Acute abdominal pain in systemic lupus erythematosus: focus on lupus enteritis (gastrointestinal vasculitis)

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ls of the Rheumatic Diseases 2002;61:547-550

Acute abdominal pain in systemic lupus erythematosus: focus on lupus

enteritis (gastrointestinal vasculitis)

C-K Lee1, M S Ahn1, E Y Lee1, J H Shin1, Y-S Cho1, H K Ha2, B Yoo1 and

H-B Moon1

1 Division of Allergy and Rheumatology, Department of Internal Medicine,

Asan Medical Centre, Seoul, Korea

2 Department of Radiology, University of Ulsan College of Medicine, Asan

Medical Centre, Seoul, Korea

Correspondence to:

Dr B Yoo, Division of Allergy and Rheumatology, Department of Internal

Medicine, University of Ulsan College of Medicine, Asan Medical Center,

388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea;

byoo@...

ABSTRACT

Objective: To determine the causes of acute abdominal pain in systemic

lupus erythematosus (SLE) and to compare the clinical and laboratory

data, especially antiphospholipid antibodies and the SLE Disease

Activity Index (SLEDAI), between lupus enteritis (gastrointestinal

vasculitis) and acute abdominal pain without lupus enteritis in patients

with SLE.

Methods: A retrospective study was carried out for all patients admitted

with SLE from 1993 to March 2001. The SLEDAI and laboratory data were

collected at the time of diagnosis of SLE and at the time of acute

abdominal pain. Lupus enteritis (gastrointestinal vasculitis) was

diagnosed by clinical investigation and abdominal computed tomographic

findings.

Results: Chart review identified 175 patients (20 male, 155 female) who

had been admitted with SLE. Of these patients, 38 (22%) presented with

acute abdominal pain. Lupus enteritis was the most common cause of acute

abdominal pain. Patients were divided into three groups: group 1: lupus

enteritis (n=17), group 2: acute abdominal pain without lupus enteritis

(n=21), and group 3: SLE without acute abdominal pain (n=137). There was

no difference in age and sex among the three groups. Antiphospholipid,

anti-RNP, anti-Sm, anti-Ro, and anti-La antibodies did not differ among

the three groups. There was no difference in the SLEDAI at the time of

diagnosis and at the time of acute abdominal pain between groups 1 and

2. Complement, erythrocyte sedimentation rate, C reactive protein, and

anti-dsDNA measured at the time of acute abdominal pain did not differ

between groups 1 and 2. A drop in the white blood cell count at the time

of abdominal pain was more prominent in group 1 than group 2. In lupus

enteritis, the jejunum and ileum were the sites most commonly affected.

Rectal involvement was rare. Even though four patients relapsed, all the

patients with lupus enteritis, including those who relapsed, responded

well to corticosteroid.

Conclusion: Lupus enteritis is the most common cause of acute abdominal

pain in SLE. All patients with lupus enteritis responded well to a high

dose of a corticosteroid without surgical intervention. The SLEDAI and

laboratory data, except leucopenia, do not correlate with the occurrence

of lupus enteritis.