Accelerated atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus

It is important for primary care physicians to recognise rheumatoid arthritis and systemic lupus erythematosus patients as high-risk groups for atherosclerosis, requiring aggressive risk-factor modification. Recent studies suggest that this increased risk is not explained by an excess of traditional risk factors, but rather appears to be related to underlying rheumatic disease activity. Moreover, there is emerging data that aggressive treatment with disease-modifying agents may reduce the incidence of atherosclerosis in these conditions.     

Premature atherosclerosis and acute coronary syndrome in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a vasculitic disorder with potential for multisystem organ dysfunction. Among the organ systems affected is the cardiovascular system. Patients with SLE are prone to premature atherosclerosis; this premature atherosclerosis places the patient at risk for myocardial infarction with onset at a relatively young age. We present 4 patients with SLE who experienced myocardial infarction; these patients also experienced diagnostic and treatment delays because of their relatively young age at presentation. Relevant pathophysiology and diagnostic strategies are discussed.     

以消化系统表现为首发症状的系统性红斑狼疮30例临床分析

目的分析以消化系统表现为首发症状的系统性红斑狼疮(SLE)的临床特征,以提高对该病临床多样性的认识和诊治水平。方法回顾性总结和分析30例以消化系统表现为首发症状的SLE患者的临床和实验室资料,并以关节痛和(或)皮疹首发的60例SLE患者作为对照组。结果SLE消化系统为首发症状者误诊率高达50%,首发症状以腹痛最多见(12例)。影像学检查显示病变累及消化系统多个部位,表现形式多样。与对照组相比确诊时间明显缩短(P<0.05)、补体C3水平显著下降(P<0.05)、肝酶水平升高。对照组以关节炎/关节痛、皮疹、光过敏、脱发多见,抗核小体抗体水平显著升高(P<0.01)和抗Sm抗体阳性率显著增高(P<0.05)。消化道症状在大剂量激素治疗10 d左右缓解。结论SLE消化系统受累表现形式多样,作为首发表现时常引起误诊。大剂量激素有明显疗效。     

Severe pulmonary vascular disease in systemic lupus erythematosus.

A young woman with systemic lupus erythematosus (SLE) had clinical evidence of acute cor pulmonale. Autopsy disclosed vascular lesions in the lungs resembling those seen in advanced pulmonary hypertension. This case illustrates that severe pulmonary vascular disease may complicate SLE and mimic pulmonary thromboembolic disease.     

白细胞介素-18启动子基因多态性与系统性红斑狼疮的相关性

目的:探讨白细胞介素-18(IL-18)启动子基因-137和-607两个位点的多态性是否与中国南方汉族系统性红斑狼疮(SEE)人群的易感性有关,并进一步分析其与SLE患者血清IL-18水平的相关性.方法:采用PCRSSP法检测165例SLE患者和124例健康人群中IL-18启动子基因-137和-607两个位点的多态性频率.分析两个位点的基因分型与SLE的相关性.结果:165例SLE中,-137 C的等位基因频率为16.4%:而124例健康人群中-137 C的频率为12.3%,两组无明显差别;SLE患者中-607 C的等位基因频率为84.8%.健康人群中-607C的频率为61.3%,SLE组明显高于健康人群(P＜0.01),携带-607 C的个体SLE发病危险性大.血清中IL-18水平与基因型-607AC和-607CC强相关.结论:IL-18启动子基因-607位点(A→C)的多态性与中国南方汉族SLE人群相关,它可能通过影响IL-18基因的表达而参与SLE的发病.     

男性系统性红斑狼疮的临床特点

目的探讨男性系统性红斑狼疮(SLE)的临床特点。方法收集1998年6月至2011年6月住院的32例男性SLE患者和同期264例女性患者的临床资料进行统计学对比分析。结果男性SLE患者蝶形红斑、雷诺现象发生率明显低于女性(P<0.05),而肾脏损害、浆膜炎、贫血、血小板下降发生率则显著高于女性(P<0.01),抗Sm抗体阳性率亦较女性患者明显升高(P<0.05)。结论男性SLE患者临床症状不典型,肾脏损害重,应引起重视。     

Lupus nephritis as a factor of atherosclerosis risk in patients with systemic lupus erythematosus

