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Subclinical carotid atherosclerosis in a patient with systemic lupus erythematosus

Nature Clinical Practice Rheumatology volume 3, pages 473–478 (2007)Cite this article

Abstract

Background A 41-year-old, previously healthy woman presented with chest pain, fevers, arthritis, facial rash, pericarditis, proteinuria and a positive antinuclear antibody; she was diagnosed with systemic lupus erythematosus (SLE). She initially responded well to steroids, azathioprine and hydroxychloroquine; however, disease manifestations subsequently worsened in the setting of erratic medical compliance. During this time she participated in an observational study to evaluate risk factors for the development of subclinical atherosclerosis in patients with SLE.

Investigations Physical examination, laboratory and serologic evaluations, echocardiography, serial carotid artery ultrasonography for detection of atherosclerotic plaque, chest CT, thoracentesis, pleurodesis, and lymphnode biopsy.

Diagnosis Subclinical carotid atherosclerosis in the setting of active SLE.

Management Over the course of 7 years the patient received prednisone, azathioprine, hydroxychloroquine, low-dose aspirin, NSAIDs including celecoxib, meloxicam and ibuprofen, mycophenolate mofetil, and methotrexate. Ultimately the patient was prescribed mycophenolate mofetil and prednisone, but she was lost to follow-up.

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Figure 1: Ultrasound image of the patient's carotid artery, which shows atherosclerotic plaque in the carotid bulb (indicated by arrow)

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Acknowledgements

Written consent was obtained from this patient to participate in the Hospital for Special Surgery Autoimmune Disease Registry and Accelerated Atherosclerosis in SLE study. Both these protocols were approved by the Hospital for Special Surgery Institutional Review Board.

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Authors and Affiliations

  1. and JE Salmon is Collette Kean Research Professor at the Department of Rheumatology, Hospital for Special Surgery. A Davis is a is a third-year Medical Student and MJ Roman is Professor of Medicine at the Division of Cardiology, D Alpert is a Rheumatology Fellow, D Erkan is an Assistant Attending Rheumatologist and Clinical Researcher, Weill Medical College of Cornell University, New York, NY, USA.,

    Deborah Alpert, Adrienne Davis, Doruk Erkan, Mary J Roman & Jane E Salmon

Authors
  1. Deborah Alpert
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  2. Adrienne Davis
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  3. Doruk Erkan
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  4. Mary J Roman
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Corresponding author

Correspondence to Deborah Alpert.

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Competing interests

JE Salmon is the recipient of an investigator-initiated grant from Genentech to study a biomarker of atherosclerosis in lupus. JE Salmon is also on the Advisory Boards of Amgen, Centocor, Roche and Wyeth. The other authors declared no competing interests.

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Alpert, D., Davis, A., Erkan, D. et al. Subclinical carotid atherosclerosis in a patient with systemic lupus erythematosus. Nat Rev Rheumatol 3, 473–478 (2007). https://doi.org/10.1038/ncprheum0560

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