Manifestaciones clínicas y laboratoriales en el Lupus Eritematoso Sistémico-LES
Palabras clave:
manifestaciones clínicas, lupus eritematoso sistémico, análisis laboratorialesResumen
El Lupus eritematoso sistémico (LES) es una enfermedad autoinmune compleja que se caracteriza por su capacidad de afectar a diversos órganos, lo que determina las diferentes manifestaciones clínicas objetivadas durante la evolución de la enfermedad. De forma asociada se ha descrito que estas manifestaciones presentan una variación geográfica o étnica, siendo por lo general menos grave en pacientes con ascendencia europea que en aquellos que presentan ascendencia africana, asiática o hispana. Alteraciones, tanto del sistema inmune adaptativo (células T y B) como del innato (Toll like receptorx-TLR), contribuyen al desarrollo del LES. Las células B tienen su papel en la producción de los autoanticuerpos (i.e. anticuerpos anti-ADN y anticuerpos anti-nucleosoma) y de determiandas citocinas. Las pruebas de laboratorio son de gran valor cuando se evalúa a un paciente con sospecha de enfermedad autoinmune. Los resultados pueden confirmar el diagnóstico, estimar la severidad de la enfermedad, evaluar el pronóstico y son de suma utilidad para el seguimiento de la actividad del LES.
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Borchers AT, Naguwa SM, Shoenfeld Y, Gershwin ME. The geoepidemiology of systemic lupus erythematosus. Autoimmunity Reviews. 2010;9(5):A277-A87.
Fernández-Nebro A, Marsal S, Chatham W, Rahman A. Systemic Lupus Erythematosus: Genomics, Mechanisms, and Therapies. Clinical and Developmental Immunology. 2012;2012:1-2.
Gonzalez Martinez-Pedrayo AL. Bases genéticas de las enfermedades reumáticas. In: Blanco FJ, Cañete JD, Pablos JL, editors. Técnicas de investigación básica en reumatología. Madrid: Editorial médica Panamericana; 2007. p. 3-10.
Alarcón Riquelme ME. Genética del lupus eritematoso generalizado. ¿Qué se sabe y a dónde se va? Reumatología Clínica. 2010;6(1):1-2.
Fraser PA, Ding WZ, Mohseni M, Treadwell EL, Dooley MA, St Clair EW et al. Glutathione S-transferase M null homozygosity and risk of systemic lupus erythematosus associated with sun exposure: a possible gene-environment interaction for autoimmunity. J Rheumatol. 2003;30(2):276-82.
Schoenfeld SR, Kasturi S, Costenbader KH. The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: a systematic review. Semin Arthritis Rheum. 2013;43(1):77-95.
Urowitz MB, Bookman AA, Koehler BE, Gordon DA, Smythe HA, Ogryzlo MA. The bimodal mortality pattern of systemic lupus erythematosus. Am J Med. 1976;60(2):221-5.
Pons-Estel BA, Catoggio LJ, Cardiel MH, Soriano ER, Gentiletti S, Villa AR et al. The GLADEL multinational Latin American prospective inception cohort of 1,214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among "Hispanics". Medicine (Baltimore). 2004;83(1):1-17.
Devins GM, Edworthy SM. Illness intrusiveness explains race-related quality-of-life differences among women with systemic lupus erythematosus. Lupus. 2000;9(7):534-41.
Ginzler EM, Diamond HS, Weiner M, Schlesinger M, Fries JF, Wasner C et al. A multicenter study of outcome in systemic lupus erythematosus. I. Entry variables as predictors of prognosis. Arthritis Rheum. 1982;25(6):601-11.
Halberg P, Alsbjorn B, Balslev JT, Lorenzen I, Gerstoft J, Ullman S et al. Systemic lupus erythematosus. Follow-up study of 148 patients. II: Predictive factors of importance for course and outcome. Clin Rheumatol. 1987;6(1):22-6.
