T cell subsets and immunoglobulin G levels are associated with the infection status of systemic lupus erythematosus patients

Systemic lupus erythematosus (SLE) is a chronic, autoimmune disorder that affects nearly all organs and tissues. As knowledge about the mechanism of SLE has increased, some immunosuppressive agents have become routinely used in clinical care, and infections have become one of the direct causes of mortality in SLE patients. To identify the risk factors indicative of infection in SLE patients, a case control study of our hospital's medical records between 2011 and 2013 was performed. We reviewed the records of 117 SLE patients with infection and 61 SLE patients without infection. Changes in the levels of T cell subsets, immunoglobulin G (IgG), complement C3, complement C4, globulin, and anti-double-stranded DNA (anti-ds-DNA) were detected. CD4+ and CD4+/CD8+ T cell levels were significantly lower and CD8+ T cell levels were significantly greater in SLE patients with infection than in SLE patients without infection. Additionally, the concentrations of IgG in SLE patients with infection were significantly lower than those in SLE patients without infection. However, complement C3, complement C4, globulin, and anti-ds-DNA levels were not significantly different in SLE patients with and without infection. Therefore, clinical testing for T cell subsets and IgG is potentially useful for identifying the presence of infection in SLE patients and for distinguishing a lupus flare from an acute infection.

Systemic lupus erythematosus and pregnancy: clinical evolution, maternal and perinatal outcomes and placental findings

CONTEXT AND OBJECTIVE: Systemic lupus erythematosus is a chronic disease that is more frequent in women of reproductive age. The relationship between lupus and pregnancy is problematic: maternal and fetal outcomes are worse than in the general population, and the management of flare-ups is difficult during this period. The aim here was to compare the outcomes of 76 pregnancies in 67 women with lupus, according to the occurrence or absence of flare-ups. DESIGN AND SETTING: An observational cohort clinical study evaluating the evolution of pregnant women with lupus who were receiving care at the prenatal outpatient clinic, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas (CAISM/Unicamp), between 1995 and 2002. METHODS: Data were collected on a precoded form. The women were divided into two groups according to the occurrence or absence of flare-ups, as defined by the systemic lupus erythematosus disease activity index (SLEDAI). The presence or absence of flare-ups and renal involvement was considered to be the independent variable and the other results were dependent variables. RESULTS: Flare-ups occurred in 85.3 percent of cases, and were most significant when there was renal involvement. This was related to greater numbers of women with preeclampsia and poor perinatal outcome. Intrauterine growth restriction was more common in the women with active disease. Placental weight was significantly lower in the women with renal involvement. CONCLUSIONS: Flare-ups and renal involvement in lupus patients during pregnancy are associated with increased maternal and perinatal complications.

CONTEXTO E OBJETIVO: O lúpus eritematoso sistêmico é uma doença crônica que acomete preferencialmente mulheres em idade reprodutiva. A associação entre lúpus e gravidez é problemática e os resultados maternos e perinatais são piores que na população geral. O objetivo foi determinar os resultados de 76 gestações de 67 mulheres lúpicas segundo a atividade da doença. TIPO DE ESTUDO E LOCAL: Estudo clínico descritivo avaliando a evolução de gestantes lúpicas seguidas no Ambulatório de Pré-Natal Especializado do Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas (CAISM/Unicamp), no período de 1995 a 2002. MÉTODOS: Os dados foram coletados a partir de uma ficha pré-codificada. As mulheres foram divididas em dois grupos segundo atividade do lúpus eritematoso sistêmico (LES) na gestação, conforme o índice de atividade de doença lúpica SLEDAI (Systemic Lupus Erythematosus Disease Activity Index). A presença ou não de atividade de doença e de envolvimento renal foram consideradas variáveis independentes e os demais resultados as variáveis dependentes. RESULTADOS: A doença em atividade durante a gestação ocorreu em 85,3 por cento dos casos, sendo o acometimento renal o mais importante, relacionando-se a um maior número de mulheres que tiveram pré-eclâmpsia e pior evolução perinatal. Restrição do crescimento intra-uterino foi mais freqüente nas mulheres com doença ativa. O peso da placenta também foi significativamente menor nas mulheres com envolvimento renal. CONCLUSÕES: A atividade da doença e o envolvimento renal do LES na gestação associam-se com o aumento de complicações maternas e perinatais.

Presencia de anticoagulante tipo lupus, en lupus eritematoso sistémico y otras entidades clínicas / Presence of lupus anticoagulant in systemic lupus erythematosus and other clinical entities

La incidencia del anticoagulante lúpico (AL), se estudia en 51 pacientes con diagnóstico de Lupus Eritomatoso Sistémico (LES), 15 con Púrpura Trombocitopénica Autoinmune (PTA), y tres con tiempo tromboplastina parcial alargado (TTP), dos de ellas con antecedentes de accidente cerebrovascular y la otra con diagnóstico de hemoglobinuria paroxística nocturna. En cada paciente se investigó el anticoagulante lúpico (AL), mediante el tiempo de recalcificación del plasma y el tiempo de recalcificación del plasma y el tiempo de coagulación con el veneno de Russell (TCVR). Ocho casos (15.6%) con LES y 6 casos (40%) con PTA, mostraron la presencia de AL. También fueron positivos los tres casos con TTP alargado. Con la excepción de dos casos con, todos los pacientes recibían terapia esteroidea. Los 8 casos con LES y Al tenían alargado el TTP y el tiempo de Protrombina (TP), 3 de los pacientes con PTA y AL tenían el TP alargado y los otros 3 tenían alargadas ambas pruebas. Todos los pacientes con AL eran del sexo femenino y de edades comprendidas entre 19 y 59 años. De los casos de LES con AL, en uno había antecedentes de trombosis y en 5 de muerte fetal recurrente. Solo las pacientes con TPA presentaron manifestaciones hemorrágicas y una de ellas sufrió un accidente cerebrovascular agudo. La manifestación clínica más frecuente en todos los pacientes con AL, fué la trombocitopenia, seguida de muerte fetal recurrente. Se estima que la terapia inmunosupresora, haya incidido disminuyendo la frecuencia del anticoagulante lúpico en los pacientes con LES y con PTA crónica