Search PubMed⌕ Search

Biomedical subjects

M Petri

Publications and source records attributed to M Petri.

At least 127 records · Page 7Linked to original sources
PubMed1994

Depressive symptoms in patients with systemic lupus erythematosus: association with central nervous system lupus and Sjögren's syndrome.

OBJECTIVE: To determine if patients with systemic lupus erythematosus (SLE) with depressive symptoms differ in regard to organ involvement and serological activity from other patients with SLE. METHODS: Disease manifestations were compared between 71 patients with SLE with a history of depressive symptoms and 278 patients without a history of depressive symptoms by univariate analysis and multiple logistic regression. RESULTS: Both univariate and logistic regression analysis revealed an association of depressive symptoms with neuropsychiatric lupus and secondary Sjögren's syndrome (SS). Patients with neuropsychiatric lupus had an adjusted odds ratio of 3.43 (95% CI 2.55, 4.63; p = 0.00005), and patients with secondary SS had an adjusted odds ratio of 2.97 (95% CI 2.08, 4.25; p = 0.0006) for depressive symptoms. No other organ involvement or serological abnormality was associated with depressed mood. CONCLUSION: These discrete associations of depressive symptoms with neuropsychiatric lupus and secondary SS suggest that depression does not occur purely as a response to social stresses, and may be a manifestation of autoimmune disease in some patients.

Adult↗
PubMed1994

Diagnosis of antiphospholipid antibodies.

The antiphospholipid antibody syndrome consists of a presentation with venous thrombosis, arterial thrombosis (or vasculopathy), recurrent pregnancy loss, or thrombocytopenia, in the setting of high-titer anticardiolipin antibody or lupus anticoagulant. Characteristics of the lupus anticoagulant (an antibody detected by a functional assay) and anticardiolipin antibody are reviewed, in light of new information on the role of plasma proteins, especially B2-glycoprotein I. The advantages and disadvantages of screening and confirmatory assays for lupus anticoagulant are detailed, as well as modifications of the anticardiolipin antibody assay to improve sensitivity and specificity.

Antibodies, Anticardiolipin↗
PubMed1994

Systemic lupus erythematosus and pregnancy.

Although most women with systemic lupus erythematosus can achieve a successful pregnancy, fetal (fetal loss, preterm birth) and maternal (lupus flares, worsening renal function) morbidity remain major problems. Predictors of fetal loss and preterm birth have been identified and are reviewed. Modern management of lupus pregnancy includes identification of high-risk pregnancies with appropriate monitoring and treatment (when indicated) for anti-Ro and antiphospholipid antibodies, frequent assessment of and control of maternal lupus activity, adjustment of medications to avoid those associated with fetal teratogenicity, and the appropriate use of fetal assessment tests to guide intervention for the fetus at risk of intrauterine death.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1993

Clinical features of systemic lupus erythematosus.

Descriptive and analytic clinical research investigations dealing with systemic lupus erythematosus have focused on disease manifestations involving the heart, kidneys, and central nervous system, the complications of corticosteroid therapy, particularly cardiovascular and peripheral vascular disease, and outcomes of pregnancy. Studies exploring prognostic factors in patients with lupus nephritis as well as risk factors for the development of cardiovascular disease emphasize the importance of control of comorbid conditions, particularly hypertension and hyperlipidemia, in preventing poor outcomes in patients with systemic lupus erythematosus. The effectiveness of parenterally administered pulse cyclophosphamide has been demonstrated in patients with severe central nervous system involvement, and the effectiveness of plasmapheresis in patients with thrombotic thrombocytopenic purpura was reviewed.

Arthritis↗
PubMed1993

Clinical expression of systemic lupus erythematosus in patients with C4A deficiency.

