Jill P Buyon

CUNY Graduate Center, New York, New York, United States

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Publications (262)1528.35 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Because systemic lupus erythematosus (SLE) affects women of reproductive age, pregnancy is a major concern. To identify predictors of adverse pregnancy outcomes (APOs) in patients with inactive or stable active SLE. Prospective cohort. Multicenter. 385 patients (49% non-Hispanic white; 31% with prior nephritis) with SLE in the PROMISSE study. Exclusion criteria were urinary protein-creatinine ratio greater than 1000 mg/g, creatinine level greater than 1.2 mg/dL, prednisone use greater than 20 mg/d, and multifetal pregnancy. APOs included fetal or neonatal death; birth before 36 weeks due to placental insufficiency, hypertension, or preeclampsia; and small-for-gestational-age (SGA) neonate (birthweight below the fifth percentile). Disease activity was assessed with the Systemic Lupus Erythematosus Pregnancy Disease Activity Index and the Physician's Global Assessment (PGA). APOs occurred in 19.0% (95% CI, 15.2% to 23.2%) of pregnancies; fetal death occurred in 4%, neonatal death occurred in 1%, preterm delivery occurred in 9%, and SGA neonate occurred in 10%. Severe flares in the second and third trimesters occurred in 2.5% and 3.0%, respectively. Baseline predictors of APOs included presence of lupus anticoagulant (LAC) (odds ratio [OR], 8.32 [CI, 3.59 to 19.26]), antihypertensive use (OR, 7.05 [CI, 3.05 to 16.31]), PGA score greater than 1 (OR, 4.02 [CI, 1.84 to 8.82]), and platelet count (OR, 1.33 [CI, 1.09 to 1.63] per decrease of 50 × 109 cells/L). Non-Hispanic white race was protective (OR, 0.45 [CI, 0.24 to 0.84]). Maternal flares, higher disease activity, and smaller increases in C3 level later in pregnancy also predicted APOs. Among women without baseline risk factors, the APO rate was 7.8%. For those who either were LAC-positive or were LAC-negative but nonwhite or Hispanic and using antihypertensives, the APO rate was 58.0% and fetal or neonatal mortality was 22.0%. Patients with high disease activity were excluded. In pregnant patients with inactive or stable mild or moderate SLE, severe flares are infrequent, and absent specific risk factors, outcomes are favorable. National Institutes of Health.
    Annals of internal medicine 06/2015; DOI:10.7326/M14-2235 · 16.10 Impact Factor
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    ABSTRACT: Only 2% of mothers positive for anti-SSA/Ro (Ro) antibodies have children with congenital heart block (CHB). This study aimed to determine whether reactivity with p305, an epitope within the α1G T-type calcium channel, confers added risk over anti-Ro antibodies. Using sera from anti-Ro-exposed pregnancies resulting in offspring with CHB, no disease but CHB-sibling, and no disease and no CHB-sibling, as well as disease (lupus without anti-Ro) and healthy controls, reactivities were determined for binding to Ro60, p305, and an epitope within Ro60, p133-Ro60, which shares structural properties with p305, including key amino acids and an α-helical structure. Candidate peptides were further evaluated in an in vitro model that assessed the binding of maternal antibodies to apoptotic cells. In anti-Ro-positive mothers, anti-p305 autoantibodies (>3 SD above healthy controls) were detected in 3/59 (5%) CHB pregnancies, 4/30 (13%) unaffected pregnancies with a CHB-sibling, and 0/42 (0%) of unaffected pregnancies with no CHB-sibling. For umbilical bloods (61 CHB, 41 healthy with CHB sibling), no association of anti-p305 with outcome was detected; however, overall levels of anti-p305 were elevated compared to mothers during pregnancy in all groups studied. For anti-p133-Ro60, reactivity paralleled that of anti-p305. In the screen employing apoptotic cells, p133-Ro60, but not p305, significantly attenuated the binding of immunoglobulin G isolated from a mother whose child had CHB (42.1% reduced to 13.9%, absence/presence of p133-Ro60, respectively, P<0.05). These data suggest that anti-p305 is not a robust maternal marker for assessing increased risk of CHB during an anti-SSA/Ro pregnancy. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