Karlson EW, Daltroy LH, Lew RA, Wright EA, Partridge AJ, Fossel AH et al. The relationship of socioeconomic status, race, and modifiable risk factors to outcomes in patients with systemic lupus erythematosus. Arthritis Rheum. 1997;40(1):47-56.
McCarty DJ, Manzi S, Medsger TA, Jr., Ramsey-Goldman R, LaPorte RE, Kwoh CK. Incidence of systemic lupus erythematosus. Race and gender differences. Arthritis Rheum. 1995;38(9):1260-70.
Molokhia M, Hoggart C, Patrick AL, Shriver M, Parra E, Ye J et al. Relation of risk of systemic lupus erythematosus to west African admixture in a Caribbean population. Hum Genet. 2003;112(3):310-8.
Alarcon GS, Roseman J, Bartolucci AA, Friedman AW, Moulds JM, Goel N et al. Systemic lupus erythematosus in three ethnic groups: II. Features predictive of disease activity early in its course. LUMINA Study Group. Lupus in minority populations, nature versus nurture. Arthritis Rheum. 1998;41(7):1173-80.
Peralta-Ramirez MI, Jimenez-Alonso J, Godoy-Garcia JF, Perez-Garcia M. The effects of daily stress and stressful life events on the clinical symptomatology of patients with lupus erythematosus. Psychosom Med. 2004;66(5):788-94.
Reveille JD, Moulds JM, Ahn C, Friedman AW, Baethge B, Roseman J et al. Systemic lupus erythematosus in three ethnic groups: I. The effects of HLA class II, C4, and CR1 alleles, socioeconomic factors, and ethnicity at disease onset. LUMINA Study Group. Lupus in minority populations, nature versus nurture. Arthritis Rheum. 1998;41(7):1161-72.
Bernatsky S, Boivin JF, Joseph L, Manzi S, Ginzler E, Gladman DD et al. Mortality in systemic lupus erythematosus. Arthritis Rheum. 2006;54(8):2550-7.
Black L, Katz S. Respiratory Disease: Task Force Report on Problems,Research Approaches, Needs. DHEW report NIH77-1248. Arlington, VA: National Heart and Lung Institute. 1977.
Mohan C, Putterman C. Genetics and pathogenesis of systemic lupus erythematosus and lupus nephritis. Nat Rev Nephrol. [Review]. 2015;advance online publication.
Lisnevskaia L, Murphy G, Isenberg D. Systemic lupus erythematosus. Lancet. 2014;384(9957):1878-88.
Choi J, Kim ST, Craft J. The pathogenesis of systemic lupus erythematosus—an update. Current Opinion in Immunology. 2012;24(6):651-7.
Munoz LE, Gaipl US, Franz S, Sheriff A, Voll RE, Kalden JR et al. SLE--a disease of clearance deficiency? Rheumatology (Oxford). 2005;44(9):1101-7. Epub 2005 May 31.
Sullivan KE. Genetics of systemic lupus erythematosus. Clinical implications. Rheum Dis Clin North Am. 2000;26(2):229-56, v-vi.
Walport MJ. Complement and systemic lupus erythematosus. Arthritis Res. 2002;4(Suppl 3):S279-93.
Niu Z, Zhang P, Tong Y. Value of HLA-DR genotype in systemic lupus erythematosus and lupus nephritis: a meta-analysis. Int J Rheum Dis. 2015;18(1):17-28.
Lee YH, Bae SC. Association between the functional ITGAM rs1143679 G/A polymorphism and systemic lupus erythematosus/lupus nephritis or rheumatoid arthritis: an update meta-analysis. Rheumatol Int. 2015;35(5):815-23.
Ostanek L, Ostanek-Panka M, Bobrowska-Snarska D, Binczak-Kuleta A, Fischer K, Kaczmarczyk M et al. PTPN22 1858C>T gene polymorphism in patients with SLE: association with serological and clinical results. Mol Biol Rep. 2014;41(9):6195-200.
