Tuberculosis en una cohorte de pacientes con lupus eritematoso sistémico / Tuberculosis in a cohort of patients with systemic lupus erythematosus

Objetivos. Analizar los casos de tuberculosis (TB) en una cohorte de pacientes con lupus eritematoso sistémico (LES) y comparar la frecuencia y características de la TB en nuestra serie con las de otras series publicadas; identificar características diferenciales entre los pacientes que presentaron TB y los que no la presentaron, y evaluar si las formas más graves se relacionaron con dosis más altas de glucocorticoides (GC) u otros inmunosupresores. Material y método. Análisis descriptivo de 13 pacientes con TB de una serie de 789 pacientes con LES. Revisión de las historias clínicas de los casos. Búsqueda bibliográfica en MEDLINE-PubMed de las series LES/TB publicadas, utilizando los términos «infection», «tuberculosis», «lupus erythematosus». Estudio comparativo de casos (LES/TB+) y controles (LES/TB–) en cuanto a las características clínicas, de laboratorio y el tratamiento realizado, mediante test X2 y test exacto de Fisher. Resultados. Trece pacientes estuvieron afectados por TB (10 mujeres, con edad media de 36 años; DE de 11,2, y prevalencia del 1,6%). Se diagnosticaron 9 primoinfecciones (69,2%) y 4 reactivaciones (30,8%). El diagnóstico se confirmó mediante aislamiento microbiológico (baciloscopia y/o cultivo) en 11 casos (84,6%). La afectación pulmonar fue la más frecuente (69,2%). Ocho pacientes (61,5%) presentaron formas extrapulmonares, de las que 6 (46%) fueron diseminadas. En el momento del diagnóstico, 9 pacientes (69,2%) recibían tratamiento con GC. Fallecieron 4 pacientes (30,8%). La afectación muscular fue más frecuente en el grupo casos (p < 0,05). Conclusiones. La TB en nuestra serie supuso una alta mortalidad (30,8%) en los enfermos con LES. Las formas extrapulmonares representaron el doble con respecto a la observada en la población general. Los pacientes que recibieron dosis mayores de GC fueron los que presentaron formas más graves de TB. Los datos son similares a los publicados en la mayoría de las series nacionales y extranjeras (AU)

Objectives. 1) To study tuberculosis (TB) infection in a cohort of patients with systemic lupus erythematosus (SLE) and to compare its frequency and characteristics with that of others series. 2) To look for differential characteristic among SLE patients with and without TB. 3) To investigate if there was any relationship between TB's most severe forms and higher doses of glucocorticoids (GC) or other immunosuppressants. Patients and Method Retrospective review of medical records of 789 SLE patients and description of the clinical characteristics of 13 cases of active TB infection among them. Bibliographical search in MEDLINE-PubMed of the SLE/TB series published, using the terms: infection, tuberculosis, systemic lupus erythematosus. Comparative study of clinical, biological and therapeutic differences between cases (SLE/TB+) and controls (SLE/TB) using X2 and Fisher exact test. Results. Thirteen patients with active tuberculosis were detected (10 women, average age 36 years/SD 11,2/prevalence 1,6%). Nine (69,2%) of them were primary infections and 4 (30,8%) reactivations. Microbiological diagnosis (smear examination for acid-fast bacilli and/or culture on Lowestein-Jensen medium) was established in 11 patients (84,6%). TB Pulmonary manifestations was present in 9 patients (69,2%) and extra-pulmonary manifestations were found in 8 [(61,5%); 6 of them (46%) were disseminated forms]. Nine (69,2%) patients were on GC therapy at the moment TB was diagnosed. Four of the TB patients died (30,8%). Myositis was more frequent in TB cases (p < 0,05). This data is similar to that reported in the literature. Conclusions. In our series, TB mortality was high (30,8%) in a patients with SLE. Frequency of extrapulmonary forms was double than that described in the Spanish population. Patients with higher GC dose had more severe forms of TB (AU)

Coexistencia de anticuerpos antitopoisomerasa I y anticentrómero en la esclerodermia / Coexistence of antitopoisomerase I and anticentromere antibodies in systemic sderosis

No disponible

No disponible

[Tuberculosis in a cohort of patients with systemic lupus erythematosus]. / Tuberculosis en una cohorte de pacientes con lupus eritematoso sistémico.

