Picture Of Systemic Lupus Erythematosus Research Articles

Extended high frequency audiometry can diagnose sub-clinic involvement in a seemingly normal hearing systemic lupus erythematosus population

Conclusions: Sensorineural hearing loss must be considered within the clinical picture of systemic lupus erythematosus. The results confirm the usefulness of extended high-frequency audiometry in the audiologic testing of these patients, enabling the possibility of modifying or applying a preventive treatment for a possible hearing loss.Objectives: Hearing involvement is usually under-diagnosed with routine auditory examination. This study proposes the use of extended high-frequency audiometry to achieve a correct detection of a possible asymptomatic hypoacusis in early stages of the disease. The aim of this study is to analyze the hearing levels in extended high-frequencies in these patients and to correlate the hearing loss with the severity of the disease and the immunological parameters.Methods: A descriptive cross-sectional study was performed. Fifty-five patients with systemic lupus erythematosus were included in the study. The control group consisted of 71 patients paired by age and sex with the study population. Both a pure tone audiometry and an extended high-frequency audiometry (8–18 KHz) were performed.Results: In total, 70% were diagnosed with sensorineural hearing loss with extended high-frequency audiometry, overcoming the results obtained with pure tone audiometry (30.9%). Statistically significant correlations were found within the patients regarding sensorineural hearing loss related with age, disease activity and cryoglobulinemia.

Auditory function in patients with systemic lupus erythematosus

Objective Patients with systemic lupus erythematosus (SLE) may develop hearing and balance disorders as a result of the immune-mediated inner ear damage due to vasculitis or ototoxicity of drugs used in SLE treatment. The aim of the study was evaluation of the hearing organ disorders in patients with SLE with particular regard to their prevalence and relationship to duration and severity of disease. The severity was assessed from involvement of organs that resulted in poorer SLE outcome, i.e. kidneys and central nervous system (CNS), and from the presence of antibodies associated with unfavourable SLE prognosis. Methods Thirty-five unselected, consecutive patients (33 women, two men, mean age 47.8 years) with SLE diagnosed in compliance to the international diagnostic criteria of the American Rheumatism Association (1982) were enrolled into the study. The control group consisted of 30 otologically healthy persons matched to the SLE group for age and sex. Case history was recorded for all patients from questionnaire data and laryngological examinations were performed, followed by pure-tone, speech and impedance audiometry and auditory brainstem response audiometry (ABR). Results In the anamnesis 71.4% of patients reported vertigo, 62.9% headaches, 40% tinnitus, 25.7% hyperacusis, 17.1% hearing loss and 2.9% ear fullness. It was found that SLE patients had a significantly poorer mean hearing thresholds than the control group for all frequencies, except for 500; 2000 and 4000 Hz. Longer ABR latency averages were observed in the group of SLE patients compared to control. Ten patients (28.6%) developed high-frequency and symmetric sensorineural hearing loss (SNHL). Significant positive correlation between mean air-conduction hearing thresholds and SLE duration ( r = 0.46, p < 0.001) was found. After taking age into consideration, hearing acuity in SLE was related to duration of disease in younger patients. Furthermore, no relation was seen between hearing level and severity of disease. Conclusions Auditory system involvement ought to be considered as one of elements of the clinical picture of systemic lupus erythematosus while determination of its character, original or secondary, requires further research.

Chorea as a rare symptom of systemic lupus erythematosus in the elderly

The opinion that systemic lupus erythematosus (SLE) is a young people disease translates into its rare diagnosing in subjects in their 6th decade of life and older. The variability of neuropsychiatric disorders that may be the first symptoms of the disease suggest the need for their in-depth diagnostics and treatment. Chorea is one of the rarest neuropsychiatric symptoms of SLE. It may be present in an early stage of the disease and it is one of the most common motor disorders in SLE. The presented case of diagnosing SLE in a 79-year-old male shows the importance of individual and thorough assessment of the clinical picture of every patient regardless of his/her age and gender. In the discussed case the clinical course of the disease denies common opinions about the picture of SLE in the elderly.

