Lupoid sclerosis

Lupoid sclerosis (LS) is a controversial entity, comprising features of both systemic lupus erythematosus and multiple sclerosis. Diagnostic criteria are a matter of debate, as well as the role of antinuclear and antiphospholipid antibodies. In this review, clinical and laboratory findings of LS available on Pubmed up to date are discussed.

[Myelopathy revealing lupus. Two cases and review of the literature]

INTRODUCTION

Myelopathy is a rare manifestation of systemic lupus erythematosus, occurring most often during the course of the disease.

EXEGESIS

We report two cases of women with myelopathy as the first manifestation of systemic lupus erythematosus; both had an unusual course. We review the literature for previously reported cases.

CONCLUSION

The clinical presentation of myelitis is heterogeneous. Usually, neurologic deficits evolve within a few hours (typically acute transverse myelitis) and outcome is usually poor. However, chronic or recurrent transverse myelitis has also been reported, including relapsing myelitis that resolved spontaneously. Myelopathy can be the first manifestation of the disease and this might be more common than initially thought. Magnetic resonance imaging (MRI) findings depend on the timing of the examination and the stage of the disease; the MRI may therefore be normal. An association with optic neuritis is frequently reported in the literature and differential diagnosis with multiple sclerosis may be difficult. Overlapping features between both diseases have been termed "lupoid sclerosis" and are actually classified as demyelinating syndromes associated with lupus. Myelopathy does not appear to be consistently associated with antiphospholipid antibodies, as has been previously suggested. The best treatment protocol has not been determined; however, in recent years, pulses of methylprednisolone and cyclophosphamide have gained acceptance by most authors.

Immunoadsorption onto protein A induces remission in severe systemic lupus erythematosus

BACKGROUND

Reduction of pathological autoantibodies and circulating immune complexes can be useful in the treatment of autoimmune disease. Plasmapheresis has been shown to reduce autoantibody levels in systemic lupus erythematosus (SLE), but its effect on patients' outcome was not better compared with conventional immunosuppression in the past.

AIM OF THE STUDY

Immunoadsorption as a selective extracorporeal immunoglobulin elimination technique was evaluated as rescue therapy in patients suffering from SLE.

METHODS

Eight patients with severe, therapy-resistant SLE underwent immunoadsorption onto protein A sepharose without concomitant immunosuppressants.

RESULTS

Remission of the disease was achieved in seven patients. Therapy had to be stopped in one patient because of side-effects. The best results were obtained when immunoadsorption was carried out daily, without supplementary intravenous immunoglobulin therapy. Oral cyclophosphamide for 3-6 months during follow-up was used to suppress relapse. Autoantibodies and circulating immune complexes were effectively eliminated regardless of their IgG subclass.

CONCLUSION

Immunoadsorption onto protein A might be used as an extracorporeal treatment option in SLE when other therapies are ineffective.