Latest news with #lupus
Medical News Today
5 days ago
- General
- Medical News Today
Leukemia and lupus: Link and research explained
Link explained Cancer risk Symptoms Seeking medical help Summary Leukemia and lupus are both conditions that affect the immune system. Although they are different, they share certain symptoms. A person with lupus may have increased risk of developing leukemia. Lupus is an autoimmune disease. A person's immune system is responsible for protecting the body from infection and disease. Autoimmune conditions affect the immune system, causing it to attack healthy tissue. Leukemia is cancer of the blood. There are different forms of leukemia. The type a person has is determined by what type of blood cell it affects, as well as its speed of growth. Some forms of leukemia affect the white blood cells. White blood cells help to fight diseases as part of the immune system. If a person has a problem with their white blood cells, they may be prone to sickness or infection. Lupus and leukemia have certain symptoms in common. Additionally, some research suggests that there may be a link between the two conditions. Read on to learn more about the relationship between lupus and leukemia, as well as when to see a doctor. AbrahamCertain research suggests that there may be a link between lupus and leukemia. A review from 2018 found that having lupus may increase a person's overall risk of developing cancer. It may also increase a person's risk of specific cancers, including: leukemia non-Hodgkin's lymphoma Hodgkin's lymphoma multiple myeloma cervical cancer vaginal/vulval cancer renal cancer bladder cancer esophageal cancer gastric cancer hepatobiliary cancer lung cancer oropharynx cancer larynx cancer non-melanoma skin cancer thyroid cancer Additionally, research from 2022 noted that autoimmune hemolytic anemia (AIHA) may increase a person's risk of leukemia. AIHA is a condition that causes the immune system to destroy red blood cells. A further study from 2022 stated that around 10% of people with lupus develop AIHA. A study from 2024 noted that there are rare reports of chronic myeloid leukemia (CML) occurring alongside lupus. CML is a form of leukemia that affects the blood and bone marrow. Researchers believe that lupus may increase a person's risk of certain cancers due to its weakening of the immune system. Further research is required to determine the link between lupus and leukemia. A doctor may use immunosuppressants to treat a person with lupus. Immunosuppressants work by suppressing a person's immune system. This helps to prevent it from damaging healthy tissue. However, immunosuppressants may reduce how well the immune system works. This may weaken a person's immune system, causing them to become vulnerable to infections. Information from the American College of Rheumatology notes that the immunosuppressant cyclophosphamide (Cytoxan) is used for severe complications of lupus. They also note that this medication may increase a person's risk of certain cancers, including: lymphoma skin cancer bladder cancer Research from 2017 found that the increased cancer risk of cyclophosphamide may occur when it is given at higher doses. Additionally, researchers found that hydroxychloroquine, another immunosuppressant used to treat lupus, may reduce a person's cancer risk when given at low doses. If a person has lupus, they should speak with their doctor about the risks and benefits of their treatments. Although lupus and leukemia are different conditions, they do have some overlapping symptoms. These shared symptoms include: fatigue fever weight loss petechiae, which are tiny red dots on the skin joint pain swollen glands dizziness A person should speak with their doctor if they notice any signs of lupus or leukemia. If a person has lupus, they should speak with their doctor if they notice any new or concerning symptoms. shortness of breath during physical activities paleness frequent infections bruising easily prolonged bleeding from cuts frequent or severe nosebleeds bleeding gums heavier or more frequent menstrual bleeding night sweats enlarged spleen or liver feeling of pain or fullness below the ribs wheezing coughing painful breathing Lupus and leukemia are both conditions that affect a person's immune system. If a person has lupus, they may be more likely to develop certain cancers. These may include leukemia. Researchers are not currently sure what the link is between lupus and leukemia. They believe lupus may increase a person's risk of cancer by weakening the immune system. Additionally, certain treatments for lupus may increase cancer risk. Both lupus and leukemia share certain symptoms. If a person notices any symptoms of either condition, they should speak with a doctor. A person with lupus should speak with their doctor if they notice any signs of leukemia, such as prolonged bleeding from cuts. Leukemia Lupus Blood / Hematology Cancer / Oncology Medical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy. BalajiSubramanian S, et al. A rare case of dual metachronous primary malignancies, chronic myeloid leukemia, and tongue carcinoma in a patient with long-standing systemic lupus erythematosus: A case report and review of literature. Cyclophosphamide (Cytoxan). (2024). Guo J, et al. (2020). The relationship between cancer and medication exposure in patients with systemic lupus erythematosus: A nested case-control study. Hsu C-Y, et al. (2017). Cumulative immunosuppressant exposure is associated with diversified cancer risk among 14 832 patients with systemic lupus erythematosus: A nested case–control study. Leukemia. (n.d.). Leukemia—patient version. (n.d.). Lupus. (2024). Medications used to treat lupus. (2023). Signs and symptoms. (n.d.). Song L, et al. (2018). The risks of cancer development in systemic lupus erythematosus (SLE) patients: A systematic review and meta-analysis. Suzuki E, et al. (2023). Systemic lupus erythematosus and antiphospholipid syndrome accompanied by mixed-type autoimmune hemolytic anemia. Systemic lupus erythematosus. (2022). Systemic lupus erythematosus (Lupus). (2022). Zhang Y, et al. (2022). Hematological malignancies in systemic lupus erythematosus: Clinical characteristics, risk factors, and prognosis—a case-control study.