    Journal of the American Heart Association 04/2015; 4(5). DOI:10.1161/JAHA.115.001836 · 2.88 Impact Factor
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    ABSTRACT: Autoimmune congenital heart block (CHB) is an immune-mediated acquired disease that is associated with the placental transference of maternal antibodies specific for Ro and La autoantigens. The disease develops in a fetal heart without anatomical abnormalities that could otherwise explain the block, and which is usually diagnosed in utero, but also at birth or within the neonatal period. Autoantibody-mediated damage of fetal conduction tissues causes inflammation and fibrosis and leads to blockage of signal conduction at the atrioventricular (AV) node. Irreversible complete AV block is the principal cardiac manifestation of CHB, although some babies might develop other severe cardiac complications, such as endocardial fibroelastosis or valvular insufficiency, even in the absence of cardiac block. In this Review, we discuss the epidemiology, classification and management of women whose pregnancies are affected by autoimmune CHB, with a particular focus on the autoantibodies associated with autoimmune CHB and how we should test for these antibodies and diagnose this disease. Without confirmed effective preventive or therapeutic strategies and further research on the aetiopathogenic mechanisms, autoimmune CHB will remain a severe life-threatening disorder.
    Nature Reviews Rheumatology 03/2015; 11(5). DOI:10.1038/nrrheum.2015.29 · 10.25 Impact Factor
  • Joan T. Merrill, Jill P. Buyon, Tammy Utset
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    ABSTRACT: Systemic lupus erythematosus (SLE) is a chronic, relapsing autoimmune connective tissuedisease, primarily affecting the skin, joints, kidneys, heart, lungs, nervous system, blood elements, and serosal membranes. SLE is characterized by cytokine dysregulation, polyclonal B-cell activation, autoantibody production, and increased immune complex formation due to aberrations involving hyperactive B cells, T cells, and cells of the monocytic lineage. The symptoms of SLE are often diverse and nonspecific, and timely identification of SLE and associated comorbidities in patients is critical as aggressive monitoring and therapy may be warranted especially in patients with poor prognoses. Based on the up-to-date understanding of the pathophysiology of SLE, the first targeted biological agent, belimumab, has been approved by the US Food and Drug Administration (FDA) in more than 50 years, and many targeted agents are being evaluated in late-stage clinical trials. There is a clear need to discuss how and when to incorporate the new and emerging biological agents in managing patients with SLE. Additionally, the potential for increased risk of infections is a factor that heavily influences the rheumatologist’s decision to use biological agents in managing patients with SLE. Hence, in this roundtable educational activity, expert faculty will review and discuss the strategies for timely diagnosis of SLE and associated comorbidities. They will also discuss the current understanding of the pathophysiology of SLE and how the new and emerging biological agents help address the underlying pathophysiological aberrations in patients with SLE. The faculty will also review strategies to minimize the risk of infections and other toxicities in patients with SLE.
