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Biomedical subjects

M Petri

Publications and source records attributed to M Petri.

At least 91 records · Page 5Linked to original sources
PubMed1997

The reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index in patients with systemic lupus erythematosus.

OBJECTIVE: To test the reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in the assessment of patients with SLE. METHODS: Ten patients with SLE, representing a spectrum of damage and activity, were included. Each patient was examined by 6 of 10 physicians from 5 countries, representing 10 lupus clinics. The SLICC/ACR Damage Index was used to assess accumulated damage, and the SLEDAI was used to assess disease activity. The order of the patients and physicians was randomized according to a Youden square design. RESULTS: The SLICC/ACR Damage Index detected differences among patients (P < 0.001). There was no detectable observer difference (P = 0.933), and there was no order effect (P = 0.261). Similar results were obtained with the SLEDAI. There was concordance in the SLICC/ACR Damage Index among observers, despite a wide spectrum of disease activity detected by the SLEDAI. CONCLUSION: Physicians from different centers are able to assess patients with SLE in a reproducible way, using the SLEDAI to assess disease activity and the SLICC/ACR Damage Index to assess accumulated damage.

Adult↗
PubMed1997

Pathogenesis and treatment of the antiphospholipid antibody syndrome.

Antiphospholipid antibody syndrome (APS) is one of the most important causes of thrombophilia, presenting most often as venous or arterial thrombosis, recurrent pregnancy loss, or thrombocytopenia. Both the lupus anticoagulant and anticardiolipin antibody are associated with APS. The mechanism of the prothrombotic state is not understood, but may involve beta-2 glycoprotein 1 (a naturally occurring anticoagulant), platelet aggregation, the protein C pathway, or endothelial cell function. The current treatment recommendation, after a venous or arterial thrombosis, is high-intensity, long-term warfarin therapy.

Abortion, Habitual↗
PubMed1997

Hopkins Lupus Pregnancy Center: 1987 to 1996.

This article discusses lupus and pregnancy from experiences at the Hopkins Lupus Pregnancy Center. This center has made important strides in the understanding of lupus flares, maternal morbidity, and causes of preterm birth and pregnancy loss in lupus pregnancy.

Contraception↗
PubMed1997

A quantitative study of daytime sleepiness induced by carbamazepine and add-on vigabatrin in epileptic patients.

INTRODUCTION: The clinical relevance of daytime sleepiness associated with carbamazepine (CBZ) and vigabatrin (VGB) was objectively assessed by the multiple sleep latency test (MSLT) and nocturnal sleep recordings. MATERIAL AND METHODS: Twenty-six patients with partial epilepsy and mean monthly seizure frequency of 4, aged 18 to 48 years, receiving chronic monotherapy with CBZ and subsequent VGB addition for 2 months (14 patients), were compared with a group of healthy subjects. Subjective daytime sleepiness was complained by 13 patients on CBZ monotherapy and 9 patients during VGB add-on treatment. RESULTS: No differences in nocturnal sleep parameters, but significantly shorter daytime sleep latencies at the MSLT, were detected in CBZ-treated patients as compared with healthy controls. Addition of VGB therapy did not further enhance objective daytime sleepiness. CONCLUSION: Some sleepiness occurs in chronically CBZ-treated epileptic patients, which can be objectively measured by the MSLT, but it is not aggravated by add-on VGB.

Adolescent↗
PubMed1997

Core decompression for osteonecrosis of the femoral head in systemic lupus erythematosus.

A cross sectional study was performed to try to identify various demographic and radiologic risk factors for disease progression in 50 patients (79 hips) with corticosteroid associated osteonecrosis of the femoral head who had a core decompression. Thirty-one of the hips were in 18 patients who had systemic lupus erythematosus and were compared with the remaining group of 48 hips in 32 patients who were taking corticosteroids for other reasons. All patients in the study had been taking greater than 30 mg of prednisone for at least 2 weeks at least 6 months before the onset of osteonecrosis. Patients underwent a core decompression and were then observed for an average of 12 years (range, 4-18 years). Overall, 42 of the 79 hips (53%) had satisfactory outcomes. Of the 31 hips in patients with systemic lupus erythematosus, 21 (68%) were converted to a total hip replacement. In the patients without systemic lupus erythematosus taking corticosteroids, 16 of 48 hips (33%) progressed to arthroplasty. A subset of 25 hips from each group (systemic lupus erythematosus and without systemic lupus erythematosus) were matched for age, gender, prednisone dose, Ficat and Arlet Stage, and length of followup. The matched group without systemic lupus erythematosus had 44% survival (11 of 25 hips), which was not statistically different when compared with the 36% survival (9 of 25 hips) found in the systemic lupus erythematosus group. The major risk factors for disease progression were late stage of disease (Stage III) at presentation and radiographic extent of the lesion (>200 degrees), regardless of diagnosis. None of the factors that have been found to be associated with osteonecrosis in patients with systemic lupus erythematosus could be associated with disease progression. Because cause seems to be less significant than the onset and extent of the disease, the clinician should make the diagnosis of osteonecrosis as promptly as possible so that treatment can be started at the earliest possible time, when it will be most efficacious.

