Hepatitis Lupus in Systemic Lupus Erythematosus in Male Patients

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease characterized by autoantibodies against the cell nucleus and involves many organ systems in the body with unknown etiologies and various clinical manifestations, disease course and prognosis. SLE can be found at all ages, generally appearing at age 9-58 years with a peak at age 28 years. It is more common in women with a ratio of women to men 15: 1 to 22: 1. The highest incidence and prevalence of SLE was found in North America 23.2 / 100.000 population / year and 241 / 100.0000 population. In Indonesia, there has been an increase in visits to SLE patients from 17.9-27.2% in 2015 to 30.3-58% in 2017. One of the manifestations of SLE is hepatitis lupus, which is inflammation of the liver tissue. Lupus hepatitis can occur in 20-50% of patients with SLE. It was reported that a 20-year-old man presented with complaints of pain in the joints of the right and left hands which increased since 1 week. The patient also complained of reddish patches on the face, hair loss and mouth sores. Physical examination revealed anemic eye conjunctiva, malar rash, oral ulcer. During the joint examination, there was tenderness in bilateral MCP and PIP. The abdominal examination revealed hepatomegaly. Investigations revealed anemia, thrombocytopenia, increased liver function. Abdominal ultrasound revealed hepatomegaly. ANA profile examination was positive for anti RNP, anti-sm, and anti- ribosomal protein antibodies. The patient was diagnosed with Systemic Lupus Erythematosus with lupus hepatitis according to the ACR (American College of Rheumatology) criteria in which the patient had 6 criteria. The patient was given therapy with 2x125 mg of intravenous methyl prednisolone for 3 days and hydroxychloroquine 1x200 mg orally and other symptomatic drugs.

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THE CLINICAL, LABORATORY MANIFESTATIONS AND HISTOPATHOLOGY IN NEPHROTIC PATIENTS WITH LUPUS NEPHRITIS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.2.9 ◽

2018 ◽

pp. 52-58

Author(s):

Le Thuan Nguyen ◽

Bui Bao Hoang

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

Clinical Laboratory ◽

Activity Index ◽

Clinical Manifestations ◽

Systemic Lupus ◽

Cross Sectional ◽

Organ Systems ◽

Tubulointerstitial Lesions

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organ systems. The kidney appears to be the most commonly affected organ, especially nephrotic is a serious kidney injury. The clinical, laboratory manifestations and histopathology are very useful for diagnosis, provide the means of predicting prognosis and guiding therapy in nephrotic patients with lupus nephritis. Methods: Descriptive cross-sectional study of nephrotic patients with lupus treated in the Department of Nephrology Trung Vuong Hospital and Cho Ray Hospital between May/2014 and May/2017. Renal histopathological lesions were classified according to International Society of Nephrology/Renal Pathology Society - ISN/RPS ’s 2003. The clinical, laboratory manifestations and histopathological features were described. Results: Of 32 LN with nephritic range proteinuria cases studied, 93.7% were women. The 3 most common clinical manifestations were edema (93.8%), hypertension (96.8%) and pallor (68.9%), musculoskeletal manifestions (46.9%), malar rash (40.6%). There was significant rise in laboratory and immunological manifestions with hematuria (78.1%), Hb < 12g/dL (93.5%), increased Cholesterol (100%), and Triglycerid (87.5%), Creatinine > 1.4 mg/dL (87.5%), increased BUN 71.9%, ANA (+) 93.8%, Anti Ds DNA(+) 96.9%, low C3: 96.9%, low C4: 84.4%. The most various and severe features were noted in class IV with active tubulointerstitial lesions and high activity index. Conclusion: Lupus nephritis with nephrotic range proteinuria has the more severity of histopathological feature and the more severity of the more systemic organ involvements and laboratory disorders were noted. Key words: Systemic lupus, erythematosus (SLE) lupus nepphritis, clinical

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Systemic Lupus Erythematosus Disease: An Overview of the Clinical Approach to Pathogenesis, Diagnosis, and Treatment

Borneo Journal of Pharmacy ◽

10.33084/bjop.v4i2.1950 ◽

2021 ◽

Vol 4 (2) ◽

pp. 91-98

Author(s):

Saurabh Nimesh ◽

Md. Iftekhar Ahmad ◽

Shikhka Dhama ◽

Pradeep Kumar ◽

Muhammad Akram ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Immune System ◽

