- September 2011
Another record! – the first of October earlier this week was the hottest October day on record (as always, the record was recorded in Gravesend, Kent). “Hotter than the Sahara”.
This month was an important one for our charity. Estelle Morris (the Right Honourable Baroness of Yardley) has agreed to become the Chair of our charity. Estelle, a member of the House of Lords and MP for Birmingham Yardley, was the minister of education in the previous government.
She has become a friend and loyal supporter of our Louise Coote Lupus Unit at St Thomas’ Hospital and patron of the Hughes Syndrome Foundation for several years, and we are all absolutely delighted that she has agreed to become Chair.
Two lectures in September: one in Hong Kong and one in London. The Hong Kong meeting was high quality, organised by an old friend Chak Lau and with a keen audience – very knowledgeable about Hughes Syndrome. For me it was something of a whirlwind – out Thursday night-Friday, lecture Saturday, home Sunday. My theory is that if you come straight home, the body doesn’t have time to think about jet-lag (almost certainly wrong).
The second talk, here at the King’s Fund in London, was at the Anticoagulation Education Day organised by Anticoagulation Europe – many thanks to Michael and Eve Knight for their tremendous hard work. The audience consisted mainly of nurses and clinicians working in anticoagulation clinics.
Hughes Syndrome patients often require a high INR – especially those with headache or balance problems. In the past, this has often led to difficulties in the anticoagulation clinic, where lower INRs – for example 2-2.5 are the norm. This year at the Anticoagulation Education Day, there was a far wider acceptance of the need for better control in Hughes Syndrome patients, but also of the value of self-testing INR kits and their use in parallel with the anticoagulation clinic’s control.
Case of the Month
This patient, a 41 year old Guyanese lady, came up to me after the London meeting. She had had a long history of lupus, treated variously with Plaquenil and steroids over the years, and without severe kidney damage. Two years previously, she developed increasingly severe headaches, marked fatigue and widespread aches and pains. She then developed a DVT in the leg and was started on warfarin.
Before the warfarin treatment, her pains had never really totally left her. Since the start of warfarin therapy, almost all her symptoms have abated.
What is this patient teaching us?
Yes, she was (belatedly) found to have antiphospholipid antibodies (aPL). And her history suggests that in those 1 in 5 lupus patients who are aPL positive, a significant constellation of clinical features may be more down to circulation problems (‘sticky blood’) than to the inflammation of lupus. An important lesson.