Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of high morbidity and mortality associated mainly with the activity of disease, infections and cardiovascular disease. In this condition, both premature atherosclerosis (AT) as well as left ventricular hypertrophy (LVH) are related to traditional risk factors for cardiovascular disease (CVD) and probably the peculiar characteristics of the pathophysiology of inflammatory disease. Some evidence shows the association of AT and LVH, which is considered a strong predictor for the presence of atherosclerotic plaques in carotid arteries. This study aimed to determine the frequency of AT and LVH in patients with SLE and to evaluate its relationship with traditional risk factors and factors specific to the disease. We conducted a prospective study of 70 SLE patients attending the outpatient clinic of Rheumatology, Federal University of Sergipe (UFS) and Private Practice of Rheumatology. We evaluated clinical, laboratory and research intima-media thickness of carotid arteries (CIMT) in atherosclerotic plaques and the index of left ventricular mass (LVMI), through questionnaires, the completion of the carotid duplex scan and echocardiogram, respectively. Statistical analysis was determined by multiple logistic regression, after performing descriptive statistics and odds ratios adjusted and simple. We observed the presence of AT in 34.3% of cases, LVH in 45.7% and concomitant LVH with AT in 23% of cases. AT was significantly associated with age > 50 years, systolic blood pressure (SBP), dyslipidemia, non-white race, renal disease, absence of antimalarial, late age of diagnosis, time course of disease and LVH, (p<0.05). In multivariate analysis, the relationship was demonstrated age > 50 years (OR:7.3), p = 0.01, absence of antimalarial (OR:4.7), p=0.006 and SBP (OR:1.5), p=0.05. LVH was associated with age > 50 years, not white race, hypertension (HBP), c-reactive protein > 1 mg/dL (CRP), time course of disease and AT (p <0.05). In the multivariate analysis, we found that hypertension (OR:11.4), p=0.001, CRP > 1 mg/dL (OR:8.2), p=0.004, AT (OR:6.04); p=0.02, remained linked to LVH and body mass index (BMI) > 25 kg/m² (OR:4.61), p=0.04, was added as a strong predictor of LVH. The data suggest that in SLE, the presence of AT and LVH are associated not only to some traditional risk factors for CVD such as hypertension and obesity, but also to the chronicity of the disease, its treatment; and serological markers of inflammation. / O lúpus eritematoso sistêmico (LES) é uma doença inflamatória crônica de elevada morbidade e mortalidade associada, sobretudo, à atividade de doença, infecções e doença cardiovascular. Nessa afecção, tanto a aterosclerose prematura (AT) como a hipertrofia ventricular esquerda (HVE) encontram-se relacionadas a fatores de risco tradicionais para doença cardiovascular (DCV) e provavelmente, a características peculiares na fisiopatogênese dessa doença. Algumas evidências demonstram a associação da AT e HVE, sendo esta considerada um forte preditor para a presença de placas ateroscleróticas nas carótidas. O presente estudo teve como objetivo determinar a frequência de AT e HVE em pacientes com LES e avaliar sua relação com fatores de risco tradicionais e fatores próprios da doença. Foi realizado um estudo prospectivo em 70 pacientes portadores de LES, atendidos no ambulatório de Reumatologia da Universidade Federal de Sergipe (UFS) e consultório particular de Reumatologia. Foram avaliados dados clínicos, laboratoriais e pesquisa da espessura médio-intimal das carótidas (EIMC), de placas ateroscleróticas e do índice de massa do ventrículo esquerdo (IMVE), por intermédio de questionário, da realização do duplex scan de carótidas e do ecocardiograma, respectivamente. A análise estatística foi determinada pela regressão logística múltipla, após realização de estatística descritiva e cálculo de odds ratio (OR) simples e ajustado. Observou-se a presença de AT em 34,3% dos casos, a HVE, em 45,7% e concomitância de AT com HVE em 23% dos casos. Na análise univariada, a AT associou-se significativamente à idade > 50 anos, pressão arterial sistólica (PAS), dislipidemia, raça branca, doença renal, ausência de antimalárico, idade tardia de diagnóstico, tempo longo de doença e HVE; (p<0,05). Em análise multivariada, a relação demonstrada foi idade > 50 anos, (OR:7,3); p=0,01, ausência do antimalárico, (OR:4,7); p=0,006 e pressão arterial sistólica (PAS) (OR:1,5); p=0,05. A HVE esteve associada à idade > 50 anos, cor não branca, hipertensão arterial sistêmica (HAS), proteína c reativa (PCR) > 1mg/dL, tempo longo de doença e AT, (p<0,05). Já na análise multivariada, observou-se que HAS (OR:11,4); p=0,001, PCR > 1 mg/dL, (OR:8,2); p=0,004 e AT (OR:6,04) ; p=0,02, permaneceram relacionadas à HVE e o índice de massa corpórea (IMC) > 25 kg/m² (OR:4,61); p=0,04, foi acrescentado como forte preditor de HVE. Os dados sugerem que, no LES, as presenças de AT e HVE estão associadas não somente a alguns fatores de risco tradicionais para DCV, como a HAS e obesidade, mas também à cronicidade da doença, tratamento instituído e marcadores inflamatórios da doença.

