Systemic lupus erythematosus of the urinary tract: focus on lupus cystitis

Risk factors of lower urinary tract symptoms measured by the International Consultation on Incontinence Modular Questionnaire in females with lupus cystitis: A case-control study

Background

Lupus cystitis may cause significant lower urinary tract symptoms (LUTS). This study aimed to evaluate LUTS and identify potential risk factors in female patients with systemic lupus erythematosus (SLE).

Materials and methods

In this case-control study, 46 female patients with SLE were assessed for LUTS using the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). The findings were compared with a control group of 20 women.

Results

The total incidence rates of LUTS in the SLE and control groups were 82.6% and 55%, respectively (p = 0.022). Statistically significant differences were observed between the 2 groups in symptom duration (p < 0.001), filling (p < 0.001), voiding (p = 0.001), incontinence (p < 0.001), and total LUTS scores (p < 0.001) as measured by ICIQ-FLUTS. Additional significant differences included renal echogenicity (p = 0.003), bladder wall thickness (p = 0.045), and the presence of pus cells in urine (p = 0.045). The possible risk factors for the occurrence of LUTS in patients with lupus cystitis included rapid weight loss (p = 0.025), easy fatigability (p = 0.006), fever (p = 0.046), psychosis (p = 0.033), and both renal (p = 0.025) and clinical (p = 0.047) SLE disease activity indices. The Spearman correlation between the total ICIQ-FLUTS score and the SLE Disease Activity Index was not significant (r = −0.203; p = 0.181). However, a statistically significant but weak correlation was observed between the ICIQ-FLUTS score and easy fatigability (r = 0.381; p = 0.013).

Conclusions

The ICIQ-FLUTS demonstrated acceptable content validity and consistency in evaluating LUTS in patients with lupus cystitis. Rapid weight loss, easy fatigability, fever, psychosis, and elevated renal and clinical SLE Disease Activity Index scores were significantly associated with the occurrence of LUTS in these patients.

A Rare Manifestation of Systemic Lupus Erythematosus: A Case of Lupus Cystitis in Puerto Rico

Lupus cystitis is an uncommon, yet serious complication of systemic lupus erythematosus (SLE) marked by inflammation of the bladder and associated with significant urinary tract manifestations. The diagnosis of lupus cystitis can be very challenging as it often appears before the diagnosis of lupus has been established. This report presents the case of a 36-year-old male patient with a history of SLE admitted with gastrointestinal (GI) and urinary symptoms who was subsequently diagnosed with lupus cystitis and highlights the clinical presentation, diagnostic challenges, and management strategies in these patients. The diagnosis was confirmed through a combination of clinical examination and laboratory findings. Treatment with corticosteroids and immunosuppressive agents can lead to substantial improvement for which early diagnosis and recognition by primary care team providers in a hospital setting is pivotal as delayed diagnosis can result in significant morbidity. This report highlights the critical importance of considering lupus cystitis as a differential diagnosis in patients with systemic SLE patients presenting with urinary symptoms.

Systemic lupus erythematosus presenting with progressive massive ascites and CA-125 elevation indicating Tjalma syndrome? A case report

BACKGROUND

Ascites, pleural effusion and raised CA-125 in the absence of malignancy in systemic lupus erythematosus is known as Tjalma syndrome.

CASE SUMMARY

We report a special case of a systemic lupus erythematosus patient presenting with Tjalma syndrome. She presented with ascites and elevated CA-125 in the absence of benign or malignant ovarian tumor and no pleural effusions, which is an unusual presentation for this rare condition.

CONCLUSION

Tjalma syndrome can present with massive ascites alone without pleural or pericardial effusions.

INTERSTITIAL CYSTITIS AS A PLAUSIBLE CAUSE OF OVERACTIVE BLADDER IN SYSTEMIC SCLEROSIS: A HYPOTHESIS

Patients with chronic inflammatory disease of the bladder, known as interstitial cystitis (IC), tend to have autoimmune diseases, such as Sjogren’s syndrome, systemic lupus erythematosus (SLE), rheumatoid arthritis and, rarely, systemic sclerosis (SSc). SLE patients with IC are prone to present with overactive bladder (OAB) symptoms. Lower urinary tract involvement is less usual in SSc but OAB symptoms are quite common among SSc patients with lower urinary tract involvement. The underlying mechanisms of lower urinary tract involvement, including OAB, in SSc could be as follows: i) vasculopathy, ii) fibrosis and/or sclerosis of bladder wall, iii) systemic sclerosis-associated myopathy, and iv) autonomic dysfunction. However, the role of IC leading to OAB is unclear. This hypothesis suggests that in patients with SSc, OAB may be associated with IC.

Ureteritis associated with systemic lupus erythematosus: a case report

We report herein an unusual case of systemic lupus erythematosus in a 35-year-old woman who developed acute abdominal pain while hospitalized. Abdominal computed tomography (CT) scan with enhancement indicated long-segment inflammatory lesions in the right ureter. The patient received spasmolytic and analgesic drugs with poor effect and continued to have persistent severe abdominal pain and signs of peritonitis. We suspected that the patient had acute abdominal disease, but no abnormality was detected during laparoscopic surgery. Therefore, we considered the possibility of right upper urinary tract hydronephrosis; the patient’s abdominal pain was relieved after double-J tube implantation. The patient’s clinical symptoms improved after hormone and mycophenolate mofetil therapy for 1 year, and all laboratory indicators returned to normal. Reexamination by abdominal CT showed that the long-segment inflammatory lesions of the right ureter had resolved. Early identification and diagnosis are important for ureteritis associated with systemic lupus erythematosus.

Risks of interstitial cystitis among patients with systemic lupus erythematosus: A population-based cohort study

OBJECTIVE

To investigate whether the risk of interstitial cystitis increases among the patients with systemic lupus erythematosus.

METHODS

This was a nationwide population-based cohort study. Data were obtained from the National Health Insurance Research Database in Taiwan. Women aged >18 years newly diagnosed as systemic lupus erythematosus during 2001-2008 were identified as the control group. The comparison included individuals randomly selected from the National Health Insurance Research Database in the year of 2000, by matching one systemic lupus erythematosus participant with eight non-systemic lupus erythematosus participants with sex and age. These participants were followed up until being diagnosed as interstitial cystitis, or the end of 2011. Women diagnosed with lupus cystitis were excluded from this study.

RESULTS

This study included 7240 women with systemic lupus erythematosus and 57 920 women without systemic lupus erythematosus as controls. The incidence rate of interstitial cystitis was significantly higher in the systemic lupus erythematosus group, with an incidence rate ratio of 2.26 (95% confidence interval 1.57-3.27, P < 0.0001). After adjustment, the risk increased by 2.45-fold (adjusted hazard ratio 2.45, 95% confidence interval 1.57-3.27, P < 0.05). Age as a factor increases incidence rate ratios among all age groups, 2.12-, 3.32- and 4.65-fold. Age ≥45 years had an increased adjusted hazard ratio (2.07, 95% confidence interval 1.37-3.13, P < 0.05). Comorbidities, for example, hypertension, diabetes mellitus, dyslipidemia and renal disease, were insignificant.

CONCLUSIONS

This is the first population-based cohort study showing a higher incidence of interstitial cystitis among patients with systemic lupus erythematosus. These findings support the concordance of interstitial cystitis with autoimmune diseases, and the temporal relationship to develop interstitial cystitis in patients with systemic lupus erythematosus.