A new year, and a promise to myself to reduce the frequency of the monthly blogs – I had in mind a three monthly article, but have already failed on my promise!
The monthly international journal ‘LUPUS’ is one of my pride and joys. The February issue of this, the 21st annual volume of the journal was, I believe, a landmark issue – devoted to a series of articles on environmental factors influencing diseases such as lupus and Hughes syndrome.
As all of you know, there has been headline news recently concerning silicone breast implants and cancer. In fact, the bigger story has been the link with autoimmune diseases. Silicone is known to be an ‘adjuvant’ – a chemical which has the property of increasing an immune response. Another ‘adjuvant’ is aluminium, widely used in vaccines, in order to increase the chances of a successful immune response in the recipient.
This issue of LUPUS, edited by my friend Professor Yehuda Shoenfeld, brings together a striking collection of papers, linking adjuvants to a variety of autoimmune diseases including lupus, scleroderma, nerve inflammation ……. and the generation of antiphospholipid antibodies!
Which takes me back three years to one of my earlier blogs (February 2009) when, sitting on a bench several thousand miles away in Leon, Mexico, Yehuda and I discussed the story and its ramifications, and first planned this ‘special issue’ of LUPUS: lup.sagepub.com/.
Case of the Month
Mrs BJ, aged 54, suffered from Hughes syndrome, with frequent severe headaches. She also had Sjogrens syndrome with widespread and prominent aches and pains – especially in the muscles.
In view of the severity of the headaches, and the poor response to low dose aspirin, it was decided to order a trial of heparin. This is a clinical practice which I have been using for several years, especially in Hughes syndrome patients in whom aspirin seems less than effective. The reasons for this approach are two-fold.
Firstly, the move to warfarin is a major step, especially in a patient who has not had a thrombosis. Secondly, ‘modern’ heparin (low molecular weight heparin, such as Fragmin or Clexane) is very safe, its only problem being that it requires injection. (Many, many pregnant Hughes syndrome patients take heparin injections for 8-9 months).
Mrs BJ returned after three weeks. All headaches gone! Not a single headache or migraine. Presumably the headaches had been linked in some way to the ‘sticky blood’.
But the story didn’t end there. All the muscle aches gone! Disappeared. I don’t think this clinical observation has been recorded before; I would like to record it here. One might cynically suggest that it is a placebo response, but the remission of the muscle aches has persisted with a further four weeks heparin treatment.
What is this patient teaching us?
Presumably every organ in the body depends on its oxygen via the blood supply. The brain and heart certainly. The nerves, certainly. The joints (such as the hip joint, probably). And the muscles?
If I were a keen young medical researcher, I would be testing muscle physiology and blood flow in Hughes syndrome patients before and after anticoagulation.