Medscape
7 days ago
- Health
- Medscape
Long-Term Anifrolumab Use Improves Quality of Life in Lupus
Patients with moderate to severe active systemic lupus erythematosus (SLE) who continued anifrolumab treatment over 4 years showed sustained improvements in health status and quality of life, along with improvements in health utilities and employment measures. METHODOLOGY: Researchers conducted an extension trial (TULIP-LTE) to assess the long-term effects of anifrolumab treatment on patient-reported outcomes in SLE at baseline through week 208. They included 369 patients with moderate to severe SLE who were randomly assigned to receive either 300 mg anifrolumab (n = 257; mean age, 43.4 years; 92% women) or placebo (n = 112; mean age, 41.4 years; 92% women) every 4 weeks. These patients had completed the 1-year TULIP-1 and TULIP-2 trials and maintained the same treatment in the long-term extension study. Exploratory endpoints were changes in patient-reported outcomes related to health status and health-related quality of life. TAKEAWAY: At week 208, the anifrolumab group had numerically higher Short Form-36 version 2 acute recall scores for mental health and bodily pain domains than the placebo group (least squares mean [LSM] difference, 3.7; 95% CI, −1.2 to 8.6 and 5.9; 95% CI, −0.7 to 12.5, respectively). The Short Form-6 Dimension scores showed numerically greater improvements in the anifrolumab group than in the placebo group, with differences evident from week 24 (LSM difference, 0.013; 95% CI, −0.007 to 0.032) and sustained through week 208 (LSM difference, 0.016; 95% CI, −0.010 to 0.042). Similarly, Patient Global Assessment and EuroQoL 5 Dimensions–derived Single Summary Utility Index scores showed numerically greater improvements in the anifrolumab group than in the placebo group at week 208. At week 208, the proportion of patients in paid employment remained stable in both the anifrolumab and placebo groups (45% vs 44%), with both groups showing similar reductions in the number of work hours missed in the preceding week. IN PRACTICE: 'These findings highlight the importance of including patient-reported outcomes as single, composite indices (eg, SF-6D) in clinical trials to allow comprehensive assessment of meaningful benefit for patients,' the authors wrote. SOURCE: This study was led by Vibeke Strand, MD, Division of Immunology and Rheumatology, Stanford University, Palo Alto, California, and was published online on May 2, 2025, in The Lancet Rheumatology . LIMITATIONS: The exploratory and post hoc nature of the analysis may have limited the interpretation of the results, as the trials were not powered for the exploratory endpoints examined. Patients with active, severe lupus nephritis or severe neuropsychiatric SLE were not included. Additionally, the study did not include any individuals with lived experience of SLE at any stage of its design, conduct, or reporting. DISCLOSURES: This study was funded by AstraZeneca. One author reported receiving honorarium and consulting fees from various pharmaceutical companies and other sources, including AstraZeneca. Another author reported receiving consulting fees from AstraZeneca. A few authors reported being current or former employees or holding stocks of AstraZeneca or having other ties with a biotechnology company.
