Background/Purpose:

Systemic lupus erythematosus (SLE) is a rheumatic autoimmune condition characterized by altered lipoprotein profile, physical dysfunction and increased risk of cardiovascular disease. Exercise is, therefore, a promising therapeutic strategy to counteract SLE disease outcomes. However, there are no studies evaluating exercise-induced inflammation in moderately active SLE patients, with some evidence of clinical safety in patients in remission. Therefore, the aim of the present study was to assess cytokines (INF-γ, IL-10, IL-6, TNF-α) and soluble TNF receptors (sTNFR) response to bouts of either moderate or intense exercises in patients with active SLE.

Methods:

Eleven patients with active SLE (SLEDAI: 5.8±2.0) and 10 healthy controls with comparable age- and body mass index (BMI) performed 30 minutes of moderate and intense (~50% and ~70% of VO₂max, respectively) exercises in a treadmill. Serum cytokines (INF-γ, IL-10, IL-6, TNF-α) and sTNFR1 and sTNFR2 were assessed at baseline, immediately after the exercise, every 30 minutes of a 3-h recovery period and 24h after the end of exercise. Serum cytokines and sTNFRs were assessed by multiplex technique.

Results:

SLE patients and controls had similar mean age (30.4 ± 4.5 vs. 30.6±5.2 yrs, P=1.0) and BMI (26.1±4.8 vs. 24.1±2.3 kg/m², P=0.66). At baseline, patients had a significant higher levels of IL-6 (P=0.043) and TNF-α (P=0.020) compared to controls. After moderate exercise, IL-6 decreased at the 60^th (7.6±5.8 vs. 6.0±4.5 pg/mL; P=0.035) and 180^th (7.6±5.8 vs. 5.2±3.9 pg/mL; P=0.022) minute of recovery compared to baseline whereas levels of IFN-γ, IL-10, TNF-α, sTNFR1, and sTNFR2 remained stable (P>0.05). Healthy controls showed solely a sTNFR1 decrease at 90^th, 120^th, 150^th, 180^th minute of exercise recovery (P<0.05) with no significant changes in the levels of IFN-γ, IL-10, TNF-α, IL-6, and sTNFR2 (P>0.05) when compared with baseline. In response to intense exercise, IL-6 at the end of exercise (P=0.028) and TNF-α at the 30^th minute of recovery (P=0.038) increased transiently, followed by a decrease during late recovery [IL-6: 60^th (P=0.047), 120^th (P=0.022), and 180^th (P=0.028) minute of recovery; TNF-α: 120^th (P=0.037) minute of recovery].  IL-10 increased at the end of exercise (P=0.034) and at the 30^th minute of recovery (P=0.039), whereas sTNFR1 decreased at the 180^th minute of recovery (P=0.05) compared to baseline. IFN-γ and sTNFR2 did not change (P>0.05). Healthy controls showed no significant changes in IL-10, TNF-α, sTNFR1, and sTNFR2 after the intense exercise bout (P>0.05). INF-γ decreased at the end of the exercise (P=0.05), whereas IL-6 increased at the end of exercise (P=0.028) and at the 30^th minute of recovery (P=0.037). Of note, cytokines and sTNFRs returned to baseline levels 24h after the end of the moderate and intense exercise bout (P>0.05) in active SLE and healthy controls.

Conclusion:

In conclusion, the minor and transient change of cytokines and sTNFR with a complete recovery in 24h reinforces the safety of exercise in SLE patients with active disease. This finding opens a window of opportunity to develop interventions aimed to promote exercise in lupus patients in the course of treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/active-systemic-lupus-erythematosus-cytokines-and-soluble-tumor-necrosis-factor-receptors-response-to-moderateintense-exercise/