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Retrospective analysis of plasma exchange combined with glucocorticosteroids for the treatment of systemic lupus erythematosus-related acute pancreatitis in central China

  • Yi-kai Yu (余毅恺)
  • Fei Yu (于 飞)
  • Cong Ye (叶 丛)
  • Yu-jie Dai (戴玉洁)
  • Xiao-wei Huang (黄晓伟)
  • Shao-xian Hu (胡绍先)Email author
Article

Summary

Systemic lupus erythematosus-related acute pancreatitis (SLEAP) has a poor prognosis with a high mortality. We described the clinical features of SLEAP, and discussed the feasibility of plasma exchange (PE) combined with glucocorticosteroids (GC) in short-term prognosis and possible mechanism in reducing serum inflammatory cytokine IL-6 and removing serum lipids. A retrospective study was performed by an independent rheumatologist. Medical records of SLEAP from March 2010 to December 2014 were retrieved from Tongji Hospital information system, and patients were divided into two groups according to whether PE therapy was adopted. Sixteen patients treated with PE in combination with GC were classified as group A, and the other 10 patients who were treated with merely GC were classified as group B. Patients’ clinical remission rate and average daily GC dosage after two-week therapy were compared between the two groups. Patients’ serum inflammatory cytokines and lipid concentration were compared between baseline and after two-week treatment in both groups. Pearson correlation test was performed to determine association between serum cytokines and Ranson score. SLEDAI score in group A patients at baseline (14.8±3.1) showed no statistical difference from that in group B (14.1±3.3). At baseline serum IL-6 levels had no significant difference between group A [13.14 (11.12, 16.57) mg/L] and group B [14.63 (11.37, 16.37) mg/L]; after two-week therapy IL-6 decreased significantly in group A [9.16 (7.93, 10.75)mg/L] while it did not show decreasing trend in group B [13.62 (9.29,17.63) mg/L]. Serum lipid concentration after two-week therapy in group A [(TC=5.02±0.53, TG=1.46±0.44) mmol/L] decreased significantly compared to baseline [(TC=6.11±0.50, TG=2.14±1.03) mmol/L], while similar tendency was not observed in group B. The remission rate after two-week therapy was higher in group A (70.0%) than in group B (25.0%). Acute pancreatitis (AP) was one of the clinical manifestations of active SLE. PE combined with GC could reduce serum IL-6 level, and remove serum lipid to improve short-term prognosis. Therefore, it might be a safe and effective way in treating SLEAP and was worth continuing to explore its feasibility.

