Lues and lupus: syphilis mimicking systemic lupus erythematosus (SLE)

Malar rash and photosensitivity are common findings in systemic lupus erythematosus (SLE). However, a number of inflammatory, dermatologic, infectious or drug-induced conditions may mimic cutaneous findings of SLE. These typically include seborrheic dermatitis, contact dermatitis, rosacea, polymorphous light eruption, syphilis and dermatomyositis sine myositis. Herein we describe a patient with fever, malar rash, alopecia, photosensitivity, arthralgias and lymphadenopathy who was subsequently diagnosed with secondary syphilis. In this case report we review clinical and histopathological findings in the differential diagnosis of malar rash and photosensitivity and discuss the overlapping features of syphilis and SLE.     

系统性红斑狼疮与早发动脉粥样硬化及其相关危险因素

目的 研究绝经期前系统性红斑狼疮（SLE）女性患者动脉粥样硬化的发病情况，并与正常对照组进行比较，进一步探讨传统心血管疾病危险因素在此过程中的作用。方法 采用颈动脉超声检测110例绝经前SLE女性患者及40名健康女性颈部动脉粥样硬化斑块发生情况。所有人选对象均要求无临床心血管疾病史。在此基础上对高血压、血脂情况、吸烟、肥胖等传统的心血管疾病危险因素与颈动脉斑块之间的相关性进行研究。结果 在111例SLE组患者中有16例（14．4％）存在颈动脉斑块，而在40名正常对照组中无一例存在颈动脉斑块（P=-0．007）。与对照组相比，SLE组患者中高血压患病率明显增高（P〈0．01），血清总胆固醇（TC）（P=-0．022）、甘油三酯（TG）明显增高（P〈0．01）。SLE病程、患高血压及体重指数是SLE患者发生颈动脉斑块的独立预测指标。结论 在绝经前SLE患者中颈动脉粥样硬化斑块的发生率明显高于正常对照组。SLE病程、高血压及体重指数是SLE患者发生颈动脉斑块的危险因素。     

Articular mobility in systemic lupus erythematosus (SLE)

Summary The study was prompted by the suggestion that inflammatory polyarthritis and corticosteroids increase articular mobility. Ninety female patients with systemic lupus erythematosus (SLE) of whom 85 had polyarthritis and at least 75 of whom had received corticosteroid therapy were studied and compared to an equal number of carefully matched controls. The difference between the number of hypermobile patients [6(7%)] and controls [5(6%)] was not significant. There was also no significant difference when either the pooled mobility scores or the pooled hand scores of the patients and controls were compared. No significant association between articular mobility and either age at onset of disease, duration of disease or corticosteroid therapy was demonstrated. There was a significant association between deformity and duration of disease (p=0.04) but not with mobility score. We conclude that SLE patients do not have a hypermobile tendency and therefore that neither SLE nor corticosteroids predispose to increased articular mobility. There is also no association between articular mobility and deformity.     

Serum ferritin,transferrin and metabolic syndrome are risk factors for subclinical atherosclerosis in Egyptian women with systemic lupus erythematosus (SLE)

Aim of the work

This work aimed to measure serum ferritin and transferrin levels and to study the presence of metabolic syndrome (MetS) in Egyptian systemic lupus erythematosus (SLE) females and to correlate them with disease activity, damage, clinical status and subclinical atherosclerosis.

