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https://www.readbyqxmd.com/read/27872476/new-insights-into-the-immunopathogenesis-of-systemic-lupus-erythematosus
#1
REVIEW
George C Tsokos, Mindy S Lo, Patricia Costa Reis, Kathleen E Sullivan
The aetiology of systemic lupus erythematosus (SLE) is multifactorial, and includes contributions from the environment, stochastic factors, and genetic susceptibility. Great gains have been made in understanding SLE through the use of genetic variant identification, mouse models, gene expression studies, and epigenetic analyses. Collectively, these studies support the concept that defective clearance of immune complexes and biological waste (such as apoptotic cells), neutrophil extracellular traps, nucleic acid sensing, lymphocyte signalling, and interferon production pathways are all central to loss of tolerance and tissue damage...
November 22, 2016: Nature Reviews. Rheumatology
https://www.readbyqxmd.com/read/27821390/update-on-lupus-nephritis
#2
Salem Almaani, Alexa Meara, Brad H Rovin
SLE is a chronic inflammatory disease that affects the kidneys in about 50% of patients. Lupus nephritis is a major risk factor for overall morbidity and mortality in SLE, and despite potent anti-inflammatory and immunosuppressive therapies still ends in CKD or ESRD for too many patients. This review highlights recent updates in our understanding of disease epidemiology, genetics, pathogenesis, and treatment in an effort to establish a framework for lupus nephritis management that is patient-specific and oriented toward maintaining long-term kidney function in patients with lupus...
November 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27055518/gastrointestinal-manifestations-in-systemic-lupus-erythematosus
#3
M Fawzy, A Edrees, H Okasha, A El Ashmaui, G Ragab
Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by multisystem involvement, including the gastrointestinal (GI) tract. There is a significant variation in the clinical presentation and severity of GI disorders. When GI symptoms present as the initial manifestation of SLE, there is likely to be a delay in the diagnosis. The cause of these GI manifestations in SLE may be the disease, or the side effects of medications, or infections. In this study we investigated the GI manifestations in a group of SLE patients...
April 6, 2016: Lupus
https://www.readbyqxmd.com/read/27703051/application-of-slicc-classification-criteria-in-undifferentiated-connective-tissue-disease-and-evolution-in-systemic-lupus-erythematosus-analysis-of-a-large-monocentric-cohort-with-a-long-term-follow-up
#4
A Bortoluzzi, F Furini, F Campanaro, M Govoni
OBJECTIVES: The objectives of this study were to analyse the performance of the Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria for systemic lupus erythematosus (SLE) in a large cohort of undifferentiated connective tissue disease (UCTD) population at onset of the disease and during a long-term follow-up of 15 years (1999-2013) and to evaluate the transition from UCTD to SLE, according to American College of Rheumatology (ACR) 1997 and SLICC 2012 classification criteria...
October 4, 2016: Lupus
https://www.readbyqxmd.com/read/27744358/diagnosing-and-attributing-neuropsychiatric-events-to-systemic-lupus-erythematosus-time-to-untie-the-gordian-knot
#5
Sen Hee Tay, Anselm Mak
Neurological and psychiatric syndromes, collectively referred to as NPSLE, occur frequently in SLE. The frequency of NPSLE varies from 21 to 95%; however, only 13-38% of neuropsychiatric (NP) events could be attributable to SLE in the NPSLE SLICC inception cohort. This variability in the frequency of NPSLE is attributable to the low specificity of the ACR case definitions for SLE-attributed NP syndromes, inclusion of minor NP events in the ACR nomenclature, difficulty in ascertainment of NP events and diverse experience of rheumatologists in the clinical assessment of NP events...
