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A study of metabolic syndrome in systemic lupus erythematosus patients
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i n d i a n j o u r n a l o f r h e u m a t o l o g y 9 ( 2 0 1 4 ) S 7 eS 6 7
lymphadenopathy, to constitute hypercalcemia-lymphadenopathy (HL-SLE) or with lymphedema as 'hypercalcaemia-lymphoedema syndrome'. Lymphadenopathy is morecommon than lymphedema. The pathophysiology of hypercalcemia in SLE is not completely understood. In some cases it is associated with elevated levels of parathyroid-related peptide (PTHrP). In others it is suggested that autoantibodies may cause hypercalcemia by activating the PTH receptor. This may develop due to polyclonal over activation of B lymphocytes. Patients with active SLE also have elevated levels of certain cytokines that might stimulate osteoclastic bone resorption, leading to hypercalcemia.
P104. A study of metabolic syndrome in systemic lupus erythematosus patients Rajadhyaksha A., Mangalgi S., Mishra D.; KEM Hospital, Mumbai, India Introduction: SLE, a systemic autoimmune disease and Metabolic Syndrome(MetS),both confer a pro-inflammatory and pro-
P105. Bone marrow abnormalities in systemic lupus erythematosus patients and outcomes in those with hypocellular marrow Aparna Reddy Sa, Liza Rajasekhara, I.R. Varaprasada, Roshini Paulb; a Departments of Rheumatology and bPathology, Nizam's Institute of Medical Sciences, Hyderabad, India Introduction: Hypocellular marrow with peripheral cytopenia in systemic lupus erythematosus (SLE) is not commonly reported in literature. While steroids are used in these patients the data safety and efficacy of further immunosuppression is not widely reported. Methods: Hospital records of SLE patients with bone marrow examination between 2011 to 2014 were reviewed. Results: Ninety six records (90% females) with mean age of 26.8 ± 10.4 years, median disease duration was 12 months [interquartile range 6-24] were reviewed. Forty-one patients had normal marrow. Marrow abnormalities and hematologic correlates are mentioned below:
Marrow abnormality
Frequency (n)
Frequency of pancytopenia (n)
Frequency of leucopenia and thrombocytopenia (n)
Frequency of single line cytopenia (type)
Hypocellular Reactive Erythroid hyperplasia Megaloblastic Haemophagocytosis AML-M2 Myeloid maturation arrest
22 15 9 2 1 1 1
16 6 3 2 1 0 1
3 4 5 0 0 0 0
1-thrombocytopenia, 1-leucopenia,2-thrombocytopenia 0 0 1 0 0
thrombotic state with role in coronary artery disease, hence, focused CHD risk assessment is required in such patients. Establishing the contribution of SLE phenotype and therapeutic exposure to the development of MetS in SLE patients would yield important insights into pathophysiology of cardiovascular event and help in CHD risk stratification. Methods: It is a cross-sectional observational study with 104 SLE patients in a tertiary care center. Having obtained appropriate permission and written informed consent, personal data, clinical history, general anthropometric and systemic examination are entered in the record form. Serological tests in the management of SLE and MetS are performed. Using appropriate statistical tests, association between presence of MetS and SLE and its variation with various parameters are determined. Results: Of the 104 SLE patients,35had MetS as per modified NCEP/ATP III criteria, higher the age more the risk...Longer disease duration and presence of lupus nephritis are significantly associated with MetS. Patients with MetS had higher disease accrual as measured by SLICC/ACR damage index. Positive antidsDNA and higher serum creatinine at presentation were associated with risk of MetS; whereas low C3 and high ESR were more frequent in patients without MetS. Patients with MetS had higher carotid artery intima-media thickness. Higher cumulative doses of steroids(IV pulse MPS and oral both) was associated with MetS. Conclusion: Screening for risk factors of MetS in SLE will help in identifying at risk for premature atherosclerotic cardiovascular disease for early intervention.
75.6%. had SLEDAI more than 12. Recovery from cytopenia with treatment of active SLE occurred in all except four. Of 22 patients with hypocellular marrow five were due to azathioprine. Of 17 patients 7 were lost to follow-up. The median duration of follow-up was 5 months [range (0-13)] two died of sepsis. Ten improved with steroids, in 4 cytopenias required further immunosuppression (3 cyclosporine, 1 mycophenolate mofetil). In 4 patients cytopenia did not recur while on immunosuppressive for other indications. Conclusions: Hypocellular marrow in SLE recovered with steroids in 62.5%, immunosuppression in s25% and 12.5% died.
