Clinical Features, Morbidity, and Risk Factors of Intestinal Pseudo-obstruction in Systemic Lupus Erythematosus: A Retrospective Case-control Study

Objective.To analyze the epidemiology, clinical characteristics, and risk factors for systemic lupus erythematosus-related intestinal pseudo-obstruction (SLE-IPO).Methods.We retrospectively examined 85 patients with SLE with IPO as the case group and 255 randomly matched patients with SLE without any gastrointestinal manifestations as the control group, out of 4331 inpatients at the Peking Union Medical College Hospital (PUMCH) from 2003 to 2014.Results.Over the last 11 years at PUMCH, the prevalence of IPO in patients with SLE was 1.96% and the in-hospital fatality rate was 7.1%. Of these patients, 57.6% presented with IPO as the initial affected system of SLE, and the rate of misdiagnosis was about 78%. Pyeloureterectasis was the most common complication (58.9%) in patients with SLE-IPO and the incidence of biliary tract dilation was 7.1%. Patients with SLE with IPO were always diagnosed at an earlier stage of SLE with a higher frequency of hematological disturbance, polyserositis, and hypocomplementemia. Pyeloureterectasis, hypocomplementemia, and elevated C-reactive protein levels in serum were independent risk factors for IPO in SLE disease. Patients with SLE-IPO with long IPO duration and those diagnosed during late stages of SLE or concurrent with pyeloureterectasis and megacholedochus always had an unfavorable outcome.Conclusion.IPO is a rare complication, but commonly presents as the initial affected system of SLE, which can lead to a difficult diagnosis and delayed treatment. SLE-IPO occurrence concomitantly with pyeloureterectasis and megacholedochus showed a severe clinical situation in our cohort. Thus, patients with SLE-IPO with systemic smooth muscular involvement should be diagnosed early and treated aggressively.

Download Full-text

AB0507 INVASIVE ASPERGILLOSIS IN ADULT RHEUMATOLOGICAL PATIENTS IN SAINT PETERSBURG, RUSSIA.

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3796 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1551.1-1552

Author(s):

V. Mazurov ◽

O. Shadrivova ◽

M. Shostak ◽

L. Martynova ◽

M. Tonkoshkur ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Renal Failure ◽

Invasive Aspergillosis ◽

Lupus Erythematosus ◽

Granulomatosis With Polyangiitis ◽

Control Group ◽

Systemic Lupus ◽

Anca Associated Vasculitis ◽

Underlying Diseases

Background:Invasive aspergillosis (IA) is a severe opportunistic infection that is not well understood in rheumatological patients.Objectives:To study risk factors, etiology, clinical manifestations and results of treatment of IA in adult rheumatological patients.Methods:Retrospective analysis of 830 patients (1998-2019) with “proven” and “probable” IA (EORTC / MSG, 2019), adults - 699 (84%). The main group included 18 (3%) adult rheumatological patients with IA, a control group included 610 (87%) adult hematological patients. Rheumatological patients were older, the average age was 59 years (21–75) vs 45 years (18–79), p = 0.005, and among them there were more women – 56% vs 42%, p = 0.01.Results:In rheumatological patients with IA, underlying diseases were ANCA-associated vasculitis (28%), granulomatosis with polyangiitis (22%), periarteritis (11%), systemic lupus erythematosus (22%), rheumatic heart disease (11%) and ankylosing spondylitis (6%). In the control group, underlying diseases were acute leukemia (45%), lymphomas (34%), chronic leukemia (9%), multiple myeloma (7%), myelodysplastic syndrome (3%), and other hematological diseases (2%).The main risk factors for IA development in rheumatological patients were: systemic steroids use (89% vs 69%), prolonged lymphocytopenia (76% vs 65%, median - 14 vs 12 days), treatment in ICU (44% vs 18%, p = 0.01), acute or chronic renal failure (39% vs 1%, p = 0.0008) and immunosuppressive therapy (28% vs 25%). Severe neutropenia was noted significantly less frequently (18% vs 83%, p = 0.0001). Additional risk factors were decompensated diabetes mellitus (17% vs 2%, p = 0.004), previous surgery (17% vs 1%, p = 0.001) and organ transplantation (6% vs 0%). In rheumatological patients, lung (83% vs 98%, p = 0.0001) and ≥2 organs (6% vs 8%) involvement were less common. Heart (11% vs 0%), sinuses (6% vs 5%) and central nervous system (6% vs 4%) involvement more often developed. In rheumatological patients, respiratory failure (61 vs 37%, p = 0.03), hemoptysis (28% vs 7%, p = 0.0001) and chest pain (17% vs 7%, p = 0, 04) were noted more often, less often - fever ≥380С (67% vs 85%, p = 0.01) and cough (61% vs 70%). CT signs of lung damage were similar in both groups, but rheumatologic patients were more likely to show an «air crescent» sign and / or destruction cavity (44% vs 10%, p = 0.0001). In rheumatologic patients, IA was more often confirmed by isolation ofAspergillusspp. from BAL (80% vs 45%, p = 0.005) and by histological examination (22% vs 7%, p = 0.01). The main pathogens wereA. fumigatus(50% vs 43%),A. niger(29% vs 32%), andA. flavus(14% vs 17%).Rheumatological patients were less likely to receive antifungal therapy 89% vs 99%, p = 0,0003. The main drug in both groups was voriconazole. The overall 12-week survival did not significantly differ between groups, but was lower in rheumatological patients with IA (69% vs 81%).Conclusion:In rheumatological patients, invasive aspergillosis more often developed at an older age, mainly in women. The main background diseases were ANCA-associated vasculitis, granulomatosis with polyangiitis, and systemic lupus erythematosus. Typical risk factors were steroids and immunosuppressants use, prolonged lymphocytopenia, ICU stay, and renal failure. The main causative agents wereA. fumigatus,A. niger, andA. flavus. The main localization of infection were lungs. Respiratory failure, hemoptysis and heart involvement were typical. The overall 12-week survival of rheumatological patients with invasive aspergillosis was 69%.Disclosure of Interests:None declared

