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Biomedical subjects

M J Cuadrado

Publications and source records attributed to M J Cuadrado.

41 records · Page 3Linked to original sources
PubMedDate not supplied

Skin manifestations of systemic lupus erythematosus refractory to multiple treatment modalities: poor results with mycophenolate mofetil.

OBJECTIVE: Skin disease can be one of the most refractory clinical manifestations of systemic lupus erythematosus (SLE). The standard therapy consists of sunscreens, topical corticosteroids and antimalarials. However in difficult cases a variety of other drugs have been tried. Here we describe our clinical experience with mycophenolate mofetil (MMF) in patients with cutaneous manifestations of SLE. METHODS: Seven patients with SLE and skin involvement (including acute cutaneous lupus, subacute cutaneous lupus, discoid lupus erythematosus, vasculitis, urticarial rash and chilblain lupus) who had received treatment with MMF were included. The clinical characteristics, serologicalfindings and response to treatment were recalledfrom retrospective review of the files. RESULTS: Our results showed no response in 5 patients, partial response in 1 patient and initial response but skin flare whilst on MMF in 1 patient. The median dose of MMF was 2 g (range 2-3 g). Adverse events on MMF were mild, mainly gastrointestinal and occurred in 5 patients. No patients discontinued MMF due to adverse events. CONCLUSIONS: MMF appears not to be particularly effective in the treatment of skin disease in SLE. It should be noted that our group of patients had previously failed to respond to a median of 4 (range 2-10) different drugs used to treat SLE skin disease. Thus, the patients in the study could be considered at the severe end of skin disease spectrum.

Adolescent↗
PubMedDate not supplied

Prevalence and clinical significance of subungual splinter haemorrhages in patients with the antiphospholipid syndrome.

OBJECTIVE: To assess the prevalence and clinical significance of subungual splinter haemorrhages in patients with the antiphospholipid syndrome. METHODS: A group of 147 patients with the antiphospholipid syndrome (124 female, 23 male) were studied. All patient histories were carefully reviewed and each patient was interviewed at least once. Particular attention was paid to clinical manifestations of the antiphospholipid syndrome at the time of subungual splinter haemorrhages. Patients who had evidence of infective endocarditis confirmed by echocardiogram and a positive blood culture were excluded from the study. RESULTS: Six out of 147 patients developed subungual splinter haemorrhages. Amongst 80 patients (54%) with a history of venous thrombosis, only one developed subungual splinter haemorrhages during a lupus flare in the post-partum period. This sign was found in 4 out of 67 patients with arterial occlusions; in 2 of these the occlusion manifested as a cerebrovascular accident. Another patient with a history of lupus and recurrent miscarriages developed subungual splinter haemorrhages during a lupus flare. CONCLUSION: Subungual splinter haemorrhages appeared to be relatively uncommon in our group of patients with the antiphospholipid syndrome. The differences in clinical setting and response to different treatment regimes in these cases suggest varied aetiopathologies and may reflect a number of different types of vascular insult.

Adolescent↗
PubMedDate not supplied

Immunosuppressive therapy in lupus nephritis.

OBJECTIVE: To evaluate the outcomes and side effects of immunosuppressive therapy in patients with lupus nephritis. PATIENTS AND METHODS: Thirty-nine patients with lupus nephritis assessed between 1988 and 1993 with a median follow-up of 46 months (range 12-60 months) were studied. Lupus nephritis was biopsy-proven in 37 patients. Patients received a median of 3 (500 mg) weekly pulses of intravenous cyclophosphamide followed either by azathioprine (n = 32) or oral cyclophosphamide (n = 7). All patients received oral prednisolone. The time from biopsy to renal insufficiency, defined by doubled serum creatinine and/or end stage renal failure, was used to assess outcome. RESULTS: There were significant improvements in the median changes of all major laboratory parameters. Serum creatinine levels did not change significantly. The prednisolone dose was significantly reduced during the follow-up period. OUTCOME: renal function remained stable in 26 (67%) and deteriorated despite therapy in 13 (33%) patients. 6/13 (42%) of these patients had impaired renal function at the time of biopsy. The adverse effects of intravenous cyclophosphamide seen were Herpes zoster (1), transient leucopenia (2), rash (1) and fatal septicaemia (1); of azathioprine urinary infections (3), leucopenia (5), rash (1) and increased liver enzymes (1); and of oral cyclophosphamide ovarian failure (4), Herpes zoster (3), haemorrhagic cystitis (1), and fatal septicaemia (1). CONCLUSIONS: Therapy with weekly low dose intravenous pulse cyclophosphamide to induce remission, followed by azathioprine appears to be useful in preserving renal function in patients with diffuse proliferative lupus nephritis. In comparison to other studies, the reduced incidence of ovarian failure using this regimen was striking.

Administration, Oral↗