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https://www.readbyqxmd.com/read/28148586/systemic-lupus-erythematosus
#1
Maliha F Shaikh, Natasha Jordan, David P D'Cruz
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease that is highly heterogeneous in its presentation. This can pose significant challenges for physicians responsible for the diagnosis and treatment of such patients. SLE arises from a combination of genetic, epigenetic and environmental factors. Pathologically, the disease is primarily driven by loss of immune tolerance and abnormal B- and T-cell function. Major organ involvement may lead to significant morbidity and mortality. Classification criteria for SLE have been developed largely for research purposes; however, these are also widely used in clinical practice...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28159705/demyelinating-syndrome-in-sle-encompasses-different-subtypes-do-we-need-new-classification-criteria-pooled-results-from-systematic-literature-review-and-monocentric-cohort-analysis
#2
Matteo Piga, Elisabetta Chessa, Maria Teresa Peltz, Alberto Floris, Alessandro Mathieu, Alberto Cauli
OBJECTIVE: To describe features of demyelinating syndrome (DS) in systemic lupus erythematosus (SLE). METHODS: A systematic review using a combination of Mesh terms in PubMed and a retrospective analysis of 343 adult patients with SLE were carried out to identify patients with DS. Retrieved cases were classified as affected with DS according to 1999 ACR nomenclature and attributed to SLE by applying the 2015 algorithm. DS defined according to the clinical but not temporal 1999 ACR criteria was classified as clinically isolated syndrome (CIS)...
January 31, 2017: Autoimmunity Reviews
https://www.readbyqxmd.com/read/28147263/subclinical-atherosclerosis-in-systemic-lupus-erythematosus-comparable-risk-with-diabetes-mellitus-and-rheumatoid-arthritis
#3
Maria G Tektonidou, Evrydiki Kravvariti, George Konstantonis, Nicholas Tentolouris, Petros P Sfikakis, Athanasios Protogerou
OBJECTIVE: Although a high risk of subclinical atherosclerosis has been reported in Systemic Lupus Erythematosus (SLE), it is not adequately compared with that observed in other rheumatic and non-rheumatic high-cardiovascular (CVD) risk diseases, such as Rheumatoid Arthritis (RA) and Diabetes Mellitus (DM). Our objective was to evaluate the relative risk (RR) of subclinical atherosclerosis in SLE, RA and DM patients compared to healthy controls, and examine potential associations with traditional and disease-related CVD risk factors in SLE...
January 29, 2017: Autoimmunity Reviews
https://www.readbyqxmd.com/read/28130918/anifrolumab-an-anti-interferon-%C3%AE-receptor-monoclonal-antibody-in-moderate-to-severe-systemic-lupus-erythematosus
#4
Richard Furie, Munther Khamashta, Joan T Merrill, Victoria P Werth, Kenneth Kalunian, Philip Brohawn, Gabor G Illei, Jorn Drappa, Liangwei Wang, Stephen Yoo
OBJECTIVE: To assess the efficacy and safety of anifrolumab, a type I interferon (IFN) receptor antagonist, in a phase IIb, randomized, double-blind, placebo-controlled study of adults with moderate-to-severe systemic lupus erythematosus (SLE). METHODS: Patients (n = 305) were randomized to receive intravenous anifrolumab (300 mg or 1,000 mg) or placebo, in addition to standard therapy, every 4 weeks for 48 weeks. Randomization was stratified by SLE Disease Activity Index 2000 score (<10 or ≥10), oral corticosteroid dosage (<10 or ≥10 mg/day), and type I IFN gene signature test status (high or low) based on a 4-gene expression assay...
February 2017: Arthritis & Rheumatology
https://www.readbyqxmd.com/read/28095869/macrophage-activation-syndrome-different-mechanisms-leading-to-a-one-clinical-syndrome
#5
REVIEW
Claudia Bracaglia, Giusi Prencipe, Fabrizio De Benedetti
BACKGROUND: Macrophage activation syndrome (MAS) is a severe complication of rheumatic disease in childhood, particularly in systemic Juvenile Idiopathic Arthritis (sJIA). It is characterize by an uncontrolled activation and proliferation of T lymphocytes and macrophages. MAIN CONTENT: MAS is currently classified among the secondary or acquired forms of haemophagocytic lymphohistiocytosis (sHLH). The reason is that MAS shares clinical and laboratory features with primary genetic HLH (pHLH)...