系统性红斑狼疮亚临床动脉粥样硬化危险因素研究

目的 评价系统性红斑狼疮(SLE)患者亚临床动脉粥样硬化的发生率、传统及非传统危险因素对动脉粥样硬化发生的影响.方法 选择58例确诊SLE同时既往无动脉粥样硬化疾病发生的患者作为研究对象.记录其传统危险因素、SLE临床及实验室指标、活动度评分、治疗情况.同时通过颈动脉彩色多普勒超声测量双侧颈动脉内中膜厚度(IMT)并观察有无动脉粥样硬化斑块.结果 58例患者中IMT增厚者22例(38%).有动脉粥样硬化斑块者10例(17%).有斑块者较无斑块者SLE病程更长,同时存在更多传统危险因素:年龄大、有高血压、糖尿病及已绝经者多,有更高的收缩压、总胆固醇及低密度脂蛋白水平.多因素分析显示,患者所具有的传统危险因素的数量及SLE病程是出现颈动脉粥样硬化斑块的独立危险因素.结论 传统危险因素在SLE患者动脉粥样硬化的发生中仍然发挥着重要作用,应该积极地予以控制.SLE病程是影响动脉粥样硬化发生的非传统独立危险因素,随着病程的延长,应该定期进行相关检查,尽早发现并治疗.     

Splenic platelet kinetics in systemic lupus erythematosus (SLE)

The splenic blood flow, intrasplenic platelet kinetics and spleen size were determined in 8 females with systemic lupus erythematosus (SLE), all without signs of active disease, by using gamma-camera scintigraphy with 111In-labelled platelets and 99mTc-stannous colloid. The results for splenic blood flow, intrasplenic platelet transit time and splenic platelet pool size, obtained by compartmental analysis of the initial distribution of radiolabelled platelets between blood and spleen, did not differ from those of a control group. In all SLE patients the spleen size was within normal limits. There was a significant relationship between the spleen volume and the splenic platelet pool size (r = 0.75; p less than 0.05), and between the spleen volume and splenic blood flow (r = 0.76; p less than 0.05). A borderline, inverse correlation was present between an estimate of splenic perfusion and intrasplenic platelet transit time (r = 0.62; p = 0.1). It is concluded that the splenic function, measured as splenic blood flow and intrasplenic platelet kinetics, is not disturbed in SLE patients without active disease.     

系统性红斑狼疮合并静脉血栓栓塞症临床相关危险因素分析

目的探讨系统性红斑狼疮（SLE）合并发生静脉血栓栓塞症（VTE）的临床相关危险因素。方法回顾性连续收集2008年1月至2012年2月期间在解放军总医院住院治疗的27例SLE并发VTE的患者入血栓组,并募集同期27例与血栓组性别、年龄、体质量指数（BMI）、生活方式等环境因素相匹配的不伴有VTE的SLE患者作为对照组,利用单因素统计学分析两组患者的静脉血栓形成相关临床危险因素（血小板计数、免疫功能、补体、合并低蛋白血症、狼疮肾炎、肾功能不全、肾病综合征、肾性高血压、蛋白尿、血尿等）及实验室诊断指标[C-反应蛋白（CRP）、D-二聚体,白细胞计数、活化部分凝血活酶时间（APTT）、血浆凝血酶原时间（PT）、血浆纤维蛋白原（FIB）1的差异。结果与对照组相比,血栓组合并低蛋白血症（70．37％）、狼疮肾炎（74．07％）、肾功能不全（70．37％）、肾病综合征（55．56％）、肾性高血压（66．67％）的发生率均显著升高（P值分别为0．003,0．000,0．000,0．027,O．029）。血栓组患者的实验室检测指标CRP（7．19±9．23）mg／L和D．二聚体（6．32±5．75）mg／L均显著高于对照组（P值分别为0．004,0．000）。结论低蛋白血症、狼疮肾炎、肾功能不全、肾病综合征及肾性高血压可能是SLE合并VTE的临床相关危险因素;CRP及D-二聚体可能成为SLE合并VTE的实验室诊断指标。     

Synovial fluid findings in systemic lupus erythematosus (SLE)

Synovial fluids from 26 patients with SLE were usually clear and viscous, with few WBCs and low complement. Twelve fluids, studied in detail, were further characterized according to protein and IgG concentrations. Four were transudates. Fluids from 3 subjects with atypical features of SLE were exudates that contained increased concentrations of proteins and complement. Five other fluids were exudates with very low complement, thus similar to rheumatoid effusions, but lacking the polymorphonuclear leukocytosis and rheumatoid factor found in RA.     

