Lupus enteritis: clinical characteristics, risk factor for relapse and association with anti-endothelial cell antibody

Abstract

The study was undertaken to evaluate clinical and laboratory characteristics of patients with lupus enteritis and to investigate its association with anti-endothelial cell antibodies (AECAs). Systemic lupus erythematosus (SLE) patients who were admitted to Kangnam St. Mary's Hospital with complaints of acute abdominal pain from January 1990 to July 2006 were reviewed retrospectively. The clinical features, laboratory data and prognosis of these patients were analyzed. Among the 706 SLE patients admitted during the study period, 87 were found to admit for acute abdominal pain. Among them, 41 patients were identified with lupus enteritis. The SLE disease activity index score at admission and the mean prednisolone dose administered during the last three months prior to admission were significantly higher in patients with lupus enteritis than those with other causes (P < 0.001, P = 0.036). Serum anti-endothelial cell antibody (AECA-IgG) titer was also significantly higher in patients with lupus enteritis than those with other manifestations or healthy controls (P = 0.040, P < 0.001). Four out of 13 recurrent patients had pre-existing anti-phospholipid syndrome (APS), whereas only one out of 28 non-recurrent patients had pre-existing APS (P = 0.028). Most of the patients with lupus enteritis showed good response to high-dose intravenous steroids and there was no death directly associated with lupus enteritis.

Lupus Enteritis: An Important Cause to Be Considered in Systemic Lupus Erythematosus Patients with Acute Abdomen – A Case Report

“…Abdominal pain is the most common presenting symptom amongst other non-specific manifestations like ascites, nausea, vomiting, diarrhea and fever and has been shown to be the most common cause of abdominal pain in SLE patients seeking emergency room treatment (6). Typically, the abdominal pain described in lupus enteritis is diffuse in pattern and in some cases accompanied by rebound tenderness and abdominal muscle guarding (1).…”

“…Other than a drop in white blood cell count and complement titres, which may correlate with the occurrence of lupus enteritis, none of the laboratory indices have been found to be useful to establish the diagnosis (5, patient discussed had Low complement levels. Medina et al (7) and Buck et al (8) have reported that gastrointestinal vasculitis or thrombosis in SLE had higher SLEDAI scores than patients with active SLE with non-SLE related acute abdomen, but no such correlation was established by Lee et al (6). However, the presence of autoantibodies against phospholipids and endothelial cells might provide information about the likelihood of recurrence of lupus mesenteric vasculitis (9).…”

“…Lack of specificity of these signs is a limitation of CT because they can also be seen in patients with pancreatitis, mechanical bowel obstruction, peritonitis, or inflammatory bowel disease, all of which may mimic intestinal ischemia (1,5,6). …”

“…Cyclophosphamide or Mycophenolate may be added in case of resistance to corticosteroids or when warranted by other organ involvement (1). Complete resolution of acute abdominal pain took a few weeks and no patients developed GI perforation in the series by Lee et al, (6). Medina et al, (7) emphasizes the importance of early laparotomy as it influences positively on the prognosis of SLE patients with acute abdomen, however seems unnecessary with the available evidence unless there is a strong suspicion of perforation.…”

Clinical and laboratory manifstations in Systemic Lupus Erythematosus

“…Esta última manifestación se observa en los pacientes que presentan fenómeno de Raynaud (74). Los pacientes con LES pueden tener compromiso de los vasos mesentéricos por vasculitis o trombosis (75).…”