Pulmonary manifestations of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease that primarily affects young women. The respiratory system is more commonly involved in SLE than in any other collagen vascular disease. SLE may affect virtually all components of the respiratory system, including the upper airway, lung parenchyma, pulmonary vasculature, pleura, and respiratory muscles. Respiratory system involvement ranges from symptomatic to fulminant and life threatening. This article reviews the pulmonary manifestations of SLE, including drug-induced SLE.     

Psychiatric manifestations of systemic lupus erythematosus

Low-intensive laser radiation used by topical, intravenous, and transendoscopic routes was employed in the complex antituberculosis therapy of 120 patients with pulmonary tuberculosis concurrent with chronic nonspecific respiratory diseases (n = 48), diabetes mellitus (n = 20 patients), gastrointestinal diseases (n = 45). The results of treatment were compared with the parameters of 62 patients with the similar clinical and X-ray characteristics of a tuberculosis process and concomitant diseases. It was ascertained that laser therapy might enhance the efficiency of treatment of patients with concurrent abnormality statistically significantly, by reducing the time of bacterial isolation, closure of decay cavities in the lung tissue, hospital treatment and by accelerating the onset of stable remission of concomitant diseases.     

Neurological presentation of systemic lupus erythematosus

We describe the case of a 61 years-old-woman with lupus erythematosus who presented with neurological symptoms, namely dementia, focality and crisis. The neurological presentation of lupus is evaluated clinically, being similar to the central manifestations of patients with systemic onset. The marked cognitive affectation with relation to other cases of lupus with a neurological onset is emphasized. MR has been shown to be a sensitive means of detection of corticosubcortical lesions of neurolupus, not specific to this condition, as well as to their response to immunosuppressors. The aetiopathogenesis of some of the manifestations of cerebral lupus and the clinical response to corticosteroids and cyclophosphamide is reviewed.     

Computed tomography of systemic lupus erythematosus

Computed tomographic (CT) findings in 14 patients with systemic lupus erythematosus are correlated with clinical symptomatology. Microinfarction (manifested by perisuical atrophy) large infarcts, and hematomas are the major abnormalities demonstrated by CT. The neuropathology of these changes is discussed.     

Simultaneous systemic lupus erythematosus and dermatitis herpetiformis

The binding in vitro of the sodium salts of cholic acid, chenodeoxycholic acid, deoxycholic acid, taurocholic acid, taurochenodeoxycholic acid, taurodeoxycholic acid, glycocholic acid, glycochenodeoxycholic acid, and glycodeoxycholic acid by alfalfa, bran, cellulose, lignin, and cholestyramine was measured. Cholestyramine bound an average of 81.3% of all the bile acids and salts tested whereas cellulose bound only negligible amounts (1.4%). Of the other substances tested, lignin bound 29.2%, alfalfa, 15.9% and bran, 9.0%. No distinct pattern of binding was discerned. It is therefore apparent that the validity of statements concerning the effect of fiber on bile salf metabolism rests upon the specificity of the composition of the fiber involved and the bile acids or salts tested.     