OBJECTIVES: 1) To study tuberculosis (TB) infection in a cohort of patients with systemic lupus erythematosus (SLE) and to compare its frequency and characteristics with that of others series. 2) To look for differential characteristic among SLE patients with and without TB. 3) To investigate if there was any relationship between TB's most severe forms and higher doses of glucocorticoids (GC) or other immunosuppressants. PATIENTS AND METHOD: Retrospective review of medical records of 789 SLE patients and description of the clinical characteristics of 13 cases of active TB infection among them. Bibliographical search in MEDLINE-PubMed of the SLE/TB series published, using the terms: infection, tuberculosis, systemic lupus erythematosus. Comparative study of clinical, biological and therapeutic differences between cases (SLE/TB+) and controls (SLE/TB) using χ(2) and Fisher exact test. RESULTS: Thirteen patients with active tuberculosis were detected (10 women, average age 36 years/SD 11,2/prevalence 1,6%). Nine (69,2%) of them were primary infections and 4 (30,8%) reactivations. Microbiological diagnosis (smear examination for acid-fast bacilli and/or culture on Lowestein-Jensen medium) was established in 11 patients (84,6%). TB Pulmonary manifestations was present in 9 patients (69,2%) and extra-pulmonary manifestations were found in 8 [(61,5%); 6 of them (46%) were disseminated forms]. Nine (69,2%) patients were on GC therapy at the moment TB was diagnosed. Four of the TB patients died (30,8%). Myositis was more frequent in TB cases (p < 0,05). This data is similar to that reported in the literature. CONCLUSIONS: In our series, TB mortality was high (30,8%) in a patients with SLE. Frequency of extrapulmonary forms was double than that described in the Spanish population. Patients with higher GC dose had more severe forms of TB.

Eficacia de rituximab combinado con ciclofosfamida en una paciente con lupus eritematoso sistémico y vasculitis peritoneal resistente a tratamiento inmunosupresor convencional / Efficacy of rituximab combined with cyclophosphamide in a patient with systemic lupus erythematosus and peritoneal vasculitis refractory to conventional inmunosupressive therapy

La vasculitis peritoneal es una manifestación clínica infrecuente y grave del lupus eritematoso sistémico. Se presenta el caso de una paciente con ascitis por vasculitis peritoneal y afección cutánea, articular, hemática y renal. El tratamiento con glucocorticoides e inmunosupresores resultó ineficaz para el control de la ascitis. Dada la resistencia al tratamiento convencional, se administró rituximab en cuatro infusiones semanales de 375mg/m2, potenciado con pulsos de ciclofosfamida las semanas 1 y 3. Con esta estrategia se consiguió una respuesta completa, que se repitió en brotes posteriores (el segundo y el tercero, multisistémicos y de nuevo con ascitis significativa, y el cuarto con nefritis) (AU)

Peritoneal vasculitis is a rare and severe clinical manifestation of systemic lupus erythematosus. We report a patient who presented with ascites due to peritoneal vasculitis and cutaneous, articular, hematological and renal inflammatory activity. Treatment with glucocorticoids and immunosuppressive drugs was ineffective. In view of the resistance to different therapies, 4 weekly infusions of 375mg/m2 of rituximab (RTX) were started, in association with cyclophosphamide pulses during the first and the third weeks. With this treatment strategy, the patient reached a complete response which was achieved in later flares of inflammatory activity (the second and third flares were multisystemic and with ascites again, and the fourth flare with nephritis) (AU)

[Efficacy of rituximab combined with cyclophosphamide in a patient with systemic lupus erythematosus and peritoneal vasculitis refractory to conventional inmunosupressive therapy]. / Eficacia de rituximab combinado con ciclofosfamida en una paciente con lupus eritematoso sistémico y vasculitis peritoneal resistente a tratamiento inmunosupresor convencional.

Peritoneal vasculitis is a rare and severe clinical manifestation of systemic lupus erythematosus. We report a patient who presented with ascites due to peritoneal vasculitis and cutaneous, articular, hematological and renal inflammatory activity. Treatment with glucocorticoids and immunosuppressive drugs was ineffective. In view of the resistance to different therapies, 4 weekly infusions of 375mg/m2 of rituximab (RTX) were started, in association with cyclophosphamide pulses during the first and the third weeks. With this treatment strategy, the patient reached a complete response which was achieved in later flares of inflammatory activity (the second and third flares were multisystemic and with ascites again, and the fourth flare with nephritis).