Harley JB, Alarcon-Riquelme ME, Criswell LA, Jacob CO, Kimberly RP, Moser KL et al. Genome-wide association scan in women with systemic lupus erythematosus identifies susceptibility variants in ITGAM, PXK, KIAA1542 and other loci. Nat Genet. 2008;40(2):204-10.
Remmers EF, Plenge RM, Lee AT, Graham RR, Hom G, Behrens TW et al. STAT4 and the risk of rheumatoid arthritis and systemic lupus erythematosus. N Engl J Med. 2007;357(10):977-86.
Klemperer P, Pollack A, Baehr G. Diffuse collagen disease. Acute disseminated lupus erythematosus and diffuse scleroderma. JAMA. 1942:331-2.
Cutolo M, Sulli A, Straub RH. Estrogen metabolism and autoimmunity. Autoimmun Rev. 2012;11(6-7):A460-4.
Mason LJ, Isenberg D. The pathogenesis of systemic lupus erythematosus. In: Davidson AM, Cameron JS, Grunfeld JP, editors. Oxford textbook of clinical nephrology. Oxford, England: Oxford University Press; 2005. p. 809-29.
Rubin R. Drug induced lupus. In: Wallace DJ, Hahn BH, editors. Dubois’ lupus erythematosus. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 885-916.
Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982;25(11):1271-7.
Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40(9):1725.
Kuwana M, Kaburaki J, Okazaki Y, Miyazaki H, Ikeda Y. Two types of autoantibody-mediated thrombocytopenia in patients with systemic lupus erythematosus. Rheumatology (Oxford). 2006;45(7):851-4.
Musio F, Bohen EM, Yuan CM, Welch PG. Review of thrombotic thrombocytopenic purpura in the setting of systemic lupus erythematosus. Semin Arthritis Rheum. 1998;28(1):1-19.
Villa Blanco I, Calvo Alén J. Lupus eritematoso sistémico. In: Alperi Lopez M, Balsa Criado A, Blanco A, Hernandez Cruz B, Medina Luezas J, Muñoz-Fernández S et al., editors. Manual SER de enfermedades reumáticas. 6 ed. Madrid: Elsevier; 2014. p. 335-62.
Krupp LB, LaRocca NG, Muir J, Steinberg AD. A study of fatigue in systemic lupus erythematosus. J Rheumatol. 1990;17(11):1450-2.
Kuhn A, Landmann A. The classification and diagnosis of cutaneous lupus erythematosus. J Autoimmun. 2014;48-49:14-9.
Provost TT. Nonspecific cutaneous manifestations of systemic lupus erythematosus. In: Khun A, Lehmann P, Ruzicka T, editors. Cutaneous lupus erythematosus: Springer; 2004. p. 93-106.
Werth VP. Clinical manifestations of cutaneous lupus erythematosus. Autoimmunity Reviews. 2005;4(5):296-302.
Kuhn A, Lehmann P, Ruzicka T. Clinical manifestations of cutaneous lupus erythematosus. In: Kuhn A, Lehmann P, Ruzicka T, editors. Cutaneous lupus erythematosus: Springer; 2004. p. 59-92.
Horne NS, Narayan AR, Young RM, Frieri M. Toxic epidermal necrolysis in systemic lupus erythematosus. Autoimmun Rev. 2006;5(2):160-4.
Gronhagen CM, Fored CM, Linder M, Granath F, Nyberg F. Subacute cutaneous lupus erythematosus and its association with drugs: a population-based matched case-control study of 234 patients in Sweden. Br J Dermatol. 2012;167(2):296-305.
Tebbe B, Mansmann U, Wollina U, Auer-Grumbach P, Licht-Mbalyohere A, Arensmeier M et al. Markers in cutaneous lupus erythematosus indicating systemic involvement. A multicenter study on 296 patients. Acta Derm Venereol. 1997;77(4):305-8.
