Serositis related to systemic lupus erythematosus: prevalence and outcome

Abstract

The objective of this study was to describe the prevalence and outcome of disease-related serositis in Chinese patients with systemic lupus erythematosus (SLE). The records of all SLE patients who attended the medical clinics of Tuen Mun Hospital, Hong Kong were retrospectively reviewed. Patients with disease-related serositis at any stage of their illness were identified and the outcome of these serositis episodes was reported. Three-hundred and ten patients (90% women) who fulfilled at least four of the ACR criteria for SLE were studied. The mean age of SLE onset was 32.6 +/- 13.1 years. sixty-nine episodes of SLE-related serositis occurred in 37 patients - 18 (26%) episodes were pericarditis/ pericardial effusion, 30 (44%) were pleuritis/pleural effusion and 21 (30%) were peritonitis/ascites. The prevalence of serositis was 12%. At the time of serositis, 34 (92%) patients had active SLE in other systems. Nonsteroidal anti-inflammatory drugs (NSAIDs) were initially used in 13 (35%) patients. Moderate to high doses of oral prednisolone was used in 28 (76%) patients for both serositis and concomitant disease activity in other organs. All episodes of serositis resolved completely within two months. Over a mean observation of 46 months, nine patients had 18 relapses of serositis, which were responsive to either NSAIDs or augmentation of prednisolone dosage. Pleural fibrosis developed in three patients. Serosal complications are not uncommon in patients with SLE and can be life-threatening. NSAIDs and corticosteroids are often effective but more aggressive immunosuppressive therapy is required for severe or refractory cases. The prognosis of lupus serositis is generally good. Relapse or progression to fibrotic disease is uncommon.

Pleuroparenchymal fibroelastosis in patients with pulmonary disease secondary to bone marrow transplantation

“…The correlation of idiopathic pneumonia syndrome with serositis, fibrosis and pneumothorax may be of particular interest in our cases, as the latter two are certainly present and chronic serositis may have preceded the extensive pleuroparenchymal changes seen. Pleuritis, in the context of systemic lupus erythematosus, is known to have the potential to lead to pleural fibrosis in a minority of patients, 22 as can drug-induced and rheumatoid pleuritis. 23 Given organising pneumonia is a known complication of bone marrow transplantation, we hypothesise that pleuroparenchymal fibroelastosis may also represent persistence rather than resolution of intra-alveolar organisation.…”

Massive and painful ascites as a presenting manifestation of systemic lupus erythematosus flare: a case report and literature review

“…According to the literature, non-steroidal anti-inflammatory drugs (NSAIDs) 13 , antimala-rials 3,14 and immunosuppressive drugs including glucocorticoids 3,[15][16][17] , azathioprine 15,18 and cyclophosphamide 19 have been used in the management of LP-associated ascites. Patients usually respond well to steroids 16,17 .…”

Autologous hematopoietic stem cell transplantation in systemic lupus erythematosus patients with cardiac dysfunction: feasibility and reversibility of ventricular and valvular dysfunction with transplant-induced remission

“…The reported prevalence of pericardial effusions/pericarditis in SLE ranges from 9 to 58% on echocardiographic studies, and is usually asymptomatic and associated with active disease. 32,33 Pericardial tamponade is rare; 34,35 and while our patient had echocardiographic evidence of tamponade, she was managed expectantly given the absence of clinical hemodynamic compromise. Serosal disease in SLE usually responds to immunosuppressive therapy, as occurred in our patient after auto-HSCT.…”