[Experience with imatinib to treat pulmonary arterial hypertension]. / Experiencia en el tratamiento de la hipertensión arterial pulmonar con imatinib.

Despite advances in the treatment of patients with pulmonary arterial hypertension (PAH), survival has not improved greatly (is still very affected). Imatinib, an antagonist of platelet-derived growth factor with antiproliferative activity, has been effective in experimental models and clinically in several published reports. We report the results of imatinib therapy in 4 patients with PAH (functional class IV) who were refractory to treatment with drug combinations for this condition. The final outcome was favorable in only 1 of the 4 cases. In this case, the patient was in functional class III and his hemodynamic parameters had improved significantly within 5 months after starting therapy. However, the patient died as a result of severe toxic hepatitis in which imatinib may have played a role. The present report adds to the few already in the literature (4 cases) and suggests that care should continue to be shown when using imatinib to treat PAH.

Experiencia en el tratamiento de la hipertensión arterial pulmonar con imatinib / Experience with imatinib to treat pulmonary arterial hypertension

A pesar de los avances en el tratamiento de los pacientescon hipertensión arterial pulmonar (HAP), su supervivenciasigue estando muy afectada. El imatinib, un antagonista delfactor de crecimiento derivado de las plaquetas con acciónantiproliferativa, ha sido eficaz en modelos experimentales yen algunos casos comunicados. Se describe el resultado deltratamiento con imatinib en 4 pacientes con HAP en clasefuncional IV y refractarios al tratamiento con asociacionesde medicamentos para la HAP. La respuesta final fue favorablesólo en uno de los 4 casos, que 5 meses después de iniciadoel tratamiento estaba en clase funcional III y con mejoríasignificativa de los parámetros hemodinámicos. Sinembargo, el paciente falleció por hepatitis tóxica grave en laque el imatinib pudo haber participado. Estos resultados seañaden a la escasa experiencia clínica comunicada (sólootros 4 casos) e indican que debemos mantener la cautela sobrela utilidad del imatinib en el tratamiento de la HAP

Despite advances in the treatment of patients withpulmonary arterial hypertension (PAH), survival has notimproved greatly (is still very affected). Imatinib, an antagonistof platelet-derived growth factor with antiproliferative activity,has been effective in experimental models and clinically inseveral published reports. We report the results of imatinibtherapy in 4 patients with PAH (functional class IV) whowere refractory to treatment with drug combinations for thiscondition. The final outcome was favorable in only 1 of the4 cases. In this case, the patient was in functional class III andhis hemodynamic parameters had improved significantlywithin 5 months after starting therapy. However, the patientdied as a result of severe toxic hepatitis in which imatinib mayhave played a role. The present report adds to the few alreadyin the literature (4 cases) and suggests that care shouldcontinue to be shown when using imatinib to treat PAH

[Rituximab for treatment of patients with systemic autoimmune diseases]. / Utilidad del rituximab en el tratamiento de pacientes con enfermedades sistémicas autoinmunitarias.

BACKGROUND AND OBJECTIVE: To assess the value of rituximab in systemic autoimmune diseases which are refractory to others treatments. PATIENTS AND METHOD: Prospective study on 12 patients -7 with systemic lupus erythematosus (SLE), 4 with Wegener's granulomatosis (WG), and 1 with overlapping connective disease and autoimmune thrombocytopenia-, controlled in a specialized unit of a tertiary hospital. Four weekly doses of rituximab, 2 biweekly doses of cyclophosphamide, and glucocorticoids were administered to all patients, and other immunosuppressants were also administered as considered necessary in each case. RESULTS: Mean follow up after treatment with rituximab was 12.8 moths for SLE patients and 12.3 for WG patients. In SLE patients, proteinuria was reduced below 1 g daily in 5 cases (83%), with a clear parallel improvement in the urinary sediment. Serositis was resolved in both cases. One patient required 3 treatment cycles to obtain an adequate response and another required a second cycle for relapse. Only one patient with WG had a favorable response. The patient treated for autoimmune thrombocytopenia had a favorable response, with no relapses, and creatine-kinase levels also tended to return to normal. There were 2 serious adverse events (terminal renal failure and serious colitis in a patient with SLE, and death of one patient with WG), that were not adjudicated directly to rituximab. Immunoglobulin levels did not change substantially. There were no infusion reactions or associated infections. CONCLUSIONS: Rituximab was useful in patients with SLE refractory to other immunosuppressants. On the contrary, its efficacy in WG was limited. The response of thrombocytopenia was complete and maintained.