    Seminars in Arthritis and Rheumatism 10/2014; 44(2). DOI:10.1016/j.semarthrit.2014.09.013 · 3.63 Impact Factor
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    ABSTRACT: OBJECTIVE: Anti-C1q has been associated with systemic lupus erythematosus (SLE) and lupus nephritis in previous studies. We studied anti-C1q specificity for SLE (vs rheumatic disease controls) and the association with SLE manifestations in an international multicenter study. METHODS: Information and blood samples were obtained in a cross-sectional study from patients with SLE (n = 308) and other rheumatologic diseases (n = 389) from 25 clinical sites (84% female, 68% Caucasian, 17% African descent, 8% Asian, 7% other). IgG anti-C1q against the collagen-like region was measured by ELISA. RESULTS: Prevalence of anti-C1q was 28% (86/308) in patients with SLE and 13% (49/389) in controls (OR = 2.7, 95% CI: 1.8-4, p < 0.001). Anti-C1q was associated with proteinuria (OR = 3.0, 95% CI: 1.7-5.1, p < 0.001), red cell casts (OR = 2.6, 95% CI: 1.2-5.4, p = 0.015), anti-dsDNA (OR = 3.4, 95% CI: 1.9-6.1, p < 0.001) and anti-Smith (OR = 2.8, 95% CI: 1.5-5.0, p = 0.01). Anti-C1q was independently associated with renal involvement after adjustment for demographics, ANA, anti-dsDNA and low complement (OR = 2.3, 95% CI: 1.3-4.2, p < 0.01). Simultaneously positive anti-C1q, anti-dsDNA and low complement was strongly associated with renal involvement (OR = 14.9, 95% CI: 5.8-38.4, p < 0.01). CONCLUSIONS: Anti-C1q was more common in patients with SLE and those of Asian race/ethnicity. We confirmed a significant association of anti-C1q with renal involvement, independent of demographics and other serologies. Anti-C1q in combination with anti-dsDNA and low complement was the strongest serological association with renal involvement. These data support the usefulness of anti-C1q in SLE, especially in lupus nephritis. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
    Lupus 08/2014; DOI:10.1177/0961203314547791 · 2.48 Impact Factor
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    ABSTRACT: Transplacental transfer of maternal anti-Ro and/or anti-La autoantibodies can result in fetal cardiac disease including congenital heart block and cardiomyopathy, called cardiac Neonatal Lupus (NL). Thousands of women are faced with the risk of cardiac NL in their offspring, which is associated with significant morbidity and mortality. There are no known therapies to permanently reverse third degree heart block in NL, although several treatments have shown some effectiveness in incomplete heart block and disease beyond the atrioventricular node. Fluorinated steroids taken during pregnancy have shown benefit in these situations, although adverse effects may be concerning. Published data are discordant on the efficacy of fluorinated steroids in the prevention of mortality in cardiac NL. β-agonists have been used to increase fetal heart rates in utero. The endurance of β-agonist effect and its impact on mortality are in question, but when used in combination with other therapies, they may provide benefit. No controlled experiments regarding the use of plasmapheresis in cardiac NL have been performed, despite its theoretical benefits. Intravenous immunoglobulin was not shown to prevent cardiac NL at a dose of 400 mg/kg, although it has shown effectiveness in the treatment of associated cardiomyopathy both in utero and after birth. Retrospective studies have shown that hydroxychloroquine may prevent the recurrence of cardiac NL in families with a previously affected child, and a prospective open-label trial is currently recruiting patients in order to fully evaluate this relationship.
    Cardiology in Review 07/2014; 22(6). DOI:10.1097/CRD.0000000000000026 · 3.24 Impact Factor
  • 69th Annual Meeting of the Canadian-Rheumatology-Association (CRA); 07/2014
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    ABSTRACT: Objective To compare the performance characteristics of cell-bound complement (C4d) activation products (CBCAPS) on erythrocyte (EC4d) and B cells (BC4d) with antibodies to double-stranded DNA (anti-dsDNA) and complement C3 and C4 in systemic lupus erythematosus (SLE). Methods The study enrolled 794 subjects consisting of 304 SLE and a control group consisting of 285 patients with other rheumatic diseases and 205 normal individuals. Anti-dsDNA and other autoantibodies were measured using solid-phase immunoassays while EC4d and BC4d were determined using flow cytometry. Complement proteins were determined using immunoturbidimetry. Disease activity in SLE was determined using a non-serological Systemic Lupus Erythematosus Disease Activity Index SELENA Modification. A two-tiered methodology combining CBCAPS with autoantibodies to cellular and citrullinated antigens was also developed. Statistical analyses used area under receiver operating characteristic curves and calculations of area under the curve (AUC), sensitivity and specificity. Results AUC for EC4d (0.82±0.02) and BC4d (0.84±0.02) was higher than those yielded by C3 (0.73±0.02) and C4 (0.72±0.02) (p<0.01). AUC for CBCAPS was also higher than the AUC yielded by anti-dsDNA (0.79±0.02), but significance was only achieved for BC4d (p<0.01). The combination of EC4d and BC4d in multivariate testing methodology with anti-dsDNA and autoantibodies to cellular and citrullinated antigens yielded 80% sensitivity for SLE and specificity ranging from 70% (Sjogren's syndrome) to 92% (rheumatoid arthritis) (98% vs. normal). A higher proportion of patients with SLE with higher levels of disease activity tested positive for elevated CBCAPS, reduced complement and anti-dsDNA (p<0.03). Conclusions CBCAPS have higher sensitivity than standard complement and anti-dsDNA measurements, and may help with the differential diagnosis of SLE in combination with other autoantibodies.
