SYSTEMIC LUPUS ERYTHEMATODES AND SILICOSI S

A 60-year-old stonemason, suffering for many years from joint pains an d exertional dyspnoea, developed a high fever with weight loss. Physic al examination revealed reddening of light-exposed skin areas, fine ra les and overly warm and reddened hand and knee joints. Abnormal labora tory findings were increased erythrocyte sedimentation rate of 66 mm/h , C-reactive protein concentration of 1 mg/dl, haemoglobin of 9.4 g/dl and white cell count of 3300/mu l. Urine contained albumin (100 mg/dl ) and cylinders. Titres of both antinuclear and anti-ds-DNA antibodies were elevated (1:2560 and >97 U/ml, respectively). The chest radiogra phy showed enlarged hill, as well as reticular and nodular shadows whi ch histologically showed silicosis. Systemic lupus erythematodes was d iagnosed and the patient was treated with prednisone (2 mg/kg daily), the dosage being reduced to 12 mg daily within 3 months. When the join t pains recurred, azathioprine (50 mg daily) was added for 24 months. At present he is receiving prednisone (12 mg daily) and there has been no recurrence for 4 years.