Outcome in a patient with systemic lupus erythematosus and concurrent chronic hepatitis B infection.

A 35-year-old Caucasian woman with proven systemic lupus erythematosus (SLE) had been effectively managed with hydroxychloroquine and methylprednisolone for many years. In 2005 she was admitted to the rheumatology clinic with a flare up of the disease and with proteinuria of 3.2 g/24 h. Renal biopsy was performed and revealed diffuse proliferative nephritis. Before the renal biopsy a positive HB(s)Ag was found with high virus replication (hepatitis B virus (HBV)-DNA-4 170 000 copies/ml). Liver biopsy revealed chronic hepatitis with minimal activity (TAIS=1). Lamivudine was administered with concomitant maintenance corticosteroid treatment, but without antimalarials. Pulsed methylprednisolone treatment for diffuse lupus nephritis was begun on the background of lamivudine therapy. The liver enzymes returned to normal values, HBV replication was suppressed, and the proteinuria disappeared. At present the patient is not being treated with lamivudine and there are no objective signs of nephritis and hepatitis, or HBV activation.

Diffuse mesangial IgA glomerulonephritis in a patient with rheumatoid arthritis: a possible extra-articular manifestation in rheumatoid arthritis.

Rheumatoid arthritis (RA) is an inflammatory joint disease, in which, unlike systemic lupus erythematosus (SLE), renal involvement is uncommon. The major causes of renal disease in RA are usually linked to amyloid or secondary effects of drugs. Nevertheless the relation between IgA, IgA-rheumatoid factor (RF) and renal disease in patients with RA is not clear, but the affinity of IgA for mesangium, skin and synovium might explain clinical presentation of RA with mesangial IgA glomerulonephritis. The case of a 42-year-old Caucasian man with RA and diffuse mesangial IgA glomerulonephritis proven by renal biopsy is presented. The patient was treated with boluses of methylprednisolone 1000 mg and cyclophosphamide 1000 mg monthly for 13 months. Between boluses there was a supported therapy with methylprednisolone 8 mg/day. After a year of treatment full clinical and laboratory remission of RA and IgA glomerulonephritis was achieved. Pathogenic therapy will be stopped and the patient followed-up.