Intradermal tests with autologous white blood cells in chronic discoid lupus erythematosus. systemic lupus erythematosus and control subjects.
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Antigen-Antibody Reactions↗
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Fcgamma receptors in the initiation and progression of systemic lupus erythematosus.
Systemic lupus erythematosus, a systemic autoimmune disorder, is characterized by the production of autoantibodies to nuclear constituents and inflammatory lesions in multiple organ systems. Although the pathogenesis of the disease is largely unknown, recent studies have suggested that disturbances in apoptosis and/or clearance of apoptotic cells may play an important role in the induction and perpetuation of autoantibody production. When autoantibodies subsequently complex to autoantigens present on apoptotic cells, ligation of Fcgamma receptor will result in inflammation and disease development. Indeed, mice deficient in activating Fcgamma receptors were protected against inflammation in models of immune complex-mediated autoimmune disease, whereas deletion of the inhibitory Fcgamma receptors increased autoantibody production and susceptibility to immune complex-induced inflammation. Additionally, functional polymorphisms in Fcgamma receptors were shown to be associated with development of human systemic lupus erythematosus. This review focuses on the role of Fcgamma receptors in the initiation of autoantibody production, inflammatory handling of immune complexes, and disease development in systemic lupus erythematosus.
Animals↗
Cholestatic hepatitis: a rare hepatic manifestation of systemic lupus erythematosus.
Systemic lupus erythematosus is a multi-system inflammatory disease. The clinical manifestations are diverse. Hepatic manifestation is a rarely seen complication of systemic lupus erythematosus. We report a case of complication of systemic lupus erythematosus presenting as cholestatic hepatitis in a 56-year-old Chinese woman. The cholestatic hepatitis progressed as part of the lupus activity and responded to steroid therapy.
Journal Article↗
[Cardiological state of offsprings of the mothers suffering from systemic lupus erythematosus].
Systemic lupus erythematosus is a disease in which inflammatory process provoked by different antibodies affects many organs and systems. The circulatory system is one of them. In patients with systemic lupus erythematosus cardiac disorders are generally known and well proved. It is known that this disease has heritage background. Thus, the offsprings of patients suffering from systemic lupus erythematosus belong to a risk group. Moreover, it is thought that maternal antibodies crossing transplancentally to the fetus cause damages of tissues including the heart. The aim of this study was to evaluate cardiological status of 38 children whose mothers suffered from systemic lupus erythematosus. In all sick mothers the diagnosis fulfilled criteria of the American Rheumatism Association. The mothers have been remaining under medical treatment while the children have been under control and simultaneously prophylaxis of lupus has been undertaken. The study was undertaken in 17 girls and 21 boys aged 3 to 18 years (average: 12 +/- 4.5 years). Physical development of presented children was satisfactory. During cardiological examination all subjects were in good general condition, without any clinical evidence of collagen disease and infection. Obtained results were compared with the ones found in control group of 38 children of healthy mothers, being at the same age. Study methods were: physical examination, arterial blood pressure measurement, standard and 24 hours according to Holter method ECG record, echocardiographic and Doppler examination, and physical performance test according to Bruce's protocol. In children of sick mothers examined laboratory parameters were within the normal limits excluding the presence of antinuclear antibodies (controlled by indirect immunofluorescence test), result of which was positive in 15 studied children (39%). In the group of the children of sick mothers the abnormalities of sinus node function were detected in 12 cases (32%), significantly more often than in the control. There were found abnormalities of atrio-ventricular and intraventricular conduction in 15 subjects (40%). The premature beats of ventricular origin were noticed in 3 cases (8%). These disturbances were significantly different from the control group. In addition, correlation between the presence of antinuclear antibodies and the cardiac abnormalities was taken into consideration. So, significant correlation between antinuclear antibodies and heart rhythm disorders was proved. During echocardiographic examination structural and functional abnormalities were found. They were: ventricular septal defect (muscular part) (1), pericarditis effusion (1), prolapse of the mitral valve anterior leaflet (2), mitral valve regurgitation of the second degree (2) and increased diameter of left atrium (8). One girl from the studied group, suffering from atrio-ventricular block of III* was operated on because of persistent ductus arteriosus still in the newborn's period. At the same time the permanent pace-maker was implanted. After 1 year of age this girl was operated on because of atrial septal defect (ASD II). In studied group of children echocardiographic global indices of left ventricular systolic function were normal. The subclinical impairment of diastolic left ventricle function was found in 8 children with increased left atrium-aorta index. Both the theoretical knowledge and the results of the studies suggest that the offsprings of mothers suffering from SLE need a careful cardiological observation.
