Risk Factors for Low Bone Mineral Density in Korean Patients with Systemic Lupus Erythematosus

OBJECTIVE: To determine the degree and risk factors for decreased bone mineral density (BMD) in patients with systemic lupus erythematosus (SLE). METHODS: One hundred and one patients with SLE and 57 age- and gender- matched healthy controls were enrolled in this study. The BMD was measured by dual energy X-ray absorptiometry (DXA). The laboratory findings and clinical variables evaluated in the SLE patients consisted of disease duration, SLE disease activity index (SLEDAI), and medications, including mean and cumulative dose of glucocorticoid. At the time of the clinical and laboratory assessment, the levels of serum osteocalcin, serum FSH/LH, urine deoxypyridinoline (DPD), and serum cytokines, such as IL-6 and soluble receptor activator of NF-kB ligand (RANKL), were determined in SLE patients using a enzyme-linked immunosorbent assay. RESULTS: The BMD T score decreased in patients with SLE compared to the healthy controls (-1.11 versus -0.41, p=0.001 at lumbar spine, -0.84 versus -0.01, p<0.001 at femur neck, -1.20 versus -0.45, p<0.001 at total hip, respectively). Osteoporosis and osteopenia was present in 16.8% and 46.5% of patients, respectively. Multiple regression analysis revealed a low BMD in the lumbar spine to be associated with increased FSH, low BMI and cumulative glucocorticoid dose. A low BMD in the hip and femur neck was associated with increased FSH, low BMI, and duration of glucocorticoid. On the other hand, the levels of osteocalcin, deoxypyridinoline (DPD), IL-6, and soluble RANKL were similar in patients with a low BMD and those with normal BMD. CONCLUSION: Osteoporosis and osteopenia are more common in young Korean SLE patients than in control subjects. Elevated FSH, low BMI, and the use of glucocorticoid are independent risk factors linked to a decreased BMD in Korean patients with SLE.

Comparison of the Clinical Manifestations, Brain MRI and Prognosis between NeuroBehcet's Disease and Neuropsychiatric Lupus

BACKGROUND: Neuropsychiatric systemic lupus erythematosus (NPSLE) shows some similarities to neuroBehcet's disease (NBD) in that both conditions have some analogous clinical features and they are both pathologically associated cerebral vasculopathy. This study compared the clinical manifestations, brain MRI findings and prognosis of NPSLE and NBD patients. METHODS: Forty three patients with NPSLE (n = 25) or NBD (n = 18), who were monitored at a single center, were enrolled in this study. We retrospectively analyzed the clinical and brain MRI data. The neuropsychiatric manifestations were classified in both groups according to the new American College of Rheumatology nomenclature for NPSLE. RESULTS: The diffuse symptoms that included mood disorders, psychosis, confusion, cognitive dysfunctions, generalized seizures and headaches other than migraine or cluster headaches were more commonly observed in the NPSLE patients, while the frequency of focal diseases such as cranial neuropathy tended to be higher in the NBD patients. The brain MRI revealed that the NBD patients had more abnormalities in the brain stem than did the NPSLE patients. Most of the patients improved, at least partially, after being treated with glucocorticoid and/or immune suppressants. However, the disease course differed significantly between the two groups. There were more episodic cases in the NPSLE group of patients, while there were more remittent cases in the NBD group of patients. CONCLUSION: NPSLE had a tendency to cause diffuse neuropsychiatric manifestations, and it has a different predilection of brain lesions compared with NBD. The NBD patients showed a poorer outcome than did the NPSLE patients, suggesting that different therapeutic strategies for the two diseases need to be considered.

