| 1. |
- Almehed, Katarina, 1966, et al.
(författare)
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Health-related quality of life in systemic lupus erythematosus and its association with disease and work disability.
- 2010
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Ingår i: Scandinavian journal of rheumatology. - : Informa UK Limited. - 1502-7732 .- 0300-9742. ; 39:1, s. 58-62
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To determine the health-related quality of life (HRQOL) and its relationship to disease variables, vertebral fractures, and employment status in female patients with systemic lupus erythematosus (SLE). Methods: HRQOL was assessed with the Swedish version of the Medical Outcomes Study (MOS) 36-Item Short Form Survey (SF-36) in female patients (n=163) and in age- and sex-matched controls (n=1045). Associations between the SF-36 score and demographics, disease variables, prevalent vertebral fractures, and employment status were analysed. Results: The SLE patients, aged 20 to 82 years, scored significantly lower than the controls on all SF-36 subscales. Patients with vertebral fractures were older, had greater disease damage, and lower physical functioning (PF) than patients without fractures. Of the SLE patients of working age (n=142), 54% worked full or part time. These patients scored their HRQOL significantly higher (better) than patients not working. Being able to work was significantly associated with low age and high scores in PF and role physical (RP): the area under the receiver operating characteristic (ROC) curve for these variables was 0.82, confidence interval 0.75-0.89. Conclusions: HRQOL is substantially lower in SLE than in the general population but working ability indicates better health. We encourage further research regarding the effects on HRQOL by preventive actions taken against work disability in SLE.
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| 2. |
- Almehed, Katarina, 1966
(författare)
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Osteoporosis in SLE
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As the treatment of Systemic Lupus Erythematosus (SLE) has become more effective the focus has partly shifted from main concern of short term morbidity and survival to long term complications such as osteoporosis. The aims of this thesis were to a) determine prevalence and risk factors of osteoporosis and of b) vertebral fractures c) evaluate if adequate osteoporotic treatment was provided d) determine if resistin, an adipokine with proposed pro-inflammatory properties, was associated with markers of inflammation or bone mineral density (BMD) and to e) investigate patients self reported health related quality of life (HRQOL) and its relationship to disease variables and employment status in female SLE patients. In this cross sectional study 163 female patients with SLE were examined during the winter and spring 2002-2003. BMD was significantly reduced in patients compared to expected calculated reference values. Bisphosphonates were taken by 35% of patients with osteoporosis and 36% of patients with osteoporosis and/or osteopenia and concomitant glucocorticosteroid medication. Factors associated with low BMD in SLE were markers of inflammation, impaired kidney function and disease damage in addition to the conventional risk factors, high age and low weight. Glucocorticosteroid, current and cumulative doses, were associated with BMD in simple but not in multiple regression models. Only 6 (4%) women had a history of a clinical vertebral fracture whereas 29% had radiological fractures. High age was the strongest risk factor of vertebral fracture. There were no significant differences regarding SLE specific variables or current or cumulative glucocorticosteroid doses between patients with or without vertebral fractures. The SLE patients scored their HRQOL significantly lower than age and sex matched references in all SF-36 subscales. Prevalent vertebral fractures did not have a major impact on HRQOL. In patients 64 years old or younger (n=142) 54% worked full or part time. Working ability was associated with low age and high scores (indicating better health) in physical SF-36 subscales. Serum levels of resistin did not differ between patients and controls. There were clear associations between high resistin levels and general inflammation, renal disease, treatment with glucocorticosteroids and bone loss in the SLE patient group. Resistin was independently associated to inflammation in multiple logistic regression analyses. In conclusion, our results show that female patients with SLE have increased risk of low BMD and osteoporosis and few patients are treated adequately. Vertebral fractures are common but seldom diagnosed. More attention should also be given factors of importance to the patients HRQOL, which is scored considerably lower than in general population. We suggest that resistin has pro-inflammatory properties in SLE and possibly also influence bone quality negatively. Keywords: Systemic lupus erythematosus, bone mineral density, osteoporosis, vertebral fracture, health-related quality of life, SF-36, resistin, cross sectional study ISBN: 978-91-628-7630-2 Göteborg 2008
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| 3. |
- Almehed, Katarina, 1966, et al.