Adolescent↗
Acute gastrointestinal manifestations of systemic lupus erythematosus.
Systemic lupus erythematosus is a common multisystem disorder of young women, and gastrointestinal symptoms are a frequent clinical manifestation. There is serious danger that appropriate therapy may be delayed in the patient with an acute abdomen when systemic lupus erythematosus is not considered as a cause. This paper describes four patients with acute abdomen as a manifestation of systemic lupus erythematosus. They responded dramatically and without complication to steroid therapy. The symptoms recurred in one patient but responded to plasmapheresis and intravenous administration of cyclophosphamide. The other gastrointestinal manifestations of systemic lupus erythematosus and their pathogenesis are discussed. Management requires consideration of systemic lupus erythematosus as the cause of acute abdomen, paracentesis for culture and treatment with high doses of steroids with or without broad-spectrum antibiotics. If there is no notable improvement within 24 hours laparotomy should be performed.
Abdomen↗
T cell receptor clonotypes in skin lesions from patients with systemic lupus erythematosus.
Systemic lupus erythematosus is an autoimmune disease characterized by the presence of autoantibodies and by lymphocytic infiltration into lesions at several sites such as skin, kidney, and other organs. Immunohistologic studies have clarified that the majority of lymphocytes in the skin are CD4+ alphabeta T cells. In the present work, to clarify the pathologic role of T cells in the skin of systemic lupus erythematosus patients, we analyzed T cell receptor (TCR) clonotypes of T cells infiltrating into skin lesions. TCR Vbeta gene transcripts from T cells from discoid lesions of the skin and peripheral blood lymphocytes of four systemic lupus erythematosus patients were amplified by reverse transcriptase polymerase chain reaction. Southern blot analysis of polymerase chain reaction product demonstrated the heterogeneous TCR Vbeta repertoire of T cells in the skin of systemic lupus erythematosus. Single-strand conformation polymorphism analysis showed several distinct bands for smears of most TCR Vbeta genes from T cells infiltrating the skin, whereas smears with few bands were found for all TCR Vbeta genes from peripheral blood lymphocytes of the same patients. The number of bands encoding each TCR Vbeta gene from the skin was significantly higher compared with peripheral blood lymphocytes. Sequencing analysis showed a Leucine-X-Glycine amino acid motif at position 96-98 in the CDR3 region at the frequency of 23-24% in skin-accumulated T cells from two patients, whereas the frequency of this motif in peripheral T cells was only 0-3%, indicating limited T cell epitopes. In conclusion, T cells infiltrating into the skin of systemic lupus erythematosus patients might recognize restricted T cell epitopes on autoantigens and trigger the autoimmune reaction in skin lesions.
Amino Acid Sequence↗
Pregnancy outcome in women with systemic lupus erythematosus.
Systemic lupus erythematosus has a predilection for women of childbearing age and may potentially complicate pregnancy. Poor pregnancy outcome in women with systemic lupus erythematosus has been principally ascribed to the presence of renal involvement. Maternal risks have been more difficult to evaluate because of the unpredictable nature of the disease and limited individual experience. The present study reports the outcome of 108 pregnancies in 39 women affected by systemic lupus erythematosus with and without renal manifestation of the disease. Prematurity, small-for-gestational-age birth weight, stillbirth, and spontaneous abortion occurred more frequently in women after the diagnosis of systemic lupus erythematosus was made. Those women with renal involvement had an even further increase in spontaneous abortions as well as a decrease in successful pregnancy outcome (P less than .05). Morbidity in this group of women was rare in the immediate postpartum period, but increased morbidity and mortality did occur in the first two years after delivery.