Medical Therapy for Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovitis and damage of bone and cartilage. The major goals of therapy in RA are to relieve pain, swelling of joints; improve joint function; stop joint damage, and prevent disability and disease-related morbidity. The past decade has seen a major transformation in the treatment of RA in terms of approach and choice of drugs. The previous therapeutic approach, termed the therapeutic pyramid, penerally involved initial conservative management with non-steroidal anti-inflammatory drugs (NSAIDs) for several years; disease-modifying antirheumatic drugs (DMARDs) were withheld until clear evidence of erosions was seen. DMARDs were then added individually in slow succession as the disease progressed. This form of treatment has been supplanted by early initiation of DMARDs and combination DMARD therapy in patients with the potential for progressive disease. The idea of early intervention with DMARDs has been validated in several randomised trials. This paradigm shift partly resulted from unsatisfactory outcomes with the pyramid approach, and an increased awareness of the cost, lost productivity, morbidity, and decreased life expectancy associated with RA. These findings are the consequences of progressive disease, and have provided the impetus for development of more effective therapies to prevent joint destruction and maintain functional status. The continuing elucidation of pathophysiological pathways relevant in RA, coupled with advanced in biotechnology, offer substantial hopes for the development of potent and specific pharmacotherapy for RA.

Elevated monocyte chemoattractant protein-1 in patients with Behcet's disease / 대한내과학회지

BACKGROUND: Monocyte chemoattractant protein-1 (MCP-1) belongs to C-C subfamily of chemokines, which stimulates the migration of monocytes. MCP-1 exerts various effects on the monocytes, including the induction of integrin and tissue factor, and synthesis of proinflammatory cytokines and arachidonic acid. In this study, we measured the MCP-1 levels in patients with Behcet's disease and evaluated the associations between the levels of MCP-1 and the level of other chemokines and various clinical features of Behcet's disease. METHODS: Serum samples were obtained from 67 patients with Behcet's disease and 30 healthy controls. Simultaneously, whole blood was isolated from patients (n=25) with Behcet's disease and healthy controls (n=11) and cultured in 24 well plates for 48 hours in the absence or presence of lipopolysaccharide (LPS) 5 microgram/mL, phytohaemagglutinin (PHA) 5 microgram/mL, phorbol 12-myristate 13-acetate (PMA) 50 ng/mL + ionomycin 5 microgram/mL. The MCP-1 concentrations were measured in the sera and culture supernatants by enzyme-linked immunosorbent assay (ELISA). RESULTS: The levels of serum MCP-1 were 2.5 times higher in patients with Behcet's disease than healthy controls. The patients with Behcet's disease had also higher levels of MCP-1 in the culture supernatants of whole blood cells, stimulated with LPS, but not with either PHA or PMA plus ionomycin, compared to healthy controls. Serum MCP-1 levels (n=67) were strongly correlated with serum RANTES, MIP-1alpha, IL-8 levels in Behcet's disease. In addition, the production of MCP-1 by whole blood culture from Behcet's disease patients (n=25) were also correlated well with those of RANTES, MIP-1alpha, and IL-8, when stimulated with LPS. However, MCP-1 levels in the sera and culture supernatants did not show any association with various clinical features of Behcet's disease including oral ulcer, genital ulcer, erythema nodosum, arthritis, uveitis, intestinal involvement, central nervous system involvement, and vascular thrombosis. CONCLUSION: In the sera and culture supernatants of whole blood stimulated with LPS, MCP-1 levels were higher in patients with Behcet's disease than controls and correlated well with RANTES, MIP-1alpha, IL-8 levels. These results suggest that the activation and migration of monocytes triggered by the increased production of MCP-1 may play a role in the pathogenesis of Behcet's disease.

Serum Levels of Zinc and Copper are Associated with Disease Activity in Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: To investigate the relationship between serum trace element levels with disease activity in Korean patients with rheumatoid arthritis (RA). METHODS: The serum levels of zinc, copper and ceruloplasmin were measured by inductively coupled plasma atomic emission spectrometers in 80 patients th , 26 osteoarthritis (OA), and 30 healthy controls (HC). We also measured the levels of zinc and copper in the synovial fluid (SF) of patients with RA. We nvestigated the clinical parameters simultaneously obtained at sampling of serum and analyzed correlation between serum levels of trace elements and disease activity in RA. RESULTS: In RA, the levels of serum zinc were significantly lower than that of HC, and thelevels of serum copper and ceruloplasmin were significantly higher than those of HC. In active RA, the levels of serum zinc were more decreased , and the levels of serum copper and ceruloplasmin were more increased than those of inactive group of RA. The levels of both copper and ceruloplasmin showed positive correlation with the levels of serum ESR and CRP. On the other hand, the levels of serum zinc showed negative correlation with the levels of serum ESR and CRP. CONCLUSION: Serum zinc levels are significantly lower and serum copper levels significantly higher in patients with active RA and these trace elements were useful parameter of disease activity in RA.