Adolescent↗
PubMed1997

Risk factors for osteonecrosis in systemic lupus erythematosus.

OBJECTIVE: To study clinical and laboratory factors in patients with systemic lupus erythematosus (SLE) to identify subgroups at extraordinary risk for developing osteonecrosis. METHODS: 31 of 103 (30%) patients with SLE had developed osteonecrosis. Patients were studied to identify clinical characteristics that differentiated patients with and without osteonecrosis. Subjects were studied to determine whether and to what degree factors leading to thrombophilia (anticardiolipin antibodies, aCL) or hypofibrinolysis [lipoprotein(a)] are associated with osteonecrosis. RESULTS: Clinically, the patients with osteonecrosis had significant increases in Cushingoid body habitus, thrombophlebitis, vasculitis, cigarette smoking, and preeclampsia. Highest prednisone dose was positively associated with osteonecrosis. Although IgG aCL were also found to be associated with osteonecrosis, particularly in the white patients with SLE, lipoprotein(a) levels were not increased in either the white or black patients. CONCLUSION: Maximal prednisone doses, changes in body habitus in response to corticosteroid therapy, IgG aCL levels, and clinical evidence of venous thrombosis and vasculitis were associated with osteonecrosis in patients with SLE.

Adolescent↗
PubMed1996

Plasma homocysteine as a risk factor for atherothrombotic events in systemic lupus erythematosus.

BACKGROUND: The aim of this study was to assess whether plasma homocysteine is a risk factor for stroke and other thrombotic events in patients with systemic lupus erythematosus (SLE)--a condition known to be associated with premature atherothrombotic complications. METHODS: In this prospective study, we investigated the association between homocysteine and risk of stroke and thrombotic events in 337 SLE patients in the Hopkins Lupus Cohort Study, with follow-up of 1619 person-years (mean 4.8 [SD 1.7] years). Each patient had four follow-up assessments per year to obtain information about established risk factors for thrombosis and coronary artery disease. The prospectively defined endpoints were occurrence of stroke and arterial or venous thrombotic events between 1987 and 1995. Blood samples were taken at study entry from fasting patients. Plasma homocysteine, folate, vitamin B12, and pyridoxal 5'-phosphate (PLP) concentrations were measured. Raised homocysteine concentrations were defined as more than 14.1 mumol/L. FINDINGS: 93% of the study population were women, 54% African American, and 45% white. The mean age of participants was 34.9 (SD 11.7) years. During follow-up there were 29 cases of stroke and 31 arterial thrombotic events. Raised homocysteine concentrations were found in 51 (15%) SLE patients. The log-transformed total homocysteine concentrations correlated with serum folate (r = 0.31, p = 0.0001). In univariate analyses, raised homocysteine concentrations were significantly associated with stroke (odds ratio 2.24 [95% CI 1.22-4.13], p = 0.01) and arterial thrombotic events (3.74 [1.96-7.13], p = 0.0001). After adjustment for established risk factors, total plasma homocysteine concentrations remained an independent risk factor for stroke (2.44 [1.04-5.75], p = 0.04) and arterial thromboses (3.49 [0.97-12.54], p = 0.05). INTERPRETATION: Homocysteine is a potentially modifiable, independent risk factor for stroke and thrombotic events in patients with SLE.

Adult↗
PubMed1996

Surface blebs on apoptotic cells are sites of enhanced procoagulant activity: implications for coagulation events and antigenic spread in systemic lupus erythematosus.

The restriction of phosphatidylserine (PtdSer) to the inner surface of the plasma membrane bilayer is lost early during apoptosis. Since PtdSer is a potent surface procoagulant, and since there is an increased incidence of coagulation events in patients with systemic lupus erythematosus (SLE) who have anti-phospholipid antibodies, we addressed whether apoptotic cells are procoagulant and whether anti-phospholipid antibodies influence this. Apoptotic HeLa cells, human endothelial cells, and a murine pre-B-cell line were markedly procoagulant in a modified Russell viper venom assay. This procoagulant effect was entirely abolished by addition of the PtdSer-binding protein, annexin V, confirming that it was PtdSer-dependent. The procoagulant effect was also abolished by addition of IgG purified from the plasma of three patients with anti-phospholipid antibody syndrome, but not IgG from normal controls. Confocal microscopy of apoptotic cells stained with fluorescein-isothiocyanate-conjugated-annexin V demonstrated (Ca2+)-dependent binding to the surface of membrane blebs o apoptotic cells, but not to intracellular membranes. Recent data indicate that the surface blebs of apoptotic cells constitute an important immunogenic particle in SLE. We propose that the PtdSer exposed on the outside of these blebs can induce the production of anti-phospholipid antibodies, which might also enhance the immunogenicity of the bleb contents. When apoptosis occurs in a microenvironment in direct contact with circulating plasma, the unique procoagulant consequences of the apoptotic surface may additionally be expressed. This might explain the increased incidence of pathological intravascular coagulation events that occur in some lupus patients who have anti-phospholipid antibodies.

