Lupus - Need to Know最新文献

{"title":"Systemic Lupus Erythematosus Pregnancy","authors":"Melissa Fernandes, V. Bernardino, A. Taulaigo, Jorge Fernandes, A. Lladó, F. Serrano","doi":"10.5772/intechopen.99008","DOIUrl":"https://doi.org/10.5772/intechopen.99008","url":null,"abstract":"Systemic Lupus Erythematosus (SLE) is an autoimmune disease of unknown etiology that often affects women during childbearing age. Pregnant women with SLE are considered high-risk patients, with pregnancy outcomes being complicated by high maternal and fetal mortality and morbidity. Obstetric morbidity includes preterm birth, fetal growth restriction (FGR), and neonatal lupus syndromes. Active SLE during conception is a strong predictor of adverse pregnancy outcomes and exacerbations of disease can occur more frequently during gestation. Therefore, management of maternal SLE should include preventive strategies to minimize disease activity and to reduce adverse pregnancy outcomes. Patients with active disease at time of conception have increased risk of flares, like lupus nephritis, imposing a careful differential diagnosis of pre-eclampsia, keeping in mind that physiological changes of pregnancy may mimic a lupus flare. Major complications arise when anti-phospholipid antibodies are present, like recurrent pregnancy loss, stillbirth, FGR, and thrombosis in the mother. A multidisciplinary approach is hence crucial and should be initiated to all women with SLE at childbearing age with an adequate preconception counseling with assessment of risk factors for adverse maternal and fetal outcomes with a tight pregnancy monitoring plan. Although treatment choices are limited during pregnancy, prophylactic anti-aggregation and anticoagulation agents have proven beneficial in reducing thrombotic events and pre-eclampsia related morbidity. Pharmacological therapy should be tailored, allowing better outcomes for both the mother and the baby. Immunosuppressive and immunomodulators, must be effective in controlling disease activity and safe during pregnancy. Hydroxychloroquine is the main therapy for SLE due to its anti-inflammatory and immunomodulatory effects recommended before and during pregnancy and other immunosuppressive drugs (e.g. azathioprine and calcineurin inhibitors) are used to control disease activity in order to improve obstetrical outcomes. Managing a maternal SLE is a challenging task, but an early approach with multidisciplinary team with close monitoring is essential and can improve maternal and fetal outcomes.","PeriodicalId":329276,"journal":{"name":"Lupus - Need to Know","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131926029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Use of Mesenchymal Stem Cells in Treatment of Systemic Lupus Erythematosus","authors":"H. Bukulmez, G. Kumar","doi":"10.5772/INTECHOPEN.97261","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.97261","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune inflammatory disorder with considerable clinical heterogeneity and a prevalence of 26 to 52 out of 100,000. In autoimmune diseases, such as SLE, the immune system loses its ability to distinguish between self and other. Treatment of SLE is challenging because of clinical heterogeneity and unpredictable disease flares. Currently available treatments, such as corticosteroids, cyclophosphamide (CYC), and other immunosuppressive or immunomodulating agents, can control most lupus flares but a definitive cure is rarely achieved. Moreover, standard therapies are associated with severe side effects, including susceptibility to infections, ovarian failure, and secondary malignancy. Alternative therapeutic options that are more efficacious with fewer side effects are needed to improve long-term outcome. Mesenchymal stem cells/multipotent stromal cells (MSCs), which secrete immunomodulatory factors that help restore immune balance, could hold promise for treating these diseases. Because MSCs do not express major histocompatibility complex II (MHC-II) or costimulatory molecules, they are also “immunologically privileged” and less likely to be rejected after transplant. Stem cells are defined as a class of undifferentiated cells in multicellular organisms that are pluripotent and self-replicating. MSCs are promising in regenerative medicine and cell-based therapies due to their abilities of their self-renewal and multilineage differentiation potential. Most importantly, MSCs have immunoregulatory effects on multiple immune system cells. While some studies report safety and efficacy of allogeneic bone marrow and/or umbilical cord MSC transplantation (MSCT) in patients with severe and drug-refractory systemic lupus erythematosus (SLE), others found no apparent additional effect over and above standard immunosuppression. The purpose of this chapter is to discuss immune modulation effects of MSCs and the efficacy of MSCs treatments in SLE.","PeriodicalId":329276,"journal":{"name":"Lupus - Need to Know","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130520298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrine Manifestations of Systemic Lupus Erythematosus","authors":"I. Kostoglou-Athanassiou, L. Athanassiou, P. Athanassiou","doi":"10.5772/INTECHOPEN.97363","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.97363","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a systemic autoimmune disease affecting all organ systems. It affects primarily female patients in the reproductive age. The disease has a variable course from very mild to severe and may be fatal. It is characterized by exacerbations of disease activity called flares. Estrogens seem to be involved in SLE pathogenesis as they have multiple immunomodulating properties. In SLE the autoimmune process affects the neuroendocrine axis. Stress modulates disease expression in lupus patients. The disease affects the endocrine system. Hypothyroidism occurs in SLE patients in a higher rate than that of the general population. Hyperthyroidism is also observed in SLE, however, in the rate expected for the general population. Hashimoto’s thyroiditis is observed in SLE in a higher rate than that of the general population. Hyperparathyroidism is also observed in SLE, primary