH
- vaskulitida centrálního nervového systému při lupus erythematodes diagnóza epidemiologie imunologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVE: Systemic lupus erythematosus (SLE) is accompanied by severe oxidative stress. Bilirubin has been reported as a strong negative predictor of oxidative stress-mediated diseases, such as atherosclerosis. The objective of our study was to evaluate the association between serum bilirubin levels and SLE manifestation. METHODS: The study was performed with 259 SLE patients, diagnosed according to American Rheumatism Association (ARA) criteria. A subset of these patients, having normal hepatic function (n = 218, mean age 39.5 years), was studied in greater detail to eliminate the possible confounding effects of any underlying or drug-induced liver disease on the serum bilirubin levels. Age-matched healthy subjects (n = 180) served as the control group. A standard biochemical and immunological work-up was performed on all subjects. RESULTS: Compared to the controls, substantially lower levels of serum bilirubin were detected in SLE patients (p < 10⁻⁵); these were inversely correlated with disease activity and extent (p < 0.05). Furthermore, each 1 μmol/L decrease in serum bilirubin was associated with a 37% increase in the odds for a positive SLE status [odds ratio (OR) 1.37, 95% confidence interval (CI) 1.28-1.47, p < 10⁻⁵]. Simultaneously, the odds of unconjugated hyperbilirubinaemia (a phenotypic sign of Gilbert's syndrome) were more than four times lower in SLE patients (OR 0.235, 95% CI 0.072-0.764, p = 0.016). CONCLUSION: Low serum bilirubin represented a strong predictor of the manifestation of SLE symptoms. The most likely explanation for this finding is the increased consumption of bilirubin due to the severe oxidative stress accompanying SLE. Subjects with higher serum bilirubin levels, such as those with Gilbert's syndrome, might be protected from the development of SLE.
- MeSH
- bilirubin krev MeSH
- dospělí MeSH
- Gilbertova nemoc krev diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nemoci jater krev diagnóza MeSH
- oxidační stres MeSH
- studie případů a kontrol MeSH
- stupeň závažnosti nemoci MeSH
- systémový lupus erythematodes krev diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