January 17, 2017: Pediatric Rheumatology Online Journal
https://www.readbyqxmd.com/read/28121495/belimumab-for-the-treatment-of-recalcitrant-cutaneous-lupus
#6
P Vashisht, K Borghoff, J R O'Dell, M Hearth-Holmes
Background Belimumab is a monoclonal antibody that reduces B lymphocyte survival by blocking the binding of soluble human B lymphocyte stimulator (BLyS) to its B cell receptors. The utility of belimumab for management of resistant systemic lupus erythematosus (SLE) skin manifestations has not been reported. We present our experience of using this novel molecule for the successful management of cutaneous lupus at our center. Methods We studied five patients with significant SLE skin manifestations. All patients met 1997 American College of Rheumatology (ACR) SLE criteria and had failed multiple medications to control their skin disease...
January 1, 2016: Lupus
https://www.readbyqxmd.com/read/28118528/clinical-and-serological-features-distinguish-patients-with-incomplete-lupus-classification-from-systemic-lupus-erythematosus-patients-and-controls
#7
Teresa Aberle, Rebecka L Bourn, Melissa E Munroe, Hua Chen, Virginia C Roberts, Joel M Guthridge, Krista Bean, Julie M Robertson, Kathy L Sivils, Astrid Rasmussen, Meghan Liles, Joan T Merrill, John B Harley, Nancy J Olsen, David R Karp, Judith A James
OBJECTIVE: Incomplete lupus erythematosus (ILE) involves clinical and/or serologic manifestations consistent with but insufficient for SLE classification. Because the nature of ILE is poorly understood and no treatment recommendations exist, we examined clinical manifestations, medication history, and immunologic features in a diverse collection of ILE and SLE patients. METHODS: Medical records of subjects enrolled to the Lupus Family Registry and Repository were reviewed for medication history and American College of Rheumatology (ACR) classification criteria to identify ILE patients (3 ACR criteria; n=440) and SLE patients (≥4 ACR criteria; n=3,397)...
January 24, 2017: Arthritis Care & Research
https://www.readbyqxmd.com/read/28059024/incidence-of-cervical-human-papillomavirus-infection-in-systemic-lupus-erythematosus-women
#8
C Mendoza-Pinto, M García-Carrasco, V Vallejo-Ruiz, S Méndez-Martínez, A Taboada-Cole, I Etchegaray-Morales, M Muñóz-Guarneros, J Reyes-Leyva, A López-Colombo
Objectives Our objective was to study the incidence, persistence and clearance of human papillomavirus infection in systemic lupus erythematosus women and assess risk factors for persistence of human papillomavirus infection. Methods We carried out a prospective, observational cohort study of 127 systemic lupus erythematosus women. Patients were evaluated at baseline and at three years. Traditional and systemic lupus erythematosus women-related disease risk factors were collected. Gynaecological evaluations and cervical cytology screening were made...
January 1, 2017: Lupus
https://www.readbyqxmd.com/read/28054130/posterior-reversible-encephalopathy-syndrome
#9
REVIEW
Marlene Fischer, Erich Schmutzhard
The posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of (sub)acute onset characterized by varied neurological symptoms, which may include headache, impaired visual acuity or visual field deficits, disorders of consciousness, confusion, seizures, and focal neurological deficits. In a majority of patients the clinical presentation includes elevated arterial blood pressure up to hypertensive emergencies. Neuroimaging, in particular magnetic resonance imaging, frequently shows a distinctive parieto-occipital pattern with a symmetric distribution of changes reflecting vasogenic edema...
January 4, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28039419/cumulative-immunosuppressant-exposure-is-associated-with-diversified-cancer-risk-among-14-832-patients-with-systemic-lupus-erythematosus-a-nested-case-control-study
#10
Chung-Yuan Hsu, Ming-Shyan Lin, Yu-Jih Su, Tien-Tsai Cheng, Yu-Sheng Lin, Ying-Chou Chen, Wen-Chan Chiu, Tien-Hsing Chen
OBJECTIVES: Immunosuppressive therapy is necessary to alter the natural course of SLE. However, immunosuppressant-related cancer risk is a major concern. The aim of this study was to determine whether immunosuppressant use is associated with cancer risk in SLE. METHODS: We designed a retrospective nested case-control study within an SLE population based on the National Health Insurance Research Database in Taiwan. We screened 14 842 patients with SLE from 2001 to 2013 and compared patients with SLE complicated by later cancer with patients with SLE but without cancer...