and secondary in the context of renal insufficiency due to lupus nephritis. Addison’s disease is rare in SLE. Cushing’s disease due to an adrenal adenoma has been observed, but it is rare. Ovarian function may be compromised in SLE, due to autoimmune oophoritis or drug toxicity. The recognition of endocrine disease in SLE is important as it may guide proper management and symptom amelioration.","PeriodicalId":329276,"journal":{"name":"Lupus - Need to Know","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127812989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lupus Nephritis: Renal Biopsy Guiding the Clinician","authors":"R. Viero, D. D. Santos","doi":"10.5772/INTECHOPEN.97169","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.97169","url":null,"abstract":"Systemic lupus erythematosus is a chronic autoimmune disease that affects mostly women. The kidneys are involved in 50% of patients causing a high degree of disease morbidity and mortality with poor prognosis. Early diagnosis of lupus nephritis with prompt therapy correlates with a better outcome. The renal biopsy provides important informations to clinicians to monitor the patients. The patterns of glomerular lesion, degree of activity and chronicity of the disease and extent of lesions to the tubulointerstitial and vascular compartments are fundamental information for the clinician to decide the most appropriate treatment. In order to correlate the kidney disease with clinical manifestations and patient outcome the glomerular lesions are classified according to International Society of Nephrology and Renal Pathology Society Classification (ISN/RPS). The definition of active and chronic lesions was introduced by studies conducted at National Institute of Health (NIH). The ISN/RPS classification and NIH indices have recently been revised by a series of retrospective validation studies to improve and minimize the controversial aspects.","PeriodicalId":329276,"journal":{"name":"Lupus - Need to Know","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129106410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Therapeutic Interventions in Systemic Lupus Erythematosus","authors":"P. Athanassiou, L. Athanassiou, I. Kostoglou-Athanassiou","doi":"10.5772/INTECHOPEN.97168","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.97168","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a systemic autoimmune disease. It is characterized by a variable clinical course ranging from mild to fatal disease. It can affect the kidneys. The aim of treatment in SLE is the prevention of flares and the prevention of accumulation of damage to the main organs affected as well as the prevention of drug side effects. The cornerstone of SLE treatment is hydroxychloroquine. Corticosteroids are used both as induction treatment in disease flares as well as in small doses as maintenance treatment. Immunosuppressants, such as azathioprine, methotrexate and mycophenolate mofetil are used as steroid sparing agents. Calcineurin inhibitors, namely tacrolimus and cyclosporin A may also be used as immunosuppressants and steroid sparing agents. Pulse methylprednisolone, along with mycophenolate mofetil and cyclophosphamide are used as induction treatment in lupus nephritis. Rituximab, an anti-CD20 biologic agent may be used in non-renal SLE. In patients insufficiently controlled with hydroxychloroquine, low dose prednisone and/or immunosuppressive agents, belimumab may be used with beneficial effects in non-renal disease and lupus nephritis.","PeriodicalId":329276,"journal":{"name":"Lupus - Need to Know","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129611606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lupus Nephritis: Current Updates","authors":"F. Adeeb, Wan Ahmad Hafiz Wan Md Adnan","doi":"10.5772/INTECHOPEN.96891","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.96891","url":null,"abstract":"Lupus is a heterogenous multisystem autoimmune disease whereby nephritis is one of its most common cause of overall morbidity and mortality. Accurate, timely diagnosis and effective treatment in lupus nephritis (LN) remains a challenge to many clinicians including those who are directly involved in the daily care of these patients. Despite significant improvement in patients’ survival rate in recent years, in this era of precision medicine, there is pressing need to further improve our understanding and management of this disease. Our chapter would shed light on the key issues in LN including recent advances in our scientific understanding of its’ pathophysiology, major challenges and treatment strategies.","PeriodicalId":329276,"journal":{"name":"Lupus - Need to Know","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114777352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Don’t Miss Lupus","authors":"S. Soloway","doi":"10.5772/INTECHOPEN.96892","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.96892","url":null,"abstract":"Chapter for Lupus Book Systemic lupus erythematosus is a well-recognized multi-system disease. Hallmarks of the disorder include the prevalence of antinuclear antibodies (ANA) and double stranded antibodies (DNA). The disease often presents with lupus rashes and/or arthritis or arthralgias. Lupus is “the great imitator,” as no organ system is excluded, when diagnosing and treating a lupus patient. While lupus remains evasive in novel therapies with true benefit; one issue has been consistent, in that the preponderance of the evidence thus far, leads to B cell dysfunction. More recently Belimumab was indicated for use in lupus patients. This is a BLyS-Specific inhibitor (B lymphocyte stimulator) medication. At this time, I would like to focus on lupus in a manner that you are not used to hearing. Typically, any practitioner who approaches a patient with a plethora of symptoms, would order blood tests, and conclude a diagnosis of lupus. In this chapter, I will point out and focus on the need to think “outside the box” and perhaps consider lupus as simply one of various other scenarios.","PeriodicalId":329276,"journal":{"name":"Lupus - Need to Know","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120839634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}