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Systemic Lupus Erythematosus: HELP
Articles by Abdulla Watad
Based on 14 articles published since 2008
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Between 2008 and 2019, A. Watad wrote the following 14 articles about Lupus Erythematosus, Systemic.
 
+ Citations + Abstracts
1 Review HPV vaccines and lupus: current approaches towards preventing adverse immune cross-reactivity. 2019

Bragazzi, Nicola L / Bridgewood, Charlie / Sharif, Kassem / Kamal, Mohamad / Amital, Howard / Watad, Abdulla / Shoenfeld, Yehuda. ·a Postgraduate School of Public Health, Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy. · b Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine , University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital , Leeds , UK. · c Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel. ·Expert Rev Vaccines · Pubmed #30526148.

ABSTRACT: INTRODUCTION: If not properly treated, human papillomavirus (HPV) infection may evolve from a common sexually transmitted disease to genital warts and cervical cancer. Various prophylactic HPV vaccines (HPVv), approved to reduce the incidence of the infection, have been found to be effective and safe; however, accounts of post-vaccination autoimmune phenomena, including systemic lupus erythematosus (SLE), have been reported in genetically susceptible individuals. AREAS COVERED: Infectious agents play a role in breaking the immunologic tolerance to self-antigens, resulting in autoimmune events. There is molecular evidence supporting the involvement of HPV in SLE, with a high prevalence of L1 HPV peptide homology to proteins being associated with SLE. Therefore, approaches in vaccine preparations aiming to prevent adverse immune cross-reactivity are sought. Performing a broad search of the literature, we review the association between SLE, HPV, and HPVv, with a focus on the mechanisms of molecular mimicry and cross-reactivity, and the approaches currently being elaborated towards preventing such phenomena. EXPERT COMMENTARY: The advantages of using low-similarity peptide antigens may be two-fold, abolishing the risk of cross-reactivity and eliminating the vaccine adjuvantation procedure. Vaccines based on pathogen unique sequences would provide effective vaccine preparation while curbing the risk for the human host.

2 Review Diverse patterns of anti-TNF-α-induced lupus: case series and review of the literature. 2018

Shovman, Ora / Tamar, Shalev / Amital, Howard / Watad, Abdulla / Shoenfeld, Yehuda. ·Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel. · Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel. · Department of Gastroenterology, The E. Wolfson Medical Center, Holon, Israel. · Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. · Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel. shoenfel@post.tau.ac.il. · Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. shoenfel@post.tau.ac.il. · Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. shoenfel@post.tau.ac.il. ·Clin Rheumatol · Pubmed #29063464.

ABSTRACT: The induction of autoantibodies is common following therapy with anti-TNF-α agents. However, anti-TNF-α-induced lupus (ATIL) is rare. We assessed the clinical characteristics of three patients with inflammatory bowel disease (IBD) who were treated with infliximab and developed distinct subsets of ATIL. Also, we searched for similar cases in the published literature. We describe three patients with ATIL. The first patient had a classical drug-induced lupus (DIL) presented by thrombocytopenia that resolved after infliximab discontinuation. The second case experienced symmetric polyarthritis of 14 joints in rheumatoid arthritis (RA)-like distribution accompanied by lymphopenia. The third one had a severe serositis including ascites and pleural and pericardial effusions along with pancytopenia. In this patient, ATIL coexisted with anti-TNF-α-induced hepatitis. The second and third patients met the American College of Rheumatology classification criteria for SLE. Nevertheless, all three cases exhibited ANA and anti-dsDNA positivity, and only the second patient had anticardiolipin (aCL IgG) and anti-histone antibodies. The coexistence of both lupus-like syndrome and hepatitis following anti-TNF-α therapy in the same patient is very rare, and to the best of our knowledge, only four such case reports are mentioned in literature. Patients with mild ATIL may tolerate another anti-TNF-α agent without recurrence of the disease. Rheumatologists should be aware of the distinct clinical presentations of ATIL and its coexistence with other rare anti-TNF-alpha complications such as hepatitis.

3 Review Vitamin D and Systemic Lupus Erythematosus: Myth or Reality? 2016

Watad, Abdulla / Neumann, Shana G / Soriano, Alessandra / Amital, Howard / Shoenfeld, Yehuda. · ·Isr Med Assoc J · Pubmed #27228639.

