scholarly journals Chorea as a First Manifestation in Young Patients with Systemic Lupus Erythematosus who Was Initially Diagnosed with Rheumatic Fever

2012 ◽  
Vol 5 ◽  
pp. CCRep.S9143 ◽  
Author(s):  
Jamal A Albishri
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Rheumatic Fever ◽  
Lupus Erythematosus ◽  
Young Patients ◽  
Systemic Lupus ◽  
Incorrect Diagnosis ◽  
Rare Manifestation ◽  
Specific Increase ◽  
Anti Phospholipid Syndrome

Chorea is a rare manifestation of systemic lupus erythematosus (SLE). We report on a young patient with chorea who was diagnosed initially with rheumatic fever. Follow up and further evaluation confirmed the diagnosis of SLE and anti-phospholipid syndrome. Of special interest were the negative antiphospholipid (aPL) antibodies and the initial diagnosis of rheumatic fever which is still not uncommon problem in our region. The rarity of such presentation with joint and non specific increase of antistreptolysin O (ASO) titer might be the factors that led to an incorrect diagnosis. Early diagnosis and treatment of SLE and anti-phospholipid syndrome are very crucial and should be considered with such presentation.

scholarly journals PReS-FINAL-2308: Catatonia due to systemic lupus erythematosus: characteristics and 36 months follow up of this rare manifestation of disease

2013 ◽  
Vol 11 (S2) ◽  
Author(s):  
V Selmanovic ◽  
T Avčin ◽  
S Mesihović-Dinarević ◽  
A Omerčahić-Dizdarević ◽  
L Oruč ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Rare Manifestation

scholarly journals THU0284 PREVALENCE OF NEUROPSYCHIATRIC LUPUS IN PSYCHOSIS PATIENTS WITH A POSITIVE ANTINUCLEAR ANTIBODY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 369.1-369
Author(s):  
M Spies ◽  
J Gutjahr-Holland ◽  
J. V. Bertouch ◽  
A Sammel
Keyword(s):  
Mental Health ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Antinuclear Antibody ◽  
Systemic Lupus ◽  
Positive Antinuclear Antibody ◽  
Rare Manifestation

Background:Psychosis is a rare manifestation of Neuropsychiatric Systemic Lupus Erythematosus (NPSLE). Patients with SLE may have Psychosis as part of their initial presentation of disease1. Current guidelines do not make a recommendation regarding the use of Antinuclear Antibody (ANA) in the assessment of patients with psychosis2. There is limited evidence assessing the utility of ANA testing in this setting.Objectives:Primary objective: Determine the prevalence of NPSLE in patients admitted to a mental health service with a diagnosis of a psychosis, who have had a positive antinuclear antibody test.Secondary objectives: Determine the frequency and proportion of positive ANA testing in this patient group. Determine the pattern and titres of positive ANAs. Determine the subsequent investigation, referral and diagnosis of patients with positive ANAs.Methods:Retrospective chart review of patients admitted to a mental health service of two metropolitan tertiary referral centres, Prince of Wales Hospital (POWH) and Royal Prince Alfred Hospital (RPAH), with a diagnosis of psychosis who had been tested for ANA. Patients were identified using their electronically entered diagnosis based on the International Classification of Disease3codes. Assessment of patient data for SLE used the 2019 ACR/EULAR classification criteria4. Decisions regarding attribution of psychosis related events to SLE follows the criteria used by Bortoluzzi et al5.Results:Between 1stof January 2010 and 31stof March 2018 there were 5585 (POWH) and 4620 (RPAH) mental health admission with an ICD diagnosis of psychosis representing 2451 and 2315 individual patients. 449/2451 (18%) and 462/2315 (20%) patients were tested for ANA. 78/449 (17%) and 57/462 (12%) were positive. Discharge data was available for all patients and long-term follow up data was completed for 53/78 (81% - POWH) patients and 50/57 (88% - RPAH). The mean follow-up time 43 ± 23 months and 51 ± 29 months respectively.At discharge there were four patients who met 2019 ACR/EULAR for SLE. Of these, two patients met criteria for NPSLE. One was diagnosed clinically and treated specifically for NPSLE with intravenous methylprednisolone and rituximab.There were no additional diagnoses of SLE or NPSLE clinically or by criteria found in the available follow up data. Hence the overall prevalence of NPSLE in patients admitted with psychosis was 1.3%, 95%CI [0,6.9%] and 1.8%, 95%CI [0,9.4%] respectively.Conclusion:The prevalence of neuropsychiatric lupus in patients with psychosis and a positive ANA was 1/78 and 1/57 a two tertiary referral centres. This study expands significantly on the limited evidence available as to the expected outcomes of a positive ANA test in a patient with psychosis.References:[1]Pego-Reigosa JM, Isenberg DA. Psychosis due to systemic lupus erythematosus: characteristics and long-term outcome of this rare manifestation of the disease. Rheumatology (Oxford). 2008; 47:1498–502.[2]National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. London: NICE; 2014. Clinical guideline CG178.[3]World Health Organization. (2004). ICD-10: international statistical classification of diseases and related health problems: tenth revision, 2nd ed.[4]Aringer M, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2019; 71(9): 1400–1412.[5]Bortoluzzi A, et al. Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus. Rheumatology. 2015; 54: 891-898.Acknowledgments:Gordana Popovic, Statistical Consultant, Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia.Disclosure of Interests:None declared

