Vascular Manifestations of Systemic Autoimmune Diseases

624 Pages·2001·11.5 MB·English

by  Ronald A. Asherson

Vascular
Manifestations
of
Systemic
Autoimmune
Diseases
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Vascular
Manifestations
of
Systemic
Autoimmune
Diseases
Edited by
Ronald A. Asherson, M.D.
Ricard Cervera, M.D.
Associate Editors
Steven B. Abramson, M.D.
Jean-Charles Piette, M.D.
Douglas A. Triplett, M.D.
CRC Press
Boca Raton London New York Washington, D.C.
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Library of Congress Cataloging-in-Publication Data
Vascular manifestations of systemic autoimmune disease / edited by Ronald A.
Asherson, Ricard Cervera, Douglas A. Triplett.
p. cm.
Includes bibliographical references and index.
ISBN 0-8493-1335-X (alk. paper)
1. Vasculitis. 2. Autoimmune diseases—Complications. 3.
Blood-vessels—Diseases—Immunological aspects. I. Asherson, Ronald A. II. Cervera,
Ricard. III. Triplett, Douglas A.
[DNLM: 1. Autoimmune Disease—complications. 2. Vascular Diseases—etiology. WD
305 V331 2000]
RC694.5.I53 V365 2000
616.1'3—dc21 00-060809
CIP
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Printed on acid-free paper
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Dedication
Dr. Asherson dedicates this book to the research fellows with whom he
has worked at the Royal Postmedical School of London and the St.
Thomas’ Hospital in London, and to Professors Robert Lahita of New
York, Jean-Charles Piette of Paris, and Yehuda Schoenfeld of Israel.
Dr. Cervera dedicates this book to his wife Carme and his daughters
Marta and Laura.
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Foreword
In the beginning, we thought inflammation of blood vessels was the sole manifestation of systemic
autoimmune diseases. Now, by this new millennium, we have learned that disorders of coagulation,
autoantibodies to phospholipids, vasospasm, both injury to and antibodies to neutrophils and
endothelial cells, and certain lipids and amino acids are all intricately involved in the development
of vascular disease in these patients. How are all these processes linked? What strategies can we
employ or develop to halt the progression of vascular damage? What are the best ways to control
acute vasculitis and vasospasm therapeutically? What are the risks and benefits of various strategies
to prevent clotting? How soon should we initiate preventive strategies that protect blood vessels
from arteriosclerosis in people with acute rheumatic diseases? What should those strategies be?
The biology of these attacks on blood vessels, the clinical consequences, therapeutic approaches,
and preventive strategies are all addressed in this book. International experts in the vascular diseases
associated with autoimmunity, Drs. Ronald Asherson, Ricard Cervera, Douglas Triplett, Jean-
Charles Piette, and Steven Abramson, have gathered other experts who lead the thinking in such
studies — experts of great international standing. Together they have assembled a comprehensive
look at this ever-increasing problem. Now that most individuals survive the onset of severe acute
systemic autoimmune diseases and live for decades more, halting the long-term attack on the
vasculature is increasingly important.
Welcome to you, the reader. Whether you use this volume to look up a particular aspect of
vascular disease in autoimmune settings or whether you read it from cover to cover, you are sure
to have your thinking stimulated and your knowledge increased. Perhaps you will pursue some of
these questions further and will be the first to solve some of these most puzzling problems.
Bevra H. Hahn, M.D., FACR
Professor of Medicine, Chief of Rheumatology
University of California, Los Angeles
Immediate Past President, American College of Rheumatology
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The Editors
Ronald A. Asherson, M.D., FACP, FRCP (London), FCP (SA), FACR, is Honorary Consultant
Physician and Principal Scientific Officer at the Rheumatic Disease Unit, Department of Medicine,
Groote Schuur Hospital, University of Cape Town, South Africa.
Dr. Asherson qualified in Medicine at the University of Cape Town in 1957 and, after completing
his internship, became H/P at the Hammersmith Hospital, London, in 1960. In 1961, he accepted
a fellowship at the Columbia Presbyterian and Francis Delafield Hospitals in New York, returning
to become Senior Registrar at the Groote Schuur Hospital in Cape Town from 1961 to 1964. After
10 years as a Clinical Tutor in the Department of Medicine, he returned to the U.S. and was
appointed as Assistant Clinical Professor of Medicine at the New York Hospital–Cornell Medical
Center. From 1981 to 1986, he was associated with the Rheumatology Department at the Royal
Postgraduate Medical School of London. It was at that time that he developed his interest in systemic
autoimmune diseases and antiphospholipid antibodies. In 1986 he moved to the Rayne Institute
and St. Thomas’ Hospital in London, where he was appointed Honorary Consultant Physician and
Senior Research Fellow. In 1991 he took a year’s sabbatical at St. Luke’s Roosevelt Hospital Center
in New York before returning to South Africa.
He is a Fellow of the American College of Physicians (FACP), a Founding Fellow of the
American College of Rheumatology (FACR), and a Fellow of the Royal College of Physicians
(FRCP) of London. From 1988 to 1991 he was on the Council of the Royal Society of Medicine
in London. In 1992 he was the co-winner of the European League Against Rheumatism (EULAR)
Prize and in 1993 was the co-recipient of the International League Against Rheumatism (ILAR)
Prize, both for research on antiphospholipid antibodies.
Dr. Asherson has been an invited speaker at many universities and international conferences.
He is the author of more than 200 papers on systemic autoimmune diseases and has contributed
to more than 40 leading textbooks of medicine, rheumatology, and surgery as well as having co-
edited the books Phospholipid-Binding Antibodies, CRC Press (1991), and The Antiphospholipd
Syndrome, CRC Press (1996). Dr. Asherson is on the editorial boards of several international journals
and is a member of the “Rheume 21st” group of international experts on rheumatology. He is
currently engaged in research on systemic autoimmune diseases, particularly on the antiphospholipd
syndrome, and is involved in clinical practice in South Africa.
Ricard Cervera, M.D., Ph.D., is Senior Specialist Physician at the Systemic Autoimmune Diseases
Unit, Hospital Clinic of Barcelona, and Associate Professor of Medicine at the University of
Barcelona School of Medicine, Barcelona, Catalonia, Spain.
Dr. Cervera qualified in Medicine in 1983 from the University of Barcelona and from 1984
until 1988 trained in Internal Medicine at the Hospital Clinic of Barcelona. He obtained his Ph.D.
degree from the University of Barcelona in 1988 for his thesis on anticardiolipin antibodies. His
postdoctoral experience included 2 years at the Lupus Research Unit, The Rayne Institute, St.
Thomas’ Hospital, London, working with Drs. Graham R. V. Hughes and Ronald A. Asherson.
Among other awards, he has received the Spanish Society of Internal Medicine Award for
research on antibodies to endothelial cells, the Fernández-Cruz Award from the Rhône-Poulenc
Farma Foundation, and the Juan Vivancos Award from the Consorci d’Hospitals de Barcelona. He
has been the recipient of research grants from the Spanish Departments of Health and Education
and Science, the British Council, and the European Commission.