CBS News
27-05-2025
- General
- CBS News
Pregnant mothers with lupus face risks but have better outlooks than ever before, doctor says
Expectant mothers with lupus have better outlooks than ever before, doctors say Kiana Cornejo has been living with lupus since she was just 11 years old — and after an unplanned pregnancy, she learned the challenges of having the autoimmune disease while expecting her first child. "When I first got diagnosed, I felt like I was paralyzed. At one point I couldn't do anything. Everything was just hurting," Cornejo told CBS News. Lupus can affect many parts of the body, with a range of symptoms that can include fever, rashes, hair loss, joint pain, swelling and sensitivity to sunlight. According to the Lupus Foundation of America, while its exact cause is not known, scientists believe lupus occurs due to a combination of genes, hormones and environmental factors. The organization says 9 out of 10 people with lupus are women. One immediate challenge Cornejo faced after finding out she was pregnant was that some medications for lupus are not safe for pregnancy. "Their pregnancies are not like the average pregnancy, between the risk of active disease and sometimes the risk of the medications that they need to take," said Dr. Lisa Sammaritano, a rheumatologist at the Hospital for Special Surgery in New York. The Lupus Foundation of America says a healthy pregnancy with lupus is possible, but the disease also raises your risk for certain complications, including preeclampsia. Luckily, Sammaritano said the chances for a woman with lupus to have a successful pregnancy are better than ever before. "Having quiet disease before one becomes pregnant is perhaps the best thing you can do. They really have to plan ahead of time, sometimes even years ahead of time, so that they have quiet disease on medicines that are safe to take during pregnancy," she said. The Lupus Foundation of America also notes it's best to wait until your lupus is "minimally active and your symptoms are under good control on medications that are safe to take during pregnancy" before trying for a baby. Cornejo's lupus symptoms remained stable after the dosage on some of her medications was lowered, and both mom and baby were closely monitored. "I felt healthy until after I gave birth to her," Cornejo said, though she added that she's been dealing with a major flare up since then. "The symptoms I'm having now are worse than before. I'm losing a lot of hair. I'm getting a lot of headaches. I'm very tired. Going through a very tough time to kind of deal with these sometimes," she said. Cornejo is working with her doctors to try to manage her disease and be able to enjoy more time with her family.
National Post
22-05-2025
- Health
- National Post
Ventus Therapeutics to Present Phase 1 Results for VENT-03, a First-in-Class cGAS Inhibitor, at LUPUS 2025
Article content WALTHAM, Mass. & MONTREAL — Ventus Therapeutics, a clinical-stage biopharmaceutical company advancing two Phase 2 small-molecule programs for immunological, inflammatory, and neurological disorders, today announced the upcoming presentation of the Phase 1 safety, tolerability, pharmacokinetics (PK), and pharmacodynamic (PD) results of VENT-03 at the 16 th International Congress on Systemic Lupus Erythematosus (LUPUS 2025), taking place from May 21-24 in Toronto, Canada. Article content VENT-03 is the first oral small-molecule cyclic GMP-AMP synthase (cGAS) inhibitor to successfully complete a first-in-human Phase 1 study and was discovered using Ventus' proprietary ReSOLVE ® platform. Data from the Phase 1 study, initially announced in October 2024, showed that VENT-03 was safe and well tolerated at all tested dose levels with a favorable PK profile enabling once-daily dosing. Article content 'We are pleased to present at LUPUS 2025 the first reported Phase 1 results for a cGAS inhibitor, demonstrating that VENT-03 has the potential to become a first- and best-in-class therapy for lupus and other autoimmune disorders,' said Marcelo Bigal, M.D., Ph.D., President and CEO of Ventus. 'Ventus is eager to unlock the potential of cGAS inhibition across multiple autoimmune diseases, with the first Phase 2 trial evaluating VENT-03 in patients with lupus to commence later this year.' Article content The Phase 1, double-blind, placebo-controlled, first-in-human trial included 72 healthy adult volunteers across single ascending dose (SAD) and multiple ascending dose (MAD) cohorts. The study results show that VENT-03 was safe and well tolerated up to single doses of 2000 mg once daily (QD) and multiple dosing of 900 mg QD for 10 days, which are substantially higher than our anticipated Phase 2 dose. The proportion of participants with adverse events (AEs) in the MAD cohorts was similar for VENT-03 and placebo (79% vs. 75%), and the vast majority of AEs in the study were mild and considered unrelated to the study drug. The PK profile of VENT-03 supports once-daily dosing with or without food, and the PD results demonstrate robust target engagement, supporting further clinical development. Article content 'More than five million people worldwide are estimated to have a form of lupus. These patients can experience disease progression and severe symptoms that can affect quality of life, and currently available treatment options may not be able to adequately address these symptoms for all patients,' said Mona Kotecha, M.D., Chief Medical Officer of Ventus. 