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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The lupus anticoagulant may be defined as an immunoglobulin (IgG, IgM or both) which interferes with one or more of the in vitro phospholipid-dependent tests of coagulation. For many years, lupus anticoagulants were regarded as a laboratory nuisance; consequently, reagents were often selected on the basis of insensitivity to lupus anticoagulants. Recently, lupus anticoagulants have been associated with a variety of clinical conditions including recurrent thromboembolic events (both arterial and venous), obstetrical complications including fetal death and spontaneous abortion, and a variety of hematologic and neurologic complications. As a result, many laboratories are now being asked to identify the presence of lupus anticoagulants in selected patient populations. In addition to assays for lupus anticoagulants, there are immunologic assays designed to detect phospholipid antibodies using solid phase systems (RIA or ELISA). A variety of screening tests have been designed to enhance sensitivity to lupus anticoagulants. Test systems with decreased amounts of phospholipid (phosphatidylserine) appear to be most sensitive to lupus anticoagulants. Of the various tests used, the activated partial thromboplastin time (APTT) appears to be most sensitive. The sensitivity of any screening test system is inversely proportional to the residual platelets in the patient sample. APTT reagents differ widely in their sensitivity to lupus anticoagulants. The dilute Russell viper venom time is also highly dependent on the choice and concentration of phospholipid with respect to its sensitivity. Once an abnormality of a screening test has been identified, it is necessary to prove the abnormal result is due to the presence of an inhibitor. This step in the diagnosis may utilize either mixing studies or plasma agarose gels. The final step in the diagnosis of lupus anticoagulants is the demonstration of phospholipid specificity of the inhibitor. Two approaches have been utilized: 1. test systems designed to enhance anticoagulant effect (phospholipid-depleted), and 2. test systems with increased or altered phospholipids which will bypass or neutralize the anticoagulant.
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PMID:Screening for the lupus anticoagulant. 251 52

Antiphospholipid antibodies (APAs) may be identified in the laboratory by using either coagulation studies or solid-phase immunologic assays (ELISA; RIA). These methodologies do not necessarily evaluate the same antibody; consequently, it is appropriate to screen a patient's plasma by utilizing both assays. APAs have been associated with a variety of obstetrical complications including recurrent spontaneous abortion, intrauterine fetal death, early onset preeclampsia, deep vein thrombosis, and postpartum serositis syndrome. The Kaolin Clotting Time appears to be the most sensitive coagulation test for identifying the lupus anticoagulant. However, preliminary studies would suggest the presence of anticardiolipin antibodies as detected by solid-phase assays are more sensitive and predictive of the clinical course. Although there are no prospective trials to analyze treatment of patients with APA, preliminary data suggest the use of prednisone in combination with aspirin significantly improves the probability of delivery of a viable infant. In addition, heparin, intravenous gammaglobulin, and exchange plasmaphoresis have all been tried with varying degrees of success in individual patients in small series.
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PMID:Antiphospholipid antibodies and reproduction. 251 82

In women with a previous intrauterine fetal death related to lupus anticoagulant (LAC), we studied the effect of prednisone and calcieparine treatment to enable longer intrauterine life, increased fetal growth and increased survival rate. LAC was determined by the kaolin clotting time and was associated with elevated levels of antinuclear and anticardiolipin antibody in 42% and 21% of the cases, respectively. 14 women entered the study; they had a past history of 27 pregnancies, with only 1 small-for-gestational age (SGA) liveborn. The mean gestational age at the time of fetal death was 30 +/- 4 weeks. During index pregnancies, we observed 2 miscarriage, 9 liveborns (6 of appropriated gestational weight, 3 SGA) and a mean gestational age of 35 +/- 3 weeks. The mean decrease in fetal weight from the 50th percentile in previous pregnancies was 44%, and with treatment this was reduced to 12%. All these differences were statistically significant. We conclude that prednisone and heparin treatment can improve reproductive prognosis in fertile patients with LAC.
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PMID:Effect of prednisone and heparin treatment in 14 patients with poor reproductive efficiency related to lupus anticoagulant. 251 72

We reviewed the obstetric history of 57 patients with systemic lupus erythematosus (SLE). The number and outcome of pregnancies before and after the diagnosis of SLE was recorded. The clinical course of 21 patients who became pregnant during the observation period was noted. Before the diagnosis of SLE, 158 pregnancies resulted in a 20% rate of fetal loss (abortion, pre and neonatal death). This was lower than a 35% rate of fetal loss during pregnancies developed after the diagnosis of SLE. Both rates are significantly higher than the 10% which is considered normal for our reference population (p less than 0.001). A higher rate of fetal loss was observed in active SLE (37%) compared to inactive SLE (19%) and in the presence of SLE nephropathy (34%) than in its absence (17%), (p less than 0,01). A flourishing of SLE was observed in 50% of pregnancies, especially during the first trimester (59%) and after delivery (35%). We conclude that pregnancy occurs frequently in patients with SLE. The fetal risk is high although the clinical course of the disease is usually benign. Results in both terms are unfavourably influenced by the activity of SLE and the presence of nephropathy.
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PMID:[Systemic lupus erythematosus and pregnancy. Clinical experience in 57 patients]. 251 99

