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PubMed2003

Bullous SLE: response to methotrexate and relationship with disease activity.

We report on a case of 40-year-old female with systemic lupus erythematosus (SLE) who developed a severe bullous eruption on sun-exposed areas. The bullous manifestation was associated with a flare of lupus serologies, whereas the previous manifestations of the disease were quiescent. Due to prior intolerance to many drugs, she was given oral methotrexate (10 mg/week). The drug administration was followed by a rapid and full resolution of cutaneous lesions. Five months later she developed a class III lupus nephritis. Our case is the first report of efficacy of methotrexate in bullous SLE and rises the question of the relationship between bullous eruption and SLE activity.

Administration, Oral↗

PubMed2003

Acute renal failure complicating HELLP syndrome, SLE and anti-phospholipid syndrome: successful outcome using plasma exchange therapy.

Renal disease is very common in patients with systemic lupus erythematosis (SLE) and it may emerge during pregnancy or the post-partum period. Patients with anti-phospholipid syndrome (APS)are also at risk of renal disease. We present a case of acute renal failure in the post-partum period in a patient with SLE and APS. This case illustrates the potential difficulties in reaching a diagnosis in such a patient. It also illustrates the complexities of management and the potential interactions between SLE, Haemolysis, elevated liver enzymes and low platelets syndrome, thrombotic thrombocytopenic purpura, haemolytic uraemic syndrome and APS. We also review the role of plasma exchange therapy in managing our patient.

Acute Kidney Injury↗

PubMed2005

Association between beta2-glycoprotein I gene polymorphisms and pediatric SLE and antiphospholipid antibodies.

Antibodies against phospholipids (PL) and PL-binding proteins have been causally implicated in antiphospholipid syndrome (APS). Mutations in the fifth domain of the beta2-glycoprotein I (beta2GPI) protein, a putative PL-binding site, may play a critical role in APS pathogenesis. The purpose of this study was to identify associations between beta2GPI mutations and both antiphospholipid antibodies (aPL) and their associated clinical manifestations in a pediatric and adolescent cohort and to search for novel mutations. Genetic analysis of beta2GPI was performed in 58 youths with systemic lupus erythematosus (SLE) and/or aPL, to identify known polymorphisms at amino acids 247 and 306 as well as novel mutations in exon 7 of the beta2GPI gene, and their association with aPL-associated clinical manifestations. Our results demonstrate an association between substitution of Val for Leu at AA247 (L247V) of beta2GPI and both the development of aPL (P = 0.05) and aPL-associated clinical manifestations (P = 0.03) among pediatric patients. The odds ratio associated with risk of aPL-associated clinical manifestations for the homozygous VV polymorphism was 5.5 (CI 1.3-23, P = 0.03) for the overall cohort, and 4.75 (CI 0.66-55.49, P = 0.06) after adjusting for ethnicity. The association was not significant after stratifying for SLE versus non-SLE. Association between the VV genotype at amino acid 247 of beta2GPI and clinical disease supports a genetic cause for APS among children and adolescents. Neither novel exon 7 beta2GPI mutations or the previously described C306G polymorphism was identified in this pediatric cohort.

Adolescent↗

PubMed1998

Basaloid follicular hamartoma, total body hair loss and SLE.

We describe a patient with systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APLS) who developed a plaque-like lesion around the mouth and lost all body hair. Biopsies of the circumoral lesion and scalp, were originally reported as containing extensive basal cell carcinoma, but on review, both showed the typical appearance of a benign malformation of the hair follicle known as basaloid follicular hamartoma. Regrowth of hair and partial resolution of the peri-oral plaque occurred with more aggressive treatment of her SLE, but the basaloid follicular hamartomas in her scalp skin persisted. There is a known, but rare, association between this pattern of basaloid follicular hamartoma, alopecia and myasthenia gravis, but only two cases have been described in association with SLE and none with APLS.

Adult↗

PubMed1998

Frequency of antibodies to the cholesterol transport protein apolipoprotein A1 in patients with SLE.

In examining reasons for premature atherosclerosis in systemic lupus erythematosus (SLE), we previously reported low levels of the cholesterol transport protein apolipoprotein A1 (apoA1) in these patients, and specific antibodies to purified apoA1 were identified in the sera of 5 out of 30 lupus patients. The current study was initiated to determine whether these antibodies are common in lupus patients. 520 serum samples from 175 patients with SLE or primary antiphospholipid syndrome (PAPS) were tested for antibodies to purified apoA1. Positive sera were retested for binding to apolipoprotein incorporated into reconstructed nascent or mature high-density lipoprotein (HDL). Autoantibodies to apoA1 were found in 32.5% of patients with SLE and 22.9% of patients with PAPS, associated with the presence of aPL (anti-beta2 glycoprotein-1, anti-beta2 GP1) antibodies. When reconstructed, nascent and mature HDL molecules were compared as antigen-containing environments, positive sera reacted best to apoA1 embedded in mature HDL molecules. This report confirms the high prevalence of antibodies to apoA1 in patients with systemic lupus and suggests a high affinity of these antibodies for mature HDL.

