Pregnancy and disease outcome in patients with systemic lupus erythematosus (SLE): a study at Srinagarind Hospital.

BACKGROUND: Systemic lupus erythematosus (SLE) is a multi-system involvement autoimmune disease that commonly occurs in childbearing age women. During pregnancy and postpartum period, disease activity may be severe or unchanged. Disease flare during pregnancy consistently affects pregnancy outcome. OBJECTIVE: To study pregnancy outcomes and predictive factor for disease flare during pregnancy in SLE patients. MATERIAL AND METHOD: Retrospective descriptive study was performed The study population was pregnant SLE patients who were treated between January 1997 and December 2006 at Department of Obstetrics-Gynecologic and Medicine, Srinagarind Hospital, Khon Kaen University, Thailand. RESULT: The medical records of37 pregnant SLE patients were reviewed Of these, 33 cases gave delivery at Srinagarind Hospital. Mean age was 27.3 +/- 3.26 years, and mean disease duration was 59.67 +/- 38.62 months. Mostly SLE was established before pregnancy; about 10% SLE were firstly recognized during pregnancy During pregnancy, the disease activity was defined active in about two third (25 cases) of the patients. In most cases (60%), disease activity was continued from the pre-pregnancy period. The most common manifestations during pregnancy were lupus nephritis, hemolytic anemia, cutaneous rash, and arthritis respectively. In 40% (10 patients), SLE was severely active but could be controlled with high doses of corticosteroid, two of these required immunosuppressant. Overall live-birth in SLE patients who delivered at Srinagarind Hospital was 72.7%. Among this group, premature labor and intrauterine growth retardation were more commonly found in the patients who had active SLE than who had disease remission throughout pregnancy period with ratio of 4:1 and 7:1 respectively. Pregnancy lost (27.3%) was due to abortion (6 cases) and dead fetus in utero (DFIU; 2 cases) Termination of pregnancy was performed in 10 patients. Indications were severe active lupus (6 cases), DFIU (2 cases), and premature rupture of membrane (1 case). Pregnancy outcome was the best in patients who had inactive disease throughout pregnancy (75%) and worse in groups of patients whose disease flared up (54.5%) or emerged (50%) during pregnancy. CONCLUSION: Even contraception was routinely advised in treating SLE patients, getting pregnant during active disease was eventually found. Lupus nephritis was the most common manifestation. Overall live-birth was 72.7%. Pregnancy lost was due to abortion and dead fetus in utero. Pregnancy outcome was worse in SLE patients who had disease flares up or emerging during pregnancy.

The best criteria to diagnose metabolic syndrome in hypertensive Thai patients.

The metabolic syndrome (MS) is commonly found in clinical practice. There are many criteria to diagnose MS. The authors did a cross-sectional study to study the difference among the WHO criteria, the National Cholesterol Educational Program (NCEP) Adult Treatment Panel (ATP III), and the International Diabetes Foundation (IDF) in hypertensive patients. Between July and September 2005, 100 patients (62 women) treated at the hypertension clinic, Srinagarind Hospital were included. The WHO, NCEP A TP III and IDF criteria gave the diagnosis of MS in 37, 33, 60 cases, respectively. The IDF criteria had the significantly highest yield among those three criteria (p < 0.0001). Body mass index (BMI) was the only significant correlated with the diagnosis of MS by the IDF criteria (p-value = 0.04). It also had moderately positive correlated with waist circumference, WC (p < 0.0001, Pearson Correlation 0.58). At the cut point of BMI 23 kg/m2, we suggested the appropriate WC cut-point for Thai hypertensive men and women was 82.5 cm (32.5") and 79.5 cm (31.3"), respectively.

D-dimer and pulmonary arterial hypertension in systemic sclerosis.

BACKGROUND: Micro-vascular thrombus is a common pathological finding in pulmonary artery hypertension. The association between plasma D-dimer, a marker of thrombus formation, and pulmonary artery hypertension (PAH) in patients with systemic sclerosis is unknown. OBJECTIVE: To assess the correlation of the level of plasma D-dimer and pulmonary artery pressure in patients with systemic sclerosis. MATERIAL AND METHOD: One hundred and twenty nine patients with systemic sclerosis between 19 and 75 years of age (mean, 48 +/- 11.3) entered the study. Plasma D-dimer was determined using immunoturbidimetric assay (D-dimer plus, Dade Behring Inc., Newark, USA). Pulmonary artery pressure was estimated by Doppler echocardiography. PAH was considered present if the Doppler echocardiography-estimated right ventricular systolic pressure (RVSP) exceeded 36 mmHg. RESULTS: Forty-seven patients (36.4%) had PAH according to Doppler echocardiography including 32 (68.1 %) mild (RVSP, 36-45 mmHg), nine (19.1%) moderate (RVSP, 46-55 mmHg), and six (12.8%) severe PAH (RVSP > or = 56 mmHg). No significant correlation was found between plasma D-dimer and RVSP (r = 0. 02, p = 0. 82). CONCLUSION: The present study demonstrated that the D-dimmer level is not associated with the level of pulmonary artery pressure in patients with systemic sclerosis, indicating that microvascular thrombosis may not play a significant role in the pathogenesis of PAH in patients with systemic sclerosis.

Reversible posterior leukoencephalopathy caused by azathioprine in systemic lupus erythematosus.

The authors report a case of systemic lupus erythematosus with posterior leukoencephalopathy who presented with headache, tonic-clonic seizure, loss of consciousness and bilateral loss of vision, after taking azathioprine for three weeks. The patient had hypertension with normal eye grounds. The brain CT showed a hypodensity lesion at both bilateral occipital lobes, mainly in the white matter The symptoms and follow-up MRI were improved after the control of hypertension and discontinuation of azathioprine.

Estimated volumetric bone mineral density in a rural Thai men and women: Khon Kaen Osteoporosis Study (KKOS).

The authors examined the areal bone mineral density (aFNBMD) and estimated volumetric bone mineral density at the femoral neck (vFNBMD) in rural Thai men and women. A total of 181 men and 255 women, between 20 and 84 years of age, living in rural areas of Khon Kaen province, were randomly selected. Areal FNBMD and estimated v FNBMD were determined using dual energy X-ray absorptiometry (DPX-IQ, GE Lunar Corp, Madison, WI). Men had a significantly higher aFNBMD than women, whereas the estimated vFNBMD was similar regardless of sex. The peak for the aFNBMD vs. vFNBMD was observed between 20 and 29 vs. 30 and 39 years of age in men and women, respectively. The prevalence of osteoporosis in men and women using estimated vFNBMD vs. aFNBMD cut-offs was 19 and 14.2 vs 11.8 and 26 percent, respectively. Prevalence increased with age. Estimated vFNBMD shows only small sex-correlated differences in bone density. Estimated vFNBMD was more sensitive than aFNBMD, when used to define the osteoporotic cut-offs in men, while it was less sensitive than aFNBMD in women.