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Sleep disturbances and prevalence of depression in systemic lupus erythematosus patients receiving intravenous cyclophosphamide
Mesquita, Rafael Carvalho;Souza, Lívia Noronha Coelho de;Bruin, Pedro Felipe Carvalhedo de;Carvalho, Raquel Ribeiro;Medeiros, Marta Maria das Chagas;Rocha, Francisco Airton Castro da;Bruin, Veralice Meireles Sales de;
Revista Brasileira de Reumatologia , 2007, DOI: 10.1590/S0482-50042007000600002
Abstract: background: pulse i.v. cyclophosphamide is a therapeutic option in severe forms of systemic lupus erythematosus (sle). however, the overall toxicity and risk profile are yet to be adequately defined. objective: to evaluate the occurrence of sleep disturbances in sle patients subjected to i.v. cyclophosphamide. methods: we studied thirty consecutive sle patients (27 female) age range 14 to 53 years (mean 30.5 ± 10 years) that received i.v. cyclophosphamide (mg) (mean 948.27 ± 221.39). depressive symptoms, quality of sleep, and the presence of excessive daytime sleepiness were evaluated. disease severity was assessed by the sledai. quality of sleep was assessed by the pittsburgh sleep quality index (psqi) and excessive daytime sleepiness (eds) by the epworth sleepiness scale (ess). depressive symptoms were evaluated using the 21-item beck depression inventory (bdi). results: sledai values ranged from 2 to 46 (mean 17 ± 11.4). the most common comorbidities were systemic arterial hypertension (30%), anemia (23.3%), osteoporosis (23.3%), and cardiomyopathy (6.6%). seizures occurred in one patient (3.3%). poor quality of sleep (psqi e" 6) and eds (ess >10) were found in 66.7% and 30% of the patients, respectively. depressive symptoms (bdi >19) were present in 40% of the patients and were associated with poor sleep quality (p = 0.03). conclusions: our findings show an increased prevalence of poor sleep quality and depressive symptoms in sle patients receiving pulse i.v. cyclophosphamide. these findings were similar to other previously reported series of sle patients regardless of the therapies used.
Dexamethasone-cyclophosphamide pulse therapy in systemic lupus erythematosus  [cached]
Dhabhai Ravindra,Kalla G,Singhi M,Ghiya B
Indian Journal of Dermatology, Venereology and Leprology , 2005,
Abstract: BACKGROUND AND AIMS: Therapy systemic lupus erythematosus (SLE) has been generally discouraging. Methyl-prednisolone pulse therapy has been used for various connective tissue disorders. We used intravenous dexamethasone cyclophosphamide pulse therapy to treat SLE. METHODS: Fourteen patients (10 females and 4 males) between the age of 15-48 years with definite or classical clinical criteria laid by American Rheumatism Association criteria were treated by Dexamethasone-Cyclophosphamide pulse (DCP) therapy at our center. RESULTS: It was possible to induce a complete clinical remission with DCP therapy in most of the patients thereby offering them life free from disease and drugs. The side effects commonly observed with conventional daily dose regimen of corticosteroids were not present or were mild. CONCLUSIONS: Almost all patients had good response after 3-4 pulses to allow them a normal life style. Fever, malar rash and oral ulceration responded early but photosensitivity, discoid rash, alopecia and joint pains took some more time.
