Bladder problems in SLE more common than thought

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Rheumawire

Jan 20, 2002

Bladder problems in SLE more common than thought

Taipei, Taiwan - Bladder involvement in systemic lupus erythematosus

(SLE) is generally thought to be rare, but a new study shows for the

first time that patients with SLE have a " substantial increase in the

prevalence of voiding dysfunction " compared with healthy controls. The

finding is reported in the January 2004 issue of Arthritis & Rheumatism

[1].

Dr Hong-Jeng Yu and colleagues at the National Taiwan University in

Taipei, Taiwan, found a variety of voiding dysfunctions with different

etiologic mechanisms involved and say that early recognition and

appropriate treatment of these problems may improve quality of life for

these patients.

Yu and colleagues conducted a prospective study over a 15-month period,

investigating bladder problems in 152 women with SLE (mean age 41 years,

mean duration of disease 90 months) and 227 healthy controls. They

assessed lower urinary-tract symptoms using the American Urological

Association (AUA) index questionnaire and in the worst-affected patients

also carried out urodynamic evaluations (uroflowmetry, multichannel

water-fill cystometry, perineal patch electromyography, and intravenous

urography).

SLE patients reported significantly higher rates of many lower

urinary-tract symptoms, including frequency (20.4% vs 9.7% in controls),

urgency (9% vs 4%), incomplete emptying, weak urinary stream, and pelvic

pain (6.6% vs 2.2%). Also, the proportion of individuals with severe

lower urinary-tract symptoms (with an AUA index score >20) was

significantly higher in the SLE group than in the control group (7.9% vs

1.8%, p>0.05). However, there was no detectable difference between the 2

groups in the prevalence of urinary incontinence.

In addition, responses on a questionnaire assessing the impact of

urinary symptoms on quality of life (Uro-QoL) were significantly

different between the 2 groups (poor Uro-QoL index score in 19.1%

patients vs 10.6% controls, p<0.05).

Among the SLE patients, the AUA index score showed a modest correlation

with the SLE disease-activity-index (SLEDAI) score but not with patient

age or disease duration, the researchers comment. Among the patients,

the average AUA index score was 13 and the average symptom duration was

28 months (range 2 to 150 months). Of the 152 SLE patients studied, 31

(20.4%) linked their lower urinary-tract symptoms to SLE.

Some patients had obvious bladder dysfunction. Thirty-two patients had

" remarkable " lower urinary-tract symptoms, the researchers write, and 29

of these consented to undergo urodynamic studies. Abnormal findings were

found in 14 patients, including small bladder capacity (n=7), increased

sensation to void (n=6), subnormal urinary flow rate (n=6), and a

remarkable amount of residual urine (n=6). Of the 7 patients with small

bladder capacity, 3 were documented through imaging to have a contracted

bladder with bilateral hydroureteronephrosis. In addition, 3 patients

had complete urinary retention: 2 were documented to have transverse

myelitis, and another had diffuse cortical dysfunction.

Bladder involvement in patients with SLE may be more common than

previously thought, Yu et al comment. Lupus cystitis, caused by the

deposition of immune complex in the small vessels and smooth-muscle

cells of the bladder, has been reported previously at a prevalence of 1%

to 2%. In their own cohort of SLE patients, they found 3 patients (2%)

with clinical features of severe lupus cystitis, which ties in with

these previous findings. But the higher prevalence of storage problems

(frequency, urgency, and pelvic pain) coupled with findings of a

hypersensitive bladder (increased sensations and decreased bladder

capacity) makes them suspect that milder degrees of lupus cystitis may

be more common than is currently appreciated.

As corticosteroids are effective in lupus cystitis and early initiation

of therapy has been suggested to give a better prognosis for bladder

function, Yu et al recommend that " physicians should be more aware of

the voiding dysfunction in SLE patients and institute appropriate

therapies in the early stages of the disease. "

Zosia Chustecka

Source

1. Yu HJ, Lee WC, Lee KL, et al. Voiding dysfunction in women with

systemic lupus erythematosus. Arthritis Rheum 2004 Jan; 50(1):166-172.

I'll tell you where to go!

Mayo Clinic in Rochester

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s Hopkins Medicine

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