Systemic Lupus Erythematosus

Confirming the high pneumonia risk in lupus patients, researchers in Spain have found that it may precede the onset of the immune disorder. Their biological studies suggest that a particular underlying immune abnormality may explain both.

The patient is plagued by problems: Severe headaches, nausea, vomiting, a rash, chest and abdominal pains, and by the time she reaches a rheumatologist, periorbital edema and photophobia. Can you guess the cause?

Last year's approval of belimumab (Benlysta) revolutionized lupus treatment. How safe and effective is it, actually? Do similar inhibitors of the B-cell activating factor BAFF, now in testing, appear even more promising? Here are the basics from an expert on the subject.

Researchers found a more than tripled risk of ASDs and VSDs in children born to SLE mothers in a study reported at the recent annual meeting of the American College of Rheumatology.

ACR2013: Joints erode in systemic lupus erythematosus and primary Sjӧgren’s Syndrome. But French researchers say their MRI studies don't justify classing them as erosive disorders like rheumatoid arthritis.

ACR2013: Retrospective analysis of more than 10,000 pregnancies documents increased risks for hypertension, preeclampsia, preterm delivery and stillbirths among women with SLE.

ACR 2013: Stymied by high response rates in the "usual care" comparison arm of new-drug trials, lupus researchers are testing a bold idea: Carefully withdraw treatment from the control group.

ACR2013: As well as neonatal lupus and heart block, new research suggests that children born to women with lupus may face higher risks for autism and attention deficit hyperactivity disorder.

Last week the major British journal published an exhaustive series of reviews on autoimmune rheumatic disease, summarized briefly here. Also new in the nonspecialty journals: Macitentan for pulmonary hypertension, small fiber neuropathy in Sjögren syndrome, and risk factors for infection with glucocorticoids.

A 45-year-old woman presented with longstanding left knee pain. Both knee and hand radiographs showed abnormalities. Bony infarcts had become complicated by an infection/septic joint and had progressed to frank bony destruction.

A 39-year-old woman, in her eighth week of pregnancy, experienced aching pain that worsened with activity. Weakness and fatigue set in three days later in her thigh and proximal arm muscle. Then a mildly pruritic rash developed across the forehead, nose, and forearms.

Diagnosing systemic lupus erythematosus (SLE) can take 2-3 years, because most symptoms are both common and nonspecific. Here are clues to quick, accurate detection.

SLE can manifest as lymphadenopathy. This man fulfilled at least 4 diagnostic criteria for SLE, including rash and blood results.

Benlysta (belimumab) has received FDA approval for the treatment of patients with active, autoantibody-positive lupus (systemic lupus erythematosus) who are receiving standard therapy, including corticosteroids, antimalarials, immunosuppressives, and NSAIDs, the agency announced.

Diverse mechanisms of pathogenesis have been proposed for the autoimmune diseases. A growing body of medical literature suggests a potential effect of occupational exposures on their development.

There may be genetic susceptibility factors for systemic lupus erythematosus (SLE) that act only in men. In about 1% of families with SLE, all the patients with SLE are male and the women universally have positive antinuclear antibodies; also, men with SLE have more children with SLE than do women with SLE.

ABSTRACT: A 36-year-old woman presented with Raynaud phenomenon, arthralgia, photosensitive rash, proteinuria, dry eyes and dry mouth, and alopecia.

Late-onset systemic lupus erythematosus (SLE), often considered to have a benign disease course, actually involves greater disease activity and comorbidities than early-onset SLE. Differences in disease activity may be associated with an interaction between the SLE and age.

The prevalence and extent of vascular calcification over the thoracic aorta and coronary and carotid arteries are greater in patients with systemic lupus erythematosus (SLE) than in healthy persons. Because the process of atherosclerosis related to SLE disease activity is diffuse and widespread rather than limited to the coronary arteries, coronary calcification used alone as a marker for atherosclerosis may not disclose the association.

Once a diagnosis of systemic lupus erythematosus (SLE) has been made, numerous neurological and psychiatric manifestations may be found to accompany the disease.

The features of systemic lupus erythematosus (SLE) are common in the lifetime course of rheumatoid arthritis (RA) and are significantly associated with an increased mortality risk, even after adjusting for well-described RA-specific predictors of mortality. For some SLE features, the increased risk may be as high as 6-fold.

ABSTRACT: Increased disease recognition and therapeutic advanceshave led to improved survival in patients with systemic lupus erythematosus(SLE) over the past several decades. As a result, managementof the long-term comorbidities and complications of SLE has taken ongreater importance. Maintaining a high index of suspicion for cardiovasculardisease in SLE and screening for traditional risk factors isprudent. Minimizing the use of immunosuppressive agents remainsthe main strategy for decreasing infections, but providing routinevaccinations also can decrease the burden of infections. Despite thehigh prevalence of osteoporosis, screening and treatment remainsuboptimal in patients with SLE and deserve increased attention.Patients with SLE are at increased risk for malignancy and physiciansshould remain vigilant for cancer in these patients. (J MusculoskelMed. 2008;25:316-320)

SLE is an unpredictable and often confusing disease that affects more than 1.5 million Americans and at least 5 million persons worldwide.

A 29-year-old African American woman came to our rheumatology clinic with right hip pain that had been getting worse for the past 3 months. She had been diagnosed with systemic lupus erythematosus (SLE) 2 years earlier. She reported excruciating right hip pain and mild pain in her left hip on weight bearing and, occasionally, at rest.