Determina las manifestaciones clínicas al inicio y durante la evolución de la enfermedad en pacientes con Lupus Eritematoso Sistémico (LES) atendidos en el Hospital Nacional Dos de Mayo (HNDM) durante el periodo 2000 – 2017. El estudio descriptivo, observacional, longitudinal y retrospectivo. Se consideraron 100 historias clínicas de pacientes con LES que cumplieron con los criterios de selección y se registraron las manifestaciones al momento del diagnóstico y durante la evolución. El 85 de los pacientes fueron mujeres y 15, varones. La edad promedio al momento del diagnóstico fue 34.11 ± 11.64 años. Las manifestaciones clínicas más frecuentes al inicio de la enfermedad fueron artralgia y anemia no hemolítica en 69% respectivamente, alopecia en 66%, artritis en 54%, eritema malar en 38%, fiebre en 37%, proteinuria en 34%, fatiga en 33% y disminución de peso en 32%. Se realizó biopsia renal a 23 pacientes, de los cuales, 18 presentaron nefritis lúpica clase IV. Las manifestaciones más frecuentes durante la evolución de la enfermedad fueron artralgia en 42.10%, anemia no hemolítica en 40.78%, alopecia y artritis en 35.52% cada una, proteinuria en 14.47% y; fiebre, fatiga e hiporexia/anorexia en 11.84% cada una. La conclusión es que hubo mayor frecuencia de manifestaciones clínicas al inicio de la enfermedad. La artralgia, alopecia, anemia no hemolítica y artritis fueron las manifestaciones que predominaron tanto al inicio como durante la evolución del LES. / Tesis

Systemic Lupus Erythematosus (SLE) is an autoimmune disease affecting 20 to 250 individuals per 100,000 worldwide. Symptomology includes dermatological manifestations such as discoid lesions, acute cutaneous rashes, and oral and nasal ulcers, along with musculoskeletal, pulmonary, and renal complications. Abnormal T and B lymphocyte function and apoptosis, immune complex clearance, complement function, and nucleosome processing are typical of disease pathophysiology. SLE is the result of both environmental and genetic factors, which together create the conditions leading to disease onset and progression. Of these environmental factors, Epstein-Barr virus (EBV) infection is known to cause the genesis of cross-reactive antibodies in SLE prone individuals that can initiate disease activity. Viral infection and modulation of cellular genes is important in understanding the microenvironment that could lead to immune mis-regulation and the inception of lupus in those individuals at risk. During disease development, a variety of variables assist and detract from disease progression and the quality of life experienced by SLE patients. Research into EBV-infected naïve B lymphocytes revealed that EBV modulates the chemotactic receptor EBI2 during viral infection via the BRRF1 viral gene product Na. This likely changes B lymphocyte chemotaxis in secondary tissue in virally infected B cells. Current literature suggests this results in sequestration of cells to peripheral areas of the tissue and mis-regulation of the immune response. It is not uncommon for SLE patients to have neuropsychiatric disorders due to lupus disease activity. With SLE patients being up to 6 times more at risk for depression, recognition and treatment of depression and anxiety have been shown to improve quality of life, pain, and treatment outcomes. Two studies investigate both clinical laboratory and psychosocial assessment variables that we suspect to be correlated with depression in patients with SLE. Univariate and multivariate analysis from our first study identified an array of variables that show strong associations with depression, including: Body Mass Index, Pain, Total Complement, fatigue assessments, and SF-36 scores. The second study found similar associations, but further found that serum IL-10 levels demonstrated a strong correlation with depression in SLE patients. In this final study SLE patients are compared alongside healthy, clinically depressed, and rheumatoid arthritis patients to provide evidence that increased depression in SLE patients is due more to disease pathology than a result of chronic inflammation.

