SeminarSystemic lupus erythematosus
Section snippets
Classification criteria
After 15 years of intensive use, the American College of Rheumatology classification criteria for systemic lupus erythematosus (SLE) were updated in 1997.1 The criterion “positive LE cell preparation” was deleted, and the item “false-positive test for syphilis” was expanded to “positive finding of antiphospholipid antibodies”, including IgG or IgM anticardiolipin antibodies and lupus anticoagulant.
These new criteria have not been totally free from criticism. Piette2 has pointed out the lack of
Incidence and prevalence
Uramoto and colleagues in Minnesota, USA,6 reported that the incidence of SLE has more than tripled over the past four decades. Using the 1982 American College of Rheumatology criteria, they showed that the adjusted incidence of SLE was 5·56 per 100 000 during 1980-92, compared with 1·51 per 100 000 during 1950-79. A review of 19 papers published between 1965 and 1995 gave a pooled incidence of SLE of 7·3 per 100 000.7
In keeping with these data, two studies in the USA—both done by random
Randomised controlled trials
During the past 5 years, only ten randomised controlled trials have been published, most of which included small numbers of patients (table).23, 24 The study by Gourley and colleagues25 of 82 patients divided into three groups confirmed that cyclophosphamide-containing regimens were better than long-term courses of methyl-prednisolone alone in achieving clinical remission of nephritis. However, the differences between the two groups treated, respectively, with cyclophosphamide alone or combined
Management of thrombosis in antiphospholipid syndrome
In 1995, we published a retrospective study of 147 patients with APS and history of thrombosis.71 Our results were in keeping with a previous series72 in that the risk of recurrence in non-treated patients is unacceptably high, and that anticoagulation at international normalised ratios (INRs) higher than 3·0 offers the best protection against further thrombosis. The main limitations of this work were its retrospective character and the impossibility of analysing separately patients with
Pregnancy
Lupus tends to flare during pregnancy and the puerperium,78 most flares being mild. The frequency of exacerbations is lower in women with mild and well controlled disease.79 Maternal flares are associated with increased prematurity,80 and active nephritis has been shown to be an independent factor for fetal mortality.81
APS is a recognised cause of pregnancy complications, including miscarriage, fetal death, and pre-eclampsia.82 Several prospective series have shown the impressive improvement in
Outstanding questions
Some important issues that will hopefully be resolved in the near future are shown in panel 2.
The study was supported by grant 99/5007 of Fondo de Investigacion Sanitaria, Spain, the Department of Health of the Basque Government, and Lupus UK.
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A nomogram to predict the risk of lupus enteritis in systemic lupus erythematosus patients with gastroinctestinal involvement
2021, EClinicalMedicineCitation Excerpt :We conducted a retrospective study of 8505 SLE patients who were hospitalized in West China Hospital from January 2010 to January 2020. SLE patients with the following criteria were included in the analysis: meet the 1997 American College of Rheumatology and/or the 2012 Systemic Lupus Erythematosus International Clinical Assistance Group classification criteria; [18,19]. have gastrointestinal symptoms and signs such as abdominal pain, diarrhea, nausea, vomiting, black stool, bloody stool, and fatigue as well as completed one or more abdominal CT examinations; and have complete inspection data.
Gastrointestinal involvement in systemic lupus erythematosus: A systematic review
2021, Journal of Translational AutoimmunitySLE serum induces altered goblet cell differentiation and leakiness in human intestinal organoids
2024, EMBO Molecular Medicine