scholarly journals When systemic lupus erythematosus affects vision: a rare presentation of this condition

2020 ◽  
Vol 13 (1) ◽  
pp. e229382
Author(s):  
Tiago Gama Ramires ◽  
Luísa Vieira ◽  
Nuno Riso ◽  
Maria Francisca Moraes-Fontes
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Blurred Vision ◽  
Rare Presentation ◽  
Complement Components ◽  
Oral Ulcers ◽  
Dsdna Antibody ◽  
Rare Manifestation ◽  
Retinal Vascular Tortuosity

A 23-year-old woman with fever, oral ulcers, arthalgias and weight loss of 2-week duration suddenly developed blurred vision, with reduced visual acuity, cotton wool exudates and retinal vascular tortuosity. Laboratory testing revealed anaemia, lymphopaenia, positive antinuclear antibody and high anti-dsDNA antibody titre with low complement components. There was no evidence of infection, clinching the diagnosis of lupus retinopathy. Steroid therapy alone was highly effective and was also accompanied by a normalisation of haemoglobin and lymphocyte counts, after which azathioprine was added. Hydroxychloroquine was introduced after resolution of retinal changes. Immunosuppressive therapy was progressively tapered over the course of 12 months and then discontinued, and the patient remains in remission 48 months after the initial presentation. Our patient exemplifies a very rare manifestation of systemic lupus erythematosus. We emphasise the importance of its early detection and complexity of treatment in order to reduce visual morbidity.

Lower P1NP serum levels: a predictive marker of bone loss after 1 year follow-up in premenopausal systemic lupus erythematosus patients

2014 ◽  
Vol 26 (2) ◽  
pp. 459-467 ◽  
Author(s):  
L. P. C. Seguro ◽  
C. B. Casella ◽  
V. F. Caparbo ◽  
R. M. Oliveira ◽  
A. Bonfa ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Bone Loss ◽  
Lupus Erythematosus ◽  
Predictive Marker ◽  
Serum Levels ◽  
Systemic Lupus

scholarly journals The Impact of T Cell Vaccination in Alleviating and Regulating Systemic Lupus Erythematosus Manifestation

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Liuye Huang ◽  
Yuan Yang ◽  
Yu Kuang ◽  
Dapeng Wei ◽  
Wanyi Li ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
T Cells ◽  
T Cell ◽  
Side Effects ◽  
Lupus Erythematosus ◽  
Clinical Symptoms ◽  
Systemic Lupus ◽  
T Cell Vaccination ◽  
Dna Antibodies

Objective. Systemic lupus erythematosus (SLE) is an autoimmune disease identified by a plethora of production of autoantibodies. Autoreactive T cells may play an important role in the process. Attenuated T cell vaccination (TCV) has proven to benefit some autoimmune diseases by deleting or suppressing pathogenic T cells. However, clinical evidence for TCV in SLE is still limited. Therefore, this self-controlled study concentrates on the clinical effects of TCV on SLE patients. Methods. 16 patients were enrolled in the study; they accepted TCV regularly. SLEDAI, clinical symptoms, blood parameters including complements 3 and 4 levels, ANA, and anti-ds-DNA antibodies were tested. In addition, the side effects and drug usage were observed during the patients’ treatment and follow-up. Results. Remissions in clinical symptoms such as facial rash, vasculitis, and proteinuria were noted in most patients. There are also evident reductions in SLEDAI, anti-ds-DNA antibodies, and GC dose and increases in C3 and C4 levels, with no pathogenic side effects during treatment and follow-up. Conclusions. T cell vaccination is helpful in alleviating and regulating systemic lupus erythematosus manifestation.