O desencadeamento do Lúpus Eritematoso Sistêmico (LES) está relacionado às situações estressantes e traumáticas da vida dos pacientes, o que sugere o fator psicológico como deflagrador da doença. A Nefrite Lúpica (NL) pode ser a primeira manifestação do LES e constitui fator de maior morbidade e mortalidade, por levar à insuficiência renal, com necessidade de hemodiálise, e colocar o sujeito diante de mudanças da rotina de vida, da autoimagem, o que faz da própria doença um evento traumático para o paciente. Dentro desse contexto, os objetivos desta pesquisa foram: (i) verificar a existência de eventos de vida associados ao deflagramento do LES nos relatos dos pacientes com NL e a forma como esses pacientes compreendem o seu adoecimento; e (ii) analisar correlações entre eventos de vida, estado de atividade do LES e perfil socioeconômico. Para a pesquisa empírica, adotou-se uma abordagem quali-quantitativa, por meio da aplicação dos seguintes instrumentos: entrevista semiestruturada (psicológica), entrevista para eventos de vida recentes (psiquiátrica) e instrumental de classificação socioeconômica. A amostra foi composta por 43 sujeitos internados no Serviço de Nefrologia do Hospital das Clínicas de São Paulo, sendo 22 pacientes do grupo caso, com NL e 21 pacientes do grupo controle, com doença glomerular primária. Os dados clínicos e laboratoriais foram coletados por meio do SLEDAI e por consulta ao prontuário. Os principais resultados obtidos demonstram que a ocorrência de eventos de vida não apresentou correlação à atividade do LES. Evidencia-se uma associação entre eventos de vida negativos e o deflagramento da doença nos dois grupos estudados, o que demonstra que eventos negativos também antecedem e podem estar associados ao início de outras patologias. Quanto à maneira como os pacientes com NL compreendem o seu adoecimento, observou-se que eles compreendem parcialmente sua doença, atribuindo um significado negativo e associam uma situação emocional ao início do adoecimento. São pacientes que percebem os problemas de suas vidas e possuem necessidade de lidar com o adoecimento implicando-se ao tratamento. Há sofrimento quanto ao adoecimento pelas mudanças e limitações que a doença impõe, principalmente em relação à autoestima, por isto, sofrem emocionalmente e possuem necessidade de serem escutados e amparados. Portanto, conclui-se que os eventos de vida negativos e/ou traumáticos estão relacionados ao deflagramento do LES tanto de forma objetiva como um acontecimento que envolve mudanças no ambiente social externo, sem considerar a subjetividade do sujeito quanto de forma subjetiva como um evento de vida singular, relatado pelos próprios pacientes como um evento traumático. Essas evidências sugerem que os pacientes com NL possuem fatores psicológicos particulares que atuam tanto no curso da doença, quanto em seu deflagramento / The onset of Systemic Lupus Erythematosus (SLE) is related to stressful and traumatic situations in patient lives, which suggests the psychological factor to trigger the disease. The Lupus Nephritis (LN) may be the first manifestation of SLE and is a major factor of morbidity and mortality, because it leads to kidney failure, requiring hemodialysis. Furthermore, the LN changes the routine of life and selfimage of patients, which makes the disease itself a traumatic event. Within this context, this study aims to: (i) verify the existence of life events associated with the outbreak of SLE, and how these patients understand their illness, and (ii) evaluate correlations between life events, status of SLE activity and socioeconomic profile. For the empirical research, we used a qualitative and quantitative approach, applying the following instruments: a semi-structured psychological interview; a psychiatric interview for recent life events and an instrumental for socioeconomic status. The sample was consisted of 43 subjects admitted to the Nephrology Department, at Hospital das Clinicas in Sao Paulo: 22 patients formed the case group, with LN and 21 formed the control group, with primary glomerular disease. The clinical and laboratory data were collected using the SLEDAI. The main results show that the occurrence of life events had no correlation with SLE activity. There was an association between negative life events and the outbreak of the disease in both groups, showing that negative events also precede and may be associated with the onset of other pathologies. Regarding the manner LN patients understand their illness, we see that they partially understand their disease, giving a negative meaning and associating an emotional situation at the beginning of illness. These are patients who perceive problems in their lives and need to deal with the disease giving importance to the treatment. The illness process causes suffering due to the changes and limitations the disease imposes, especially related to self-esteem, therefore, patients suffer emotionally and demand to be heard and supported. Thus, we conclude that the negative life events and/or trauma are related to the triggering of SLE both in an objective way as an event that involves changes in the external social environment, without taking into account the subjectivity of the subject as in a subjective singular life event, reported by the patient as a traumatic event. Based on this analysis, we suggest that patients with LN have particular psychological factors that operate both in the course of the disease, and in its triggering

