Systemic lupus erythematosus-myositis overlap syndrome with lupus nephritis

Dey, Biswajit; Rapahel, Vandana; Khonglah, Yookarin; Jamil,

doi:10.4103/jfmpc.jfmpc_186_20

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…Renal involvement in SLE occurs in 20-50 % of cases during their disease course [10]. In the present study, 43.7% of cases had renal involvement as documented by renal biopsy.…”

Section: Discussionsupporting

confidence: 48%

Natural Killer Cell Count in Systemic Lupus Erythematosus Patients: A Flow Cytometry-Based Study

Thangjam,

Dey,

Khonglah

et al. 2023

Cureus

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BackgroundNatural killer cells (NK cells) are important mediators of innate immune regulation and literature has shown that they have a role in shaping the adaptive immune system. ObjectiveThe present study was undertaken to analyze the NK cell count in systemic lupus erythematosus (SLE) patients as compared to that of controls. Materials and methodsSafety of Estrogens in Lupus Erythematosus National Assessment SLE Disease Activity Index (SELENA-SLEDAI) score was assessed in 32 SLE cases. CD3(-) cells were identified as NK cells on flow cytometry, and then their subsets CD56(+) and CD16(+) cells were identified compared to 30 healthy controls. Receiver Operating Characteristic (ROC) curve analysis was performed on NK cells to attempt to determine a cut-off point. ResultsThe CD3(-) NK cells, including the percentages of CD56(+) and CD16(+), were significantly (p<0.001) reduced in SLE patients (12.35%, and 18.7%) as compared to controls (24.67%, and 46.6%). On ROC curve analysis, cut-off values <481/cumm with sensitivity of 86.7% and specificity of 84.4% for CD3(-) NK cells (p<0.001), <23% with 60% sensitivity and 75% specificity for CD56(+) NK cells (p<0.001), and <29% with sensitivity of 70% and specificity of 87.5% for CD16(+) NK cells (p<0.001) were noted. Subsets of NK cells showed no association with the clinicopathological parameters like age, sex, disease activity, anti-nuclear antibodies (ANA), dsDNA, absolute lymphocyte count, and renal involvement. ConclusionNK cells, and their subpopulations of CD56(+) and CD16(+) cells, are decreased in patients with SLE as compared to controls.

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“…Renal involvement in SLE occurs in 20-50 % of cases during their disease course [10]. In the present study, 43.7% of cases had renal involvement as documented by renal biopsy.…”

Section: Discussionsupporting

confidence: 48%

Natural Killer Cell Count in Systemic Lupus Erythematosus Patients: A Flow Cytometry-Based Study

Thangjam,

Dey,

Khonglah

et al. 2023

Cureus

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“…Regarding the management of this case, glucocorticoids are usually used in the flare-up of SLE and myositis to achieve remission while tapering the dose and replacing it with hydroxychloroquine or an immunosuppressant. Nevertheless, patients with lupus nephritis are treated with an anti-inflammatory immediately, followed by a potent immunosuppressive agent usually for three to six months, and a maintenance phase that lasts for three years [ 2 , 4 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…These myopathies are further subcategorized into four main subtypes based on both the clinical phenotype and histopathology, namely, dermatomyositis, polymyositis, inclusion body myositis, and necrotizing myopathies [ 3 ]. To date, many myositis-associated and specific autoantibodies have been detected and their clinical significance on manifestation and prognosis have been elucidated [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Overlap Syndrome in a Male Presenting With Progressive Lower Limb Weakness: A Case Report

