Lupus Nephritis
Richard K. Burt, Alberto M. Marmont in Stem Cell Therapy for Autoimmune Disease, 2019
Systemic lupus erythematosus (SLE) is a clinically heterogeneous autoimmune disease that can affect multiple organs. Studies of new therapies for SLE often involve, or may even be confined, to individuals with renal involvement because an unambiguous endpoint may be defined, i.e., time to dialysis. Although only 25-50% of patients with lupus demonstrate clinical and laboratory evidence of nephropathy early in the course of disease, 60-75% subsequently develop overt renal abnormalities. The clinical presentation of lupus nephritis is variable, ranging from minimal proteinuria and hematuria, to nephrotic syndrome and depressed renal function in severe cases. The classification of lupus nephritis is based upon light microscopy (WHO), immunoflorescence, and electron microscopy findings on renal biopsy. Lupus nephritis contributes significantly to the morbidity and mortality of patients with SLE. Almost fifty years ago, the five year survival of patients with the most severe forms of lupus nephritis was less than 20%. In the ensuing years, survival has improved dramatically with advances in therapy. Nonetheless, when aggressive immunosuppressive therapy is used in lupus nephritis, there is considerable morbidity and mortality related to the treatment itself. The treatment of lupus nephritis, therefore, needs to balance carefully the therapeutic benefits with the toxicity of therapy. Steroids are the cornerstone of therapy for lupus nephritis, either alone or in combination with cytotoxic agents.
Chronic diseases and medication in the breastfeeding mother
Wendy Jones in Breastfeeding and Medication, 2018
Lupus is a chronic inflammatory auto-immune disease. It can affect the joints, kidneys, skin, heart, lungs, brain and blood vessels. The peak incidence is in the 20s and 30s and affects more women (85%). There is a three-times higher incidence in African Americans and African Caribbeans. It seems to be familial. Symptoms of lupus include arthralgia, fatigue, weight loss, a butterfly-shaped rash across the nose and cheeks, sores in the mouth and nose, depression, headache, problems with memory and thinking, chest pain when taking deep breaths, Raynaud’s phenomenon, inflammation of the kidneys, blood clots due to antiphospholipid antibodies, and severe dryness of the eyes and mouth (Sjögren’s syndrome) occurs in about 10% of people with lupus. Additionally, pre-eclampsia, premature birth and intrauterine growth retardation are common, necessitating additional support to establish breastfeeding. Hand expression to stimulate supply and to express colostrum for syringe feeding may be beneficial. Raynaud’s phenomenon is also seen and should be expected if a breastfeeding mother with lupus reports nipple pain. There’s an increased risk of miscarriage associated with high levels of antiphospholipid antibodies. However, treatment with aspirin and/or heparin reduces this risk. Women are usually advised to conceive when their symptoms are well controlled or they are in remission. Lupus, along with RA, osteoarthritis and fibromyalgia, is associated with high prolactin levels. The significance is not understood but seems to be part of auto-immune conditions. Mok et al. (1998) published a case study where a mother had a flare that was associated with hyper-prolactinaemia (reported in Walker 2006). There is no suggestion that breastfeeding contributes to exacerbations.
The Musculoskeletal System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
If the uric acid level is not elevated, analysis of synovial fluid will still show urate crystals in the white blood cells. Acute gout is treated with colchicine, nonsteroidal anti-inflammatory agents, or corticosteroids. For recurrent episodes, uricosuric agents such as probenecid and sulfinpyrazone are utilized to prevent increased serum urate levels. Allopurinol is used to decrease uric acid production. Additional terms associated with this disorder include monosodium urate, purines, and podagra. No laboratory tests are specific for ankylosing spondylitis. The sedimentation rate, alkaline phosphatase, and the genotype HLA-B27 are used for a possible association. Treatment is with a vigorous exercise program and cautious use of nonsteroidal antiinflammatory agents (NSAlDs). Systemic lupus erythematosus is diagnosed by presentation of a number of clinical symptoms, most commonly arthralgia (arth = joint, algia = pain) and arthritis. Laboratory tests show abnormal ANA titer, positive LE cell test. Several different drugs are utilized in the treatment of systemic lupus erythematosus. Aspirin and the NSAIDs are used to manage arthralgias or synovitis (inflammation of the synovium), pleurisy, headache, and low-grade fever. The antimalarial agent hydroxychloroquine is effective in treating arthralgias, arthritis, and skin disease. Corticosteroids are used to control the inflammatory response. Connective tissue disorders are treated by rest and exercise, physical and occupational therapy, heat, supportive or rehabilitative devices, education, nutrition, and orthopedic surgery. Polymyositis and deraiatomyositis are diagnosed by measuring the creatinine pliesphokinase (CPK); ANA and rheumatoid factor (RF) are present in some cases. Ekcfrsmyogram (EMG) findings are abnormal. A muscle biopsy can confirm diagnosis by showing degeneration of muscle fibers. Treatment of these diseases includes physical therapy, corticosteroids, and immunosuppressive agents if necessary. Scleroderma is often diagnosed by what is called the CREST syndrome, the presence of calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia. Since there is no specific treatment, general supportive therapy is indicated.
Stroke in systemic lupus erythematosus
Published in Expert Review of Neurotherapeutics, 2002
With improved control of the immunological phenomena of systemic lupus erythematosus, the epidemiology of this disease is changing. While both cardiac and neurological manifestations of systemic lupus erythematosus have been consistently described, there is increasing awareness of the need for general cardiovascular prevention in systemic lupus erythematosus. An excess of stroke is seen in systemic lupus erythematosus especially, in those cases with anticardiolipin antibodies. There is increasing evidence for the contributory role of other cardiovascular risk-factors, including hypertension, hyperlipidemia and inflammatory markers, to the epidemiology of stroke and recognition of the role of endothelial dysfunction may play in systemic lupus erythematosus. Therapeutic approaches currently rely on anticoagulation alone. This review suggest that the full panoply of stoke interventions, including antihypertensive therapy and lipid-lowering, should be applied in the case of stroke in systemic lupus erythematosus just as in atherosclerotic stroke.
Successful use of etanercept in the treatment of acute lupus hemophagocytic syndrome
Published in Modern Rheumatology, 2008
Nobuyuki Takahashi, Taio Naniwa, Shogo Banno
Hemophagocytic syndrome has been reported to be associated with systemic lupus erythematosus. A 25-year-old woman with systemic lupus erythematosus developed hemophagocytic syndrome that was refractory to the combination therapy with high-dose corticosteroid, cyclosporine, and high-dose intravenous immunoglobulin, and successfully treated with the tumor necrosis factor inhibitor, etanercept. This case report provided the first observation that etanercept may be useful for the treatment of hemophagocytic syndrome associated with systemic lupus erythematosus refractory to conventional therapy.
Cytokines and their receptors as biomarkers of systemic lupus erythematosus
Published in Expert Review of Molecular Diagnostics, 2008
Systemic lupus erythematosus is the most clinically diverse autoimmune disease. Owing to its heterogeneous presentation, clinical management of systemic lupus erythematosus remains as one of the greatest challenges. Therefore, there is a great need to assess disease activity accurately. Biomarkers can be objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes or pharmacologic responses to a therapeutic intervention, and may also predict the risk of the disease, confirm diagnosis, monitor disease activity and provide prognostic information. Cytokines play an important and diverse role in the immune dysregulation in systemic lupus erythematosus. Measuring serum levels of soluble IL-2 receptor, IL-6, IL-10, soluble TNF receptor and IFN-α/IFN-induced genes may be promising biomarkers of disease activity in systemic lupus erythematosus.
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