Chronic Disease ◽

Lupus Erythematosus ◽

The Body ◽

Clinical Approach ◽

Systemic Lupus Erythematosus Disease ◽

Systemic Lupus ◽

Organ Systems ◽

Novel Approaches

The systemic lupus erythematosus (SLE), commonly known as Lupus, is a rare and complex multisystem autoimmune disease where one’s immune system is overactive, and the body attacks its organ systems. SLE is a historically old disease described already in antiquity; it is an example of a chronic disease with physical, psychological, financial, and social implications for individuals diagnosed. It has inspired medical and basic biological scientists that focus on molecular biology, basic immunology, immunopathology, clinical science, genetics, and epidemiology. The syndrome is real in its existence-although hidden behind obstacles, cumbersome for patients and clinicians, and rebellious for scientists. There is currently no cure for SLE. The goal of treatment is to ease symptoms. This article will review information on the general approach to SLE therapy, focusing on currently approved therapies and novel approaches that might be used in the future.

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Cognitive and Psychiatric Manifestations of Childhood-Onset Systemic Lupus Erythematosus

Cognitive and Behavioral Abnormalities of Pediatric Diseases ◽

10.1093/oso/9780195342680.003.0009 ◽

2010 ◽

Author(s):

Deborah M. Levy ◽

Gail S. Ross

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Organ Damage ◽

Multiple Organ ◽

Childhood Onset ◽

Systemic Lupus ◽

Disease Manifestation ◽

American College Of Rheumatology ◽

Organ Systems ◽

Similar Disease

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of autoantibodies directed against multiple organ systems. Individuals with SLE may have disease of only one organ system or of many organ systems at one time during a “flare” of disease activity. Systemic lupus erythematosus is characterized by multiple flares and remissions, and flares may lead to end-organ damage. The diagnosis of SLE is generally made by fulfilling four out of 11 of the American College of Rheumatology (ACR) 1997 Revised Classification Criteria for SLE (Hochberg 1997). Although the 1997 revised criteria have not been validated, the earlier 1982 criteria (Tan et al. 1982) have a sensitivity of 96% and specificity of 100%in childhood-onsetSLE(cSLE) (Ferraz et al. 1994). See Table 3.1 for these criteria. Systemic lupus erythematosus has a prevalence rate of 500 per million persons in the U.S. population (Klippel 1997) but may be as high as 130 per 100,000 persons (Uramoto et al. 1999). Approximately 15% of all SLE has its onset in childhood (prior to 18 years of age). Systemic lupus erythematosus occurs more commonly in non-Caucasians, with greater severity of SLE in children and adult Latino and African Americans than in non-Latino Caucasians (Michet et al. 1979).The female predominance of SLE in adulthood (10:1 female-to-male ratio) is less pronounced in childhood, and the ratio prior to puberty is more likely to be 5:1 or even 3:1.The majority of cSLE cases have onset in the peripubertal age period (10–15 years), which continues to suggest a link between estrogen and other hormones on the development of SLE. Childhood-onset SLE differs from adult-onset SLE in that the frequency of renal disease is higher, and the incidence and prevalence of neuropsychiatric SLE (NPSLE) is probably greater (Tucker et al. 1995; Sibbit et al. 2002). Children require aggressive immunosuppression, which on a dose per kilogram of body weight is generally higher than that required by an adult to treat a similar disease manifestation. Immunosuppression often includes corticosteroids. At least in adults, corticosteroids do not appear to cause cognitive impairment (Carbette et al. 1986; Denburg et al. 1997; Carlomagno et al. 2000).

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IgM Anti-ß2Glycoprotein I Is Protective Against Lupus Nephritis and Renal Damage in Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.100650 ◽

2010 ◽

Vol 38 (3) ◽

pp. 450-453 ◽

Cited By ~ 32

Author(s):

TARANEH MEHRANI ◽

MICHELLE PETRI

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Protective Effect ◽

Lupus Erythematosus ◽

Renal Damage ◽

Damage Index ◽

Clinical Manifestations ◽

Systemic Lupus ◽

American College Of Rheumatology ◽

Glycoprotein I

Objective.Antibodies to ß2glycoprotein I (IgG and IgM isotypes) have recently been added to the laboratory criteria of the revised antiphospholipid syndrome classification criteria. We investigated whether IgM anti-ß2-glycoprotein I (anti-ß2-GPI) is associated with clinical manifestations of systemic lupus erythematosus (SLE).Methods.Anti-ß2-GPI was measured in 796 patients with SLE (93% women, 53% white, 38% African American, mean age 45 yrs). IgM anti-ß2-GPI (> 20 phospholipid units) was found in 16%. Associations were determined with clinical manifestations of SLE and with components of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index.Results.As expected, IgM anti-ß2-GPI was highly associated with both the lupus anticoagulant and with anticardiolipin. It was associated with transient ischemic attack (OR 2.64, p = 0.04), but not significantly with venous or arterial thrombosis. IgM anti-ß2-GPI was protective against lupus nephritis (OR 0.54, p = 0.049), renal damage (p = 0.019), and hypertension (OR 0.58, p = 0.008). This protective effect remained after adjustment for ethnicity.Conclusion.In SLE, IgM anti-ß2-GPI is not associated with thrombosis but is protective against lupus nephritis and renal damage. “Natural” autoantibodies of the IgM isotype may have a protective effect.

