PATHOGENETIC ASSOCIATION OF VASCULAR AND CARDIAC LESIONS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: CHARASTERISTICS AND PREVALENCE

Abstract

Introduction. Vascular and cardiac lesions are the most common lesions in patients with systemic lupus erythematosus (SLE). They also top the list of mortality reasons in patients with SLE and yet have to be addressed individually. Objective. To characterize and clarify the prevalence of vascular and cardiac lesions that are pathogenetically associated with systemic lupus erythematosus. Materials and methods. 370 patients (331 women and 39 men) were included in the study with a prior stratification by age, SLE duration and its degree of severity. The patients were comprehensively examined and diagnosed according to the requirements of modern medicine. In particular, the patients were subjected to electrocardiography, echocardiography, ultrasonography of lower limb veins and aortic arch branches, blood pressure monitoring, Holter monitoring, capillaroscopy, as well as ophthalmoscopy. The obtained data was processed in Microsoft Excel by means of descriptive statistics, χ2 test and z-test for comparing two proportions; the relationship was considered to be statistically significant when p < 0.05. Results and discussion. 350 patients (94.60%) with systemic lupus erythematosus had vascular and cardiac lesions, especially Raynaud syndrome, atherosclerosis, retinal angiopathy, livedo reticularis, hemorrhagic vasculitis, capillaritis, varicose veins, veinous thrombosis, post-thrombotic syndrome, lymphedema, venous ulcers, thrombophlebitis, secondary hypertension, primary hypertension, pulmonary hypertension, myocarditis, mitral insufficiency, aortic insufficiency, tricuspid insufficiency, atherosclerotic heart disease, ischaemic heart diseases: stable angina, old myocardial infarction, cardiomyopathy. Of these lesions, Raynaud syndrome, capillaritis, hemorrhagic vasculitis, stable angina, retinal angiopathy, livedo reticularis, atherosclerosis, veinous thrombosis, pulmonary hypertension, secondary hypertension, myocarditis were pathogenetically associated with systemic lupus erythematosus. Other lesions were induced by co-occurring circulatory system diseases, since there were no relationship between their prevalence and the severity degree of the underlying disease (SLE). The patients with systemic lupus erythematosus were predominantly diagnosed with stage II Reynaud syndrome, and it affected mostly hand fingers. the intima-media thickness ranged from 8.0 mm to 14.9 mm. The retinal angiopathy was of the first degree of severity, livedo reticularis predominantly affected lower limbs (legs). All patients had cutaneous form of hemorrhagic vasculitis (first degree of severity), and capillaritis affected hands. The veinous thrombosis was observed at tibial and popliteal vein segments. The secondary hypertension was of first degree of severity, pulmonary hypertension was  asymptomatic (first degree of severity), myocarditis was mild, and stable angina was of functional class II. The lesions that were pathogenetically associated with systemic lupus erythematosus had their own factors of prevalence: Raynaud syndrome was significantly more prevalent in women and patients aged 18 to 24, retinal angiopathy, livedo reticularis and secondary hypertension were significantly more prevalent in women and patients with the disease duration of more than 10 years. The veinous thrombosis and stable angina were significantly more prevalent in elderly patients and patients with the disease duration of more than 10 years. Myocarditis was significantly more prevalent in men; atherosclerosis and pulmonary hypertension were significantly more prevalent in elderly patients.