scholarly journals Risk Factors of Glucocorticoid-Induced Diabetes Mellitus in Systemic Lupus Erythematosus

2013 ◽  
Vol 2 (2) ◽  
pp. 39-43
Author(s):  
Mojdeh Zabihi Yeganeh ◽  
Saeideh Sadeghi
Keyword(s):  
Diabetes Mellitus ◽  
Systemic Lupus Erythematosus ◽  
Mycophenolate Mofetil ◽  
Family History ◽  
Old Age ◽  
Lupus Erythematosus ◽  
Glucocorticoid Therapy ◽  
High Dose ◽  
Systemic Lupus ◽  
History Of

Background: The aim of this study was to investigate the prevalence and associated factors of glucocorticoid-induced Diabetes mellitus (GIDM) in patients with systemic lupus erythematosus (SLE) under glucocorticoid therapy.Methods: Patients with SLE who had received high-dose glucocorticoid therapy (prednisolone≥1 mg/kg/day) at Rasoul Akram and Firoozgar hospitals were recruited during 2006-2011.Results: A total of 81 patients with SLE were evaluated. 21 patients (25.9%) of them developed GIDM after high-dose glucocorticoid therapy. Univariate analysis of data showed that old age, family history of diabetes mellitus (DM) and use of Mycophenolate mofetil were factors that would increase the likelihood of GIDM.Conclusion: In summary, GIDM was developed among 25.9% of patients with SLE after high-dose glucocorticoid therapy. Old age, family history of DM and use of Mycophenolate mofetil were determined to be factors responsible for increasing the risk of developing GIDM.

scholarly journals Family history of systemic lupus erythematosus and risk of autoimmune disease: Nationwide Cohort Study in Denmark 1977–2013

Rheumatology ◽  
2017 ◽  
Vol 56 (6) ◽  
pp. 957-964 ◽  
Author(s):  
Constance Jensina Ulff-Møller ◽  
Jacob Simonsen ◽  
Kirsten Ohm Kyvik ◽  
Søren Jacobsen ◽  
Morten Frisch
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Family History ◽  
Autoimmune Disease ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
History Of

Psychiatric Problems in Systemic Lupus Erythematosus

1976 ◽  
Vol 128 (5) ◽  
pp. 442-445 ◽  
Author(s):  
A. MacNeill ◽  
D. M. Grennan ◽  
D. Ward ◽  
W. C. Dick
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
High Dose ◽  
Systemic Lupus ◽  
System Disease ◽  
History Of ◽  
Psychiatric Complications ◽  
A Minor ◽  
Psychiatric Manifestations ◽  
Psychiatric Problems

SummaryFour patients with systemic lupus erythematosus (SLE) are described in whom there were major psychiatric complications. Two of these patients had cerebral lupus with psychiatric manifestations of the disease together with other features of disease activity and responding to treatment with high dose steroids. The first of these had had a ten-year history of recurrent episodes of depression before other features of the disease became evident; in the second patient recurrent psychotic episodes occurred after the onset of typical multi-system disease. The third patient had had a minor cerebro-vascular accident four years before other features of SLE became manifest, and cerebral deterioration later on in her life was probably due to hypertensive cerebro-vascular disease secondary to the renal disease of SLE. The fourth patient, a young man, had had recurrent episodes of depression and aggressive behaviour for several years and committed suicide at the age of 33.

Dancelike Movements in a Patient With a History of Rash

2021 ◽  
pp. 113-115
Author(s):  
Andrew McKeon
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Family History ◽  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Cutaneous Lupus Erythematosus ◽  
Sun Exposure ◽  
Rapid Progression ◽  
Systemic Lupus ◽  
Neurology Clinic ◽  
History Of

