NEUROPSYCHIATRIC MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS

Forty-six episodes of major neuropsychiatric manifestations of systemic lupus erythematosus occurring in 35 patients over a ten-year period were reviewed. The frequency of central nervous system SLF was lower than that reported from overseas referral centres. Glucocorticosteroid treatment did not precipitate psychiatric problems in this group. Whilst neuropsychiatric recovery was the rule, such features indicated a subgroup of SLE with high short-term mortality.     

系统性红斑狼疮十年随访

报道50例SLE患者的10年(1980年～1990年)随访结果。10年的生存率情况,以发病时间计算,其一年、五年、十年生存率分别为98％、98％、84％,以确诊时间计算,则分别为98％、86％、76％。本组患者十年中死亡12例(24％),感染与肾功能衰竭为两大主要死因,分别占33％及33％。74％存活的患者能很好工作与生活,12例患者病情缓解,平均缓解时间4年(2年～9年)随访,结果表明SLE的早期诊断,以及预防感染与肾衰是进一步降低SLE死亡率的两大关键。     

OESTROGEN-INDUCED SYSTEMIC LUPUS ERYTHEMATOSUS

The subject of this case report, a 64-year-old white female,was treated for osteoporosis with oestrogens. She developedunequivocal systemic lupus erythematosus, from which she hadsuffered as a young woman and which had remitted with her menopauseat 38. The close relationship of the relapses and remissions of herdisease with her hormonal status underlines the importance ofendocrine factors in the clinical expression of systemic lupuserythematosus. KEY WORDS: Oestrogens, Systemic lupus erythematosus, Osteoporosis     

晚发系统性红斑狼疮的临床特点分析

目的分析晚发系统性红斑狼疮（SLE）患者的临床表现及治疗情况,并与早发SLE患者进行比较,以探讨晚发SLE的临床特点。方法收集2000～2004年于我院就诊的晚发SLE患者21例,并随机选取了同期40例发病时年龄〈50岁的患者作为早发SLE组,分析比较两组的临床表现、实验室指标、治疗情况。结果晚发SLE占所有SLE患者的6．18％。晚发SLE组性别比例女：男差异有统计学意义（3．2,P〈0．01）,且一些临床表现较少见：关节炎（P〈0．01）;蝶形红斑（P〈0．05）;肾脏受累（P〈0．01）。实验室指标中类风湿因子阳性率更高（P〈0．05）,而低补体C3血症较早发SLE组低（P〈0．01）。治疗方面,晚发SLE组较少使用大剂量皮质类固醇和免疫抑制剂。结论晚发SLE的临床表现多较轻,治疗上较少需要使用大剂量皮质类固醇和免疫抑制剂。     

系统性红斑狼疮诊断标准对照研究

为了验证SLE的ARA标准(1982)、上海标准(1987)及北京标准(1982),将90例SLE患者和88例非SLE的其他风湿病患者进行回顾性对照研究。所有资料分成三个组分析,A组具有上述三个标准中所要求的免疫学检查;B组未进行抗Sm抗体检查;C组未进行任何免疫学检查。ARA标准、上海标准、北京标准的敏感性在A组分别为92.2％、100％、96.1％(P>0.05);在B组分别为77.8％、92.2％、91.1％(P<0.05);在C组分别为55.6％、56.7％、46.7％(P>0.05)。三个标准在各组的特异性为95.6％～98.9％(P>0.05)。敏感性以上海标准最高,特异性以ARA标准最高。     

HYPOSPLENISM IN SYSTEMIC LUPUS ERYTHEMATOSUS

Hyposplenism, which is suggested by a typical peripheral bloodsmear and by the absence of splenic activity in a ^99m To sulphurcolloid scan, has been recently found to be associated withvarious diseases. This condition increases the susceptibilityof patients to certain bacterial infections principally by pneumococci,meningococci and Haemophilus influenzae. The association ofSLE and hyposplenism has not often been reported before; thuswe see fit to report another such case. The administration ofpolyvalent pneumococcal vaccine is recommended in this condition. KEY WORDS: Hyposplenism, Systemic lupus erythematosus     

SEVERE THORACIC SYSTEMIC LUPUS ERYTHEMATOSUS

The effects of corticosteroid administration to eight patients with severe thoracic systemic lupus erythematosus (SLE) were assessed in a prospective study over a mean period of 26 months by serial measurements of respiratory function, ESR, and a clinical score. Initial assessment of respiratory function showed severe restrictive ventilatory defects and impairment of carbon monoxide uptake not wholly attributable to the small lung volumes. ESR and clinical score showed high correlation coefficients with FEV₁ in all patients, with VC and TLC in seven patients, and with T_LCO in four patients, indicating that changes of respiratory function were reflecting the activity of the disease. This study shows that in patients with severe thoracic SLE it is valid to use serial measurements of respiratory function to assess the response to treatment and that pronounced and sustained improvement of respiratory function can be expected.     