Correlation of Sonographic Findings with Knee Joint Pain in Knee Osteoarthritis Patients / 대한류마티스학회지

OBJECTIVE: To investigate the ultrasonographic findings in knee OA patients and to examine the possible causes of pain in osteoarthritis by ultrasonography. METHODS: Ultrasonography was performed with 7.5 MHz linear probe in 64 knee OA patients who fulfilled the ACR criteria. All patients were graded according to the Kellgren-Lawrence grades and then classified into group 1 (K/L I and II) and Group 2 (K/L III and IV). Also WOMAC score, BMI, laboratory finding (ESR, CRP) were checked. Ultrasonographic findings was examined; effusion, thickening of synovium, vertical length of medial and lateral osteophyte (longitudinal view), length of capsular distension (medial longitudinal view), evidence of bursitis and articular cartilage. RESULTS: 50.0% of patients had effusion, among whom 68.7% patients also had synovial thickening. In all patients, the severity of pain was correlated with 4 variables; the presence of effusion, disease duration, the length of medial osteophyte, the length of capsular distension (r=0.279, r=0.415, r=0.537, r=0.608, respectively, p<0.05). The length of medial osteophyte, the degree of capsular distension and disease duration were significantly correlated with WOMAC pain score in Group 1 (p<0.05). After multiple regression analysis, the length of medial osteophyte alone had correlation with the pain severity in Group 1 (r2= 0.396 p<0.05) and the only length of capsular distension was significantly correlated with WOMAC pain score in Group 2 (r=0.609, p<0.05). CONCLUSION: The length of osteophyte may be more related with pain severity in mild cases (K/L score I and II) while capsular distension could be an important factor causing knee pain in more advanced knee OA (K/L score III and IV).

Autologous Hematopoietic Stem Cell Transplantation for Treatment of Refractory Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: To investigate the safety and efficacy of immunoablation and subsequent autologous hematopoietic stem cell transplantation (HSCT)in refractory rheumatoid arthritis (RA). METHODS: Three patients with severe,refractory RA were treated.We mobilized autologous hematopoietic stem cells (HSCs)with cyclophosphamide(Cy)and granulocyte colony-stimulating factor.HSCs were collected and enriched ex vivo using CD34-positive immunoselection.Two different immunoablative conditioning regimens were employed; fludarabine-Cy-anti-thymoayte glonulin (ATG)in patients whose disease activity was transiently ameliorated in response to Cy used in stem cell mobilization,or fludarabine-busulfan-ATG in those who didn't show any response to that. RESULTS: Median time to engraftment with an absolute neutrophil count greater than 500/microliter and nontransfused platelet count greater than 20,000/microliter was 15 days (range 12-16)and 9 days (range 7-13),respectively.Regimen-related toxicity was minimal.Two patients were markedly improved at 2 or 3 months after HSCT,repectively.In another patient,disease activity was transiently subsided,but relapsed at 2 months after HSCT,which led to reinstitution of anti-rheumatic medications.This resulted in subsequent marked improvement of disease activity whereas her disease had been refractory to these medications. CONCLUSIONS: These results underscore the feasibility and potential efficacy of intensive immunosuppression followed by autologous HSCT for treatment of refractory rheumatoid arthritis.The durability of remission remains to be clarified.