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The diagnostic accuracies of the 2012 SLICC criteria and the proposed EULAR/ACR criteria for systemic lupus erythematosus classification are comparable

Lupus ◽

10.1177/0961203319846388 ◽

2019 ◽

Vol 28 (6) ◽

pp. 778-782 ◽

Cited By ~ 11

Author(s):

Ö Dahlström ◽

C Sjöwall

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Diagnostic Sensitivity ◽

Systemic Autoimmune Disease ◽

Systemic Lupus ◽

American College Of Rheumatology ◽

Acr Criteria ◽

Independent Evaluation ◽

Organ Systems ◽

Sensitivity Specificity

In a joint effort, the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) recently proposed new criteria for the classification of systemic lupus erythematosus (SLE) with the overarching goal to identify potential participants for clinical studies. Herein, we present the first independent evaluation of these criteria in comparison with older classification grounds using an adult Scandinavian study population of confirmed SLE cases and individuals with SLE-mimicking conditions. We included 56 confirmed SLE cases meeting the 1982 ACR criteria (ACR-82) and/or the Fries “diagnostic principle” (antinuclear antibodies on at least one occasion plus involvement of at least two defined organ systems) and 55 controls with possible systemic autoimmune disease, including the presence of any SLE-related autoantibody. The proposed EULAR/ACR criteria showed a diagnostic sensitivity of 93% (95% confidence interval (CI), 0.83–0.98) compared with 83% (95% CI, 0.72–0.91) for the updated ACR criteria from 1997. The diagnostic accuracy of all tested classification grounds was fairly similar, achieving approximately 85%. However, the disease specificity of the EULAR/ACR criteria reached only 73% (95% CI, 0.59–0.83), which was comparable with the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria, 75% (95% CI, 0.61–0.85), but clearly lower than for ACR-82, 94% (95% CI, 0.83–0.99). In this first independent evaluation of a limited number of cases, we found comparable results with respect to diagnostic sensitivity, specificity and accuracy regarding the SLICC-12 and the proposed EULAR/ACR classification criteria. However, their specificity for SLE appeared to be lower compared with ACR-82.

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MANIFESTASI NEUROPSIKIATRIK PADA LUPUS ERITEMATOSUS SISTEMIK DI RSUD DR. SOETOMO SURABAYA

Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia ◽

10.52386/neurona.v36i4.88 ◽

2020 ◽

Vol 36 (4) ◽

Author(s):

Nadya Rinda Eka Rana ◽

Awalia Awaliah ◽

Yetti Hernaningsih ◽

Hanik Badriyah Hidayati

Keyword(s):