    06/2014; 1(1):e000056. DOI:10.1136/lupus-2014-000056
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    ABSTRACT: Noninvasive carotid measurements have independent value in the estimation of future cardiovascular (CV) outcomes in systemic lupus erythematosus (SLE). Natural IgM-antibodies to phosphorylcholine (PC) epitopes can enhance apoptotic-cell clearance and induce anti-inflammatory pathways. Herein, we show that subclinical CV disease, as detected by carotid ultrasound, in a cross-sectional SLE cohort was associated with lower levels of IgM anti-PC, as well as lower levels of the ratio of IgM anti-PC/total IgM, compared to patients without plaque (p=0.004 and p=0.02, respectively).The IgM anti-PC/total IgM association remained significant after adjusting for age, cholesterol and hypertension. Adiponectin and sE-selectin were significantly elevated in patients with plaque, and statistical models showed that combining adiponectin, sE-selectin and IgM anti-PC/total IgM was better for predicting plaque than either test alone. These results support the hypothesis that IgM-natural autoantibodies may inhibit atherogenesis, and confirms the utility of IgM anti-PC levels as a biomarker for subclinical CV disease.
    Clinical Immunology 04/2014; 153(1). DOI:10.1016/j.clim.2014.03.017 · 3.99 Impact Factor
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    04/2014; 1(1):e000033. DOI:10.1136/lupus-2014-000033
  • Article: Reply.
    02/2014; 66(2):480. DOI:10.1002/art.38251
  • Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):538-538. DOI:10.1136/annrheumdis-2012-eular.3144 · 9.27 Impact Factor
  • Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):537-538. DOI:10.1136/annrheumdis-2012-eular.3142 · 9.27 Impact Factor
  • Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):540-541. DOI:10.1136/annrheumdis-2012-eular.3151 · 9.27 Impact Factor
  • Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A257-A257. DOI:10.1136/annrheumdis-2013-eular.799 · 9.27 Impact Factor
  • Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):673-673. DOI:10.1136/annrheumdis-2012-eular.615 · 9.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Noninvasive carotid measurements have independent value in the estimation of future cardiovascular (CV) outcomes in systemic lupus erythematosus (SLE). Natural IgM-antibodies to phosphorylcholine (PC) epitopes can enhance apoptotic-cell clearance and induce anti-inflammatory pathways. Herein, we show that subclinical CV disease, as detected by carotid ultrasound, in a cross-sectional SLE cohort was associated with lower levels of IgM anti-PC, as well as lower levels of the ratio of IgM anti-PC/total IgM, compared to patients without plaque (p = 0.004 and p = 0.02, respectively).The IgM anti-PC/total IgM association remained significant after adjusting for age, cholesterol and hypertension. Adiponectin and sE-selectin were significantly elevated in patients with plaque, and statistical models showed that combining adiponectin, sE-selectin and IgM anti-PC/total IgM was better for predicting plaque than either test alone. These results support the hypothesis that IgM-natural autoantibodies may inhibit atherogenesis, and confirms the utility of IgM anti-PC levels as a biomarker for subclinical CV disease.
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    Article: Editorial.
