Alveolar hemorrhage in systemic lupus erythematosus: an overview

Alveolar hemorrhage [AH] is a rare, but serious manifestation of SLE. It may occur early or late in disease evolution. Extrapulmonary disease may be minimal and may be masked in patients who are already receiving immunosuppressants for other symptoms of SLE. The capacity of AH to occur and recur despite ongoing immunosuppressive therapy is emphasized. Reporting our experience with alveolar hemorrhage in patients with systemic lupus erythematosus. Records of SLE patients admitted between years 2000 and 2008 were reviewed. Seven patients with SLE admitted with nine episodes of AH were found. For all study subjects, the pertinent demographic, clinical, laboratory, histologic, therapeutic and outcome data were abstracted and chest X-ray reviewed. The disease activity was assessed using SLEDAI. The seven patients were females. Their age ranged from 17 to 35 years and disease duration ranged from 4 to 48 months. AH occurred within 4 months of SLE onset in two patients. All patients presented with hemoptysis, new pulmonary infiltrates and hemoglobin drop. Glomerulonephritis was the most common extrapulmonary SLE manifestation [85%]. Initial treatment included IV methylprednisolone in all cases [100%], with cyclophosphamide in four episodes. Plasmapheresis [one session] was done in only one episode. Survival rate was 14%.Alveolar hemorrhage is a rare but lethal complication of SLE and represents a remarkable challenge. It should be diagnosed promptly with falling red cell indices and new infiltrates on chest radiograph. It occurs in vicinity of active disease. Lupus nephritis is most associated manifestation. Alveolar hemorrhages frequently recur despite ongoing immunosuppressant therapy. Early treatment with intra venous [IV] pulse methylprednisolone and IV cyclophosphamide should be instituted for a better outcome

Characteristics of rheumatoid arthritis patients with concomitant hepatitis C virus infection

Hepatitis C virus [HCV] is frequently associated with rheumatic autoimmune manifestations including rheumatoid-like arthritis. This work is aimed to study the impact of concomitant HCV infection on rheumatoid arthritis [RA] patients. 110 RA patients [mean age 44.6 +/- 12.7, disease duration 7.92 +/- 6.56 years] were included. HCV infection was diagnosed by HCV-antibody [HCV-Ab] and polymerase chain reaction. Disease activity was assessed using the disease activity score 28 [DAS28] and radiological damage by a modified Larsen method. Functional disability was assessed by the Modified Health Assessment Questionnaire [MHAQ]. HCV-Ab was detected in 20% and viremia in 12.7% of RA patients. HCV-Ab positive patients were significantly older [p < 0.001] and had a longer disease duration [p = 0.02]. No differences were found between HCV-Ab positive and -negative patients in DAS28 and modified Larsen's scores, however, HCV-Ab positive patients had a higher frequency of deformities [p < 0.005] associated with older age [p < 0.001] and higher MHAQ scores [p = 0.002], independent of age and disease duration. They also had a higher frequency of hepatomegaly [p < 0.001] and vasculitis [p < 0.001]. Hepatomegaly was associated with older age [p = 0.004] and longer disease duration [p = 0.003] while vasculitis was associated with older age [p = 0.02]. Concomitant HCV infection in RA patients is associated with significant disability and comorbidities in the form of hepatomegaly and vasculitis. Hepatomegaly and vasculitis were associated with older age. Hepatomegaly was also associated with longer disease duration. Screening for HCV infection is recommended in Egyptian RA patients

Joint involvement in asymptomatic Egyptian patients with HCV infection; ultrasonographic study

This case control diagnostic ultrasonographic study was undertaken to detect the presence of early articular and peri-articular involvement in Egyptian patients infected with hepatitis C virus [HCV] without any articular manifestation. The knee, hip and shoulder were evaluated clinically and by ultrasonography in a cohort of fifty patients with HCV without any current or previous articular manifestations in comparison with twenty healthy controls who were negative for HCV and HBV infections. Ultrasonographic alterations were detected in 96% of the HCV patients with highly significant difference in comparison to controls [p < 0.000]. Slight inflammatory changes were found in all the joints examined more than the moderate or severe changes. The knee and shoulder joints were involved in 74% of the HCV patients for each and the hip in 68%. There were higher prevalence and highly significant differences as regard the knee synovial thickening and effusion, hip effusion, trochanteric bursitis, supraspinatus tendon fluid collection and acromioclavicular joint effusion in comparison to the control group. Our study demonstrated the presence of joint changes in near all the asymptomatic patients with HCV with the prevalence of slight inflammatory alterations that can be explained by the presence of sub-clinical synovitis as well as the presence of significant changes in some of peri-articular structures. In countries like Egypt, the HCV is an endemic disease, so it is thus recommended that patients with rheumatic symptoms should be tested for the HCV infection and conversely that sign and symptoms of articular involvement should be evaluated in HCV patients