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Patients with SLE and IPO, ureterohydronephrosis have higher disease activity, organ involvement
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Patients with systemic lupus erythematosus with onset or complications of intestinal pseudo-obstruction and ureterohydronephrosis had more severe disease activity and organ involvement than patients with systemic lupus erythematosus alone, according to results from a retrospective, observational study.
Researchers analyzed data from 61 patients with systemic lupus erythematosus (SLE) who presented with complications of intestinal pseudo-obstruction (IPO) or ureterohydronephrosis, or both, to the Peking Union Medical College Hospital (PUMCH). Ultrasound and CT were used to diagnose ureterohydronephrosis, and IPO was diagnosed based on symptoms and signs of intestinal blockage, as well as X-ray and CT images without signs of anatomical or structural abnormalities. All patients were antinuclear antibody (ANA)-positive. Patients were not included if symptoms were caused by medications, tumors or other factors.
The researchers identified 32 patients with both IPO and ureterohydronephrosis, 21 patients with IPO and eight patients with ureterohydronephrosis. Thirteen patients had concurrent Sjögren’s syndrome.
Symptoms across all patient groups included fever in 31 patients, weight loss in 29 patients serositis in 40 patients, hematological involvement in 45 patients, glomerulonephritis in 42 patients and mucocutaneous involvement in 42 patients. Leukocytopenia was seen in 31 patients, and autoimmune hemolytic anemia was seen in 12 cases.
In 26 patients, IPO was the onset symptom of SLE, whereas IPO was a complication that occurred 1 month to 12 years after diagnosis in 27 patients. IPO was classified as chronic in 21 patients and acute in 32 patients. Of the patients with ureterohydronephrosis, 13 presented with ureterohydronephrosis as the first symptom of SLE.
Plain abdominal radiography of patients with IPO showed bowel distention, and CT revealed dilated bowel loops and bowel wall thickening.
In patients with ureterohydronephrosis, ultrasound revealed bladder wall thickening in 13 patients. Patients with both IPO and ureterohydronephrosis had significant gall bladder wall thickening, biliary tract dilation but were less likely to have serositis and mucocutaneous involvement. Significant differences in gallbladder wall thickening, nervous system involvement, serositis, erythrocyte sedimentation rate, immunoglobulin-G levels and in treatment type were seen among patients with both IPO and ureterohydronephrosis, and in patients who only had ureterohydronephrosis, according to the researchers.
Patients were treated with immunosuppression therapy, to which 96.2% responded. Four patients relapsed at 5, 6, 13 and 27 months and responded to retreatment with a high-dose steroid or intravenous methylprednisolone. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
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