'Through targeting cGAS, VENT-03 has the potential to become a safer and more effective treatment option for patients in need, addressing key unmet needs across multiple organ systems while providing the additional benefit of once-daily oral dosing. We look forward to sharing these results and to connecting with the wider lupus community at LUPUS 2025.' Article content Details of the poster presentation are as follows: Article content Title: Safety, Tolerability, Pharmacokinetics and Pharmacodynamics in Healthy Volunteers of VENT-03, a Novel cGAS Inhibitor for the Treatment of Systemic Lupus Erythematosus Authors: Xavier Valencia, Kelly Pike, Loraine Warner, Conrad Winters, Jeanne Stewart, Ramsay Beveridge, Patrick Cyr, Nadine Fradet, Amandine Chefson, Ofer Spiegelstein Abstract Number: Poster 286 Session Date: May 22 nd Article content cGAS is an intracellular pattern recognition receptor that is activated after binding to double-stranded DNA (dsDNA) in the cytoplasm. The presence of dsDNA in the cytoplasm is often the result of cellular dysfunction, which is a hallmark of many autoimmune and inflammatory diseases. Activation of cGAS leads to cGAMP formation, activation of STING, pronounced inflammation, and tissue damage. In both patients and preclinical models of disease, the cGAS pathway has been shown to be a key driver of lupus and other inflammatory diseases, such as rheumatoid arthritis, systemic sclerosis, dermatomyositis, and Sjögren's disease. Article content Ventus Therapeutics is a clinical-stage biopharmaceutical company advancing two Phase 2 small-molecule programs for immunological, inflammatory, and neurological disorders. Using its proprietary drug discovery platform, ReSOLVE ®, the company has established a robust pipeline, including two wholly-owned programs. VENT-03 is a first-in-class, oral cGAS inhibitor expected to enter Phase 2 development for lupus in 2025. VENT-02 is a best-in-class, brain-penetrant, oral NLRP3 inhibitor in Phase 2 for Parkinson's disease, and is expected to enter Phase 2 development for osteoarthritis in obese patients later in 2025. In addition, Ventus has out-licensed VENT-01, a peripherally-restricted, oral NLRP3 inhibitor in Phase 1, to Novo Nordisk A/S. For more information, please visit and engage with Ventus on LinkedIn. Article content Article content Article content Article content Article content Contacts Article content Media Dan Budwick 1AB dan@ Article content Article content
Medscape
21-05-2025
- Health
- Medscape
Episode 4: Lupus and Lifestyle: What Patients Can Control
This transcript has been edited for clarity. For more episodes, download the Medscape app or subscribe to the podcast on Apple Podcasts, Spotify, or your preferred podcast provider. Maureen McMahon, MD, MS: Hello, I'm Dr Maureen McMahon. Welcome to the Medscape InDiscussion podcast series on systemic lupus erythematosus. Today, we'll discuss environmental exposure in lupus with our guest, Dr Karen Costenbader. Dr Costenbader is a professor of medicine at Harvard Medical School and holds the Michael E. Weinblatt MD Distinguished Chair in clinical rheumatology at Brigham and Women's Hospital, where she serves as the director of the lupus program. She specializes in treating systemic lupus erythematosus and related connective tissue diseases. Karen Costenbader, MD, MPH: Hi, Maureen. It's very nice to be here. Thanks. McMahon: I'm excited to talk about this with you. Of the questions that I get from my lupus patients, these topics are at the top of the list of things that people want to know about. I'm excited to hear what you can tell us today. I know you've done a lot of research in this area. Costenbader: I think it's a fascinating topic as well. McMahon: The top thing that I get asked about, concerning how patients got their lupus in the first place and how they should manage their lupus, is around the topic of diet. I know that you've done some research on different food exposures, and I was wondering if you could talk to us about that. Costenbader: To back up, I've been looking for why people get lupus and environmental exposures for most of my career. I think it's such a complex disease. There's so much going on in the immune system. We know that people develop lupus because they probably have a genetic predisposition. But then, along the way, there are environmental factors, including everything you can think of in life that might be environmental, or even behavioral and lifestyle, and all these other things, like diet, that we're exposed to that could increase or decrease our risk of developing lupus. And then those factors can interact with each other. It may not just be one exposure; it could be multiple things. It's been complicated to study, but I've been lucky to have access to the Nurses' Health Study, which is a very large cohort of women, started back in 1976 here at the Brigham Women's Hospital in Boston. We've also studied diet and the risk of lupus in the Black Women's health study, which is based at Boston University. We are not the only ones studying diet in the Nurses' Health Study and Black Women's Health Study