Cartilage oligomeric matrix protein in serum in systemic lupus erythematosus and knee osteoarthritis. Preliminary communication

The cartilage oligomeric matrix protein (COMP) is a glycoprotein, which occurs mainly in an articular cartilage. The amount of this protein increases under the influence of cytokines and growth factors. As a result of various diseases that cause damage to cartilage, fragments of matrix protein are released into synovial fluid and then into blood. The assessment of matrix protein level in serum, for example COMP, permits the establishment of the degree of cartilage damage in inflammatory joint diseases, and permits observation of the effectiveness of the treatment. Blood was collected from 30 systemic lupus erythematosus (SLE) patients, and from 30 patients with knee osteoarthritis (OA) who constituted the control group. Serum COMP level was determined using an inhibition enzyme-linked immunosorbent assay (ELISA). The average value of the serum COMP level in SLE patients was 11.3+/-3.7 U/l. According to correlation coefficients, serum COMP level is independent of patients' age, disease duration and the clinical picture of SLE. No correlation was found between serum COMP level and bone mass density (BMD) changes. In SLE patients with decreased haemoglobin levels (<11.0 g/dl) values compared with patients with normal haemoglobin level, the serum COMP level was observed to be significantly higher (P<0.05). Both in SLE patients with erythrocyte sedimentation rate (ESR) values over 60 mm/h and in patients with ESR values below 60 mm/h, the serum COMP level was observed to be significantly higher (P<0.05). A significant positive correlation was found between serum COMP level and ESR value, as well as a number of thrombocytes. Negative correlation occurred between the serum COMP level and the value of haemoglobin. The average value of COMP in OA patients was 10.4+/-2.7 U/l. No correlation was found between serum COMP level and patients' age and disease duration. There was correlation between the serum COMP level and the T-score value of densitometry examinations in OA patients. No statistical differences were found between the average serum COMP levels for SLE and OA patients.

Unusual presentation of lupus nephritis

We report a male patient who presented with pyrexia, generalized lymphadenopathy, hepatosplenomegaly, and pleural effusion with no cutaneous or musculoskeletal symptoms. Despite extensive investigation, no cause was detected. His initial serology was also negative for autoantibodies. The patient was placed on a trial of antitubercular treatment in view of a positive Mantoux test. His disease evolved into the full clinical picture of systemic lupus erythematosus with nephritis (World Health Organisation class IV) and strongly positive antinuclear antibody and dsDNA over a period of months. He was treated successfully with intravenous cyclophosphamide pulses along with oral prednisolone, and the disease was still in remission after 3 years of follow-up.

Neuropsychiatric involvement in systemic lupus erythematosus. Part 1: clinical presentation and pathogenesis

Central nervous system (CNS) involvement is a frequent complication of systemic lupus erythematosus (SLE) ranging from a subclinical to a severe disabling disease. Neuropsychiatric manifestations have been described in 18-67% of cases depending on the diagnostic criteria. The cerebral involvement may precede the full-blown picture of SLE or may develop in the course of disease, most frequently within the first 3 years. Neuropsychiatric manifestations in SLE comprise diffuse psychiatric symptoms, focal neurologic symptoms, and the involvement of the peripheral nervous system. Numerous CNS syndroms have been described: migraine, seizure, stroke, chorea, transverse myelopathy, psychosis, mood disorders, acute confusional state, and cognitive dysfunction. The diagnosis of cerebral involvement can be difficult and has to be differentiated from neurologic complications which may be, for instance, due to uremia, hypertension, drug toxicity, and infection. A large number of etiopathophysiologic processes are involved: antineuronal antibodies, antibodies against ribosimal P-protein, and cytokines have been implicated in the pathogenesis of diffuse neuropsychiatric symptoms. Focal neurologic symptoms are the consequence of vascular injury induced by circulating immune complex, occlusive vasculopathy as a result of endothelial cell activation induced by cytokines and complement activation, or macro- and microvascular thrombosis induced by antiphospholipid antibodies. In the later stages of disease, cerebrovascular manifestations are often related to accelerated atherosclerosis, which is entertained by increased intravascular complement turnover and antiphospholipid antibodies.