ABSTRACT: There is growing interest in the contribution of vitamin D deficiency to autoimmunity. Several studies have shown an association between low levels of vitamin D and autoimmune disorders, including multiple sclerosis, rheumatoid arthritis, type 1 diabetes, autoimmune thyroid diseases, celiac disease, and systemic lupus erythematosus (SLE). Vitamin D receptor ligands can mediate immunosuppressive effects. It has been suggested that low levels of this hormone contribute to the immune activation in lupus and other autoimmune diseases. This review updates and summarizes the literature on the association between vitamin D and SLE, and discusses the various correlations between vitamin D and SLE activity, clinical expressions, serology, and gene polymorphisms of vitamin D receptors.

4 Review Hypothyroidism among SLE patients: Case-control study. 2016

Watad, Abdulla / Mahroum, Naim / Whitby, Aaron / Gertel, Smadar / Comaneshter, Doron / Cohen, Arnon D / Amital, Howard. ·Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel, Sackler; Faculty of Medicine, Tel-Aviv University, Israel. · Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel, Sackler. · Chief Physician's Office, Clalit Health Services Tel Aviv, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. · Chief Physician's Office, Clalit Health Services Tel Aviv, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. · Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel, Sackler; Faculty of Medicine, Tel-Aviv University, Israel. Electronic address: howard.amital@sheba.health.gov.il. ·Autoimmun Rev · Pubmed #26826435.

ABSTRACT: BACKGROUND: The prevalence of hypothyroidism in SLE patients varies considerably and early reports were mainly based on small cohorts. OBJECTIVES: To investigate the association between SLE and hypothyroidism. METHODS: Patients with SLE were compared with age and sex-matched controls regarding the proportion of hypothyroidism in a case-control study. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was performed utilizing the medical database of Clalit Health Services. RESULTS: The study included 5018 patients with SLE and 25,090 age and sex-matched controls. The proportion of hypothyroidism in patients with SLE was increased compared with the prevalence in controls (15.58% and 5.75%, respectively, P<0.001). In a multivariate analysis, SLE was associated with hypothyroidism (odds ratio 2.644, 95% confidence interval 2.405-2.908). CONCLUSIONS: Patients with SLE have a greater proportion of hypothyroidism than matched controls. Therefore, physicians treating patients with SLE should be aware of the possibility of thyroid dysfunction.

5 Article Immunogenicity, safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis. 2019

Adawi, Mohammad / Bragazzi, Nicola Luigi / McGonagle, Dennis / Watad, Samaa / Mahroum, Naim / Damiani, Giovanni / Conic, Rosalynn / Bridgewood, Charlie / Mahagna, Hussein / Giacomelli, Luca / Eggenhöffner, Roberto / Mahamid, Mahmud / Pigatto, Paolo Daniele Maria / Amital, Howard / Watad, Abdulla. ·Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel; Padeh and Ziv Medical Centers, Zefat, Israel. · Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. Electronic address: robertobragazzi@gmail.com. · Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK. · Department of Statistics and Operations Research, Tel Aviiv University, Tel Aviv, Israel. · Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel. · Young Dermatologists Italian Network (YDIN), GISED, Bergamo, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, Milano, Italy; Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopaedic Institute, University of Milan, 20126 Milan, Italy. · Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA. · Dipartimento di Scienze chirurgiche e Diagnostiche Integrate (DISC) Università degli Studi di Genova, Genova, Italy. · Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel; Endoscopy Unit of the Nazareth Hospital EMMS, Nazareth, Israel. · Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, Milano, Italy. · Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK; Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel; Zabludowicz center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel. ·Autoimmun Rev · Pubmed #30408581.

ABSTRACT: The immunological perturbations associated with systemic lupus erythematosus (SLE) put many patients at a higher risk of infections, including pneumococcal pneumonia. However, the uptake and utility of anti-pneumococcal vaccines in SLE patient is both controversial and not completely agreed upon. Indeed, several epidemiological studies of anti-pneumococcal vaccine safety and efficacy in SLE have reported short-term immunogenicity with elevated anti-pneumococcal antibody titres but inconsistent long-term findings, with some studies finding poor responses, mainly for long-term immune protection. Moreover, the safety and efficacy of the pneumococcal vaccine in SLE patients remains controversial due to the different types of anti-pneumococcal vaccines, and the heterogeneity of SLE patients. Several reviews addressing anti-pneumococcal vaccination in SLE patients exist, however, to the best of our knowledge, the present is the first systematic review and meta-analysis. To better understand the efficacy and safety of pneumococcal vaccination in SLE, a comprehensive literature search was performed identifying 18 studies, which have been included in the present systematic review and meta-analysis. All studies were designed as longitudinal investigations, 2, in particular, were of high quality, being randomized, double-blind trials (RCTs). Four studies had control groups. Total sample size included 601 participants. Vaccine immunogenicity in terms of subjects with protective antibody titers ranged from 36% to 97.6%. According to our systematic review and metanalysis, high erythrocyte sedimentation rate (ESR), older age, earlier SLE onset, high disease activity, and immunosuppressive therapy were predictors of poor immunogenicity, although belimumab was found to have no significant impact. With regard to safety, no serious adverse events were found, with up to one third of cases reporting mild/low-grade complaints. In conclusion, due to the high risk of pneumococcal infection in SLE patients and given the safety and, at least partial, effectiveness, according to our systematic review and meta-analysis, in such patients, preventive strategies mainly by immunization, are required in all age groups and, in those needing immunosuppressive therapy, immunization should be given prior the initiation of the treatment. PROSPERO registration code CRD42018103605.