Mielitis transversa en lupus eritematoso sistémico / Transverse myelitis in systemic lupus erythematosus

Objetivo: La mielitis transversa aguda (MTA) es una rara complicación en los pacientes con lupus eritematoso sistémico (LES). Revisamos nuestra serie de pacientes con LES para determinar la prevalencia de MTA y analizar las características clínicas, las pruebas complementarias, la evolución y la respuesta al tratamiento. Pacientes y método: Se identificó a 6 pacientes con MTA que se sometieron a valoración clínico-neurológica, resonancia magnética y estudio electrofisiológico y recibieron el mismo tratamiento. Realizamos un estudio estadístico descriptivo. Resultados: Observamos una prevalencia de MTA del 0,92% de nuestros pacientes con LES. El 83,3% presentaba anticuerpos antifosfolipídicos y/o anticoagulante lúpico. La resonancia magnética confirmó el diagnóstico en 5 de los 6 casos; 3 de los 5 pacientes con anticuerpos antifosfolipídicos fueron anticoagulados o antiagregados, con buena evolución neurológica; 2 de ellos han quedado sin secuelas. Conclusiones: Encontramos una prevalencia similar a la observada en otras series, en torno al 1%. La alta prevalencia de anticuerpos antifosfolipídicos en los pacientes, con buen resultado en los antiagregados o anticoagulados, indica un importante papel patogénico en el desarrollo de la MTA, y nos hace plantearnos la importancia de añadir al tratamiento estándar terapia antiagregante o anticoagulante (AU)

Objective: Transverse myelitis (TM) is a rare complication in patients with systemic lupus erithematosus (SLE). We reviewed a series of our SLE patients to determine the prevalence of TM, and evaluate the clinical characteristics, medical tests, evolution and response to the treatment. Patients and method: Six patients with TM were identified and underwent a neurological evaluation, MRI, electrophysiologic study and were all subjected to the same treatment. A descriptive statistical study was conducted. Results: We observed a prevalence of 0.92% in our patients with SLE. Eighty three point three per cert had antiphospholipid antibodies and/or lupus anticoagulant. The MRI confirmed the diagnosis in 5 cases. Of the 5 patients with antiphospholypid antibodies, 3 were anticoagulated or took aspirin with a good neurological outcome, leaving 2 of them without posterior complications. Conclusions: We found a prevalence similar to that observed in other series, around 1%. The high prevalence of antiphospholypid antibodies in these patients, with good outcome in those anticoagulated or treated with antiplatelet agents suggests an important pathogenic role in the development of TM, and emphasized the possibility of adding to the standard treatment, antiplatelet agents or anticoagulation (AU)

Utilización de fármacos contra el factor de necrosis tumoral en una paciente con afección neurológica por enfermedad de Behçet / No disponible

No disponible

Utilidad del rituximab en el tratamiento de pacientes con enfermedades sistémicas autoinmunitarias / Rituximab for treatment of patients with systemic autoimmune diseases

Fundamento y objetivo: Evaluar la utilidad del rituximab en el tratamiento de enfermedades autoinmunitarias sistémicas refractarias a otros tratamientos. Pacientes y método: Se ha realizado un estudio prospectivo de 12 pacientes: 7 con lupus eritematoso sistémico (LES), 4 con granulomatosis de Wegener (GW) y 1 con conectivopatía de superposición y trombocitopenia autoinmunitaria. Se administraron 4 dosis semanales de rituximab y 2 quincenales de ciclofosfamida, además de glucocorticoides y otros inmunodepresores según se estimó necesario en cada caso. Resultados: El tiempo de seguimiento medio tras finalizar el tratamiento con rituximab fue de 12,8 meses para los pacientes con LES y de 12,3 para los pacientes con GW. Entre los casos de LES, la proteinuria se redujo por debajo de 1 g al día en 5 pacientes (83%), con mejoría paralela evidente en el sedimento urinario. La serositis se resolvió en los 2 casos. Un paciente requirió 3 ciclos de tratamiento antes de obtener una respuesta adecuada y otro requirió un segundo ciclo por recaída. Sólo un paciente con GW tuvo una respuesta favorable. El paciente tratado por trombocitopenia autoinmunitaria tuvo una respuesta favorable, sin recurrencias, y además sus valores de creatincinasa tendieron a normalizarse. Hubo 2 acontecimientos adversos graves (insuficiencia renal terminal y colitis grave en una paciente con LES, y fallecimiento de un paciente con GW), que no se atribuyeron directamente al rituximab. Los valores de inmunoglobulinas no se modificaron sustancialmente. No hubo reacciones infusionales ni infecciones asociadas. Conclusiones: El rituximab resultó útil en pacientes con LES resistente a otros inmunodepresores. Por el contrario, su eficacia en la GW resultó limitada. La respuesta de la trombocitopenia fue completa y mantenida

