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Article: Acute transverse myelopathy in systemic lupus erythematosus: Clinical presentation, treatment, and outcome

TitleAcute transverse myelopathy in systemic lupus erythematosus: Clinical presentation, treatment, and outcome
Authors
Issue Date1998
PublisherJournal of Rheumatology Publishing Co Ltd. The Journal's web site is located at http://www.jrheum.com
Citation
Journal Of Rheumatology, 1998, v. 25 n. 3, p. 467-473 How to Cite?
AbstractObjective. Acute transverse myelopathy (ATM) is a rare manifestation of systemic lupus erythematosus (SLE). The pathogenesis is unclear and the optimal management strategy is uncertain because of the lack of controlled trials. In this study, the clinical presentation, autoantibody profile, treatment, and outcome of cases of ATM in our local SLE population were retrospectively analyzed and compared with SLE controls. Results. Ten cases of ATM were identified among 315 patients with SLE studied, giving a prevalence of 3.2%. In 5 of the patients, ATM was the initial manifestation of SLE. The cervical cord was the most common site of involvement (50%). Cerebrospinal fluid abnormalities were present in 63% of the patients, while magnetic resonance imaging (MRI) of the spinal cord revealed abnormal T2 signals in 56%. Only one patient had lupus nephritis. ATM was not associated with antiribosomal P or anti-extractable nuclear antigen (anti-ENA) antibodies. Positive dsDNA antibody was present in 40% of the ATM cases, which was significantly lower than that of patients with active SLE without spinal cord disease (75%; p = 0.04). No significant differences in the prevalence of anticardiolipin antibodies and lupus anticoagulant between the ATM and the non-ATM group were observed. Only 3 patients with ATM showed hypocomplementemia or disease activity in other organs at the time of diagnosis. All the patients with ATM received corticosteroids, while 9 were given cytotoxic agents in addition. The response to treatment was variable - 40% of patients had complete motor and sphincter recovery and 30% had mild residual spasticity of the lower limbs. Conclusion. In our SLE population, ATM was not associated with antiribosomal P, anti-ENA, or antiphospholipid antibodies. Systemic complement activation was not evident in most patients during the acute phase of myelitis. Early aggressive therapy using a combination of corticosteroid and cytotoxic agents is associated with a satisfactory outcome. Further prospective study is needed to delineate the best treatment and its efficacy in the prevention of relapses.
Persistent Identifierhttp://hdl.handle.net/10722/162886
ISSN
2015 Impact Factor: 3.236
2015 SCImago Journal Rankings: 1.225
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorMok, CCen_US
dc.contributor.authorLau, CSen_US
dc.contributor.authorChan, EYTen_US
dc.contributor.authorWong, RWSen_US
dc.date.accessioned2012-09-05T05:24:47Z-
dc.date.available2012-09-05T05:24:47Z-
dc.date.issued1998en_US
dc.identifier.citationJournal Of Rheumatology, 1998, v. 25 n. 3, p. 467-473en_US
dc.identifier.issn0315-162Xen_US
dc.identifier.urihttp://hdl.handle.net/10722/162886-
dc.description.abstractObjective. Acute transverse myelopathy (ATM) is a rare manifestation of systemic lupus erythematosus (SLE). The pathogenesis is unclear and the optimal management strategy is uncertain because of the lack of controlled trials. In this study, the clinical presentation, autoantibody profile, treatment, and outcome of cases of ATM in our local SLE population were retrospectively analyzed and compared with SLE controls. Results. Ten cases of ATM were identified among 315 patients with SLE studied, giving a prevalence of 3.2%. In 5 of the patients, ATM was the initial manifestation of SLE. The cervical cord was the most common site of involvement (50%). Cerebrospinal fluid abnormalities were present in 63% of the patients, while magnetic resonance imaging (MRI) of the spinal cord revealed abnormal T2 signals in 56%. Only one patient had lupus nephritis. ATM was not associated with antiribosomal P or anti-extractable nuclear antigen (anti-ENA) antibodies. Positive dsDNA antibody was present in 40% of the ATM cases, which was significantly lower than that of patients with active SLE without spinal cord disease (75%; p = 0.04). No significant differences in the prevalence of anticardiolipin antibodies and lupus anticoagulant between the ATM and the non-ATM group were observed. Only 3 patients with ATM showed hypocomplementemia or disease activity in other organs at the time of diagnosis. All the patients with ATM received corticosteroids, while 9 were given cytotoxic agents in addition. The response to treatment was variable - 40% of patients had complete motor and sphincter recovery and 30% had mild residual spasticity of the lower limbs. Conclusion. In our SLE population, ATM was not associated with antiribosomal P, anti-ENA, or antiphospholipid antibodies. Systemic complement activation was not evident in most patients during the acute phase of myelitis. Early aggressive therapy using a combination of corticosteroid and cytotoxic agents is associated with a satisfactory outcome. Further prospective study is needed to delineate the best treatment and its efficacy in the prevention of relapses.en_US
dc.languageengen_US
dc.publisherJournal of Rheumatology Publishing Co Ltd. The Journal's web site is located at http://www.jrheum.comen_US
dc.relation.ispartofJournal of Rheumatologyen_US
dc.subject.meshAcute Diseaseen_US
dc.subject.meshAdolescenten_US
dc.subject.meshAdulten_US
dc.subject.meshAnti-Inflammatory Agents - Therapeutic Useen_US
dc.subject.meshAntirheumatic Agents - Therapeutic Useen_US
dc.subject.meshCyclophosphamide - Therapeutic Useen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshLupus Erythematosus, Systemic - Complications - Diagnosis - Immunologyen_US
dc.subject.meshMagnetic Resonance Imagingen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshMyelitis, Transverse - Diagnosis - Drug Therapy - Etiology - Immunologyen_US
dc.subject.meshPrednisolone - Therapeutic Useen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleAcute transverse myelopathy in systemic lupus erythematosus: Clinical presentation, treatment, and outcomeen_US
dc.typeArticleen_US
dc.identifier.emailLau, CS:cslau@hku.hken_US
dc.identifier.authorityLau, CS=rp01348en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid9517765-
dc.identifier.scopuseid_2-s2.0-2642709239en_US
dc.identifier.hkuros40629-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-2642709239&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume25en_US
dc.identifier.issue3en_US
dc.identifier.spage467en_US
dc.identifier.epage473en_US
dc.identifier.isiWOS:000072245800012-
dc.publisher.placeCanadaen_US
dc.identifier.scopusauthoridMok, CC=34668219600en_US
dc.identifier.scopusauthoridLau, CS=14035682100en_US
dc.identifier.scopusauthoridChan, EYT=7401994013en_US
dc.identifier.scopusauthoridWong, RWS=34875928200en_US

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