AIM: To investigate early atherosclerosis (AS) risk factors in patients with systemic lupus erythematosus (SLE) in respect to the presence of lupus nephritis (LN) and antiphospholipid (APL) antibodies. MATERIAL AND METHODS: We analysed case histories of 137 SLE patients observed in E.M. Tareev clinic from 1970 to 2006. AS manifestations were studied by echocardiography, ultrasonic dopplerography of the peripheral vessels, x-ray methods. AS was considered early if it arose at the age under 55 years. Patients with chronic renal failure were not included in the study. RESULTS: AS development was seen in 54 (45%) patients, early symptoms appeared at the age of 25-68 years (mean 54 +/- 10 years). In 37 (31%) patients AS symptoms manifested at the age under 55 years. Significant factors of early AS risk were age, hyperlipidemia, arterial hypertension, menopause for women, APL antibodies circulation, stage IV chronic disease of the kidneys, hyperuricemia, higher blood creatinine, mean dose of prednisolone over 15 mg/day, frequent elevation of the level of C-reactive protein. A direct correlation between lupus nephritis or nephrotic syndrome (NS) and early AS was not found. In LN hyperlipidemia occurred more often (p = 0.055), lipids level and NS were not related during its remission. LN patients developed AS more frequently, had lower complement concentration in the end of the study, were treated with prednisolone more intensively than patients free of renal disease (p < 0.05). CONCLUSION: Early AS develops in more than one third of SLE patients. Main risk factors of early AS are conventional ones and APL antibodies, persistence of chronic inflammation, decreased glomerular filtration rate, prednisolone therapy. LN influence on the process of atherogenesis in SLE may be mediated and caused by high rate of other risk factors.     

Atheroscleotic vascular lesion in systemic lupus erythematosus and antiphospholipid syndrome in men

The aim of the study was to determine the prevalence of various clinical and subclinical manifestations of atherosclerosis (AS) in men with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APLS), as well as to evaluate correlations between vascular atherosclerotic lesions, risk factors, and the levels of C-reactive protein (CRP) and cardiolipin antibodies (CLA). The subjects of the study were 62 patients (mean age 35.7 +/- 11.6 years, disease duration 129 +/- 102 months). Conventional and disease-related risk factors were analyzed. Carotic ultrasonography (CU) was performed in order to reveal vascular atherosclerotic lesions. Serum CRP levels were measured by the high-sensitive immunonephelometric technique. IgG and IgM CLA were studied by solid-phase immunoenzyme assay. CU found carotic arterial involvement in 58% of the patients; clinical manifestations of AS were revealed in 42% of the patients. The patients were divided into two groups: group I included 19 patients with APLS signs, group II consisted of 43 patients without APLS symptoms. The disease duration and lesion index were higher in group I. The study revealed a significant correlation between CRP level and intima-media complex (IMC) thickness in patients suffering from SLE with or without APLS (p < 0.05). Patients with AS displayed higher levels of IgG CLA, although the difference was insignificant. The study demonstrates that men suffering from SLE with or without APLS have a high risk of AS. An increase in CRP level is associated with an increase in IMC thickness.     

Soluble receptors of TNF-alpha: association with atherosclerotic vascular affection in systemic lupus erythematosus in males

AIM: To study association between concentration of soluble receptors of TNF-alpha (sTNFa-R1) and atherosclerotic vascular affection in systemic lupus erythematosus (SLE) in men. MATERIAL AND METHODS: The examination covered 75 patients (mean age 34.76 +/- 11.8 years), duration of the disease 126 +/- 110 months. Standard cardiovascular risk factors were analysed. SLE activity was estimated by SLEDAI and ECLAM scales, SLICC/ACR index was calculated. Atherosclerotic vascular affection was studied with ultrasonic scanning of the carotid arteries. sTNFa-RI concentration in blood serum was determined with enzyme immunoassay technique in 73 SLE patients and 20 healthy donors. RESULTS: By sTNFa-R1 concentration, the patients were divided into two groups. Group 1 consisted of patients with sTNFa-R1 < or = 2.87 ng/ml, group 2 > 2.87 ng/ml. Higher concentrations of the receptors were associated with higher mean values of the damage index and proteinuria occurrence, with older age and higher body mass, with signs of vascular atherosclerotic affection (atherosclerotic plaques and intima-media thickness > 0.9 mm. CONCLUSION: Concentration of sTNFa-R1 can be considered as a laboratory marker of atherosclerotic vascular lesions.     

Antibody-dependent cellular cytotoxicity of human vascular endothelium in systemic lupus erythematosus

Sera from 35 patients with systemic lupus erythematosus were examined for a cytotoxic effect on human umbilical vein endothelium. Although none of these sera produced direct cytotoxicity of 51Cr-labelled endothelial cells, even with added complement, 3 sera regularly produced increased 51Cr release when co-cultured with endothelial cells and normal human peripheral blood mononuclear cells. The effector cells involved in this cytotoxicity possessed Fc-receptors but were non-T and non-adherent while fractionation studies indicated that the responsible serum factor(s) was IgG, probably in the form of immune complexes of small size. Control studies, using sera from both 27 normal controls and 19 patients with either diabetes or extensive atherosclerotic vascular disease failed to reveal any similar cytotoxicity. Two of the 3 patients, whose sera produced this antibody-dependent cellular cytotoxicity, had had clinical episodes of major vascular thrombosis, raising the possibility that the cytotoxicity might provide an additional pathogenic mechanism in certain patients with systemic lupus erythematosus.     