in other cohorts. A lot of the world's greatest researchers in nutritional epidemiology work in these cohorts and have developed different algorithms for looking at diet and putting all these foods into different patterns. We've looked at Western and prudent diets and the risk, and a lot of this we've done for rheumatoid arthritis as well, which is more common. In the rheumatoid arthritis analyses, we have a larger sample size and more power. And then we look for lupus, which has a smaller sample size. As you said, everybody is interested in diet. What are we taking in that might change our immune system, that might increase or decrease the immune stimulation of someone who might be developing lupus or another disease? We looked at Western and prudent diet, and we didn't see anything for the risk of lupus. We looked at several different dietary patterns that were already put together, including the DASH (Dietary Approaches to Stop Hypertension) diet to reduce hypertension, as well as the Alternative Healthy Eating Index (AHEI), a Mediterranean dietary pattern, and an empirical, pro-inflammatory diet, which was based on biomarkers. At that point, we didn't see much risk related to diet. We saw, maybe, that nuts and legumes were associated with a lower risk; the same is possibly true when reducing carbohydrates. In the Black Women's Health Study, we looked at Western and prudent diets, and then we looked at many different dietary and nutritional components. We saw that high carbohydrate intake was associated with an increased risk of developing lupus later on. The Black Women's Health Study started in 1995 and followed women forward with similar questionnaires. It was based very closely on the nurses' health study pattern. It's been easy for us to translate our work over there, asking women every couple of years about their dietary intakes over time. And then we have also gotten medical records and validated the new cases. And so, here we saw especially high intake of carbohydrates. And then most recently, we've been interested in what people are ingesting through their diet for a long time. For example, junk food, ultra-processed food. The categories of ultra-processed food were defined by Professor Carlos Monteiro in Brazil a few years ago. He categorizes foods into these four categories, where ultra-processed is the most processed. And then we had to adapt them for the nurses' health study. It puts food into categories. The lowest is raw. You eat an apple, that's unprocessed. You know where it came from, what it is, et cetera. And then there are two intermediate categories of semi-processed and then processed, which is like eating applesauce probably out of a can. It depends on what else is in it. Ultra-processed is something that only vaguely resembles food anymore. It's like a lot of chips and soda. It doesn't have a lot of nutritional components. It has a lot of other stuff in it, including emulsifier and stabilizers, and other stuff that they put in, like dyes and things that are hopefully regulated. We don't know if they're harmful to human health. And there is a lot of high fructose corn syrup, especially in sodas and things. There, we did see an increase in the risk of developing lupus many years later. When we did this in many ways, in terms of cumulatively updating from the beginning and putting people into tertiles of the highest intake of ultra-processed food, the real junk food, there was a clear signal of an increased risk. And then in many of these analyses, we have done stratified analyses by double-stranded DNA positivity from the medical records at the time of diagnosis. We don't follow the women and the studies after their diagnosis. That's a little too hard. But at least we get all the medical records at the time of diagnosis. About 50% of patients tested are positive. We saw a stronger signal with double-strand DNA positivity, which is always good to see because, in my opinion, that's real lupus, you know? We know that that's highly specific for lupus, and it's about a doubling of risk. It was about a 50% increased risk overall in the highest tertile. So that's a real signal. After looking at the data multiple ways over multiple years, I think we now see that it's the bad food. The ultra-processed food may be contributing to the risk rather than these other patterns. And these are all calorie-adjusted. Taking in a lot of this food. We looked at absolute intake as well as relative intake. And it looked like it was the absolute intake in terms of grams per day, or servings per day, rather than the percent of the dietary intake. It's really how much exposure you have. McMahon: How are you counseling your patients when it comes to diet? They're your patients; they've already developed lupus. Costenbader: I think we can still recommend a healthy diet, avoidance of ultra-processed food. When we looked at all the different kinds of ultra-processed food, of course, we didn't have the power to look in every single category, but we did anyhow. And we saw that it was soft drinks, soda, both artificially sweetened and sugar sweetened, that had the strongest signal. So, I think if you're going to change one thing about your diet that really might be pro-inflammatory and has a lot of high fructose corn syrup and