Adolescent↗

PubMed1999

'Sustained remission' in a case of SLE following megadose cyclophosphamide.

Cytotoxic therapy, especially with cyclophosphamide in the dose 8-20 mg/kg used as intermittent pulses, has been shown to improve both patient and renal survival in systematic lupus erythematosus (SLE), but to date there is no cure for the disease. Owing to the paucity of recognisable clones, the rationale and goal of cytotoxic immunosuppressive therapy in the treatment of immune-mediated diseases as against malignancies is to suppress the aberrant inflammation and immune-mediated reactions responsible for tissue damage, without dangerously suppressing the normal host defence mechanism(s). We report the case of a patient suffering from SLE with nephritis who has remained in sustained remission over the past 8 years without any maintenance therapy following an accidental administration of a single dose of 5000 mg of intravenous cyclophosphamide (44.2 mg/kg body weight). The patient recovered fully from pancytopenia following the injection. Presently, she is asymptomatic and working gainfully. Her laboratory parameters including blood counts, urine analysis, FANA and anti-dsDNA have reverted to normal. Cyclophosphamide in the dose of 30-160 mg/kg has been safely and effectively used in various neoplastic conditions with the aim of destroying every possible tumour cell. The experience of the present case suggests that such an approach may be applicable to SLE.

Adult↗

PubMed1999

Decreased expression of the p21ras stimulatory factor hSOS in PBMC from inactive SLE patients.

Expression of the p21 ras protooncogene is reported to be increased in animal models and in patients with SLE. However, the expression of p21ras regulatory elements has not been determined. We determined the expression of p21ras, and its regulatory elements p120-ras-GAP and hSOS, in PBMC of 10 patients with inactive SLE (mean SLEDAI score 1.8+/-0.53) and 10 age- and sex-matched healthy controls. No difference was found between the two groups in the levels of p21 ras (3760+/-513 and 3367+/-335, P=0.25) and ras-GAP (1048+/-261 and 1534+/-247, P=0.11) in patients and controls, respectively. In contrast, levels of hSOS were significantly decreased in patients as compared to controls: 955+/-218 and 2306+/-327, P = 0.002, respectively. The mitogen-induced proliferative response was comparable in the two groups: SI 20.8+/-4.2 and 15.03+/-4.9, P=0.135, in patients and controls, respectively. Taken together, our data demonstrate that nonactive SLE patients are characterized by reduced hSOS expression and underscore the need for a comprehensive evaluation of p21ras pathway in these patients.

Adult↗

PubMed1999

Immunological abnormalities in primary APS evolving into SLE: 6 years follow-up in women with repeated pregnancy loss.

We have performed a prospective study to determine the prevalence of immunological abnormalities and the evolution from primary antiphospholipid syndrome (APS) into systemic lupus erythematosus (SLE) in women who had had unexplained repeated pregnancy loss (PL) and APS. Of 105 women with abortions or fetal deaths, 33(31%) fulfilled criteria for APS. Among these patients with primary APS, 24% had antinuclear antibodies (ANA), 91% had elevated circulating immune complexes (CIC), 70% had low total haemolytic complement (CH100), 52% had low levels of complement 4 (C4) and 30% had low levels of complement 3 (C3), in a significantly higher prevalence than women whose pregnancies were successful (control group). Through out a 6 y follow-up, 3 (9%) of the patients with APS who had autoimmune related abnormalities when entered into the study developed features of lupus like disease (LLD) or fullblown SLE. Our findings suggest that women with unexplained repeated PL with APS who presented with positive ANA, high levels of CIC, low levels of CH100, C3 and C4, may define a subset of patients exhibiting immunological alterations similar to those of SLE. These parameters may help in the assessment of prognosis in APS patients with PL. Those patients should be carefully surveyed with regard to the development of connective tissue diseases.

Abortion, Spontaneous↗

PubMed1999

Human Fc gamma receptor IIA (FcgammaRIIA) genotyping and association with systemic lupus erythematosus (SLE) in Chinese and Malays in Malaysia.