Association between low-dose pulsed intravenous cyclophosphamide therapy and amenorrhea in patients with systemic lupus erythematosus: A case-control study
Sayumi Baba, Yasuhiro Katsumata, Yasushi Kawaguchi, Takahisa Gono, Tomoko Sugiura, Tokiko Kanno, Masako Hara, Hisashi Yamanaka
BMC Women's Health , 2011, DOI: 10.1186/1472-6874-11-28
Abstract: A case-control retrospective study of premenopausal women ≤ 45 years old who had been treated for SLE with low-dose IVCY (500 mg/body/pulse) plus high-dose glucocorticoids (0.8-1.0 mg/kg/day of prednisolone; IVCY group) or glucocorticoids alone (0.8-1.0 mg/kg/day of prednisolone; steroid group) in our hospital from 2000 through 2009 was conducted using a questionnaire survey and medical record review.Twenty-nine subjects in the IVCY group and 33 subjects in the steroid group returned the questionnaire. A multivariate analysis revealed that age at initiation of treatment ≥ 40 years old was significantly associated with amenorrhea [p = 0.009; odds ratio (OR) 10.2; 95% confidence interval (CI) 1.8-58.7]. IVCY treatment may display a trend for association with amenorrhea (p = 0.07; OR 2.9; 95% CI 0.9-9.4). Sustained amenorrhea developed in 4 subjects in the IVCY group and 1 subject in the steroid group; all of these patients were ≥ 40 years old. Menses resumed in all subjects < 40 years old, irrespective of treatment.Although low-dose IVCY may increase the risk for amenorrhea, our data suggest that patients < 40 years old have a minimum risk for sustained amenorrhea with low-dose IVCY treatment. A higher risk for sustained amenorrhea following treatment with IVCY is a consideration for patients ≥ 40 years old.Systemic lupus erythematosus (SLE) remains a therapeutic challenge. One of the most successful therapies for severe SLE has been administration of monthly intravenous cyclophosphamide (IVCY) for 6 months followed by quarterly maintenance infusions for 2 years (traditional/NIH IVCY regimen) [1-3]. However, the side effects of long-term exposure to cyclophosphamide include infection, bone marrow damage, malignancy, hemorrhagic cystitis, and ovarian dysfunction [2]. Ovarian dysfunction may result in physiological changes associated with menopause, including loss of bone mineral density, hypercholesterolemia, onset of vasomotor and genitourinary symptoms, psychological
Primary osteosarcoma of the urinary bladder following cyclophosphamide therapy for systemic lupus erythematosus: a case report
Dilek Baydar, Cigdem Himmetoglu, Sertac Yazici, Halil Kiziloz, Haluk Ozen
Journal of Medical Case Reports , 2009, DOI: 10.1186/1752-1947-3-39
Abstract: A 24-year-old Caucasian woman with a 13-year history of systemic lupus erythematosus, who had been treated with high dose immunosuppressive agents, presented with pain and hematuria. A deeply invasive high-grade tumor was detected in the urinary bladder and the patient underwent radical surgery. A diagnosis of osteosarcoma was made based on the characteristic histology.Predisposing factors for primary sarcomas in the urinary bladder are mostly unknown; however, in our case, long-term administration of immunosuppressive agents, as well as long standing systemic lupus erythematosus, may both be of significance.In this report, we present the case of a 24-year-old woman with a primary osteosarcoma of the urinary bladder. Malignant mesenchymal tumors comprise less than 0.04% of urinary bladder malignancies [1]. The most frequent histology is rhabdomyosarcoma in children and leiomyosarcoma in the older age group. In the English language medical literature, only 30 cases of primary osteosarcoma of the urinary bladder have been reported to date. Our case, being the 31st, is unique in respect to the patient's age and the history of systemic lupus erythematosus (SLE), which appears as a possible predisposing factor. The patient had been treated with immunosuppressive medications including cyclophosphamide for active SLE for many years. Neoplastic transformations in SLE are accepted as occurring more frequently than in the general population [2];most tumors are lymphomas with sarcomas being exceptional and, to our knowledge, no previous cases of osteosarcoma, in any location in the body, accompanying SLE, have been reported.We first saw our patient in 1995 when she was an 11-year-old girl and she presented with fever, fatigue, loss of appetite, malar rash and swelling in the small joints of her hands. Laboratory investigations at that time revealed elevated antinuclear antibody titer (1/1000) and anti-dsDNA levels (124 IU/mL), anemia, decreased C3 (14.3) and C4 (8.1) and SLE w
Osteoporosis en mujeres premenopáusicas con lupus eritematoso sistémico Osteoporosis en premenopausal women with systemic lupus erythematosus
Miguel Hernán Estévez del Toro,Araceli Chico Capote,Marx Montes Zavala,ángela Gutiérrez Rojas
Revista Cubana de Medicina , 2007,
