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Query: UMLS:C0409974 (lupus)
 22,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of systemic lupus erythematosus (SLE) is reported in which chorea was the dominant clinical feature, and which presented following a spontaneous mid-trimester abortion. The diagnosis, natural history and management of this uncommon manifestation of CNS lupus is discussed, as well as the influence of pregnancy on disease activity in SLE.
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PMID:Systemic lupus erythematosus presenting as post-partum chorea. 29 13

Women with systemic lupus erythematosus (SLE) have increased adverse pregnancy outcomes. The reasons for these problems include maternal disease, clinical or serologic activity, medication use, and residual organ impairment from prior disease flares. In retrospective studies, pregnancy data are often treated cross-sectionally, with births rather than mothers as the unit of analysis. Multiple pregnancies from the same mother may be highly correlated with each other. In an unmatched retrospective study, the first two pregnancy outcomes in lupus patients with anticardiolipin antibody (anti-CL IgG or IgM isotype) (cases N = 47) and without anticardiolipin antibody (controls, N = 125) were assessed according to birth order. A good outcome was defined as a full-term (> 38 weeks) live birth without neonatal complications. All other pregnancy outcomes were considered adverse outcomes. Therapeutic abortions and ectopic or molar pregnancies were excluded. Both cases and controls with an adverse outcome in their first pregnancy had at least a 50% chance of another adverse outcome in their second pregnancy. Cases with a late miscarriage (fetal loss at 14 to 20 weeks' gestation) in their first pregnancy had the highest risk, 80%, of an adverse outcome in their second pregnancy. Both previous pregnancy loss and anti-CL antibody status should be considered in the analysis of pregnancy outcomes in women with SLE.
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PMID:Previous pregnancy outcome is an important determinant of subsequent pregnancy outcome in women with systemic lupus erythematosus. 128 77

We report a 21-year-old woman in whom chorea was associated with antiphospholipid antibodies. In August 1986, she developed involuntary movement which started in the right hand but subsided spontaneously. In September 1988, she again developed right-sided involuntary movements which started in the right hand but rapidly progressed to involve the whole of the right side. In September 1990, she was admitted to our hospital for investigation of choreiform movements, because her involuntary movements had progressed to involve all four extremities. She had no family or past history of chorea, psychiatric, rheumatological or vascular disease. On admission, she had difficulty in speaking and swallowing due to choreiform movements of her mouth and tongue. Her gait was unsteady. On walking she had wild gyrations of the arms. Choreiform movements of all four extremities, neck, face, mouth and tongue were present at rest, more marked on the right side. There was no other neurological deficits. She had none of the classical features of SLE. She had none of the complications commonly associated with antiphospholipid antibody syndrome (APS) (i.e., recurrent spontaneous abortion, thrombosis and thrombocytopenia). Laboratory tests revealed that antinuclear antibody was present. Cardiolipin antibody (VDRL) was positive but specific tests for syphilis were negative. Anticardiolipin antibodies were present. All coagulation studies have failed to reveal lupus anticoagulant. Brain CT, MRI, 123IMP-SPECT and cerebral angiography were normal. Associated with her chorea, she had the serological but not the clinical features of APS. We suggest that antiphospholipid antibodies should be looked for in all unexplained cases of chorea, even when the associated clinical signs of APS are absent.
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PMID:[Chorea associated with antiphospholipid antibodies]. 130 Feb 73

We examined the prevalence of the antibodies to cardiolipin measured by solid-phase enzyme immunoassay during a prospective study of patients with subacute cutaneous lupus erythematosus (SCLE). Seven of 44 (16%) consecutive patients with SCLE had positive anticardiolipin antibodies; of these only three satisfied the American Rheumatism Association's revised criteria for the classification of systemic lupus erythematosus. Clinical findings probably associated with the positive anticardiolipin antibodies were found in four cases, including clotting abnormalities, thrombocytopenia, hemolytic anemia, livedo reticularis, chilblain lupus erythematosus lesions, migraine, leg venous thrombosis and pulmonary embolism after surgery, and spontaneous abortion. Our data suggest that it is reasonable to screen SCLE patients for these antibodies to confirm the presence of the antiphospholipid syndrome.
Lupus 1992 Aug
PMID:Prevalence of anticardiolipin antibodies in subacute cutaneous lupus erythematosus. 130 91

