Another record! The coldest March for 50 years! It's nearly a year since the UK's drought warning and it hasn't stopped raining since. Let's hope Easter brings a change!
Earlier this week, my colleague Professor Munther Khamashta excitedly showed me a report taken from a recent American Academy of Neurology meeting. The headline was "migraines linked to heart attacks and blood clots". The study involved 27,860 women and showed that women with migraine (with aura) had a higher risk of thrombosis including heart attacks and strokes.
The authors had not measured aPL (antiphospholipid antibodies) but all readers of this monthly 'blog' will know that the link is clear. For years we have been publishing articles suggesting that Hughes syndrome is almost certainly the link between migraine and stroke - a potentially treatable and preventable link!
Easter tends to signal the start of the lecture season and this year is no exception. Coming up we have a number of GP meetings here in London Bridge Hospital. We also have the world lupus meeting in Buenos Aires next month. I won't be going but three of our team from the London Lupus Centre will be there. Just a reminder: our annual Hughes Syndrome Foundation Patients' Day meeting is at St Thomas' Hospital on Wednesday 15th May (for details please visit: hughes-syndrome.org/get-inv...
Patient of the Month
Hughes syndrome is capable of affecting every organ of the body. Some features - pregnancy loss, brain involvement - are well recognised. Others are less so. For example, the gut.
Mr. P.T., a 56 year old office worker, was referred by Professor David Silk - a good friend and an eminent gastroenterologist. Professor Silk had, over the past several years, referred a number of patients to me with bowel problems (particularly constipation and abdominal discomfort) in whom he and his colleagues had demonstrated "neuropathy" - a malfunctioning of the nerves supplying, in this case, the gut.
Interestingly, we found that a number of their patients also had features of an associated auto-immune disease - most commonly Sjogrens syndrome (an overactive immune syndrome, leading to fatigue, aches and pains), and sometimes other 'auto-immune' problems including thyroid problems and Hughes syndrome.
Mr. P.T. was found to have positive antinuclear antibodies (ANA), but negative antiphospholipid tests. He did, however, have features of Sjogrens syndrome, and suffered from frequent migraines, one of the hallmarks of Hughes syndrome. He also had a sister with Hughes syndrome.
Normally, I would have considered a trial of low dose aspirin, but Mr. P.T. had once suffered indigestion on (a higher dose of) aspirin. The alternative was clopidogrel (Plavix), a medicine similar to aspirin in its beneficial effects on 'sticky' platelets.
Eight weeks later, Mr. P.T. returned for follow-up. "Hard to believe". Almost complete improvement in the bowel symptoms.
Is this just a fluke? Time will tell - both for the patient and for those of us studying and trying to help our patients.
If indeed it does prove to be a genuine effect, my best guess is that it is secondary to an improvement in blood flow to the gut - and to its vital nerve supply.