5 e-Letters

  • Comment on: TNF-α and plasma albumin as biomarkers of disease activity in systemic lupus erythematosus

    Dear editor,
    We read with interest the article of Idborg et al.1 who recently analyzed the role of several inflammatory mediators, and their usefulness as biomarkers in the measurement of activity of disease and the identification of clinical subphenotypes in systemic lupus erythematosus (SLE). Although interesting, these results may benefit of further discussion in light of systems medicine.
    Authors concluded that the two main inflammatory mediators related with activity of SLE were TNF-α and p-albumin. However, previous studies have found that TNF-α and the TNF/IL-10 ratio were higher in patients with low activity of disease,2 and that TNF-α antagonists may induce SLE-like disease.3 These controversial data argues against a generalized model based on TNF-α as clinical activity biomarker, and advocate for the influence of other mediators in such a condition.
    As shown by Idborg et al., IL-6, IL-10, IL-15, MCP-1, IP-10, MIP-1α, ESR, anti-dsDNA and U-albumin/creatinine were also positively correlated with activity of disease,1 suggesting that the exclusive role of TNF-α and p-albumin on activity of disease is unlikely. In fact, the pathological functions of these biomarkers are not isolate since they emerge from the interactions among them and between cells and tissues (i.e., systems medicine).4
    In this sense, cytokine and autoantibody clusters (i.e., neutral, chemotactic/anti-phospholipid antibodies, and IFN-α/dsDNA) have been reported to be associat...

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  • Response to Editorial

    The Editor,
    Lupus Science and Medicine
    BMJ Journals

    Dear Madam/Sir,

    Our esteemed peer Dr. Boers has editorialised1 on our recently published study of associations of glucocorticoid use with damage accrual in SLE2, suggesting that studies of the type reported are ‘harmful’. As this is such a serious accusation, we feel compelled to respond, even though we suspect that in the end the views of the authors and of Dr Boers as serious physician-researchers are in fact highly aligned. Essentially, we do not resile from our view that long-term reliance on glucocorticoids for the control of inflammation in SLE carries harm, and that steroid-reducing regimens for SLE management are urgently needed. At no time in our report, and certainly not in our clinical practice, do we advise against the use of these drugs, though such an imprecation was implied (incorrectly) in Dr Boers’ editorial. Rather, it is our view that strategies to achieve control of disease activity with reduced reliance on glucocorticoids, such as improving the use of non-glucocorticoid agents or the introduction of novel therapies, are as urgently needed as ever – and that complacency about the chronic use of glucocorticoids in SLE is not an acceptable status quo.

    As we stated in the opening remarks, ‘The objective of the present study was to quantify damage accrual in a prospectively followed cohort of patients with SLE and determine the association of glucocorticoid use with damage...

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  • Prolonged QT interval and atherosclerosis in systemic lupus erythematosus

    Geraldino-Pardillaet al.1 recently published an interesting article analysing one of the most important aspects of systemic lupus erythematosus (SLE): the risk of cardiovascular disease, a leading cause of death in SLE patients. Although there were no healthy control group to compare, and the SLE patient sample size was limited, their conclusions are clinically valuable and should be taken into consideration.

    The usefulness of the corrected QT interval (QTc) as a marker of atherosclerosis risk is well-established in the general population and in some sub-groups with high cardiovascular risk. QTc prolongation is also linked to cardiovascular events and mortality during follow-up2-3. QTc interval prolongation in SLE patients has been described in previous studies4.However, no data on the clinical repercussions of this finding are available. Our research group recently published a paper on the positive correlation between QTc interval prolongation in SLE patients and higher arterial stiffness measured by pulse-wave velocity5. The association was independent of hypertension and age. Our data complement those published by Geraldino-Pardilla et al.1, suggesting an independent association between QTc interval prolongation and subclinical atherosclerosis. However, there is no evidence of the long-term clinical effects of this association. Prospective studies with large sample sizes and long follow-up periods are required to study the potential long-term effects. In any case...

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  • Biological change or poor measurement instrument?
    Mauricio Restrepo-Escobar

    Dear Editors,

    We read with great interest the article of Greloni et al, "Value of repeat biopsy in lupus nephritis flares" and have some comments.

    There is a high probability that what they call "histologic transformation" is further evidence of the poor reproducibility of the interpretation of the renal biopsy in lupus nephritis and no evidence that there really been a change in the biological phenomenon o...

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  • Calcidiol hypovitaminosis D and glucocorticoid therapy
    Norberto Ortego-Centeno

    Dear Editor,

    After reading the article by Carli et al.(1) we would like to share some thoughts that could be of practical use regarding vitamin D supplementation in patients on low-dose glucocorticoids therapy.

    In 2011, we published the results of a follow-up carried out in our unit (located in a hospital in Granada, a sunny city in the south of Spain) that included a cohort of 55 patients with systemi...

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