The Association of Cancer Development in Patients with Systemic Lupus Erythematosus by Rose Michelle Coley MPH, Walden University, 2011 BS, University of Mount Olive, 2008 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University March 2016 Both cancer and autoimmune diseases have been associated with numerous factors that may independently lead to the development of either disease. When these factors overlap the difficulty in assessing association is compounded. The numerous factors that are thought to cause systemic lupus erythematosus (SLE), which leads to the development of cancer, makes the study of an association between the 2 diseases challenging. The purpose of this study was to examine whether the risk of cancer development increased in SLE patients compared to the risk in non-SLE patients. Researchers have not shown consistent relationships of cancer development in patients with SLE; however, consideration of the various factors that contribute to the diseases is necessary to measure an association between the 2 diseases. This study used the Clinical Practice Research database (CPRD), a large, population-based database to test the relationship between SLE and cancer. A matched retrospective cohort study among SLE (n=3025) and non-SLE (n=180555) patients was conducted using the propensity score methodology to help balance the differences between the comparison groups. The propensity score methodology created a similar distribution of observed baseline covariates between the 2 groups. With adjustment for age, the predictor variable of SLE indicates that a patient with SLE is still 2.7 times more likely to develop cancer than is a non-SLE patient. The study outcomes could promote positive social change by reinforcing current recommendations for cancer screenings in persons with SLE, which could enhance the ability to detect cancer early enough to decrease mortality because of cancer in persons with SLE.

Thèse d'exercice : Médecine. Médecine interne : Paris 12 : 2006. / Titre provenant de l'écran-titre. Bibliogr. f. 55-66.

Reproduction de : Thèse d'exercice : Médecine : Nancy 1 : 2005. / Titre provenant de l'écran-titre.

published_or_final_version / Medicine / Master / Master of Research in Medicine

 Neuropsychiatric systemic erythematosus (NPSLE) is a complicated complication of systemic erythematosus (SLE). Asian patients are associated with high prevalence of systemic disease and mortality It increases patients’ morbidity and mortality (Samanta et al., 1991). But the detailed pathology and pathogenesis are still remained unclear. Our study’s purpose is to use advanced functional imaging method, including diffusion tensor imaging (DTI) and magnetic resonance spectroscopy imaging (MRSI) to detect intracranial volumetry, functional and other metabolite changes in NPSLE patients. We recruited 3 age-matched female groups, one patient group with NPSLE (20 patients), one patient group with SLE (20 patients) and one control group (15 normal controls). Each patient was applied to structural 3D-T1 and axial T2, DTI and MRSI. Whole brain volumetry and hippocampus volumetry were analyzed by FSL and MARINA software from T1 images. White matter hyperintensity was calculated manually. Whole brain FA and other indices were collected. Regional FA was also collected and was collected with MRS over corpus callosum slice. The result showed no significant whole brain atrophy in NPSLE patients and SLE patients compared with controls. But with segmentation of grey matter, white matter and CSF, NPSLE patients showed significant decrease volume from SLE patients in white matter. Left hippocampus showed significant decreased volume in white matter and grey matter compared with control, while right hippocampus showed significant decreased volume in white matter. No other significant difference was found between NPSLE vs SLE and SLE vs controls. Whole brain FA was significantly decreased in NPSLE compared to SLE and controls, but not significantly different between SLE and controls. MD, λ∥ and λ⊥ were significantly increased in NPSLE and SLE compared with controls, but not significantly different between SLE and controls. White matter hyperintensity score was consistent with MD, λ∥ and λ⊥ results, showed significantly higher scores in two patients groups compared to controls. Regional FA, involving frontal lobes and corpus callosum, periventricular regions adjacent to centrum semiovale and posterior lateral temporal lobe, confirmed the regional FA decrease showed in whole brain FA statistical color map and NPSLE patients’ regional FA decrease correlated with MRS metabolic changes. N-acetyl aspartate (NAA)/ Creatine (Cr), the marker of neurons, decreased significantly in NPSLE patients compared with SLE and controls. Choline (Cho)/Cr showed significant increase of tendency of significant increase in NPSLE and SLE patients in some ROIs compared with controls. Our finding suggested that, although the whole brain atrophy is not obvious in NPSLE, the hippocampus and white matter suffered atrophy in NPSLE patients. These atrophy in white matter of whole brain and hippocampus combined with functional imaging results of DTI and MRS, indicated that NPSLE endured more severe axonal damage than SLE, which might be due to a variety of lesions, such as demyelination, microangiopathy, large vessel thrombosis, cytokine, etc. Varying ratio of NAA/Cr and Cho/Cr may be associated with the severity of axonal damage, probably due to demyelination in the background of inflammatory/ischemic/vasculitic changes. / published_or_final_version / Diagnostic Radiology / Master / Master of Philosophy

published_or_final_version / Medicine / Master / Doctor of Medicine

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.