Lymphocyte subset T4/T8 ratio in systemic lupus erythematosus: correlation with disease activity, laboratory abnormalities and treatment.

Lymphocyte subsets were studied in forty-nine patients with SLE using monoclonal antibodies and flow cytometry. A decrease in T4+ reactive cells (helper/inducer) was the most frequent observation. Decreased T4/T8 ratios were seen in patients with increasing clinically active disease, patients with positive anti-DS-DNA, positive anti-RNP antibodies and patients with low CH50 activity. However, low T4/T8 ratios were seen in patients with negative anti-Sm. Low T4/T8 ratios were also observed in patients taking prednisone at more than 10 mg/day and in patients treated with immunosuppressive drugs.

Cause of death in systemic lupus erythematosus: a pattern based on age at onset.

We reviewed the causes of death in 50 patients treated for systemic lupus erythematosus at the University of Mississippi Medical Center between 1973 and 1985. Two groups of patients could be distinguished based on the age at onset but not on the duration of disease. Younger patients more often died of active renal disease an infectious complications, while older patients died of other organ involvement, inactive renal disease, and miscellaneous causes. Common causes of infection were gram-positive cocci and gram-negative bacilli. Atherosclerotic cardiovascular disease was an infrequent cause of death, and no patients died of malignancy. Patients who died had more multisystemic involvement, with serositis and renal, central nervous system, and hematologic manifestations than patients who were alive at last follow-up.

Lupus nephritis: efficacy of monthly pulse therapy with intravenous methylprednisolone.

Fourteen patients with severe systemic lupus erythematosus and nephritis were treated with high-dose intravenous methylprednisolone (IVMP) pulse therapy. Six patients (group 1) received one or two courses of 1 gm of IVMP when they were acutely ill with rapidly progressive renal failure or with multisystemic disease. All patients had a poor outcome; three died and three had end-stage renal disease. Eight patients (group 2) were treated with repeated pulses of 1 gm of IVMP for four to 21 months. Six of the eight patients had a favorable outcome, with four in complete remission and two in partial remission. One of the eight patients had partial response with stable renal disease at 16 months after pulse therapy. Only one patient had no response, with gradual worsening of renal function. All patients in both groups had rapid improvement of levels of anti-DNA and CH50 after pulse therapy was started. Patients in group 2 were compared to 21 randomized patients (group 3) with comparable severity of disease. Renal function deteriorated in group 3, with a mean duration of disease of 82.5 +/- 56.4 months. Renal function improved in group 2, with a mean duration of disease of 87.8 +/- 46.8 months. We conclude that repeated monthly pulse therapy with IVMP in severe SLE was effective and that major side effects can be avoided with proper timing of pulsing.