A CASE OF SYSTEMIC LUPUS ERYTHEMATOSUS PRESENTING AS GUILLAIN-BARRE SYNDROME

Acute demyeKnating polyneuropathy has been reported only twiceas a presenting feature of systemic lupus erythematosus (SLE)in female patients. We report a male presenting with an acutedemyelinating polyneuropathy who subsequently was found to haveSLE. KEY WORDS: Polyneuropathy, Demyelination, Treatment     

MORTALITY OF JAMAICAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

A retrospective study of all patients with systemic lupus erythematosus(SLE) who died at the University Hospital of the West Indiesover a 14-year period is presented. The major cause of deathwas infection followed by renal failure. Gram-negative organismswere the major microbiological agents causing infections. Side-effectsof therapy were common, in particular bone marrow depressionand haemorrhage related to anticoagulants. It appears that controllingsevere lupus activity without increasing the risk of life-threateningcomplications remains an important goal in the treatment ofSLE. KEY WORDS: Systemic lupus erythematosus, Mortality, Infection, Anticoagulants, Jamaica     

LUPUS ANTICOAGULANT AS A PROGNOSTIC MARKER IN SYSTEMIC LUPUS ERYTHEMATOSUS

To evaluate the prognostic significance of lupus anticoagulant(LA), 37 SLE patients with LA and 37 age- and sex-matched SLEpatients without LA were followed up for a median of 22 years,of which 16 years (median) after the initial LA-testing. Deepvenous thrombosis was observed in 20 (54%) patients with LA.Of these patients, 90% had the first episode within 8 yearsafter the onset of SLE symptoms, as compared to only one ofthe six LA-negative patients with deep venous thrombosis (P0.0001). Cerebral artery occlusions were more common in patientswith LA (P 0.016), but typically appeared as a late phenomenon.Nephritis or neuropsychiatric manifestations, previously associatedwith a poor outcome in SLE, did not correlate with the presenceof LA. However, higher mortality was associated with both LA(P 0.021) and a history of deep venous thrombosis (P 0.004),as well as with nephritis (P 0.038). The most common cause ofdeath in both LA positives and negatives was vascular occlusion. In conclusion, it appears that the first episode of deep venousthrombosis in patients with LA is typically seen early in thecourse of disease, and that LA and a history of deep venousthrombosis are both associated with increased mortality. KEY WORDS: Antiphospholipid antibodies, Lupus anticoagulant, Lupus erythematosus, Survival, Thrombocytopenia, Thrombosis     

SYSTEMIC LUPUS ERYTHEMATOSUS PRESENTING AS PSEUDOCYESIS

A patient with SLE whose initial manifestation was with a raredelirious disorder manifested as pseudocyesis is described.The psychiatric manifestations were considered to be due toSLE and treated with pulse steroid therapy. Special attentionis focused on treatment and MRI. KEY WORDS: Systemic lupus erythematosus, Pseudocyesis, Neuropsychiatric lupus, Central nervous system     

SYSTEMIC LUPUS ERYTHEMATOSUS EVOLVING INTO SYSTEMIC VASCULITIS: A REPORT OF FIVE CASES

Five patients with systemic lupus erythematosus are describedwho developed the disease in their second or third decade. Thepattern of their disease then changed markedly and they developedthe clinical features of a systemic vasculitis. The possibleexplanations for this transition of one connective tissue diseaseto another is discussed. KEY WORDS: Systemic lupus erythematosus, Systemic vasculitis, Connective tissue disease     

UNUSUAL TRANSFORMATIONS OF RENAL INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract: :The clinical course of a woman with systemic lupus erythematosus demonstrated that renal involvement in this disease can change, both in the predominant site of renal injury and in the pattern of glomerular lesions. Over 50 months she had first tubulo-interstitial lupus nephritis with no glomerular change, then a membranous nephropathy with disappearance of tubulo-interstitial inflammation, and finally crescentic glomerulonephritis. This case emphasizes the need for close follow-up of all lupus patients regardless of their initial renal manifestations and pathology.     

RAPID DEVELOPMENT OF CEREBRAL ATROPHY IN SYSTEMIC LUPUS ERYTHEMATOSUS

A 21-year-old female is described who developed severe cerebrallupus 9 months after the onset of her disease. A dramatic changein her CT brain scan from normal to gross cerebral atrophy wasobserved in the month following onset of her cerebral disease. This patient developed hepatitis during the course of her hospitalization.This is an unusual manifestation of systemic lupus. The patient'sserum also contained anti-Sm antibodies. This is a relativelyinfrequent finding in the serum of lupus patients outside theUnited States. KEY WORDS: Systemic lupus erythematosus, Cerebral disease, Sm antibodies     

SYSTEMIC LUPUS ERYTHEMATOSUS AND ABDOMINAL PAIN

Abdominal pain is a common symptom in systemic lupus erythematosus.We report two patients with recurrent severe attacks of abdominalpain, often necessitating hospital admission, which were notdiagnosed until laparotomy. In one an active arteritis of themesenteric arteries was seen, with infarction of the jejunumand ileum, and in the second infarction of the ileum with haemorrhageand conglutination of red cells, but no true arteritis. KEY WORDS: Systemic lupus erythematosus, Abdominal pain