title: Lupus cystitis in Korean patients with systemic lupus erythematosus: risk factors and clinical outcomes.
abstract: This study was performed to investigate the clinical characteristics of lupus cystitis and determine the risk factors and clinical outcomes of lupus cystitis in patients with systemic lupus erythematosus (SLE). We retrospectively reviewed 1064 patients at Seoul St. Mary's Hospital in Seoul, Korea, from 1998 to 2013. Twenty-four patients had lupus cystitis. Lupus cystitis was defined as unexplained ureteritis and/or cystitis as detected by imaging studies, cystoscopy, or bladder histopathology without urinary microorganisms or stones. Three-fourths of patients with lupus cystitis had concurrent lupus mesenteric vasculitis (LMV). The initial symptoms were gastrointestinal in nature for most patients (79.2%). High-dose methylprednisolone was initially administered to most patients (91.7%) with lupus cystitis. Two patients (8.3%) died of urinary tract infections. Sixty-five age- and sex-matched patients with SLE who were admitted with other manifestations were included as the control group. Patients with lupus cystitis showed a lower C3 level (p = 0.031), higher SLE Disease Activity Index score (p = 0.006), and higher ESR (p = 0.05) upon admission; more frequently had a history of LMV prior to admission (p < 0.001); and less frequently had a history of neuropsychiatric lupus (p = 0.031) than did patients with SLE but without lupus cystitis. The occurrence of lupus cystitis was associated with a history of LMV (OR, 21.794; 95% CI, 4.061-116.963). The median follow-up period was 3.4 years, and the cumulative one-year mortality rate was 20%. Complications developed in 33.3% of patients with lupus cystitis and were related to survival (log-rank p = 0.021). Our results suggest that the possibility of lupus cystitis should be considered when a patient with SLE and history of LMV presents with gastrointestinal symptoms or lower urinary tract symptoms. Development of complications in patients with lupus cystitis can be fatal. Thus, intensive treatment and follow-up are needed, especially in the presence of complications.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, School of Medicine, Seoul St. Mary' Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Koh
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, School of Medicine, Seoul St. Mary' Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, School of Medicine, Seoul St. Mary' Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: S M
authors.initials: SM
authors.lastname: Jung
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, School of Medicine, Seoul St. Mary' Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Ju
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, School of Medicine, Seoul St. Mary' Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Park
authors.affiliation: Divison of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul St. Mary' Hospital, Seoul, South Korea.
authors.forename: H-Y
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, School of Medicine, Seoul St. Mary' Hospital, The Catholic University of Korea, Seoul, South Korea seungki73@catholic.ac.kr.
authors.forename: S-K
authors.initials: SK
authors.lastname: Kwok
mesh_terms: D000328:Adult; D003556:Cystitis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008775:Methylprednisolone / Q000627:therapeutic use; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014657:Vasculitis / Q000150:complications*; D055815:Young Adult
chemical_list: D008775:Methylprednisolone
keywords: Interstitial cystitis; enterocolitis; hydronephrosis; systemic lupus erythematosus