APRIL polymorphism and systemic lupus erythematosus (SLE) susceptibility

OBJECTIVE: Two novel non-synonymous polymorphisms of the APRIL gene, codon 67 (rs11552708) and 96 (rs3803800), were recently identified and tested for disease association. The 67G allele was reported to be associated with systemic lupus erythematosus (SLE) in a Japanese population. The aim of the study is to investigate whether the APRIL polymorphism associated with susceptibility to SLE in a Japanese population is associated with the susceptibility to SLE in other ethnic groups. METHODS: Three hundred and forty-eight SLE patients (204 European-American, 103 African-American and 41 Hispanic) and 345 ethnicity-matched controls (201 European-American, 104 African-American and 40 Hispanic) were included from the Lupus Multiplex Registry and Repository (LMRR) and evaluated for genetic association. The APRIL codon 67 and codon 96 were genotyped by a 3-base extension method. Statistical evaluations were performed using both chi-square and logistic regression analysis. RESULTS: Both the single-nucleotide polymorphisms (SNPs) were in Hardy-Weinberg equilibrium in cases and controls within each ethnic group. The APRIL codon 67 was significantly associated with SLE risk under the dominant model adjusted by ethnicity (odds ratio, 95% confidence interval and P-values were 1.45 and 1.02-2.06 and 0.036, respectively). Race-specific analysis also showed a trend for association in African-American and Hispanic SLE subjects. CONCLUSION The APRIL codon G67R polymorphism associated with SLE in a Japanese population may also be associated with SLE in other populations.     

系统性红斑狼疮中疾病相关危险因素与早发动脉粥样硬化的关系

目的 研究绝经期前系统性红斑狼疮(SLE)女性患者动脉粥样硬化的发病情况,探讨SLE疾病相关因素等非传统危险因素在SLE早发动脉粥样硬化中的作用.方法 对111例绝经前SLE女性患者及40名健康女性进行研究.入选对象均要求无临床心血管疾病史.采用颈动脉超声检测颈部动脉粥样硬化斑块,同时测定颈动脉内膜中层厚度(IMT).对SLE疾病相关因素与动脉粥样硬化之间的关系进行研究.采用肱动脉超声检测血管内皮功能,以此评价SLE患者与健康对照之间内皮功能的差异.采用t检验、χ2检验和Logistic回归分析等方法进行统计学分析.结果 在110例绝经前SLE患者中有16例(14.4%)存在颁动脉斑块,而在40名健康对照组中无一例存在颈动脉斑块(P=0.007).SLE患者组的平均IMT(m-IMT)(0.62 mm)高于健康对照组(0.45 mm)(P<0.01),最大IMT(M-IMT)(0.7 mm)高于健康对照组(0.6 mm)(P<0.01). SLE患者中有颈动脉斑块者相对于无斑块者年龄更大,病程更长,体质量指数(BMI)更大,血压偏高,凝血酶原时间更短,C反应蛋白更高,系统性红斑狼疮损伤指数(SLICC)积分更高,累积激素剂量更大,更少使用羟基氯喹,m-IMT和M-IMT更大,血流介导的血管扩张功能(FMD)和硝酸甘油介导的血管扩张功能(NMD)减弱(P均<0.05).运用Logistic回归分析,在SLE患者中,年龄增大(P=0.012,OR=1.137),BMI增高(P=0.051,OR=1.205),SLICC积分增高(P=0.000.OR=2.888)是发生颈动脉斑块的独立预测指标.结论 SLE患者颈动脉粥样硬化斑块的发生率明显高于健康对照.除了传统心血管疾病危险因素的影响外,SLE本身以及与疾病相关的一些因素也参与其中,对SLE早发动脉粥样硬化起重要作用.SLE患椭明显的血管内皮功能障碍,因此,内皮功能受损也可看作SLE早发动脉粥样硬化的一个表现.