6 Article Tuftsin-phosphorylcholine (TPC) equally effective to methylprednisolone in ameliorating lupus nephritis in a mice model. 2018

Shemer, A / Kivity, S / Shovman, O / Bashi, T / Perry, O / Watad, A / Ben-Ami Shor, D / Volkov, A / Barshack, I / Bragazzi, N L / Krule, A / Fridkin, M / Amital, H / Blank, M / Shoenfeld, Y. ·Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. · Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel. · Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel. · Institute of Pathology, Sheba Medical Center, Tel Hashomer, Israel. · Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy. · Department of Organic Chemistry, The Weizmann Institute of Sciences, Rehovot, Israel. · Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ·Clin Exp Immunol · Pubmed #29698559.

ABSTRACT: The role of helminth treatment in autoimmune diseases is growing constantly. Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease with challenging treatment options. Tuftsin-phosphorylcholine (TPC) is a novel helminth-based compound that modulates the host immune network. This study was conducted to evaluate the potential value of TPC in ameliorating lupus nephritis in a murine model and specifically to compare the efficacy of TPC to the existing first-line therapy for SLE: corticosteroids (methylprednisolone). Lupus-prone NZBxW/F

7 Article Hidradenitis suppurativa associated with systemic lupus erythematosus: A case report. 2018

Ben David, Chen / Bragazzi, Nicola L / Watad, Abdulla / Sharif, Kassem / Whitby, Aaron / Amital, Howard / Adawi, Mohammad. ·Rheumatology Unit, Ziv and Padeh Medical Centers. · Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel. · School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. · Department of Medicine 'B'. · Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer. · Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. ·Medicine (Baltimore) · Pubmed #29561436.

ABSTRACT: RATIONALE: Hidradenitis suppurativa (HS) is a chronic inflammatory condition characterized by recurrent swollen, deep, and painful abscesses. Several autoimmune conditions have been shown to be associated with HS including inflammatory bowel disease and spondyloarthropathies. PATIENT CONCERNS: 40-year-old female with systemic lupus erythematous (SLE) presented with recurrent abscesses and nodules on her extremities. DIAGNOSIS: Early considerations related the described dermatologic findings to the dermatologic manifestations of SLE, however findings from lesion biopsy were suggestive of HS. INTERVENTIONS: Prednisone and antibiotic therapy with clindamycin were started. Subsequently upon discharge, the patient was also treated with rifampicin and azathioprine. OUTCOME: In this communication, we demonstrate a case of HS in a patient with SLE that significantly improved under antibiotic and immunosuppressant therapy. LESSONS: HS can coexist in patients with SLE. Evidence pertinent to the etiology of HS and its association with other autoimmune conditions implies a possible denominator in the disease etiopathogenesis. Increased awareness of the co-occurrence of the two conditions calls for increased efforts to devise better treatment modalities.

8 Article Advances in our understanding of immunization and vaccines for patients with systemic lupus erythematosus. 2017

Bragazzi, Nicola Luigi / Watad, Abdulla / Sharif, Kassem / Adawi, Mohammad / Aljadeff, Gali / Amital, Howard / Shoenfeld, Yehuda. ·a School of Public Health, Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy. · b Departement of Medicine 'B' , Sheba Medical Center , Tel-Hashomer , Ramat Gan , Israel. · c Zabludowicz Center for Autoimmune Diseases , Sheba Medical Center , Tel-Hashomer , Israel. · d Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel. · e Faculty of Medicine , Baruch Padeh Medical Center, Bar-Ilan University , Israel. ·Expert Rev Clin Immunol · Pubmed #28749245.