Urinary Excretion of Rantes is Elevated in Lupus Nephritis / 대한류마티스학회지

OBJECTIVE: Infiltrating T cells and monocytes have been implicated in the pathogenesis of lupus nephritis (LN). Chemokines may play a key role in the recruitment of these cells. We investigated whether RANTES (regulated on activation normal T cell expressed and secreted), one of the CC chemokine family, may be involved in the pathogenesis of LN. METHODS: We measured the levels of RANTES in sera and urine from 87 systemic lupus erythematosus (SLE) patients and 78 healthy controls using ELISA. Clinical and laboratory assessment including SLE disease activity index (SLEDAI) were performed at the time of sampling. RESULTS: Serum RANTES levels were significantly higher in the patients with SLE than in healthy controls (115.0+/-5.6 vs. 91.5+/-4.0 pg/ml, p=0.001, mean+/-SEM). Serum RANTES levels correlated well with anti-dsDNA antibody titer (r=0.29, p<0.05) and inversely with serum complement C4 level (r=-0.28, p<0.05). Urinary RANTES/creatinine ratios were significantly higher in patients with nephritis than those without (3.4+/-0.4 vs. 2.2+/-0.3, p=0.004), while serum RANTES level was not different between patients with nephritis and those without. Moreover, urinary RANTES/creatinine ratio positively correlated with urine protein/creatinine ratio (r=0.41, p<0.001). CONCLUSIONS: Our results demonstrate that serum RANTES was elevated in patients with SLE and urinary excretion of RANTES was strongly associated with presence of nephritis. These data suggest that RANTES may be expressed in renal inflammatory sites and may participate in the pathogenesis of LN possibly by augmenting the recruitment of T cells and monocytes.

T cell Proliferative Response to Type II collagen is related to Inflammatory Process and Joint Damage in Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: To investigate the role of T cell responses to type II collagen (CII) in disease progression in rheumatoid arthritis (RA). METHODS: T cell proliferative responses to bovine CII by peripheral blood mononuclear cells (PBMC) from early RA patients (duration or =2) had higher levels of CRP and ESR than those (n=21) not showing T cell responses. The number of damaged joints (by Steinbrocker's method) and damaged joint scores (by Sharp's method) were significantly higher in patients with positive T cell responses than in those without. The joint space narrowing scores correlated well with T cell responsiveness to CII. Patients (n=15) with both positive T cell responses and RA-susceptible allotypes, HLA-DR1 or DR4, had greater damaged joint scores than the rest of patients (n=24). CONCLUSION: T cell proliferative responses to CII are associated with inflammatory activity and radiographic severity in RA. Our data suggest that CII reactive T cells may play an important role in the pathogenic process of joint damage.

Elevated serum interleukin 15 (IL-15) in Behcet's disease / 대한류마티스학회지

OBJECTIVE: To evaluate clinical significance of interleukin 15 (IL-15) in patients with Behcet's disease (BD). METHODS: Serum samples were obtained from 31 patients with BD and 29 healthy controls. BD patients were divided into active and inactive group according to the presence of clinical manifestations on the day of sampling. Serum levels of IL-15 and IL-8 were measured by sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum levels of IL-15 and IL-8 were significantly higher in BD patients than in healthy controls (117.2+/-26.2 pg/ml versus 51.8+/-15.4 pg/ml, p<0.01, 287.7+/-100.9 pg/ml versus 138.5+/-17.2 pg/ml, p<0.01, respectively). There was a significant correlation between serum levels of IL-15 and IL-8 IL-15 levels compared with those without it (161.1+/-68.8 pg/ml versus 96.4+/-3 4 . 8pg/ml, p<0.05). Serum levels of IL-15 and IL-8 tended to be higher in active group than in inactive group, but didn't reach statistical significance. CONCLUSION: Serum level of IL-15 was elevated in patients with BD, especially those with uveitis, but it did not seem to be useful as a marker of disease activity in BD.

Association of MICA Polymorphism with HLA-B51 and Disease Severity in Korean Patients with Behcet's Disease

The HLA-B51 allele is known to be associated with Behcet's disease (BD) in many ethnic group. However, it has not yet been clarified whether the HLA-B51 gene itself is the pathogenic gene related to BD or whether it is some other gene in linkage disequlibrium with HLA-B51. Recently, the Triplet repeat (GCT/AGC) polymorphism in transmembrane region of the MHC class I chain-related A (MICA) gene was identified. To investigate the association of MICA with BD, we studied the MICA polymorphism in 108 Korean BD patients and 204 healthy controls in relation to the presence of HLA-B51 and clinical manifestations. The triplet repeat polymorphism was determined by polymerase chain reaction (PCR)-denaturing polyacrylamide gel electrophoresis (PAGE). The phenotype frequency of the MICA*A6 allele (relative risk, RR=2.15, p=0.002) and HLA-B51(RR=1.87, p=0.022) were significantly increased in the Korean patients with BD. A strong linkage disequilibrium was observed between the MICA*A6 and HLA-B51 in both the patients with BD and control subjects. Stratification analysis showed that MICA*A6 homozygosity was strongly associated with BD in the HLA-B51-negative population, and HLA-B51 was also associated with MICA*A6-negative population. In conclusion, MICA*A6 rather than HLA-B51 was strongly associated with Korean patients with BD, and the MICA*A6 allele is a useful susceptibility marker of BD, especially in the HLA-B5-negative