We studied 121 patients with systemic lupus erythematosus (SLE), of whom 119 were complement typed. Both black and white patients with SLE were more likely than racially matched controls to have a C4A null allotype. Patients with homozygous C4A deficiency had less proteinuria than other patients (p = 0.02) and both homozygous and heterozygous C4A-deficient patients (p = 0.05) had fewer seizures than other patients. Anti-dsDNA, anti-Sm, anti-Ro, and anticardiolipin antibodies were less common in patients with homozygous C4A deficiency, with heterozygous C4A-deficient patients intermediate in frequency between homozygous C4A-deficient and normal patients with SLE. Both homozygous and heterozygous C4A-deficient patients (p < 0.005) had higher C3 levels than other patients, and heterozygous C4A-deficient patients had higher, not lower, C4 levels (p < 0.002), compared with non-C4A-deficient patients. C4A gene deletion was found in 23.4% of patients. C4A gene deletion was associated with subacute cutaneous lupus erythematosus (p = 0.04) and Sjögren syndrome (p = 0.02) in patients with SLE. Both anti-dsDNA (p = 0.04) and anticardiolipin (p = 0.04) were found less frequently in patients with C4A gene deletion. Patients with C4A gene deletion had lower C4 levels than patients with C4A deficiency from other mechanisms. We conclude that the presence of 1 or 2 C4A null allotypes and the presence of a C4A gene deletion identify subgroups of patients with SLE that differ in clinical, laboratory, and autoantibody characteristics from other patients with SLE.

Adolescent↗
PubMed1993

The investigations of mechanical properties of ossificating thyroid cartilages of the human larynx.

40 thyroid cartilages were used to investigations, they were taken from bodies of people, died between the ages of 19-99, by the use of the endurance machine with controlled speed of the increase of deformation. It was observed that the durability for flexion and the inflexibility of the investigated cartilages depends on the level of the process of their ossification, that is estimated by the help of the radiological index of the ossification (RIO). On the other hand, the searches of durability forcing of the regions of cartilages that presented different levels of the ossification process, proved the heterogenicity of the structure of the cartilage, in which ossified parts are separated by zones, that did not submit to this process.

Adult↗
PubMed1993

Fetal outcome of lupus pregnancy: a retrospective case-control study of the Hopkins Lupus Cohort.

OBJECTIVE: To determine the frequency of pregnancy loss, preterm birth, and therapeutic abortion in patients with systemic lupus erythematosus (SLE) versus controls. METHOD: The outcome of lupus pregnancy was determined in the largest retrospective case-control study to date, involving 203 patients with SLE with 481 pregnancies, 166 "best friends" with 356 pregnancies and 177 relatives with 566 pregnancies. RESULTS: Pregnancy loss (spontaneous abortion, miscarriage, or stillbirth) was more common in lupus pregnancies (21%) than in pregnancies in friends (14%, p = 0.01) or in relatives (8%, p < or = 0.0001) and was more common after the diagnosis of SLE than before (27 19%, p = 0.04). Preterm birth (< or = 36 weeks) was more common in lupus pregnancies (12%) than in pregnancies in friends (4%, p < or = 0.0001) or in relatives (4%, p < or = 0.0001) and was more common after the diagnosis of SLE than before (24 vs 6%, p < or = 0.0001). Preterm birth in lupus pregnancies after the diagnosis of SLE was associated with nonhigh school graduates (p = 0.001), Raynaud's phenomenon (p = 0.007), and hypertension requiring treatment (p = 0.01). CONCLUSION: We conclude that both pregnancy loss and preterm birth are significantly increased in lupus pregnancy versus control pregnancy and that these pregnancy outcomes are more common after the diagnosis of SLE.

Abortion, Spontaneous↗
PubMed1992

Hair product use in systemic lupus erythematosus. A case-control study.

OBJECTIVE: We sought to determine if hair product use is associated with the development of systemic lupus erythematosus (SLE) and whether SLE patients who use hair products have more severe disease. METHOD: A questionnaire on hair product use was administered to 218 members of the Hopkins Lupus Cohort, 178 first- or second-degree relatives, and 186 best friends of the patients. RESULTS: There was no significant difference in exposure to hair dye or hair permanent in SLE patients before the diagnosis of SLE as compared with controls, nor were there any significant differences in measures of SLE disease activity in patients who used hair products after their diagnosis versus those who did not. CONCLUSION: Exposure to hair dyes and hair permanents is not associated with the development of lupus. No hair product is associated with SLE disease activity after diagnosis.

Adult↗
PubMed1992

Risk factors for coronary artery disease in patients with systemic lupus erythematosus.