A 67-year-old man visited the neurology clinic for new-onset, generalized, uncontrollable movements. His wife noticed onset of some unusual facial expressions and facial movements. This then evolved to him having some writhing movements of the left upper and left lower extremity. His speech and swallowing also became affected. He noted a tendency to bite his tongue, which was moving uncontrollably. Shortly before his neurology clinic visit, the same writhing movements of right-sided limbs developed. No cognitive or behavioral changes were reported. He had been diagnosed with cutaneous lupus erythematosus 5 years previously after a malar rash of his face developed after sun exposure. The patient had a strong family history of autoimmunity, with 3 sisters having systemic lupus erythematosus. On physical examination, he had marked chorea, hyperkinetic movements that were unpredictable. When he walked in the hallway, he had a narrow-based gait, with some mild upper extremity hyperkinetic movements. Because of the time course and the personal and family history of autoimmunity, autoimmune chorea was suspected. His cerebrospinal fluid demonstrated normal protein concentration, blood cell count, immunoglobulin G index and synthesis rate, and oligoclonal bands. Indirect immunofluorescence assays using HEp-2 substrate were positive for antinuclear antibody and Sjö‎gren syndrome-A antibody (anti-Ro). Autoimmune chorea was diagnosed in the context of a known history of a limited form of systemic lupus erythematosus. The patient received intravenous methylprednisolone infusions. Trimethoprim-sulfamethoxazole, double strength was given for Pneumocystis jirovecii prophylaxis. A rash developed, and the patient was determined to be sulfa allergic. Instead, he received atovaquone as prophylaxis. Three years later, the patient remained in remission from his chorea except for mild occasional hyperkinetic movements of his tongue. In adults, autoimmune chorea is the most common form of chorea after levodopa-induced dyskinesias and Huntington disease. Patients have a subacute onset of symptoms and rapid progression. Patients may have accompanying neuropsychiatric symptoms.

Intracranial Hemorrhage in Systemic Lupus Erythematosus Associated with an Autoantibody against Factor XIII

2002 ◽  
Vol 88 (12) ◽  
pp. 919-923 ◽  
Author(s):  
Pauline Velasco ◽  
John Hill ◽  
Karen Hoffmeister ◽  
Fredric Kaye ◽  
Laszlo Lorand
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Family History ◽  
Conformational Change ◽  
Young Woman ◽  
Intracranial Hemorrhage ◽  
Lupus Erythematosus ◽  
Factor Xiii ◽  
Systemic Lupus ◽  
History Of ◽  
Activation Peptides

SummaryIntracranial hemorrhage in a young woman with systemic lupus erythematosus necessitated two surgical evacuations. In the absence of a family history of bleeding, clot solubility in urea suggested a factor XIII (FXIII) inhibitor. The patient’s IgG bound well to the virgin and the thrombin-modified zymogen ensemble (A2B2 and A2’B2) and to the free rA2 but reacted poorly with the thrombin-modified rA2’. Since the IgG did not block the thrombin-catalyzed proteolysis of A subunits nor the dissociation of the A2’B2, its action might be to interfere with the release of activation peptides from the thrombincleaved zymogen, hindering the conformational change necessary for generating FXIIIa.Treatment with cryoprecipitate and cyclophosphamide arrested the hemorrhage and almost neutralized the antibody so that the patient’s clot became insoluble in urea and showed a close to normally cross-linked γ-γ and αn fibrin chain profile. Nevertheless, she still has detectable anti-FXIII antibody and may be at risk for hemorrhage.

scholarly journals POS0723 HERPES ZOSTER IN A MULTI-ETHNIC SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) COHORT: CLINICAL FEATURES AND RISK FACTORS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 611.2-612
Author(s):  
S. S. Shaharir ◽  
S. Rajalingham ◽  
R. Mohd ◽  
N. Kori ◽  
A. Jamil
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Mycophenolate Mofetil ◽  
Herpes Zoster ◽  
Lupus Erythematosus ◽  
Lower Risk ◽  
The Other ◽  
Systemic Lupus ◽  
History Of ◽  
Time Of Infection