Download Full-text

Non-corticosteroid risk factors of symptomatic avascular necrosis of bone in systemic lupus erythematosus: A retrospective case-control study

Modern Rheumatology ◽

10.3109/14397595.2014.987366 ◽

2014 ◽

Vol 25 (4) ◽

pp. 590-594 ◽

Cited By ~ 9

Author(s):

Seyedeh Tahereh Faezi ◽

Azam Sadat Hoseinian ◽

Pedram Paragomi ◽

Mahmood Akbarian ◽

Fatemeh Esfahanian ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Avascular Necrosis ◽

Lupus Erythematosus ◽

Case Control Study ◽

Case Control ◽

Systemic Lupus ◽

Retrospective Case ◽

Avascular Necrosis Of Bone ◽

Control Study

Download Full-text

Risk Factors for Development of Coronary Artery Disease in Women with Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.090011 ◽

2009 ◽

Vol 36 (11) ◽

pp. 2454-2461 ◽

Cited By ~ 49

Author(s):

ROBERT J. GOLDBERG ◽

MURRAY B. UROWITZ ◽

DOMINIQUE IBAÑEZ ◽

MANDANA NIKPOUR ◽

DAFNA D. GLADMAN

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Prospective Study ◽

Lupus Erythematosus ◽

Control Group ◽

Systemic Lupus ◽

Artery Disease ◽

A Prospective Study

Objective.To ascertain coronary artery disease (CAD) outcomes and predictive factors in a prospective study of patients with systemic lupus erythematosus (SLE) and matched healthy controls.Methods.SLE patients and non-SLE age-matched controls without a history of CAD were recruited into a prospective study between 1997 and 1999. CAD events were assessed at clinic visit for SLE patients and through telephone interview and chart review for controls. All events were verified with patient medical records.Results.Followup information was available on 237 controls and 241 SLE patients. The mean followup time was 7.2 years. Univariate analyses identified age and postmenopausal status as predictors of CAD in both the groups. Sedentary lifestyle, hypertension, the presence of metabolic syndrome, and the number of Framingham risk factors were predictive in the control group only. The 10-year risk of CAD score was predictive in both groups but was not as marked in the SLE group as in the controls. None of the lipid subfractions were predictive for CAD in the SLE group, whereas in the controls, a high triglyceride level ≥ 2.8 was predictive. Time-to-event multivariate analysis for CAD in all subjects revealed SLE itself, older age, and triglycerides ≥ 2.8 to be highly predictive for CAD.Conclusion.In a prospective study of patients with SLE and matched controls followed over a median of 8 years, patients with SLE developed significantly more CAD events than controls. Accounting for demographic variability, CAD risk factors, and lipid factors, SLE is an independent risk factor for the development of CAD.

