A huge medical breakthrough came in Dr. Then in , Dr. This was the turning point where it enabled Medical Doctors to diagnose the disease faster and with greater reliability.
In , Dr. Philip Hench also from Mayo demonstrated that a hormone, cortisone, can treat Rheumatoid Arthritis. Oral contraceptives must be given cautiously because high doses of estrogen can cause SLE exacerbations. Baseline and monthly monitoring e. If a woman is pregnant and has active SLE, corticosteroids may be prescribed with caution to manage the disease.
Most steroids are Pregnancy Category C drugs. NSAIDs Pregnancy Category C and D have also been used, but to a lesser extent, and they should be avoided during early pregnancy and the last trimester. If necessary, hydroxychloroquine may be used, but it is also a Pregnancy Category C drug. Immunosuppressive agents are contraindicated in pregnancy, except for azathioprine, a Pregnancy Category C drug.
In women with SLE and antiphospholipid antibodies, prophylaxis with aspirin, low-molecular-weight heparin, or both, is indicated for the prevention of fetal loss. Lupus continues to present many unanswered questions. Although no cure has been discovered for this autoimmune disease, many medications are available to help control flares, to maintain remission, and to manage symptoms.
Pharmacists and other health care professionals can play a vital role in treatment by educating patients, monitoring their therapeutic regimens, and identifying preventable drug-associated adverse events. Current research is under way, with the hope that improved quality of life and increased survival can be achieved for the many patients affected by SLE each year.
Disclosure: The authors report no financial or commercial relationships in regard to this article. National Center for Biotechnology Information , U. Journal List P T v. Author information Article notes Copyright and License information Disclaimer. Accepted Feb See " Belimumab Benlysta " on page This article has been cited by other articles in PMC.
Abstract Lupus is a chronic inflammatory autoimmune disease with a wide range of clinical presentations resulting from its effect on multiple organ systems.
Sex and Age SLE is more common in women, particularly those of child-bearing age. Drug-Induced Lupus Each year, approximately 15, to 30, cases of lupus are induced by a pharmaceutical product. Open in a separate window. Steroids Corticosteroids mimic naturally occurring hormones excreted by the adrenal gland and help regulate blood pressure and immune function.
Immunosuppressive Agents Immunosuppressants are primarily used in more severe cases of lupus when high-dose corticosteroids or antimalarial treatments have failed to control the signs and symptoms of disease.
Additional Treatment Options Researchers have been particularly interested in the use of stem-cell transplantation to introduce healthy cells into the body in order to help rebuild the immune system.
Footnotes Disclosure: The authors report no financial or commercial relationships in regard to this article. Elish D, Silverberg NB. Neonatal lupus erythematosus. Discoid lupus erythematosus as part of a larger disease spectrum: Correlation of clinical features with laboratory findings in lupus erythematosus. Arch Dermatol. Shmerling RH. Diagnostic tests for rheumatic disease: Clinical utility revisited.
South Med J. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. Prevalence of adult systemic lupus erythematosus in California and Pennsylvania in Estimates obtained using hospitalization data. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum. Systemic lupus erythematosus.
Lupus Foundation of America. Statistics on lupus. Available at: www. Accessed March 1, Trager J, Ward MM. Mortality and causes of death in systemic lupus erythematosus.
Curr Opin Rheumatol. Predictors of survival in systemic lupus erythematosus. Medicine Baltimore ; 85 3 — Pediatr Clin North Am. Rahman A, Isenberg D. N Engl J Med. Autoantigens targeted in systemic lupus erythematosus are clustered in two populations of surface structures on apoptotic keratinocytes.
J Exp Med. SLE: A disease of clearance deficiency? Rheumatology Oxford ; 44 — Genetic, structural and functional properties of an IgG DNA-binding monoclonal antibody from a lupus patient with nephritis.
Eur J Immunol. Kidney Int. Significance of enzyme linked immunosorbent assay ELISA for antibodies to double stranded and single stranded DNA in patients with lupus nephritis: Correlation with severity of renal histology. Ann Rheum Dis. Mechanism and regulation of immunoglobulin isotype switching. Adv Immunol. Rahman A. Autoantibodies, lupus and the science of sabotage. Rheumatology Oxford ; 43 — J Immunol.
