Q & A session on Lupus, Hughes Syndrome and the Brain – Prof Hughes

Posted on: July 25, 2020
Last Updated: October 2, 2020

Professor Graham Hughes is a Consultant Rheumatologist and the founder and editor of the international journal LUPUS,’ and Head of London Lupus Centre. In 1983 he described the clotting disorder now known as Hughes Syndrome for which he received the World Rheumatology (ILAR) Research Prize in 1993.  

Author Quotes 

The skin doctors tell us there’s two types of livedo…the livedo we see is quite connected, more circular with lots of interconnections and very much a feature of bad news in my experience.

 Like all these things, as knowledge increases we recognise that there are many people, probably, with classic syndrome whose aPL testing is negative…but if you have someone that you strongly think has the syndrome, especially if there’s a family history actually, then you treat. 


The session starts with a question about the problem of treating severe night sweats with depression in a patient diagnosed with lupus, for which as Prof Hughes commented, there is no easy answer.  

The subject of novel oral anticoagulants versus warfarin is discussed where clinical practice concern over dosage is expressed compared with how they have been embraced by cardiologists. The problem of how to prescribe anticoagulation in a patient with comorbidities including temporal lobe epilepsy is also examined.  

The Q&A session ends with a conversation about anticoagulation treatment in patients with mild symptoms and on the different tests available to distinguish Hughes syndrome from SLE.  

Take-Home Points 

  • Patients with untreated livedo go on to develop multifocal lesions. 
  • There is a lack of high-quality publications from migraine clinics on how the condition presents and develops over the lifecycle. 
  • The most important of the antiphospholipid tests is the anticardiolipin test (aCL). 


Learn more

  1. Neuropsychiatric Manifestations in Antiphospholipid Syndrome (APS) – Prof Graham Hughes
  2. Antiphospholipid Syndrome (APS) and CNS Lupus: Anticoagulation Treatment By Prof Graham Hughes
  3. Antiphospholipid Syndrome (APS) Case Files (Stillbirths and Epilepsy) By Prof Graham Hughes
  4. Antiphospholipid Syndrome (APS) Case Files (Stroke and Thrombosis) By Prof Graham Hughes
  5. Antiphospholipid Syndrome (APS) Case Files (Gut, Tinnitus and Migraine) – Prof Graham Hughes
  6. Antiphospholipid Syndrome (APS):The Clinical Experience – Dr. Graham Hughes
  7. Antiphospholipid Syndrome : 30 Years On – Dr. Graham Hughes
  8. Central Nervous System (CNS) Involvement in Antiphospholipid (Hughes) Syndrome – Prof Graham Hughes
  9. Clues to the Diagnosis of Antiphospholipid Syndrome – Prof Graham Hughes
  10. Neuropsychiatric Lupus and The Curious Case of Molly – What Does This Case Teach Us? – Prof Hughes
  11. Pathogenesis of Neuropsychiatric Systemic Lupus Erythematosus – Prof Graham Hughes
  12. What is Lupus? – Prof Graham Hughes
  13. Prof Graham Hughes Introduces You To The World of Lupus and Antiphospholipid Syndrome – Prof Graham Hughes