Download Full-text

ROLE OF INFLAMMATION AND PLATELETS ACTIVATION IN ATHEROSCLERISIS PROGRESSION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Тромбоз, гемостаз и реология ◽

10.25555/thr.2018.2.0831 ◽

2018 ◽

Author(s):

А.В. Аршинов ◽

Н.Ю. Левшин ◽

И.Г. Маслова ◽

А.Н. Лужинский

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Intima Media Thickness ◽

Control Group ◽

Systemic Lupus ◽

Reactive Protein ◽

Traditional Risk Factors ◽

Atherosclerosis Development ◽

Aggregation Activity

Цель исследования: выявить взаимосвязь между дислипидемией, активностью воспаления и функцией тромбоцитов в развитии атеросклероза у пациентов с системной красной волчанкой (СКВ), а также оценить сходство и различия механизмов атерогенеза у больных СКВ и ишемической болезнью сердца. Материалы и методы. Обследовано 102 женщины, из них — 50 больных СКВ, 31 — с инфарктом миокарда (ИМ); контрольную группу составили здоровые женщины (n = 21). Определяли показатели липидного спектра, содержание антител к окисленным липопротеинам низкой плотности (АТ-оксЛПНП), высокочувствительного С-реактивного белка (вчСРБ), интерлейкина 6 (ИЛ-6), тромбоцитарного фактора 4 (ТФ4), агрегационную функцию тромбоцитов и толщину комплекса интима-медиа (ТКИМ) общих сонных артерий. Результаты. У больных СКВ и у пациентов с ИМ выявлено значительное увеличение ТКИМ сонной артерии и выраженная активация воспаления: повышение содержания вчСРБ, ИЛ-6 и увеличение СОЭ. За исключением значений ИЛ-6, лабораторные показатели воспаления у больных СКВ и с ИМ достоверно не различались. Также у пациентов с СКВ и ИМ установлена значительная активация тромбоцитов (достоверный рост содержания ТФ4). Несмотря на наличие дислипидемии в обеих группах, у больных СКВ данные изменения были выражены более отчётливо и сопровождались повышением уровня АТ-оксЛПНП. Заключение. Кроме традиционных факторов риска развития сердечно-сосудистых заболеваний, ассоциация между СКВ и атеросклерозом может быть объяснена дополнительными факторами риска — воспалением и аутоиммунными процессами. Aim: to reveal a relationship between dyslipidemia, infl ammatory activity and platelets reactivity in atherosclerosis development in patients with systemic lupus erythematosus (SLE) and also to assess the similarity and diff erences of atherogenesis mechanisms in patients with SLE and ischemic heart disease. Materials and methods. The study included 102 women: 50 patients with SLE, 31 — with myocardial infarction (MI); control group included 21 healthy women. We measured parameters of lipid spectrum, levels of antibodies against oxidized low density lipoproteins (oxLDL), high-sensitive C-reactive protein (hsCRP), interleukin 6 (IL-6), platelets factor 4 (PF4), platelets aggregation activity and complex intima-media thickness (TCIM) of carotid arteries. Results. Patient with SLE and MI had markedly increased TCIM. Increased infl ammation activity was the second sign of two groups of patients, including increased hsCRP, IL-6, erythrocyte sedimentation test. Laboratory signs of infl ammation did not markedly diff er in two groups except IL-6. Our study also revealed considerable platelets activation in patients with SLE and MI (signifi cant growth of PF4 content). Despite dyslipidemia, all indicated changes were more clearly expressed in patients with SLE; they were accompanied by increased level of antibodies against oxLDL. Conclusion. Except traditional risk factors for cardiovascular diseases development the association between SLE and atherosclerosis. can be explained by additional risk factors — infl ammation and autoimmune processes.

Download Full-text

Incidence and risk factors of osteomyelitis in adult and pediatric systemic lupus erythematosus: a nationwide, population-based cohort study

Lupus ◽

10.1177/0961203318811601 ◽

2018 ◽

Vol 28 (1) ◽

pp. 19-26

Author(s):