ABSTRACT: INTRODUCTION: Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease. In SLE, immune system dysfunction is postulated to result by virtue of the disease itself as well as by the impact of treatment modalities employed. A myriad of immune dysregulations occur including complement system dysfunction among others. Infectious agents are known to complicate the disease course in close to 25-45% of SLE patients. Areas covered: In this review a discussion of the immunogenicity and safety of viral and bacterial vaccinations in SLE was performed. The search included ISI Web of Science (WoS), Scopus, MEDLINE/PubMed, Google-Scholar, DOAJ, EbscoHOST, Scirus, Science Direct, Cochrane Library and ProQuest. Proper string made up of a key-words including 'SLE', 'vaccination', 'safety' and 'efficacy' was used. Expert commentary: Vaccination of SLE patients is proven to be immunogenic. Concerns regarding vaccine safety are postulated, yet no direct relationship between vaccination and disease exacerbation were established. While live virus vaccines are generally contraindicated in immunosuppressive states, generally live attenuated vaccinations are recommended in SLE patients on a case-to-case basis. In SLE patients, clinical parameters such as vaccination during disease exacerbations have not been intensively studied and therefore while apparently safe, vaccination is generally recommended while disease is quiescent.

9 Article The association between systemic lupus erythematosus and valvular heart disease: an extensive data analysis. 2017

Watad, Abdulla / Tiosano, Shmuel / Grysman, Noam / Comaneshter, Doron / Cohen, Arnon D / Shoenfeld, Yehuda / Amital, Howard. ·Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel. · Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel. · Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. · Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel. · Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. ·Eur J Clin Invest · Pubmed #28295225.

ABSTRACT: BACKGROUND: Association between antiphospholipid syndrome in systemic lupus erythematosus (SLE) and valvular heart disease (VHD) is well reported, but relatively few studies have been carried out to establish the linkage between VHD and SLE itself. We aimed to investigate link between VHD and SLE and to evaluate the association of diverse factors with VHD among these patients in a large-scale population-based study. MATERIALS AND METHODS: We used the databases of the largest state-mandated health service organization in Israel. All SLE patients were included (n = 5018) as well as their age and sex-matched controls (n = 25 090), creating a cross-sectional population-based study. Medical records of all subjects were analysed for documented VHD and the presence of antiphospholipid antibodies (aPLs). A logistic regression model was carried out to evaluate the diverse factors including SLE and aPLs as independent risk factors for VHD. RESULTS: Valvular heart disease were found to be more frequent among SLE group when compared to controls (aortic stenosis, 1·08% vs. 0·35% respectively, P < 0·001; aortic insufficiency, 1·32% vs. 0·29% respectively, P < 0·001; mitral stenosis, 0·74% vs. 0·21% respectively, P < 0·001; mitral insufficiency, 1·91% vs. 0·39% respectively, P < 0·001). Male sex, hypertension, aPLs and SLE were found to be significant independent risk factors for VHD. CONCLUSION: All VHD are more prevalent among SLE patients when compared to controls. SLE and aPLs are independent risk factor for VHD (OR of 2·46 and 1·7, respectively). Physicians must be aware of such significant association, and routine echocardiography should be considered in SLE patients regardless of their aPL status.

10 Article Association between ischemic heart disease and systemic lupus erythematosus-a large case-control study. 2017

Watad, Abdulla / Abu Much, Arsalan / Bracco, Danielle / Mahroum, Naim / Comaneshter, Doron / Cohen, Arnon D / Amital, Howard. ·Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel, Sackler Faculty of Medicine, Tel-Aviv University, 52621, Tel-Hashomer, Israel. · Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. · Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel. · Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel, Sackler Faculty of Medicine, Tel-Aviv University, 52621, Tel-Hashomer, Israel. howard.amital@sheba.health.gov.il. ·Immunol Res · Pubmed #28093682.

ABSTRACT: Ischemic heart disease (IHD) is a well identified cause of mortality in systemic lupus erythematosus (SLE) patients due to an accelerated premature atherosclerosis. We investigated the proportion of comorbid IHD among SLE patients derived from a large, national real-life database. Using data from the largest HMO in Israel, the Clalit Health Services, we selected for patients with SLE. These patients were compared with age and sex matched controls with regards to the proportion of IHD in a case-control study. Chi-square and t tests were used for univariate analysis, and a logistic regression model was used for multivariate analysis. The study included 5018 patients with SLE and 25090 age and sex-frequency matched controls. The prevalence of IHD in patients with SLE was increased in comparison to controls (11.3 and 3.1%, P < 0.001). In a multivariate analysis, SLE was associated with IHD (OR 3.77, 95% confidence interval 3.34-4.26). We have confirmed that SLE patients suffer a high prevalence of IHD. Our data supports that SLE is an independent risk factor for IHD. When evaluating by gender, the risk seems even more substantial in females. No significant difference was found in the risk of IHD in SLE among the difference socioeconomic strata.

