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Systemic Lupus Erythematosus: When Your Immune System Attacks You. Healthline. p.16-20. November-December 2000.

Systemic lupus erythematosus is one of a group of autoimmune diseases in which the immune system attacks the patient's own body tissues and organs. Lupus is often manifested through joint pains and skin rash, but it can also involve other organs, such as the kidneys. This article describes lupus, including the causes, the symptoms, how it is diagnosed, and the different means of treatment. Genes influence the appearance and manifestation of lupus. The differences in the manifestation of lupus in the two sexes (a higher prevalence in females) can be explained by the hormonal influences of estrogen and of the androgens. The criteria for a diagnosis of lupus include skin rash, facial butterfly shaped rash, hair loss, over sensitivity to sunlight, ulcers of the mouth, joint pain, inflammation of the lining of the heart and lungs, kidney damage, damage to the central nervous system, defects in blood cells, evidence of damage to the immune system (low level of the complement proteins), and presence of antinuclear antibodies in the blood (autoantibodies). Treatment options include nonsteroidal antiinflammatory drugs (NSAIDs), steroids, immunosuppressive drugs, and antimalaria drugs. The author describes some of the challenges to living with a chronic disease, including coping with the side effects of some of the drugs prescribed to control the disease. Readers are encouraged to educate themselves about the disease and to take an active part in their own health care team.

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Treatment of Lupus Nephritis. Seminars in Nephrology. 20(3): 265-276. May 2000.

Patients with lupus nephritis pose a therapeutic challenge and stimulate investigation of innovative treatment strategies. This article reviews those current and potential strategies that may optimize management of lupus nephritis. The clinical presentations of lupus nephritis can vary from asymptomatic hematuria (blood in the urine) or proteinuria (protein in the urine) to acute nephritic or nephrotic syndromes and from rapidly progressive glomerulonephritis to insidious chronic renal insufficiency. Although patient survival and renal function outcomes have improved over the last 4 decades, contemporary immunosuppressive regimens are not consistently effective and often require extended courses (resulting in negative drug effects and toxicity). Several strategies are under investigation to induce remissions more rapidly and to reduce the risk of long courses of cytotoxic drug therapy. The combination of pulse methylprednisolone and pulse cyclophosphamide may be more effective than pulse cyclophosphamide alone for patients with relatively severe proliferative lupus nephritis. A particularly vigorous strategy employs immunoablative cyclophosphamide, with or without stem cell rescue. Several studies of sequential immunosuppressive therapy are in progress. It is anticipated that long term toxicities can be lessened by substituting various maintenance agents (e.g., azathioprine or mycophenolate mofetil) after initial cyclophosphamide therapy has induced a renal responses. Innovative approaches (e.g., costimulatory blockade) offer the hope of more effective treatments without the risks of contemporary regimens. 2 figures. 2 tables. 88 references.

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Treatment of Lupus Nephritis: A Work in Progress (editorial). New England Journal of Medicine. 343(16): 1182-1183. October 19, 2000.

Until the pathogenesis (development of disease state) of nephritis (kidney infection) due to systemic lupus erythematosus (SLE) is unraveled, optimal treatment for patients with this disease remains an elusive goal. This article outlines one option for treatment of lupus nephritis, serving as an introduction to a separate article in this issue of the Journal. The author first reviews the differing presentations of SLE, noting that in some patients the kidneys are not involved but in others, there is rapidly progressive destructive kidney disease. This difference may be due in part to genetic risk factors, to environmental factors (such as exposure to ultraviolet light, infectious pathogens, and silica dust), race, or socioeconomic factors. In general, the treatment of lupus glomerulonephritis depends on the severity of the disease. Intravenous cyclophosphamide is given, in addition to oral glucocorticoids, for the aggressive forms of the disorder. However, the adverse effects of these therapies have prompted the search for alternative treatments. The author then comments on the accompanying article which presents the results of a study in which patients with diffuse proliferative lupus nephritis were successfully treated with prednisolone and mycophenolate mofetil. The editorial author notes that there are several reasons for caution before generalizing these findings to other patients with proliferative lupus glomerulonephritis, notably underrepresentation of patients with poor prognosis and certain demographic characteristics. 10 references.

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