SLE is an autoimmune and polygenic disorder characterized by an accumulation and deposition of immune complexes. Several studies have indicated differential impact of FcgammaR polymorphism genotypes in different ethnic groups studied. The Fc receptor for IgG class IIA gene (FcgammaRIIA) occurs in two allelic forms. The allele FcgammaRIIA-H131 encodes a receptor with a histidine at the 131 amino acid position; the other allele FcgammaRIIA-R131 encodes an arginine. This polymorphism is believed to determine the affinity of the receptor for hIgG2 in immune complexes. FcgammaRIIA-H131 has a higher capacity for hIgG2 compared to FcgammaRIIA-R131 as measured by in vitro studies of insoluble immune complex clearance. We have investigated the polymorphism for FcgammaRIIA using a novel polymerase chain reaction-allele specific primer (PCR-ASP) method designed specifically to distinguish the two allelic forms. Our studies were based on 175 Chinese and 50 Malays SLE patients as well as 108 and 50 ethnically matched healthy controls for the respective groups. Analysis of the data (chi2 test with Yates correction factors and odds ratios) revealed that there were no significant differences between SLE patients and controls. We have not found evidence of a protective effect conferred by FcgammaRIIA-H131 in the ethnic groups studied.

Alleles↗

PubMed2003

Novel Approaches to Therapy for SLE.

Systemic lupus erythematosus (SLE) is an autoimmune disease manifested by multi-organ involvement and elevated titers of anti-DNA antibodies. Current therapies for SLE are broadspectrum, and include steroids and immunosuppressive cytotoxic agents that are counterbalanced by the toxicity and side effects of the medications. One of the goals is to target therapies by altering specific known mechanisms of inflammation and autoimmunity. Although the inciting antigen is still unknown in SLE, it may be possible to alter the regulation of the immune response by targeted molecular therapy. Methods under investigation, which may be beneficial, are manipulation of second-signal stimulation of the immune response (anti-CD40L), manipulation of cytokines (monoclonal anti-IL-10), inducing tolerance by administration of blocking peptides (LJP394), and the manipulation of idiotypes (IVIg). In this article, we also discuss modalities that are steroid-sparing (MTX), and selective immunosuppression (stem-cell restoration and MMF). We review the ongoing literature from 2000-2002, utilizing the MEDLINE search. Controlled trials, open trials, and trials in phase I and II have been included, and anecdotal reports were excluded. The major advances have been with mycophenolate mofetil (MMF) and LJP 394.

Autoimmunity↗

PubMed1995

Kidney disease in systemic lupus erythematosus (SLE) of children--morphometric analysis of kidneys from autopsy cases.

We have investigated the histopathological changes of kidney from 16 autopsy cases of children with systemic lupus erythematosus (SLE) using morphometric and immunohistochemical methods. These 16 cases accounted for 61% of the child autopsy cases with SLE registered in the data base "Annual of the Pathological Autopsy Cases in Japan" during the nine years from 1984 to 1992. Based on the histologic and morphometric findings, we divided the SLE-associated renal disease into three types: glomerular (3 cases), vascular (3 cases) and non-renal (10 cases) types. The glomerular and vascular types had renal lesions, while in the non-renal the main changes were found in extrarenal tissues. Of the 16 cases examined, three showed diffuse proliferative glomerulonephritis, with one of the three having crescentic formations in the glomeruli. Two of the three had wire-loop lesions. Recently the crescentic or wire-loop lesions are rarely experienced even in renal biopsy and autopsy of adult cases. The vascular type was characterized by necrotizing angiitis (1 case) and severe intimal thickening of interlobular arteries (2 cases), but they had no advanced glomerular lesion. Morphometric methods allowed us to demonstrate that the severity of arterial lesions, especially intimal thickening, does not correlate with that of glomerular lesions in children.

Adolescent↗

PubMed1996

[A case of the "shrinking lung syndrome" in SLE--improvement with corticosteroid therapy].

A 56-year-old Japanese woman had a 8-year history of systemic lupus erythematosus (SLE) with recurrent flares. When she was 48 years old, she was diagnosed as having SLE on the basis of fever, polyarthritis, oral ulcers, leukopenia, and positive anti-DNA antibody. Three years later she developed pericarditis and pleuritis, that were improved with treatment with 30 mg of prednisone a day. With tapering of prednisone dose to 9 mg a day in January 1993, she was admitted due to shortness of breath on exertion. Chest radiograph revealed bilateral elevated diaphragms and sluggish movement with clear lung field. Pulmonary function tests showed restrictive defect with a vital capacity 38% of predicted value. A diagnosis of "shrinking lung syndrome" was made. Simultaneously, blood test revealed leukopenia, elevated red cell sedimentation rate, and elevated anti-DNA antibody titer. Therefore, we suspected this pulmonary involvement was related to lupus flare-up. Treatment with 20 mg of prednisone a day resulted in resolution of the patient's dyspnea and in improvement of her vital capacity. Corticosteroid therapy for acute "shrinking lung syndrome" in active SLE can improve symptoms and pulmonary function.

Acute Disease↗

PubMed1981

Platelet kinetics in systemic lupus erythematosus (SLE), with special reference to corticosteroid and azathioprine therapy.

