WCIM 2014 SEOUL KOREA 231
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0709 Rheumatology
The Impact of Immunological Tests in Systemic Lupus Erythematosus Activity
Artur ZOTO1, Zamira YLLI2, Arjan HARXHI3, Renato OSMENAJ4, Brikena SELIMI5 Rheumatology, University Hospital Center, Albania1, Immunology, University Hospital Center, Albania2, Infectious Disease, University Hospital Center, Albania3, Radiology, University Hospital Center, Albania4, Ophthalmology, University Hospital Center, Albania5
Background: Systemic lupus erythematosus is a complex systemic autoimmune dis- ease, with numerous immunologic and clinical manifestations. It is considered as the prototype of autoimmune disease and it is characterized by the production of a wide series of autoantibodies as well as by a variable clinical presentation. Purpose of our study was to evaluate the impact of immunological tests in disease activity in patients with systemic lupus erythematosus
Methods: We analyzed 80 patients with systemic lupus erythematosus. The labora- tory tests requested for the patients such as: anti-nuclear antibody test, anti double stranded DNA antibody, complement levels and antiphospholipid antibody. Lupus ac- tivity was assessed according to systemic lupus erythematosus Disease Activity Index.
Patients are divided into three groups which were mild, moderate and severe based on disease activity index.
Results: Patients with positive anti-nuclear antibody were 74 (92.5 %), anti-ds DNA antibody positive were 52 ( 65 %) patients, low complement levels were 36 (45 %) patients and antiphospholipid antibody were 22 (27.5 %) patients. Patients with severe disease were 42 (52.5 %), moderate disease were 20 (25 %) patients and mild disease was 18 (22.5 %) patients. We found correlation between immunological alterations and disease activity.
Conclusions: Immunological alterations are important factor in disease activity in patients with systemic lupus erythematosus and may help physician to evaluate prog- nosis in systemic lupus erythematosus patients.
PS 0710 Rheumatology
Detection of Anti-ENA and Anti-Ds DNA Antibodies in Sera of Patients Positive for Anti-Nuclear Antibodies (ANA)
Efterpi BOGIA1, Christina BOTZIORI2, Christina STEFANIDOU3, Pantelis FYTAS4, Eleni KAKASI5, Asimoula KOTELI6
General Hospital Agios Pavlos, Greece1, General Hospital Agios Pavlos, Greece2, General Hospital Agios Pavlos, Greece3, General Hospital Agios Pavlos, Greece4, General Hospital Agios Pavlos, Greece5, Gen- eral Hospital Agios Pavlos, Greece6
Background: The detection of extractable nuclear antibodies (anti-ENA: Jo-1, Scl-70, SSA/Ro, SSB/La, Sm, Sm/RNP) and anti-ds DNA in sera of patients positive for antinu- clear antibodies (ANA).
Methods: 1084 sera of patients with autoimmune disorders, collected between Septem- ber 2010 and August 2012, were tested for ANA and anti-ds DNA, by indirect immuno- fl uorescence technique (IFA), and for anti-ENA, by enzyme immunosorbent assay (ELISA).
Results: 328 out of the 1084 (30,26%) were found ANA positive and 756 (69,74%) ANA negative. The most common pattern for the ANA was the speckled, followed by the homogeneous. In 154 of the positive samples, anti-ds DNA was tested, with 8 cases (5,2%) positive, over 146 (94,8%) negative. 224 samples were evaluated for anti-ENA, with 104 (46,43%) that were found positive and 120 (53,57%) negative. The prevalent anti-ENA was SSA/Ro, that was found in 37 patients (35,57%) and was associated with other antinuclear antibodies in 26 cases (25%). Second in prevalence was Sm/
RNP, isolated in 15 cases (14,42%) and associated with other antinuclear antibodies in 13 patients (12,5%), all of them with coarse speckled nuclear pattern. The remaining 13 samples positive for anti-ENA had other positive antibodies from the panel.
Conclusions: The identification of autoantibodies contributes to the diagnosis and prognosis of autoimmune disorders. Especially, the anti-ds DNA are detected only when ANA are positive in SLE suspected cases.