C1q and systemic lupus erythematosus

In this chapter we review the association between SLE and C1q. In the first part of the chapter we discuss the clinical associations of C1q deficiency, and tabulate the available information in the literature relating to C1q deficiency and autoimmune disease. Other clinical associations of C1q deficiency are then considered, and we mention briefly the association between other genetically determined complement deficiencies and lupus. In the review we explore the relationship between C1q consumption and lupus and we discuss the occurrence of low molecular weight (7S) C1q in lupus, which raises the possibility that increased C1q turnover in the disease may result in unbalanced chain synthesis of the molecule. Anti-C1q antibodies are also strongly associated with severe SLE affecting the kidney, and with hypocomplementaemic urticarial vasculitis, and these associations are also examined. We address the question of how C1q deficiency may cause SLE, discussing the possibility that this may be due to abnormalities of immune complex processing, which have been well characterised in a umber of different human models. There is clear evidence that immune complex processing is abnormal in patients with hypocomplementaemia, and this is compatible with the hypothesis that ineffective immune complex clearance could cause tissue injury, and this may in turn stimulate an autoantibody response. We have also considered the possibility that C1q-C1q receptor interactions are critical in the regulation of apoptosis, and we explore the hypothesis that dysregulation of apoptosis could explain important features in the development of autoimmune disease associated with C1q deficiency. An abnormally high rate of apoptosis, or defective clearance of apoptotic cells, could promote the accumulation of abnormal cellular products that might drive an autoimmune response. Anti-C1q antibodies have been described in a number of murine models of lupus, and these are also briefly discussed. We focus on the recently developed C1q "knockout" mice, which have been developed in our laboratory. Amongst the C1q deficient mice of a mixed genetic background high titres of antinuclear antibodies were detected in approximately half the animals, and around 25% of the mice, aged eight months had evidence of a glomerulonephritis with immune deposits. Large numbers of apoptotic bodies were also present in diseased glomeruli, and this supports the hypothesis that C1q may have a critical role to play in the physiological clearance of apoptotic cells.     

Pulmonary involvement in systemic lupus erythematosus

BACKGROUND: We wanted to find out whether the borders of the blind spot depend on the surface topography of the optic disc and its surrounding area. PATIENTS AND METHODS: We therefore examined ten eyes with parapapillary atrophy adjacent to the temporal side of the disc. Fundus perimetry was performed under direct fundus control using a Rodenstock scanning laser ophthalmoscope. We examined the horizontal meridian of the optic discs in 0.5 degree steps using Goldmann IV-stimuli with 10 different degrees of brightness and the Goldmann stimulus 1, 0 dB (greatest luminance). Six eyes with symmetric, "normal" excavation served as controls. Optic disc topography was measured with the Heidelberg Retina Tomograph (HRT). RESULTS: Stimuli with a large luminance power (Goldmann IV, 4 dB) were seen up to 0.8 degree centrally (i.e., towards the optic disc center) from the temporal edge of the parapapillary atrophy, but up to 1.9 degrees centrally from the nasal optic disc border (P < 0.01). Horizontal HRT section profiles of the optic disc consistently showed prominent nasal disc borders contrasting with a shallow excavation within the temporal parapapillary atrophy. In all six subjects with a normally shaped disc there was no such "nasotemporal asymmetry." CONCLUSIONS: The size of scotomas depends on the surface topography of the tested area. The prominent nasal part of the optic disc appears less "blind" than the shallow temporal part, probably due to more intensive light scattering by the prominent nasal part of the disc.     

Defective phagocytosis in systemic lupus erythematosus

The authors describe a case of traumatic retinal dialysis with retinal detachment from a water balloon slingshot during a "water balloon war." A 31-year-old woman presented with decreased visual acuity in her right eye 2 days after being hit by a water balloon. The visual acuity in the right eye was counting fingers and fundus examination showed subtotal retinal detachment secondary to a superonasal dialysis. The patient underwent a scleral buckling procedure with external drainage, and at 18 months visual acuity was stable at 20/50 with attached retina. Water balloon eye injuries can result in permanent visual loss. More public awareness needs to be created regarding the potential harmful effects of this commonly used "toy."     

Body composition in systemic lupus erythematosus

Bovine enamel is commonly used in enamel bonding studies, therefore, a familiarity with some aspects of bovine enamel bonding are important in order to evaluate the studies. Bovine enamel has the advantages of easy attainability and similar microstructure to human enamel. In this study the strength of the enamel bond using an orthodontic adhesive was compared between deciduous bovine, permanent bovine, and human enamel, as well as, the effect on bond strength of multiple rebonding to bovine enamel. This study found that the bond strength to bovine enamel was 21% to 44% weaker than to human enamel, and the bond strength to deciduous bovine enamel was significantly greater than to permanent bovine enamel. Either all deciduous or all permanent bovine incisors should be used, or permanent and deciduous bovine incisors evenly distributed in sample groups. Bovine enamel was rebonded five times without significantly affecting bond strength, thus, bovine enamel can be reused in bonding studies without significantly affecting the results.