Animals↗
PubMed1996

The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus.

OBJECTIVE: To develop and perform an initial validation of a damage index for systemic lupus erythematosus (SLE). METHODS: A list of items considered to reflect damage in SLE was generated through a nominal group process. A consensus as to which items to be included in an index was reached, together with rules for ascertainment. Each center submitted 2 assessments, 5 years apart, on 2 patients with active and 2 with inactive disease, of whom 1 had increased damage and the other had stable disease. Analysis of variance was used to test the factors physician, time, amount of damage, and activity status. RESULTS: Nineteen physicians completed the damage index on 42 case scenarios. The analysis revealed that the damage index could identify changes in damage seen in patients with both active and inactive disease. Patients who had active disease at both time points had a higher increase in damage. There was good agreement among the physicians on the assessment of damage in these patients. CONCLUSION: This damage index for SLE records damage occurring in patients with SLE regardless of its cause. The index was demonstrated to have content, face, criterion, and discriminant validity.

Health Status Indicators↗
PubMed1996

Mannose-binding protein genetic polymorphisms in black patients with systemic lupus erythematosus.

OBJECTIVE: To determine whether dysfunctional or deficient mannose-binding protein (MBP) variants are found with increased frequency in black patients with systemic lupus erythematosus (SLE) compared with controls. METHODS: Allele-specific polymerase chain reaction amplification of 4 different polymorphic sites was performed on samples from 92 black SLE patients and 86 geographically matched black controls. RESULTS: Two structural polymorphisms of MBP, associated with low serum levels of MBP, were found with significantly increased frequency in the SLE patient population compared with controls. In contrast, a promoter haplotype associated with particularly high serum levels of MBP was negatively associated with SLE. CONCLUSION: Deficiencies of MBP predispose individuals to SLE.

Acute-Phase Proteins↗
PubMed1996

Antiphospholipid antibodies and retinal vascular disease.

BACKGROUND: Antiphospholipid antibody retinopathy is a rare and poorly defined clinical entity in which the proper diagnosis has important ocular and systemic implications. The clinical course of five patients with antiphospholipid antibody retinopathy is described and the role of such antibodies in idiopathic retinal venous occlusive disease is investigated. METHODS: Five case reports are presented highlighting the presentation, course, therapy, associations and outcomes of patients with antiphospholipid antibody retinopathy. In addition, twenty additional patients presenting with idiopathic retinal venous occlusive disease were tested for the presence of antiphospholipid antibodies. RESULTS: All five patients with antiphospholipid antibody retinopathy had diffuse retinal vascular occlusion. All five patients presented with associated rheumatologic disease, including three with lupus or lupus-like disease. Antibodies to antiphospholipid were not detected in any of the twenty patients with idiopathic retinal venous occlusive disease. Prompt panretinal photocoagulation together with varying regimens of corticosteroids, immunosuppressives, or warfarin was partially successful in stabilizing the ocular and systemic disease. CONCLUSION: The diagnosis of antiphospholipid antibody retinopathy should be suspected in patients with diffuse retinal vaso-occlusion, particularly when characterized by involvement of both arteries and veins, neovascularization at presentation, and symptoms of symptoms of systemic rheumatologic disease. Antiphospholipid antibodies do not appear to play an important role in idiopathic retinal vein occlusions.

Adult↗
PubMed1996

Thrombosis and systemic lupus erythematosus: the Hopkins Lupus Cohort perspective.

Vascular damage in systemic lupus erythematosus (SLE) occurs through vasculitis, premature atherosclerosis, and hypercoagulability (predominantly due to the antiphospholipid antibody syndrome). In the Hopkins Lupus Cohort, a prospective cohort study, the incidence of thrombosis is 2 per 100 person-years of follow-up. Markers of immune-complex mediated injury (high anti-dsDNA and low C3), atherosclerosis (hypertension, hyperlipidemia, homocysteine) and antiphospholipid antibodies (lupus anticoagulant or anticardiolipin) are independent predictors of thrombosis. Hydroxychloroquine use is protective against future thrombosis.

Cohort Studies↗
PubMed1996

Hydroxychloroquine use in the Baltimore Lupus Cohort: effects on lipids, glucose and thrombosis.

Hydroxychloroquine is used by 35% of SLE patients enrolled in the Baltimore Lupus Cohort. Eighty per cent of patients who took hydroxychloroquine at cohort entry remain on it six years later. In addition to its role for disease manifestations of lupus, hydroxychloroquine may be indicated for the prevention of disease or treatment-induced complications, including hyperlipidemia, diabetes mellitus, liver function test elevation and thrombosis.

Antirheumatic Agents↗