John came to BioXcellerator to help find a solution for a variety of conditions that have been impacting his day-to-day life. Lupus and Rheumatoid Arthritis are just a couple main reasons he sought out the clinic in Medellin. John took the opportunity to improve his overall health and wellness, here is his wellness vacation.
Southwestern researchers have identified factors that put patients with childhood-onset lupus at elevated risk for poor outcomes, such as end-stage renal disease or death, as they transition from pediatric to adult health care. The findings, published online in Seminars in Arthritis and Rheumatism, emphasize the precarious nature of this period and shine a spotlight on areas prime for intervention to help protect these vulnerable patients. CREDIT UT Southwestern Medical Center
UT Southwestern researchers have identified factors that put patients with childhood-onset lupus at elevated risk for poor outcomes, such as end-stage renal disease or death, as they transition from pediatric to adult health care. The findings, published online in Seminars in Arthritis and Rheumatism, emphasize the precarious nature of this period and shine a spotlight on areas prime for intervention to help protect these vulnerable patients.
Patients with chronic diseases that used to be fatal early in life now often survive to live long lives. However, says study senior author Bonnie Bermas, M.D., professor of internal medicine at UTSW, while pediatric patients often have significant support in managing their conditions as children, they are expected to take much more responsibility for their health care as they transition to adult care.
Studies have shown that patients with chronic diseases such as HIV and sickle cell disease tend to have poor outcomes during this time. As an adult rheumatologist who cares for young adult patients with childhood-onset lupus erythematosus, an autoimmune disease, Bermas says she has witnessed a similar phenomenon. However, it’s unclear what factors put young lupus patients who transition to adult care at higher risk.
To explore this question, Nicole Bitencourt – a former UTSW pediatric and adult rheumatology fellow who is now on the faculty of the University of California Los Angeles Medical Center – along with Bermas and her UTSW colleagues used medical records to identify childhood-onset lupus patients who transitioned to adult care between 2010 and 2019. These 190 patients were seen at two different rheumatology clinics: One is a safety-net hospital that mainly treats patients with public insurance; the other is a university hospital that primarily sees patients with private insurance.
The researchers followed patients for an average of nearly 3.5 years and looked at three major outcomes: time to the first hospitalization following a patient’s final pediatric rheumatology visit; time to end-stage renal disease, a condition in which severe kidney failure necessitates dialysis; and death.
Of the 190 patients, 11 percent developed end-stage renal disease and 5 percent died during the follow-up period. Out of 114 patients with hospitalization data, 53 percent were hospitalized as young adults.
The research team found several factors linked with these poor outcomes. End-stage renal disease and death were associated with having public health insurance, a history of Child Protective Services involvement, and an unscheduled hospitalization during the final year of pediatric care. A shorter time to hospitalization in adult care was linked with a pediatric outpatient opioid prescription and Black race or Hispanic ethnicity.
Bermas, the Dr. Morris Ziff Distinguished Professor in Rheumatology, notes that these findings could help health care providers better target childhood-onset lupus patients who might be at higher risk of poor outcomes during their transition to make sure they have the support and resources needed to stay healthy after they become adults.
“Transitioning to young adulthood has its own challenges, but these patients are struggling with a chronic disease on top of that. We’re asking an awful lot of these patients to navigate the medical system, often with little support,” says Bermas. “By identifying those patients who may need more help, we can improve outcomes and even potentially save lives.”
Patients with lupus are more likely to have metabolic syndrome and insulin resistance – both factors linked to heart disease – if they have lower vitamin D levels, a new study reveals.
Researchers believe that boosting vitamin D levels may improve control of these cardiovascular risk factors, as well as improving long-term outcomes for patients with systemic lupus erythematosus (SLE).
Given that photosensitivity is a key feature of SLE, the scientists say that a combination of avoiding the sun, using high-factor sunblock and living in more northerly countries may contribute to lower levels of vitamin D in lupus patients. Patients with more severe disease also had lower vitamin D levels.