Orientador: Simone Appenzeller / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T13:41:07Z (GMT). No. of bitstreams: 1 Barbosa_Renata_M.pdf: 1172344 bytes, checksum: 3fc9e9d779a4b94077d1d56223dc0d79 (MD5) Previous issue date: 2014 / Resumo: O nosso objetivo foi determinar a prevalência de atrofia hipocampal no lúpus eritematoso sistêmico juvenil (LESj) determinando a volumetria hipocampal por ressonância magnética e avaliar a possível relação entre atrofia hipocampal e fatores associados. Todos os pacientes com quatro ou mais critérios classificatórios de LES seguidos no ambulatório de reumatologia pediátrica com início da doença até aos 18 anos foram incluídos. Uma análise clínica e neurológica foi realizada de acordo com os critérios classificatórios do Colégio Americano de Reumatologia. Dados laboratoriais e de tratamento foram obtidos através da revisão criteriosa dos prontuários clínicos. Observamos que os volumes hipocampais dos nossos pacientes foram significativamente menores quando comparados aos volumes hipocampais dos nossos controles (p<0,001). A atrofia hipocampal foi identificada em 25 pacientes (34,72%) e no grupo controle 1 indivíduo (1,38%) apresentou atrofia hipocampal direita. A esclerose hipocampal esteve presente em 1(4%) paciente e o hipersinal em 13 (52%) pacientes. Em relação ao tratamento medicamentoso a atrofia hipocampal no LESj esteve associada ao uso de corticosteroides (p= 0,008), micofenolato mofetil (p=0,012), ciclosporina (p=0,018) e ciclosfosfamida (p=0,037). A idade de início da doença (p= 0,038) e dano cumulativo (p= 0,040) também se mostraram associados. Quanto à análise de dados laboratoriais, apenas o anticoagulante lúpico (p= 0,017) e a diminuição do complemento (p= 0,018) se mostraram associados. A esclerose hipocampal apresentou relação com pulso metilprednisolona no início da doença (p=0,023), ciclofosfamida (p=0,023) e com a função cognitiva organização perceptual, planejamento e praxia (p< 0,001). O hipersinal demonstrou associação com atrofia hipocampal (p=0,024), volume hipocampal direito (p=0,024), volume hipocampal esquerdo (p=0,007), no entanto a presença de hipersinal no hipocampo esquerdo apresentou associação apenas com a dose total de corticosteróides (p=0,034). Em relação aos domínios cognitivos, o raciocínio espacial apresentou uma correlação inversa com o volume hipocampal esquerdo (p=0,041; r= -0,281). A memória visográfica apresentou uma correlação direta com o volume hipocampal direito (p=0,042; r= 0,281). A velocidade de processamento associou-se com atrofia hipocampal (p=0,026). O raciocínio temporal demonstrou uma associação com atrofia hipocampal direita (p=0,015), atrofia hipocampal bilateral (p=0,012), e uma correlação inversa com o volume hipocampal direito (p=0,008; r= - 0,359) e volume hipocampal esquerdo (p=0,003; r= -0,400). A atrofia hipocampal é frequente no LESj. A idade de início da doença, tratamento medicamentoso e anticorpos antifosfolípides estão associados à sua ocorrência / Abstract: Our aimed was to determine the prevalence of hippocampal atrophy in childhood-onset SLE (cSLE) using manual magnetic resonance imaging (MRI) volumetric measurements and to evaluate the possible relationship between hippocampal atrophy and associated factors. All patients with four or more classification criteria for SLE, followed at the Pediatric Rheumatology Unit with diagnosis up to 18 years old was included. A clinical analysis and neurological evaluation was analyzed according to the American College of Rheumatology (ACR) classification criteria. Laboratory and treatment features were obtained through a review of clinical records. We observed that the hippocampal volumes of our patients were significantly smaller when compared hippocampal volumes to our controls (p <0.001). Hippocampal atrophy was identified in 25 patients (34.72%) and 1 (1.38%) control at the right hippocampus atrophy. Hippocampal sclerosis was present in 1 (4%) and increased signal in 13 (52%) patients. In relation to drug treatment in cSLE hippocampal atrophy was associated with the use of corticosteroids (p=0.008), mycophenolate mofetil (p=0.012), cyclosporine (p=0.018) e cyclophosphamide (p=0.037).The age of onset (p= 0.038) and cumulative damage (p= 0.040) were also associated. However the analysis of laboratory features, only lupus anticoagulant (p=0.017) and decreased complement (p=0.018) were associated. Hippocampal sclerosis showed relation