1
|
Butt S, Kiran S, Qadir N, Menghani D, Tanzeem H. Cardiac Conduction Defects in Systemic Lupus Erythematosus. Cureus 2020; 12:e10882. [PMID: 33178534 PMCID: PMC7652344 DOI: 10.7759/cureus.10882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Systemic autoimmune conditions may cause morbidity and mortality. Systemic lupus erythematosus (SLE) is a prominent example of such diseases. It can result in conduction abnormalities due to accelerated atherosclerosis, vasculitis, or autoantibodies-induced myocarditis. Cardiac conduction abnormalities may produce sinus tachycardia, sinus bradycardia, prolonged QT intervals, atrial fibrillation, or atrioventricular (AV) nodal blocks. Neonatal lupus is sometimes associated with anti-Ro/SSA and anti-La/SSB antibodies, but their role remains a matter of controversy in adults.
Collapse
Affiliation(s)
- Shayan Butt
- Internal Medicine, Baptist Memorial Hospital, Oxford, USA
| | - Simra Kiran
- Pulmonology and Critical Care, University of Cincinnati Medical Center, Cincinnati, USA
| | - Nida Qadir
- Infectious Diseases, University of Louisville, Louisville, USA
| | - Divya Menghani
- Infectious Diseases, University of Louisville, Louisville, USA
| | - Hammad Tanzeem
- Medicine, Dow Medical College/Civil Hospital, Karachi, PAK
| |
Collapse
|
2
|
Abstract
Conduction abnormalities are uncommon in adult patients with lupus. We present a young woman with recurrent syncope caused by third-degree atrio-ventricular block as the initial manifestation of lupus and review 31 additional cases of systemic lupus erythematosus patients that have been described previously with complete heart block. Heart blocks occurred almost exclusively in females. The median age was 37 years. In 24 cases heart blocks were diagnosed in patients with established lupus. In only five patients, including the patient presented here, heart blocks were diagnosed before the lupus diagnosis. Syncope was the most common presenting symptom of heart block. Electrocardiographic findings prior to heart block episodes were reported in 17 cases: eight had normal findings, but nine had already variant forms of atrioventricular or intraventricular conduction defects. Anti-nuclear antibody tests were reported in 25 cases and were all positive. Anti-DNA antibodies were also common and were positive in 16 of 19 cases (84%). Anti-La and anti-Ro antibodies were less common (13% and 35%, respectively). Three patients died, all prior to 1975. Heart block resolved in 10 cases. Follow-up was reported in four of these cases and heart block recurred in three of them. A permanent pacemaker was the eventual treatment in 22 cases. The etiology of lupus-associated complete heart block is not clear. It is probably variable, possibly related to effects of autoantibodies reacting with the conduction system, myocardial disease and adverse effects of antimalarials. Insertion of a permanent pacemaker seems to be the preferable method of treatment.
Collapse
Affiliation(s)
- A Natsheh
- Rheumatology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - D Shimony
- Department of Medicine, Share Zedek Medical Center, Jerusalem, Israel
| | - N Bogot
- Department of Radiology, Share Zedek Medical Center, Jerusalem, Israel.,Department of Medicine, Hebrew University School of Medicine, Jerusalem, Israel
| | - G Nesher
- Rheumatology Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,Department of Medicine, Share Zedek Medical Center, Jerusalem, Israel.,Department of Medicine, Hebrew University School of Medicine, Jerusalem, Israel
| | - G S Breuer
- Rheumatology Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,Department of Medicine, Share Zedek Medical Center, Jerusalem, Israel.,Department of Medicine, Hebrew University School of Medicine, Jerusalem, Israel
| |
Collapse
|
3
|
Association of Anti-Ro/Sjögren's syndrome type A Antibodies and Complete Atrioventricular Block in an Adult With Sjögren's Syndrome. Arch Rheumatol 2017; 33:225-229. [PMID: 30207577 DOI: 10.5606/archrheumatol.2018.6492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/17/2017] [Indexed: 11/21/2022] Open
Abstract
A 57-year-old female patient with underlying hypertension, dyslipidemia, membranous glomerulonephritis, and Sjögren's syndrome presented to our clinic with near-syncope and dizziness symptoms. We detected non-conducted sinus beat in 12-lead electrocardiography. An echocardiography showed that the left ventricular systolic function was preserved without a regional wall abnormality. The patient did not have symptoms of congestive heart failure or recent myocardial infarction. We observed complete atrioventricular block with longest pause of 6.2 seconds in a 24-hour Holter electrocardiography, and subsequently implanted a permanent pacemaker. Anti-Ro/Sjögren's syndrome type A antibodies are commonly seen in Sjögren's syndrome and associated with a neonatal complete heart block. The pathogenesis of anti-Ro/Sjögren's syndrome type A antibodies in the conduction system of an adult heart is still uncertain. In this article, we report Sjögren's syndrome in an adult patient with complete atrioventricular block and membranous glomerulonephritis, which may be associated with a positive titer of anti-Ro/Sjögren's syndrome type A antibodies.
