Of non-specific ANAs, anti-Ro antibody clearly appears to be an important disease mediator. This study demonstrates that patients with SLE who were anti-Ro positive had notable clinical and immunological features: hypocomplementemia, overlapping features with Sjögren’s syndrome, more rash and more renal disease. Not surprisingly, anti-Ro-positive patients were more likely to be treated with immunosuppressive agents than those without this specificity.
These findings point to a role of anti-Ro antibody in important events in lupus; this role may result from the formation of immune complexes that induce interferon production and, therefore, drive more severe disease.
Despite its non-disease-specific nature, anti-Ro antibody may serve as a biomarker in SLE not just to identify an overlap with Sjögren’s syndrome, but also to denote a more severe phenotype that may need more intensive immunosuppression.
Abstract 1273—A 12-week aerobic exercise training program in women with systemic lupus erythematosus (SLE) improves fatigue, mitochondrial dysfunction and associated interferon gene signature5
Research by Hasni S, et al.
Fatigue is one of the most pervasive, persistent and disabling symptoms of SLE. Its origin is unclear, although fatigue may emerge during inflammatory responses as part of so-called sickness behavior. Fatigue does not appear related to disease activity in SLE, however, and there is no established treatment approach.
As shown in a small trial of patients with low disease activity but significant fatigue, an aerobic exercise program (i.e., treadmill exercise for 30 minutes three times a week for 12 weeks) can have significant benefits. These benefits include increases in the time to the anaerobic threshold and 10-minute walk time, along with decreased fatigue. Interestingly, blood from some patients in this trial exhibited reductions in interferon-stimulated gene (ISG) expression, a signature immunological feature of SLE.
Because these changes may reflect improvements in mitochondrial function, exercise may have an impact on patient symptoms as well as underlying disease mechanisms.
Given the powerful effect of fatigue on patient well-being and quality of life, further investigation into the role of exercise is clearly indicated. Correspondingly, as trials for pharmacological agents with new mechanisms of action advance, it will be important to assess more directly their effects on fatigue (and related symptoms), even if the link to measures of disease activity is uncertain.
Abstract 1460—Lupus nephritis renal responses in relation to treatment and demographics: Observations from a multi-racial/ethnic cohort of 159 patients in the NYU Lupus Registry6
Research by Haj-Ali M, et al.
Lupus nephritis is a heterogeneous disease that differs in course among racial and ethnic populations. In the U.S., African American and Hispanic patients have worse outcomes than Americans of European descent, while, in Asia, the response rates observed for certain agents (e.g., mycophenolate mofetil or MMF) appear better. Added to these differences is heterogeneity in the approach to therapy.