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Autoantibodies against the multicatalytic proteinase in patients with systemic lupus erythematosus.

Sera from patients with systemic lupus erythematosus contain specific autoantibodies directed against different polypeptide components of the multicatalytic proteinase (also known as proteasome or prosome). These human autoantibodies, in contrast to polyclonal antibodies obtained in rabbits against the purified enzyme, recognize highly conserved epitopes of the multicatalytic proteinase polypeptides from yeast to human.

Animals↗

Systemic lupus erythematosus. Recognizing its various presentations.

Systemic lupus erythematosus (SLE) is a multisystem disease that predominantly affects women. Probable causative factors include genetic predisposition, complement deficiencies, persistence of antigen, drugs, and environmental factors. The widely varying presentations of SLE include skin, musculoskeletal, cardiovascular, renal, pulmonary, gastrointestinal, neuropsychiatric, systemic, hematologic, and immunologic manifestations. Milder symptoms can be managed with nonsteroidal anti-inflammatory drugs and antimalarial agents. Corticosteroids and cytotoxic drugs are given in more severe disease.

Female↗

Chronic aseptic meningitis in a patient with systemic lupus erythematosus.

Chronic aseptic meningitis is a rare manifestation of systemic lupus erythematosus. It may occur early in the course of the disease and sometimes may be the initial symptom. We report a patient with chronic aseptic meningitis associated with systemic lupus erythematosus. Magnetic resonance imaging showed several ischemic lesions and an appearance which was compatible with chronic inflammation of the ependyma of the lateral ventricles.

Chronic Disease↗

Evidence of an immediate hypersensitivity mechanism in systemic lupus erythematosus.

In 30 patients with systemic lupus erythematosus the number of a circulating basophils was countered in different stages of activity. An inverse correlation was found between the absolute basophils count and anti-DNA antibodies and presumptive circulating immune complexes (as judged by polyethylene glycol precipitation of serum). A positive correlation was found between the absolute basophil count and C3 or C4 levels. IgE on the basophil surface was determined by radioimmunoassay in 7 patients. All of them showed a significantly higher surface IgE number. When the count of circulating basophils was roughly normal, 5 out of the 6 patients showed a positive basophil degranulation test with native DNA. These results suggest the existence of an anti-DNA specific IgE in lupus patients. Depression of the circulating basophil count may be a useful index of lupus activity.

Antibodies, Antinuclear↗

Systemic lupus erythematosus: a multisystem autoimmune disorder.

Systemic lupus erythematosus (SLE) is a chronic illness that has no known cause. As an autoimmune, inflammatory disease, it can affect various organs in different ways. Because of its fluctuating, unpredictable qualities, it requires the implementation of physiologic and psychosocial interventions that may change daily. A plan of care unique to each individual with SLE is essential to its management.

Adrenal Cortex Hormones↗

Systemic lupus erythematosus with pulmonary hypertension.

A 50-year-old Japanese female with a long history of Raynaud's phenomenon presented with progressive dyspnea due to pulmonary hypertension. The diagnosis of systemic lupus erythematosus was confirmed by proteinuria, lymphocytopenia, bilateral pleurisy, and a seizure of convulsion which was consistent with neurological manifestations of systemic lupus erythematosus, whereas the antinuclear antibody showed a low titer. Despite improvement in the activity of systemic lupus erythematosus, steroid treatment did not alter the progression of pulmonary hypertension, which increased in severity, eventually resulting in her death. We believe pulmonary hypertension to be an unusual but critical complication of systemic lupus erythematosus.

Diagnosis, Differential↗

[Acute chorea revealing lupus erythematosus disseminatus].

A case of systemic lupus erythematosus (SLE) is reported in a 12 year-old girl who presented with chorea. This rare manifestation of SLE was previously recorded as a mode of presentation in half of the 51 reported cases. In view of the relative rarity of rheumatic fever in economically advanced countries, SLE should be entertained as a manifestation of chorea. The possible pathophysiologic mechanisms of this central nervous system involvement are discussed.

Child↗

Perspectives in pediatric systemic lupus erythematosus.

As in the adult, systemic lupus erythematosus is a disorder with many manifestations and a number of subgroups, but in any personal series the total is usually small so that these are not always obvious. There is thus an urgent need for multicenter collection of data. This is important not only for appraisal of different aspects of the disease, particularly central nervous system involvement but also to look at prognosis. Assessment of therapy on the different aspects of this disease also requires multicenter cooperation.

Autoantibodies↗

Surgery of systemic lupus erythematosus arthritis of the hand.

Systemic lupus erythematosus (SLE) is one of a group of three uncommon arthritic diseases, including psoriatic arthritis and scleroderma, that superficially resemble rheumatoid arthritis (RA). These diseases frequently involve the hand and wrist and therefore are significant to the hand surgeon. SLE has certain specific characteristics that separate it from the other two conditions. Each of these diseases has distinct features affecting the nature of the deformities as well as the treatment indicated to adequately care for these patients.

Arthritis↗

Sex hormones and pregnancy in rheumatoid arthritis and systemic lupus erythematosus.

