A week ago, I gave a lecture on Hughes Syndrome to the British Society of Rheumatology (BSR) meeting in Birmingham. For me, this was a red letter day – my first presentation on Hughes Syndrome to the BSR in over 30 years – in fact the first since the ‘Heberden Round’ to the society in 1982 – the meeting at which I first publicly described our new syndrome – three young women with features of APS.
Firstly, it is unusual to get so many clues in a patient – the clinical history, the physical findings, the powerful family history.
This month I received an honour of which I am so proud. My colleague in Portugal (Dr Jorge Martins) has opened a new clinic for lupus and related diseases, and has named it‘The Graham Hughes Clinic for Autoimmune Diseases’.
Interestingly, a number of the doctors at the meeting had the feeling that Hughes syndrome was over-taking lupus – possibly secondary to the growing recognition of the syndrome by specialities such as cardiology, gastroenterology, surgery and …… neurology, the area of this month’s ‘patient of the month’.
Firstly, the diagnosis and management of miscarriage. Official recommendation is that aPL testing should be considered after three miscarriages. Although this advice is based on the fact that there are many other causes of miscarriages, and the cost of testing all pregnancies would be too high, to test earlier in Mrs M.J. would have prevented a stillbirth – one of life’s greatest tragedies – in Mrs M.J. her fourth pregnancy attempt.
For me, migraine is one of the hallmarks of Hughes syndrome. Many doctors and patients tend to think of thrombosis and miscarriage as the main pointers to diagnosis. But many other features – migraine, memory loss, balance problems, cold circulation, chest pains, sleep disturbance and even unexpected bone fractures (e.g. in the foot) are recognised components of Hughes syndrome, yet often side-lined.