Evidence Of Systemic Lupus Erythematosus Research Articles

Paramyxovirus-like inclusions in rubella syndrome

A Negro female infant with recurrent respiratory infections, nodular generalized skinrash, lymphadenopathy, and hepatosplenomegaly was studied from 3 to 34 months of age. Initially she had inadequate delayed immune response, which became normal at 34 months. She had a persistently elevated IgM antibody level. Skin and lymph node biopsies on electron microscopy showed paramyxovirus-like intracytoplasmic inclusions similar to those seen in systemic and discoid lupus erythematosus and in dermatomyositis. The infant and mother did not have clinical or laboratory evidence of systemic lupus erythematosus. The rubella hemagglutination inhibition titers were persistently elevated during the period of follow-up.

Lupoid hepatitis of late onset.

Three cases of lupoid hepatitis according to the definition of Mackay et al. (1965) are presented. To comply with this definition such cases should have (a) evidence of continuing hepatitis, as manifested by elevated levels of transaminases, associated with a relapsing jaundice; (b) hypergammaglobulinaemia; (c) liver biopsy showing cirrhosis, ‘piece mealrsquo; liver cell necrosis and lymphocyte and plasma cell infiltrate; and (d) improvement on immunosuppressive agents such as corticosteroids. Furthermore there should be evidence of systemic lupus erythematosus in the form of anti-nuclear factor or positive L.E. cell test or minor manifestations of S.L.E. Each patient was aged 50 or over at the onset of symptoms, an unusual finding, as most patients studied have been aged 21 or under at onset. The modes of presentation were (1) recurrent obstructive ***aundice; (2) recurrent haematemesis and melaena; and (3) polyarthritis and hepatomegaly. The co-existence of other diseases thought to have an auto-immune basis is noted in 2 cases. The need for a common definition of this disorder is stressed as the condition has been described by various authors with varying criteria for diagnosis. The possible aetiologies of the condition are discussed. It is thought that these studies lend support to the suggestion that lupoid hepatitis is a disease of auto-immune aetiology.

Factor Analysis in the Evaluation of Criteria and Variants of Systemic Lupus Erythematosus

The value of factor analysis in defining complex diseases was tested with a series of 135 patients with more or less evidence of systemic lupus erythematosus (SLE).The factor analytic classification of the patients according to the interdependence of 25 unweighed criteria for’ SLE concurred rather well with a clinical classification into definite, probable, and possible SLE cases obtained by transforming the »diagnostic«, »major«, and »minor« criteria into numerical values. The clinical evaluation of the criteria appeared thus to have a sound statistic basis, even if there was evidence of that too much confidence had been paid to the diagnostic value of certain criteria, especially in oligosymptomatic cases.Five factors corresponded to a clinically meaningful symptom complex or variant of SLE: the classical visceral and erythematous types of SLE, and rheumatoid, discoid and drug associated variants. This suggests that the factorial structure of SLE obtained in this study is rather invariant, i.e., susceptible to profound alterations neither by réévaluation with other series nor by addition of new characteristics to the set of criteria for SLE.

THROMBOTIC THROMBOCYTOPENIC PURPURA AND SYSTEMIC LUPUS ERYTHEMATOSUS.

In 1924 Eli Moschcowitz 89 described an acute, febrile, rapidly fatal illness characterized by hyaline thrombi in the terminal arterioles—a syndrome later termed thrombotic thrombocytopenic purpura (TTP). 121 Subsequently several investigators noted that TTP was occasionally associated with systemic lupus erythematosus (SLE) 12,52,119 ; however, most authors have denied the existence of any clinical or pathologic relationship between these entities. 5,8,41,45,54,79,121,136 Changes compatible with SLE were found at autopsy in two of three patients who died recently of TTP in this hospital. The two cases with features of both conditions are herein reported in detail. In view of the absence in the literature of any study establishing the frequency of this association, published reports of TTP were analyzed for evidence of SLE. Included in the analysis were only those published cases of TTP in which the characteristic pathologic features described by Moschcowitz 89 were found at necropsy. In 23% of the

ARTERITIS AND LOCALISED PERIOSTEAL NEW BONE FORMATION

1. Three patients with localised periosteal new bone formation associated with periosteal arteritis and other evidence of systemic lupus erythematosus are described. 2. Systemic steroid therapy was valuable in the management of this condition.

Systemic rheumatic disease and malignant lymphoma.

Although patients with malignant lymphoma occasionally have articular complaints, the occurrence of frank rheumatic disease is unusual and the basis for the joint symptoms is often poorly understood. Patients with rheumatoid arthritis or systemic lupus erythematosus may have hyperplastic lymphadenopathy which, on occasion, may be difficult clinically to distinguish from lymphoma. While the concurrence of systemic rheumatic disease and lymphoma has been noted in several individual case reports (Table), there appears to be no previous instance in which there has been convincing pathologic evidence of an association between systemic lupus erythematosus and lymphoma. We first became interested in this problem in 1959 because of the unexpected finding of disseminated Hodgkin's disease in a patient who had clinical, serologic and pathologic evidence of systemic lupus erythematosus (Case 1). This led to a search for similar cases. Review of our records for the previous 5 years failed to disclose a single additional