Bilateral central retinal artery occlusion (CRAO) has been rarely reported as the primary manifestation in patients with systemic lupus erythematosus (SLE). The severe retinal vaso-occlusive diseases usually cause devastating and permanent damage to visual function in spite of vigorous treatment. A 42-year-old Chinese woman presented with abrupt bilateral vision loss. The diagnosis of bilateral CRAO was suggested by the ocular presentation and fluorescein angiography. Laboratory studies showed positive results of antinuclear antibody, anti-Ro/SSA anti-La/SSB; decreased levels of C3, C4 complement and normal levels of antiphospholipides antibodies (APAs). Her visual acuity deteriorated despite systemic steroid and immunosuppressant treatment. Severe vaso-occlusive retinopathy may be an earlier manifestation of SLE without elevated level of APAs.
Adult ; Blindness ; etiology ; Female ; Humans ; Lupus Erythematosus, Systemic ; complications ; drug therapy ; immunology ; Retinal Artery Occlusion ; etiology

Candidiasis ; drug therapy ; immunology ; metabolism ; Diabetes Mellitus, Type 1 ; complications ; drug therapy ; immunology ; therapy ; Humans ; Lupus Erythematosus, Systemic ; drug therapy ; immunology ; metabolism ; Mycoses ; complications ; immunology ; therapy ; Paraneoplastic Syndromes ; drug therapy ; immunology ; metabolism ; Pemphigus ; drug therapy ; immunology ; metabolism

OBJECTIVETo study the effect and mechanism of Langchuangjing Granule (LCJ) in inhibiting the lupoid change of kidney in lupus-prone mice.

METHODSIntervention therapy was applied to three group of BW female mice of lupus, 3 months in age, for 6-12 weeks with LCJ, prednisone and LCJ + prednisone respectively to observe the dynamic development of disease, changes of CD4+, CD8+ and CD54 expression, and the effect on pathology of renal corpuscles.

RESULTSBoth western and Chinese medicines can partially improve the symptoms and plasma CD4+ and CD8+ distribution, inhibit the increase of serum ICAM-1 content and the high expression of CD54 in surface of lymphocyte of peripheral blood, suppress the atrophy of renal corpuscles and the proliferation of mesangial cell. The optimal effect was showed by the combination of LCJ and prednisone.

CONCLUSIONLCJ could effectively control and improve the genesis and development of lupoid changes in model mice, and regulate the cellular immune function, inhibit the excessive immune reaction, and improve the pathology of lupoid nephritis, it could cooperate with western medicine to give full play of its effective role and show the superiority in treatment.

Animals ; CD4-CD8 Ratio ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Intercellular Adhesion Molecule-1 ; blood ; Kidney ; pathology ; Lupus Erythematosus, Systemic ; drug therapy ; immunology ; pathology ; Lupus Nephritis ; drug therapy ; immunology ; pathology ; Male ; Mice ; Mice, Inbred NZB ; Phytotherapy ; Random Allocation

The presence of lupus anticoagulant is associated with an elevated risk of venous and arterial thrombosis, and recurrent miscarriages as well. For some cases, this disease can present with bleeding as a consequence of lupus anticoagulant hypoprothrombinemia (LAHPS). LAHPS is a rare disease and it is reported to be most frequent in young females with/without systemic lupus erythematosus or in healthy children who are suffering with a viral infection. In such cases, steroid therapy is usually effective in normalizing the biological abnormalities and controlling the bleeding problems. A 34-year-old previously healthy man was admitted to our department because of his prolonged coagulation times; these abnormalities were discovered before performing orthopedic surgery. The prothrombin time (PT) was 15.2 sec, and the activated partial thromboplastin time (APTT) was 37.7 sec. A 1:1 dilution of patient plasma with normal plasma nearly corrected the PT, but this failed to correct the APTT. Evaluation of the clotting factors revealed decreased levels of factors II, V, VIII, IX and XI. The presence of LA was demonstrated by the dRVVT test, and the patient was diagnosed with LAHPS. He was successfully treated with corticosteroid before performing the orthopedic surgery.
Adrenal Cortex Hormones/therapeutic use ; Adult ; Humans ; Hypoprothrombinemias/*diagnosis/drug therapy/immunology/physiopathology ; Lupus Coagulation Inhibitor/*immunology ; Lupus Erythematosus, Systemic/*diagnosis/immunology/physiopathology ; Male ; Partial Thromboplastin Time ; Preoperative Care ; Prothrombin Time

