Rheumatology Advance Access originally published online on October 18, 2005
Rheumatology 2006 45(4):425-429; doi:10.1093/rheumatology/kei164
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Outcome of protein-losing gastroenteropathy in systemic lupus erythematosus treated with prednisolone and azathioprine
Department of Medicine, Tuen Mun Hospital and 1 Department of Medicine, Princess Margaret Hospitals, Hong Kong, China.
Corresponding author: C. C. Mok, Department of Medicine, Tuen Mun Hospital, Tsing Chung Koon Road, New Territories, Hong Kong, SAR, China. E-mail: ccmok2005{at}yahoo.com
Objectives. To report the efficacy of prednisolone and azathioprine (AZA) in the treatment of systemic lupus erythematosus (SLE)-related protein-losing gastroenteropathy (PLGE).
Methods. Between 1995 and 2002, 16 consecutive patients with SLE-related PLGE were treated with a regimen consisting of high-dose prednisolone (0.8–1 mg/kg/day for 6 weeks, then tapered to 
10 mg/day) and AZA (2 mg/kg/day). Protein leakage from the gastrointestinal tract was confirmed by 99mTc-labelled human serum albumin scintigraphy and significant urinary loss of protein was excluded. Clinical response at 6 months of therapy was assessed and patients were followed for relapse of PLGE.
Results. Clinical characteristics of our patients at the time of PLGE were: age 36.2 ± 8.7 (S.D.) yr; female:male ratio 15 : 1; mean SLE duration 29.6 ± 65 months. Twelve patients had PLGE as the initial presentation of SLE. Fifteen (94%) patients had concomitant activity in other organs. All patients presented with oedema and eight patients (50%) had non-bloody diarrhoea. The mean serum albumin level was 22.8 ± 5.7 g/dl. Protein leakage was at the small bowel in 11 (69%) patients and the large bowel in 5 (31%) patients. At 6 months of therapy, 14 (88%) patients had complete clinical response, 1 (6%) patient responded partially and 1 patient (6%) was treatment-refractory. Patients who responded were maintained on low-dose prednisolone (7.8 ± 6.1 mg/day) and AZA (56.3 ± 37 mg/day). Over a mean follow-up of 57.5 months, 1 (6%) patient had relapse of PLGE which responded to augmentation of prednisolone dosage. No patients developed alternative gastrointestinal diagnoses. Corticosteroid-induced psychosis, AZA-induced pancytopenia and herpes zoster occurred in three patients.
Conclusion. PLGE is an uncommon manifestation of SLE. Treatment with a combination of prednisolone and AZA is effective and well tolerated.
KEY WORDS: Gastrointestinal, Enteropathy, Therapy, Complications, Serositis
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