Is there an ethnic difference in the prevalence of lupus cystitis? A report of six cases

Abstract

Lupus cystitis was rare but frequently resulted in obstructive uropathy and had a strong association with gastrointestinal(GI) symptoms. We treated six patients with systemic lupus erythematosus(SLE) and obstructive uropathy from January 1996 to December 2001 in a university hospital. Evidence of cystitis was obtained from cystoscopic biopsy or the presence of thickened bladder wall in image study. Similar to other reports, five patients had GI manifestations such as abdominal pain, nausea/vomiting, diarrhoea or ileus. In addition, mesenteric lymphadenopathy or pancreatitis was noted in three patients. Two patients had been treated for idiopathic thrombocytopenicpurpura (ITP), four and 20 years ago, respectively. All six patients had antibodies to double-stranded DNA (dsDNA). Five patients each had antibodies to cardiolipin (IgG aCL) or SSA. The high prevalence of anti-SSA had also been reported in Chinese lupus patients with intestinal pseudo-obstruction, a clinical manifestation frequently associated with bilateral ureterohydronephrosis. Two patients died of intractable infection after the surgical procedures for persistent ureterohydronephrosis and both patients had antibodies to ribosomal P proteins. Lupus cystitis might not be so rare in Chinese patients with SLE. The diagnosis should be kept in mind when lupus patients have urinary and/or GI symptoms.

Keywords

anti-ribosomal P anti-SSA lupus cystitis

Get full access to this article

View all access options for this article.

References

Weisman MH , McDanald EC , Wilson CB. Studies of the pathogenesis of interstitialcystitis, obstructiveuropathy, and intestinalmalabsorptionina patient with systemic lupus erythematosus . Am J Med 1981; 70: 875-881 .

Orth RW , Weisman MH , Cohen AH , Talner LB , Nachtsheim D , Zvaifler NJ. Lupus cystitis: primary bladder manifestations of systemic lupus erythematosus . Ann Intern Med 1983; 98: 323-326 .

Sotolongo JR , Swerdlow F , Schiff HI , Schapira HE. Successful treatment of lupuserythematosus cystitis with DMSO . Urology 1984;23: 125-127 .

Moriuchi J , Ichikawa Y , Takaya M et al. Lupus cystitis and perforation of small bowel in a patient with systemic lupus erythematosus and overlapping syndrome . Clin Exp Rheumatol 1989; 7: 533-536 .

Vicencio GP , Chung-Park M , Ricannati E , Lee KN , De Baz BP. SLE with interstial cystitis, reversible hydronephrosis and intestinal manifestations . J Rheumatol 1989; 16: 250-251 .

Lu KC , Chou CT. Systemic lupus erythematosus complicated with cystitis, obstructive uropathy and intractable diarrhea: report of a case . J Formosan Med Assoc 1991; 90: 700-704 .

Eberhard A , Shore A , Silverman E , Laxer R. Bowel perforation and interstitial cystitis in childhood systemic lupus erythematosus . J Rheumatol 1991; 18: 746-747 .

Meulders Q , Michel C , Marteau P et al. Association of chronic interstitial cystitis, protein-losing enteropathy and paralytic ileus with seronegative systemic lupus erythematosus: case report and review of the literature . Clin Nephrol 1992; 37: 239-244 .

de Arriba G , Velo M , Barrio V , Garcia-Martin F , Hernando L. Association of interstitial lupus cystitis with systemic lupus erythematosus . Clin Nephrol 1993; 39: 287-288 .

10.

Nakauchi Y , Suehiro T , Tahara K et al. Systemic lupus erythematosus relapse with lupus cystitis . Clin Exp Rheumatol 1995; 13: 645-648 .

11.

Segawa C , Wada T , Yokoyama H. Effect of steroid pulse therapy in lupus cystitis . J Rheumatol 1995; 22: 2373-2374 .

12.

Kim HJ , Park MH. Obstructive uropathy due to interstitial cystitis in a patient with systemic lupus erythematosus . Clin Nephrol 1996; 45: 205-208 .

13.

Odeh M. Severe lupus cystitis with obstructive uropathy . Nephron 1996; 74: 493-494 .

14.

La Manna A , Polito C , Papale MR , Rocco CE , Marte A. Chronic interstitial cystitis and systemic lupus erythematosus in an 8-year-old girl . Pediatr Nephrol 1998; 12: 139-140 .

15.

Tanaka H , Waga S , Takeyama T et al. Interstitial cystitis and ileus in pediatric-onset systemic lupus erythematosus . Pediatr Nephrol 2000; 14: 859-861 .

16.

Gornisiewicz M , Rodriguez M , Smith JK , Sagg K , Alcon GS. Protein-losing enteropathy in a young African-American woman with abdominal pain, diarrhea and hydronephrosis . Lupus 2001; 10: 835-840 .