Liebman-Sachs endocarditis

The diagnosis of Liebman-Sachs endocarditis is difficult, since the clinical picture of systemic lupus erythematosus (SLE) has signs similar to other diseases, in particular with rheumatism and infectious endocarditis. The establishment of the etiology and pathogenesis of the defect determines the timeliness and effectiveness of the patient's treatment.

A comparative immunologic analysis of several murine strains with autoimmune manifestations

The genetic autoimmune disease (lupus-like) in mice of several strains (NZB, NZB × W, MRL 1 , MRL n , BXSB) has been analyzed comprehensively. Comparison of the histoimmunopathologic, serologic, and cellular characteristics of these mice reveals several pathogenic common denominators but no obvious etiologic factors in common. In all kinds of autoimmune mice studied, the lupus-like syndrome consists of a fatal immune complex glomerulonephritis, thymic atrophy, and lymphoid hyperplasia that varies in degree. The lymphoid hyperplasia is most prominent in MRL 1 mice and it is of T-cell origin. MRL 1 mice, in addition, may exhibit arteritis and arthritis. Serologically, all SLE mice have abnormally elevated serum Ig levels, antinuclear antibodies, anti-ds- and ssDNA antibodies, and anti-hapten antibodies. Some of the MRL 1 mice, in addition to the above antibodies, develop antibodies to Sm ( MRL 1 and MRL n ) and antiglobulins ( MRL 1 ). Natural thymocytotoxic antibodies and anti-erythrocyte antibodies are predominantly found in NZB and NZB × W mice. With advanced age and disease all lupus mice have depressed complement levels and circulating immune complexes. Some of these complexes in all lupus mice are composed of retroviral gp70-anti-gp70 antibodies, whereas MRL 1 mice, in addition, contain circulating IgG-IgG RF complexes. Characterizing the various recognized lymphoid cell surface markers, one notes that each strain of lupus mice has some variation from the normal distribution, but in no two of these strains are the abnormalities the same. The B cells of these mice seem advanced in maturity, whereas the developmental isotype diversity is normal in all of them. NZB and NZB × W mice are characterized by a nonspecific early B-cell hyperactivity but it is not known if this activity is responsible for their subsequent specific autoantibody production. The proliferating T cells of older MRL 1 mice seem to exert excessive helper activity on syngeneic B cells. Both antigen-specific and antigen-nonspecific Con A-induced suppression are within normal limits in all lupus mice. Although transfer studies have shown that the basic defect is associated with the lymphoid system, from our work and that of others it appears that the abnormalities in these mice are polygenic and different from one strain to another. Thus, murine lupus as a syndrome can be the result of many different abnormalities which eventuate in B-cell hyperactivity and involvement of a number of the available endogenous antigens in a systemic immune complex disease which is responsible for the “characteristic” clinical picture of systemic lupus erythematosus.

Chest roentgenographic changes in systemic lupus erythematosus.