Abstract: La prevalencia de osteoporosis en pacientes con lupus eritematoso sistémico (LES) no es bien conocida. Se realizó un estudio de cohorte que incluyó, 96 pacientes con LES y un grupo control de 96 mujeres, aparentemente sanas, pareadas con las pacientes por edad y color de piel, para identificar la frecuencia con que se presenta la misma en pacientes mujeres premenopáusicas con esta enfermedad e identificar algunos de los factores de riesgo asociados a su presencia. A los 2 grupos se les recogieron datos demográficos y en las enfermas además se precisaron exposición a hábitos tóxicos como cigarro, café y alcohol, edad al diagnóstico, tiempo de evolución de la enfermedad y medicamentos utilizados. Tanto a pacientes como controles se les realizó una densitometría por medio de un osteosonómetro de calcáneo y se clasificaron en normales, osteopénicas u osteoporóticas. Se relacionó la presencia de osteoporosis con las variables consideradas. Se observó osteoporosis en 10 de las 96 pacientes (10,4 %) y en 1 sola mujer del grupo control, la diferencia fue estadísticamente significativa (p = 0,005). El riego relativo de tenerla es 10 veces mayor en las enfermas que en los controles, se relacionó de forma significativa con su presencia, el mayor tiempo de evolución (p = 0,04) y la dosis acumulada de glucocorticoides (p = 0,008), factores de riesgo como el consumo de alcohol, café y hábito de fumar no se asociaron con la presencia de osteoporosis. Se concluyó que la osteoporosis se presenta en las pacientes con LES y la dosis acumulada de glucocorticoides se asocia con su presencia. The prevalence of osteoporosis en patients with systemic lupus erythematosus (SLE) is not well known. A cohort study including 96 patients with SLE and a control group of 96 apparently sound women, matched with the patients by skin colour and sex, was conducted to identify its frequency in premenopausal women with this disease and to know some of the risk factors associated with its presence. Demographic data were collected in the 2 groups and the presence of toxic habits, such as alcohol, coffee and cigarettes, the age on diagnosis, the time of evolution of the disease and the drugs used were determined among the sick. Patients and controls underwent a densitometry by means of a calcaneus osteosonometer, and they were classified into normal, osteopenic and osteoporotic. The presence of osteoporosis was related to the variables considered. It was observed osteoporosis in 10 of the 96 patients (10.4 %) and in only one woman of the control group. The difference was statistically significa
Nocardial cerebellar abscess in a case of systemic Lupus erythematosus receiving long term corticotherapy
Saberi H,Fakhr Tabatabai SA,Hussain Khan Z
Acta Medica Iranica , 2001,
Abstract: Central nervous system ranks among the favorite sites to get involved by Nocardia astroides. This opportunistic organism complicates many disorders characterized by cellular or humoral immunity disturbances.A 36-year-old woman is being presented, known to have systemic lupus erythematosus (SLE) and having received a two year course of corticosteroid treatment. Cerebellar abscess was found on diagnostic imagings performed because of heddaches and dysequilibrium of two weeks duration.Craniectomy was performed and the abscess excised. Nocardia astroides grew in the pus culture. On switching the empirical therapy to a combination of trimethoprimsulfamethoxazole and vancomycin, the patient exhibited dramatic improvement in symptoms later on and postoperative imaging showed an absence of the lesion. We recommend a high index of clinical suspicion for nocardia abscess in patients suffering from SLE and presenting with neurological treatment presents the only plausible option
Lupus erythematosus profundus  [cached]
Aggarwal Kamal,Jain V,Dayal Surbhi
Indian Journal of Dermatology, Venereology and Leprology , 2002,
Abstract: A case of lupus erythematosus profundus, with associated mastitis, but without any lesions of discoid lupus erythematosus or systemic lupus erythematosus is being reported.
Mycophenolate mofetil in neuropsychiatric systemic lupus erythematosus  [cached]
Jose J,Paulose B,Vasuki Z,Danda D
Indian Journal of Medical Sciences , 2005,
Abstract: Neuropsychiatric abnormalities frequently occur in patients with systemic lupus erythematosus, affecting as many as 14-75% of people with this disease. High-dose steroid with or without anticoagulation is the mainstay of treatment in neuropsychiatric systemic lupus erythematosus (NPSLE). Use of mycophenolate as a steroid sparing drug may be a potential alternative agent in the therapy of NPLE, but lack of randomized trials and cost prohibit its widespread use. Its safety profile is higher than that of cyclophosphamide and azathioprine. We report a successfully treated case of neuropsychiatric systemic lupus erythematosus, presenting as psychosis, whose long-term remission was maintained on treatment with mycophenolate mofetil.
Bullous systemic lupus erythematosus  [cached]
Aswani V,Vaz B,Shah S,Malkani R
Indian Journal of Dermatology, Venereology and Leprology , 1993,
Abstract: Bullous systemic lupus erythematosus (BSLE) is a rare variant of systemic lupus erythematosus (SLE) which histologically resembles dermatitis herpetiformis (DH) and responds dramatically to dapsone. We report a case of bullous SLE.
Longitudinal Myelitis As The First Manifestation of Systemic Lupus Erythematosus
Journal of Neurological Sciences , 2009,
Abstract: Acute longitudinal myelitis (ALM) as the initial manifestation of systemic lupus erythematosus (SLE) has been reported in just two cases. We herein present the third case associated with antiphospholipid antibodies with an unfavorable outcome. All patients with ALM should be tested for SLE and urgent treatment with intravenous pulse methylprednisolone and cyclophosphamide must be started. Alternative treatment trials must also be established as there are patients with permanent neurologic disability like ours despite appropriate therapy.
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