Prevalence, severity, and clinical features of acute and chronic pancreatitis in patients with systemic lupus erythematosus

Abstract

Pancreatitis is a rare, life-threatening complication of systemic lupus erythematosus (SLE). This study aimed to describe the clinical features of acute pancreatitis (AP) and chronic pancreatitis (CP) in patients with SLE. Data of patients who fulfilled the revised criteria of the American Rheumatism Association for diagnosis of SLE were retrospectively analyzed. SLE activity was graded according to the SLE Disease Activity Index. Logistic regression analysis was conducted to find out independent associations. Survival rates were estimated by using Kaplan-Meier plots. This study included 5665 SLE patients admitted between January 1983 and January 2014, of whom 52 patients were diagnosed with pancreatitis. Pancreatitis prevalence in SLE patients was 0.92 % (52/5665). AP (0.8 %, 46/5665) was more prevalent than CP (0.1 %, 6/5665), presented mostly during active SLE, and affected more organs. Hypertriglyceridemia occurred in 76.9 % of AP patients and in none of the CP patients. AP patients were divided into severe (n = 10) or mild (n = 20) cases. The average triglyceride level in severe AP cases was higher than that in mild AP cases (P = 0.006), and the mortality rate of lupus-associated AP was 32.6 % (15/46). Concomitant infections and thrombocytopenia were independently associated with poor prognosis (P < 0.001, P = 0.028, respectively). There were significant differences in the clinical manifestations of AP and CP. Patients with severe AP were found to have a higher incidence of concomitant infection and serum triglyceride levels. Concomitant infections and thrombocytopenia were independent risk factors for poor prognosis.

Acute pancreatitis in childhood-onset systemic lupus erythematosus: Case report

“…12 Corticosteroids should be used for the medical management of SLE-related acute pancreatitis; in particular, treatment with additional steroids at high doses has been successful in the management of SLE-related pancreatitis. 2,13 In this report, the patient developed SLE-related acute pancreatitis concurrently with lupus nephritis; both complications were successfully treated with corticosteroids. Immunosuppressive agents such as mycophenolate mofetil or cyclophosphamide can be used in combination with corticosteroids.…”

“…Good supportive measures are helpful for facilitating functional recovery and improving patient outcomes 2 . In severe cases, plasmapheresis and intravenous gamma-globulin infusion may be beneficial 13 . Our case suggests that methylprednisolone pulse therapy should be promptly administered if clinical and biochemical investigation suggest that SLE is responsible for pancreatitis.…”

Pancreatitis aguda en el lupus eritematoso sistémico de inicio en la niñez: A propósito de un caso

“…12 Se deben usar corticoesteroides para el tratamiento médico de la pancreatitis aguda asociada a LES; en particular, el tratamiento con corticoesteroides en dosis altas adicionales ha sido satisfactorio en el manejo de la pancreatitis asociada a LES. 2,13 La paciente descrita en este informe desarrolló pancreatitis aguda asociada a LES concurrente con nefritis lúpica; ambas complicaciones se trataron adecuadamente con corticoesteroides. Los agentes inmunosupresores, como micofenolato mofetilo o ciclofosfamida, p u e d e n u s a r s e e n c o m b i n a c i ó n c o n corticoesteroides.…”

Silence pancreatitis in systemic lupus erythematosus

“…The high mortality rate in SLE pancreatitis is associated with severe disease activity, thrombocytopenia and acute renal failure (3,4,6). Due to clinically significant renal failure, our patient was referred to haemodialysis treatment via CVK.…”

“…Other biochemical abnormalities include hypertriglyceridemia, hypocalcaemia, hypoalbuminemia, abnormal liver function tests and elevated serum creatinine. The exact pathogenic mechanisms of SLE related pancreatitis are not clear, but are probably mediated by immune complex-induced microangiitis (2)(3)(4).…”