11 Article Correlation between systemic lupus erythematosus and malignancies: a cross-sectional population-based study. 2017

Azrielant, Shir / Tiosano, Shmuel / Watad, Abdulla / Mahroum, Naim / Whitby, Aaron / Comaneshter, Doron / Cohen, Arnon D / Amital, Howard. ·Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel. · Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. · Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel. · Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. · Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel. howard.amital@sheba.health.gov.il. · Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. howard.amital@sheba.health.gov.il. ·Immunol Res · Pubmed #28091805.

ABSTRACT: Autoimmune conditions reflect dysregulation of the immune system; this may be of clinical significance in the development of several malignancies. Previous studies show an association between systemic lupus erythematosus (SLE) and the development of malignancies; however, their investigations into the development of specific malignancies are inconsistent, and their external validity may be questionable. The main objective of this study is to investigate the association between the presence of SLE and various malignancies, in a large-scale population-based study. Data for this study was collected from Clalit Health Services, the largest state-mandated health service organization in Israel. All adult members diagnosed with SLE were included (n = 5018) and their age and sex-matched controls (n = 25,090), creating a cross-sectional population-based study. Medical records of all subjects were analyzed for documentation of malignancies. Logistic regression models were built separately for each malignant condition, controlling for age, gender, BMI, smoking, and socioeconomic status. Diagnosis of malignancy (of any type) was more prevalent in the SLE population (odds ratio [OR] 3.35, 95% confidence interval [CI] 3.02-3.72). SLE diagnosis was also found to be independently associated with higher proportions of non-Hodgkin lymphoma (OR 3.02, 95% CI 2.72-3.33), Hodgkin lymphoma (OR 2.43, 95% CI 1.88-2.99), multiple myeloma (OR 2.57, 95% CI 1.85-3.28), cervix uteri malignancies (OR 1.65, 95% CI 1.10-2.20), and genital organ malignancies (OR 2.32, 95% CI 1.42-3.22), after adjustment for confounding variables. The presence of an SLE diagnosis was found to be independently associated with higher proportions of malignancies, particularly hematologic malignancies. These findings should be considered while treating SLE patients, and possibly supplement their screening routine.

12 Article Low levels of calcium or vitamin D - which is more important in systemic lupus erythematosus patients? An extensive data analysis. 2017

Watad, Abdulla / Tiosano, Shmuel / Azrielant, Shir / Whitby, Aaron / Comaneshter, Doron / Cohen, Arnon D / Shoenfeld, Yehuda / Amital, Howard. ·Department of Medicine 'B', and The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer; and Sackler Faculty of Medicine, Tel-Aviv University, Israel. · Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer; and Sackler Faculty of Medicine, Tel-Aviv University, Israel. · Sackler Faculty of Medicine, Tel-Aviv University, Israel. · Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. · Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva; and Chief Physician's Office, Clalit Health Services Tel Aviv, Israel. · The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer; and Sackler Faculty of Medicine, Tel-Aviv University, Israel. · Department of Medicine 'B', and The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer; and Sackler Faculty of Medicine, Tel-Aviv University, Israel. howard.amital@sheba.health.gov.il. ·Clin Exp Rheumatol · Pubmed #27608168.

ABSTRACT: OBJECTIVES: Several reports have indicated an association between systemic lupus erythematosus (SLE) and low levels of vitamin D. We examined several blood work parameters in SLE patients and controls and performed an extensive data analysis in order to investigate the links between blood levels of calcium, vitamin D, and SLE disease. METHODS: 4,278 SLE patients and 16,443 age and sex-matched controls were selected from a national health insurer database in Israel. Patients with no blood work results or having renal disease were excluded. Retrospective data from five consecutive years of routine blood work results were then analysed for mean serum calcium, albumin, albumin-corrected calcium, vitamin D levels, and the presence of a hypocalcaemic episode (Corrected Ca <8.5 mg/dL). RESULTS: The mean levels of corrected serum calcium levels were slightly higher among SLE patients than controls (9.23±0.34 vs. 9.19±0.36 mg/dL p≤.001 respectively). In contrast to results of published studies, SLE patients had slightly higher levels of 25(OH)-vitamin D (SLE patients: 22.2±9.06 ng/ml, controls: 20.0±8.76 ng/ml, p≤.001). The most impressive finding entailing SLE patients was that they were twice as likely to experience episodes of hypocalcaemia in comparison to controls (SLE patients: 13.8%, controls: 6.4%, OR 2.34; 95% CI 2.33-2.83). CONCLUSIONS: Calcium levels may play a significant role in the SLE disease process, more than originally thought, since SLE patients are at a higher risk for hypocalcaemic events. Specific changes in vitamin D and calcium homeostasis in SLE patients may be responsible for the severity of symptoms. Further research is required to determine the role of calcium supplementation.