October 15, 2016: Rheumatology
https://www.readbyqxmd.com/read/27744359/distinguishing-infections-vs-flares-in-patients-with-systemic-lupus-erythematosus
#6
Fabio E Ospina, Alex Echeverri, Diana Zambrano, Juan-Pablo Suso, Javier Martínez-Blanco, Carlos A Cañas, Gabriel J Tobón
SLE is a chronic autoimmune disease involving multiple systems. Patients with SLE are highly susceptible to infections due to the combined effects of their immunosuppressive therapy and the abnormalities of the immune system that the disease itself causes, which can increase mortality in these patients. The differentiation of SLE activity and infection in a febrile patient with SLE is extremely difficult. Activity indexes are useful to identify patients with lupus flares but some clinical and biological abnormalities may, however, make it difficult to differentiate flares from infection...
October 15, 2016: Rheumatology
https://www.readbyqxmd.com/read/27461045/the-diagnosis-and-management-of-the-haematologic-manifestations-of-lupus
#7
Alba Velo-García, Sara Guerreiro Castro, David A Isenberg
Haematological manifestations in systemic lupus erythematosus (SLE) are frequently observed. They are diverse and range from mild to severe. Therefore, different treatment approaches are needed from simply keeping vigilant to significant immunosuppression. Most treatment evidence is based on case-reports or small retrospective studies, as few randomized controlled trials have been performed. The development of biological therapy has opened new possible ways to treat the most severe cases but further clinical trials are necessary...
July 22, 2016: Journal of Autoimmunity
https://www.readbyqxmd.com/read/27703052/disseminated-cytomegalovirus-infection-complicating-active-treatment-of-systemic-lupus-erythematosus-an-emerging-problem
#8
N Berman, H M Belmont
Patients with systemic lupus erythematosus (SLE) often require immunosuppression to induce remission of active disease exacerbations. Over the past two decades, treatment modalities for this condition have emerged leading to improved morbidity from disease related outcomes. However, as a result, infection risks and patterns have changed, leading to higher rates of opportunistic infections among this population. We report four cases of cytomegalovirus (CMV) in patients with SLE who received immunosuppressive therapy, including pulse steroids, antimetabolites such as mycophenolate mofetil, and alkylating agents such as cyclophosphamide...
October 4, 2016: Lupus
https://www.readbyqxmd.com/read/27548593/systemic-lupus-erythematosus-primary-care-approach-to-diagnosis-and-management
#9
Nguyet-Cam Vu Lam, Maria V Ghetu, Marzena L Bieniek
Systemic lupus erythematosus is an autoimmune disease that affects many systems, including the skin, musculoskeletal, renal, neuropsychiatric, hematologic, cardiovascular, pulmonary, and reproductive systems. Family physicians should be familiar with the manifestations of lupus to aid in early diagnosis, monitoring patients with mild disease, recognizing warning signs that require referral to a rheumatologist, and helping to monitor disease activity and treatment in patients with moderate to severe disease...
August 15, 2016: American Family Physician
https://www.readbyqxmd.com/read/27687029/urinary-sediment-suggests-lupus-nephritis-histology
#10
M U Martínez-Martínez, L M de G Llamazares-Azuara, D Martínez-Galla, P B Mandeville, F Valadez-Castillo, S Román-Acosta, J A Borjas-García, C Abud-Mendoza
OBJECTIVES: The objective of this paper was to evaluate correlations between kidney biopsy indexes (activity and chronicity) and urinary sediment findings; the secondary objective was to find which components of urinary sediment can discriminate proliferative from other classes of lupus nephritis. METHODS: Lupus nephritis patients scheduled for a kidney biopsy were included in our study. The morning before the kidney biopsy, we took urine samples from each patient...
September 29, 2016: Lupus
https://www.readbyqxmd.com/read/27558659/the-global-burden-of-sle-prevalence-health-disparities-and-socioeconomic-impact
#11
REVIEW
Erin E Carter, Susan G Barr, Ann E Clarke
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can potentially lead to serious organ complications and even death. Its global burden - in terms of incidence and prevalence, differential impact on populations, economic costs and capacity to compromise health-related quality of life - remains incompletely understood. The reported worldwide incidence and prevalence of SLE vary considerably; this variation is probably attributable to a variety of factors, including ethnic and geographic differences in the populations being studied, the definition of SLE applied, and the methods of case identification...