Collapse
|
4
|
Santos-Pardo I, Villuendas R, Salvador-Corres I, Martínez-Morillo M, Olivé A, Bayes-Genis A. Anti-Ro/SSA antibodies and cardiac rhythm disturbances: Present and future perspectives. Int J Cardiol 2014; 184:244-250. [PMID: 25725306 DOI: 10.1016/j.ijcard.2014.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/06/2014] [Accepted: 11/01/2014] [Indexed: 12/17/2022]
Abstract
Several case reports, small case series, and original research papers have recently suggested that the action of certain auto-antibodies related to connective tissue diseases may be responsible for significant cardiac rhythm disturbances in adults. The relationship between anti-Ro/SSA antibodies and congenital complete atrioventricular block is well recognized in the fetal heart. Herein we review the emerging evidences of the link to increased levels of anti-Ro/SSA antibodies with rhythm disorders of unknown origin in the adult. Confirmation of this distinct etiology may eventually be the basis for new therapies.
Collapse
Affiliation(s)
- Irene Santos-Pardo
- Cardiology Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Spain
| | - Roger Villuendas
- Cardiology Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Spain
| | - Iñaki Salvador-Corres
- Immunology Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), FOCIS-CE, Spain
| | - Melania Martínez-Morillo
- Rheumatology Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Spain
| | - Alejandro Olivé
- Rheumatology Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Spain; Department of Medicine, Universitat Autònoma de Barcelona (UAB), Spain
| | - Antoni Bayes-Genis
- Cardiology Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Spain; Department of Medicine, Universitat Autònoma de Barcelona (UAB), Spain
| |
Collapse
|
5
|
Sung MJ, Park SH, Kim SK, Lee YS, Park CY, Choe JY. Complete atrioventricular block in adult Sjögren's syndrome with anti-Ro autoantibody. Korean J Intern Med 2011; 26:213-5. [PMID: 21716914 PMCID: PMC3110856 DOI: 10.3904/kjim.2011.26.2.213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 04/07/2008] [Accepted: 04/22/2008] [Indexed: 11/27/2022] Open
Abstract
Anti-Ro autoantibody is associated with Sjögren's syndrome (SS), systemic lupus erythematosus (SLE), and neonatal lupus syndrome (i.e., congenital complete heart block in newborns). Generally, the adult atrioventricular (AV) node is believed to be relatively resistant to the scarring effects of anti-Ro/anti-La autoantibodies. However, there have been some reports of adult complete AV block in SS and SLE patients. Here, we report a case of complete heart block in primary SS with anti-Ro autoantibodies, with no other risk factor for the development of heart block, and review their etiological association.