Keywords

systemic lupus erythematosus acute pancreatitis plasma exchange IL-6 serum lipid 

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References

  1. 1.
    Nesher G, Breuer GS, Temprano K, et al. Lupus-associated pancreatitis. Semin Arthritis Rheum, 2006,35(4): 260–267CrossRefPubMedGoogle Scholar
  2. 2.
    Wang CH, Yao TC, Huang YL, et al. Acute pancreatitis in pediatric and adult-onset systemic lupus erythematosus: a comparison and review of the literature. Lupus, 2011,20(5):443–452CrossRefPubMedGoogle Scholar
  3. 3.
    Masoodi I. The simultaneous incidence of acute pancreatitis and autoimmune hemolytic anemia: a rare duo in a patient with SLE. Ger Med Sci, 2014,12: Doc12PubMedPubMedCentralGoogle Scholar
  4. 4.
    Jia Y, Ortiz A, McCallum R, et al. Acute pancreatitis as the initial presentation of systematic lupus erythematosus. Case Rep Gastrointest Med, 2014:571493Google Scholar
  5. 5.
    Kapoor D, Mendez E, Espinoza LR. Corticosteroids and SLE pancreatitis. J Rheumatol, 1999,26(4):1011–1012PubMedGoogle Scholar
  6. 6.
    Zanen S, Brand A, Cats A. Acute pancreatitis in systemic lupus erythematosus (SLE). Successful treatment with plasmapheresis after failure of prednisone. Clin Exp Rheumatol, 1983,1(4):341–4PubMedGoogle Scholar
  7. 7.
    Kolk A, Horneff G, Wilgenbus KK, et al. Acute lethal necrotising pancreatitis in childhood systemic lupus erythematosus—possible toxicity of immunosuppressive therapy. ClinExpRheumatol, 1995,13(3):399–403Google Scholar
  8. 8.
    Garcia-Consuegra J, Merino R, Alonso A, et al. Systemic lupus erythematosus: a case report with unusual manifestations and favourable outcome after plasmapheresis. Eur J Pediatr, 1992,151(8):581–582CrossRefPubMedGoogle Scholar
  9. 9.
    Feld J, Isenberg D. Why and how should we measure disease activity and damage in lupus? Presse Med, 2014,43(6 Pt 2):e151–156CrossRefPubMedGoogle Scholar
  10. 10.
    FitzGerald JD, Grossman JM. Validity and reliability of retrospective assessment of disease activity and flare in observational cohorts of lupus patients. Lupus, 1999, 8(8):638–644CrossRefPubMedGoogle Scholar
  11. 11.
    Banks PA, Freeman ML. Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol, 2006,101(10):2379–2400CrossRefPubMedGoogle Scholar
  12. 12.
    Kuo DC, Rider AC, Estrada P, et al. Acute Pancreatitis: What's the Score? J Emerg Med, 2015,48(6):762–770CrossRefPubMedGoogle Scholar
  13. 13.
    Malaviya AN, Sharma A, Agarwal D, et al. Acute abdomen in SLE. Int J Rheum Dis, 2011,14(1):98–104CrossRefPubMedGoogle Scholar
  14. 14.
    Penalva JC, Martinez J, Pascual E, et al. Chronic pancreatitis associated with systemic lupus erythematosus in a young girl. Pancreas, 2003,27(3):275–277CrossRefPubMedGoogle Scholar
  15. 15.
    Singh R, Saunders B, Scopelitis E. Pancreatitis leading to thrombotic thrombocytopenic purpura in systemic lupus erythematosus: a case report and review of literature. Lupus, 2003,12(2):136–139CrossRefPubMedGoogle Scholar
  16. 16.
    Ikura Y, Matsuo T, Ogami M, et al. Cytomegalovirus associated pancreatitis in a patient with systemic lupus erythematosus. J Rheumatol, 2000,27(11):2715–2717PubMedGoogle Scholar
  17. 17.
    Nieto Y, Russ P, Everson G, et al. Acute pancreatitis during immunosuppression with tacrolimus following an allogeneic umbilical cord blood transplantation. Bone marrow transplantat, 2000,26(1):109–111CrossRefGoogle Scholar
  18. 18.
    Yi GC, Yoon KH, Hwang JB. Acute Pancreatitis Induced by Azathioprine and 6-mercaptopurine Proven by Single and Low Dose Challenge Testing in a Child with Crohn Disease. J Pediatr Gastroenterol Nutr, 2012,15(4):272–275CrossRefGoogle Scholar
  19. 19.
    Sadr-Azodi O, Mattsson F, Bexlius TS, et al. Association of oral glucocorticoid use with an increased risk of acute pancreatitis: a population-based nested case-control study. JAMA, 2013,173(6):444–449Google Scholar
  20. 20.
    Breuer GS, Baer A, Dahan D, et al. Lupus-associated pancreatitis. Autoimmun Rev, 2006,5(5):314–318CrossRefPubMedGoogle Scholar
  21. 21.
    Makol A, Petri M. Pancreatitis in systemic lupus erythematosus: frequency and associated factors-a review of the Hopkins Lupus Cohort. J Rheumatol, 2010,37(2):341–345CrossRefPubMedGoogle Scholar
  22. 22.
    Terzin V, Foldesi I, Kovacs L, et al. Association between autoimmune pancreatitis and systemic autoimmune diseases. World J Gastroenterol, 2012,8(21):2649–2653CrossRefGoogle Scholar
  23. 23.
    Gregoric P, Sijacki A, Stankovic S, et al. SIRS score on admission and initial concentration of IL-6 as severe acute pancreatitis outcome predictors. Hepatogastroenterology, 2010,57(98):349–353PubMedGoogle Scholar
  24. 24.
    Zhang J, Niu J, Yang J. Interleukin-6, interleukin-8 and interleukin-10 in estimating the severity of acute pancreatitis: an updated meta-analysis. Hepatogastroenterology, 2014,61(129):215–220PubMedGoogle Scholar
  25. 25.
    Aoun E, Chen J, Reighard D, et al. Diagnostic accuracy of interleukin-6 and interleukin-8 in predicting severe acute pancreatitis: a meta-analysis. Pancreatology, 2009,9(6):777–785CrossRefPubMedGoogle Scholar
  26. 26.
    Dong L, Hu S, Chen F, et al. Increased expression of ganglioside GM1 in peripheral CD4+ T cells correlates soluble form of CD30 in systemic lupus erythematosus patients. J Biomed Biotechnol, 2010:569053Google Scholar
  27. 27.
    Arai A, Nogami A, Imadome K, et al. Sequential monitoring of serum IL-6, TNF-alpha, and IFN-gamma levels in a CAEBV patient treated by plasma exchange and immunochemotherapy. Int J Hematol, 2012,96(5):669–673CrossRefPubMedGoogle Scholar
  28. 28.
    Sadeghi M, Daniel V, Wang H, et al. Plasmapheresis adjusts inflammatory responses in potential kidney transplant recipients. Transplantation, 2013,95(8):1021–1029CrossRefPubMedGoogle Scholar
  29. 29.
    Nakae H, Asanuma Y, Tajimi K. Cytokine removal by plasma exchange with continuous hemodiafiltration in critically ill patients. Ther Apher, 2002,6(6):419–424CrossRefPubMedGoogle Scholar
  30. 30.
    Szodoray P, Hajas A, Toth L, et al. The beneficial effect of plasmapheresis in mixed connective tissue disease with coexisting antiphospholipid syndrome. Lupus, 2014, 23(10):1079–1084CrossRefPubMedGoogle Scholar
  31. 31.
    Yang Y, Ye Y, Liang L, et al. Systemic-lupus-erythematosus-related acute pancreatitis: a cohort from South China. Clin Dev Immunol, 2012:568564Google Scholar
  32. 32.
    Huang JL, Huang CC, Chen CY, et al. Acute pancreatitis: an early manifestation of systemic lupus erythematosus. Pediatr Emerg Care, 1994,10(5):291–293CrossRefPubMedGoogle Scholar

Copyright information

© Huazhong University of Science and Technology and Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Yi-kai Yu (余毅恺)
    • 1
  • Fei Yu (于 飞)
    • 1
  • Cong Ye (叶 丛)
    • 1
  • Yu-jie Dai (戴玉洁)
    • 1
  • Xiao-wei Huang (黄晓伟)
    • 2
  • Shao-xian Hu (胡绍先)
    • 1
    Email author
  1. 1.Department of Rheumatology and ImmunologyHuangzhong University of Science and TechnologyWuhanChina
  2. 2.Department of Digestive Medicine, Tongji Hospital, Tongji Medical CollegeHuangzhong University of Science and TechnologyWuhanChina

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