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.

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.

Tuberculous pyomyositis.

Tuberculosis, caused by Mycobacterium tuberculosis is a common infection both in immunocompromised and normal hosts. Its clinical manifestation can by divided as pulmonary and extrapulmonary form. Pyomyositis caused by M. tuberculosis is extremely rare. The authors report 2 patients, one with underlying dermatomyositis, and the other with polymyositis. The diagnosis was delayed according to nonspecific symptoms and masking effect of steroid therapy, which led to complications. Microscopy and culture of the pus confirmed the diagnosis. Surgical drainage was done and antituberculous therapy was given. The patient with dermatomyositis was complicated by drug induced hepatitis and died but the other was cured. Tuberculous pyomyositis should be considered in patients who are immunocompromised hosts.

Quinolones and Salmonella septic arthritis.

Salmonella septic arthritis is an infrequent infectious disease but can cause progressive joint destruction resulting in disability. The authors retrospectively reviewed cases with culture proved Salmonella septic arthritis in Srinagarind Hospital, Khon Kaen from 1994 to 2000. There were 23 episodes in 16 cases; all had underlying diseases and a history of steroid abuse or steroid and immunosuppressive therapy. Systemic lupus erythematosus was the most commonly found underlying disease (56%). Salmonella group D and group B were isolated in 13 and 3 cases. Most first episodes had acute onset of monoarthritis. The antibiotics used as initial treatment of the first episodes were beta lactam, cotrimoxazole or quinolones. There were 8 cases with disabled sequelae and 7 cases with relapse. For 13 evaluable first episodes, relapse occurred in 3 cases in the cephalosporin/penicillin and 4 cases in the cotrimoxazole treated group but none in the quinolones. Six relapse cases were treated successfully with quinolones as well as one with cotrimoxazole. Although 5 relapse cases treated with quinolones had previous progressive joint destruction or avascular necrosis, there was no further joint damage after re-treatment with quinolones. In conclusion, quinolones were more effective than beta-lactams and cotrimoxazole for the treatment of Salmonella septic arthritis to prevent relapse and progressive joint destruction.