Antinucleolar antibodies and their disease association.

The prevalence of the antinucleolar antibodies (ANoA) demonstrated by indirect immunofluorescence technique in 1,662 sera of patients with a known or suspected rheumatic disease increased from 1.97% when mouse kidney (MK) was used as substrate to 4.9% when HEp-2 cells were used as substrate. However, an appropriate commercial HEp-2 substrate must be selected in order to increase the sensitivity of ANoA positivity. There were 3 distinct staining patterns of the nucleolar immunofluorescence: homogeneous speckle, and clumpy. Irrespective of the patterns, the most common diagnoses among patients who had ANoA were systemic sclerosis (PSS) and systemic lupus erythematosus (SLE); 36% and 35%, respectively). On the contrary, the incidence of these antibodies in PSS was 41% while it was only 3% in SLE patients. Almost all patients with speckled nucleolar staining had PSS as their underlying disease while most of the patients with homogeneous nucleolar staining had SLE. No distinct correlation between the different nucleolar staining patterns and specific organ involvements in our lupus and PSS patients was found except for the higher frequency of clumpy staining in male scleroderma with no joint involvement. This study demonstrates that: 1) ANoA are uncommon in unselected sera although use of a cell line substrate doubles the rate of positivity; 2) the proper HEp-2 substrate is critical in the detection of ANoA; 3) PSS and SLE are the most frequent diseases associated with ANoA but the frequency of these antibodies in SLE patients was very low.; 4) there are 3 distinct nucleolar staining patterns which may be associated with different rheumatic diseases; and 5) compared with ANoA negative scleroderma, clumpy nucleolar staining had significantly higher incidence in men with no joint involvement but a tendency towards more lung manifestations.

Neonatal lupus erythematosus in Thailand.

Systemic lupus erythematosus (SLE) is not uncommon in Thai children and adults but neonatal lupus erythematosus has never been reported in Thailand. A case of NLE born of a mother without prior history of SLE was reported. He was initially misdiagnosed as congenital self-healing histiocytosis because of seborrheic dermatitis-like lesions, petechiae, hepatosplenomegaly and thrombocytopenia. Features supporting the diagnosis of NLE in this case were presented.

Infection in systemic lupus erythematosus.

A review of 1,069 total admissions of 537 systemic lupus erythematosus (SLE) patients during a 10-yr period at Ramathibodi Hospital showed that 220 episodes which occurred in 137 patients (25.5%) were motivated by infection. Skin was the most common site (23%) with Herpes zoster being the most common organism (15.5%) found in our lupus patients. However, if we considered only major infections, pulmonary tuberculosis, salmonella septicemia and urinary tract infection by E. coli would be the most frequent complications respectively. In the absence of immunosuppressive therapy, infections coincided with the initial manifestation of SLE in 25 patients and were associated with exacerbation of the disease in 20 patients. Mean SLEDAI score in these patients was 8.8, suggesting that active lupus link together with infection. Steroid therapy influenced the rate of opportunistic infections (p = 0.006). Infections were determined to be the cause of death in 23 of 77 patients (29.9%). Opportunistic pathogens played an equal role as other common bacterial organisms in these fatal cases. SLE patients who died from infections were treated with cyclophosphamide in higher proportion than those with no infectious complication (p = 0.025). Our study demonstrated the rate, nature and predisposing factors of infection in SLE which may lead to better anticipation and diminution of morbidity and mortality related to infection in hospitalized patients with SLE.