Læknablaðið - 15.09.1990, Blaðsíða 57

LÆKNABLAÐIÐ 1990; 76: 375
375
NÝR DOKTOR í LÆKNISFRÆÐI - HELGI
JÓNSSON
í september 1989 lauk Helgi Jónsson læknir
doktorsprófi frá Lundarháskóla. Ritgerðin
nefnist á frummáli: »ON SYSTEMIC LUPUS
ERYTHEMATOSUS. Clinical studies with
special reference to epidemiology, lung
function and complement activation«.
SLE patients from a defined population
(mean population at risk 158,572) were
monitored prospectively during 1981-
1986. By the end of 1986, 86 patients (72
females, 14 males, median age 48) had been
included in the cohort, the point prevalence
being 68 patients (42/100,000 population at
risk). The annual incidence was 4,0 cases/
100.000/adults /year. A high completeness
of retrieval of patients was achieved by
computerized diagnosis and ANA registers
in addition to clinical case finding. Five
year survival in the prospective group was
97 percent. The proportion of patients with
cutaneous manifestations, antibodies to
dsDNA and hypocomplementemia decreased
with increasing age at diagnosis, while the
proportion of patients with serositis, secondary
Sjögren’s syndrome and antibodies to SSA
increased.
Outcome was considered favorable, as
witnessed by low mortality, low frequency
of organ damage, and high percentage of
patients gainfully employed. Disease flares
occurred at a constant frequency after the
first year. Patients with neuropsychiatric
disease, drug hypersensitivity, persistent
hypocomplementemia, antibodies to dsDNA
and cardiolipin had a high frequency of
relapse. Myocardial infarctions were nine
times more common than in a Swedish control
population and were related to long disease
duration and glucocorticoid treatment.
Extensive lung function tests in twelve
consecutive symptomatic patients revealed
no functionally significant lung damage in
the majority of the patients. Reduced working
capacity was related to non-respiratory factors.
Spirometry screening in the epidemiological
cohort revealed only a moderate reduction of
vital capacity in patients with a past history of
serositis.
In prospective studies of C1 dissociation,
the concentration of C1 IA complexes of
the tetramer C1 IA-Clr-Cls-Cl IA variety
correlated with the concentrations of C2
and C3 fragments, suggesting effective
activation of the classical pathway. This
was a characteristic finding in active SLE
nephritis. Trimer C1 IA-Clr-Cls complexes
were found in low amounts in nephritis, but
in high concentrations in extrarenal SLE, and
probably reflected C1 activation controlled at
the Clr level.