probably a lot of excess carbohydrate as well, is to stop the soda. We also know it's bad for kidney disease and a lot of other things. I think that we can counsel our patients about ultra-processed foods for a variety of reasons. This includes rheumatology patients and all patients in general, because the high intake of ultra-processed foods has been associated with risk of all-cause mortality, cancer, cardiovascular disease, diabetes, hypertension, you name it. And we take in a ton of them. When I was doing research for this paper, we looked at data from NHANES (National Health and Nutrition Examination Survey), from I think 2011 to 2017, that found that for adults in the US, about 50% or more of the diet in terms of calories comes from ultra-processed food. It's gone up in every category of people. When they did stratified analysis, it's going up even faster, above 60%, almost 70% of the diet comes from ultra-processed food in people with less than a high school education. There's a clear gradient. It's still going up, but it's much lower in people with a college education. And then the other category that really surprised me is older people. It's very high in older people, and I think maybe they just don't have access to healthy foods and maybe are eating many more processed and prepared foods. McMahon: That's really helpful to know and helpful to have that conversation with patients, because it is sometimes easy to follow the path of least resistance and get the easily prepared ultra-processed foods. One of the other things that comes up frequently when patients are asking about how they developed their lupus in the first place, is that maybe they had an infection that preceded it, that they're linking to it. And I was wondering what you know about the data that confirms or denies that. Costenbader: It's much harder to study infections and whether they trigger the onset of lupus or other diseases; I think there've been a lot of glimmers that they probably do. Because, as you can imagine, there are a lot of good reasons to think that infections, and maybe it's not just one type of infections, have an effect. We learned during COVID that they trigger cytokine storms, that there's lots of inflammation going on. There have been several studies now using large populations and administrative data that do show that the risk of developing all kinds of autoimmune disease. McMahon: One of the other things I have to ask you about is the role of vaccinations and what you know about vaccinations triggering or worsening ongoing disease. Costenbader: So, I'll start off with a disclaimer that I'm a big fan of vaccinations. Some people should not get vaccinated, if they've had bad reactions in the past or if they have Guillain-Barre is something autoimmune that is triggered by vaccinations. I don't think we have such evidence for lupus. It is hard to study because, in the past few years, we've all been getting a lot of vaccinations for COVID. I think in general those vaccinations have saved so many lives that the risk benefit is heavily in favor of the benefit. And definitely for people with lupus, I'm a big proponent of getting all the vaccinations because they are immunosuppressed, and vaccinations save lives. It's not been well studied, but there are some signals that some of the COVID vaccinations were associated with pericarditis in younger people especially. I don't think that we have a signal for lupus or other autoimmune diseases that is as strong as having the disease itself. And other vaccinations as well have been a little bit investigated over the years, but I've never seen any strong evidence that having vaccinations was associated with the onset of lupus. McMahon: Great. Thank you. What about other environmental exposures. things like air pollution or chemical exposures? What do we know about those? Costenbader: There's more and more data on those, too. Smoking is a risk factor for lupus, as it is for rheumatoid arthritis. And we've seen that smoking increases the risk by about 50%, especially for current smokers. And then the risk dissipates over time, and that also is more strongly [associated] with doublet stranded DNA positivity. It is probably auto-antibody generation, at least that was my hypothesis, because it does the same thing in generation of anti-CCP (anti-cyclic citrullinated peptide) positivity in rheumatoid arthritis. I think from there we started thinking much more about other inhaled exposures and air pollution. There are several nice studies. We had looked at air pollution many years ago, it was one of my first grants actually. We looked at the risk of lupus and RA in the Nurses' Health Study. We probably didn't have the power at that point. We did see a signal for rheumatoid arthritis, but not for lupus. But there are other studies. I know Sasha Bernatsky in Canada has studied air pollution and risk of systemic autoimmune rheumatic diseases in general, including lupus. There is an increased risk. More recently, there has been work on fire and air pollution in rheumatoid arthritis. It wouldn't surprise me at all if it's similar in lupus. And then in terms of pesticides, I think some of the nicest work has been done by Christine Parks and the Agricultural Health Study. She gets into all the different