Collapse
Affiliation(s)
- Myung Jun Sung
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Arthritis and Autoimmunity Research Center, Daegu, Korea
| | - Sung-Hoon Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Arthritis and Autoimmunity Research Center, Daegu, Korea
| | - Seong-Kyu Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Arthritis and Autoimmunity Research Center, Daegu, Korea
| | - Young-Soo Lee
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Arthritis and Autoimmunity Research Center, Daegu, Korea
| | - Chul-Yeon Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Arthritis and Autoimmunity Research Center, Daegu, Korea
| | - Jung-Yoon Choe
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Arthritis and Autoimmunity Research Center, Daegu, Korea
| |
Collapse
|
6
|
Lazzerini PE, Capecchi PL, Laghi-Pasini F. Anti-Ro/SSA antibodies and cardiac arrhythmias in the adult: facts and hypotheses. Scand J Immunol 2010; 72:213-22. [PMID: 20696018 DOI: 10.1111/j.1365-3083.2010.02428.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
It is well established that the passive trans-placental passage of anti-Ro/SSA antibodies from mother to foetus is associated with the risk to develop an uncommon syndrome named neonatal lupus (NLE), where the congenital heart block represents the most severe clinical feature. Recent evidence demonstrated that also adult heart, classically considered invulnerable to the anti-Ro/SSA antibodies, may represent a target of the arrhythmogenicity of these autoantibodies. In particular, the prolongation of the QTc interval appears the most frequent abnormality observed in adults with circulating anti-Ro/SSA antibodies, with some data suggesting an association with an increased risk of ventricular arrhythmias, also life threatening. Moreover, even though the association between anti-Ro/SSA antibodies and conduction disturbances is undoubtedly less evident in adults than in infants, from the accurate dissection of the literature data the possibility arises that sometimes also the adult cardiac conduction tissue may be affected by such antibodies. The exact arrhythmogenic mechanisms involved in foetus/newborns and adults, respectively, have not been completely clarified as yet. However, increasing evidence suggests that anti-Ro/SSA antibodies may trigger rhythm disturbances through an inhibiting cross-reaction with several cardiac ionic channels, particularly the calcium channels (L-type and T-type), but also the potassium channel hERG, whose different expression and involvement in the cardiac electrophysiology during lifespan might account for the occurrence of age-related differences.
Collapse
Affiliation(s)
- P E Lazzerini
- Department of Clinical Medicine and Immunological Sciences, Division of Clinical Immunology, University of Siena, Italy.
| | | | | |
Collapse
|
7
|
Nanke Y, Yago T, Kotake S. [An asymptomatic mother of cutaneous neonatal lupus child was diagnosed with Sjögren's syndrome suspected]. NIHON RINSHO MEN'EKI GAKKAI KAISHI = JAPANESE JOURNAL OF CLINICAL IMMUNOLOGY 2010; 33:154-156. [PMID: 20601836 DOI: 10.2177/jsci.33.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We report an asymptomatic mother of a cutaneous neonatal lupus child was diagnosed with Sjögren's syndrome suspected after parturition. A 30-year old woman was visited our hospital to evaluated autoimmune disease because her baby was diagnosed as cutaneous neonatal lupus. Both gum test and Schirmer's test were positive. Antinuclear antibody, anti-SS-A and anti-SS-B antibody were positive. Serum IgG was elevated (2918 mg/dl). Finally, this case was suspected as Sjögren's syndrome. Continuoues follow-up of asymptomatic mothers of a neonatal lupus child is warranted.
Collapse
Affiliation(s)
- Yuki Nanke
- Institute of Rheumatology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | | | | |
Collapse
|
8
|
Arrhythmogenic effects of anti-Ro/SSA antibodies on the adult heart: More than expected? Autoimmun Rev 2009; 9:40-4. [DOI: 10.1016/j.autrev.2009.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 03/02/2009] [Indexed: 11/18/2022]
|
9
|
Sánchez Román J, Ocaña Medina C, García Hernández FJ, González León R, Garrido Rasco R, Colorado Bonilla R, González Escribano F, Wichmann I. [Complete auriculoventricular blockage in adult patients with systemic lupus erythematosus. Case series and a review of the literature]. ACTA ACUST UNITED AC 2006; 2:294-7. [PMID: 21794346 DOI: 10.1016/s1699-258x(06)73064-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Accepted: 09/14/2006] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Congenital complete atrioventricular heart block (CHB) is due to the lesion of the cardiac conduction system by specific transplacental antibodies of maternal origin. In adults with systemic lupus erythematosus (SLE), cardiac toxicity is very questionable and has been related to treatment with synthetic antimalarial drugs (AM). Here we evaluate, in our geographic area, the presence of non congenital CHB in adult patients with SLE and its possible association with AM treatment. PATIENTS AND METHODS The frequency of CHB has been studied revising the clinical records of 595 SLE patients followed at the Unit for Systemic Diseases. RESULTS Five women (0.8% of the total series) suffered from CHB (2 patients developed it during a lupic crisis). All were on treatment with AM (100 versus 60% of the rest of the series) and maintained a dose of 250 mg/day (except one, with a dose of 500 mg/day) for a mean period of 90 months. The accumulated mean dose of AM was 753 g. Three patients developed cardiac insufficiency; 2 nephropathy; 2 myopathy; and one maculopathy. As accompanying processes we detected Sjögren's syndrome (2) and hypothyroidism (3). The frequency of HLA DR3, positive in 80% of the cases, is higher than observed in the total series, 34% (p = 0.053). CONCLUSIONS We detected the presence of CHB in 0.8% of SLE patients. They were all treated with AM. We did not verify any relationship with anti-ENA (anti-Ro/La and anti-RNP) antibodies, as communicated by others, but rather a trend to the association with HLA DR3 (at the limit of statistical significance).
