Volume 4, Number 9; July 15, 2005
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Volume 4, Number 9; July 15, 2005 |
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25-year-old African-American female with 4 months progressive DOE & 50 lb. weight loss.
Recommended reading:
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Patient: A 25-year-old african american female presented with "various complaints" including dyspnea on exertion progressive over 4 months, 50 lb. weight loss, amenorrhea, fatigue, bilatieral tingling and pain, and mild unproductive cough. Patient exhibited pulsus paradoxus. Chem 7 and CBC were normal.
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Session Handout:
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Clinical Question: 1) What is the prevalence of peripheral neuropathy in patients with systemic lupus erythematosus?
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Readings:
<1> Fulltext Available in EBSCOHost Academic Search Premier Unique Identifier [PMID]: 11421851 Authors: Omdal R. Loseth S. Torbergsen T. Koldingsnes W. Husby G. Mellgren SI. Institution: Department of Clinical Medicine/Neurology, University Hospital of Tromso, Oslo, Norway. romdal@online.no Title: Peripheral neuropathy in systemic lupus erythematosus--a longitudinal study.
Source: Acta Neurologica Scandinavica. 103(6):386-91, 2001 Jun. Abstract: OBJECTIVE: Peripheral neuropathy (PN) is reported to occur in 5-27% of patients with systemic lupus erythematosus (SLE) mostly as a length-dependent sensorimotor axonopathy. Studies over time have not been performed. Design - Longitudinal study. Subjects and Methods: Thirty-three Caucasian SLE patients consented to participate in the study and were subjected to clinical examination, laboratory tests, and nerve conduction velocity (NCV) studies. At the follow-up 7 years later, 7 patients (21%) were dead, 4 refused to participate, and 2 did not want to perform NCV studies. Twenty patients were thus available for longitudinal study. RESULTS: When all SLE patients were considered on a group basis at follow-up, 8 (33%) out of 24 NCV parameters showed significant deterioration despite correction for time, while 16 (67%) were unchanged. Analysis of change from baseline showed that, except for F-responses, several NCV changes were highly dependent (negative regression coefficients) on baseline levels at start of study. No demographic, laboratory, or disease associated quantitative factor was associated with these changes in NCV parameters over time. Nor was a consistent effect on NCV parameters from any qualitative demographic or disease associated factor confirmed by Repeated Measures ANOVA analyses. CONCLUSIONS: A modest progressive neuropathic process exists in patients with SLE. Important is also the finding that, over time, the abnormalities of NCV parameters fluctuate in the individual patients, and the impairments are not necessarily irreversible. This study also shows no association to medication, demographic-, or other disease associated factors. Publication Type: Journal Article.
<2> Link Directly to Fulltext article in Ovid Unique Identifier [PMID]: 10359503 Authors: Huynh C. Ho SL. Fong KY. Cheung RT. Mok CC. Lau CS. Institution: Department of Medicine, University of Hong Kong, Queen Mary Hospital. Title: Peripheral neuropathy in systemic lupus erythematosus.
Source: Journal of Clinical Neurophysiology. 16(2):164-8, 1999 Mar. Abstract: The prevalence of clinically apparent peripheral neuropathy in systemic lupus erythematosus is reported to be between 2% to 18%. The purpose of this prospective case-control study was to determine the prevalence of peripheral neuropathy (PN) using electrodiagnostic criteria. Subgroup analysis was performed to determine whether PN correlated with disease activity, renal involvement, or serum immune markers. Fifty-four systemic lupus erythematosus patients and 30 controls were recruited in the study. The right median, ulnar, peroneal, tibial, and sural sensory and motor nerve conduction studies were obtained. PN in our study was defined as any abnormal values in motor and sensory distal latency, sensory action potential, motor action potential, or conduction velocity affecting 2 or more nerves. Of the 54 patients studied, PN was present in 15 patients (27.8%) of which 4 were symptomatic. There was a significant correlation between PN and anti-SM antibody, and there was a trend showing decreased motor and sensory action potential amplitudes in our systemic lupus erythematosus group compared to the controls. This observation was also seen in an active disease group when compared to those with inactive disease. The amplitude of the action potential was more often affected than the distal latency, and sensory nerves were more susceptible than motor nerves. The sural sensory action potential amplitude appears to be the most sensitive indicator of PN which may be used as an index to monitor disease activity. Publication Type: Journal Article.
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Resident Report / Department of Medicine & Grady Branch Library Emory University School of Medicine 2005 Edition Participating Faculty: Carlos Del Rio MD / Joyce Doyle MD / Lorenzo Difrancesco MD / Erich Folch MD / Alicia Hidron MD
Contact:
Karl Woodworth
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