Background and objective: To assess the value of rituximab in systemic autoimmune diseases which are refractory to others treatments. Patients and method: Prospective study on 12 patients ­7 with systemic lupus erythematosus (SLE), 4 with Wegener's granulomatosis (WG), and 1 with overlapping connective disease and autoimmune thrombocytopenia­, controlled in a specialized unit of a tertiary hospital. Four weekly doses of rituximab, 2 biweekly doses of cyclophosphamide, and glucocorticoids were administered to all patients, and other immunosuppressants were also administered as considered necessary in each case. Results: Mean follow up after treatment with rituximab was 12.8 moths for SLE patients and 12.3 for WG patients. In SLE patients, proteinuria was reduced below 1 g daily in 5 cases (83%), with a clear parallel improvement in the urinary sediment. Serositis was resolved in both cases. One patient required 3 treatment cycles to obtain an adequate response and another required a second cycle for relapse. Only one patient with WG had a favorable response. The patient treated for autoimmune thrombocytopenia had a favorable response, with no relapses, and creatine-kinase levels also tended to return to normal. There were 2 serious adverse events (terminal renal failure and serious colitis in a patient with SLE, and death of one patient with WG), that were not adjudicated directly to rituximab. Immunoglobulin levels did not change substantially. There were no infusion reactions or associated infections. Conclusions: Rituximab was useful in patients with SLE refractory to other immunosuppressants. On the contrary, its efficacy in WG was limited. The response of thrombocytopenia was complete and maintained

[Transverse myelitis in systemic lupus erythematosus]. / Mielitis transversa en lupus eritematoso sistémico.

OBJECTIVE: Transverse myelitis (TM) is a rare complication in patients with systemic lupus erithematosus (SLE). We reviewed a series of our SLE patients to determine the prevalence of TM, and evaluate the clinical characteristics, medical tests, evolution and response to the treatment. PATIENTS AND METHOD: Six patients with TM were identified and underwent a neurological evaluation, MRI, electrophysiologic study and were all subjected to the same treatment. A descriptive statistical study was conducted. RESULTS: We observed a prevalence of 0.92% in our patients with SLE. Eighty three point three per cert had antiphospholipid antibodies and/or lupus anticoagulant. The MRI confirmed the diagnosis in 5 cases. Of the 5 patients with antiphospholypid antibodies, 3 were anticoagulated or took aspirin with a good neurological outcome, leaving 2 of them without posterior complications. CONCLUSIONS: We found a prevalence similar to that observed in other series, around 1%. The high prevalence of antiphospholypid antibodies in these patients, with good outcome in those anticoagulated or treated with antiplatelet agents suggests an important pathogenic role in the development of TM, and emphasized the possibility of adding to the standard treatment, antiplatelet agents or anticoagulation.

Bloqueo auriculoventricular completo en pacientes adultos con lupus eritematoso sistémico. Casuística propia y revisión de la bibliografía / Complete auriculoventricular blockage in adult patients with systemic lupus erythematosus. Case series and a review of the literature