Collapse
Affiliation(s)
- Julio Sánchez Román
- Servicio de Medicina Interna. Unidad de Colagenosis. Hospital Universitario Virgen del Rocío. Sevilla. España
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Lim LT, Joshua F. Resolution of complete heart block after prednisolone in a patient with systemic lupus erythematosus. Lupus 2005; 14:561-3. [PMID: 16130515 DOI: 10.1191/0961203305lu2155xx] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
11
|
Liautaud S, Khan AJ, Nalamasu SR, Tan IJ, Onwuanyi AE. Variable atrioventricular block in systemic lupus erythematosus. Clin Rheumatol 2004; 24:162-5. [PMID: 15517446 DOI: 10.1007/s10067-004-0995-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Accepted: 06/18/2004] [Indexed: 10/26/2022]
Abstract
Systemic lupus erythematosus (SLE), a connective tissue disease characterized by the production of auto-antibodies and immune complexes, can affect all organs including the heart. The involvement of the conduction system in SLE has been less commonly described. We report a case of an asymptomatic 45-year-old woman with SLE referred to the emergency department (ED) for thrombocytopenia, and was found to have alternating first- and second-degree atrioventricular block (AVB) during routine electrocardiographic screening for hospital admission. Serial electrocardiograms (ECG) done in the ED when compared to those recorded 24 h prior revealed progression from mild first-degree AVB (PR interval = 216 ms) to significant first-degree AVB (PR interval = 510 ms), followed by second-degree AVB (Mobitz type I-Wenckebach phenomenon). The conduction abnormalities recorded over a 28-h period resolved with corticosteroid treatment. Review of the literature on the disruption of the cardiac conduction system in SLE is discussed.
Collapse
Affiliation(s)
- Sybille Liautaud
- Division of Pulmonary and Critical Care, Department of Medicine, Mount Sinai School of Medicine, 164-04, 85th Avenue, Jamaica, NY 11432, USA.
| | | | | | | | | |
Collapse
|
12
|
Comín-Colet J, Sánchez-Corral MA, Alegre-Sancho JJ, Valverde J, López-Gómez D, Sabaté X, Juan-Mas A, Esplugas E. Complete heart block in an adult with systemic lupus erythematosus and recent onset of hydroxychloroquine therapy. Lupus 2001; 10:59-62. [PMID: 11243511 DOI: 10.1191/096120301673172543] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Complete heart block (CHB) is a rare complication of systemic lupus erythematosus (SLE), mainly seen during an acute flare-up of the disease or after high-dose long-term treatment with antimalarial drugs, although anti-Ro and anti-RNP antibodies have also been implied by some authors. A 40-y-old woman developed CHB in the context of an acute flare-up of SLE, first diagnosed three years ago, having recently commenced hydroxychloroquine (HCQ) treatment. Anti-Ro and anti-RNP antibodies were also positive. No features of myocarditis were found. A temporary pacemaker was required and complete resolution was achieved on steroid therapy with withdrawal of antimalarial therapy. The characteristics of previous cases are well publicised and discussion focuses on the possible aetiology and pathogenesis of the present case.
Collapse
Affiliation(s)
- J Comín-Colet
- Department of Cardiology, Hospital Prínceps d'Espanya, Ciutat Sanitária i Universitária de Bellvitge, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Garcia S, Campos-de-Carvalho AC. Neonatal lupus syndrome: the heart as a target of the immune system. AN ACAD BRAS CIENC 2000; 72:83-9. [PMID: 10932109 DOI: 10.1590/s0001-37652000000100012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Neonatal lupus erythematosus (NLE) is an auto-immune disease related to systemic lupus erythematosus (SLE). Unlike SLE it is not a spontaneous syndrome but rather an acquired one. In NLE the most common disease manifestations are a transient cutaneous lesion and cardiac conduction disturbances. The cutaneous lesions and other non-cardiac manifestations of NLE are transient and disappear about six months after birth, at the time when maternal antibodies disappear from the neonatal circulation. This fact suggests that maternal antibodies may cross the placenta leading to an inflammatory reaction in the fetal tissues. NLE is the principal cause of atria-ventricular block, when it is not associated with congenital birth defects. All the clinical studies to date correlate the heart block in NLE with the presence of certain types of circulating maternal antibodies, against the Ro/SSA nuclear proteins, in the serum of the newborn. In this paper we discuss animal models that have been developed by our and others groups to study the participation of the anti-Ro/SSA antibodies in the pathogenesis of the cardiac conduction blockades that occur in NLE.
