This week we welcomed to the London Lupus Centre a visiting group of 10 nurses from Daytona State College, Florida. They have a particular interest in Hughes Syndrome, so we organised a mini symposium for them and also included a tour of the facilities in the Shard. Fortunately it proved to be one of London’s best and brightest sunny days!
I realise that the majority of my blogs proclaim clinical success (I guess that’s natural), but in today’s blog, I want to concentrate on one aspect of Hughes Syndrome where there is uncertainly. How pro-active one should be with treatment of a patient with positive tests but little in the way of clinical problems?
Patient of the Month
Ms P.J., aged 47, is a ‘high flying’ executive in a fashion company. Her job includes frequent foreign travel.
Ten years ago she was investigated for a complaint of general fatigue and lupus had been suggested (a cousin had been diagnosed with lupus). Her tests for lupus were negative but she did have positive antiphospholipid tests (aCL medium positive, anti-Beta2 medium positive, lupus anticoagulant negative).
A past history for features of Hughes Syndrome (apart from, possibly, migraines) was negative. No thrombosis. No miscarriages (she had had one pregnancy – a 23 year old daughter).
The migraines had been frequent in her teens – sometimes as common as weekly. A neurologist had arranged a brain MRI which was clear.
However, in her 20’s the migraines slowly disappeared. She remained well and on no medicines for approximately 5 years.
She then developed a new complaint, that of frequent acute ‘stabbing’ pains around the right eye. There was no loss of vision, or any redness of the eye. She was seen by a neurologist and an ophthalmologist, who found no obvious abnormality. Again a brain MRI was normal.
The eye/eye socket pains became worse.
The neurologist could find no obvious cause for the symptoms. Blood tests were normal (apart from the positive aPL tests – giving much the same results as those 10 years ago).
Would aspirin be worth trying………?
Yes….. she started baby aspirin, 75mgs daily. Success!
Almost total resolution of the acute eye pain attacks.
Back to full time work.
What is this patient teaching us?
As the public and the medical profession become aware of aPL testing, and the importance of Hughes Syndrome, it is inevitable that we will see more patients with positive tests (for example, relatives or offspring of APS patients) but without any medical complaints. (For example, the longer term follow-up of women found positive during pregnancy assessment.)
At present, most doctors might give no treatment, or, at most, daily low dose aspirin (that, I must say, is my own practice).
But, in patient Ms P.J., there were symptoms, albeit one not readily associated with Hughes Syndrome.
In this patient, the symptoms were significant and a trial of 75mgs daily aspirin produced a great result.
We will, of course, follow-up Ms P.J. in the future.
Professor Graham R V Hughes MD FRCP