  • Autoimmunity reviews 09/2013; DOI:10.1016/j.autrev.2013.08.003 · 7.10 Impact Factor
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    ABSTRACT: Objective. Identify predictors of moderate-severe systemic lupus erythematosus (SLE) flare in 562 patients treated with standard therapy alone in phase 3 belimumab trials and evaluate impact of standard therapies on preventing flares. Methods. Post-hoc analysis assessed baseline demographics, disease activity, and biomarkers in patients with and without flare at treatment weeks 24/52. Severe flare: modified SLE Flare Index (SFI) and 1 new British Isles Lupus Assessment Group (BILAG) A. Severe and moderate flare: any new BILAG A/2 new B scores. Baseline characteristics associated with ≥10% absolute difference/≥50% increase in flare rates were considered predictive. Results. Frequencies of SFI, BILAG 1A, and BILAG 1A/2B flares over 52 weeks were 24%, 23%, and 32%, respectively. Flare predictors by univariate analysis on all 3 indices at weeks 24/52: Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI) ≥12, anti-dsDNA positivity and proteinuria (≥0.5 g/24h); BILAG renal, vasculitic, and hematologic scores; elevated C-reactive protein, and B-lymphocyte stimulator (BLyS) ≥2 ng/mL. Independent predictors by multivariate analysis at week 52: SELENA-SLEDAI/BILAG renal involvement and anti-dsDNA ≥200 IU/mL (all 3 indices); SELENA-SLEDAI/BILAG neurologic and vasculitic involvement (BILAG A/2 B or 1A scores); BLyS ≥2 ng/mL (SFI and BILAG 1A/2B scores); and low complement 3 (C3; SFI). Baseline medications did not significantly decrease or increase moderate-severe SLE flare risk. Conclusion. Patients on standard SLE therapy with renal, neurologic, or vasculitic involvement, elevated anti-dsDNA or BLyS, or low C3 had increased risk for clinically meaningful flare over 1 year. Hydroxychloroquine use was not predictive. © 2013 by the American College of Rheumatology.
    Arthritis & Rheumatology 08/2013; 65(8). DOI:10.1002/art.37995 · 7.87 Impact Factor

Publication Stats

10k Citations
1,528.35 Total Impact Points

Institutions

  • 1984–2015
    • CUNY Graduate Center
      New York, New York, United States
  • 2003–2014
    • NYU Langone Medical Center
      • Department of Medicine
      New York, New York, United States
    • Uppsala University
      Uppsala, Uppsala, Sweden
  • 2013
    • Idera Pharmaceuticals, Inc.
      Cambridge, Massachusetts, United States
  • 1999–2013
    • Hospital for Special Surgery
      New York City, New York, United States
  • 1995–2013
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
    • Yale University
      New Haven, Connecticut, United States
  • 2011
    • The Children’s Hospital at Montefiore (CHAM)
      New York City, New York, United States
  • 2009
    • New York Medical College
      • Department of Pediatrics
      New York City, New York, United States
  • 2007
    • Toronto Western Hospital
      Toronto, Ontario, Canada
    • Albert Einstein College of Medicine
      New York, New York, United States
  • 2006
    • Treatment Research Institute, Philadelphia PA
      Filadelfia, Pennsylvania, United States
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 2005
    • Howard Hughes Medical Institute
      Ashburn, Virginia, United States
    • King's College London
      • Department of Academic Rheumatology
      London, ENG, United Kingdom
  • 1998–2003
    • New York University
      • • Medicine
      • • Division of Rheumatology
      New York City, NY, United States
    • New York Downtown Hospital
      New York, New York, United States
  • 2002
    • University of Colorado
      • Department of Pediatrics
      Denver, Colorado, United States
  • 1995–1999
    • The Scripps Research Institute
      • Department of Molecular and Experimental Medicine
      La Jolla, CA, United States
  • 1997
    • Azienda Ospedaliera Niguarda Ca' Granda
      Milano, Lombardy, Italy
    • Gracie Square Hospital, New York, NY
      New York City, New York, United States
  • 1995–1997
    • Beth Israel Medical Center
      New York, New York, United States
  • 1994
    • Columbia University
      • Department of Pediatrics
      New York, New York, United States
  • 1992
    • Bellevue University
      Bellevue, Nebraska, United States
    • State University of New York Downstate Medical Center
      • Department of Medicine
      Brooklyn, New York, United States
  • 1991
    • University of North Carolina at Chapel Hill
      • Department of Medicine
      Chapel Hill, NC, United States
  • 1989
    • The Rockefeller University
      New York City, New York, United States
    • The New York Academy of Sciences
      New York City, New York, United States