Objective To evaluate the efficacy and safety of eltrombopag in patients with systemic lupus erythematosus (SLE)-associated immune thrombocytopenia, with a particular focus on thrombotic risk. Methods We conducted a retrospective cohort study of 23 patients with SLE-associated thrombocytopenia treated with eltrombopag. Baseline clinical characteristics, treatment patterns, and outcomes were collected. The primary outcomes were sustained platelet response (≥50 ×10 9 /L at last follow-up) and occurrence of thrombotic events. Exploratory analyses assessed associations between antiphospholipid antibody (aPL) status and thrombosis. Results The mean age was 33.7 ± 12.3 years, and 65.2% were female. aPL positivity was present in 52.2% of patients. A sustained platelet response was achieved in 65.2% of patients, and 21.7% were successfully weaned off corticosteroids. Thrombotic events occurred in 8 patients (34.8%), with arterial events accounting for 50% of cases. The median time to thrombosis was 5.5 months. Thrombosis occurred across a range of platelet counts and was not consistently associated with thrombocytosis. A higher proportion of thrombotic events was observed in aPL-positive patients (41.7% vs 27.3%), although this did not reach statistical significance (OR 1.90, 95% CI 0.33–11.01, p = 0.667). Conclusion Eltrombopag was associated with platelet response in this cohort. Thrombosis was numerically more common in aPL-positive patients, but the small sample and imprecise estimate preclude conclusions about its independent contribution. Without a comparator group, whether these events reflect eltrombopag, the prothrombotic milieu of SLE and aPL antibodies, or their interaction cannot be determined.
Objective Antiphospholipid syndrome (APS) is a common acquired thromboinflammatory disease and catastrophic APS (CAPS) its most rare and lethal variant. The objective of this report is to describe a case of probable CAPS triggered after vaccination with an mRNA vaccine in the context of the COVID-19 pandemic. Methods This is a descriptive case report conducted at a Brazilian university hospital, involving a single 40-year-old patient admitted with dysarthria, gross hematuria, signs of pulmonary embolism, and a large intracavitary cardiac thrombus. He had a history of multiple past venous thrombotic events, but investigations for malignancy had consistently yielded negative results. Approximately 48 hours earlier, he had received the second dose of the Pfizer® mRNA vaccine (Pfizer-BioNTech BNT162b2). After infections and concomitant autoimmune diseases were ruled out, thrombocytopenia and positive serologic testing for APS raised the possibility of CAPS, and treatment was promptly initiated with anticoagulation, corticosteroids, low-dose aspirin, and hydroxychloroquine. Main outcome measures were organ involvement, laboratory abnormalities, imaging findings, and clinical response to treatment. Results After therapeutic measures were instituted, the patient showed laboratory improvement — restoration of renal function and increased platelet count — as well as clinical improvement, with resolution of neurological deficits. Follow-up testing revealed persistent triple positivity for APS-related serologies. Conclusions This emblematic report brings a rare complication of APS in association with immunization using an mRNA COVID-19 vaccine, presenting clinical features that resemble those described in other CAPS cases documented in the CAPS Registry. Additional reports of immune-mediated diseases induced by vaccine platforms have also been described, suggesting pathophysiological mechanisms that remain incompletely understood, particularly molecular mimicry. Immunization against COVID-19 and other pathogens should not, however, be discouraged, as vaccines continue to play a fundamental role in preventing potentially severe infectious diseases. Instead, scientific research should be encouraged in order to better understand which individuals are more predisposed to such a severe complication.
Background A proportion of patients with systemic lupus erythematosus (SLE) remain refractory to standard therapies. Advanced B-cell-targeted therapies (ABT), including chimeric antigen receptor T-cell therapy, T-cell–engaging approaches, and anti-CD19 monoclonal antibodies, are emerging for selected patients in clinical trials. Methods We conducted a single-centre observational study of patients with SLE treated with biologic therapies at a tertiary lupus service between January 2024 and December 2025, during active recruitment to ABT clinical trials. We assessed clinical factors associated with referral for multidisciplinary team (MDT) discussion regarding ABT and explored documented reasons for non-participation. We compared patients discussed at ABT-MDT with those not referred within the same cohort. Results Among 101 patients treated with biologics, 21 (20.8%) were discussed at ABT-MDT. Patients referred for ABT-MDT had higher rates of lupus nephritis (90.5% vs 46.2%, p < 0.001), higher SLEDAI-2K scores (16.0 vs 2.0, p < 0.001), higher daily prednisolone doses (15.0 vs 1.0 mg, p < 0.001), and greater exposure to prior immunosuppressive therapies. In multivariable analysis, higher SLEDAI-2K (OR 1.92 per 4-point increase, 95% CI 1.10–4.27) and prednisolone dose (OR 3.44 per 5-mg increase, 95% CI 1.23–14.50) were independently associated with ABT-MDT referral. Of those discussed, 7 patients proceeded to ABT. Reasons for non-participation included patient preference, perceived infection risk, clinical improvement, and protocol-related constraints. Conclusion In a tertiary SLE cohort, referral for advanced B-cell-targeted therapies was associated with markers of high disease activity and renal involvement. However, multiple clinical and patient-related factors limited trial participation. These findings highlight important considerations in referral and trial participation for advanced B-cell-targeted therapies.