17.

Alarcon-Segovia D , Abud-Mendoza C , Neyes-Gutierrez E , Iglesias-Gamarra A , Diaz-Jouanen E. Involvement of the urinary bladder in systemic lupus erythematosus. A pathologic study . J Rheumatol 1984; 11: 208-210 .

18.

Chomczynski P , Sacchi N. Single-step method of RNA isolation by acid guanidiniumthiocyanate-phenol-chloroform extraction . Anal Biochem 1987; 162: 156-159 .

19.

Plotz PH , Klipper JH , Decker JL. Bladder complications in patients receiving cyclophosphamide for rheumatoid arthritis or systemic lupus erythematosus . Arthritis Rheum 1979; 22: 647-647 (abstract).

20.

Sweeney JP , Fan CW , Keogh JAB , Thornhill JA. Upper renal tract deterioration after cyclophosphamide-induced cystitis: the case for monitoring after cyclophosphamide therapy . Br J Urol 1998; 81: 639-640 .

21.

Mok MY , Wong RW , Lau CS. Intestinal pseudo-obstruction in systemic lupus erythematosus: an uncommon but important clinical manifestation . Lupus 2000; 9: 11-18 .

22.

Tan EM , Cohen AS , Fries JF et al. The 1982 revised criteria for the classification of systemic lupus erythematosus . Arthritis Rheum 1982; 25: 1271-1277 .

23.

Byun JY , Ha HK , Yu SY et al. CT features of systemic lupus erythematosus in patients with acute abdominal pain: emphasis on ischemic bowel disease . Radiology 1999; 211: 203-209 .

24.

Si-Hoe CK , Thng CH , Chee SG , Teo EK , Chng HH. Abdominal computed tomography in systemic lupus erythematosus . Clin Radiol 1997; 52: 284-289 .

25.

Teodorescu M , Froelich CJ. Laboratory evaluation of systemic lupus erythematosus. In Lahita RG ed. Systemic lupus erythematosus. San Diego: Academic Press , 1998: 477-505.

26.

Lee SS , Li CS , Li PC. Clinical profile of Chinese patients with systemic lupus erythematosus . Lupus 1993; 2: 105-109 .

27.

Koh WH , Fong KY , Boey ML , Feng PH. Systemic lupus erythematosus in 61 oriental males. A study of clinical and laboratory manifestations . Br J Rheumatol 1994; 33: 339-342 .

28.

Wang CL , Ooi L , Wang F. Prevalence and clinical significance of antibodies to ribonucleoproteins in systemic lupus erythematosus in Malaysia . Br J Rheumatol 1996; 35: 129-132 .

29.

Panzer S , Penner E , Graninger W , Schulz E , Smolen JS. Antinuclear antibodies in patients with chronic idiopathic thrombocytopenia followed 2-30 years . Am J Hematol 1989; 32: 100-103 .

30.

Kuruta Y , Miyagawa S , Kosugi S et al. High titer antinuclear antibodies, anti-SSA/Ro antibodies and anti-nuclear RNP antibodies in patients with idiopathic thrombocytopenic purpura . Thromb Haemast 1994; 71: 184-187 .

31.

Bonfa E , Golombek SJ , Kaufman LD et al. Association between lupus psychosis and anti-ribosomal P-protein antibodies . N Engl J Med 1987; 317: 265-271 .

32.

Teh LS , Isenberg DA. Antiribosomal P protein antibodies in systemic lupus erythematosus. A reappraisal . Arthritis Rheum 1994; 37: 307-315 .

33.

Chindalore V , Neas B , Reichlin M. The association between anti-ribosomal P antibodies and active nephritis in systemic lupus erythematosus . Clin Immunol Immunopathol 1998; 87: 292-296 .

34.

Sato T , Uchiumi T , Ozawa T et al. Autoantibodies against ribosomal proteins found with high frequency in patients with systemic lupus erythematosus with active disease . J Rheumatol 1991; 18: 1681-1684 .

35.

Gerli R , Caponi L , Tincani A et al. Clinical and serological associations of ribosomal P autoantibodies in systemic lupus erythematosus: prospective evaluation in a large cohort of Italian patients . Rheumatology 2002; 41: 1357-1366 .

36.

The LS , Lee MK , Wang F et al. Antiribosomal P protein antibodies in different populations of patients with systemic lupus erythematosus . Br J Rheumatol 1993; 32: 663-665 .

37.

Arnett FC , Reveille JD , Moutsopoulos HM , Georgescu L , Elkon KB. Ribosomal P autoantibodies in systemic lupus erythematosus. Frequencies in different ethnic groups and clinical and immunogenetic association . Arthritis Rheum 1996; 39: 1833-1839 .