Sulphasalazine in rheumatoid arthritis.
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Biomedical subjects
Publications and source records attributed to M L Boey.
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Antiphospholipid antibodies are prevalent in systemic lupus erythematosus. These antibodies are not specific for systemic lupus erythematosus but may be found in other diseases such as rheumatoid arthritis, mixed connective tissue disease. Sjögren's syndrome, syphilis and chronic idiopathic thrombocytopenic purpura. High serum levels of anticardiolipin antibodies in systemic lupus erythematosus are associated with circulating lupus anticoagulant, false positive VDRL and the occurrence of thrombosis, thrombocytopenia and recurrent abortions. The immunological reactions of the antiphospholipid antibodies are not fully understood. Optimal treatment and length of therapy of patients with antiphospholipid antibodies remain tentative.
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A 5 year old girl with systemic lupus erythematosus developed extensive thromboses at multiple sites. Coagulation screen confirmed presence of the lupus anticoagulant. She recovered satisfactorily on high dose steroids without the use of anticoagulant treatment.
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A woman presented with multiple cerebral thromboses and skin lesions characteristic of Degos' disease. Her serum contained high titres of anticardiolipin antibodies and showed lupus anticoagulant activity, both known to be strong markers of a thrombotic tendency in systemic lupus erythematosus. This finding may have therapeutic implications for this usually fatal disease.
A young woman with systemic lupus erythematosus developed portal hypertension and pulmonary hypertension. This is the first report of such a case. We suggest that the presence of the lupus anticoagulant may have been related to the development of these two unusual features of her illness.
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A new solid-phase radioimmunoassay for the detection of anticardiolipin antibodies is 200-400 times more sensitive than the precipitation method used in the Venereal Disease Reference Laboratory test. 61% of serum samples from patients with systemic lupus erythematosus (SLE) had high levels of anticardiolipin antibodies of at least one immunoglobulin class. There were strong correlations between raised anticardiolipin levels and the lupus anticoagulant, venous and arterial thrombosis, and thrombocytopenia, but no correlation with anti-DNA antibody levels. Of the 15 patients with the highest anticardiolipin titres, 6 had a history of venous thrombosis, 5 cerebral thrombosis, 5 thrombocytopenia, and 2 each pulmonary hypertension and multiple abortions. This simple immunoassay appears to have predictive value for thrombosis in SLE and related disorders.
The lupus anticoagulant was found in the plasma of 31 of 60 patients with systemic lupus erythematosus and other connective tissue disorders (mixed connective tissue disease, systemic vasculitis, polyarteritis nodosa, primary sicca syndrome, discoid lupus, Behcet's syndrome, and systemic sclerosis). Strong associations were found with biological false positive seroreaction for syphilis and thrombocytopenia. The most striking association, however, was with the high prevalence of thrombosis. This tendency to thrombosis was independent of disease activity of systemic lupus erythematosus. The lupus anticoagulant appears to be a useful marker for a subset of patients with systemic lupus erythematosus at risk for the development of thromboembolic complications.
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A clinical survey of idiopathic systemic lupus erythematosus (SLE) was conducted in 183 Chinese patients from 1970-1980. The major initial manifestations were skin and mucous membrane involvement (52%), fever and malaise (48%), arthritis and arthralgia (44%). Renal and neuropsychiatric involvements are described in some detail. Five-year survival was 70% and 10-year survival was 60%. The three major causes of death were renal, neurologic and infective. Factors contributing to this relatively high mortality compared with Western series are discussed.
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