PURPOSE: To estimate the frequency of and examine risk factors for coronary artery disease (CAD) in patients with systemic lupus erythematosus (SLE) in a prospective longitudinal study. PATIENTS AND METHODS: Patients were SLE are enrolled in The Johns Hopkins Lupus Cohort, a prospective study of outcomes in 229 subjects with SLE. CAD was defined as angina, myocardial infarction, or sudden death. Data on CAD risk factors were obtained prospectively every 3 months and were analyzed using univariate and multiple logistic regression. RESULTS: CAD occurred in 19 (8.3%) of 229 patients with SLE and accounted for 3 (30%) of 10 deaths as of December 31, 1990. Compared to subjects without CAD, those with CAD were more likely to have been older at both diagnosis of SLE (37.1 years versus 28.9 years, p = 0.004) and at entry into the cohort (47.1 years versus 34.7 years, p < 0.0001), to have a longer mean duration of SLE (12.3 years versus 8.1 years, p = 0.013) and a longer mean duration of prednisone use (14.3 years versus 7.2 years, p < 0.0001), to have a higher mean serum cholesterol (271.2 mg/dL versus 214.9 mg/dL, p < 0.0001) or a cholesterol level greater than 200 mg/dL (odds ratio [OR] 14.5, 95% confidence intervals [CI] 1.9, 112.1), and to have both a history of hypertension (OR 3.5, 95% CI 1.3, 9.6) and a history of use of antihypertensive medications (OR 5.5, 95% CI 1.8, 17.2). There were no significant associations with other known CAD risk factors such as smoking, diabetes, family history of CAD, race, or sex, or variables related to steroid therapy including the presence of cushingoid features or ever use of corticosteroids. The best multiple logistic regression model for CAD included age at diagnosis, duration of prednisone use, requirement for antihypertensive treatment, maximum cholesterol level, and obesity (using NHANES-II [National Health and Nutrition Examination Survey] definitions). CONCLUSION: Primary and secondary prevention strategies directed at hypertension, hypercholesterolemia, and obesity, as well as other known CAD risk factors, should be routinely employed in the management of patients with SLE.

Adult↗
PubMed1992

Coronary artery disease risk factors in the Johns Hopkins Lupus Cohort: prevalence, recognition by patients, and preventive practices.

Known risk factors for coronary artery disease are very common in the Hopkins Lupus Cohort, in spite of the fact that the average patients age is only 38.3 years. Three or more known risk factors were found in 53% of patients. Risk factors for CAD were common even in patients not on a regimen of prednisone therapy during their cohort follow-up. Hypercholesterolemia increased significantly with greater average prednisone dose. Despite the frequency of risk factors, patients' awareness of the risk of CAD was low, with only 16.9% of patients believing they were at high risk for developing CAD within 5 years. In general, awareness of individual risk factors was lower in black than in white patients with SLE. Preventive practices were most commonly addressed towards hypertension. Preventive practices directed against obesity, hypercholesterolemia, and smoking were underutilized. Whether these known risk factors are sufficient in and of themselves to explain the high frequency of CAD in the cohort (8%) or whether they are "enabling" factors acting upon endothelium damaged by immune-complex disease cannot be addressed by this study. However, both further investigation of these risk factors and attention to lifestyle and pharmacologic approaches to risk factor reduction are indicated by this study.

Adolescent↗
PubMed1992

Incidence of and risk factors for hospitalizations in systemic lupus erythematosus: a prospective study of the Hopkins Lupus Cohort.

OBJECTIVE: To determine the incidence of and risk factors for hospitalization in systemic lupus erythematosus (SLE). METHOD: A prospective study of hospitalizations in 1989 and 1990 in the Hopkins Lupus Cohort was conducted. RESULTS: Of 261 patients with SLE in the Hopkins Cohort, 147 (56.3%) were hospitalized in 1989 or 1990. The incidence of hospitalization was 0.69 admissions/person-year. The mean length of stay was 9.6 days +/- 12.7 (SD). Activity of SLE accounted for 35% of admissions. Risk factors for hospitalization for active lupus in 1990 included activity of SLE in 1989 (measured by either the highest physician's global assessment in 1989, p = 0.004, highest lupus activity index (LAI) score in 1989, p = 0.002, or highest systemic lupus erythematosus disease activity index score in 1989, p = 0.008), an average prednisone dose greater than 10 mg in 1989 (p = 0.002), and the presence of neurologic lupus in 1989 (p = 0.02). Medical admissions other than for active SLE accounted for an additional 27% of admissions; one-half of these admissions (47%) were for complications of SLE and/or its treatment, with coronary artery disease the most common (21% of medical admissions). Infections were responsible for 14% of admissions. The majority of infections were bacterial (90%). Risk factors for hospitalization for infection in 1990 included active SLE in 1989 (p = 0.03), average prednisone dose of greater than 10 mg in 1989 (p = 0.04), immunosuppressive drug use in 1989 (p = 0.003), neurologic SLE in 1989 (p = 0.02) and previous hospitalization in 1989 (p = 0.03). CONCLUSION: Hospitalization is common in the Hopkins Lupus Cohort, with active SLE (35%), infection (14%, infection and/or active SLE; 11%, infection alone) and medical complications of SLE (13%) as the 3 most common causes.