During the past eight years, 275 patients with systemic lupus erythematosus have been under the clinical supervision of one of the authors (E. L. D.). Roentgenograms of the chest were reviewed in 207 of these. In view of the variability of the reported incidence and nature of the roentgenographic changes in this disease, it was thought that a presentation of the findings and a comparison with those of others would aid in evaluation of one facet of this complex entity. Clinical Features Systemic lupus erythematosus is a chronic disease occurring predominantly in females and subject to spontaneous exacerbations and remissions. In one study, remissions were seen in almost 40 per cent of cases (1). Although occasionally a single organ system bears the brunt of this disease, the manifestations are protean and characteristically many organ systems are affected. The extent of involvement of any site and the number of organs involved are equally unpredictable. The outline below classifies the clinical manifestations and demonstrates their multiplicity. Clinical Picture of Systemic Lupus Erythematosus 1. Signs of catabolism: fever, weight loss, emaciation. 2. Connective-tissue lesions: pleurisy, pericarditis, rheumatoid arthritis. 3. Vascular lesions: skin, ocular fundi, kidney, central nervous system, gastrointestinal tract, adenopathy, splenomegaly, Raynaud's phenomenon. 4. Depression of peripheral blood elements: normocytic anemia, leukopenia, thrombocytopenia, circulating anticoagulant. The first 62 cases of the present series have been reported previously by one of the authors (2), and succeeding cases have shown no significant change in pattern or course. Of the many symptoms listed above, arthritis, cutaneous eruptions, pleurisy, and cardiac involvement are the most frequent. At the onset of the disease and with only one organ system affected, diagnosis is often impossible. This would apply when a patient exhibits atypical rheumatoid arthritis. If, however, unusual skin lesions and renal involvement develop, systemic lupus is very likely. Multiple organ involvement need not be concurrent. A patient may have healed discoid skin lesions and years later develop pleuropericarditis with or without a cutaneous relapse. The extent to which the L. E. cell test and skin biopsy contribute to diagnosis is shown in Table 1. Review of the Literature with Respect to Pleural, Pulmonary, and Cardiac Changes Before any extensive reviews of radiologic findings in the chest had been reported, Rakov and Taylor (3) in 1942 and Foldes (4) in 1946 focused attention upon pulmonary changes by reporting single cases of long standing consolidation with peculiar histopathologic features consisting of vascular involvement and disappearance or hyalinization of alveoli. This was called atelectasizing pneumonia. Sante and Wyatt (5) in 1951 stated that, in their experience, involvement of the lung proper was very uncommon except in the terminal stages of the disease.

Pleuritis in systemic lupus erythematosus: its importance as an early manifestation in diagnosis.

Excerpt INTRODUCTION Although pleuritis and pleural effusion have long been considered as cardinal signs in the clinical picture of systemic lupus erythematosus (S. L. E.‡), these have usually been...

Systemic lupus erythematosus: recent advances in its diagnosis and treatment.

Excerpt During the last six years the author has had the opportunity personally to study and treat 175 patients with systemic lupus erythematosus. The purpose of this paper is to review the current...

Military tuberculosis developing during prolonged cortisone therapy of systemic lupus erythematosus.

