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A series of measures in the management of patients with systemic lupus erythematosus (SLE) which usually are not found in the lupus guidelines are discussed. In the lupus patient who has been well-controlled in the long term, the dose of hydroxychloroquine should be progressively reduced, without decreasing more than approximately 600 mg per week. We recommend taking this drug in the morning in patients with insomnia, at night in those with dyspepsia and to separate the intake of the drug from the shower (and the water should be as cool as possible) in those patients with aquagenic pruritus. We do not use prednisone on alternate days and exceptionally divide the dose into ¾ before breakfast and ¼ before dinner. Twenty to 30 min should be used per patient in every scheduled visit to assure a good clinical and human practice. We analyzed the follow-up of 112 consecutive patients from our systemic disease unit and found that 71.4% of them had symptoms that were unexplained by lupus and we only referred 8.9% of them to other specialists, probably because of our general training as internal medicine doctors. We suggest that knowing the views of SLE specialists might be of interest since, well-designed studies that would allow to progress in the understanding of this disease could be performed based on their experience.

Resumen Se comentan una serie de medidas para los pacientes con lupus eritematoso sistemico, que no suelen estar en las guias. Al enfermo muy bien controlado durante anos tendemos a ir reduciendo progresivamente la dosis de hidroxicloroquina, sin bajar de aproximadamente 600 mg/semana. Este farmaco aconsejamos tomarlo por la manana en los pacientes con insomnio, por la noche en los casos de dispepsia y en los que presentan prurito de tipo acuagenico que separen la toma de la ducha, y que esta sea con agua lo menos caliente posible. No usamos el tratamiento con prednisona a dias alternos, y excepcionalmente dividimos la dosis en ¾ antes del desayuno y ¼ antes de la cena. En consultas deberiamos dedicar entre 20 y 30 min por paciente, para hacer una buena practica clinica y humana. En nuestra unidad hemos analizado el seguimiento de 112 enfermos consecutivos, y el 71,4% tenian una sintomatologia no explicable por el lupus, y solamente al 8,9% los derivamos a otros especialistas, probablemente, por nuestra capacitacion general como internistas. Sugerimos que conocer la opinion de los especialistas dedicados a tratar a los enfermos con lupus puede ser de interes, pues a partir de sus experiencias, se pueden programar trabajos bien disenados, que permitirian el avance en el conocimiento de esta enfermedad.

The objective of this article was to evaluate whether serum uric acid (SUA) correlates with arterial stiffness and inflammation markers in a cohort of women with systemic lupus erythematosus (SLE) without overt atherosclerotic cardiovascular diseases, who attended a community hospital. One hundred and two women with SLE were assessed as part of this cross-sectional study. Carotid-femoral pulse wave velocity (PWV) was measured using an automatic device (Complior®). C-reactive protein (CRP), fibrinogen and homocysteine levels as well as other metabolic results were recorded. Duration and activity of SLE, damage accrual and treatments were recorded. SLE women were categorized as having or not having hyperuricaemia (HU) according to SUA levels (greater than or up to 6.2 mg/dl, respectively). A multiple linear regression analysis was used to determine the independent link between SUA levels and other variables. Women with SLE and HU (n = 15, 15%) had a worse cardiovascular risk profile that included ageing, hypertension, obesity, higher total cholesterol levels, renal failure and presence of metabolic syndrome. Also, the duration of SLE was increased and damage accrual was greater. In the unadjusted analysis, SUA levels correlated with PWV, CRP, fibrinogen and homocysteine. However, in a multivariate linear regression analysis, SUA levels independently correlated with the duration of SLE, creatinine, total cholesterol and homocysteine levels but did not correlate with PWV. In conclusion, SUA was associated with arterial stiffness, but not independently of age and homocysteine levels. Nevertheless, SUA might be an ancillary indicator of subclinical atherosclerosis in SLE women without clinically evident atherosclerotic cardiovascular disease. Lupus (2010) 19, 591—598.

To determine the “in-vitro” intrinsic cell radiosensitivity (RS) as a risk indicator of radiation-related side-effects in patients with systemic lupus erythematosus (SLE) compared with healthy subjects (control group). Moreover, we elucidated if clinical, therapeutic and biological parameters could affect the “in-vitro” intrinsic RS in patients with SLE. Intrinsic RS was determined by the quantification of the initial radiation-induced DNA double-strand breaks in peripheral lymphocytes, measured by pulsed-field gel electrophoresis from 52 patients with SLE and a control group consisting of 48 sex- and age-matched healthy subjects. No difference in intrinsic RS was found among both groups. However, SLE patients with anaemia, increased erythrocyte sedimentation rate and those with positive result for anti-La/SSB and anti-RNP antibodies showed significantly higher DNA double-strand breaks than those without them. In our study, patients with SLE did not have a higher intrinsic RS than healthy subjects. According to these results, and with the caution of being a limited laboratory study, the use of radiotherapy should not be avoided in patients with SLE when it is clinically needed.