Systemic Lupus Erythematosus ◽

Cerebrovascular Disease ◽

General Hospital ◽

Lupus Erythematosus ◽

Clinical Manifestations ◽

Systemic Lupus ◽

Neuropsychiatric Manifestation ◽

American College Of Rheumatology ◽

Common Diagnosis ◽

Neuropsychiatric Manifestations

NEUROPSYCHIATRIC MANIFESTATION AMONG SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS IN GENERAL HOSPITAL SURABAYAABSTRACTIntroduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with unknown causes and extensive clinical manifestations and diverse disease pathways. The clinical manifestations of SLE are very diverse, including the involvement of the nervous system and psychiatric syndrome (neuropsychiatric).Aims: To describe clinical neuropsychiatric manifestations of patients with SLE in Soetomo General Hospital Surabaya.Methods: This was a cross-sectional study based on medical record data on all SLE patients treated at Dr. Soetomo Hospital Surabaya, from January-December 2017. Neuropsychiatric manifestations assessment were based on the nomenclature of the American College of Rheumatology (ACR) in 1999.Results: There were 49 patients, mostly women (98%) with mean age 30,8±10,2 years old. Neurological manifestation was the 3rd most common diagnosis (43%) after hematologic disorder (73.5%) arthritis (53.1%). The manifestations of neuropsychiatric manifestation were mainly seizures (40.8%), headache (34.7%), cerebrovascular disease (26.5%), acute confusional state (20.4%), cognitive dysfunction (6.1%), and polyneuropathy (8.2%).Discussion: The most common neuropsychiatric clinical features in SLE patients are seizures, headache, cerebrovascular disease, and acute confusional state.Keywords: Lupus neuropsychiatry, prevalence, systemic lupus erythematosusABSTRAKPendahuluan: Lupus eritematosus sistemik (LES) merupakan penyakit inflamasi autoimun kronik yang belum diketahui penyebabnya dengan perjalanan penyakit yang luas. Manifestasi klinis LES sangat beragam, antara lain keterlibatan sistem saraf dan sindrom psikiatri (neuropsikiatri).Tujuan: Untuk mengetahui manifestasi neuropsikiatrik pasien dengan LES di RSUD Dr. Soetomo, Surabaya.Metodologi: Penelitian potong lintang berdasarkan data rekam medik terhadap semua pasien LES yang dirawat di RSUD Dr. Soetomo, Surabaya, pada bulan Januari hingga Desember 2017. Manifestasi neuropsikiatrik dinilain berdasarkan nomenklatur American College of Rheumatology (ACR) tahun 1999.Hasil: Didapatkan 49 subjek yang hampir semuanya (98%) adalah perempuan dengan rerata usia 30,8±10,2 tahun. Gangguan neurologis merupakan ketiga tersering (43%) setelah gangguan hematologi (73,5%) dan artritis (53,1%). Manifestasi neuropsikiatri terutama kejang (40,8%), nyeri kepala (34,7%), penyakit serebrovaskular (26,5%), keadaan konfusi akut (20,4%), dan polineuropati (8,2%).Diskusi: Manifestasi klinis neuropsikiatri yang paling banyak dialami oleh pasien LES adalah kejang, nyeri kepala, penyakit serebrovaskular, dan keadaan konfusi akut.Kata kunci: Lupus eritematosus sistemik, manifestasi klinis, neuropsikiatri

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Characteristics of systemic lupus erythematosus and lupus nephritis in children in the Republic of Belarus and the Republic of Tatarstan

Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) ◽

10.21508/1027-4065-2019-64-5-199-203 ◽

2019 ◽

Vol 64 (5) ◽

pp. 199-203

Author(s):

T. P. Makarova ◽

A. V. Sukalo ◽

I. A. Kazyro ◽

Yu. S. Melnikova ◽

N. N. Firsova ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

Clinical Manifestations ◽

Immunosuppressive Drugs ◽

Systemic Lupus ◽

American College Of Rheumatology ◽

Severe Manifestation ◽

Extrarenal Manifestations ◽

The Republic

Systemic lupus erythematosus is an autoimmune disease characterized by a pronounced polymorphism of clinical manifestations. Lupus nephritis is the most severe manifestation of the disease. The article presents a retrospective analysis of the cases of systemic lupus erythematosus and assessment of the clinical manifestations of the disease and variants of lupus nephritis in children in the Republics of Belarus and Tatarstan. The authors analyzed 60 cases of systemic lupus erythematosus, lupus nephritis. All patients had at least 4 of the 11 diagnostic criteria proposed by the American College of rheumatology (ACR, 1997), and 35 patients had a morphologically verified nephritis. It was found that the disease in children developed very actively with fast multi-organ involvement and it required aggressive therapy with several immunosuppressive drugs. During follow-up, the percentage of patients with renal damage increased, so renal function should be controlled in all patients with systemic lupus erythematosus, especially with early onset. Lupus nephritis is combined with extrarenal manifestations and it is difficult to diagnose when it begins with kidney damage. The overall survival rate of children with systemic lupus erythematosus is closely related to the severity of renal manifestations. Lupus nephritis is a serious problem that requires early aggressive intervention and continuous maintenance therapy.

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Case of a Сombination of Lupus Erythematosus, Antiphospholipid Syndrome and Myocardial Infarction

Kardiologiia ◽

10.18087/cardio.2019.12.n610 ◽

2019 ◽

Vol 59 (12) ◽

pp. 92-96

Author(s):

N. A. Kosheleva ◽

N. M. Nikitina ◽

E. U. Andreeva

Keyword(s):

Myocardial Infarction ◽

Systemic Lupus Erythematosus ◽

Antiphospholipid Syndrome ◽

Lupus Erythematosus ◽

Clinical Manifestations ◽

The Body ◽

Systemic Autoimmune Disease ◽

Unknown Etiology ◽

Systemic Lupus ◽

Wide Range

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease of unknown etiology characterized by a wide range of clinical manifestations with damage to various organs and systems of the body. There are bad prognostic factors for SLE: damage to the heart, kidney, central nervous system, the development of hematological crises and secondary antiphospholipid syndrome. A number of authors consider systemic lupus erythematosus a “new” risk factor for atherosclerosis. The overall risk of myocardial infarction (MI) in patients with SLE is 10 times higher than in the general population. The article presents clinical case report of the development of myocardial infarction in a woman with SLE, receiving therapy for secondary antiphospholipid syndrome.