with pulse methylprednisolone at disease onset (p=0.023), cyclophosphamide (p = 0.023) and cognitive function perceptual organization, planning and praxis (p <0.001). Increased signal showed association with hippocampal atrophy (p=0.024), right hippocampal volume (p=0.024), left hippocampal volume (p = 0.007). However presence of increased signal in the left hippocampus was associated with total corticosteroid dose (p=0.034). Considering cognitive domains, spatial reasoning showed inverse correlation with left hippocampal volume (p = 0.041, r = -0.281). Visografica memory showed a direct correlation with the right hippocampal volume (p= 0.042, r = 0.281). Processing speed is associated with hippocampal atrophy (p = 0.026). Temporal reasoning demonstrated an association with right hippocampal atrophy (p = 0.015), bilateral atrophy (p = 0.012) and inverse correlation with right hippocampal volume (p=0.008, r= -0.359) and left hippocampal volume (p = 0.003, r = -0.400). Hippocampal atrophy is prevalent in cSLE. The age of onset of disease, drug treatment and antiphospholipid antibodies are associated / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

Magister Scientiae (Physiotherapy) - MSc(Physio) / Rheumatic disease is estimated to be one of the most disabling diseases in South Africa and the world. The most common rheumatic diseases are osteoarthritis, fibromyalgia, rheumatoid arthritis, gout and systemic lupus erythematosus. The symptoms of the disease include pain, stiffness, swelling, decreased function. The patient’s functional abilities are severely affected by the pain which in turn, leads to poor quality of life and adverse stress. As a result patients who suffer with one or with a combination of rheumatic disease will experience pain, stress, decreased functional abilities and poor quality of life. The physical properties of water and the therapeutic effects of hydrotherapy, make hydrotherapy an effective form of exercise available to physiotherapists in the treatment of rheumatic disease. The aim of the current study was to determine the effects of a hydrotherapy intervention on the pain, stress, quality of life and functional abilities in patients with rheumatic disease. A quantitative and qualitative research design was employed to meet the objectives. The quantitative aspect involved an A-B-A design and the qualitative part of the study compromised indepth interviews which took place after the intervention. The instruments used were the WHOQOL-BREF instrument, the Visual Analogue Scale (VAS), the Weekly Stress Inventory-Short Form (WSI-SF) and the Health Assessment Questionnaire. (HAQ). The sample consisted of 19 patients who were diagnosed with one or a combination of rheumatic disease. The study was conducted at the hydrotherapy pool at Groote Schuur Hospital in Cape Town. Within the study sample, the majority of the participants were female (84%) with osteoarthritis being common among the participants (53%). The mean age was 60 years. The intervention had a significant impact on pain reduction (p = 0.0001), quality of life (p<0.05). However, the impact of hydrotherapy on stress and the social relationship domain in quality of life was inconclusive. It is thus evident from this study that hydrotherapy as a treatment modality for physiotherapists can be used to impact on the pain, quality of life and functional abilities in patients with rheumatic disease. iv Keywords

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease that cause various inflammatory conditions in the body. The pathogenesis of this disease is yet unknown, and the diversity within the patients bring on major obstacle to clinical research for specific diagnostic markers. As a biomarker of SLE, both Interferon Regulatory Factor-5 (IRF5) and Microparticles (MP) have been suggested. Recently a study demonstrated higher concentration of IRF5+ MP in a small number of SLE patients compared to controls.  Aim: The purpose of this study was to validate and analyze IRF5+ MPs in a larger number of SLE patients and compare the results to known SLE subgroup based on IRF5 concentration.  Materials and methods: Totally 50 plasma samples from a larger cohort of SLE-patients (n=35) was analyzed together with population-based controls(n=15). Three different antibodies (in-house and commercial) were used for detection of IRF5+ MP with flow cytometry. Students t-test was used to investigate significant differences between SLE subgroup, controls and compared to the previous values. Results and Conclusion: The concentration of IRF5+ MP in SLE subgroup was significantly higher compared to controls (p&lt;0,05). However, there were no correlations between our results and the values from the previous study, suggesting that both methods measure various forms of IRF5. These results imply that IRF5+ MP could be a possible biomarker for pathogenesis in SLE, but further studies are needed for a better understanding of IRF5, as well as of MP.