Nine pregnant women with false-positive syphilis test results, and 13 matched controls, were screened for autoimmune antibodies to ascertain whether any relationship might exist between their presence and the occurrence of obstetric problems. Investigations included assays for anti-cardiolipin antibodies (ACA), lupus anticoagulant (LAC), anti-nuclear antibodies (ANA) (including antibodies against extractable nuclear antigen), anti-smooth muscle antibodies, anti-mitochondrial antibodies, anti-DNA antibodies, IgM-RF and complement factors. We found no significant difference in the incidence of obstetric problems between the two groups. Except that significantly more women were positive for ACA in the group with false-positive syphilis tests than in the control group, there were no differences between the groups with regard to the antibodies tested for. There was only one case of SLE, a patient positive for LAC, and who had had several miscarriages and no pregnancy resulting in a live birth. Our findings suggest that it would be unwarranted to devote resources to routine screening for these antibodies in healthy women with a false-positive syphilis test result, though the presence of LAC could possibly be used as an indicator of the risk of spontaneous abortion due to SLE.
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PMID:Autoimmune antibodies and pregnancy outcome in women with false-positive syphilis test results. A retrospective controlled investigation of women from 5170 deliveries. 252 Aug 10

The obstetric outcome in 37 patients with antiphospholipid antibodies (APAs) is described. The APAs were measured by the lupus anticoagulant assay and/or more recently anticardiolipin antibodies. There were 15 patients with SLE who without therapy had 51/58 pregnancy failures, either abortion or fetal death in utero, a failure rate of 88%. Likewise, 22 patients without definite SLE lost 69/87 pregnancies, a failure rate of 79%. After treatment the pregnancy wastage rate was 55% and 25% in the 2 groups respectively. When treatment regimens used were examined in detail the improvement with therapy was most clearly evident in the group who received low dose aspirin (75-150 mg) in association with immunosuppression. This improvement was most apparent in the patients without definite SLE.
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PMID:Pregnancy loss with phospholipid antibodies: improved outcome with aspirin containing treatment. 261 75

There are many reports in the literature associating lupus anticoagulant with fetal death. Successful pregnancies have been reported following suppression of the antibody by prednisone and the addition of antiaggregants and possibly anticoagulants. This report describes our experience treating such patients and the outcome of subsequent pregnancies. The results are less successful than the figures in the literature, 13 live births out of 27 pregnancies in 19 patients. This may be due to lupus anticoagulant being diagnosed as the cause for a wide variety of clinical presentations including habitual first trimester abortion, mid trimester fetal death, intrauterine growth retardation and placental dysfunction in the third trimester. Our experience shows that steroids and antiaggregants have a definite place in cases of second and third trimester fetal death and in cases of clinical systemic lupus erythematosus. However, lupus anticoagulant is one of a spectrum of autoantibodies whose pathophysiology has not been fully elucidated. It is questionable whether this regimen of treatment has a place in patients with no previous fetal loss or in cases of primary habitual abortion.
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PMID:Fetal demise associated with lupus anticoagulant: clinical features and results of treatment. 262 Aug 62

Under normal conditions, pregnancy constitutes a developmental crisis. In high-risk pregnancies, the stages of adaptation and attachment to the developing fetus may be delayed. Prior miscarriage or loss of a more fully developed baby, which is common in SLE, may further challenge the bonding process. In deciding whether or not to have a baby, couples need current medical information provided by an internist/rheumatologist, in close coordination with the obstetrician.
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PMID:Psychologic aspects of pregnancy in patients with rheumatic diseases. 265 95

We retrospectively and prospectively reviewed the incidence of stroke in 105 patients with systemic lupus erythematosus (SLE). Stroke occurred in 14 (15%) of 91 consecutive patients with documented SLE; nine (64%) of the 14 had multiple cerebral infarcts. Factors associated with stroke and the frequency of stroke were systemic thrombosis (30%), elevated partial thromboplastin time (36%), spontaneous abortion (50%), age over 60 years (57%), transient ischemic attacks (57%), previous stroke (64%), and cardiac valvular disease (86%). The major period of risk for the first stroke was during the first 5 years of SLE. The most frequent etiology was a cardiogenic embolus or an antibody-mediated hypercoagulable state, with cerebral vasculitis occurring only in association with infection. Because of the decreased fibrinolysis seen in patients with SLE, anticoagulant therapy may be the most effective preventive treatment currently available. Anticoagulant therapy seemed to prevent recurrent focal cerebral ischemia in our patients and was associated with relatively few and minor complications. Patients with a history of transient ischemic attacks or cardiac valvular lesions are at high (57% and 87%, respectively) risk of stroke. Patients who have had a stroke are at high (64%) risk for a recurrent stroke. Anticoagulant therapy is recommended for all of these patients.
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PMID:Frequency, etiology, and prevention of stroke in patients with systemic lupus erythematosus. 230 Sep 86

Pregnancy occurring in patients with diagnosed and controlled SLE will be associated with a flare of disease in 60 per cent of cases, which is not significantly different from flares in nonpregnant patients. Signs and symptoms of active SLE should be carefully evaluated and treated with steroids according to severity and organ systems involved. When pregnancy occurs with inactive kidney disease there is a 10 per cent rate of reactivation and SLE kidney disease may appear for the first time during pregnancy in 6.8 per cent of patients. These rates are similar in the control group. There will be a significantly increased abortion rate which cannot be improved with maternal treatment. There will also be a high prematurity rate and an increased number of newborns with intrauterine malnutrition that are associated with active maternal disease. The following points are important when caring for a pregnant SLE patient: 1. Maintain maternal disease inactive throughout gestation. 2. Monitor growth and development of fetus. 3. Monitor for fetal distress. 4. Interrupt pregnancy when fetal distress is diagnosed. 5. A neonatal intensive care unit should be available at the time of delivery. The short-term prognosis is good with no maternal mortality and there is no long-term deleterious influence of pregnancy on the evolution of SLE.
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PMID:Systemic lupus erythematosus. 272 53


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