Research by Munroe M, et al.
Like other autoimmune diseases, SLE develops over time, and in the months to years prior to the clinical onset of disease, the immune systems of patients show distinctive changes heralding impending disease. The changes include expression of autoantibodies, as well as increases in levels of various cytokines and chemokines that together can represent a signature for a state of pre-autoimmunity that will transition to full-blown disease classifiable as SLE.
Munroe et al. used samples from the U.S. Department of Defense Serum Repository to measure multiple analytes reflective of immune activity and create a Lupus Classification Risk Immune Index (LCRII) for risk prediction. This index could prove valuable in evaluating patients with so-called incomplete lupus in which signs and symptoms, especially anti-nuclear antibody production, are present but are insufficient to allow classification by either ACR or Systemic Lupus Erythematosus International Collaborating Clinics Group (SLICC) criteria. Screening of family members at high risk of disease (e.g., sisters) is another setting in which the use of an index, such as the LCRII, can be explored.
Abstract 0857—Association of telomere length with phenotypic frailty in systemic lupus erythematosus9
Research by Lieber S, et al.
The course of SLE can be characterized in terms of measures, such as disease activity (e.g., SLEDAI) and damage (SLICC Damage Index), whether the damage arises from inflammatory disease activity or complications of therapy. Frailty is another measure of disease that can provide valuable information about the functional capacity of patients, their resilience and physiologic reserve.
Studied most extensively in the context of aging, frailty is a physical state that can be defined in five domains: weight loss, weakness, fatigue, slowness and low activity. Importantly, frailty is associated with increased mortality. The study by Lieber et al. examined telomere length in a cohort of patients with SLE assessed using objective and self-reported measures of frailty.
Telomere length, a molecular marker related to DNA sequences at the ends of chromosomes, can be conceptualized as a measure of accelerated aging. The study shows that about one-fourth of patients with SLE are frail by at least self-reporting and that frailty is associated with shorter telomere length.
Along with other studies on frailty, these data support telomere length as a molecular correlate of accelerated aging and suggest the value of frailty assessment as an adjunct to measures of disease activity and damage.
Abstract 1489—Identification of mitochondrial antigens targeted by autoantibodies in systemic lupus erythematosus (SLE)10