(författare)
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Prevalence and risk factors of osteoporosis in female SLE patients-extended report
- 2007
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Ingår i: Rheumatology (Oxford). - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 46:7, s. 1185-90
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To determine the frequency of osteoporosis and possible risk factors of low bone mineral density (BMD) in women with systemic lupus erythematous (SLE) in western Sweden. In addition, to evaluate if adequate anti-osteoporotic treatment was provided. METHODS: BMD was measured at radius, lumbar spine and hip by dual X-ray absorptiometry (DXA). An 'expected' control BMD was calculated for each patient. Simple and multiple linear regression analyses were performed to determine associations between BMD and demographic and disease-related variables. RESULTS: One hundred and sixty-three women were included. Median age was 47 (20-82) yrs, 89 (55%) were post-menopausal and 85 (52%) were taking glucocorticosteroids. BMD was significantly reduced in all measured sites compared with expected BMD. Thirty-seven (23%), 18 (11%) and 6 (4%) of the patients were osteoporotic in at least one, two and three or more measured locations. Bisphosphonates were used by 23 (27%) of patients taking glucocorticosteroids and 13 (35%) with osteoporosis. High age and low weight or BMI were associated with low BMD in all measured sites. In total hip, high SLICC/American Collage of Rheumatology (ACR), ESR and 'combinations of DMARD' were additional markers of low BMD. High S-creatinine was associated with low BMD in lumbal spine whereas high S-creatinine and CRP were markers in radius. CONCLUSION: Women with SLE are at greater risk of osteoporosis compared with controls and few are treated adequately. Factors associated with low BMD in SLE are high age and low weight but also markers of inflammation, impaired kidney function and disease damage, however glucocorticosteroids were not associated.
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| 4. |
- Almehed, Katarina, 1966, et al.
(författare)
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Prevalence and risk factors of vertebral compression fractures in female SLE patients.
- 2010
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Ingår i: Arthritis research & therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 12:4
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: INTRODUCTION: Our objective was to determine the frequency of and factors associated with prevalent vertebral compression fractures in female SLE patients attending rheumatologists in Western Sweden. METHODS: In this cross sectional study 150 women were included. They were examined with x-ray of thoracic and lumbar spine (Th4-L4). A reduction of at least 20% of any vertebral height, assessed by Genant's semiquantitative method, was defined as a fracture. Bone mineral density (BMD) was measured by dual energy x-ray absorptiometry (DXA). RESULTS: Median patient age was 47 years (20-82) and disease duration 11 years (1-41). Only 6 (4%) women had a history of clinical compressions whereas 43 (29%) had at least one radiological fracture each. The patients with at least one fracture at any site were characterized by higher age (p<0.001), being postmenopausal (p<0.01), higher Systemic Lupus International Collaborative Clinics Damage Index (p<0.05), lower BMD total hip and femoral neck (p<0.05), more peripheral fractures (p< 0.01), medication with bisphosphonates (p<0.05) and calcium and vitamin D3 (p<0.05). There were no significant differences regarding current or cumulative glucocorticosteroid dose between the groups. In logistic regression analyses high age remained as risk factor of at least one vertebral fracture at any site whereas low BMD in total hip was associated with vertebral fracture in lumbar spine. CONCLUSION: Radiological compression fractures are common but seldom diagnosed in SLE patients. High age and low BMD in total hip, but not in spine, was associated with vertebral fractures.
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| 5. |
- Almehed, Katarina, 1966, et al.
(författare)
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Role of resistin as a marker of inflammation in systemic lupus erythematosus.
- 2008
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Ingår i: Arthritis research & therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Resistin is a cystein-rich secretory adipokine. It is proposed to have proinflammatory properties in humans. The aim of this study was to determine associations between serum levels of resistin and markers of inflammation and bone mineral density (BMD) in female patients with systemic lupus erythematosus (SLE). METHODS: One hundred sixty-three female patients with SLE (20 to 82 years old) were examined in a cross-sectional study. Venous blood samples were analyzed for resistin, erythrocyte sedimentation rate (ESR), C-reactive protein, creatinine, fasting lipids, complements, tumor necrosis factor-alpha, interleukin (IL)-1beta, IL-6, sIL-6R (soluble IL-6 receptor), ICTP (C-terminal telopeptide of type I collagen), and PINP (N-terminal propeptide of type I procollagen). Simple and multiple regression analyses as well as logistic regression analyses were performed. Resistin in serum was compared with 42 healthy female controls with respect to age. RESULTS: Serum resistin levels in controls were similar to those of patients with SLE. Markers of inflammation and current dose of glucocorticosteroids correlated positively to resistin in serum. Markers of renal function, number of prevalent vertebral fractures, and BMD were also significantly associated with resistin. In a multiple regression model, ESR, creatinine, C3, current glucocorticosteroid dose, high-density lipoprotein, and BMD radius remained significantly associated with resistin. In logistic regression analyses with resistin as the independent variable, a significant association was found with ESR (normal or elevated) but not with S-creatinine or z score for hip and radius total. CONCLUSION: Although resistin measurements did not differ between patients and controls, resistin was clearly associated with general inflammation, renal disease, treatment with glucocorticosteroids, and bone loss. We hypothesize that resistin has proinflammatory and disease-promoting properties in SLE. Further studies are needed to elucidate the mechanism behind these associations.
