Clinical analysis of 6 cases of systemic lupus erythematosus complicated by transverse myelitis / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize the clinical features and therapeutic approach of systemic lupus erythematosus (SLE) complicated by transverse myelitis (TM).</p><p><b>METHODS</b>The clinical characteristics, laboratory examinations, treatment and prognosis of 6 SLE cases with TM were retrospectively analyzed with review of the literatures.</p><p><b>RESULTS</b>The 6 patients consisted of 5 females and 1 male aged 14 to 36 years (mean 23 years). The mean duration from symptom onset of SLE to TM was 8 months (1 to 13 months). All the patients had lower limb hypodynamia, and 3 of them developed upper limb hypodynamia. MRI scanning of the spine identified lesions in the cervical spinal cord in 2 cases, thoracic lesions in 3 cases, and multiple involvement of the cervical, thoracic and lumbar cord in 1 case. Examination of the cerebrospinal fluid yielded no specific findings except for leukocytosis in 1 case and hypoglycemia in another. Five cases were treated with high-dose MP+CTX, and the other case was treated with MP (80 mg/day)+CTX. Five patients responded favorably to the treatment, while the other showed no obvious improvement.</p><p><b>CONCLUSION</b>TM is a rare complication of SLE affecting mostly young patients and occurring in the early stage of the disease. Early diagnosis and aggressive treatment might improve the prognosis.</p>

Comparative study of systemic lupus erythematosus in children and adults / 南方医科大学学报

<p><b>OBJECTIVE</b>To discuss the differences in the clinical features, laboratory tests and renal pathology between children and adults with systemic lupus erythematosus (SLE).</p><p><b>METHODS</b>A retrospective study was performed in 198 children and 200 adults with SLE.</p><p><b>RESULTS</b>Fever, rash, arthritis, anemia and renal involvement were the most common symptoms in both groups. The incidence of hepatomegaly, splenomegaly, lymphadenectasis, anemia, renal involvement, nervous system involvement and digestive apparatus involvement were higher in children with SLE. The mean SLE Disease Activity Index score was also higher in the children. Immunological findings showed that a greater proportion of children with SLE were positive for anti-double stranded DNA antibody, anticardiolipin antibody and perinuclear antineutrophil cytoplasmic antibody. Renal pathological examinations showed that children with SLE patients were more likely to have serious renal involvement. The misdiagnosis rate was higher in children with SLE patients. During the hospital stay, 12 (6.1%) children with SLE died, with an average disease course of 6.8 months; 9 (4.5%) adults with SLE died with an average disease course of 4.2 years.</p><p><b>CONCLUSION</b>Children with SLE patients are liable to have systemic involvement and higher misdiagnosis rate, often with poorer prognosis than the adult patients.</p>

Clinical study of etanercept for treating ankylosing spondylitis / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of etanercept, a tumor necrosis factor (TNF)-alpha inhibitor, in the treatment of ankylosing spondylitis (AS), and investigate its effect on serum levels of matrix metalloproteinase-3 (MMP-3).</p><p><b>METHODS</b>Forty-eight patients with AS received etanercept 25 mg twice a week for a treatment course of 12 weeks. The patients' symptoms, signs, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and side effects were observed before and after the treatment. The serum levels of MMP-3 was determined using enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>All the patients completed the treatment. The degree of spinal pain and pain at night, the duration of morning stiffness, the finger-to-floor distance, BASDAI and BASFI were significantly improved after the treatment (P<0.05). Etanercept treatment resulted in a significant reduction in serum MMP-3 level in the AS patients to 31.22-/+10.26 ng/ml as compared with the level before treatment (46.17-/+25.74 ng/ml, P<0.05). The reduction of serum MMP-3 was positively correlated to decrement of ESR and CRP (r=0.397 and 0.474, respectively, P<0.05). The most common adverse events of etanercept included injection site reaction and upper respiratory infection.</p><p><b>CONCLUSION</b>Etanercept treatment has obvious therapeutic effects on AS without serious adverse effects. MMP-3 may be a potentially useful indicator to assess the effect of anti-TNF-alpha treatment in AS patients.</p>

Expression of B lymphocyte stimulator in peripheral blood mononuclear cells in individuals with systemic lupus erythematosus and the role of interferon-? on it's expression / 中华风湿病学杂志

Objective To determine the expression of membrane-bound B lymphocyte stimulator (BLyS) protein and its mRNA in vitro of peripheral blood mononuclear cells (PBMCs) from individuals with systemic lupus erythematosus (SLE),and to investigate the role of interferon-?(IFN-?) on the expression of BLyS.Methods PBMCs were obtained from 25 SLE patients (mean age of 31+14) and 20 healthy volunteers (mean age of 28?10).They were randomized into IFN-?(5 ng/ml) group and control group.PBMCs were col- lected at 0,6,12 and 24 h for BLyS mRNA assessment using semi-quantitative reverse transcription-PCR (RT-PCR).PBMCs were also collected at 72 h for membrane-bound BLyS protein detection using flow cy- tometry (FACS) and direct immunofluorescence.Results①The expression of BLyS mRNA and membrane- bound protein in PBMCs was significantly higher in individuals with SLE compared with healthy controls (P＜0.05);②IFN-?enhanced BLyS mRNA expression in PBMCs in both healthy controls and SLE patients,with the greatest effect at 6 h (stimulated vs unstimulated,0.42?0.19 vs 0.25?0.14,P＜0.01;0.59?0.28 vs 0.44?0.21,P＜0.01 );③IFN-?also increased the expression of membrane-bound BLyS protein in both healthy con- trols and individuals with SLE (FACs,mean fluorescence intensity,4.5+3.0 vs 3.7~2.6,P