Rheumatology Oxford ; 46 — Maternal autoantibodies and congenital heart block: Mediators, markers, and therapeutic approach. A distinctive autoantibody profile in black female patients with lupus nephritis. Antiphospholipid antibodies and the antiphospholipid syndrome in systemic lupus erythematosus: A prospective analysis of consecutive patients. Medicine Baltimore ; 68 — Long-term prognosis of children born to lupus patients.
Studies of twins with systemic lupus erythematosus: A review of the literature and presentation of 12 additional sets. Am J Med. A revised estimate of twin concordance in systemic lupus erythematosus.
The genetic basis for systemic lupus erythematosus. Jt Bone Spine. Classical descriptions of the various dermatologic features of lupus were made by Thomas Bateman, a student of the British dermatologist Robert William, in the early nineteenth century; Cazenave, a student of the French dermatologist Laurent Biett, in the mid-nineteenth century; and Moriz Kaposi born Moriz Kohn , student and son-in-law of the Austrian dermatologist Ferdinand von Hebra, in the late nineteenth century.
The first published illustrations of lupus erythematosus were included in von Hebra's text, Atlas of Skin Diseases , published in Kaposi proposed that there were two types of lupus erythematosus; the discoid form and a disseminated systemic form. Furthermore, he enumerated various signs and symptoms which characterized the systemic form, including:.
The existence of a systemic form of lupus was firmly established in by the work of Osler in Baltimore and Jadassohn in Vienna. Over the next thirty years, pathologic studies documented the existence of nonbacterial verrucous endocarditis Libman-Sacks disease and wire-loop lesions in individuals with glomerulonephritis; such observations at the autopsy table led to the construct of collagen disease proposed by Kemperer and colleagues in The sentinel event which heralded the modern era was the discovery of the LE cell by Hargraves and colleagues in This discovery ushered in the present era of the application of immunology to the study of lupus erythematosus; it also allowed the diagnosis of individuals with much milder forms of the disease.
This possibility, coupled with the discovery of cortisone as a treatment, changed the natural history of lupus as it was known prior to that time. Two other immunologic markers were recognized in the s as being associated with lupus: the biologic false-positive test for syphilis and the immunofluorescent test for antinuclear antibodies. Moore, working in Baltimore, demonstrated that systemic lupus developed in 7 percent of individuals with chronic false-positive tests for syphilis and that a further 30 percent had symptoms consistent with collagen disease.
Friou applied the technique of indirect immunofluorescence to demonstrate the presence of antinuclear antibodies in the blood of individuals with systemic lupus.
Subsequently, there was the recognition of antibodies to deoxyribonucleic acid DNA and the description of antibodies to extractable nuclear antigens nuclear ribonucleoprotein [nRNP], Sm, Ro, La , and anticardiolipin antibodies; these autoantibodies are useful in describing clinical subsets and understanding the etiopathogenesis of lupus.
Two other major advances in the modern era have been the development of animal models of lupus and the recognition of the role of genetic predisposition to the development of lupus.
This murine mouse model has provided many insights into the immunopathogenesis of autoantibody formation, mechanisms of immunologic tolerance, the development of glomerulonephritis, the role of sex hormones in modulating the course of disease, and evaluation of treatments including recently developed biologic agents such as anti-CD4, among others. The familial occurrence of systemic lupus was first noted by Leonhardt in and later studies by Arnett and Shulman at Johns Hopkins.
Subsequently, familial aggregation of lupus, the concordance of lupus in monozygotic twin pairs, and the association of genetic markers with lupus have been described over the past twenty years.
Molecular biology techniques have been applied to the study of human lymphocyte antigen HLA Class II genes to determine specific amino acid sequences in these cell surface molecules that are involved in antigen presentation to T-helper cells in individuals with lupus. These studies have resulted in the identification of genetic-serologic subsets of systemic lupus that complement the clinico-serologic subsets noted earlier. It is hoped by investigators working in this field that these studies will lead to the identification of etiologic factors e.
Over the last decade or so, we have witnessed significant advances in the understanding of the genetic basis of lupus, and of the immunological derangements which lead to the clinical manifestations of the disease.
Advances have been made in the assessment of the impact of the disease in general, and in minority population groups, in particular and efforts are being made towards defining lupus biomarkers which may help both to predict disease outcome and to guide treatments.
Finally, no discussion of the history of lupus is complete without a review of the development of therapy. Payne, in , first reported the usefulness of quinine in the treatment of lupus. Four years later, the use of salicylates in conjunction with quinine was also noted to be of benefit.
Presently, corticosteroids are the primary therapy for almost all individuals with lupus. Share this: Tweet.
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