Abortion, Spontaneous↗
Diagnosis of systemic lupus erythematosus.
Systemic lupus erythematosus is a multisystem inflammatory disease that is often difficult to diagnose. Before the diagnosis can be established, four of 11 clinical and laboratory criteria must be met. Antinuclear antibody titer is the primary laboratory test used to diagnose systemic lupus erythematosus. Because of the low prevalence of the disease in primary care populations, the antinuclear antibody titer has a low predictive value in patients without typical clinical symptoms. Therefore, as specified by the American College of Rheumatology, this titer should be obtained only in patients with unexplained involvement of two or more organ systems. Patients with an antinuclear antibody titer of 1:40 and characteristic multiorgan system involvement can be diagnosed with systemic lupus erythematosus without additional testing; however, patients with an antibody titer of 1:40 who fail to meet full clinical criteria should undergo additional testing, including tests for antibody to double-stranded DNA antigen and antibody to Sm nuclear antigen. While an antinuclear antibody titer of less than 1:40 usually rules out systemic lupus erythematosus, patients with persistent, characteristic multisystem involvement may be evaluated for possible antinuclear antibody-negative disease.
Algorithms↗
Approaches to the management of systemic lupus erythematosus.
Systemic lupus erythematosus is a difficult disease to study with a variable disease course characterized by exacerbations and remissions. A variety of biologic agents are under investigation as potential treatments for systemic lupus erythematosus, either in murine disease models or in clinical trials. These products are designed to specifically interfere with the following immunologic processes: T-cell activation and T-cell-B-cell collaboration, production of anti-dsDNA antibodies, deposition of anti-dsDNA antibody complexes, complement activation, and deposition, and cytokine activation and modulation. More aggressive interventions include gene therapy and stem-cell transplantation. Recently developed immunomodulators have been studied in patients with systemic lupus erythematosus 2'-Chlorodeoxyadenosine, mycophenolate mofetil, and leflunomide. Additional innovative pharmaceutical treatments include the mild androgen dehydroepiandrosterone, estrogen antagonists, including tamoxifen and selective estrogen receptor modulators, and the prolactin inhibitor bromocriptine. Other promising pharmaceutical interventions include products designed to inhibit synthesis of the proinflammatory mediators: prostaglandins, leukotrienes, and nitric oxide. Although previously regarded as an indication to be avoided in the development of new therapeutics, enthusiasm for studying systemic lupus erythematosus in clinical trials now exists. A variety of biologic and pharmaceutical agents offer promise as potential therapies. As with rheumatoid arthritis, development of these products will benefit from active involvement of rheumatologists and efforts to develop international consensus regarding trial methodology and outcome measures.
Animals↗
Lipids, cardiovascular disease and atherosclerosis in systemic lupus erythematosus.
Systemic lupus erythematosus is commonly associated with early onset cardiovascular disease and is often associated with hyperlipidaemia. This review examines the evidence for an increased prevalence of both CHD and hyperlipidaemia in SLE and mechanisms by which autoimmunity in SLE could accelerate the progression of atheroma. It postulates how lipid lowering therapies used in cardiological disease might help reduce the incidence of CHD in SLE.
Arteriosclerosis↗
A novel susceptibility locus on chromosome 2 in the (New Zealand Black x New Zealand White)F1 hybrid mouse model of systemic lupus erythematosus.
Systemic lupus erythematosus (SLE) is inherited as a complex polygenic trait. (New Zealand Black (NZB) x New Zealand White (NZW)) F(1) hybrid mice develop symptoms that remarkably resemble human SLE, but (NZB x PL/J)F(1) hybrids do not develop lupus. Our study was conducted using (NZW x PL/J)F(1) x NZB (BWP) mice to determine the effects of the PL/J and the NZW genome on disease. Forty-five percent of BWP female mice had significant proteinuria and 25% died before 12 mo of age compared with (NZB x NZW)F(1) mice in which >90% developed severe renal disease and died before 12 mo. The analysis of BWP mice revealed a novel locus (chi(2) = 25.0; p < 1 x 10(-6); log of likelihood = 6.6 for mortality) designated Wbw1 on chromosome 2, which apparently plays an important role in the development of the disease. We also observed that both H-2 class II (the u haplotype) and TNF-alpha (TNF(z) allele) appear to contribute to the disease. A suggestive linkage to proteinuria and death was found for an NZW allele (designated Wbw2) telomeric to the H-2 locus. The NZW allele that overlaps with the previously described locus Sle1c at the telomeric part of chromosome 1 was associated with antinuclear autoantibody production in the present study. Furthermore, the previously identified Sle and Lbw susceptibility loci were associated with an increased incidence of disease. Thus, multiple NZW alleles including the Wbw1 allele discovered in this study contribute to disease induction, in conjunction with the NZB genome, and the PL/J genome appears to be protective.