Dubai¹,

Isa²

2023

Cureus

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Overlap syndrome refers to a large group of inflammatory rheumatic conditions characterized by the coexistence of clinical manifestations that include different organ systems and meet the criteria of more than one rheumatic disease. Overlap syndromes are less common compared with the conditions they encompass, for example, the global prevalence of systemic lupus erythematosus (SLE) is estimated to be 43.7 per 100,000 persons, of which only around 3.4-6.3% present with SLE-myositis overlap. Although rare, overlap syndromes commonly include lupus, rheumatoid arthritis, scleroderma, and myositis. Because overlap syndrome can manifest in several ways and has an unpredictable course, it poses a challenge to multidisciplinary teams that examine and treat patients. Therefore, we must not disregard any signs and symptoms as they might have a huge impact on the progression of the disease and the overall outcome of the treatment. We present a rare case of SLE-myositis overlap syndrome in a 44-year-old male. He initially presented with gradual weakness in the proximal muscles of the bilateral lower limb. This patient was diagnosed as having SLE with positive 5g protein/24 hours, anti-nuclear, low C3, anti-U1RNP, anti-Ro, and anti-La antibodies, as well as membranous lupus nephritis evident by the results of renal biopsy. The diagnosis of myositis was also made according to the history and evaluation of the patient, the high titer of muscle enzymes creatine kinase level, and MRI result. Although the patient tested positive for anti-U1RNP, he did not meet the criteria of mixed connective tissue disease. Eventually, the patient was found to have overlap syndrome. The prevalence of overlap between SLE and myositis is relatively rare and varies from 3.4% to 6.3%. To our knowledge, no study has discussed or reported its prevalence among males.

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“…It has been shown that myositis in SLE responds well to corticosteroids. This patient is closely monitored for SLE-myositis overlap syndrome, as this could lead to poor prognosis, especially when there is evidence of pulmonary involvement [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Recurrent Temporal Infections: The Link to Systemic Lupus Erythematosus

Shuhardi,

Mohamed Said,

Kew

et al. 2023

Am J Case Rep

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Patient: Female, 51-year-old Final Diagnosis: Osteomyelitis of the zygomatic bone • temporalis pyomyositis Symptoms: Recurrent abscess of lower left eyelid • recurrent abscess of the left temple Clinical Procedure: Incision and drainage • incisional biopsy Specialty: Dentistry • Laboratory Diagnostics • General and Internal Medicine • Radiology • Rheumatology Objective: Unusual clinical course Background: Systemic lupus erythematosus (SLE) is an autoimmune disease with diverse manifestations. The involvement of the musculoskeletal system is very common, and infection is one of the manifestations, which can involve any part of the body. We report a case of a middle-aged woman with recurrent episodes of infection of her left temple. Case Report: A 51-year old woman was referred to our clinic following failures to eradicate infection on her left temple for 9 months. Examination revealed facial asymmetry, with diffuse non-tender swelling involving her left temple area, which extended to her cheek. Computed tomography and magnetic resonance imaging (MRI) showed a periosteal reaction of the zygomatic bone. Left temporalis muscle thickening and residual osteomyelitis of the zygomatic bone were also shown by MRI. In view of the unresolved infection with incision and drainage and antibiotics, further blood investigations led to the discovery of SLE. The antinuclear antibody and anti-double-stranded DNA were positive. In addition, low nephelometry markers, C3 (26.7 mg/dL) and C4 (8.24 mg/dL), were observed. This patient was treated with 200 mg of oral hydrochloroquine once daily and 5 mg of oral prednisolone once daily. After 6 months of treatment, the infection subsided, and the structures involved showed remarkable healing. The patient is still taking the same dose and frequency of both drugs at the present time. Conclusions: Temporalis pyomyositis and osteomyelitis of the zygomatic bone could be manifestation of SLE disease; however, the involvement of infection cannot be ruled out.

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Systemic lupus erythematosus-myositis overlap syndrome with lupus nephritis

Cited by 4 publications

References 8 publications

Natural Killer Cell Count in Systemic Lupus Erythematosus Patients: A Flow Cytometry-Based Study

Natural Killer Cell Count in Systemic Lupus Erythematosus Patients: A Flow Cytometry-Based Study

Overlap Syndrome in a Male Presenting With Progressive Lower Limb Weakness: A Case Report

Recurrent Temporal Infections: The Link to Systemic Lupus Erythematosus

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