Fundamento y objetivo: El bloqueo auriculoventricular completo (BAVC) congénito se debe, en la mayoría de los pacientes, a lesión del sistema de conducción por anticuerpos trasplacentarios de origen materno (lupus neonatal). En el adulto con lupus eritematoso sistémico (LES) es muy dudosa la cardiotoxicidad por dichos anticuerpos y se ha relacionado con el tratamiento con antipalúdicos de síntesis (APS). Se valora, en nuestro medio, la presencia de BAVC (no congénito) en pacientes adultos con LES y su posible asociación con el tratamiento con APS. Pacientes y métodos: Se ha estudiado la frecuencia de BAVC en una serie de 595 pacientes afectados de LES controlados en una unidad de enfermedades sistémicas. Resultados: Cinco mujeres (0,8% del total) presentaron un BAVC (desarrollado en una crisis lúpica en 2 pacientes). Todas estaban en tratamiento con APS (el 100 frente al 60% en el resto de la serie) y mantuvieron una dosis de 250 mg/día (excepto una, con dosis de 500 mg/día) por un tiempo medio de 90 meses. La dosis media acumulada de APS fue de 753 g. Tres pacientes desarrollaron insuficiencia cardíaca; 2, nefropatía; 2, miopatía; y una, maculopatía. Como procesos acompañantes se constató síndrome de Sjögren (2) e hipotiroidismo (3). La frecuencia de HLA DR3, 80% de los casos, es superior a la observada en la serie total, 34% (p = 0,053). Conclusiones: Constatamos la presencia de BAVC en el 0,8% de pacientes con LES. Todos ellos en tratamiento con APS. No hemos comprobado relación con anticuerpos anti-ENA (anti-Ro y anti-RNP) comunicada en algunos casos, pero sí una tendencia a la asociación con HLA DR3 (en el límite de significación estadística)(AU)

Background and objective: Congenital complete atrioventricular heart block (CHB) is due to the lesion of the cardiac conduction system by specific transplacental antibodies of maternal origin. In adults with systemic lupus erythematosus (SLE), cardiac toxicity is very questionable and has been related to treatment with synthetic antimalarial drugs (AM). Here we evaluate, in our geographic area, the presence of non congenital CHB in adult patients with SLE and its possible association with AM treatment. Patients and methods: The frequency of CHB has been studied revising the clinical records of 595 SLE patients followed at the Unit for Systemic Diseases. Results: Five women (0.8% of the total series) suffered from CHB (2 patients developed it during a lupic crisis). All were on treatment with AM (100 versus 60% of the rest of the series) and maintained a dose of 250 mg/day (except one, with a dose of 500 mg/day) for a mean period of 90 months. The accumulated mean dose of AM was 753 g. Three patients developed cardiac insufficiency; 2 nephropathy; 2 myopathy; and one maculopathy. As accompanying processes we detected Sjögren’s syndrome (2) and hypothyroidism (3). The frequency of HLA DR3, positive in 80% of the cases, is higher than observed in the total series, 34% (p = 0.053). Conclusions: We detected the presence of CHB in 0.8% of SLE patients. They were all treated with AM. We did not verify any relationship with anti-ENA (anti-Ro/La and anti-RNP) antibodies, as communicated by others, but rather a trend to the association with HLA DR3 (at the limit of statistical significance)(AU)

[Complete auriculoventricular blockage in adult patients with systemic lupus erythematosus. Case series and a review of the literature]. / Bloqueo auriculoventricular completo en pacientes adultos con lupus eritematoso sistémico. Casuística propia y revisión de la bibliografía.

BACKGROUND AND OBJECTIVE: Congenital complete atrioventricular heart block (CHB) is due to the lesion of the cardiac conduction system by specific transplacental antibodies of maternal origin. In adults with systemic lupus erythematosus (SLE), cardiac toxicity is very questionable and has been related to treatment with synthetic antimalarial drugs (AM). Here we evaluate, in our geographic area, the presence of non congenital CHB in adult patients with SLE and its possible association with AM treatment. PATIENTS AND METHODS: The frequency of CHB has been studied revising the clinical records of 595 SLE patients followed at the Unit for Systemic Diseases. RESULTS: Five women (0.8% of the total series) suffered from CHB (2 patients developed it during a lupic crisis). All were on treatment with AM (100 versus 60% of the rest of the series) and maintained a dose of 250 mg/day (except one, with a dose of 500 mg/day) for a mean period of 90 months. The accumulated mean dose of AM was 753 g. Three patients developed cardiac insufficiency; 2 nephropathy; 2 myopathy; and one maculopathy. As accompanying processes we detected Sjögren's syndrome (2) and hypothyroidism (3). The frequency of HLA DR3, positive in 80% of the cases, is higher than observed in the total series, 34% (p = 0.053). CONCLUSIONS: We detected the presence of CHB in 0.8% of SLE patients. They were all treated with AM. We did not verify any relationship with anti-ENA (anti-Ro/La and anti-RNP) antibodies, as communicated by others, but rather a trend to the association with HLA DR3 (at the limit of statistical significance).