PS 0711 Rheumatology
Causal Link Between Thrombocytopenia and Poor Prog- nosis in Patients with Systemic Lupus Erythematosus
Ki-Jo KIM1, In-Woon BAEK2, Chong-Hyeon YOON3, Wan-Uk KIM4, Chul-Soo CHO2 The Catholic University of Korea, St. Vincent Hospital, Korea1, The Catholic University of Korea, Yeouido St. Mary’s Hospital, Korea2, The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Korea3, The Catholic University of Korea, Seoul St. Mary’s Hospital, Korea4
Background: Thrombocytopenia is a common hematologic manifestation of systemic lupus erythematosus (SLE) and forecasts an unfavorable outcome for SLE. The aim of this study is to investigate the causes of thrombocytopenia and their frequency in SLE patients and to fi nd out the clinical evidence linking lupus-associated thrombocytope- nia and poor prognosis.
Methods: The charts of 393 patients with SLE from a single tertiary center between 1988 and 2012 were reviewed. Thrombocytopenia was defined as a platelet count
<100,000/L and clinical and serologic characteristic of the study subjects were ana- lyzed with a focus on the incidence and associations of thrombocytopenia.
Results: Thrombocytopenia of 318 events was found in 154 patients and the most common causes are thrombocytopenia during flare-up (135, 42.5%) and isolated thrombocytopenia (105, 33%). Patients with thrombocytopenia had more pulmonary hypertension, hemolytic anemia, and neuropsychiatric involvement and received higher dose of glucocorticoid. Infection and arterial thrombosis occurred more commonly and progression rate to end-stage renal disease was higher in patients with thrombocyto- penia. Positive rate of anti-histone antibody and lupus anticoagulant was also higher in patients with thrombocytopenia. During follow-up, patients with thrombocytopenia had higher cumulative organ damage and showed signifi cantly reduced survival rate.
By multivariate analysis, thrombocytopenia (HR 4.958, 95% CI 1.231–19.969, P = 0.024), infection (HR 9.293, 95% CI 2.222–38.869, P = 0.002) and cumulative dose of glucocorticoid (HR 14.993, 95% CI 3.232–69.545, P = 0.001) were independent pre- dictors of mortality.
Conclusions: Thrombocytopenia is closely linked with critical manifestations affecting the disease outcome and functions as an independent predictor for mortality.
PS 0712 Rheumatology
Acute Myocarditis in Patients with Systemic Lupus Erythematosus: Experience from Affi liated Hospitals of Catholic University of Korea
In-Woon BAEK1, Ki-Jo KIM2, Yune-Jung PARK2, Chong-Hyeon YOON3, Wan-Uk KIM4, Chul-Soo CHO1
Yeouido St. Mary’s Hospital, The Catholic University of Korea, Korea1, St. Vincent’s Hospital, The Catho- lic University of Korea, Korea2, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Korea3, Seoul St. Mary’s Hospital, The Catholic University of Korea, Korea4
Background: To determine the factors associated with occurrence of acute myocardi- tis (AMC) and its outcomes in patients with systemic lupus erythematosus (SLE).
Methods: This was a retrospective study of hospitalized SLE patients with AMC from 2002 to 2014 at Catholic University affi liated hospitals. A diagnosis of AMC was made on the basis of clinical fi ndings, electrocardiographic changes, elevated cardiac en- zymes levels and echocardiographic abnormalities. Eighty-six SLE patients who showed no echocardiographic evidence of myocarditis were enrolled as a control group. The clinical and laboratory data from each patient were collected from the charts and compared between 2 groups.
Results: During these periods, 22 SLE patients were identifi ed to have AMC (male 3, female 19). Patients with AMC, as compared with those without, were found to be associated with shorter disease duration and higher frequency of smoking (P<0.005, P<0.05, respectively). Moreover, they showed signifi cantly higher SLE disease activity index score (P<0.001) and C-reactive protein levels (P<0.001), but lower complement levels (C3, C4 and CH50, all P<0.005). Interestingly, antiphospholipid syndrome (APS) was more prevalent in patients with AMC compared with those without (P<0.01). In multivariate analysis, shorter disease duration, smoking and presence of APS were independent factors associated with AMC in SLE patients. All patients with AMC received high-dose corticosteroid and 2 of them received intravenous cyclophospha- mide; 17 patients completely recovered, but 5 died.
Conclusions: AMC patients are more likely to have high disease activity and its occur- rence is associated with shorter disease duration, smoking, and presence of APS.