P106. What will be my future?-Childhood lupus Madeshwaran M.a, Kavitha M.M.a, Balameena S.a, Eupharasia Latha .Jb, Rajeswari S.a; aDepartments of Rheumatology and bImmunology, Madras Medical College, India Aim: To study clinical variables, disease activity and outcome of children with Systemic Lupus Erythematosus (SLE). Methods: Forty SLE children on follow-up were included out of 50 registered cases. Baseline and follow-up data was obtained from 2004 to 2014 in SLE clinic registry. Organ damage due to SLE was measured using Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). The number of deaths at 5 years and 10 years was studied. Results: Female to male ratio was 10:1. The mean disease duration before diagnosis was 4.7 months. The most common presentation was fever and musculoskeletal pain followed by skin rash. Anemia and neuropsychiatric manifestations were seen in 75 %( 30)
i n d i a n j o u r n a l o f r h e u m a t o l o g y 9 ( 2 0 1 4 ) S 7 eS 6 7
lymphadenopathy, to constitute hypercalcemia-lymphadenopathy (HL-SLE) or with lymphedema as 'hypercalcaemia-lymphoedema syndrome'. Lymphadenopathy is morecommon than lymphedema. The pathophysiology of hypercalcemia in SLE is not completely understood. In some cases it is associated with elevated levels of parathyroid-related peptide (PTHrP). In others it is suggested that autoantibodies may cause hypercalcemia by activating the PTH receptor. This may develop due to polyclonal over activation of B lymphocytes. Patients with active SLE also have elevated levels of certain cytokines that might stimulate osteoclastic bone resorption, leading to hypercalcemia.
P104. A study of metabolic syndrome in systemic lupus erythematosus patients Rajadhyaksha A., Mangalgi S., Mishra D.; KEM Hospital, Mumbai, India Introduction: SLE, a systemic autoimmune disease and Metabolic Syndrome(MetS),both confer a pro-inflammatory and pro-
P105. Bone marrow abnormalities in systemic lupus erythematosus patients and outcomes in those with hypocellular marrow Aparna Reddy Sa, Liza Rajasekhara, I.R. Varaprasada, Roshini Paulb; a Departments of Rheumatology and bPathology, Nizam's Institute of Medical Sciences, Hyderabad, India Introduction: Hypocellular marrow with peripheral cytopenia in systemic lupus erythematosus (SLE) is not commonly reported in literature. While steroids are used in these patients the data safety and efficacy of further immunosuppression is not widely reported. Methods: Hospital records of SLE patients with bone marrow examination between 2011 to 2014 were reviewed. Results: Ninety six records (90% females) with mean age of 26.8 ± 10.4 years, median disease duration was 12 months [interquartile range 6-24] were reviewed. Forty-one patients had normal marrow. Marrow abnormalities and hematologic correlates are mentioned below:
Marrow abnormality
Frequency (n)
Frequency of pancytopenia (n)
Frequency of leucopenia and thrombocytopenia (n)
Frequency of single line cytopenia (type)
Hypocellular Reactive Erythroid hyperplasia Megaloblastic Haemophagocytosis AML-M2 Myeloid maturation arrest
22 15 9 2 1 1 1
16 6 3 2 1 0 1
3 4 5 0 0 0 0
1-thrombocytopenia, 1-leucopenia,2-thrombocytopenia 0 0 1 0 0
thrombotic state with role in coronary artery disease, hence, focused CHD risk assessment is required in such patients. Establishing the contribution of SLE phenotype and therapeutic exposure to the development of MetS in SLE patients would yield important insights into pathophysiology of cardiovascular event and help in CHD risk stratification. Methods: It is a cross-sectional observational study with 104 SLE patients in a tertiary care center. Having obtained appropriate permission and written informed consent, personal data, clinical history, general anthropometric and systemic examination are entered in the record form. Serological tests in the management of SLE and MetS are performed. Using appropriate statistical tests, association between presence of MetS and SLE and its variation with various parameters are determined. Results: Of the 104 SLE patients,35had MetS as per modified NCEP/ATP III criteria, higher the age more the risk...Longer disease duration and presence of lupus nephritis are significantly associated with MetS. Patients with MetS had higher disease accrual as measured by SLICC/ACR damage index. Positive antidsDNA and higher serum creatinine at presentation were associated with risk of MetS; whereas low C3 and high ESR were more frequent in patients without MetS. Patients with MetS had higher carotid artery intima-media thickness. Higher cumulative doses of steroids(IV pulse MPS and oral both) was associated with MetS. Conclusion: Screening for risk factors of MetS in SLE will help in identifying at risk for premature atherosclerotic cardiovascular disease for early intervention.
75.6%. had SLEDAI more than 12. Recovery from cytopenia with treatment of active SLE occurred in all except four. Of 22 patients with hypocellular marrow five were due to azathioprine. Of 17 patients 7 were lost to follow-up. The median duration of follow-up was 5 months [range (0-13)] two died of sepsis. Ten improved with steroids, in 4 cytopenias required further immunosuppression (3 cyclosporine, 1 mycophenolate mofetil). In 4 patients cytopenia did not recur while on immunosuppressive for other indications. Conclusions: Hypocellular marrow in SLE recovered with steroids in 62.5%, immunosuppression in s25% and 12.5% died.
P106. What will be my future?-Childhood lupus Madeshwaran M.a, Kavitha M.M.a, Balameena S.a, Eupharasia Latha .Jb, Rajeswari S.a; aDepartments of Rheumatology and bImmunology, Madras Medical College, India Aim: To study clinical variables, disease activity and outcome of children with Systemic Lupus Erythematosus (SLE). Methods: Forty SLE children on follow-up were included out of 50 registered cases. Baseline and follow-up data was obtained from 2004 to 2014 in SLE clinic registry. Organ damage due to SLE was measured using Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). The number of deaths at 5 years and 10 years was studied. Results: Female to male ratio was 10:1. The mean disease duration before diagnosis was 4.7 months. The most common presentation was fever and musculoskeletal pain followed by skin rash. Anemia and neuropsychiatric manifestations were seen in 75 %( 30)