Objective: To investigate the diagnosis and therapy of systemic lupus erythematosus (SLE) patients with pulmonary thromboembolism (PTE).
Methods: 11 hospitalized cases were reviewed retrospectively in PUMC Hospital during January 1984-July 2001.
Results: All 11 cases were suffered from severe active lupus with PTE. The SLE-DAI (SLE-disease active index) was 21.9 +/- 4.9. 7 cases had first onset of progressive Raynaud phenomenon. Anti-RNP antibody was positive in 73% of the cases. Echocardiogram revealed medium-severe pulmonary hypertension. When PTE was found, while 6 cases had started with smaller to medium dose of prednisone treatment, which was 20-30 mg/d, and other 4 cases received no prednisone. Only 1 received large dose of prednisone and immunosuppressor. Large dosage of prednisone, immunosuppressor with or without anticoagulant were given to those 6 and 4 patients after final diagnosis, respectively. 6 of 7 cases showed relieved Raynaud phenomenon while 4 cases hemoptysis were disappeared, echocardiogram had confirmed that pulmonary artery pressure decreased in 4 cases. [(31.7 +/- 12.4) mmHg]. 5 cases survived, 3 were dead and 3 failed to be followed up.
Conclusions: Patients of SLE with PTE are liable to be misdiagnosed or missed-diagnosed, The risk factors are active-SLE, progressive Raynaud phenomenon, and symptoms of thromboembolism, positive anti-RNP antibody and mild-medium pulmonary artery hypertension. Combined therapy of present available measures like large dose of prednisone, immunosuppressors and anticoagulant are highly recommended.