A 34-year-old lady presenting with features of cold agglutinin disease during the course of systemic lupus erythematosus is described. Cold antibody titer was very high (1 in 4096) with specificity for 'I' antigen. Even though she had poor prognostic factors like high titer of cold antibodies with low thermal amplitude, she responded well to prednisolone.
Adult ; Anemia, Hemolytic, Autoimmune/immunology ; Anemia, Hemolytic, Autoimmune/etiology* ; Anemia, Hemolytic, Autoimmune/drug therapy ; Antibodies/analysis ; Case Report ; Female ; Human ; Lupus Erythematosus, Systemic/complications* ; Prednisolone/therapeutic use ; Prognosis

OBJECTIVETo research the effects of Qingyang Toujie Mixture (QTM) in combination with prednisone tablet on the balance of Th1 and Th2 (Th1/Th2) of systemic lupus erythematosus (SLE) patients of yin deficiency syndrome (YDS).

METHODSTotally 42 patients with SLE were recruited from clinics of internal medicine and hospitalization department of First Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine from August 2009 to March 2011. They were randomly assigned to the treatment group (22 cases) and the control group (20 cases) according to the random digit table. Another 12 healthy subjects were recruited as the healthy control group from employees of First Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine and healthy students in physical examinations. All patients took prednisone tablet. The dosage was adjusted according to the severity of SLE activity index and the condition: 40 -60 mg per day for severe active stage; 20-40 mg per day for moderate active stage; 15 -20 mg per day for light active stage; and less than 15 mg per day for those in the stable stage, respectively. When patients' condition had been stabilized for 1 to 2 weeks, the dosage was gradually reduced according to the method of hormone reduction. In case of the recurrence of symptoms or when complicated with lupus nephritis or lupus encephalitis uncontrollable, standard shock therapy with Cyclophosphamide Injection (0.5-1 g/m2 body surface area, intravenous dripping, once every 4 weeks) was performed. Patients in the treatment group took QTM additionally, one dose daily, taken in two portions, once in the morning and once in the evening. Those in the control group took placebos additionally, one dose daily, taken in two portions, once in the morning and once in the evening. The therapeutic course was 6 months for all. No measure was taken for those in the healthy control group. Venous blood was withdrawal before and after treatment. Th1 cytokines (IFN-gamma, IL-12) and Th2 cytokines (IL-10, IL-4) were detected by ELISA.

RESULTSCompared with the healthy control group, the serum Th1 cytokines such as IL-12 and IFN-gamma, Th2 cytokines such as IL-10 and IL-4 increased, the Th1/Th2 ratios such as IFN-gamma/IL-4 and IL-12/IL-10 decreased in the treatment group and the control group before treatment (P < 0.01). Compared with before treatment in the same group, the serum Th1 cytokines such as IL-12 and IFN-gamma decreased, the serum Th2 cytokines such as IL-10 and IL-4 decreased, the ratios of Th1/Th2 cytokines such as IFN-gamma/IL-4 and IL-12/IL-10 increased in the treatment group (all P < 0.05). Compared with the control group after treatment, IL-4 decreased, and the ratio of IFN-gamma/IL-4 increased in the treatment group (P < 0.05). Fewer patients suffered from adverse reactions in the treatment group than in the control group (P < 0.01).

CONCLUSIONQTM in combination with prednisone tablet was effective to improve the balance of Th1/Th2 cytokines, and alleviate the toxic and adverse reactions of hormone or immune inhibitors.