BackgroundSystemic Lupus Erythematosus (SLE), a chronic autoimmune disease that predominantly affects women, can alter both physical appearance and bodily functioning through its manifestations and treatment, posing challenges to body image. Although body image in SLE has been associated with clinical, psychological, and sociodemographic factors, few studies have examined these domains simultaneously in women with SLE within a biopsychosocial framework, which limits understanding of their joint contributions.ObjectiveTo examine biopsychosocial factors associated with body image in a Brazilian sample of women with SLE.MethodsA nationwide cross-sectional survey was conducted with 597 women with SLE. Participants provided sociodemographic and clinical information and completed the Body Esteem Scale for Adults and Adolescents (BESAA), Satisfaction with Life Scale (SWLS), and Depression, Anxiety, and Stress Scale-21 (DASS-21). Bivariate associations were examined with nonparametric tests, and independent associations were examined with a hierarchical multiple linear regression including theoretically pre-specified sociodemographic, clinical, and psychological blocks.ResultsIn bivariate analyses, poorer body image was associated with active disease, skin lesions, joint pain, serous membrane inflammation, fever without infection, lower life satisfaction, higher levels of depression, anxiety, and stress, lower educational attainment, and lower household income. The final model explained 35.4% of the variance in body image, with psychological variables accounting for 17.7% beyond sociodemographic and clinical characteristics. Greater life satisfaction and unintentional weight loss were independently associated with more positive body image, whereas higher levels of depression, skin lesions, and joint pain were independently associated with poorer body image.ConclusionsBody image in women with SLE is associated with factors across different biopsychosocial domains, suggesting that it should not be examined solely from a clinical perspective. Rather, psychological and social factors should be considered alongside disease-related characteristics to support more comprehensive approaches to the assessment and care of body image concerns in this population.
Background Accurate measurement of disease activity is a cornerstone in the management of patients with Systemic Lupus Erythematosus (SLE), to assist in guiding therapeutic decisions. SLE-DAS (SLE Disease Activity Score) is designed to improve accuracy and sensitivity to change compared with the standard SLE Disease Activity Index (SLEDAI) score. Objectives We aimed to assess the performance of SLE-DAS to identify flare and clinically meaningful improvement (CMI) in real-life SLE patients in India. Methods Prospective observational study at an Indian Rheumatology Clinic included SLE patients meeting 2012 SLICC and/or 2019 ACR/EULAR criteria, followed for 9 months. At baseline and subsequent follow-up, we recorded SLEDAI-2K, SLE-DAS, PGA, LLDAS, DORIS remission, prednisolone dose, and immunosuppressives; SELENA-SLEDAI flare index (SFI) was evaluated at follow-up. We assessed Spearman correlation, agreement, and discrepancies between SLEDAI and SLE-DAS for flare and improvement detection using an agreement matrix. Results A strong correlation was observed between SLEDAI-2K and SLE-DAS (rho = 0.954, 95% CI 0.934–0.968, p < 0.001). SLE-DAS identified CMI in 42.0% of visits compared to 34.8% by SLEDAI-2K. Flare detection sensitivity was higher for SLE-DAS (96%) than SLEDAI-2K (84%), with similar specificity (98.9%). The agreement of SLEDAS remission and low disease activity (LDA) with DORIS remission and LLDAS, respectively, was perfect (κ = 1, p < 0.001). Discordant analysis revealed that SLEDAI-2K underestimated severe flares and missed manifestations such as pneumonitis, AIHA, and serositis. Conclusion SLE-DAS demonstrated superior sensitivity, granularity, and remission alignment compared to SLEDAI-2K, supporting its adoption as a primary clinical index in diverse real-world lupus practices.