A Case of Stricture of Second Portion of Duodemum Induced by Chronic Use of Nonsteroidal Anti-inflammatory Drug in Patient with Ankylosing Spondylitis and Rheumathoid Arthritis: A case report / 대한소화기내시경학회지

In endoscopic clinical research studies of patients who take NSAIDs, 10% to 20% of patients develop gastric ulcers and 4% to 10% develop duodenal ulcers. Ulcers associated with chronic NSAIDs use are typically painless and are located in the prepyloric region of the stomach. These characteristics make NSAIDs potential causes of gastric outlet obstruction. There were multiple cases of single or multiple strictures that were found in the esophagus, small bowel and colon. Most of duodenal strictures were confined to bulbar area. Only one case of duodenal second portion diaphragmlike stricture was reported in association with acetylsalicylic acid. We experienced one case of chronic NSAIDs induced duodenal 2nd portion stricture in ankylosing spondylitis and rhemathoid arthritis patient and reported with a review of literature.

Effects of Rebamipide Against Nonsteroidal Anti-inflammatory Drugs (NSAIDs)Induced Gastroduodenal Mucosal Injury / 대한류마티스학회지

OBJECTIVES: To investigate protective effect of rebamipide against nonsteroidal anti-inflammatory drugs (NSAIDs)induced gastroduodenal mucosal injury. METHODS: Randomized eight patients with rheumatic disease starting NSAIDs underwent pre-treatment gastroduodenoscopy,and degree of mucosal injury and several gastrointestinal (GI)symptoms were graded by Lanza score scale (rating from 0 to 4)and symptom score scale (rating from 0 to 3).Eight weeks after the subjects had received concomitant rebamipide 100mg bid and NSAIDs they underwent post-treatment gastroduodenoscopy and degree of mucosal injury and GI symptoms were graded.Randomized previous NSAIDs-used 20 patients with rheumatic disease were also investigated.Eight weeks after 100mg bid with concomitant NSAIDs,they underwent gastroduodenoscopy and degree of mucosal injury and GI symptoms were graded. RESULTS: All eight patients who received concomitant rebamipide and NSAIDs had no interval changes between pre and post-treatment mucosal injury scores and had little interval changes between pre and post-treatment symptom scores. In previous NSAIDs-used patients with rheumatic disease,incidence of each gastric ulcer and duodenal ulcer were 16.7%and 11.1%and all mean symptom scores were lower than 1.0.No special adverse effect was developed during the study. CONCLUSION: Rebamipide seems to have a good protective effect against NSAIDs induced mucosal injury and GI symptoms and probably have rare adverse effect.

A Case of Rheumatoid Arthritis Associated with Ulcerative Colitis / 대한류마티스학회지

Rheumatoid arthritis(RA)is occasionally associated with variable extra-articular involvement and the chronic inflammatory process can affect the gastrointestinal system.The gastrointestinal involvement in RA may present in many causes:drug induced colitis,vasculitis and amyloidosis involved in the gut,association with certain bowel diseases such as collagenous colitis or infectious colitis. Ulcerative colitis(UC)is a chronic inflammatory bowel disease and is commonly associated with peripheral joint disease which correlates with the disease activity and extent of the bowel inflammation.The arthritis is usually presented in pauciarticular,generally asymmetric,transient,and nondestructive pattern.However,the chronic and destructive peripheral arthritis has been reported in a few cases and RA has not been observed in association with UC. We experienced a case of RA patient with recurrent abdominal pain,hematochezia,and tenesmus who was diagnosed as UC by endoscopic and histologic finding.We herein report the case with literature.