Recurrent adverse pregnancy outcome may be the final result of different causes, including autoimmune diseases, as the Antiphospholipid Syndrome. Antiphospholipid antibodies (lupus anticoagulant and/or anticardiolipin antibodies) were found in 16% of 197 patients with prior unexplained recurrent miscarriages. During our study 22 out of 32 antiphospholipid antibodies positive women became pregnant again. To prevent abortion relapses, 16 of them were treated with acetylsalicylic acid (50 mg x 2/day) and/or fluocortolone (20 mg/day for 5 days/week). Such therapy started as soon as pregnancy was diagnosed in 14 patients. Two patients began the therapeutic regimen during the third month of gestation. Six patients, who didn't accept this therapeutic approach, represent our control group. All the 14 early treated patients ended pregnancy with success. The 2 women that began the therapy later presented abortion relapses. Among the 6 not treated patients, 5 presented spontaneous abortion and only one gave birth to a baby. No side effect was observed neither in treated mothers nor in their babies. In conclusion, even if further studies would be necessary to standardise a therapeutic protocol, our results encourage the clinical care of patients with antiphospholipid antibodies and adverse pregnancy outcomes.
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PMID:Prevention of miscarriage in antiphospholipid syndrome. 130 78

Lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) have been reported to be associated with fetal loss. OBJECTIVE. Our aim was to estimate the incidence of LA and to examine the correlation between LA and ACA in pregnant women. To investigate the clinical significance of LA and ACA in an obstetric population. STUDY DESIGN. A prospective, cross sectional study of 2856 consecutive women admitted to a department of obstetrics and gynecology for delivery or due to pregnancy complications during an 11 month period. METHODS. Activated partial thromboplastin time (APTT) was determined in all patients. LA and ACA were determined if APTT > or = 35 sec. For reference ACA was determined in a group of randomly selected patients with APTT < 35 sec. The results were analyzed in relation to the obstetrical records. RESULTS. Overall incidence of APTT > or = 35 sec.: 7.0%, significantly more frequent in patients with early spontaneous abortion (18.6%) and intrauterine growth retardation (17.5%). Incidence of LA 0.07%. The patients had undetectable ACA and no clinical condition related to LA. Incidence of ACA class IgM (IgM-ACA) in patients with APTT > or = 35: 20.4%, significantly higher than in the reference group (9.6%). Uncomplicated pregnancy in 84% of patients with IgM-ACA. No cases of ACA class IgG (IgG-ACA) in patients with APTT > or = 35 but two cases in the reference group (one normal pregnancy, one spontaneous abortion). CONCLUSION. LA is a rare manifestation with uncertain significance in otherwise healthy pregnant women. IgM-ACA in low titer occurs relatively frequently during normal pregnancy.
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PMID:Lupus anticoagulant and anticardiolipin antibodies in an obstetric population. 133 19

The prevalence of anticardiolipin antibodies (ACA) was determined using an Elisa method in sera of 60 patients with autoimmune diseases. ACA were correlated with clinical manifestations of the antiphospholipid syndrome and other serological markers of autoimmunity. Sixty three percent of sera had ACA IgG (+) and 50% ACA IgM (+). Nine patients, five of them with systemic lupus erythematosus, had a history of arterial or venous thrombosis and all had positive ACA (IgG (+) in 7 and IgM (+) in 2). In patients with rheumatoid arthritis, no association was found between the presence of ACA and thrombosis. Patients with a history of spontaneous abortion had non significantly higher levels of ACA. There was a significant correlation between ACA levels and rheumatoid factor (ACA IgG r = 0.374, ACA IgM r = 0.676), no other association was found between ACA and other autoantibodies. It is concluded that ACA are found frequently in patients with autoimmune diseases and its clinical significance may be different in patients with lupus than in patients with rheumatoid arthritis or other connective tissue diseases.
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PMID:[Anticardiolipin antibodies in rheumatic autoimmune diseases. Correlation with clinical and laboratory findings]. 134 Sep 42