Adult ; Cytokines ; immunology ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; therapeutic use ; Female ; Humans ; Lupus Erythematosus, Systemic ; drug therapy ; immunology ; Male ; Prednisone ; administration & dosage ; pharmacology ; therapeutic use ; Th1-Th2 Balance ; drug effects ; Young Adult

OBJECTIVETo observe the curative effect of integrative medicine for treatment of systematic lupu erythematosus (SLE).

METHODSTotally 110 cases of SLE were randomized into two groups, 50 in the control group and 60 in the treated group, both were treated with prednisone, but to the treated group, integrative medica treatment was given additionally according to syndrome differentiation. The course for both groups was 6 months. Clinical symptoms, immunological indexes, peripheral blood figure, erythrocyte sedimentation rate (ESR), levels of C-reactive protein (CRP) and creatinine (Cr) in blood, and 24 h urinary total protein (u-TP/24 h) were observed before and after treatment.

RESULTSOf the 60 patients in the treated group, the treatment on 29 was evaluated as clinical remission, 18 as remarkably effective, 9 as effective, and 4 as ineffective, the total effective rate being 93.33% (56/60), while that in the control group was clinical remission in 11, remarkably effective in 10, effective in 19, ineffective in 10 respectively, and the total effective rate 80% (40/50), the difference on total ef fective rate between the two groups was significant (chi2 = 4.36, P <0.05). Besides, the improvement in the treated group was superior to that in the control group in terms of clinical symptoms such as fever, arthralgia and baldness (P <0.05, P <0.01); the negative reversion rate of anti-nuclear antibody (ANA, 51.3% vs 28.1%), antidouble-stranded DNA (ds-DNA, 53.6% vs 26.1%), anti- ribonucleoprotein (RNP, 63.2% vs 29.4%) and circulating immnue complexes (CIC, 63.2% vs 29.4%, all P <0.05); lowering of immunoglobulin (for IgG, P < 0.05; IgA, P <0.01; IgM, P <0.01); as well as bettering in peripheral blood figure, ESR, CRP, Cr and u-TP/24 h (P <0.05 or P <0.01).

CONCLUSIONIntegrative medical treatment is obviously effective for SLE patients.

Adolescent ; Adult ; Autoantibodies ; blood ; Blood Sedimentation ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Integrative Medicine ; Lupus Erythematosus, Systemic ; blood ; drug therapy ; immunology ; Male ; Middle Aged ; Prednisone ; therapeutic use ; Young Adult

To study the immediate effects of high-dose intravenous methylprednisolone pulse therapy on the immune mechanisms in the absence of other immunosuppressive agents, we treated ten patients with active systemic lupus erythematosus, six with renal and three with central nervous system involvement with three daily 1 gram intravenous doses of methylprednisolone and measured the immune response before and just after discontinuation of the drugs. After the treatment, the mean seum IgG, IgA and IgM levels were essentially unchanged. Likewise, serum C3 and C4 levels were not changed significantly. In nine of ten patients, methylprednisolone pulse therapy reduced the levels of circulating immune complexes (p < 0.05). Thus the immediate clinical improvements with methylprednisolone pulse therapy are suggested to be the result of depression of the circulating immune complex levels.
Adolescent ; Adult ; Antigen-Antibody Complex/*analysis ; Case Report ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Human ; Immunoglobulins/*analysis ; Infusions, Intravenous ; Lupus Erythematosus, Systemic/*drug therapy/immunology ; Male ; Methylprednisolone/*administration and dosage ; Support, Non-U.S. Gov't

OBJECTIVETo study the principle of clearing Fei (), cooling blood, and detoxification as well as nourishing yin and moisening Fei (abbr. as CCD-NM) in regulating the levels of peripheral T-lymphocyte subsets Th and Tc cells to explore its mechanism for lowering the incidence of infection in patients with systemic lupus erythematosus (SLE).

METHODSSixty SLE patients without complicated infection were assigned to the treatment group and the control group, 30 in each group. The control group was treated with Western medicine alone, while the treatment group was treated with the same program of Western medicine, but additionally administered with either Langchuang No.1 (I) or 2 (II), serial concerted Chinese recipes, applied respectively in patients in the active stage or in the resting stage. The total time of treatment for both groups was 1 year. Further, a healthy control group was set up with 20 healthy subjects. The expressions of Th1, Th2, and Tc1 and Tc2 cells in peripheral blood were detected and compared with those in the healthy control group.

