Gastrointestinal Manifestations of Systemic Lupus Erythematosus and Scleroderma

2009 ◽  
Vol 2 ◽  
pp. CGast.S2264 ◽  
Author(s):  
Cherag Daruwala ◽  
Giancarlo Mercogliano ◽  
Thomas P. Harder
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Abdominal Pain ◽  
Gastrointestinal Tract ◽  
Gastroesophageal Reflux Disease ◽  
Fecal Incontinence ◽  
Lupus Erythematosus ◽  
Diagnostic Tests ◽  
Systemic Lupus ◽  
Gastrointestinal Manifestations ◽  
Oral Ulcers

In this review, we analyze the effects of systemic lupus erythematosus and scleroderma on the gastrointestinal tract. There is a wide variation of gastrointestinal manifestations from these autoimmune disorders including but not limited to: oral ulcers, dysphagia, gastroesophageal reflux disease, abdominal pain, constipation, diarrhea, fecal incontinence, pseudo-obstruction, perforation and gastrointestinal bleeding. The purpose of this review is to discuss these manifestations, the appropriate diagnostic tests, and treatment.

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.

SYSTEMIC LUPUS ERYTHEMATOSUS AND ABDOMINAL PAIN

Rheumatology ◽  
1983 ◽  
Vol 22 (3) ◽  
pp. 172-175 ◽  
Author(s):  
P.J. PROUSE ◽  
E.M. THOMPSON ◽  
J.M. GUMPEL
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Abdominal Pain ◽  
Lupus Erythematosus ◽  
Systemic Lupus

scholarly journals Oral Ulcers in Juvenile-Onset Systemic Lupus Erythematosus: A Review of the Literature

2017 ◽  
Vol 18 (6) ◽  
pp. 755-762 ◽  
Author(s):  
Pongsawat Rodsaward ◽  
Titipong Prueksrisakul ◽  
Tawatchai Deekajorndech ◽  
Steven W. Edwards ◽  
Michael W. Beresford ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Review Of The Literature ◽  
Systemic Lupus ◽  
Juvenile Onset ◽  
Oral Ulcers ◽  
Onset Systemic Lupus Erythematosus

Clinical analysis of systemic lupus erythematosus with gastrointestinal manifestations

Lupus ◽  
2010 ◽  
Vol 19 (7) ◽  
pp. 866-869 ◽  
Author(s):  
D. Xu ◽  
H. Yang ◽  
C.-C. Lai ◽  
P. Li ◽  
X. Zhang ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Clinical Analysis ◽  
Systemic Lupus ◽  
Gastrointestinal Manifestations

SAT0217 PERFORMANCE OF ACR/EULAR 2019, SLICC 2012 AND ACR 1997 CLASSIFICATION CRITERIA IN A COHORT OF SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITH LONGSTANDING DISEASE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1051-1052
Author(s):  
D. Lobo Prat ◽  
B. Magallares ◽  
I. Castellví ◽  
H. Park ◽  
P. Moya ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Statistical Significance ◽  
Renal Involvement ◽  
High Sensitivity ◽  
Classification Criteria ◽  
Average Score ◽  
Systemic Lupus ◽  
Malar Rash ◽  
Oral Ulcers