Viguier M, Pinquier L, Cavelier-Balloy B, de la Salmoniere P, Cordoliani F, Flageul B et al. Clinical and histopathologic features and immunologic variables in patients with severe chilblains. A study of the relationship to lupus erythematosus. Medicine (Baltimore). 2001;80(3):180-8.
Kuhn A, Bein D, Bonsmann G. The 100th anniversary of lupus erythematosus tumidus. Autoimmun Rev. 2009;8(6):441-8.
Kuhn A, Richter-Hintz D, Oslislo C, Ruzicka T, Megahed M, Lehmann P. Lupus erythematosus tumidus--a neglected subset of cutaneous Lupus erythematosus: report of 40 cases. Arch Dermatol. 2000;136(8):1033-41.
Kuhn A, Ruland V, Bonsmann G. Photosensitivity, phototesting, and photoprotection in cutaneous lupus erythematosus. Lupus. 2010;19(9):1036-46.
Pipili C, Sfritzeri A, Cholongitas E. Deforming arthropathy in systemic lupus erythematosus. Eur J Intern Med. 2008;19(7):482-7.
Giannouli S, Voulgarelis M, Ziakas PD, Tzioufas AG. Anaemia in systemic lupus erythematosus: from pathophysiology to clinical assessment. Ann Rheum Dis. 2006;65(2):144-8.
Voulgarelis M, Kokori SI, Ioannidis JP, Tzioufas AG, Kyriaki D, Moutsopoulos HM. Anaemia in systemic lupus erythematosus: aetiological profile and the role of erythropoietin. Ann Rheum Dis. 2000;59(3):217-22.
The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999;42(4):599-608.
Brey RL, Holliday SL, Saklad AR, Navarrete MG, Hermosillo-Romo D, Stallworth CL et al. Neuropsychiatric syndromes in lupus: prevalence using standardized definitions. Neurology. 2002;58(8):1214-20.
Carbotte RM, Denburg SD, Denburg JA. Prevalence of cognitive impairment in systemic lupus erythematosus. J Nerv Ment Dis. 1986;174(6):357-64.
Appenzeller S, Cendes F, Costallat LT. Cognitive impairment and employment status in systemic lupus erythematosus: a prospective longitudinal study. Arthritis Rheum. 2009;61(5):680-7.
Devinsky O, Petito CK, Alonso DR. Clinical and neuropathological findings in systemic lupus erythematosus: the role of vasculitis, heart emboli, and thrombotic thrombocytopenic purpura. Ann Neurol. 1988;23(4):380-4.
Ellis SG, Verity MA. Central nervous system involvement in systemic lupus erythematosus: a review of neuropathologic findings in 57 cases, 1955--1977. Semin Arthritis Rheum. 1979;8(3):212-21.
Trysberg E, Nylen K, Rosengren LE, Tarkowski A. Neuronal and astrocytic damage in systemic lupus erythematosus patients with central nervous system involvement. Arthritis Rheum. 2003;48(10):2881-7.
Winfield JB, Shaw M, Silverman LM, Eisenberg RA, Wilson HA, 3rd, Koffler D. Intrathecal IgG synthesis and blood-brain barrier impairment in patients with systemic lupus erythematosus and central nervous system dysfunction. Am J Med. 1983;74(5):837-44.
Abreu MR, Jakosky A, Folgerini M, Brenol JC, Xavier RM, Kapczinsky F. Neuropsychiatric systemic lupus erythematosus: correlation of brain MR imaging, CT, and SPECT. Clin Imaging. 2005;29(3):215-21.
Ainiala H, Dastidar P, Loukkola J, Lehtimaki T, Korpela M, Peltola J et al. Cerebral MRI abnormalities and their association with neuropsychiatric manifestations in SLE: a population-based study. Scand J Rheumatol. 2005;34(5):376-82.
