Lupus
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Multicenter Study
Associations of clinical features and prognosis with age at disease onset in patients with systemic lupus erythematosus.
The objective of this study is to evaluate the association of clinical features and prognosis with age at disease onset in patients with systemic lupus erythematosus (SLE) in a large, multicenter Chinese cohort. Medical records of 1898 SLE inpatients from 15 hospitals were reviewed and classified into three groups according to their ages at disease presentation. Categorical data were analyzed by chi-square test and potentially associated factors were tested by multinomial logistic regression. ⋯ Interestingly, our data showed that more patients with late-onset disease had a SLEDAI score change of >7 at discharge. In conclusion, age at onset has an impact on SLE disease status, and infection is the main cause of death in those with late-onset lupus. Considering that the late-onset patients had simultaneously easily controllable diseases and high incidence of comorbidities, a different treatment strategy from younger patients should be considered.
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Case Reports
Superior mesenteric artery syndrome and intra-abdominal compartment syndrome in systemic lupus erythematosus.
Gastrointestinal manifestations of systemic lupus erythematosus (SLE) are common, occurring in about 50% of cases. They are usually mild, in the form of mouth ulcers, nausea, heartburn and mild abdominal pain, but they can be severe in cases of gastrointestinal vasculitis. In this report we describe an unusual combination of SLE complications, namely superior mesenteric artery syndrome (SMAS) and reversible acute obstructive renal failure. This was attributed to raised intra-abdominal pressure and hence intra-abdominal compartment syndrome (IACS) following weight loss secondary to an acute presentation of SLE with gastrointestinal vasculitis.
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Twenty-two neuropsychiatric (NPSLE) and 13 systemic lupus erythematosus (SLE) patients with a normal appearing brain on plain magnetic resonance (MR) as well as 20 age-matched healthy controls underwent MR spectroscopy (MRS), perfusion-weighted (PWI) and diffusion-tensor imaging (DTI). In MRS NAA/Cr, Cho/Cr and mI/Cr ratios were calculated from the posterior cingulate cortex and left parietal white matter. In PWI, values of cerebral blood volume (CBV) were assessed from 14 regions, including gray and white matter. ⋯ Compared to SLE, NPSLE subjects revealed lower FA values within a wide range of association fibers and corpus callosum. Advanced MR techniques are capable of in vivo detection of complex microstructural brain damage in SLE and NPSLE subjects regarding neuronal loss, mild hypoperfusion and white matter disintegrity. MRS and DTI seem to show the highest usefulness in depicting early changes in normal appearing gray and white matter in SLE patients.
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This retrospective study aimed to collect data related to the clinical manifestations and laboratory investigations of systemic lupus erythematosus (SLE) patients in the eastern part of Saudi Arabia, in one of the tertiary-care centers, King Fahd Hospital Al-Hasa, and to compare it with other regions of Saudi Arabia. Forty-six patients fulfilling the American College of Rheumatology 1997 criteria (ACR) were collected over a period from January 2004 to December 2008. The results showed an average age of onset of 26.17 (±9.17). ⋯ We found that the age of onset and sex distributions were different from other areas of Saudi Arabia, while clinical manifestations were the same as in other areas. The prognosis of lupus was good overall despite the multi-organ involvement. However, further studies based on larger number of patients are needed.
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Ferritin is an iron storage protein considered also as an acute phase reactant with high levels in various inflammatory conditions. Recently, a plausible role for ferritin in the pathogenesis of immune-mediated and especially autoimmune diseases has been suggested. However, the link between ferritin and the antiphospholipid syndrome (APS) has been rarely explored. Therefore, in the current study we evaluated ferritin levels and their correlation to clinical and serological manifestations in patients with APS. We further analyzed ferritin levels among patients with the catastrophic variant of APS (cAPS). ⋯ Herein, we found that hyperferritinemia correlates with the presence of APS, its clinical manifestations and specifically with the catastrophic variant of this disease. Hyperferritinemia was also linked with anti-CMV antibodies among patients with APS. These associations allude to a pathogenic role of ferritin in the pathogenesis of APS, and the plausible role of ferritin as a marker of ensuing cAPS, although further studies are needed to elucidate these associations.