Adult↗
PubMed1992

Pancreatitis in systemic lupus erythematosus: still in search of a mechanism.

Pancreatitis in SLE remains an enigma and probably results from multiple pathogenetic mechanisms. However, cases of pancreatic thrombus formation remain few and far between, suggesting that APS is not the major cause of pancreatitis. Whether aPL contribute to pancreatic thrombus formation in rare patients needs to be demonstrated by antemortum arteriographic studies showing thrombus or vasculopathy. The postmortem pancreatic examination of patients who have died of the disseminated vasculopathy-coagulopathy syndrome remains problematic, because if thrombi are found, they may simply represent the endstage of multiple mechanisms, including hypotension, hypoxia, DIC, or TTP, rather than an aPL specific mechanism.

Humans↗
PubMed1992

Neonatal lupus erythematosus syndrome: analysis of C4 allotypes and C4 genes in 18 families.

We examined 18 families with infants who had neonatal lupus erythematosus (NLE) syndrome to determine whether abnormalities in C4 phenotypes and genotypes were an additional risk factor for this syndrome. Fifteen of 18 mothers of infants with NLE (83%) had C4 null allotypes compared with 36% of population controls (p = less than .001). This increased frequency was due mainly to the presence of C4A null allotypes (11/18, 61%). C4 gene abnormalities, i.e., deletion or probable duplication, were present in 100% (16/16) of mothers of infants with NLE. The most common molecular genetic abnormality in mothers of infants with NLE in this study was deletion of C4A genes. Duplication of C4A and C4B loci was also commonly seen. Duplication of C4A genes was detected only in mothers of infants with complete congenital heart block (CCHB), and duplication of C4B was detected only in mothers of infants with dermatitis. No significant increase in C4A or C4B null allotypes or protein deficiencies was noted in mothers of infants with neonatal lupus when compared with anti-Ro(SS-A)-positive mothers delivered of clinically normal infants. Fathers of infants with NLE showed a trend toward increase in C4B null allotypes when compared with population controls (75%, 3/4, p = .06). The two infants with CCHB examined were C4B protein-deficient, in contrast to infants with lupus dermatitis, who had frequent C4B null allotypes but no C4B protein deficiency. C4B null allotypes were not seen in unaffected siblings of infants with NLE and in only 1 of 7 anti-Ro(SS-A)-positive mothers who delivered clinically normal infants. We conclude that inheritance of C4A null allotypes is not predictive of increased risk of neonatal lupus when present in anti-Ro(SS-A)-positive women. Examination of paternal and maternal C4 genes of additional infants with NLE, in particular those with CCHB, and of normal infants born to anti-Ro(SS-A)-positive mothers--and of the normal infants' parents--is required to determine if abnormal C4B genes are a critical factor rendering susceptibility to the NLE syndrome.

Antibodies, Antinuclear↗
PubMed1992

Validity and reliability of lupus activity measures in the routine clinic setting.