October 2016: Nature Reviews. Rheumatology
https://www.readbyqxmd.com/read/27481038/shrinking-lung-syndrome-associated-with-systemic-lupus-erythematosus-a-multicenter-collaborative-study-of-15-new-cases-and-a-review-of-the-155-cases-in-the-literature-focusing-on-treatment-response-and-long-term-outcomes
#12
REVIEW
Loïc Duron, Fleur Cohen-Aubart, Elisabeth Diot, Raphaël Borie, Sébastien Abad, Christophe Richez, Christopher Banse, Olivier Vittecoq, David Saadoun, Julien Haroche, Zahir Amoura
INTRODUCTION: Shrinking lung syndrome (SLS) is a rare respiratory manifestation of systemic lupus erythematosus (SLE), characterized by dyspnea, chest pain, elevated hemidiaphragm and a restrictive pattern on pulmonary function tests. Here, we report 15 new observations of SLS during SLE and provide a systematic literature review. We studied the clinical, biological, functional and morphologic characteristics, the treatments used and their efficacy. METHODS: The inclusion criteria were all patients with SLE defined by the American College of Rheumatology criteria Hochberg (1997) , associated with a restrictive pattern on pulmonary function tests...
October 2016: Autoimmunity Reviews
https://www.readbyqxmd.com/read/27623861/risk-of-serious-infections-with-immunosuppressive-drugs-and-glucocorticoids-for-lupus-nephritis-a-systematic-review-and-network-meta-analysis
#13
Jasvinder A Singh, Alomgir Hossain, Ahmed Kotb, George Wells
BACKGROUND: To perform a systematic review and network meta-analysis (NMA) to compare the risk of serious infections with immunosuppressive medications and glucocorticoids in lupus nephritis. METHODS: A trained librarian performed two searches: (1) PubMed for all lupus nephritis trials from the end dates for the systematic review for the 2012 American College of Rheumatology (ACR) lupus nephritis treatment guidelines and the 2012 Cochrane Systematic Review on treatments for lupus nephritis, to September 2013; and (2) PubMed and SCOPUS for all lupus trials (excluding lupus nephritis) from inception to February 2014, to obtain additional trials for harms data in any lupus patient...
2016: BMC Medicine
https://www.readbyqxmd.com/read/27639157/prevalence-and-predictors-of-valvular-heart-disease-in-patients-with-systemic-lupus-erythematosus
#14
Florencia Vivero, Cristina Gonzalez-Echavarri, Beatriz Ruiz-Estevez, Irene Maderuelo, Guillermo Ruiz-Irastorza
OBJECTIVES: We aimed to study the frequency, severity and predictors of valvular heart disease (VHD) in our lupus cohort. MATERIAL AND METHODS: 211 patients were included. A transthoracic echocardiogram was used for this study. Significant valvular lesions were classified into two groups: valvular thickening and valvular dysfunction. Univariate logistic regression was performed in order to find associations with valvular thickening and dysfunction. Those variables with a p value ≤0...
September 15, 2016: Autoimmunity Reviews
https://www.readbyqxmd.com/read/27491566/pitfalls-in-lupus
#15
M Schneider
"The objective of Pitfall!™ is to guide Harry through a maze of jungle scenes, jumping over or avoiding many deadly dangers… Harry has three lives in each game." If you exchange Harry's adventures with "Life with SLE," patients have to be guided through the jungle having just one life and the deadly dangers are flares, organ manifestations, and, e.g., consequences of immunosuppressive medications, especially glucocorticoids. Monitoring and treatment in line with recommendations and guidelines may be supportive to survive the first 3 to 5 levels in most cases, but for higher levels of the reality game, creativity is needed and life becomes more risky...