Alleles↗
[Significance of anti-nucleosome (anti-chromatin) auto-antibodies in systemic lupus erythematosus].
Systemic lupus erythematosus is characterised by the presence of antinuclear autoantibodies (ANA). Native DNA, histone proteins and small nuclear ribonucleoproteins (snRNP) are the main targets of these ANA-s, but some of them may derive against the entire chromatin, which is composed of the listed elements, and also against its fundamental unit, that is nucleosome. Authors investigated at the first time the frequency and the concentration of anti-nucleosome antibodies in a group of 107 consecutively selected Hungarian lupus patients. They calculated correlation between these parameters and the activity as well as organ--mainly kidney--manifestations of the disease. The frequencies of positive anti-nucleosome, anti-dsDNA and anti-histone antibodies were 39.2, 28.0 and 47.6%, respectively. All the three autoantibodies were present more frequently in cases with lupus nephritis, and this correlation was significant by statistical respect. Also a positive correlation was found between the concentration of these autoantibodies and activity of the diseases (SLE-DAI). Results suggest that long disease duration (mean 8.5 year) and consequently low disease activity (mean DAI: 3.28) may stand at the background of the relatively low occurrence of the measured ANA-s. Besides anti-dsDNA, the determination of anti-nucleosome and anti-histone antibodies can be useful in the diagnosis and monitoring of SLE. Authors discuss the possible role of anti-nucleosome autoantibodies in the pathogenesis of lupus nephritis.
Adult↗
Splenic hypofunction in systemic lupus erythematosus.
Systemic lupus erythematosus is a relatively common autoimmune disease in the United States. Hyposplenism is infrequently described in patients with systemic lupus erythematosus. It is seen in up to 5% of patients and is thought to be caused by vasculitic changes within the spleen. The diagnosis of hyposplenism can be made easily by identifying Howell-Jolly bodies on a peripheral blood smear. The authors describe a patient with systemic lupus erythematosus associated with hyposplenism and discuss possible diagnostic and treatment implications.
Adult↗
Genetic basis of systemic lupus erythematosus.
Systemic lupus erythematosus, a complex multigenic disease, is characterized by a wide variety of clinical manifestations, as a result of the contribution of different genes or different combinations of genes. Recent advances in molecular genetics has led to a better understanding of the genes predisposing to systemic lupus erythematosus in both humans and laboratory animal models. Identification of susceptibility genes provides key insights into the pathogenesis of systemic lupus erythematosus, making new prophylactic and therapeutic approaches feasible.
Alleles↗
[New diagnostic criteria for the neuropsychiatric form of systemic lupus erythematosus].
Systemic lupus erythematosus (SLE) is an autoimmunologic illness, which apart from changes in the skin, the locomotor system and the internal organs, attacks also the nervous system. The paper presents 19 neuropsychiatric symptomic syndromes which after conduction of multidisciplinary, international research were accepted by the American College of Rheumatology (ACR) as the criteria of systemic lupus erythematosus (SLE). This broadens the criteria applied since 1982, which were only considering acute symptoms and psychoses as characteristic of the neuropsychiatric form of systemic lupus erythematosus (NPSLE). In the new neurologic criteria concerning the CNS are: epileptic attacks and acute attack disorders, headaches, vascular diseases, demyelinating syndrome, aseptical meningitis, chorea, myelopathy. Psychiatric syndromes which make up the new criteria are: acute amentive state, anxiety disorders, cognitive function impairment, affective disorders, psychoses. The criteria connected to the CNS are: cranial nerve damage, mononeuropathy, damage of nerve plexus, polyneuropathy, vegetative neuropathy, myasthenia and acute inflammatory demyelinating polyneuropathy. Clinical symptoms of these syndromes were set and laboratory and visualising tests were developed, which are useful in their diagnosis. The intention of the ACR in setting new, significantly broader criteria of NPSLE, was to stress the diversity of symptoms and for a practical aspect to allow the diagnosis of NPSLE in patients having this disease, in whom the symptoms connected with the nervous system may dominate in the clinical picture, or may be before the dermatological, locomotor or internal organ symptoms.
