Endothelial Dysfunction in Systemic Lupus Erythematosus.

Rajesh, S (2010) Endothelial Dysfunction in Systemic Lupus Erythematosus. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Systemic lupus erythematosus (SLE) is an autoimmune disease, with a wide range of clinical manifestations. In 1976, Urowitz et al. postulated a bimodal mortality pattern in patients with this disease: in the first part of evolution, mortality is due to severe infections or to disease activity, but after 5 years of SLE course, mortality is caused by the accelerated atherosclerosis and its consequences. With the constantly increasing drugs available in the therapeutic armamentarium, even though the early mortality has been brought under control, the late mortality and morbidity associated with SLE remains at high levels. During the last 3 decades, there have been several studies on atherosclerosis in SLE. It has been proved that atherosclerosis has a high incidence among young women with SLE. These patients have a high prevalence of coronary artery disease and an incidence of myocardial infarction up to 50 times higher than age-matched healthy subjects. This high incidence of atherosclerosis in SLE cannot be attributed only to traditional risk factors. Endothelial function is thought to be an important factor in the pathogenesis of atherosclerosis, hypertension and heart failure. In healthy subjects, endothelium is more than a physical barrier and has several functions, like: a) continuous regulation of vascular tone, b) leucocytes adhesion, c) maintenance of the balance between thrombotic and anticoagulant properties of the blood. When these functions of the endothelium are affected, endothelial dysfunction appears. AIMS AND OBJECTIVES : 1. To evaluate endothelial function and to assess the extent of dysfunction in newly diagnosed SLE patients by using the measures of flow mediated dilatation of the brachial artery and carotid intima media thickness. 2. To study the correlation of flow mediated dilatation with carotid intima medial thickness. 3. To study the relationship between endothelial dysfunction and clinical characteristics of SLE. MATERIALS AND METHODS : Patients were recruited from the rheumatology outpatient clinic and wards of Government General Hospital, Chennai, during the period February 2009- February 2010. Fifty eligible patients older than 16 years of age were enrolled. They fulfilled at least four classification criteria for systemic lupus erythematosus by 1997 ACR revised criteria, with no known preexisting cardiovascular disease; and were willing to undergo measurement of flow-mediated dilation. Inclusion Criteria: Newly diagnosed SLE patients by ACR criteria of age 16 yrs and above. Exclusion Criteria: 1. Patients with co morbidities like hypertension, diabetes mellitus and hyperlipidemia. 2. Patients with history of cardiovascular disease (angina, myocardial infarction, congestive cardiac failure). 3. Patients with renal failure (creatinine >3 mg/dl or creatinine clearance <30ml/min). 4. Patients who were on long term medications like prednisolone, other immunosuppressants & statins prior to our evaluation. 5. Patients with clinical evidence of upper limb vascular insufficiency in the form of pre gangrene or gangrene. 6. Patients with overlap syndrome. 7. Infections in the previous four weeks. 8. Pregnancy or lactation in the previous 6 weeks. RESULTS : There were 47 females and 3 males, who were age and sex adjusted in the patient and control group. The mean duration of disease according to the onset of symptoms, was 7.3 months with a minimum duration of one month to a maximum of 14 months. There was no statistically significant difference with regard to the blood pressure and fasting lipid profile between both the groups. CONCLUSION : 1. Endothelial dysfunction is present in SLE patients even in the absence of traditional cardiovascular risk factors. 2. FMD using vascular ultrasonography on brachial artery represents a noninvasive, reproducible and cost effective tool for the assessment of endothelial dysfunction. 3. Impaired flow mediated dilatation of brachial artery may be an early physiological feature of endothelial dysfunction and may precede the anatomical increase in carotid intimal thickness. 4. FMD of brachial artery has significant negative correlation with disease activity and antidsDNA antibody. 5. Future prospects of FMD technique include a) early screening module for endothelial dysfunction and to start on drugs with pleotrophic effect like statins, ACE inhibitors and Aspirin. b) serial screening method to ascertain improvement while on treatment with immunosuppressive agents and vasodilators.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Endothelial Dysfunction ; Systemic Lupus Erythematosus.
Subjects: MEDICAL > Rheumatology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:46
Last Modified: 16 Aug 2017 06:30
URI: http://repository-tnmgrmu.ac.in/id/eprint/1820

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