Collapse
Affiliation(s)
- S Garcia
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro Cidade Universitária, Brasil
| | | |
Collapse
|
14
|
Alosachie IJ, Terryberry JW, Mevorach D, Chapman Y, Lorber M, Torre D, Youinou P, Peter JB, Shoenfeld Y. Central nervous system (CNS) involvement in SLE. The diagnostic role of antibodies to neuronal antigens. Clin Rev Allergy Immunol 1998; 16:275-84. [PMID: 9773254 DOI: 10.1007/bf02737637] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Lee LA, Pickrell MB, Reichlin M. Development of complete heart block in an adult patient with Sjögren's syndrome and anti-Ro/SS-A autoantibodies. ARTHRITIS AND RHEUMATISM 1996; 39:1427-9. [PMID: 8702455 DOI: 10.1002/art.1780390825] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We describe the occurrence of complete heart block in a patient with Sjögren's syndrome. The patient's serum contained antibodies to both the 60-kd and 52-kd Ro proteins. This case indicates that although the adult atrioventricular node may be relatively resistant to the development of anti-Ro-associated heart block, it can nevertheless be affected.
Collapse
Affiliation(s)
- L A Lee
- Oklahoma Medical Research Foundation, Oklahoma City 73104, USA
| | | | | |
Collapse
|
16
|
Tikly M, Burgin S, Mohanlal P, Bellingan A, George J. Autoantibodies in black South Africans with systemic lupus erythematosus: spectrum and clinical associations. Clin Rheumatol 1996; 15:261-5. [PMID: 8793257 DOI: 10.1007/bf02229704] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The clinical features and autoantibody profile of 111 black South Africans (103 females and 8 males) with systemic lupus erythematosus were retrospectively analysed. The mean age of the patients was 35.1 years and mean duration of disease 3.5 years. The commonest clinical and laboratory features noted were arthritis (62.2%), hypocomplementaemia (61.2%), haematological abnormalities (60.5%) and malar rash (55%). The serological abnormalities included antinuclear antibodies (98.2%), anti-dsDNA (66.2%), anti-Sm (44.2%), anti-RNP (65.5%), anti-Ro (60.5%), anti-La (28.4%) and rheumatoid factor (10.1%). Positive clinicoserological associations observed included: combination of anti-dsDNA antibodies and low C4 levels with renal disease; anti-dsDNA antibodies with cutaneous vasculitis; anti-Sm antibodies with psychosis; anti-RNP antibodies with Raynaud's phenomenon; anti-Ro antibodies with renal disease, psychosis and malar rash. Anti-La antibodies showed a weak negative association with serositis and Raynaud's phenomenon. Most of these clinical correlates are consistent with past studies. The high frequency of anti-Sm and anti-RNP antibodies is similar to the observations in African-Americans and Afro-Caribbeans.
Collapse
Affiliation(s)
- M Tikly
- Department of Medicine, Baragwanath Hospital, South Africa
| | | | | | | | | |
Collapse
|
17
|
Tikly M, Burgin S, Mohanlal P, Bellingan A, George J. Autoantibodies in black South Africans with systemic lupus erythematosus: spectrum and clinical associations. Clin Rheumatol 1996; 15:143-7. [PMID: 8777847 DOI: 10.1007/bf02230331] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The clinical features and autoantibody profile of 111 black South Africans (103 females and 8 males) with systemic lupus erythematosus was retrospectively analysed. The mean age of the patients was 35.1 years and mean duration of disease 3.5 years. The commonest clinical and laboratory features noted were arthritis (62.2%), hypocomplementaemia (61.2%), haematological abnormalities (60.5%) and malar rash (55%). The serological abnormalities included antinuclear antibodies (98.2%), anti-dsDNA (66.2%), anti-Sm (44.2%), anti-RNP (65.5%), anti-Ro (60.5%), anti-La (28.4%) and rheumatoid factor (10.1%). Positive clinicoserological associations observed included: combination of anti-dsDNA antibodies and low C4 levels with renal disease; anti-dsDNA antibodies with cutaneous vasculitis; anti-Sm antibodies with psychosis; anti-RNP antibodies with Raynaud's phenomenon; anti-Ro antibodies with renal disease, psychosis and malar rash. Anti-La antibodies showed a weak negative association with serositis and Raynaud's phenomenon. Most of these clinical correlates are consistent with past studies. The high frequency of anti-Sm and anti-RNP antibodies is similar to the observations in African-Americans and Afro-Caribbeans.