13 Article Schizophrenia among patients with systemic lupus erythematosus: population-based cross-sectional study. 2017

Tiosano, S / Farhi, A / Watad, A / Grysman, N / Stryjer, R / Amital, H / Comaneshter, D / Cohen, A D / Amital, D. ·Department of Medicine 'B',Sheba Medical Center,Tel-Hashomer,Israel. · Sackler Faculty of Medicine,Tel-Aviv University,Tel-Aviv,Israel. · Chief Physician's Office,Clalit Health Services Tel Aviv,Tel-Aviv,Israel. ·Epidemiol Psychiatr Sci · Pubmed #27457404.

ABSTRACT: AIMS: Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease involving multiple organs, including the central nervous system. Evidence of immune dysfunction exists also in schizophrenia, a psychiatric illness involving chronic or recurrent psychosis. The aim of our study was to investigate if there is an epidemiological association between SLE and schizophrenia. METHOD: A cross-sectional study was conducted comparing patients with SLE with age and gender-matched controls regarding the proportion of patients with comorbid schizophrenia. χ 2- and t-tests were used for univariate analysis, and interaction of schizophrenia with SLE across strata of covariates was checked. A logistic regression model was used for multivariate analysis. The study was performed utilising the medical database of Clalit Health Services in Israel. RESULTS: The study included 5018 patients with SLE and 25 090 controls. SLE patients had a female predominance, and a higher proportion of smoking compared with age and sex-matched controls. In multivariate analysis, SLE was found to be independently associated with schizophrenia while controlling for age, gender, socioeconomic status (SES) and smoking (OR 1.33, p = 0.042). CONCLUSIONS: We found a positive association between SLE and schizophrenia across patients of different age, gender and SES. This association can contribute to understanding the pathophysiology of the two disorders and may also have clinical implications for earlier as well as better diagnosis and treatment.

14 Article Hyperthyroidism association with SLE, lessons from real-life data--A case-control study. 2016

Watad, Abdulla / Cohen, Arnon D / Comaneshter, Doron / Tekes-Manova, Dorit / Amital, Howard. ·a Department of Medicine 'B' , Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center , Tel-Hashomer , Israel . · b Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel . · c Chief Physician's Office, Clalit Health Services , Tel Aviv , Israel . · d Faculty of Health Sciences , Siaal Research Center for Family Medicine and Primary Care, Ben Gurion University of the Negev , Beer Sheva , Israel , and. · e Chaim Sheba General Hospital, Sheba Medical Center , Tel-Hashomer , Israel. ·Autoimmunity · Pubmed #26462542.

ABSTRACT: BACKGROUND: Despite the frequently encountered association between thyroid disease and systemic lupus erythematosus (SLE) is well known, it is of surprise that only several reports compromised of small population size support this observation. OBJECTIVES: To investigate the association of comorbid SLE and hyperthyroidism. METHODS: Using the database of the largest health maintenance organization (HMO) in Israel, the Clalit Health Services, we searched for the co-existence of SLE and hyperthyroidism. Patients with SLE were compared with age- and sex-matched controls regarding the prevalence of hyperthyroidism in a case-control study. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. RESULTS: The study included 5018 patients with SLE and 25,090 age- and sex- matched controls. The prevalence of hyperthyroidism in patients with SLE was increased compared with the prevalence in controls (2.59% and 0.91%, respectively, p < 0.001). In a multivariate analysis, SLE was associated with hyperthyroidism (odds ratio 2.52, 95% confidence interval 2.028-3.137). CONCLUSIONS: Patients with SLE have a greater prevalence of hyperthyroidism than matched controls. Therefore, physicians treating patients with SLE should be aware of this possibility of this thyroid dysfunction.