Les cellules dendritiques plasmacytoïdes (pDCs) sont caractérisées par leur capacité unique de sécrétion massive d’interféron de type I (IFN-I) suite à la stimulation des Tolllike récepteurs (TLR) 7 et 9. Un rôle fondamental des pDCs a été démontré dans le lupus érythémateux systémique via la production d’IFN-I. Les pDC expriment le récepteur de forte affinité aux immunoglobulines de type E (IgE), FcεRI, impliqué dans la régulation négative de la sécrétion d’IFN-I. L’objectif de notre étude est d’explorer, dans le contexte lupique, les effets du traitement par les IgE sur les fonctions des pDC, particulièrement sur la production d’IFN-I. In vitro, le traitement des pDC par des IgE monoclonales permet la surexpression du FcεRI à leur surface et diminue le taux de transcrits des TLR7/9 et de l’IRF7. De plus, les pDC traitées par des IgE diminuent leur production d’IFN-I et l’expression de marqueurs de maturation, induites par leur stimulation par des ligands des TLR7/9 et des complexes immuns lupiques. En outre, ces pDC pré-traitées par des IgE induisent la différenciation de LT4 naïfs allogéniques en LT4 produisant de l’IL-10. In vivo, les patients lupiques en phase quiescente de la maladie présentent des taux plus élevés d’IgE totales comparés aux patients en phase active (indépendamment d’allergies et d’infestations parasitaires). Chez les patientslupiques, le taux d’IgE totales est inversement corrélé au taux d’anti-ADN et à l’activité de la maladie (SLEDAI). L’ensemble de nos résultats suggère un rôle protecteur des IgE dans le lupus à travers la modulation de la réponse inflammatoire des pDC. / Plasmacytoid dendritic cells (pDCs) are characterized by their unique ability to produce large amounts of type I interferon (IFN-I) upon Toll-like receptors (TLR) 7 and 9 triggering. A fundamental role for pDCs has been shown in systemic lupus erythematosus (SLE) through IFN-I production. pDCs express the high affinity Fc receptor for immunoglobulin E (IgE), FcεRI, involved in the negative regulation of IFN-I secretion. The objective of our study is to investigate, in the context of SLE, the effects of IgE treatment on pDCs functions, especially on IFN-I production. In vitro, monoclonal IgE treatment of pDCs upregulate their surface expression of FcεRI and decrease transcripts levels of TLR7/9 and IRF7. IgE-treated pDCs decrease IFN-α secretion and downregulate maturation markers expression induced by TLR7/9 and immune complexes triggering. Moreover, the coculture of IgE pretreated pDCs with allogeneic naive LT4 promotes their differentiation into IL-10-secreting cells. In vivo, patients with quiescent SLE have higher IgE levels than patients with active disease (independently of allergy or parasitic infection). In SLE patients, IgE levels are inversely correlated to anti-DNA antibodies and disease activity (SLEDAI). All together, our data suggest a protective role for IgE in SLE through the modulation of the inflammatory response by pDC.