Bacteremia in Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To determine the causative organisms and predisposing factors of bacteremia in patients with systemic lupus erythemaosus (SLE). METHODS: We retrospectively evaluated medical records of 358 patients with SLE who were followed in Kangnam St. Mary? Hospital from 1992 to 1997. Bacteremic SLE patients were compared to non-bacteremic SLE patients in terms of laboratory and clinical variables. RESULTS: Twenty-nine episodes of bacteremia in 27 patients with SLE (26 women, 1 man) were identified. The episode of community acquired bacteremia (n=21, 72.4%) was more frequent than that of hospital acquired bacteremia (n=8, 27.6%). Isolated bacterial organisms from blood were as follows: gram negative organisms (n=14); Salmonella species (n=8), E. coli (n=4), P. mirabilis (n=1), K. pneumonia (n=1). gram positive organisms (n=15); S. aureus (n=6), Streptococcus pneumoniae (n=2), coagulase negative Staphylococci (n=2), Bacillus species (n=1), Streptococcus viridans (n=1), Streptococcus pyogenes (n=1), Enterococcus faecalis (n=1), Listeria monocytogenes (n=1). SLE was the most common underlying condition among Salmonella bacteremic patients. One of twenty seven bacteremic SLE patients (3.8%) died in spite of antibiotic therapy. Logistic regression analysis of the laboratory and clinical variables between bacteremic SLE patients and non-bacteremic SLE patients (n=140) showed that bacteremic SLE patients were more frequently associated with thrombocytopenia (p=0.008, odds ratio (OR)=7.8, 95% confidence interval (CI), 1.7 to 35.9), lupus nephritis (p=0.023, OR=5.3, 95% CI, 1.1 to 26.8), and high dose steroid therapy (prednisolone > 0.5mg/kg/day, p=0.008, OR=12.1, 95% CI 2.5 to 58.6) than non-bacteremic SLE patients. CONCLUSION: Our data suggested that Salmonella was the single most frequent isolate from the blood of SLE patients. Lupus nephritis and high dose steroid therapy were independent predisposing factors for the development of bacteremia in SLE patients.

Measurement of Serum Fas Ligand (FasL), FasL-Fas Complex and FasL-IgG Complex in Patients with Rheumatic Diseases / 대한류마티스학회지

OBJECTIVE: To quantify the soluble Fas ligand (sFasL) and to measure FasL-Fas complex and FasL-IgG complex in the sera of patients with various rheumatic diseases: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc), and adult onset Still? disease (AOSD). METHODS: Serum samples were obtained from 37 patients with SLE, 40 with RA, 30 with SSc, 20 with AOSD, and 40 healthy controls. The serum sFasL, FasL-Fas complex, and FasL-IgG complex were measured using a sandwich enzyme-linked immunoabsorbent assay. Hospital medical records were retrospectively reviewed for clinical and laboratory characteristics in patients with SLE. Disease activity in SLE patients was assessed by the SLE Disease Activity Index (SLEDAI) score. RESULTS: In patients with SLE, serum sFasL levels (383.1+/-208.9pg/ml) were significantly higher (p<0.001) than those of healthy controls (192.0+/-84.7pg/ml). sFasL levels in patients with RA (150.8+/-30.7pg/ml, p=0.014), SSc (115.4+/-13.5pg/ml, p<0.001), and AOSD (137.5+/-12.9pg/ml, p=0.001) were significantly lower compared with healthy controls. The frequencies of positive FasL-Fas complex and FasL-IgG complex were higher in patients with SLE (56.8%, 56.8% respectively) than in healthy controls (2.5%, 0% respectively) (p<0.001). All patients with RA or AOSD were negative for FasL-Fas complex and FasL-IgG complex. No patients with SSc were positive for FasL-Fas complex. On the other hand, the positive frequency of FasL-IgG complex was greater in patients with SSc (16.7%) than in healthy controls (0%)(p=0.012). Serum levels of FasL-IgG complexes in active SLE patients (OD 0.467+/-0.050) were tended to be lower than those in inactive SLE patients (OD 0.509+/-0.055)(p=0.060). SLEDAI score was tended to be negatively correlated with the serum levels of FasL-IgG complex in patients with SLE (r=-0.308, p=0.068). CONCLUSION: These results suggest that FasL may possibly play a role in the pathogenesis of SLE.

