[Correlation between histological findings, activity and choronicity indices and laboratory data in patients with lupus nephritis]

Renal involvement in systemic lupus erythematosus [SLE] is one of the most serious complications. Numerous reports have documented the unpredictable course of lupus nephritis and the role of renal biopsy in evaluation of individual patients. It is impossible to predict the types, severity and activity of renal lesions based only on combination of clinical and laboratory findings. The aim of this study was to evaluate the histological findings, activity and chronicity scores, and also assessing the correlation between histology and other laboratory findings in patients with lupus nephritis. This cross-sectional study was carried out on 40 patients with diagnosis of lupus nephritis at Ghaem Hospital in Mashhad during 2003 to 2006. Renal biopsy was performed for all patients and correlation between laboratory and serologic parameters and the histological findings were investigated. Data were analyzed using t-test, Chi square test, and Fischer exact test. Activity score was 9.02 in 34 patients with proteinuria and 6.33 in 6 patients without proteinuria [p=0.018]. There was a significant correlation between the activity score and serum C4 levels [p=0.031]. Also, a significant correlation was shown between fibrous crescent [one of the chronicity criteria on biopsy] and nephrotic syndrome [p=0.047]. No significant correlation between activity and chronicity scores and other laboratory and serologic findings was found. Based on our data, no exact correlation between histological findings and laboratory data in lupus nephritis was demonstrated; therefore, emphasis on important role of renal biopsy in evaluation of these patients is suggested

Sydenham's chorea

Sydenham's chorea is a delayed complication of group AB haemolytic streptococcal infections and forms one of the major criteria of acute rheumatic fever. It is characterised by chorea, muscular weakness, and a number of neuropsychiatric symptoms. It is considered to be an autoantibody mediated disorder with the evidence suggesting that patients with Sydenham's chorea produce antibodies that cross react with streptococcal, caudate, and subthalamic nuclei. However, documented evidence of previous streptococcal infection is found in only 20%-30% of cases. It has a good prognosis for full recovery so treatment is not warranted in most cases. Following case is a high school student presented with progressive changes in his handwriting during two months before. Chief complaint of this 15-year-old boy was difficulty in writing at classroom. His physics notebook has been shown as interesting figures

Combination therapy with pulse cyclophosphamide plus corticosteroids improves renal outcome in patients with lupus nephritis

The prognosis of SLE is influenced by the onset of glomerulonephritis. Clinical trials in lupus nephritis have demonstrated that cyclophosphamide therapy is the superior regimen in the management of lupus nephritis for preserving renal function. The purpose of this study is to define the outcome of renal function with bolus pulses of cyclophosphamide and steroid according to our protocol and also to determine an appropriate pattern of treatment of lupus nephritis. In this open-label clinical trial, to evaluate the results, the short-term prognosis and the rate of complications of an immunosuppressive regimen with corticosteroids and cyclophosphamide; twenty-five patients with biopsy-proven lupus nephritis were studied. Treatment was structured in 4 phases: 1] Induction with bolus methylprednisolone and cyclophosphamide. 2] Maintenance with oral prednisolone for 4 weeks and monthly cyclophosphamide pulses for 6 months. 3] Tapering with reduction of prednisolone by 10% each month and continuing cyclophosphamide every other month till one year and for the second year every 3 months. 4] Discontinuation with oral prednisolone slowly tapered to the least effective daily dose and cyclophosphamide discontinued after 2 yr of therapy. We defined primary outcome measures according to these criteria: renal function return to normal limits or become stable, regression of systemic and local inflammatory symptoms, urine protein excretion falling below 0.3 gr/ dL or by at least 50%, RBC cast disappearance, C3, C4, Hb, and ESR return to normal limits.Twenty-three patients with lupus nephritis completed our therapeutic protocol. Renal biopsy was performed in 22 cases and indicated type IV in 20 patients [95.2%], and type V in 2 patients. After an average of 4+1.95 months 22 patients achieved remission [95.65%] and only one case remained non-responsive. She became pregnant in her fourth month of therapy. Significant statistical differences were achieved between creatinine, proteinuria, hematuria, leukocyturia, urinary cast, C3, C4, ESR, and Hb before and after therapy [p<0.05]. Plasma creatinine fell from 1.44+0.95 mg/dL to 0.97+0.78 [p<0.004]. Proteinuria fell from 1879.78+1854.46 to 408.34+572.92 mg/24h [p<0.001]. Thirteen episode of relapses were treated again with repeated cycles of Cyclophosphamide and all remitted again.Intensive immunosuppression with steroid and Cyclophosphamide provides excellent results with an acceptable rate of complications in the treatment of lupus nephritis

Interferon alfa-2b therapy in mucocutaneous manifestations of Behcet's disease

Viral infections such as Epstein-Barr virus and Herpes simplex virus may play a role in the pathogenesis of Behcet's disease [BD]. Interferons [INF] are natural defense mechanisms against viruses and inhibit their activities by enhancing major histocompatibility complex class I and cytokine expression. This study evaluated the efficacy of INF-