As part of a cohort study of 150 patients with systemic lupus erythematosus (SLE), we investigated the validity and reliability of several indices of lupus activity, including the UCSF/JHU Lupus Activity Index (LAI), the SLE Disease Activity Index (SLEDAI), and a simple Core Index combining common elements. Validity was assessed by measuring correlations of these indices at the first cohort visit with the physician's global assessment (PGA) of SLE activity. The correlation of M-LAI (LAI modified so as not to contain PGA) and SLEDAI with PGA was 0.64 (95% CI 0.50, 0.70) and 0.55 (95% CI 0.42, 0.64), respectively. Reliability was assessed in a study of 6 patients seen twice, one week apart, by 9 physicians. The interrater reliability and test-retest reliability was greater for LAI (or M-LAI) than for SLEDAI. The Core Index performed better in its correlation with PGA (R = 0.78), although it contained no treatment data or serologic tests. Its interrater reliability and test-retest reliability were comparable with LAI. We conclude that (1) all indices have high validity; (2) LAI and the Core Index have higher reliability; and (3) these indices can be readily assimilated into routine clinic practice.

Adult↗
PubMed1992

Antibiotic allergy in systemic lupus erythematosus: a case-control study.

Antibiotic allergy, especially to sulfonamides, has been reported as both a predisposing factor and as an exacerbating agent in systemic lupus erythematosus (SLE). We surveyed 221 members of The Johns Hopkins Lupus Cohort and 2 control groups, consisting of 178 relatives and 186 best friends, for antibiotic allergy to penicillin/cephalosporins, sulfonamides, tetracyclines, and erythromycin. Antibiotic allergy was common in patients with SLE exposed to the drug: 27% penicillin/cephalosporin, 31% sulfonamide, 7% tetracycline, and 13% erythromycin. In all cases, the most common allergic reaction was rash. Worsening of SLE occurred in 21% of sulfonamide allergic reactions. Allergy to penicillin/cephalosporin (OR 2.3, 95% CI 1.5-3.6), sulfonamides (OR 2.4, 95% CI 1.2-4.7) and to erythromycin (OR 4.8, 95% CI 1.5-14.9) was significantly more common in exposed patients with SLE than in exposed controls. Thus, antibiotic allergy is a frequent finding in patients with SLE and, in the case of sulfonamide allergy, can be associated with lupus exacerbation.

Adult↗
PubMed1991

Definition, incidence, and clinical description of flare in systemic lupus erythematosus. A prospective cohort study.

The course of systemic lupus erythematosus (SLE) is characterized by exacerbations (or flares) and remissions of disease activity. As part of an ongoing prospective cohort study, 3 disease activity indices, the physician's global assessment, the Lupus Activity Index, and the University of Toronto SLE Disease Activity Index, have been recorded, at least quarterly since 1987, on 185 SLE patients. We developed a definition of SLE flare and a description of its clinical epidemiology. Disease flare was defined as a change of greater than or equal to 1.0 in the physician's global assessment of disease activity (measured on a 0-3 scale) from the previous visit or from a visit within the last 93 days. Of the 185 patients, 98 (53%) had greater than or equal to 1 flare; the total number of flares was 146. The incidence of flare was 0.65 per patient-year of followup. The median time from the first study visit to a flare was 12 months. Flares were frequently characterized by constitutional symptoms, musculoskeletal involvement, cutaneous involvement, and decreasing levels of C3 and C4. At the time of flare, the mean University of Toronto SLE Disease Activity Index score increased by 3.0 and the mean Lupus Activity Index score (modified to omit the physician's global assessment) increased by 0.26. Overall, 44.8% of the flares prompted a change in treatment. Patients who experienced flares fulfilled more of the SLE criteria at entry and had been followed up for a longer duration after entry into the study, compared with those who did not have flares.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Frequency of lupus flare in pregnancy. The Hopkins Lupus Pregnancy Center experience.

To determine whether pregnancy is associated with an increased rate of flare in patients with systemic lupus erythematosus (SLE), we prospectively studied 40 pregnancies in 37 women with SLE. The women were evaluated on a monthly basis in the Hopkins Lupus Pregnancy Center. Flare was designated using a previously developed quantitative definition, i.e., a change of greater than 1.0 in the physician's global assessment (scale of 0-3) since the preceding visit or during the last 93 days. Flare occurred in 24 (60%) of the pregnancies. Flares presented most commonly as constitutional symptoms, renal involvement, or involvement of skin or joints. Comparison of the rates of flare in the same patients after delivery and in nonpregnant SLE patients showed a significant increase in the rate of flare during pregnancy (P less than 0.001 and P less than 0.0001, respectively). We conclude that flare of lupus during pregnancy is common and occurs significantly more frequently than does flare in nonpregnant SLE patients or in the same patients after pregnancy.

Adult↗