Collapse
Affiliation(s)
- M Tikly
- Department of Medicine, Baragwanath Hospital, Johannesburg, South Africa
| | | | | | | | | |
Collapse
|
18
|
Abstract
What have we learned about CNS lupus in recent years? An enormous amount of knowledge on pathophysiology of antiphospholipid antibodies, in particular, has been gathered. Although hard evidence of a direct pathogenetic role of these antibodies in cerebral lupus is still lacking, it is generally felt that the multiple microinfarctions found in the brains of lupus patients are related to their presence. Better understanding of the pathogenesis of cerebral lupus will come from the study of experimental models, as it has been possible to develop an antiphospholipid antibody syndrome in mice. Because no specific laboratory test for CNS lupus is yet available, diagnosing the condition remains a challenge to every clinician. Techniques including neuropsychometric testing, quantitative EEG, and SPECT scans have taught us more about cognitive dysfunction and psychosis in patients with SLE. These categories remain the most difficult to define. The concept of hypercoagulability in SLE patients has diverted the direction of therapy from immunosuppression towards anticoagulation. It is of utmost importance that randomised trials are commenced in order to determine the optimal mode of anticoagulation for various groups of lupus patients. It will be necessary to conduct such trials under strict inclusion criteria, based on well defined patient categories. Such an enterprise will require international co-operation of investigators.
Collapse
Affiliation(s)
- G A Bruyn
- Department of Rheumatology, Medisch Centrum Leeuwarden, The Netherlands
| |
Collapse
|
19
|
Mevorach D, Raz E, Steiner I. Evidence for intrathecal synthesis of autoantibodies in systemic lupus erythematosus with neurological involvement. Lupus 1994; 3:117-21. [PMID: 7920611 DOI: 10.1177/096120339400300211] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The diagnosis of systemic lupus erythematosus (SLE) in a patient who presents with isolated central nervous system (CNS) abnormalities, is a difficult clinical challenge. The pathogenesis of such CNS involvement in SLE is unknown. Twelve patients with active SLE were examined for serum and cerebrospinal fluid (CSF) autoantibodies and compared with 21 patients with headache. Four of six patients with SLE and active CNS presentation had CSF autoantibodies while none of the other SLE patients and the controls had autoantibodies. We describe these four patients in whom immunological work-up revealed CSF antinuclear, anti-DNA, anti-SSA/Ro, anti-SSB/La and antineuronal autoantibodies. A newly devised antibody activity index provided means to demonstrate that the CSF autoantibodies in these patients were produced intrathecally. Beyond the importance of our finding of the potential role of autoantibodies in the pathogenesis of CNS damage in SLE, we propose that CSF analysis for autoantibodies should become an essential part of the diagnostic work-up in autoimmune diseases with CNS involvement.
Collapse
Affiliation(s)
- D Mevorach
- Department of Internal Medicine, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel
| | | | | |
Collapse
|
20
|
Abstract
Report of a case of complete heart block in a patient with systemic lupus erythematosus (SLE). The cardiac disturbance presented as repeated syncopal episodes and normal cardiac clinical and electrocardiographic examination between these episodes. Circulating anti-U1RNP antibodies were detected and tests for anti-SSA/Ro, anti-SSB/La and antiphospholipid antibodies were negative. Evidence of myocarditis was not found. The diagnosis was just established when the patient developed a syncopal episode during hospitalization. Only one SLE case with a similar clinical course has been reported previously.
Collapse
Affiliation(s)
- E Fonseca
- Department of Dermatology, Hospital La Paz, Madrid, Spain
| | | | | |
Collapse
|