November 2016: Autoimmunity Reviews
https://www.readbyqxmd.com/read/27588834/early-clinical-features-in-systemic-lupus-erythematosus-can-they-be-used-to-achieve-earlier-diagnosis-a-risk-prediction-model
#16
Frances Rees, Michael Doherty, Peter Lanyon, Graham Davenport, Richard D Riley, Weiya Zhang, Matthew J Grainge
OBJECTIVES: 1) To compare the primary care consulting behaviour prior to diagnosis of people with Systemic Lupus Erythematosus (SLE) with controls, 2) to develop and validate a risk prediction model to aid earlier SLE diagnosis. METHODS: 1,739 incident SLE cases practice-matched to 6,956 controls from the UK Clinical Practice Research Datalink. Odds ratios were calculated for age, gender, consultation rates, selected presenting clinical features and previous diagnoses in the 5 years preceding diagnosis date using logistic regression...
September 2, 2016: Arthritis Care & Research
https://www.readbyqxmd.com/read/27558987/remission-in-systemic-lupus-erythematosus-durable-remission-is-rare
#17
Theresa R Wilhelm, Laurence S Magder, Michelle Petri
INTRODUCTION: Remission is the ultimate goal in systemic lupus erythematosus (SLE). In this study, we applied four definitions of remission agreed on by an international collaboration (Definitions of Remission in SLE, DORIS) to a large clinical cohort to estimate rates and predictors of remission. METHODS: We applied the DORIS definitions of Clinical Remission, Complete Remission (requiring negative serologies), Clinical Remission on treatment (ROT) and Complete ROT...
August 24, 2016: Annals of the Rheumatic Diseases
https://www.readbyqxmd.com/read/27589220/comparative-rates-of-serious-infections-among-patients-with-systemic-lupus-erythematosus-receiving-immunosuppressive-medications
#18
Candace H Feldman, Francisco M Marty, Wolfgang C Winkelmayer, Hongshu Guan, Jessica M Franklin, Daniel H Solomon, Karen H Costenbader, Seoyoung C Kim
BACKGROUND: While infection burden among patients with SLE is high, uncertainty exists about whether rates differ by immunosuppressive drug regimens. We compared infection rates among patients with SLE newly initiating immunosuppressive therapy either using mycophenolate mofetil (MMF), azathioprine (AZA), or cyclophosphamide (CYC). METHODS: Within the Medicaid Analytic eXtract (2000-10; 29 U.S. states), we identified adults with SLE starting MMF, AZA, or CYC treatment...
September 2, 2016: Arthritis & Rheumatology
https://www.readbyqxmd.com/read/27497257/a-critical-review-of-clinical-trials-in-systemic-lupus-erythematosus
#19
M A Mahieu, V Strand, L S Simon, P E Lipsky, R Ramsey-Goldman
One challenge in caring for patients with systemic lupus erythematosus (SLE) is a paucity of approved therapeutics for treatment of the diverse disease manifestations. In the last 60 years, only one drug, belimumab, has been approved for SLE treatment. Critical evaluation of investigator initiated and pharma-sponsored randomized controlled trials (RCTs) highlights barriers to successful drug development in SLE, including disease heterogeneity, inadequate trial size or duration, insufficient dose finding before initiation of large trials, handling of background medications, and choice of primary endpoint...
September 2016: Lupus
https://www.readbyqxmd.com/read/27457513/eular-recommendations-for-women-s-health-and-the-management-of-family-planning-assisted-reproduction-pregnancy-and-menopause-in-patients-with-systemic-lupus-erythematosus-and-or-antiphospholipid-syndrome
#20
L Andreoli, G K Bertsias, N Agmon-Levin, S Brown, R Cervera, N Costedoat-Chalumeau, A Doria, R Fischer-Betz, F Forger, M F Moraes-Fontes, M Khamashta, J King, A Lojacono, F Marchiori, P L Meroni, M Mosca, M Motta, M Ostensen, C Pamfil, L Raio, M Schneider, E Svenungsson, M Tektonidou, S Yavuz, D Boumpas, A Tincani
OBJECTIVES: Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). METHODS: Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. RESULTS: Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes...
July 25, 2016: Annals of the Rheumatic Diseases
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