Humans↗
Tc-99m DTPA aerosol lung clearance test in systemic lupus erythematosus.
Systemic lupus erythematosus (SLE) can affect every organ. Involvement of the lung in systemic lupus erythematosus may be a significant cause of morbidity and mortality. To evaluate alveolar epithelial damage in SLE, we studied lung epithelial permeability by measuring the clearance of inhaled Tc-99m DTPA aerosol. Twenty-three SLE patients without clinical pulmonary manifestations were studied. Of the 23 patients, 16 had normal clearance rates of Tc-99m DTPA (T1/2 > 60mins) and normal chest X-ray findings. A mild increase in the clearance rate was found in 5 cases (T1/2 between 40-60 min) and a significant increase in clearance rate in the remaining 2 (T1/2 < 40mins). Totally, 30% (7/23) of SLE patients have abnormal lung permeability. Of the 7 patients with abnormal clearance of Tc-99m DTPA, 3 had abnormal findings in chest X-rays and four had normal chest X-rays. Our study suggests that the clearance of Tc-99m DTPA aerosol may be a useful complementary study to assess pulmonary involvement in SLE.
Adolescent↗
Favourable interactions of cytostatic and steroid drugs in treatment of systemic lupus erythematosus.
Systemic lupus erythematosus (referred to below as SLE) is a disorder associated with formation of immune complexes in the circulatory system and their deposition in the internal organs, as well as in the skin. The disease can appear at any age, but the vast majority of cases are women between 15 and 40 years of age. The paper presents the case of a thirty-year-old woman with systemic lupus erythematosus. She was admitted to hospital because of erythematous and haemorrhagic lesions in the skin of her face, hands and feet and febrile states. SLE was diagnosed in the patient on the basis of criteria established by the American Rheumatological Association. The following abnormalities were observed in the patient: skin lesions of erythematous type on the face, hypersensitivity to UV light, erosions of the mucous membranes of the oral cavity, changes in the kidneys confirmed by biopsy, haematological symptoms, immune disorders. Additional criteria to establish the diagnosis included: febrile states. Raynaud's sign, hair loss, presence of immunoglobulin complexes in the skin, decreased complement level. The paper discusses modern therapy of visceral lupus erythematosus, based on corticosteroids and immunosuppressants. The interactions of these drugs were observed in the patient. The woman was treated with combined corticosteroid and cytostatic therapy, which led to the remission of the pathologic process confirmed by the clinical condition of the patient and laboratory tests.
Adrenal Cortex Hormones↗
Genetic epidemiology: systemic lupus erythematosus.
Systemic lupus erythematosus is the prototype multisystem autoimmune disease. A strong genetic component of susceptibility to the disease is well established. Studies of murine models of systemic lupus erythematosus have shown complex genetic interactions that influence both susceptibility and phenotypic expression. These models strongly suggest that several defects in similar pathways, e.g. clearance of immune complexes and/or apoptotic cell debris, can all result in disease expression. Studies in humans have found linkage to several overlapping regions on chromosome 1q, although the precise susceptibility gene or genes in these regions have yet to be identified. Recent studies of candidate genes, including Fcgamma receptors, IL-6, and tumour necrosis factor-alpha, suggest that in human disease, genetic factors do play a role in disease susceptibility and clinical phenotype. The precise gene or genes involved and the strength of their influence do, however, appear to differ considerably in different populations.
Animals↗