Background:Systemic lupus erythematosus (SLE) is an autoimmune disease with variable clinical features and a complex physiopathology. In 2019, EULAR and ACR have jointly developed new classification criteria with both high sensitivity and specificity. These criteria have the particularity of including the presence of ANA as an obligatory entry criterion and the existence of clinical and immunological domains with weighted scores.Objectives:To evaluate the performance and characteristics of the ACR/EULAR 2019, SLICC 2012 and ACR 1997 classification criteria in a cohort of SLE patients with longstanding disease.Methods:Descriptive observational study that enrolled a cohort of SLE patients with longstanding disease followed in a tertiary level hospital. Demographic and clinical data were gathered along with the fulfillment of classification criteria. The sensitivity of each classification criteria and the statistically significant associations between criteria fulfillment and clinical and immunological data were calculated. Statistical analyses were performed using the Chi2, T-student and ANOVA tests. Statistical significance was assumed in p values <0.05.Results:A total of 79 patients (88.6% women) with a mean age of 51.8±14 years, disease duration of 15.2±11.5 years and SLEDAI of 2.65±2.1 were included. The sensitivity of the different classification criteria was 51.9% for ACR 1997, 87.3% for SLICC 2012 and 86.1% for ACR/EULAR 2019 (Table 1).Table 1.Sensitivity and average scores.ACR/EULAR 2019SLICC 2012ACR 1997Sensitivity (%)86.187.351.9Average score of patients classified as SLE(±SD)18.6±5.85.3±1.45±0.9Average score of patients NOT classified as SLE(±SD)6.1±2.52.8±0.42.8±0.851.9% of patients met all three classification criteria, 29.1% met SLICC 2012 and ACR/EULAR 2019, 5% only met SLICC 2012 and 3.7% exclusively met ACR/EULAR 2019. 11.4% of patients did not meet any classification criteria and were characterized by having a low SLEDAI (0.6±0.9) and fulfilling only skin domains (alopecia or oral ulcers), antiphospholipid antibodies or hypocomplementemia.Statistically significant associations were found between meeting ACR/EULAR 2019 classification criteria and the presence of low C3 and C4 (p<0.04), DNA (p<0.001), lupus nephritis III-IV (p<0.05) and arthritis (p<0.001), highlighting that all patients with arthritis met these criteria.In the SLICC 2012 evaluation, significant associations were found between meeting these criteria and the presence of arthritis (p<0.01), renal involvement (p<0.04), leukopenia/lymphopenia (p=0.05), DNA (p<0.03) and hypocomplementemia (p=0.02).Fullfilment of ACR 1997 was associated to the presence of malar rash (p<0.001), discoid lupus (p<0.05), photosensitivity (p<0.001) and oral ulcers (p<0.04), as well as arthritis (p<0.001), serositis (p=0.02), renal (p<0.05) and hematologic (p=0.05) involvement.The Kappa concordance coefficient among classification criteria is detailed in Table 2.Table 2.Kappa concordance coefficient.ACR/EULAR 2019 - SLICC 2012ACR/EULAR 2019 - ACR 1997SLICC 2012 - ACR 1997Kappa concordance coefficient0.610.270.30Conclusion:The ACR/EULAR 2019 classification criteria maintain a high sensitivity similar to the SLICC 2012 in SLE patients with longstanding disease, both of which are much higher than ACR 1997. Patients with serological, articular or renal involvement are more likely to meet SLICC 2012 or ACR/EULAR 2019 criteria. It is noteworthy the relevance of dermatological manifestations in ACR1997 classification criteria against the increased weight that a better understanding of SLE physiopathology has provided to analytic and immunological criteria in the subsequent classification criteria.Disclosure of Interests:David Lobo Prat: None declared, Berta Magallares: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, HyeSang Park: None declared, Patricia Moya: None declared, Ignasi Gich: None declared, Ana Laiz: None declared, Cesar Díaz-Torné: None declared, Ana Milena Millán Arciniegas: None declared, Susana P. Fernandez-Sanchez: None declared, Hector Corominas: None declared

Lupus Enteritis, a Severe and Potentially Fatal Complication of Systemic Lupus Erythematosus

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S64-S64 ◽  
Author(s):  
Hany Meawad ◽  
Andrew Kobalka ◽  
Yaseen Alastal ◽  
Brooke Koltz
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Abdominal Pain ◽  
Lupus Erythematosus ◽  
Clinical Symptoms ◽  
Meckel’S Diverticulum ◽  
Severe Abdominal Pain ◽  
Meckel's Diverticulum ◽  
Systemic Lupus ◽  
Gi Symptoms ◽  
Lupus Enteritis

Abstract Objectives Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that can show wide manifestations in many organs. The gastrointestinal tract (GI) is commonly affected in SLE; symptoms are often related to the side effect of medications or to infections. One rare GI complication of SLE is lupus enteritis, a complex of manifestations including intestinal vasculitis and enteric ischemia, which presents with vague symptoms of severe abdominal pain, nausea, vomiting, and diarrhea. Methods We present the case of a 25-year-old female who was admitted to the hospital with complaints of abdominal pain, vomiting, diarrhea, and a history of SLE. Complicating the patient’s clinical picture and diagnosis was gastrointestinal bleeding requiring multiple blood product transfusions secondary to bleeding Meckel’s diverticulum, lupus flare, and positive stool culture for campylobacter antigen. Repeated upper and lower GI endoscopies with biopsy failed to identify the exact cause of bleeding and GI symptoms; the patient underwent exploratory laparotomy with right hemicolectomy to control bleeding. Microscopic examination revealed marked small vessel acute vasculitis consistent with lupus enteritis, ischemic enteritis, and Meckel’s diverticulum with gastric heterotopia. Results Our patient was subsequently aggressively treated; however, she developed further associated complications and died. Conclusion The pathologic diagnosis of lupus enteritis is challenging due to the nonspecific clinical symptoms and paucity of pathologic findings on most biopsy specimens. Lupus enteritis must be considered in the differential diagnosis of severe abdominal pain in lupus patients to aid in early diagnosis and treatment as this condition could be severe and potentially fatal.

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