Body Weight-Related Differences in Adipokines and Inflammatory Markers Among Women with Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease marked by chronic inflammation and frequent metabolic disturbances. Understanding the influence of body weight and hydroxychloroquine on adipokines and inflammatory markers may clarify their role in SLE progression.

This study examined metabolic health, adipose tissue gene expression, and serum adipokine and inflammatory profiles in normal-weight (NW) and excess body weight (EBW) female patients with SLE and explored associations with disease activity and hydroxychloroquine (HCQ) use.

Fifty women with SLE were classified as NW or EBW. Laboratory analyses included antibodies against double-stranded DNA, complement components (C3, C4), fasting glucose, triglycerides, total and fractionated cholesterol, and C-reactive protein (CRP). Subcutaneous adipose tissue gene expression was assessed by real-time PCR.

Mean age, disease duration, and SLEDAI-2K scores were similar between groups (p > 0.05). HCQ dose adjusted by body weight was lower in EBW patients (p < 0.05). EBW patients had higher total cholesterol, LDL-c, CRP, and leptin, with lower adiponectin and reduced adiponectin/leptin ratio (p < 0.05). Adipose tissue expression of TNF-α, LEP, IL-6, and ADIPOQ was elevated in EBW (p < 0.05). Stratifying by adipo/lep ratio (≤5 vs >5) showed similar disease activity (p > 0.05), though patients with preserved adipose function (ratio >5) had higher serum C4 (p = 0.004) and a trend for increased C3 (p = 0.055). Multiple regression indicated HCQ dose (mg/kg/day) was inversely associated with abdominal circumference (β = -0.43; p = 0.003) and fat mass(β = -0.38; p = 0.009) and positively associated with adiponectin (β = 0.45; p = 0.002) and adipo/lep ratio (β = 0.39; p = 0.009). Higher HCQ doses tended to increase HDL-C (p = 0.059) and reduce leptin (p = 0.058).

Excess body weight in SLE is linked to an adverse adipokine profile and increased inflammation, raising metabolic and cardiovascular risk. Weight-adjusted HCQ shows protective effects on adipose metabolism, HDL-c, and adiponectin. These findings emphasize individualized, weight-based HCQ therapy and early adipose biomarker assessment to guide precision medicine in SLE management.