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Lupus Symptoms in Women

Jul 25, 2011 > Various
Are you looking for Lupus Symptoms in Women? Lupus is a clinical syndrome, the cause of which remains uncertain. It is a member of the family of autoimmune rheumatic diseases. Lupus is more common in women, and certainly more common amongst the black and Chinese population. It’s clinical diversity is at least apparently matched by its serological diversity. The prevalence of lupus among Afro-Caribbeans is approximately five times that of a Caucasian population, and about 2 ½ times that of an Asian population.

Lupus Symptoms in Women

Lupus is far from confined to the skin. Indeed, we now recognize lupus in all its many systemic forms, much of the work being done in this century in various parts of the United States. At least 10% of the patients in my cohort who have been misdiagnoses as suffering from lymphomas or other malignant diseases. Virtually all lupus patients of course have musculoskeletal involvement, substantial number have dermatologic involvement, and a large number of patients also have gastrointestinal disease. Perhaps nowhere is the clinical diversity shown that in the cerebral system, where anything from migraine to madness may be a feature of lupus. About 30% of patients with lupus presenting to a rheumatologist will turn out to have significant renal disease. Perhaps 40% will have cardiopulmonary disease and virtually all patients with lupus have some hematological manifestation or another.

Lupus Symptoms in Women For the final clinical conundrum, I’d like to draw your attention to thrombocytopenia. I’d like to persuade you, at least to my mind, that there are at least three sorts of thrombocytopenia in patients with lupus. There are a group of patients who present with what is generally regarded as idiopathic disease, idiopathic thrombocytopenia, until other features of lupus turn up some years later. The platelet count can certainly get very low with these patients and clinical symptoms referable to thrombocytopenia are very common. In addition I recognize a group of patients with what I call chronic persistent thrombocytopenia within the context of lupus. The platelet count here often runs between 50 and 125, but the clinical symptoms referable to this platelet count are much rarer. There are a similar number of patients who have a dramatic fall in their platelet counts. This can occur over a matter of weeks or months and there are again frequent clinical features relevant to the platelet counts. How best to treat these patients? This is a review of a number of patients with lupus or the antiphospholipid syndrome, reviewed by _ and myself some years ago. In our cohort 16.5% of patients had thrombocytopenia as judged by a platelet count of less than 100; 7.5% of these patients had thrombocytopenia linked to antiphospholipid antibodies and 6% have very severe thrombocytopenia, counts less than 15 with symptoms.

Lupus Symptoms

If each of the eight organ systems, based largely on clinical questions - and I stress that, clinical questions - we define disease activity on this A-E basis. Where A represents action. The patient is severely ill, has sufficiently severe clinical features that they require major immunosuppressive therapy. B for beware, in the sense that we already knew the patient was active. C for contentment. There is low level activity, not requiring much in the way of therapy. D for discount, in the sense that the disease was once active but is no longer active. And E for no evidence of disease in the system now or previously. Here’s an example of the way that this works. Take, for example, the cardiovascular assessment. In a patient who presents with cardiac failure or symptomatic effusion and two of these other features listed here, from pleuropericardial pain due to friction rub, to deteriorating lung function. That patient will be categorized for their cardiovascular assessment as an A. In contrast, if only two of these criteria were present, they would be categorized as a B. If only one criteria or mild chest pain was present, they would get a C. A D if there was previous involvement but none current, and E for no previous involvement.

Now all of these patients were treated initially with large doses of corticosteroids and a significant number of them failed to respond. What should you do then? There is some conflicting data in the literature but we have found that splenectomy done relatively early to be a very helpful way of proceeding. So, of 17 patients that we identified during this time period, 12 had lupus, four had antiphospholipid syndrome, and one had three features of lupus and what we referred to as lupus-like. Nine of these patients were eventually given a splenectomy. Six of them responded completely, two of them gave a partial response, which unfortunately was not sustained, and one patient died of an unrelated carcinoma. The patient with the lupus-like disease also did extremely well. So for us, we tend to treat patients with thrombocytopenia, especially the acutely presenting ones, with corticosteroids. If that doesn’t work within a few months we would proceed to splenectomy. We may use some IV Ig on the way.

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