Hanly JG, Urowitz MB, Siannis F, Farewell V, Gordon C, Bae SC et al. Autoantibodies and neuropsychiatric events at the time of systemic lupus erythematosus diagnosis: results from an international inception cohort study. Arthritis Rheum. 2008;58(3):843-53.
Isshi K, Hirohata S. Association of anti-ribosomal P protein antibodies with neuropsychiatric systemic lupus erythematosus. Arthritis Rheum. 1996;39(9):1483-90.
Yoshio T, Hirata D, Onda K, Nara H, Minota S. Antiribosomal P protein antibodies in cerebrospinal fluid are associated with neuropsychiatric systemic lupus erythematosus. J Rheumatol. 2005;32(1):34-9.
Hirohata S, Arinuma Y, Takayama M, Yoshio T. Association of cerebrospinal fluid anti-ribosomal p protein antibodies with diffuse psychiatric/neuropsychological syndromes in systemic lupus erythematosus. Arthritis Res Ther. 2007;9(3):R44.
Petri M, Kasitanon N, Lee SS, Link K, Magder L, Bae SC et al. Systemic lupus international collaborating clinics renal activity/response exercise: development of a renal activity score and renal response index. Arthritis Rheum. 2008;58(6):1784-8.
Ordi-Ros J, Torres MT, Segarra A, Vilardell M. Nefropatía lúpica. In: Cervera R, Jimenez-Alonso J, editors. Avances en lupus eritematoso sistémico. Barcelona: Marge Medica Books; 2011. p. 97-122.
Christopher-Stine L, Siedner M, Lin J, Haas M, Parekh H, Petri M et al. Renal biopsy in lupus patients with low levels of proteinuria. J Rheumatol. 2007;34(2):332-5.
Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int. 2004;65(2):521-30.
Fries JF, Powers R, Kempson RL. Late-stage lupus nephropathy. J Rheumatol. 1974;1(2):166-75.
Sultan SM, Ioannou Y, Isenberg DA. A review of gastrointestinal manifestations of systemic lupus erythematosus. Rheumatology (Oxford). 1999;38(10):917-32.
Kwok SK, Seo SH, Ju JH, Park KS, Yoon CH, Kim WU et al. Lupus enteritis: clinical characteristics, risk factor for relapse and association with anti-endothelial cell antibody. Lupus. 2007;16(10):803-9.
Breuer GS, Baer A, Dahan D, Nesher G. Lupus-associated pancreatitis. Autoimmun Rev. 2006;5(5):314-8.
Runyon BA, LaBrecque DR, Anuras S. The spectrum of liver disease in systemic lupus erythematosus. Report of 33 histologically-proved cases and review of the literature. Am J Med. 1980;69(2):187-94.
Tse KC, Yung S, Tang C, Yip TP, Chan TM. Management of hepatitis B reactivation in patients with lupus nephritis. Rheumatol Int. 2009;29(11):1273-7.
Kao AH, Manzi S. How to manage patients with cardiopulmonary disease? Best Pract Res Clin Rheumatol. 2002;16(2):211-27.
Memet B, Ginzler EM. Pulmonary manifestations of systemic lupus erythematosus. Semin Respir Crit Care Med. 2007;28(4):441-50.
Pan TL, Thumboo J, Boey ML. Primary and secondary pulmonary hypertension in systemic lupus erythematosus. Lupus. 2000;9(5):338-42.
Doria A, Iaccarino L, Sarzi-Puttini P, Atzeni F, Turriel M, Petri M. Cardiac involvement in systemic lupus erythematosus. Lupus. 2005;14(9):683-6.
Wijetunga M, Rockson S. Myocarditis in systemic lupus erythematosus. Am J Med. 2002;113(5):419-23.
Makaryus JN, Catanzaro JN, Goldberg S, Makaryus AN. Rapid progression of atrioventricular nodal blockade in a patient with systemic lupus erythematosus. Am J Emerg Med. 2008;26(8):967.e5-7.