Antibodies directed against phospholipids are highly associated with episodes of venous and arterial thrombosis, which are often recurrent. There seems to be a skewed frequency of cerebral thrombosis when the arterial circulation is affected. Clinical clues that should lead to evaluation for aPL include stroke in a young adult, recurrent thrombosis or miscarriage, and thrombocytopenia. Associated laboratory abnormalities include a biologically false-positive test for syphilis, abnormal antinuclear antibody titers, and a high erythrocyte sedimentation rate. If the activated partial thromboplastin time is prolonged on routine screening and does not correct with mixing studies, a lupus anticoagulant should be suspected. However, more sensitive and specific tests are usually necessary to detect aPL. Many in vitro and more recently in vivo systems strongly suggest that aPL may be directly implicated in the pathogenesis of thrombosis. Optimal management of patients with aPL-associated thrombosis is unknown. The use of aggressive therapeutic management schemes with such agents as warfarin or corticosteroids is sometimes required.
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PMID:Antiphospholipid antibodies and ischemic stroke. 134 35

Patients with a history of three or more fetal losses before a gestational age of 20 weeks were examined. Only patients with normal chromosomal, hormonal and anatomic findings were included in this study. These patients were tested for the antinuclear antibody, the C3 and C4 levels, anti-ENA [Ro(SSA), La(SSB), SM, RNP, scl-70], anti-single-stranded DNA and anti-double-stranded DNA, lupus anticoagulant, anticardiolipin and antiphosphotidylserine. All of these patients were free of any symptoms, except for the repeated abortions. The results showed that 10 out of 213 (4.7%) patients with unexplained recurrent spontaneous abortions had abnormal serologic tests, and 28% of the abortions (nine out of 32 abortions) occurred during the second trimester. With treatment of low-dose aspirin alone, or in combination with prednisolone, two out of 11 pregnancies in these 10 patients resulted in repeated abortions (18%), which was significantly lower than their previous abortion rate where 32 out of 33 pregnancies resulted in abortions (97%). Four babies (three term and one premature) were delivered without any abnormalities and the other five pregnancies are beyond the 28th week of gestation and are progressing smoothly. This study revealed that subclinical autoimmune disorders may play a role in recurrent spontaneous abortions and adequate treatment can improve the pregnancy outcome.
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PMID:Treatment and outcome of unexplained recurrent spontaneous abortions in subclinical autoimmune disorders. 135 27

The case of a 34 year old woman with systemic lupus erythematosus with a history of three previous recurrent abortions and lupus anticoagulant and anticardiolipin antibodies is reported. Immunoadsorbent plasmapheresis with a dextran sulphate column was used to remove lupus anticoagulant, anticardiolipin antibodies, and antibodies to DNA during her fourth pregnancy in combination with low doses of aspirin and prednisolone. Although during the course of treatment prednisolone was transiently increased to 30 mg/day owing to an asymptomatic increase of lupus anticoagulant and anticardiolipin antibodies, the levels of lupus anticoagulant, anticardiolipin antibodies, and antibodies to DNA were decreased by immunoadsorbent plasmapheresis and a baby girl was delivered successfully by caesarean section. Therefore, immunoadsorbent plasmapheresis with dextran sulphate seems to reduce the risk of recurrent abortion in patients with the antiphospholipid syndrome.
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PMID:Immunoadsorbent plasmapheresis for a patient with antiphospholipid syndrome during pregnancy. 157 92


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