系统性红斑狼疮患者中检测ANCA临床意义的研究

目的探讨抗中性粒细胞胞浆抗体（ANcA）在系统性红斑狼疮（SLE）患者中检测的临床意义。方法通过间接免疫荧光法和免疫印迹法分别检测了25例健康对照组和106例SLE患者血清中的ANCA、抗核抗体（ANA）、抗双链DNA抗体、抗-SmDI抗体。结果对照组测定均为阴性。SLE患者中ANCA阳性率为47．2％（50／106）,且均为环细胞核着色的核周型（pANCA）;在ANCA阳性组及ANCA阴性组中：ANA及抗-SmDl抗体阳性率分别为100％（50／50）、91．1％（51／56）：829／0（41／50）、67．9％（38／56）,P均〉0．05;抗ds—DNA抗体阳性率分别为94％（47／50）、50％（Z8／56）,P〈0．01。在活动性sLE（52例）和非活动性sLE（54例）中ANCA阳性率分别为84．6％（44／52）;11．1％（6／54）,P〈O．01。结论ANCA在sLE患者中检测与ANA及抗-SmD1抗体没有相关性,与抗ds—DNA抗体正相关,活动期SLE患者中ANCA阳性率明显高于非活动期的患者。     

Eosinophilic enteritis with systemic lupus erythematosus

Gastrointestinal manifestations are common in systemic lupus erythematosus (SLE). Eosinophilic enteritis is a rare disorder of uncertain cause that was recently reported for the first time in association with SLE. This report presents a second case of eosinophilic enteritis in a 47-year-old female patient with SLE. The patient presented with recurrent episodes of abdominal pain, nausea, vomiting, and diarrhea. Complete blood counts on occasion showed elevated eosinophil counts. The patient underwent a comprehensive workup over several weeks, culminating in a small bowel biopsy that showed eosinophil infiltration in the muscularis propria, establishing the diagnosis. The patient was treated with a prolonged taper of prednisone with successful resolution of symptoms.     

Advances in systemic lupus erythematosus

To help to understand recent progresses in studies on systemic lupus erythematosus (SLE), the essence of the Fifth International Conference on SLE that was successfully held at Cancun, Mexico on April, 1998 is reviewed. Among more than 400 papers, most highlighted topics were (1) relationship between hyperprolactinemia and SLE, (2) molecular mechanisms of antiphospholipid syndrome, (3) roles of anti-endothelial cell antibodies, (4) apoptosis in pathogenesis, (5) autoimmunity against nucleosomes, (6) penetration of autoantibodies into living cells, and so on. Clinical studies on adverse effects of current therapies, pioneer cases of autologous stem cell transplantation for refractory SLE, and other numerous cases that were full of suggestiveness were also reported by physicians from many countries.     

载脂蛋白E在系统性红斑狼疮患者中的表达及其临床意义

目的：检测系统性红斑狼疮（SLE）患者血清中载脂蛋白 E（ApoE）水平变化,探讨其临床意义。方法选取2012年8月至2013年5月于河北北方学院附属第二医院院进行诊治的47例S L E患者及40例健康者作为研究对象,应用酶联免疫吸附试验（ELISA）检测血清中ApoE水平,根据不同临床指标进行分组并进行统计学分析。结果与健康对照组相比,SLE患者组ApoE总体表达水平升高[（15．2±4．4）pg/mL vs ．（8．6±3．3） pg/mL ,P＜0．05],其中活动组患者 ApoE较非活动组患者相比升高更为明显[（18．3±6．1）pg/mL vs ．（14．2 ± 5．7） pg/mL ,P＜0．05];狼疮性肾炎组和非狼疮性肾炎组血清中 ApoE水平较健康对照组升高（P＜0．05）,但两组间差异无统计学意义（P＞0．05）;抗双链DNA（ds-DNA）抗体阳性组患者血清中ApoE水平较抗ds-DNA抗体阴性组患者明显升高[（17．9 ± 5．8）pg/mL vs ．（13．9 ± 4．7） pg/mL ,P＜0．05]。结论 ApoE可作为反映SLE患者病情活动的有效指标,为疾病免疫治疗提供一定的理论依据。