December 30, 2016: Rheumatology
https://www.readbyqxmd.com/read/28013208/it-hasn-t-gone-away-the-problem-of-glucocorticoid-use-in-lupus-remains
#11
Diane Apostolopoulos, Eric F Morand
The treatment of SLE remains complex, and management is constrained by a lack of safe, effective, targeted therapies. Physicians, also, are constrained by a lack of evidence-based approaches with existing agents, including glucocorticoids, utilized in the majority of patients. While Cushingoid side effects of glucocorticoids are widely recognized, emerging literature now suggests that glucocorticoid use actually contributes to harmful outcomes in SLE, over and above these effects. These studies provide a compelling case for a re-evaluation of the long-term use of glucocorticoids in SLE, focusing on minimizing glucocorticoid exposure as part of the strategy to improve long-term outcomes...
December 24, 2016: Rheumatology
https://www.readbyqxmd.com/read/28013206/systemic-lupus-erythematosus-diagnosis-and-management
#12
REVIEW
Bernard Thong, Nancy J Olsen
SLE presents many challenges for clinicians. The onset of disease may be insidious, with many different symptoms and signs, making early and accurate diagnosis challenging. Tests for SLE in the early stages lack specificity; those that are useful later often appear only after organ damage is manifest. Disease patterns are highly variable; flares are not predictable and not always associated with biomarkers. Children with SLE may have severe disease and present special management issues. Older SLE patients have complicating co-morbid conditions...
December 24, 2016: Rheumatology
https://www.readbyqxmd.com/read/27992698/effects-of-hydroxychloroquine-on-cutaneous-lupus-erythematosus-a-multi-center-double-blind-randomized-parallel-group-trial
#13
N Yokogawa, H Eto, A Tanikawa, T Ikeda, K Yamamoto, T Takahashi, H Mizukami, T Sato, N Yokota, F Furukawa
Objectives To assess the efficacy and tolerability of hydroxychloroquine (HCQ) in a phase III clinical trial conducted in Japan Methods A double-blind randomized parallel-group clinical trial was performed. This was a baseline-controlled study and the group differences were evaluated in an exploratory analysis. A total of 103 patients with active CLE (CLASI activity score ≥4) were included. Patients were randomized (3:1) to receive HCQ or placebo in the 16-week double-blind period, and all patients were given HCQ in the following 36-week single-blind period...
December 19, 2016: Arthritis & Rheumatology
https://www.readbyqxmd.com/read/27307107/systemic-lupus-erythematosus-still-a-challenge-for-physicians
#14
REVIEW
A A Bengtsson, L Rönnblom
Systemic lupus erythematosus (SLE) has a complex clinical picture, and a number of defects in the immune system have been described in patients with the disease. Most organs can be involved in SLE, and in addition to the typical major organ manifestations (e.g. from kidneys and the central nervous system), early cardiovascular disease is a major determinant of prognosis. Several important findings during the last decade have increased the understanding of the mechanisms behind the disease characteristics and the underlying autoimmune process...
January 2017: Journal of Internal Medicine
https://www.readbyqxmd.com/read/27637120/diagnosis-and-treatment-of-atrial-fibrillation
#15
Cecilia Gutierrez, Daniel G Blanchard
Atrial fibrillation is a supraventricular arrhythmia that adversely affects cardiac function and increases the risk of stroke. It is the most common arrhythmia and a major source of morbidity and mortality; its prevalence increases with age. Pulse rate is sensitive, but not specific, for diagnosis, and suspected atrial fibrillation should be confirmed with 12-lead electrocardiography. Because normal electrocardiographic findings do not rule out atrial fibrillation, home monitoring is recommended if there is clinical suspicion of arrhythmia despite normal test results...
September 15, 2016: American Family Physician
https://www.readbyqxmd.com/read/27872476/new-insights-into-the-immunopathogenesis-of-systemic-lupus-erythematosus
#16
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
#17
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
#18
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...
November 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
#19
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
#20
REVIEW
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
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