Cerebrospinal fluid orexin-A levels in systemic lupus erythematosus patients presenting with excessive daytime sleepiness

Lupus ◽  
2018 ◽  
Vol 27 (11) ◽  
pp. 1847-1853 ◽  
Author(s):  
K Suzuki ◽  
M Miyamoto ◽  
T Miyamoto ◽  
T Matsubara ◽  
Y Inoue ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cerebrospinal Fluid ◽  
Lupus Erythematosus ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Acute Stage ◽  
Systemic Lupus ◽  
Orexin A ◽  
Hypothalamic Lesions

Objective Involvement of the hypothalamus is rare in patients with systemic lupus erythematosus (SLE). In this study, we measured cerebrospinal fluid (CSF) orexin-A levels in SLE patients with hypothalamic lesions to investigate whether the orexin system plays a role in SLE patients with hypothalamic lesions who present with excessive daytime sleepiness (EDS). Methods Orexin-A levels were measured in CSF from four patients with SLE who presented with hypothalamic lesions detected by MRI. Three patients underwent repeated CSF testing. All patients met the updated American College of Rheumatology revised criteria for SLE. Results Tests for serum anti-aquaporin-4 antibodies, CSF myelin basic protein and CSF oligoclonal bands were negative in all patients. All patients presented with EDS. Low to intermediate CSF orexin-A levels (92–180 pg/ml) were observed in three patients in the acute stage, two of whom (patients 1 and 2) underwent repeated testing and showed increased CSF orexin-A levels, reduced abnormal hypothalamic lesion intensities detected by MRI and EDS dissipation at follow-up. In contrast, CSF orexin-A levels were normal in one patient (patient 4) while in the acute stage and at follow-up, despite improvements in EDS and MRI findings. Patient 4 showed markedly increased CSF interleukin-6 levels (1130 pg/ml) and a slightly involved hypothalamus than the other patients. Conclusions Our findings suggest that the orexinergic system has a role in EDS in SLE patients with hypothalamic lesions. Furthermore, cytokine-mediated tissue damage might cause EDS without orexinergic involvement.

scholarly journals Risk factors for progression of carotid intima-media thickness in patients with systemic lupus erythematosus: protocol for an observational cohort study in China

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030721
Author(s):  
Haiyu Pang ◽  
Yicong Ye ◽  
Faming Ding ◽  
Mengtao Li ◽  
Xinglin Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Informed Consent ◽  
Lupus Erythematosus ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Systemic Lupus ◽  
Media Thickness ◽  
Artery Disease

IntroductionAccelerated atherosclerosis is a major complication of systemic lupus erythematosus (SLE), and it leads to increased cardiovascular morbidity and mortality in patients with SLE. This study aimed to investigate the natural progression of carotid intima-media thickness (CIMT), and to examine the risk factors for progression of CIMT and atherosclerotic plaques based on a Chinese SLE cohort.Methods and analysisParticipants were continuously enrolled as outpatients of the Department of Rheumatology in Peking Union Medical College Hospital (PUMCH) from October 2013 to December 2016. Inclusion criteria were as follows: (1) age ≥18 years, (2) fulfilment of clinical classification criteria of SLE and (3) provision of signed written informed consent. Patients with clinically overt coronary artery disease, a history of cardiovascular disease (previous stroke, heart failure, myocardial infarction, angina or symptomatic peripheral artery disease) and malignancy, and pregnant/lactating women were excluded. The primary outcome is progression of CIMT from baseline. A total of 440 patients with SLE will be enrolled. Participants will receive follow-up surveys ~5 years after their baseline visit. A standard structural survey form, including demographic data, medical history, clinical and laboratory assessments and CIMT measurement, is planned for data collection at baseline and follow-up. The risk prediction model for progression of CIMT will be created by using a mixed effect model.Ethics and disseminationThe study protocol was approved by the institutional review board of PUMCH (S-599). Informed consent was obtained from all participants according to the Declaration of Helsinki on Biomedical Research Involving Human Studies. All data will be managed confidentially according to guidelines and legislation. Dissemination will include publication of scientific papers and/or presentations of the study findings at international conferences.

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