An international research team, led by experts at the University of Birmingham and University of Manchester, studied vitamin D levels in 1,163 SLE patients across 33 centres in 11 countries (UK, USA, Canada, Spain, The Netherlands, Sweden, Iceland, Switzerland, Turkey, South Korea and Mexico), publishing its findings in Rheumatology.
Report co-author Dr John A Reynolds, Clinical Senior Lecturer in Rheumatology at the University of Birmingham, commented: “Our results suggest that co-existing physiological abnormalities may contribute to long-term cardiovascular risk early on in SLE.
“We found a link between lower levels of vitamin D and metabolic syndrome and insulin resistance. Further studies could confirm whether restoring vitamin D levels helps to reduce these cardiovascular risk factors and improve quality of life for patients with lupus.”
Lupus is an uncommon incurable immune system illness, more common in women, where the immune system is overactive, causing inflammation anywhere in the body. Untreated, the condition threatens irreversible damage to major organs including kidneys, heart, lungs and brain.
Metabolic syndrome is a combination of diabetes, high blood pressure (hypertension), abnormal cholesterol levels, and obesity. People with metabolic syndrome are at greater risk of getting coronary heart disease, stroke and other conditions affecting the blood vessels.
The researchers note that patients with SLE have an excess cardiovascular risk, up to 50 times that seen in people without the condition – this cannot be attributed to traditional cardiovascular risk factors, such as high blood pressure or smoking, alone.
The mechanisms underlying the association between high blood pressure and low vitamin D in SLE are not clear, but researchers believe they may be linked to impact of vitamin D deficiency on the renin-angiotensin hormone system, which regulates blood pressure, fluid and electrolyte balance, as well as systemic vascular resistance.
“This is the largest-ever study examining associations between vitamin D levels and metabolic syndrome in SLE; it also has the advantage of being an international cohort with diverse racial and ethnic backgrounds – generating results that will be applicable across many settings,” commented Dr. Reynolds.
Platelets may play a key role in the development of lupus, according to a study published today by researchers at Université Laval and CHU de Québec-Université Laval Research Centre. Extracellular DNA circulating in the blood of patients with lupus causes the inflammatory reaction associated with the disease. The researchers have shown that this DNA comes in part from the platelets, better known for their role in coagulating blood. The details of the breakthrough have been published today in Science Translational Medicine and could lead to a better understanding of the disease and more effective treatment.
“Lupus is an autoimmune disease that causes chronic inflammation of various body parts, particularly the joints, skin, brain, and kidneys,” explained lead author Éric Boilard, professor at the Université Laval Faculty of Medicine and researcher at CHU de Québec-Université Laval Research Centre. “It strikes 40 people per 100,000, frequently between the ages of 20 and 40, and is nine times more prevalent in women than in men. Lupus presents in a variety of ways and can be difficult to diagnose.”
One common denominator of severe forms of the disease is the presence of anti-DNA antibodies in the blood. “When DNA circulates freely in the blood, antigen-antibody complexes form and accumulate in the tissues where the lupus presents. Until now, we didn’t know exactly where this genetic material was coming from,” said Professor Boilard, who is also a researcher at the ARThrite research centre.
In collaboration with fellow professor and clinical researcher Paul R. Fortin, Boilard’s team analyzed blood samples from 74 patients with lupus and discovered that the platelets were the source of the extracellular DNA. “To be precise, the DNA is present in the platelet mitochondria. Most of the DNA was actually still inside the mitochondria in the blood we studied. The body produces antibodies against the mitochondria and the mitochondrial DNA because it considers them foreign bodies,” explained Professor Boilard.
When the platelets are activated, the mitochondria and their DNA are released. “But this activation does not seem involved in normal platelet functions such as preventing bleeding,” said Boilard. “If we can figure out how to interrupt this activation process, we can prevent the mitochondria and the mitochondrial DNA from being released, which will reduce the autoimmune reaction we see with this disease.”