types of chemical fertilizers, pesticide exposures, and insecticides. I can't tell you all the different types, but she does know all the different types and she's looked at mixing the pesticides and applying the pesticides, and being a spouse of the farmers who are as so associated with them. And here there is a risk as well. We went back in the Roxbury lupus study, which was a case-control study in urban Boston neighborhoods several years ago, and the women had answered questions about pesticide exposure. There it was rodent and roach insecticide applications in the home that people were exposed to. We saw a risk associated with that as well. I think there are a lot of chemical exposures out there, like organic solvents and pesticides, that people are exposed to that could stimulate the immune system. We don't understand all the mechanisms, if these are similar mechanisms or if they're a different mechanism. McMahon: What about some of the other lifestyle things? We talked a little bit about smoking, but what about other things like sleep or stress? Costenbader: We've studied those as well. I think that's the beauty of the Nurses' Health Study too. These are kinds of exposures have been self-reported for many years. We can look back many years before, we saw that sleep deprivation, as you mentioned, was associated with increased risk, a very strong increased risk, about two and a half times higher risk. In our study, the chronic low sleep deprivation duration category was less than 5 hours a night vs less than or equal to 5 hours a night vs greater than 7-8 hours, which is considered normal. But everybody's different. My boss, for example, only needs 4 hours of sleep at night, and it's very annoying. Some people can get away with it forever and function very well. Some people will say, I always get 10 hours of sleep, which is very lucky with them as well. You mentioned stress and psychosocial factors. PTSD has been strongly associated with the risk of lupus and other autoimmune diseases, and trauma exposure, depression, and adverse childhood experiences as well. We've seen the same with RA and with lupus. We've tried to do kind of a mediation analysis as well because it's hard to know what's going on. There are studies that show having PTSD is associated with having more systemic inflammation, so having higher CRP and IL-6 levels, interestingly. But is this through unhealthy lifestyle as well? Is it more smoking and less exercise and more obesity, and is it a lot of other things? Part of the associated risk is mediated by that, but there are also maybe direct impact. We wrote a whole review on how PTSD may be related to lupus, and there are a lot of things beyond other risk factors. We found the HPA (hypothalamic-pituitary-adrenal) axis being invoked, and vagal tone could be a part of it. People are very interested in the stimulation of the vagus now, which could be good in terms of increased awareness. And the parasympathetic nervous system is good for reducing inflammation and calming. I think that's all fascinating. McMahon: I think that's a hopeful message. Because I think it is nice for patients out there to think that there are things that they can control. There are so many things that we're out of control in our lives, but controlling your healthy lifestyle and focusing on eating well and exercising, I think that that's a good message for all of us. Well, thank you so much, Karen, for talking to us today. Today, we talked to Dr Karen Costenbader about environmental exposures in lupus. We've all learned about risk factors, but also how healthy lifestyle habits can hopefully lead to better outcomes and healthier patients all around. Thank you for joining us, everyone. Please take a moment to download the Medscape app to listen and subscribe to this podcast series on systemic lupus erythematosus. This is Dr Maureen McMahon for the Medscape InDiscussion podcast. Systemic Lupus Erythematosus (SLE) Risk Prediction Models for Incident Systemic Lupus Erythematosus Among Women in the Nurses' Health Study Cohorts Using Genetics, Family History, and Lifestyle and Environmental Factors Association of Macronutrients and Dietary Patterns With Risk of Systemic Lupus Erythematosus in the Black Women's Health Study Dietary Patterns and Risk of Systemic Lupus Erythematosus in Women Alternative Dietary Indices Both Strongly Predict Risk of Chronic Disease Ultra-Processed Foods: What They Are and How to Identify Them Anti-dsDNA Antibodies in the Classification Criteria of Systemic Lupus Erythematosus Identifying and Estimating Ultraprocessed Food Intake in the US NHANES According to the Nova Classification System of Food Processing Development of a Predictive Model for Systemic Lupus Erythematosus Incidence Risk Based on Environmental Exposure Factors Systemic Autoimmune Rheumatic Diseases and Multiple Industrial Air Pollutant Emissions: A Large General Population Canadian Cohort Analysis Pesticide Exposure and Risk of Rheumatoid Arthritis Among Licensed Male Pesticide Applicators in the Agricultural Health Study Pesticide Exposure and Risk of Systemic Lupus Erythematosus in an Urban Population of Predominantly African-American Women Association of Sleep Deprivation and the Risk of Developing Systemic Lupus Erythematosus Among Women