Moder KG, Miller TD, Tazelaar HD. Cardiac involvement in systemic lupus erythematosus. Mayo Clin Proc. 1999;74(3):275-84.
Manzi S, Meilahn EN, Rairie JE, Conte CG, Medsger TA, Jr., Jansen-McWilliams L et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol. 1997;145(5):408-15.
Magder LS, Petri M. Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus. Am J Epidemiol. 2012;176(8):708-19.
Navarra SV, Guzman RM, Gallacher AE, Hall S, Levy RA, Jimenez RE et al. Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377(9767):721-31.
Castro C, Gourley M. Diagnostic testing and interpretation of tests for autoimmunity. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S238-47.
Tan EM. Autoantibodies to nuclear antigens (ANA): their immunobiology and medicine. Adv Immunol. 1982;33:167-240.
Conrad K, Schößler W, Hiepe F, Fritzler MJ. Autoantigens, autoantibodies, autoimmunity. Autoantibodies in systemic autoimmune diseases. A diagnostic reference: Pabst Science Publisher; 2002.
Shoenfeld Y, Meroni P, Gershwin M. Autoantibodies. 2n ed. Amsterdam, Boston: Elsevier; 2007.
Coons AH, Kaplan MH. Localization of antigen in tissue cells; improvements in a method for the detection of antigen by means of fluorescent antibody. J Exp Med. 1950;91(1):1-13.
Cabiedes J, Núñez-Álvarez CA. Anticuerpos antinucleares. Reumatol Clín. 2010;6(4):224-30.
Damoiseaux JG, Tervaert JW. From ANA to ENA: how to proceed? Autoimmun Rev. 2006;5(1):10-7.
Morehead K. Evaluation of the patient. Laboratory Assessment. In: Klippel JH, Stone JH, White PH, editors. Primer on the rheumatic diseases. 13th ed. New York: Springer Science & Business Media; 2008. p. 15-21.
Reeves WH, Satoh M, Richards HB. Origins of antinuclear antibodies. In: Lahita RG, Tsokos G, Buyon J, Koike T, editors. Systemic lupus erythematosus. San Diego: Academic Press; 2004. p. 401-31.
Gullstrand B, Lefort MH, Tyden H, Jonsen A, Lood C, Johansson A et al. Combination of autoantibodies against different histone proteins influences complement-dependent phagocytosis of necrotic cell material by polymorphonuclear leukocytes in systemic lupus erythematosus. J Rheumatol. 2012;39(8):1619-27.
Jovanovic V, Dai X, Lim YT, Kemeny DM, MacAry PA. Fc gamma receptor biology and systemic lupus erythematosus. Int J Rheum Dis. 2009;12(4):293-8.
Ricklin D, Hajishengallis G, Yang K, Lambris JD. Complement: a key system for immune surveillance and homeostasis. Nat Immunol. 2010;11(9):785-97.
Julkunen H, Ekblom-Kullberg S, Miettinen A. Nonrenal and renal activity of systemic lupus erythematosus: a comparison of two anti-C1q and five anti-dsDNA assays and complement C3 and C4. Rheumatol Int. 2012;32(8):2445-51.
Li J, An L, Zhang Z. Usefulness of complement activation products in Chinese patients with systemic lupus erythematosus. Clin Exp Rheumatol. 2014;32(1):48-53.
Batal I, Liang K, Bastacky S, Kiss LP, McHale T, Wilson NL et al. Prospective assessment of C4d deposits on circulating cells and renal tissues in lupus nephritis: a pilot study. Lupus. 2012;21(1):13-26.
McPherson RA, Pincus MR. Henry's clinical diagnosis and management by laboratory methods. 21 ed. Philadelphia: WB Saunders; 2007.
Gladman D, Ginzler E, Goldsmith C, Fortin P, Liang M, Urowitz M et al The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum. 1996;39(3):363-9.
Petri M, Magder L. Classification criteria for systemic lupus erythematosus: a review. Lupus. 2004;13(11):829-37.