Autoimmune disorders lupus

Besides anemia associated with cancer and CKD, anemia of chronic disease can result from inflammatory processes and occurs commonly in autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus. In treating these types of anemia of chronic disease, the most important principle is treating the underlying disease. These patients also may have iron deficiency and should be treated in the manner already discussed. Erythropoietin therapy such as epoetin-alfa therapy at a dose of 150 units/kg three times a week also may be used in these patients. 

In addihon to treahng tumors, and because depleting B cells in humans with rituximab has been found to be safe, Rituxan is now in clinical trials and has shown efficacy for a number of autoimmune disorders. These include rheumatoid arthritis, idiopathic thrombocytopenia purpura (ITP, a platelet-depletion disorder), and lupus. It is expected that depleting B cells with rituximab will be approved in a nononcology indication within several years. 

Autoimmune disorders Development or exacerbation of autoimmune disorders, including myositis, hepatitis, idiopathic thrombocytopenic purpura, psoriasis, rheumatoid arthritis, interstitial nephritis, thyroiditis, and systemic lupus erythematosus have been reported in patients receiving alpha interferon. 

Cyclosporine appears to have promise in the treatment of autoimmune diseases. It has a beneficial effect on the course of rheumatoid arthritis, uveitis, insulin-dependent diabetes, systemic lupus erythematosus, and psoriatic arthropathies in some patients. Toxicity is more of a problem in these conditions than during use in transplantation, since higher doses of cyclosporine are often required to suppress autoimmune disorders. 

Because of these immunosuppressant activities, hydroxychloroquine is used to treat some autoimmune disorders, eg, rheumatoid arthritis and systemic lupus erythematosus. It has also been used to both treat and prevent graft-versus-host disease after allogeneic stem cell transplantation. 

The effectiveness of immunosuppressive drugs in autoimmune disorders varies widely. Nonetheless, with immunosuppressive therapy, remissions can be obtained in many instances of autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, type 1 diabetes, Hashimoto s thyroiditis, and temporal arteritis. Improvement is also often seen in patients with systemic lupus erythematosus, acute glomerulonephritis, acquired factor VIII inhibitors (antibodies), rheumatoid arthritis, inflammatory myopathy, scleroderma, and certain other autoimmune states. 

One controlled, double-blind trial plus anecdotal evidence attest to the efficacy of chlorambucil in rheumatoid arthritis. Chlorambucil has also been used in Behef s disease, systemic lupus erythematosus, vasculitis, and other autoimmune disorders. 

Many skin disorders are associated with at least one of the characteristics of inflammation, oxidative stress, hyperproliferation, hypodifferentiation, infection, apoptosis, and autoimmune reactions. GTPs are uniquely positioned to antagonize these conditions with anti-inflammatory, antioxidant, antimicrobial, prodifferentiation, anti-apoptosis, and inhibition of autoantigen properties. Thus, many skin conditions, including autoimmune-induced lupus and psoriasis, wounds created by trauma or infections, damage induced by environmental factors such as UVB, and seborrheic dermatitis (dandruff), could be treated or managed by topical application of GTPs. 

Ml 1. McCauliffe, D. P., Neonatal lupus erythematosus A transplacentally acquired autoimmune disorder. Semin. Dermatol. 14, 47-53 (1995). 

Typically, serum and synovial fluid from patients contain rheumatoid factors (>80% of patients) although serum rheumatoid factors are found in other autoimmune disorders affecting connective tissues, and in some chronic infections. The presence of small joint involvement along with the presence of rheumatoid factors is usually taken as diagnostic, however other disorders, such as systemic lupus erythematosus, need to be eliminated by clinical presentation and associated laboratory observations. 

Sjogren s Syndrome. SS is an autoimmune disorder characterized by the triad of dry eye, dry mouth (xerostomia), and a connective tissue disease. At least two components of the triad need to be present for the diagnosis of SS to be made. Primary SS, an exocrinopathy, is characterized by a lymphocytic infiltration and subsequent destruction of salivary and lacrimal glandular tissues. Symptoms include both dry eyes and dry mouth. Secondary SS includes dry eyes or xerostomia, plus a connective tissue disease, most frequently rhemnatoid arthritis but also lupus, scleroderma, polyarteritis, or other related diseases. Unfortimately, there is no cure for SS at this time. Clinical trials using oral immunomodulatory agents have produced mixed results. 

Felbamate is currently reserved for patients who are refractory to other drugs after careful consideration of the benefitrharm balance. In some countries the indication has been restricted to refractory Lennox-Gastaut syndrome. It is wise to avoid felbamate in patients with previous blood dyscrasias or autoimmune disorders, especially lupus erythematosus. Before they start to take it, patients should be informed about the potential risks and early symptoms of bone-marrow toxicity, such as bruisability, petechiae, fever of unknown origin, weakness, and fatigue. Hematology tests should be performed at baseline and during treatment, and dose escalation should be slow. 

It is wise to avoid felbamate in patients with previous blood dyscrasias or autoimmune disorders, especially lupus erythematosus. 

The possibility of autoimmune disorders during interferon alfa treatment has been addressed by many authors. The spectrum of interferon alfa-induced immune diseases includes organ-specific and systemic autoimmune diseases, such as thyroiditis, diabetes, hematological disorders, systemic lupus erythematosus, rheumatoid arthritis, dermatological disease, and myasthenia gravis (156). Several have been discussed in appropriate sections elsewhere in this monograph. The exact role of interferon alfa is usually difficult to ascertain, because the underlying disease, that is chronic hepatitis C, can also be associated with immune-mediated disease. 

Telangiectasias, seborrheic dermatitis, eczema, acne rosacea, lupus and other autoimmune disorders are among the forms of dermatitis that may be aggravated by a phenol peel. 

There is also a significantly increased incidence of IgA deficiency in patients with autoimmune or potentially autoimmune disorders, and usually it is not clear which came first. It can be argued that autoimmunity is a complication of immune imbalance subsequent to inborn IgA deficiency (H24). With inborn absence of IgA, exposure to normal human colostrum, plasma, and saliva can result in the production of antibodies to IgA. By the time such patients are discovered the etiological mechanisms are often obscured and IgA treatment is out of the question. The incidence of IgA deficiency is known to be 1-4% in the following conditions Still s disease, systemic lupus erythematosus, rheumatoid arthritis, Sjogren s disease, warm hemolytic anemia, megaloblastic anemia, idiopathic pulmonary hemosiderosis, thyrotoxicosis, and cirrhosis. 

This case of herbs complementing technology is not an isolated incidenti have had similar experiences with other conditions. For example, although best treated initially by Western medicine, traumatic head injuries have responded well to adjunctive herbal therapies, as have various cancers, heart disease, and autoimmune disorders such as lupus, ankylosing spondylitis, and scleroderma. 

Diaz-Borjon, A. et al. (2000) Multidrug resistance-1 (M DR-1) in rheumatic autoimmune disorders. Part II. Increased P-glycoprotein activity in lymphocytes from systemic lupus erythematosus patients might affect steroid requirements for disease control. 

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