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Malar rash is a predictor of subclinical airway inflammation in patients with systemic lupus erythematosus: a pilot study

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Abstract

Background

Systemic lupus erythematosus (SLE) is a chronic, auto-immune, multi-organ disease that can affect both the skin and the lungs. Malar rash is a common skin manifestation of SLE and is linked to SLE disease activity, whereas lung involvement is a generally negative prognostic factor for these patients. However, a sensitive and non-invasive screening tool for potential lung involvement in SLE patients is still not available.

Methods

This study aimed to investigate the relationship between malar rash and airway inflammation in adult SLE patients who were not known to have any lung involvement (clinical or radiologic). The study comprised of the measurement of the concentration of NO in exhaled breath or fraction of exhaled nitric oxide (FeNO) and levels were compared between those with and without malar rash. This tool is considered as a sensitive and non-invasive method that is routinely used in patients with asthma or other respiratory diseases to identify airway inflammation.

Results

A total of 125 patients (100 females, 25 males) were enrolled during the study period from January 2011 to December 2014. Patients with malar rash (N = 35) had a significant decrease in serum levels of C4 (p < 0.05) compared to patients without malar rash (N = 90). The mean levels of FeNO in overall patients were 36.44 ± 8.87 ppb. A statistically significant difference in FeNO50 values between patients with malar rash (43.46 ± 6.72 ppb) and without (29.43 ± 3.64 ppb) was found (p < 0.001). FeNO50 values were inversely correlated only with serum C4 (p < 0.01). However, no correlation between FeNO50 values and SLE clinical disease activity scores was found.

Conclusions

The presence of a malar rash may predict sub-clinical airway inflammation in SLE patients. Further prospective studies are needed to confirm the usefulness of FeNO measurements in monitoring SLE-associated airway inflammation.

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Author information

Authors and Affiliations

  1. Department of Transplant and Medico-Surgical Physiopathology, University of Milan Dermatology Unit, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy

    Giovanni Damiani & Angelo Valerio Marzano

  2. Young Dermatologists Italian Network (YDIN), Centro Studi GISED, Bergamo, Italy

    Giovanni Damiani

  3. Clinical Dermatology, IRCCS Galeazzi Orthopedic Institute, Milan, Italy

    Paolo Daniele Maria Pigatto

  4. Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy

    Paolo Daniele Maria Pigatto

  5. Department of Biomedical and Clinical Sciences (DIBIC), University of Milan Pulmonary Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy

    Maurizio Rizzi, Pierachille Santus & Dejan Radovanovic

  6. Department of Dermatology, University of Tartu, Tartu, Latvia

    Ulvi Loite

  7. Department of Mathematics and Geoscience, University of Trieste, Trieste, Italy

    Lucio Torelli

  8. St. George’s University School of Medicine, St. George’s, West Indie, Grenada

    Stephen Petrou

  9. Rheumatology Unit, Luigi Sacco University Hospital, Milan, Italy

    Piercarlo Sarzi-Puttini

  10. Rheumatology Unit, Department of Internal and Experimental Medicine, University of Messina, Messina, Italy

    Fabiola Atzeni

  11. Padeh and Ziv Hospitals, Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel

    Mohammad Adawi

  12. Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, England

    Charlie Bridgewood & Abdulla Watad

  13. School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy

    Nicola Luigi Bragazzi

  14. Department of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Abdulla Watad

  15. Chapel Allerton Hospital, Leeds, LS7 4SA, UK

    Abdulla Watad

  16. Department of Internal Medicine, University of Brescia, Brescia, Italy

    Mario Malerba

Authors
  1. Giovanni Damiani
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  2. Paolo Daniele Maria Pigatto
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  3. Angelo Valerio Marzano
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  14. Nicola Luigi Bragazzi
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Corresponding author

Correspondence to Giovanni Damiani.

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Statement of human and animal rights

All the procedures used in this study involving human beings were carried out in accordance with the ethical standards of the institutional and national research committees and the 1964 Helsinki Declaration and its later amendments, or comparable ethical standards.

Informed consent was obtained from all the patients who participated in the study.

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Damiani, G., Pigatto, P.D.M., Marzano, A.V. et al. Malar rash is a predictor of subclinical airway inflammation in patients with systemic lupus erythematosus: a pilot study. Clin Rheumatol 38, 2541–2546 (2019). https://doi.org/10.1007/s10067-019-04536-y

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  • DOI: https://doi.org/10.1007/s10067-019-04536-y

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