A Study on Cardiovascular manifestations in Lupus Patients.

Jagannathan, K (2009) A Study on Cardiovascular manifestations in Lupus Patients. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease primarily occurs in young women and characterised by varied clinical and laboratory manifestations. Severity ranges from a mild disease with rash and arthritis to a devastating illness with renal failure and central nervous system involvement. Perhaps because of the prominence of cutaneous, musculoskeletal, renal and neurological manifestations cardiac involvement has not received detailed attention. The widespread use of modern echocardiography together with the longer life spans of severe SLE patients has contributed to increased recognition of cardiovascular involvement in these patients. AIMS AND OBJECTIVES : 1. To identify the various cardiac manifestations in patients with systemic lupus erythematosus. 2. To detect the risk of association of anti cardiolipin antibodies and lupus anticoagulant with cardiac involvement in lupus patients. 3. To determine the correlation between the risk factors for atherosclerosis and carotid intima medial thickness in lupus patients. MATERIALS AND METHODS : In this prospective study, 100 consecutive patients (95 females, 5 males) with systemic lupus erythematosus (who fulfilled the1997 revision of ACR 1982 classification criteria for classification of systemic lupus erythematosus) attending the rheumatology outpatient clinic or as inpatients in the rheumatology ward of Government General Hospital, Chennai constituted the study group. This study was done during March 2007- March 2009. Inclusion criteria: Patients who fulfilled the 1997 revision of ACR 1982 classification criteria for systemic lupus erythematosus were included. Exclusion criteria: Patients with overlap syndrome, Pre-existing cardiac illness due to other causes. Patients with renal failure (defined by a serum creatinine level of 3.0 mg/dl [265moles/liter] or acreatinine clearance of 30 ml/minute). Apart from age and sex, detailed history including mode of onset, duration of illness, constitutional, mucocutaneous, musculoskeletal and symptoms pertaining to the cardiovascular system i.e. chest pain, palpitation, breathlessness, leg swelling and relevant history of other organ involvement was obtained. History of recurrent abortion if relevant, venous or arterial thrombosis and dose of steroid therapy at the time of study were noted. All patients were questioned for history of rheumatic fever, infective endocarditis, hypertension, diabetes, alcohol and smoking habits. RESULTS : There were 95 females and 5 males in the study group (Fig 1). The age of the patients varied from 11 years to 45 yrs (Fig 2). The mean age of the patients was 23±6.77 years. Disease onset in the second or third decade was common (mean age 20.83± 6.29 years). Almost one quarter of patients had childhood onset of the disease (Fig 3). The mean disease duration was 2.5±2 years. CONCLUSION : 1. Pericarditis was the most common observation followed by valvular heart disease. 2. Myocarditis, conduction abnormalities, impairment of systolic and diastolic function and pulmonary hypertension occur less frequently. 3. Significantly higher number of patients had valvular heart disease in the anticardiolipin antibody positive group. 4. SLE patients with anticardiolipin antibody positivity are 4 times more likely to have valvular heart disease, compared to their counterparts. 5. The risk of valvular heart disease is 19 times higher in lupus patients who also have secondary antiphospholipid antibody syndrome with history of recurrent abortions. 6. Dyslipidemia was found in half of the patients. 7. Patients with lupus exhibited a significantly greater IMT than controls. 8. The carotid IMT was independently related to age, systolic blood pressure and LDL cholesterol. 9. There was no relation between anticardiolipin antibodies and the carotid IMT.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cardiovascular manifestations ; Lupus Patients.
Subjects: MEDICAL > Rheumatology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:47
Last Modified: 16 Aug 2017 06:43
URI: http://repository-tnmgrmu.ac.in/id/eprint/1827

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