Duplicate platelet survival studies were carried out on 10 patients with SLE. At the time of the first study 5 of them (group I) were untreated and the remaining 5 (group II) were receiving corticosteroid (CS) therapy. The second study was performed while group I patients received CS and group II patients CS + azathioprine (AT) treatment. Untreated SLE patients were shown to have normal values for platelet mean life-span (MLS) and platelet production rate. CS and AT treatment did not affect either platelet MLS or platelet production rate. The present study also provides further evidence that a state of compensated thrombocytolysis is not present in SLE.

Adult↗

PubMed1983

Heterogeneity of antilymphocyte antibody in SLE and its correlation with disease activity.

The cytotoxic activities of individual lupus sera were demonstrated against T gamma cells, T gamma (-) cells and B cells. Immunoglobulin classes were also determined in these antilymphocyte antibodies (ALA) in SLE. T gamma-specific ALA and B-cell-specific ALA were almost equally distributed as regards IgG-dominant type, mixed IgG and IgM type and IgM dominant type, while IgM dominant type was predominant in T gamma (-)-specific ALA. Only the IgG type of T gamma-specific ALA among these ALA was significantly associated with clinical parameters, including hypocomplementemia, elevated immune complex levels and high anti-double-stranded (ds) DNA titres. Serial studies on ALA in a typical case of SLE were performed. Active clinical signs were associated with elevated cytotoxicities of IgG type of T gamma-specific ALA and with relatively low cytotoxicities of the IgM type, whereas after massive corticosteroid therapy, these signs disappeared in tact with the reduction in cytotoxic activities of IgG type of the ALA and the relative rise in cytotoxicities of IgM type of the ALA. These results suggested that IgG class of T gamma-specific ALA seemed to play a major role among several types of ALA in SLE.

Antibodies, Antinuclear↗

PubMed1985

Prevalence and mortality rates of systemic lupus erythematosus and causes of death in SLE patients in Finland.

Nationwide prevalence and mortality rates in systemic lupus erythematosus (SLE) were estimated using a computer file of all hospital discharge records and cause of death statistics from 1972 to 1978. Age-specific and sex-specific prevalence rates obtained from 1976 to 1978 and mortality rates from 1972 to 1978. In December 1978 the prevalence of SLE was 28:100 000. The overall mortality rate was 4.7 per million person-years in 1972-78. Active lupus nephritis, vascular events and infections were the most frequent causes of death in SLE patients.

Adolescent↗

PubMed1987

Methodology of validation of criteria for SLE.

The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunological knowledge and improve disease classification. The 1982 revised criteria include fluorescence antinuclear antibody (FANA) and antibody to native DNA and Sm antigen. Some criteria involving the same organ systems were aggregated into single criteria. Raynaud's phenomenon and alopecia were not included because of low sensitivity and specificity. The new criteria were 96% sensitive and 96% specific when tested with SLE and control patient data gathered from 18 participating clinics. When compared with the 1971 criteria, the 1982 revised criteria showed gains in sensitivity and specificity. Development of criteria sets is inherently circular, since the standard of evaluation must consist of the clinical diagnosis. Validation of the diagnosis over time can reduce but not eliminate the circularity. Selection of controls also influences sensitivity and specificity and, ideally, criteria should be developed with controls who represent particularly difficult problems of discrimination. Because the low "prior probability" of the diagnosis in many populations will result in a large number of false positives, preference in general should be for specificity over sensitivity. The 1982 criteria were developed from 177 patients with SLE and 162 control patients from 18 institutions using the next age-, race- and sex-matched patient seen as the control whenever possible. Results of a training sample were validated against a test sample of patients and against 500 patients from other databanks.

Humans↗

PubMed1987

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.

Adult↗

PubMed1995

Detection of antibodies to HIV-1 gp41- and HLA class II antigen-derived peptides in SLE patients.

A role for viruses in the pathogenesis of human autoimmune diseases has long been suspected but has not yet been proven. Highly conserved homologous regions has been reported in the carboxy terminus of human immunodeficiency virus (HIV)-1 gp41 (amino acids 838-844) and the amino-terminal of the beta chain of all human HLA class II antigens (amino acids 19-25). This molecular mimicry between HIV-1 and HLA class II antigens may lead to the generation of autoantibodies and may contribute to the development of autoimmune phenomena in HIV infected patients. We detected antibodies for these homologous peptides from HLA class II and HIV-1 gp41 in systemic lupus erythematosus (SLE) patients without HIV-1 infection. Thirty-seven percent of the SLE patients had IgM antibodies reacting with both HLA class II- and HIV-1 gp41-derived peptides. These results suggest the possibility that a retrovirus may be one of the causative agents of SLE.

Adult↗