Y.F. Huang ◽

Y.S. Chang ◽

W.S. Chen ◽

Y.P. Tsao ◽

W.H. Wang ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Cohort Study ◽

Incidence Rate ◽

Bone Fracture ◽

Lupus Erythematosus ◽

Cox Proportional Hazards ◽

Control Group ◽

Systemic Lupus ◽

Increased Risk

Objective The objective of this paper is to investigate the incidence rate, risk factors and outcome of osteomyelitis among patients with systemic lupus erythematosus (SLE). Materials and methods We conducted a cohort study using data for patients enrolled in the Taiwan National Health Insurance Database from 2000 to 2012. Patients with SLE and age- and sex-matched controls without SLE were enrolled. Primary endpoint was the first occurrence of osteomyelitis. Risks of osteomyelitis in SLE patients were analyzed with Cox proportional hazards regression models, including age, sex, comorbidities and medications. Results Among 24,705 SLE patients (88.4% women, mean age 35.8 years) with a median follow-up of 9.1 years, 386 patients had osteomyelitis. The incidence rate ratio (IRR) of osteomyelitis in the SLE group vs the control group was 8.52 (95% confidence interval (CI) 7.24–10.05). The SLE group had higher incidence rates of osteomyelitis than the control group, especially in pediatric subgroups (IRR 41.1 95% CI 18.57–107.35). Compared to controls, SLE patients experienced osteomyelitis at a younger age (42.3 vs 58.1 years) but did not have an increased risk of mortality (hazard ratio 0.7; 95% CI 0.21–2.38). Age >60 years, male gender, malignancy within five years, prior bone fracture and higher daily prednisolone dose (>7.5 mg) cumulatively for >180 days increased risk for osteomyelitis. Conclusions SLE patients have a higher IRR of osteomyelitis than controls. Pediatric and elder SLE patients, patients with a history of bone fracture, malignancy within five years and higher-dose glucocorticoid use have a higher risk of osteomyelitis and should be carefully monitored.

Download Full-text

Exposure levels of mycophenolic acid are associated with comorbidities in children with systemic lupus erythematosus

Lupus ◽

10.1177/09612033211034555 ◽

2021 ◽

pp. 096120332110345

Author(s):

Qiaofeng Ye ◽

Guangfei Wang ◽

Jinmiao Lu ◽

Yidie Huang ◽

Junqi Zhang ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Random Forest ◽

Mycophenolic Acid ◽

Lupus Erythematosus ◽

Therapeutic Drug ◽

Control Group ◽

Case Group ◽

Exposure Level ◽

Systemic Lupus ◽

Exposure Levels

Introduction Little is known about the relationship between exposure levels of mycophenolic acid (MPA), the active metabolite of mycophenolate mofetil (MMF), and comorbidities of systemic lupus erythematosus (SLE) in children. This study aims to explore this association. Methods Longitudinal data from SLE children, who were taking MMF for immunosuppression and under therapeutic drug monitoring (TDM), were retrospectively collected. Area under the concentration-time curve of mycophenolic acid (MPA) over 24 hours (AUC0–24h) was estimated with Bayesian methods. Logistic regression and random forest models were used to explore the association between comorbidities and MPA exposure levels. Results This study included 107 children with 358 times of follow-up (median age 169.02 months). The incidence of diabetes, acute kidney injury (AKI), or pneumonia was significantly associated with AUC0–24h (odds ratio [OR] 0.991, 95% confidence interval [CI] 0.982–0.999), SLE duration (OR 1.012, 95% CI 1.002–1.022), lymphocyte percentage (OR 0.959, 95% CI 0.925–0.991), plasma albumin levels (OR 0.891, 95% CI 0.843–0.940), use of aspirin (OR 0.292, 95% CI 0.126–0.633) and hydroxychloroquine (OR 0.407, 95% CI 0.184–0.906). The random forest model showed that albumin and AUC0–24h were two important predictors. The case group (with the three comorbidities) had a mean AUC0–24h of 73.63 mg · h/L, while the control group had a mean AUC0–24h of 100.39 mg · h/L. Conclusions Increased levels of MPA exposure are associated with decreased incidence odds of diabetes, AKI or pneumonia in SLE children. An AUC0–24h of 100.39 mg · h/L or an AUC0-12h of 50.20 mg · h/L could be used as the targeted exposure level for clinical practice.

Download Full-text

Comparison of Short-Chain Fatty Acid (SCFA) and Interleukin-10 (IL-10) Levels in Patients with Systemic Lupus Erythematosus (SLE) Compared to Healthy Populations at RSUP Dr. Mohammad Hoesin Palembang

BioScientia Medicina ◽

10.37275/bsm.v6i2.444 ◽

2021 ◽

Vol 6 (2) ◽

pp. 1358-1366

Author(s):