Background: Sialochemistry has been proposed as a simple and useful tool for the diagnosis of Sjogren syndrome (SS). Although many changes have been detected in several constituents of saliva from patients with SS, none are individually sensitive or specific enough for diagnosing SS. The aim of this study was to assess the value of the combined determination of β2-microglobulin (β2m) and gamma-glutamyl-transferase (GGT) activity in serum and saliva as a diagnostic instrument for differentiating primary and secondary [to systemic lupus erythematosus (SLE)] SS patients from normal subjects. Methods: Nineteen primary SS (pSS) patients, 15 patients with SS secondary to SLE, and 25 SLE patients without SS were studied. Thirty healthy subjects were included in the study as control group. Results: By means of a mathematical model, (a) 84.1%, (b) 85.7%, and (c) 87.0% of patients were correctly classified as SS or normal when (a) salivary β2m and GGT values, (b) serum β2m and salivary GGT values, and (c) salivary β2m and GGT along with serum β2m values, respectively, were considered. To differentiate between pSS and sSS by means of the mathematical model, the combination of serum β2m and salivary GGT values achieved that 81.8% of the patients were correctly classified. Conclusion: Since sialochemistry is an easy, safe and reliable test, the combined determination of β2m and GGT in saliva and serum was useful for differentiating SS patients from normal subjects, but not excessively good for differentiating pSS from sSS patients.

The etiological role of hair dye treatment (HDT), some of them such as permanent hair dyes containing aromatic amines, in the development of SLE has been previously ruled out. However, the possible influence of HDT use on the course and prognosis of lupus patients has been assessed only in one short-term study. Since HDT is very extensive among the population, the knowledge of this possible negative effect may be very important. Thus, the aim of this study was to assess the long-term influence of several HDTs on the course and clinical severity of patients with both systemic lupus erythematosus (SLE) and cutaneous lupus (CL). In this longitudinal case series study, 91 SLE patients and 22 CL patients were prospectively studied from October 1988 to May 2000. They were divided into three groups: (a) non-HDT users— patients who have never used HDT (n = 65); (b) P-HDT users—HDT permanent type users, alone or in combination with other types of HDT (n = 28); (c) non P-HDT—users of other treatments different from permanent tinting (bleach, lowlights, etc; n = 20). In each patient we determined: (1) number of flares/year in SLE patients and worsening of cutaneous lesions for CL; (2) Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index; (3) predominant damaged organs/systems according to the HDT use and type of HDT; and (4) subjective impression about the disease evolution in relation to HDT use. No significant differences were found with respect to flares/year and SLICC/ACR damage index between the study groups. Non-HDT group presented more renal involvement and serositis than both HDT-user groups. No patient related the HDT use to the worsening of his disease. Therefore, in this study no evidence of an association between the long-term use of several types of HDT and the clinical activity and course of SLE and CL was found.

Serotonin is involved in the control of ACTH secretion, possibly by stimulating corticotropin releasing factor secretion from the hypothalamus. Cushing's disease seems to be due to defective hypothalamic regulation of ACTH release from the pituitary gland. Cyproheptadine is a potent antagonist of serotonin and has been used successfully in some patients with Cushing's disease, although, generally, in women without radiological evidence of pituitary tumors. We report the successful use of cyproheptadine in a 54-year-old man with Cushing's disease due to pituitary basophil adenoma. Significant clinical and biochemical improvement was noted 45 days after treatment began. The results in this patient support our findings that cyproheptadine can be effective in patients with Cushing's disease due to pituitary tumors, as well as in preparing very ill patients for surgery or managing such patients until radiotherapy takes effect.

In this work the presence of gamma-glutamyltransferase (GGT), leucine amino-peptidase (LAP) and alkaline phosphatase (AP) is shown in human tear fluid. We studied these levels according to sex, age and some eye refraction defects. The differences between the levels for both sexes are not significant. LAP and AP do not show any differences in either age groups or individuals with some refraction defects. The average level of GGT is higher from 40 years of age upwards (p less than 0.005). In individuals with refraction defects, the enzymatic activity is significantly higher (p less than 0.05) than the activities found in normal subjects. The levels of the three enzymes in serum and tear fluid do not show a significant correlation nor are they significantly modified after the samples have been frozen for a month at -20 degrees C.

Some authors have suggested that carbohydrates can induce hepatic microsomal enzymes, resulting in increased serum gamma-glutamyltransferase (GGT) in diabetes mellitus. Previously we demonstrated the lack of serum GGT increases in patients with acute diabetic crises. In this work we studied serum GGT activity, blood glucose levels and glycosylated hemoglobin levels (HB A1) in 35 patients with diabetes mellitus and 27 healthy volunteers. We did not see differences in the serum GGT activity among controlled (25.05 +/- 2.72 U/l) and uncontrolled (26.44 +/- 4.05 U/l) diabetics and the control group (22.51 +/- 2.95 U/l). Also, there was no significant correlation between serum GGT and HB A1 levels in diabetic patients (r = 0.279). We think that our observations may be relevant because they support the hypothesis that hyperglycemia does not act as an enzyme-inducing agent in chronically uncontrolled diabetics and, furthermore, they indicate that in the presence of abnormal serum GGT levels in diabetics it is necessary to investigate other associated diseases.

• Salivary γ-glutamyl transferase (GGT) activity was measured in 116 patients with several diseases that involved the hepatobillary tract, pancreas, and miscellaneous disorders and in 20 normal subjects. We have found significantly elevated values of salivary GGT in cirrhosis of the liver (8.3 ± 0.9 [mean ± SEM] units/L), hepatic tumors (10.4 ± 1.3 units/L), acute cholecystitis (18.3 ± 2 units/L), acute pancreatitis (15.1 ± 2.4 units/L), diabetic ketoacidosis (11.6 ± 1 units/L), and Sjogren's syndrome (19.6 ± 4.8 units/L). Salivary GGT activities were unmodified in fatty liver, infectious hepatitis, silent cholelithiasis, and mumps. Several mechanisms explain high salivary GGT activity. Measurement of salivary GGT activity in internal medicine merits further investigations to determine its potential diagnostic value. ( Arch Intern Med 1984;144:1804-1806)