title: Clinical analysis of 61 systemic lupus erythematosus patients with intestinal pseudo-obstruction and/or ureterohydronephrosis: a retrospective observational study.
abstract: The objective of this article is to investigate the clinical features of intestinal pseudo-obstruction (IPO) and/or ureterohydronephrosis in systemic lupus erythematosus (SLE). Sixty-one SLE patients with IPO and/or ureterohydronephrosis were analyzed retrospectively. A total of 183 cases were randomly selected as controls from 3840 SLE inpatients without IPO and ureterohydronephrosis during the same period. Patients were assigned to 1 of the 3 groups (SLE with IPO and ureterohydronephrosis, SLE with IPO, and SLE with ureterohydronephrosis). The clinical characteristics, treatments, and prognosis were compared between the 3 groups. There were 57 females and 4 males, with a mean age of 32.0 years. IPO was the initial manifestation of SLE in 49.1% of the cases, whereas ureterohydronephrosis in 32.5%. All patients were initially treated with a high-dose steroid. Thirty-one of these patients (50.8%) also received intravenous methylprednisolone pulse therapy. Two patients died of bowel perforation and lupus encephalopathy, and the other 59 patients (96.7%) achieved remission after treatment. The incidences of fever, glomerulonephritis, nervous system involvement, serositis, erythrocyte sedimentation rate elevation, hypoalbuminemia, hypocomplementemia, and anti-SSA antibody positivity were significantly higher in patients with IPO and/or ureterohydronephrosis than in the control group (without IPO and ureterohydronephrosis). Also, patients with IPO and/or ureterohydronephrosis had higher SLE Disease Activity Index scores than control patients. Compared with SLE patients with IPO, the patients with IPO and ureterohydronephrosis had a significantly higher incidence of gallbladder wall thickening, biliary tract dilatation, and serositis, whereas the patients with ureterohydronephrosis had less mucocutaneous involvement and serositis. Eight of the 47 IPO patients who initially responded well to immunotherapy relapsed; however, all responded well to retreatment with adequate immunotherapy. Of these 8 patients, 4 relapsed following poor compliance and self-discontinuation of steroid or immunosuppressant therapy. The rate of poor compliance with immunotherapy and the number of organ systems involved in patients in the recurrent IPO group were significantly higher than those in the nonrecurrent IPO group. IPO and ureterohydronephrosis are severe complications of SLE. As patients usually respond readily to early optimal steroid treatment, early diagnosis and timely initiation of glucocorticoid are important to relieve symptoms, prevent complications, and improve prognosis.
authors: From the Department of General Internal Medicine (NX, X-JZ, WF, XH); and Department of Rheumatology and Immunology (JZ, JL, DW, LZ, QW, YH, ML, WZ, XZ, XT, YZ, X-FZ, FZ), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors: Na
authors: N
authors: Xu
authors: Jiuliang
authors: J
authors: Zhao
authors: Jinjing
authors: J
authors: Liu
authors: Di
authors: D
authors: Wu
authors: Lidan
authors: L
authors: Zhao
authors: Qian
authors: Q
authors: Wang
authors: Yong
authors: Y
authors: Hou
authors: Mengtao
authors: M
authors: Li
authors: Wen
authors: W
authors: Zhang
authors: Xuejun
authors: X
authors: Zeng
authors: Weigang
authors: W
authors: Fang
authors: Xiaoming
authors: X
authors: Huang
authors: Xuan
authors: X
authors: Zhang
authors: Xinping
authors: X
authors: Tian
authors: Yan
authors: Y
authors: Zhao
authors: Xiaofeng
authors: X
authors: Zeng
authors: Fengchun
authors: F
authors: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D001660:Biliary Tract Diseases / Q000150:complications; D001799:Blood Sedimentation; D016022:Case-Control Studies; D004108:Dilatation, Pathologic / Q000150:complications; D005260:Female; D005334:Fever / Q000150:complications; D005921:Glomerulonephritis / Q000150:complications; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D006869:Hydronephrosis / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D007074:Immunoglobulin G / Q000097:blood; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007418:Intestinal Pseudo-Obstruction / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D012700:Serositis / Q000150:complications; D012720:Severity of Illness Index; D014517:Ureteral Obstruction / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000974:Antibodies, Antinuclear; D005938:Glucocorticoids; D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; C035356:SS-A antibodies; D011241:Prednisone
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