Heart damage in systemic lupus erythematosus is increasingly linked to structural changes in nearby fat layers, while separate findings highlight distinct arthritis phenotypes and immunopathological features across patient groups.
Cardiovascular disease stands as a leading driver of organ harm and mortality among people with lupus, according to research from Ningbo, China. Investigators published a case-control study in Frontiers in Cardiovascular Medicine.
The study showed that epicardial adipose tissue—the thin layer of fat resting directly on the surface of the beating heart—grows significantly thicker in patients with systemic lupus erythematosus than in healthy individuals.
Echocardiography Reveals Thickened Epicardial Fat and Reduced Strain
The study recruited 67 patients admitted between February 2025 and November 2025, alongside 31 age- and gender-matched healthy controls. To confirm diagnoses, investigators applied guidelines. These were the 2019 classification guidelines updated collaboratively by the American College of Rheumatology and the European League Against Rheumatism.
The criteria require an antinuclear antibody titer of 1:80 or higher and a total score of at least 10 points spanning immunological and clinical categories.
Researchers used a Philips EPIQ CVx system operating at frame rates above 70 frames per second to capture dynamic images from apical two-chamber, three-chamber, and four-chamber views. Analyses performed via QLAB software revealed that mean epicardial fat thickness rose from 4.1 millimeters in controls to 5.0 millimeters in patients. Left ventricular posterior wall measurements increased significantly, indicating early structural remodeling. Global longitudinal strain deteriorated from approximately −20.0% in the control group to −18.2% in patients.
Paracrine Signaling and Predictors of Strain
Multiple linear regression demonstrated that mean epicardial fat thickness served as the strongest and only statistically significant independent determinant of global longitudinal strain, carrying a standardized beta of −0.497 and a p-value below 0.001. A regression coefficient of −0.932 without standardization reveals that global longitudinal strain decreases by approximately 0.93 percentage points for every 1-millimeter rise in average fat thickness. Spearman correlation analysis established that fat thickness correlated negatively with strain in the right coronary, left circumflex, and left anterior descending territories.
Inflammatory Joint Disease Impairs Lupus Patients
Joint involvement affects the majority of systemic lupus erythematosus patients and heavily dictates functional impairment and health-related quality of life. A review was published in Frontiersin.
The review notes that inflammatory joint disease manifests in multiple phenotypes. One is Jaccoud’s arthropathy, which accounted for 19.2% of lupus arthritis cases in a cohort of 2,264 patients and produces reducible deformities driven by periarticular and capsular laxity.
Conversely, arthritis featuring clinically irreducible deformities—encompassing rhupus at 8.1% of lupus arthritis cases—displays erosive synovitis along with rheumatoid factor and anti-CCP positivity. While non-deforming arthritis and Jaccoud’s arthropathy track with a high type I interferon signature, irreducible deforming arthritis aligns with a low interferon signature and lower SLEDAI-2K scores despite higher joint counts.