Bacteremia in Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To determine the causative organisms and predisposing factors of bacteremia in patients with systemic lupus erythemaosus (SLE). METHODS: We retrospectively evaluated medical records of 358 patients with SLE who were followed in Kangnam St. Mary? Hospital from 1992 to 1997. Bacteremic SLE patients were compared to non-bacteremic SLE patients in terms of laboratory and clinical variables. RESULTS: Twenty-nine episodes of bacteremia in 27 patients with SLE (26 women, 1 man) were identified. The episode of community acquired bacteremia (n=21, 72.4%) was more frequent than that of hospital acquired bacteremia (n=8, 27.6%). Isolated bacterial organisms from blood were as follows: gram negative organisms (n=14); Salmonella species (n=8), E. coli (n=4), P. mirabilis (n=1), K. pneumonia (n=1). gram positive organisms (n=15); S. aureus (n=6), Streptococcus pneumoniae (n=2), coagulase negative Staphylococci (n=2), Bacillus species (n=1), Streptococcus viridans (n=1), Streptococcus pyogenes (n=1), Enterococcus faecalis (n=1), Listeria monocytogenes (n=1). SLE was the most common underlying condition among Salmonella bacteremic patients. One of twenty seven bacteremic SLE patients (3.8%) died in spite of antibiotic therapy. Logistic regression analysis of the laboratory and clinical variables between bacteremic SLE patients and non-bacteremic SLE patients (n=140) showed that bacteremic SLE patients were more frequently associated with thrombocytopenia (p=0.008, odds ratio (OR)=7.8, 95% confidence interval (CI), 1.7 to 35.9), lupus nephritis (p=0.023, OR=5.3, 95% CI, 1.1 to 26.8), and high dose steroid therapy (prednisolone > 0.5mg/kg/day, p=0.008, OR=12.1, 95% CI 2.5 to 58.6) than non-bacteremic SLE patients. CONCLUSION: Our data suggested that Salmonella was the single most frequent isolate from the blood of SLE patients. Lupus nephritis and high dose steroid therapy were independent predisposing factors for the development of bacteremia in SLE patients.

Measurement of Serum Fas Ligand (FasL), FasL-Fas Complex and FasL-IgG Complex in Patients with Rheumatic Diseases / 대한류마티스학회지

OBJECTIVE: To quantify the soluble Fas ligand (sFasL) and to measure FasL-Fas complex and FasL-IgG complex in the sera of patients with various rheumatic diseases: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc), and adult onset Still? disease (AOSD). METHODS: Serum samples were obtained from 37 patients with SLE, 40 with RA, 30 with SSc, 20 with AOSD, and 40 healthy controls. The serum sFasL, FasL-Fas complex, and FasL-IgG complex were measured using a sandwich enzyme-linked immunoabsorbent assay. Hospital medical records were retrospectively reviewed for clinical and laboratory characteristics in patients with SLE. Disease activity in SLE patients was assessed by the SLE Disease Activity Index (SLEDAI) score. RESULTS: In patients with SLE, serum sFasL levels (383.1+/-208.9pg/ml) were significantly higher (p<0.001) than those of healthy controls (192.0+/-84.7pg/ml). sFasL levels in patients with RA (150.8+/-30.7pg/ml, p=0.014), SSc (115.4+/-13.5pg/ml, p<0.001), and AOSD (137.5+/-12.9pg/ml, p=0.001) were significantly lower compared with healthy controls. The frequencies of positive FasL-Fas complex and FasL-IgG complex were higher in patients with SLE (56.8%, 56.8% respectively) than in healthy controls (2.5%, 0% respectively) (p<0.001). All patients with RA or AOSD were negative for FasL-Fas complex and FasL-IgG complex. No patients with SSc were positive for FasL-Fas complex. On the other hand, the positive frequency of FasL-IgG complex was greater in patients with SSc (16.7%) than in healthy controls (0%)(p=0.012). Serum levels of FasL-IgG complexes in active SLE patients (OD 0.467+/-0.050) were tended to be lower than those in inactive SLE patients (OD 0.509+/-0.055)(p=0.060). SLEDAI score was tended to be negatively correlated with the serum levels of FasL-IgG complex in patients with SLE (r=-0.308, p=0.068). CONCLUSION: These results suggest that FasL may possibly play a role in the pathogenesis of SLE.