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Autoimmune Polyglandular Syndrome Type 3-D

10.21467/preprints.367 ◽

2022 ◽

Author(s):

Fadel Fikri Suharto ◽

RM Dewi Anggraini ◽

Ardianto Tamin ◽

Della Fitricana ◽

Nova Kurniati ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Immune System ◽

Autoimmune Disease ◽

Lupus Erythematosus ◽

Disease Patient ◽

The Body ◽

Graves Disease ◽

Systemic Lupus ◽

Metabolic System ◽

Organ Systems

Background: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease characterized by the presence of autoantibodies against cell nuclei and involves many organ systems in the body. The etiopathology of SLE is thought to involve complex and multifactorial interactions between genetic variation and environmental factors. Hyperthyroidism is a disease due to increased thyroid hormone function followed by signs and symptoms that affect the body's metabolic system. Graves' disease is an autoimmune disease characterized by the presence of antibodies to TSHR (TRAb). Several coexisting autoimmune diseases have been classified under different syndromes. Case Presentation: A woman, 29 years-old, came to office with complaint of chest palpitation. Patient had history of fever, joint pain, hair loss, and malar rash. Patient had been diagnosed with hyperthyroidism for 4 years and regularly taking propylthiouracil 100 mg and propranolol 10 mg. Titer ANA Test 1/100, Anti ds-DNA 68.08, C3-Complement 93 (N: 83-193), C4-Complement 11.2 (N: 15-57), Free T3 7.79 (N: 1.71-3.71), Free -T4 2.50 (N: 0.70-1.48), TSHs 0.0001 (N: 0.350-4.94), TRAb 3.38 (N: < 1.75). Patient was diagnosed with systemic lupus erythematosus (SLE) and graves’ disease. Patient treated with methimazole 10 mg, propranolol 10 mg, myfortic 360 mg, and methylprednisolone 4 mg. Conclusion: Autoimmune Polyendocrine Syndromes (APS) was at first characterized as different endocrine organ diseases related to an immune system disease in a subject. Hence, affiliation between illnesses in APS was noted not to be irregular but in specific combinations in which a few non-endocrine immune system diseases were moreover portion of the disorders.

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Polyglandular Autoimmune Syndrome Type 3D : A Case Report

10.31219/osf.io/ry7dc ◽

2022 ◽

Author(s):

Fadel Fikri

Keyword(s):

Systemic Lupus Erythematosus ◽

Immune System ◽

Autoimmune Disease ◽

Lupus Erythematosus ◽

Disease Patient ◽

The Body ◽

Systemic Lupus ◽

Metabolic System ◽

Polyglandular Autoimmune Syndrome ◽

Organ Systems

Background: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease characterized by the presence of autoantibodies against cell nuclei and involves many organ systems in the body. The etiopathology of SLE is thought to involve complex and multifactorial interactions between genetic variation and environmental factors. Hyperthyroidism is a disease due to increased thyroid hormone function followed by signs and symptoms that affect the body's metabolic system. Graves' disease is an autoimmune disease characterized by the presence of antibodies to TSHR (TRAb). Several coexisting autoimmune diseases have been classified under different syndromes. Autoimmune Polyglandular Syndrome (PGAS),Case Presentation: A woman, 29 years-old, came to office with complaint of chest palpitation. Patient had history of fever, joint pain, hair loss, and malar rash. Patient had been diagnosed with hyperthyroidism for 4 years and regularly taking propylthiouracil 100 mg and propranolol 10 mg. Titer ANA Test 1/100, Anti ds-DNA 68.08, C3-Complement 93 (N: 83-193), C4-Complement 11.2 (N: 15-57), Free T3 7.79 (N: 1.71-3.71), Free -T4 2.50 (N: 0.70-1.48), TSHs 0.0001 (N: 0.350-4.94), TRAb 3.38 (N: < 1.75). Patient was diagnosed with systemic lupus erythematosus (SLE) and grave's disease. Patient treated with methimazole 10 mg, propranolol 10 mg, myfortic 360 mg, and methylprednisolone 4 mg.Conclusion: Autoimmune Polyendocrine Syndromes (APS) was at first characterized as different endocrine organ diseases related to an immune system disease in a subject. Hence, affiliation between illnesses in APS was noted not to be irregular but in specific combinations in which a few non-endocrine immune system diseases were moreover portion of the disorders.

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