Nova Kurniaty ◽

Eddy Mart Salim ◽

Yuniza ◽

Tiara Rasmita ◽

Amelia Farianty

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Population Group ◽

Interleukin 10 ◽

Gas Chromatography Mass Spectrometry ◽

Control Group ◽

Case Group ◽

Healthy Population ◽

Systemic Lupus ◽

Normal Populations

Background. Systemic lupus erythematosus (SLE) is a prototypical autoimmune disease with various significant diseases, where SLE can affect the entire population in the world. This study aims to compare and analyze differences in the composition of the gut microbiota of SLE patients compared to healthy controls based on SCFA examination in Indonesia. Methods. The type of research conducted in this research is an analytical observational study with a case-control design. The research was conducted at Dr. RSUP. Mohammad Hoesin Palembang from October 2020 to October 2021. The sample in this study was divided into two groups, namely, the case group, and the control group. The case group was all SLE patients who met the inclusion criteria, while the control group was a healthy population who did a medical check-up at Dr. RSUP. Mohammad Hoesin Palembang. SCFA examination was carried out using Gas Chromatography-Mass Spectrometry (GCMS) from fecal samples. Results. The results showed that there were two groups of SCFA values, namely the normal group and the microbiota dysbiosis group where the SCFA value was low or less than 4. in the SLE and normal populations where there were 6 SLE subjects who had normal SCFA values or 37.5% and there were 10 SLE subjects who experienced microbiota dysbiosis. or 62.5%. In the healthy population group, all subjects had SCFA values that were included in the normal category, namely 16 subjects or 100%. Based on the severity of SLE using the SLEDAI MEX score, all SLE patients in the study were in the active or category flare where the SLEDAI MEX score was > 5. Conclusion. Patients with microbiota dysbiosis tended to have an LES of 7,222 or 7 times greater than patients who did not have microbiota dysbiosis or had normal SCFA values.

Download Full-text

AB0856 CHRONIC INTESTINAL PSEUDO-OBSTRUCTION WITH HYDRONEPHROSIS: A CASE REPORT ON SUCH DISABLING AND RARE COMPLICATION OF LUPUS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2854 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1451.3-1452

Author(s):

C. S. Ng ◽

S. L. Kan ◽

A. L. Lim

Keyword(s):

Systemic Lupus Erythematosus ◽

Smooth Muscle ◽

Abdominal Pain ◽

Lupus Erythematosus ◽

Rare Complication ◽

Muscularis Propria ◽

Gastrointestinal Complication ◽

Systemic Lupus ◽

The Past ◽

Intestinal Pseudo Obstruction

Background:Chronic intestinal pseudo-obstruction can be a rare complication of systemic lupus erythematosus. It is often late to be identified in contrast to other commoner organs involvement in systemic lupus erythematosus such as nervous system, joint and kidney.Objectives:To report a case of uncommon gastrointestinal complication of lupus, with associated hydronephrosis at the ureter, with treatment delay.Methods:We report a case of chronic intestinal pseudo-obstruction.Results:A 34 year old, with ten-year history of lupus nephritis, presented with recurrent abdominal pain and diarrhoea past nine months. The patient had just been diagnosed as end-stage renal failure a year ago, on regular haemodialysis. For the past ten years, the patient was not able to tolerate immunosuppressant due to the multiple episodes of infections, including shin carbuncle, herpes zoster, breast abscess and catheter-related candida/bacterial infections. However, the patient did not have any other major organs manifestations of lupus for the past ten years. The patient was apyretic. Multiple stool cultures were negative including Clostridium difficile. The abdominal radiography showed dilated small bowel with diffuse thickening of large and small bowels on computed tomography. Bilateral uretero-hydronephrosis was also noted without any evidence of obstructive uropathy on imaging. Ileocolic resection was done for presumed intestinal obstruction and the ileocolic biopsy did not reveal any granuloma, malignancy or vasculitis except for non-specific inflammation of cecum. Cytomegalovirus inclusion body was absent as well. Tuberculosis culture was negative. Oesophagoduodenoscopy and colonoscopy were offered in view of persistent unexplained loose stool and abdominal pain. But unremarkable findings were noted from multiple biopsy specimens of the small and large bowels. Second relook of the initial hemicolectomy specimen with special actin immunostain on the smooth muscle revealed degenerative changes of the muscularis propria. These were evidenced by cytoplasmic vacuolation, atrophy and pyknotic nucleus of the smooth muscle cells with surrounding oedema. Smooth muscle dysmotility could be the underlying pathology of this patient presentation. The patient responded well to intravenous immunoglobulin followed by azathioprine in addition to prednisolone and prokinetic agent.Conclusion:Prompt recognition is pivotal in this case could have prevented the unnecessary surgical intervention earlier. It is potentially reversible. Long term prognosis of this rare entity is, however, varying.Disclosure of Interests:None declared

Download Full-text