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| 6. |
- Jin, Tao, 1973, et al.
(författare)
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Decreased Serum Levels of TGF-β1 are associated with Renal Damages in Female Patients with Systemic Lupus Erythematosus.
- 2012
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Ingår i: Lupus. - : SAGE Publications. - 1477-0962 .- 0961-2033. ; 21:3, s. 310-318
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Transforming growth factor β1 (TGF-β1) has a large role in the control of autoimmunity. TGF-β1 production by lymphocytes is reduced in systemic lupus erythematosus (SLE). Decreased levels of TGF-β1 might associate to disease susceptibility, activity and organ damage in SLE. However, the correlation between TGF-β1 levels and severity of renal damage in SLE has not been examined. Methods: The present study was undertaken to assess the serum levels of total and active TGF-β1 in 150 female patients with SLE and 31 healthy women. Simple and multiple regression analyses between TGF-β1 levels and the diseases-related variables were performed in patients with SLE. Results: Serum levels of both total and active TGF-β1 were significantly reduced in patients with SLE compared with levels in healthy controls (p < 0.01). Total TGF-β1 levels correlated positively with white blood cell, platelet counts, calculated glomerular filtration rate (GFR), and active TGF-β1 level, and inversely with erythrocyte sedimentation rate (ESR). In multiple regression analysis, ESR and platelet counts remained determinants of total TGF-β1. Total TGF-β1 levels were lower in patients with high disease activity (SLEDAI > 10) and severe organ damage (SLICC > 3). Significantly lower levels of total TGF-β1 were found in patients with severe renal damage, i.e. lower TGF-β1 in patients with 24-h urine protein over 3.5 g than in those with below 3.5 g (p < 0.05); lower TGF-β1 in patients with GFR less than 50 ml/min than in those with over 50 ml/min (p < 0.05). In contrast, active TGF-β1 only correlated with platelet counts. There was no association between renal damage and the levels of active TGF-β1. Conclusion: This study demonstrates significantly reduced serum levels of both total and active TGF-β1 in women with SLE compared with healthy women. Total TGF-β1 levels are correlated negatively with ESR and positively with blood platelets. Total TGF-β1 levels were lower in SLE patients with high disease activity and severe organ damage. Importantly, the severity of the renal damage was associated with decreased serum levels of total TGF-β1, suggesting that TGF-β1 might be involved in pathogenesis of renal damage caused by lupus nephritis.
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| 7. |
- Jin, Tao, 1973, et al.
(författare)
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Soluble E-cadherin in systemic lupus erythematosus.
- 2013
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Ingår i: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 40:10, s. 1677-82
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: E-cadherin is a potent adherens junction molecule implicated in tissue morphogenesis, epithelial functioning, and immune regulation. Serum levels of soluble E-cadherin (sE-cadherin), an end product of proteolytic cleavage of E-cadherin, is increased in patients with cancer, infections, and inflammation-related diseases. The aim of our study was to measure serum levels of sE-cadherin in systemic lupus erythematosus (SLE) and to determine associations between serum levels of sE-cadherin and markers of inflammation and organ damage in female patients with SLE.METHODS: Serum levels of sE-cadherin were analyzed by ELISA in 150 female patients with SLE and 31 healthy women. Simple and multiple regression analyses between sE-cadherin levels and disease-related variables were performed in patients with SLE.RESULTS: Serum levels of sE-cadherin were elevated in patients with SLE compared with levels in healthy controls. sE-cadherin levels correlated positively with age, disease duration, SLE Collaborating Clinics Damage Index, erythrocyte sedimentation rate (ESR), s-creatinine, cholesterol, triglycerides, interleukin 6, and matrix metalloproteinase-3. In multiple regression analysis, s-creatinine, age, ESR, and triglycerides remained determinants of sE-cadherin. Within the patients with SLE, higher sE-cadherin levels were found only in patients with renal damage, i.e., s-creatinine > 90 μmol/l, glomerular filtration rate < 50 ml/min, or renal involvement ever by SLE.CONCLUSION: Our study demonstrates significantly elevated serum levels of sE-cadherin in women with SLE compared with healthy women. The levels of sE-cadherin were positively correlated to s-creatinine, age, ESR, and triglycerides. Significantly elevated sE-cadherin levels were observed only in patients with renal damage.
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