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are autoimmune disorders with a preponderance in females. RA and SLE differ in their response to sex hormones. Disease development of RA is mitigated by estrogen and pregnancy whereas SLE tends to flare during pregnancy and in response to estrogen. Pregnancy improves the symptoms of RA in about 75% of pregnant patients, but relapses within six months postpartum in 90% of cases. RA is regarded as a T cell-mediated and TH1 immune response-driven disease. Pregnancy induces a shift from TH1 to TH2 immune response, increasing the anti-inflammatory cytokines IL-4 and IL-10, which may contribute to gestational amelioration of RA. Prospective studies of SLE pregnancies indicate that about 50% of patients experience a flare, however, with no permanent aggravation of the disease. Lupus nephritis, presence of antiphospholipid antibodies, and a previous history of pregnancy loss increase the risk of complications during pregnancy and fetal loss. The marked increase of estrogen and progesterone during pregnancy seems to enhance some of the manifestations of SLE. The shift to a TH2 immune response may trigger SLE manifestations that are dependent on humoral immune responses such as lupus nephritis. Another factor stimulating immune responses is the pituitary hormone prolactin, which has been found elevated in SLE patients of both sexes and correlated to disease activity in several studies. The hyperprolactinemia of lactation seems to influence postpartum behavior of SLE as well as RA.

Animals↗

[No correlation between suppressor cell function and disease activity in natural history studies of patients with systemic lupus erythematosus].

In ten patients with systemic lupus erythematosus lymphocyte suppressor cell function was repeatedly monitored over a period of nine months. The method used is based on the finding that in vitro addition of ConA to PWM-stimulated lymphocytes activates suppressor T cells which in turn inhibit immunoglobulin synthesis. Nine of ten SLE patients exhibited significant impairment of IgG suppression but no correlation was found between the outcome of the IgG suppressor cell assay and disease activity or the treatment protocol applied.

Adrenal Cortex Hormones↗

Serum factors causing impaired macrophage function in systemic lupus erythematosus.

Leukocytes from patients with systemic lupus erythematosus (SLE) and healthy controls were cultured for 4 days in either SLE serum or control serum. The remaining monolayer of monocyte-derived macrophages was allowed to ingest yeast cells. Macrophages (from SLE patients or controls) incubated in SLE sera presented impaired phagocytic activity and glass adherence compared with cells grown in control sera. SLE sera contain one or more factors that impair macrophage function; IgG-containing immune complexes may be one such factor.

Adult↗

Massive bilateral pleural effusion as the only first presentation of systemic lupus erythematosus.

A rare case of systemic lupus erythematosus (SLE), with massive bilateral pleural effusions as the first manifestation, is described. The patient was a previously healthy 20-year-old soldier. Initial investigations were unrevealing, but after 3 months the patient developed the full-blown syndrome. He responded well to corticosteroids and cyclophosphamide with resolution of the pleural effusions and improvement of the clinical picture. SLE should always be considered in cases of massive pleural effusions, even in the absence of other overt stigmata of the disease.

Adult↗

Psychiatric symptoms as features of systemic lupus erythematosus.

An enquiry of the Dutch Lupus Patients Society revealed that 49% of the members had experienced psychiatric symptoms before systemic lupus erythematosus (SLE) was diagnosed and 33% had sought professional psychiatric help at that stage. To determine the frequency of SLE on psychiatric admission 2,121 patients were tested for the presence of SLE-specific antinuclear and anti-DNA autoantibodies. The results suggest that SLE is a cause of admission in psychiatric hospitals at the rate of 0.1-0.2% and routine screening of antinuclear and anti-DNA antibodies on admission is not an effective diagnostic approach.

Adult↗

Systemic and cerebral vasculitis coexisting with disseminated coagulopathy in systemic lupus erythematosus associated with antiphospholipid syndrome.

Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are closely related, but each has it own characteristic vasculopathy: vasculitis in SLE and thrombosis in APS, and either may be a serious or life threatening complication. When a patient has SLE associated with APS, systemic and cerebral vasculitis may coexist with disseminated coagulopathy. We report this complication in a 60-year-old woman who died from stroke and myocardial infarction, an occurrence seldom documented in the literature.

Antiphospholipid Syndrome↗

Diabetes insipidus in a pediatric patient with systemic lupus erythematosus. A case report.

In systemic lupus erythematosus (SLE), the central nervous system (CNS) produces numerous and varying clinical disorders. A 14-year-old girl with the features of cerebral involvement in SLE is presented. The development of diabetes insipidus (DI), which responded to desmopressin, was an interesting finding in this case. Therapy consisting of high-dose methylprednisolone combined with cyclophosphamide was effective in improving the symptoms as well as the DI.

Adolescent↗

Lymphocyte destruction by antibody-dependent cellular cytotoxicity mediated in vitro by antibodies in serum from patients with systemic lupus erythematosus.

Sera from patients with systemic lupus erythematosus (SLE) were tested for the presence of IgG antilymphocyte antibodies that are capable of mediating antibody-dependent cellular cytotoxicity (ADCC) of peripheral blood lymphocytes (PBL) from normal donors. The effector cells employed were PBL autologous with the target PBL. Positive ADCC responses were obtained with serum from 5 SLE patients with severe active diseases. It is possible that ADCC is a mechanism by which IgG antilymphocyte antibodies in patients with SLE may mediate in-vivo lymphocytolysis.

Antibody-Dependent Cell Cytotoxicity↗

Systemic lupus erythematosus in pregnancy--case report.

Systemic lupus erythematosus (SLE) is a chronic inflammatory connective tissue disease commonly diagnosed after the age of 20, mostly around the age of 30 years. It is more common in women than in men, especially during the fertile period. Women with SLE are at higher risk for spontaneous abortions, intrauterine fetal death, preeclampsia and eclampsia, preterm delivery and intrauterine growth retardation. This paper is a case report of a pregnant woman with SLE complicated with preeclampsia, but it also discusses follow-up of such pregnancies.

Adult↗