RESULTS(1) As compared with the healthy control group, ratios of Th1/Th2 and Tc1/Tc2 in SLE patients, whether complicated with infection or not, were significantly lower (P<0.05 or P<0.01). (2) Comparison between patients with complications and those uncomplicated with infection showed that the two ratios and Th1 expression were lower and Tc2 was higher in the former than those in the latter (all P<0.05). (3) Ratios of Th1/Th2 and Tc1/Tc2 increased after treatment in patients of both the treatment group and the control group (P<0.05 and P<0.01), but the changes in the treatment group were more significant (P<0.05).

CONCLUSIONThe principle of CCD-NM could regulate the Th and Tc subsets toward equilibrium in SLE patients, which might be one of the mechanisms of action for alleviating complicated infection.

Adolescent ; Adult ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Humans ; Lupus Erythematosus, Systemic ; drug therapy ; immunology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; T-Lymphocyte Subsets ; drug effects ; T-Lymphocytes, Helper-Inducer ; drug effects

OBJECTIVEAntiphospholipid antibody (APL) is a particularly important laboratory diagnostic criterion for antiphospholipid syndrome (APS). The significances of positive APL in childhood are seldom reported nor fully understood. The purpose of this study was to analyze 13 cases with positive APL seen in our hospital and to study the relationship between the positive rates of APL and various clinical diseases especially systemic lupus erythematosus (SLE) in order to improve the clinical diagnoses and treatment level of APS in children.

METHODSThe clinical data collected from 2000 to 2002 of 13 hospitalized children with positive APL were retrospectively evaluated. Enzyme linked immunosorbent assay (ELISA) and indirect immunofluorescence technique were used respectively to detect APL and antineutrophil cytoplasmic autoantibodies (ANCA) of sera from those children. Other various indexes were also detected according to different characteristics of different diseases.

RESULTSEight cases had SLE; 2 had acute post-streptococcal infections. The other 3 cases did not show any evidences of primary diseases; they probably had primary APS. SLE was the most common primary diseases to cause development of APL and the cases with SLE showed more severe cutaneous vasculitis than SLE patients who were negative for APL. There was no significant relationship between the positive rates of APL and that of ANCA. Eight APL positive cases complicated with thrombocytopenia and bleeding were treated with high dosage of immunoglobulin [400 mg/(kg.d), for 3 - 5 d] intravenously; the clinical conditions of these cases were ameliorated soon. While the 5 cases who had thrombotic vasculitis and thromboembolism were treated with anticoagulant and antithrombotic therapy with low molecular weight heparin [50 - 100 U/(kg.d)], which led to good clinical effects.

CONCLUSIONSThe clinical manifestations of children positive for APL were somehow different from those of adults. Positive APL itself may be nonspecific, it can occur from different causes of diseases. APL detection may be useful to suggest anticoagulant and/or antithrombosis therapy. Treatments for APS should be variable according to different causes and severity of diseases, in the cases of thrombocytopenia and bleeding, high dose intravenous immunoglobulin should be given as soon as possible, while in the cases of thrombotic vasculitis and thromboembolism, anticoagulant and antithrombotic therapy should be given soon.

Adult ; Antibodies, Antineutrophil Cytoplasmic ; blood ; Antibodies, Antiphospholipid ; blood ; immunology ; Anticoagulants ; therapeutic use ; Antiphospholipid Syndrome ; blood ; complications ; diagnosis ; therapy ; Child ; Fibrinolytic Agents ; therapeutic use ; Hemorrhage ; etiology ; therapy ; Humans ; Immunoglobulins, Intravenous ; therapeutic use ; Lupus Erythematosus, Systemic ; immunology ; Streptococcal Infections ; immunology ; Thrombocytopenia ; etiology ; therapy ; Thromboembolism ; drug therapy ; etiology ; Thrombosis ; drug therapy ; etiology ; Vasculitis ; drug therapy ; etiology