Case Reports1 April 1956MILIARY TUBERCULOSIS DEVELOPING DURING PROLONGED CORTISONE THERAPY OF SYSTEMIC LUPUS ERYTHEMATOSUSHAROLD M. HILL, M.D., J. D. KIRSHBAUM, M.D., F.A.C.P.HAROLD M. HILL, M.D.Search for more papers by this author, J. D. KIRSHBAUM, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-44-4-781 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptA recently published case, reported by Davidson, Fox and Gold,1described the appearance of miliary tuberculosis in a case of systemic lupus erythematosus during the course of ACTH and cortisone therapy. This paper presents an additional case of miliary tuberculosis developing under the same circumstances, and is of particular interest because of its many similarities to the previously reported one, including the absence of characteristic microscopic lesions of systemic lupus erythematosus at autopsy, in spite of typical clinical findings and the demonstration of L. E. cells. In addition, this case demonstrates several of the hazards of prolonged maintenance of therapeutic...Bibliography1. DavidsonFoxGold AGLJJ: Appearance of miliary tuberculosis following therapy with ACTH and cortisone in a case of acute disseminated lupus erythematosus, Ann. Int. Med. 38: 852-862, 1953. LinkGoogle Scholar2. Harrison TR, Ed.: Principles of internal medicine, 1st Ed., 1950, The Blakiston Co., New York, N. Y., p. 466. Google Scholar3. Dubois EL: The effect of the L. E. cell test on the clinical picture of systemic lupus erythematosus, Ann. Int. Med. 38: 1265-1294, 1953. LinkGoogle Scholar4. JessarLamont-HaversRagan RARWC: Natural history of lupus erythematosus disseminatus, Ann. Int. Med. 38: 717-731, 1953. LinkGoogle Scholar5. SofferBader LJR: Corticotropin and cortisone in acute disseminated lupus erythematosus, J. A. M. A. 149: 1002-1008, 1952. CrossrefMedlineGoogle Scholar6. Slocumb CH: Rheumatic complaints during hypercortisonism and syndromes during withdrawal of cortisone in rheumatic patients, Proc. Staff. Meet., Mayo Clin. 28: 655-657 (Nov. 18) 1953. MedlineGoogle Scholar7. KlempererPollockBaehr PADG: Pathology of disseminated lupus erythematosus, Arch. Path. 32: 569, 1941. Google Scholar8. DuboisCommonsStarrSteinMorrison ELMDPCSR: Corticotropin and cortisone treatment for systemic lupus erythematosus, J. A. M. A. 149: 995-1002, 1952. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Redlands, California*Received for publication January 14, 1955.From the Departments of Medicine and Pathology, Redlands Community Hospital, Redlands, California, and San Bernardino County Hospital, San Bernardino, California. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTuberculosis-associated hemophagocytic lymphohistiocytosis misdiagnosed as systemic lupus erythematosus: A case reportRole of Infections in the Pathogenesis of Rheumatoid Arthritis: Focus on MycobacteriaDisseminated tuberculosis masquerading as a presentation of systemic lupus erythematosusMycobacteria and autoimmunityCan Lupus Flares be Associated with Tuberculosis Infection?Case 48-1986Steroid therapy of systemic lupus erythematosus based on immunologic considerationsProphylaxis in patients receiving adrenal steroid therapyTuberculosis occurring in association with corticosteroid treatmentPulmonary tuberculosis following treatment with corticosteroidsRHEUMATISM AND ARTHRITIS: REVIEW OF AMERICAN AND ENGLISH LITERATURE OF RECENT YEARS (THIRTEENTH RHEUMATISM REVIEW)*CHARLEY J. SMYTH, M.D., F.A.C.P., ROGER L. BLACK, M.D., FELIX E. DEMARTINI, M.D., IVAN F. DUFF, M.D., F.A.C.P., EPHRAIM P. ENGLEMAN, M.D., F.A.C.P., DONALD C. GRAHAM, M.D., F.R.C.P.(C), MAX M. MONTGOMERY, M.D., F.A.C.P., HOWARD F. POLLEY, M.D., F.A.C.P., EDWARD F. ROSENBERG, M.D., F.A.C.P., CARLOS F. SACASA, M.D., F.A.C.P., OTTO STEINBROCKER, M.D., HANS WAINE, M.D., GEORGE M. WILSON JR., M.D.PLEURITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS: ITS IMPORTANCE AS AN EARLY MANIFESTATION IN DIAGNOSIS*WILLIAM A. WINSLOW, M.D., LESTER N. PLOSS, M.D., BERNARD LOITMAN, M.D.ACTH and Adrenocorticosteroids as Therapeutic Adjuncts in Infectious DiseasesEmergency Aspects of Corticosteroid Therapy 1 April 1956Volume 44, Issue 4Page: 781-790KeywordsAdrenocorticotropic hormoneDuodenal ulcersGastric ulcersHospital medicineLupus erythematosusMiliary tuberculosisNecrosisOral administrationPancreasTuberculosis ePublished: 1 December 2008 Issue Published: 1 April 1956 PDF downloadLoading ...

Scleroderma with symptomatic hemolytic anemia: a case report.

Excerpt A case of hemolytic anemia associated with scleroderma was recently observed at this hospital. In view of the rarity of this association, a brief report seems warranted. CASE REPORT A 34 ye...