Orientador: Leandro Gustavo de Oliveira / Resumo: Introdução: O Lúpus Eritematoso Sistêmico (LES) é uma doença sistêmica de caráter autoimune, que acomete mulheres em idade reprodutiva, sendo que a inter-relação entre a doença e a gestação determina importantes desfechos maternos e perinatais. Objetivos: Descrever os desfechos maternos e perinatais em gestações de pacientes portadoras de LES e avaliar o impacto da nefrite lúpica sobre os resultados encontrados. Métodos: Este é um estudo observacional descritivo desenvolvido para avaliar as inter-relações entre gestação e lúpus eritematoso sistêmico em pacientes atendidas na Maternidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu – HCFMB. O período de estudo foi de janeiro de 2010 a agosto de 2019. Resultados: Foram avaliadas 38 gestações em 31 pacientes com LES. A média das idades foi de 27,4 + 6 anos. A média das idades gestacionais ao nascimento foi de 36 + 3 semanas. As principais intercorrências observadas foram: anemia (39,4%), nefrite lúpica (29%) e hipertensão arterial crônica (10,5%). Hidroxicloroquina foi utilizada em 47,4% das gestações. Em 51,4% das pacientes houve necessidade de antecipação do parto e em 13,1% houve piora da função renal. A incidência de pré-eclâmpsia foi de 19,4%. Prematuridade ocorreu em 20% dos casos e restrição de crescimento fetal, em 19,4%. Nefrite lúpica determinou maior ocorrência de flare (p<0,05) e maior necessidade de antecipação do parto (p< 0,05). Conclusão: O presente estudo permitiu avaliar a inter-relação entre L... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Systemic Lupus Erythematosus is an autoimmune systemic disease that affects women of reproductive age, and the interrelation between disease and pregnancy determines important maternal and perinatal outcomes. Objectives: To describe maternal and perinatal outcomes in pregnancies of patients with SLE and to evaluate the impact of lupus nephritis on the results found. Methods: Descriptive observational study developed to assess the interrelation between pregnancy and systemic lupus erythematosus in patients attended at the Maternity of the Clinics Hospital from Botucatu Medical School – HCFMB. The study period corresponded to January 2010 until August 2019. Results: Thirty-eight pregnancies were evaluated in 31 patients with SLE. Their average age was 27.4 + 6.0 years. The average gestational age at birth was 36 + 3 weeks. The main clinical complications observed were anemia (39.4%), lupus nephritis (29%) and chronic hypertension (10.5%). In 51,4% of the patients, it was necessary to anticipate delivery and in 13.1%, there was worsening of the renal function. Prematurity occurred in 20% of cases and FGR in 19,4%. Hydroxicloroquine was used in 47,4% of the pregnancies. Lupus nephritis determined a higher occurrence of flare (p<0.05) and a greater need to anticipate delivery (p<0.05). Conclusion: The present study made it possible to relate the main clinical characteristics and the maternal and perinatal outcomes from the pregnant women with SLE treated at the prena... (Complete abstract click electronic access below) / Mestre

A 28-year-old female patient with active and difficult-to-treat systemic lupus erythematosus (SLE) was diagnosed with liver-dominant diffused large B-cell lymphoma. Repeated response 18F-FDG-PET studies showed persistently high, and, despite intensified immunochemotherapy, further increasing metabolic activity of one of the hepatic lymphoma residuals, whereas all other initial lymphoma manifestations had achieved complete metabolic remission. As biopsy of the 18F-FDG-PET-positive liver residual turned out to be inconclusive, complete resection was performed. Subsequent histopathological examination, however, revealed only necrotic tissue. Thus, no further lymphoma treatment was scheduled. The patient undergoes regular surveillance and is disease-free 13 months after resection. Similarly, treatment of SLE is no longer required due to lack of activity already after the first two cycles of lymphoma treatment. The case shows how closely SLE and diffused large B-cell lymphoma can be connected and stresses the importance of interdisciplinary treatment approaches. In the future, artificial intelligence may help to further classify 18F-FDG-PET-positive lymphoma residuals. This could lead to an increase of the positive predictive value of interim- and end-of-treatment 18F-FDG-PET. The patient’s point of view enables another instructive perspective on the course of treatment, which often remains hidden to treating physicians due to lack of time in clinical routine.

Patients were selected for the study on the basis of 1: A diagnosis of systemic Lupus Erythematosus according to the 1982 revised American Rheumatology Association criteria47 and 2: An adequate biopsy defined as containing at least six glomeruli. Patients were biopsied at Groote Schuur Hospital during the period 1978 to 1988 and the indications for renal biopsy were clinical based on laboratory results of renal function. Patients were followed between 1 and 120 months with a mean observation period of 34 months. The clinical records were scrutinised and the following pa·rameters were noted at the time of biopsy: age, sex, race, time from diagnosis to biopsy, serum urea, creatinine, creatinine clearence and urinary 24 hour protein. Using the latest serum urea, creatinine, creatinine clearence and / or 24 hour urinary protein where available, outcome was graded as: 1: An improvement in renal function 2: A stable renal function 3: Deterioration in renal function 4: Patient on dialysis 5: Death due to disease.

No description available.