Background:Systemic Lupus Erythematosus (SLE) patients are at risk of Herpes Zoster (HZ) infection due to the underlying immunosuppressed state. The reported incidence of HZ in SLE is 6 to 10-times higher than the general population.Objectives:To determine the clinical characteristics of SLE patients who develop Herpes Zoster (HZ) infection and their associated risk factors.Methods:Medical records review was performed on consecutive SLE patients in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from 2018 until 2019. Previous history of HZ and their demographic characteristics, clinical and medications used at the time of infection were recorded. Univariate and multivariate analyses were performed to compare the clinical and treatment characteristics between SLE patients with history of HZ and patients who had never had experienced HZ.Results:A total of 229 patients with predominantly Malay patients (n=123, 53.7%), followed by Chinese (n=90, 39.3%) and others (n=16, 7.0%) were included. A total of 37 patients had history of HZ (16.2%). Their mean age during HZ episode was 34.4 ± 13.8 years and their SLE disease duration was 68.7 ±57.1 months. More than half of them (n=21, 56.8%) developed HZ when the SLE disease was active with the mean dose of prednisolone at the time of infection was 20.7 ± 9.2 mg daily. A total of 21 HZ patients (56.8%) had ever received cyclophosphamide with the median interval of the last infusion was 6 (0.2-84) months. Almost half of the HZ patients (n=18, 48.6%) developed the infection while on cyclosporine A. Meanwhile, 4 (10.8%) were on azathioprine and mycophenolate mofetil respectively. Chinese patients tend to have HZ as compared to other ethnics (27% vs 41.7%), p=0.07. HZ occurred in a higher proportion among male patients (29%) as compared to female patients (14.1%), p=0.05. The use of azathioprine (10.8% vs 55.2%, p<0.01) and mycophenolate mofetil (10.8% vs 31.8%, p=0.009) were less associated with HZ. On the other hand, the use of cyclosporine A (48.6% vs 32.3%, p=0.05) and prednisolone ≥ 60mg daily (44.4% vs 28%, p=0.04) were associated with HZ. Higher HZ patients had hematological manifestation (81.1% vs 62.5%, p=0.04) and positive lupus anticoagulant (LA), 32.4% vs 14.6%, p=0.02. A forward logistic regression which included all factors with p<0.1 in the univariate analyses revealed that the use of prednisolone ≥ 60mg daily and hematological manifestation were the independent predictors of HZ with OR= 2.28 (95% C.I = 1.01-5.17), p=0.049 and OR= 2.78 (95% C.I = 1.09-7.04), p=0.03 respectively. The use of azathioprine was associated with a lower risk of HZ with OR 0.08 (95% C. I= 0.03-0.25), p=<0.01.Conclusion:Our study demonstrated the possible influence of male gender, Chinese ethnicity and disease characteristics such as hematological manifestation and lupus anticoagulant positivity with the occurrence of HZ. In addition, the use high dose oral prednisolone ≥ 60mg daily was the independent predictor of HZ while on the other hand, the use of azathioprine was associated with a lower risk of developing HZ as compared to other immunosuppressive agents. Further larger studies are needed to confirm these associations.References:[1]Chen D, Li H, Xie J, Zhan Z, Liang L, Yang X. Herpes zoster in patients with systemic lupus erythematosus: Clinical features, complications and risk factors. Exp Ther Med. 2017;14(6):6222-6228.Disclosure of Interests:None declared

scholarly journals Successful Treatment of Urticarial Vasculitis in a Patient With Systemic Lupus Erythematosus With Rituximab

2020 ◽  
Vol 13 ◽  
pp. 117954412096737
Author(s):  
Samar Alharbi ◽  
Jorge Sanchez-Guerrero
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Mycophenolate Mofetil ◽  
Lupus Erythematosus ◽  
Leukocytoclastic Vasculitis ◽  
Discoid Lupus Erythematosus ◽  
High Dose ◽  
Systemic Lupus Erythematous ◽  
Systemic Lupus ◽  
Urticarial Vasculitis ◽  
Dose Prednisone

Urticarial vasculitis is an eruption of erythematous wheals that clinically resemble urticaria but histologically show changes of leukocytoklastic vasculitis. In association with connective tissue disease it is most commonly seen complicating Systemic lupus erythematous (SLE) and, less often, Sjogren’s syndrome. Here, we report a 25-year-old woman who developed SLE in 1998. In May 2013 she presented with urticarial vasculitis; her skin biopsy was consistent with leukocytoclastic vasculitis. She also developed bilateral uveitis. She had most of the clinical and laboratory characteristics of hypocomplementic urticarial vasculitis syndrome (HUVS) which is difficult to be differentiated from SLE. She was treated with high-dose prednisone, Mycophenolate Mofetil (MMF), colchicine, and Dapsone but failed. We decided to give her Rituximab (RTX), her urticarial vasculitis and uveitis symptoms improved significantly. Unfortunately, later on she presented with severe discoid lupus. We started her on thalidomide and responded well. Our case highlights that Rituximab is a good option for severe refractory urticarial vasculitis and thalidomide is effective in treatment of discoid lupus erythematosus (DLE), and can be used safely in specialist rheumatological practice.

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