[Show abstract][Hide abstract] ABSTRACT: Patients with systemic lupus erythematosus (SLE) have a longer life expectancy. The occurrence of irreversible damage has become a major concern. The present study assessed damage progression in patients with SLE over a 2-year period and identified baseline features associated with damage accrual. Two hundred and twenty-one patients that fulfilled criteria for SLE and had a follow-up longer than 6 months were enrolled. Demographic, clinical, and immunological data were collected at baseline. Accumulated organ damage was scored using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SDI). Patients were prospectively followed and SDI assessment repeated at 2 years. At baseline 72 patients (33%) presented some irreversible damage, and after 2 years 53 had accrued new damage. The mean SDI for the whole cohort increased from 0.582 to 0.980. Damage progression was higher in ocular, cardiovascular, and musculoskeletal systems. Older age [OR = 1.045; 95% confidence interval (CI) 1.021-1.069; P = 0.03], presence of antiphospholipid antibodies (OR = 3.047; 95% CI 1.169-7.941; P = 0.02), steroid use (OR = 6.401; 95% CI 1.601-25.210; P = 0.008), azathioprine use (OR = 3.501; CI 1.224-10.012; P = 0.01), and hypertension (OR = 3.825; 95% CI 1.490-9.820; P = 0.005) were predictors of damage progression in multivariate analysis. Overall SDI increased over time, with some systems being affected more frequently. Demographic and clinical characteristics, co-morbidity, and treatment options may contribute to irreversible damage. It is necessary to determine whether the control of modifiable factors (e.g., hypertension and judicious use of medications) might prevent damage progression in SLE patients.
Annals of the New York Academy of Sciences 09/2009; 1173:822-8. · 4.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To characterize systemic lupus erythematosus (SLE) in Portuguese patients and to identify differences in diseases expression related to sex and ethnicity.
Retrospective cohort analysis of patients with SLE followed at five Rheumatology Departments between 1976 and 2006. Demographic data, diseases manifestations, medications used, co morbidity and damage scores were recorded.
Five hundred forty four patients were studied, 93% female, 89% Caucasians, with an average age at disease diagnosis of 35 years. The most frequent clinical features were musculoskeletal (91%), cutaneous and mucous membrane (90%) and the hematological involvement (58%). Renal diseases and serositis occurred more often in males while myositis was more common in black patients. Immunological features included the presence of anti-nuclear antibodies in 99% of the patients, anti-DNA (76%) anti-SSA (33%), anti-SSB (20%), anti-RNP (26%), anti-Sm (22%), anticardiolipine (31%) and lupus anticoagulant (21%). Anti-SSA, anti-RNP, and anti-Sm antibodies were significantly more prevalent among black patients. The presence and severity of damage measured by SLICC/ACR was similar between sexes and ethnicities. In multivariate analyses diseases duration and the presence of hypertension showed a positive association, while educational and antimalarials were negatively associated with the presence of damage.
In this cohort of Portuguese patients SLE present clinical features similar to those observed in other predominantly Caucasian populations, albeit a higher prevalence of anti-RNP and anti-Sm antibodies was observed. Some particular features were associated with male sex and African ethnicity. Some socio-demographic and clinical variables were associated with damage accrual.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
Immunoglobulin and complement deposits were demonstrated in vessels of the pleura and peritoneum in patients with Systemic Lupus Erythematosus (SLE), along with histologic evidence of vasculitis. The purpose of this work was to correlate a disease activity index with the presence or absence of pleural, pericardial or peritoneal fluid as well as with the values obtained for some haemorheological determinations.
METHOD AND MATERIALS
Twenty eight consecutive patients with confirmed diagnosis of SLE were included in the study. The patients were categorized according to their Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). An ultrasound examination was performed aiming the detection of pleural, pericardial or peritoneal fluid. Blood and plasma viscosity, red cell aggregation, red cell deformability and membrane fluidity were used as parameters of blood rheology. Pearson´s χ² test with Yate´s correction for continuity and Mann-Whitney U test were used for statistical analysis (SPSS 10.0, Inc.).
Fifteen (53.4%) patients had peritoneal, pericardial or pleural fluid. In those, the mean SLEDAI score was 11.1. In the patients with no fluid, the mean SLEDAI was 5.5 (pp=0.005). There is a tendency towards an association between elevated SLEDAI and an increase in plasma viscosity and red cell aggregation as well as a decrease in membrane fluidity.
The presence of peritoneal, pericardial or pleural fluid in SLE is associated with high disease activity as manifested by elevated SLEDAI, and can, by itself, be a relevant finding in patient management. Some haemorheological parameters can be abnormal in patients with high SLEDAI scores, a finding that might have an impact on the thromboembolic complications of SLE.
The presence of fluid in serosal cavities of patients with SLE may be an indicator of high disease activity and can have an impact in patient management. Haemorheological alterations in these patients might be related with already known thromboembolic complications.
Radiological Society of North America 2006 Scientific Assembly and Annual Meeting; 11/2006