Lupus erythematosus, systemic

SLE is a heterogeneous autoimmune disease that may affect virtually any organ, but predominant manifestations include non-deforming arthritis, serositis, photosensitivity, renal, hematological, and central nervous system involvement. Diagnosis is based on American Rheumatism Association criteria (273,274). The prevalence of SLE is estimated as 23.8/100,000 and there is a ninefold female excess (275), mostly occurring in the third to fifth decades. 

The association of ILD with SLE has long been recognized, but the prevalence of significant ILD is no higher than 3% to 8% (282,283). Interstitial fibrosis has been reported on SLB or at autopsy in 4%, 33%, and 70% (284-286), with these striking inconsistencies likely to represent variability in definition. PFT are 

Five to 10% of SLE patients are believed to have drug-induced disease, characterized by the presence of the antihistone antibody. Whereas dermatological, renal, and neuropsychiatric abnormalities are rare, the pleuropulmonary manifestations are particularly common in these cases (297). A similar spectrum of lung manifestations is reported (297,298). 

SLE showed a major pattern of UIP for one and follicular bronchiolitis with minor NSIP areas for the other (6). In contrast to the other CTDs, the place of NSIP in SLE has not been yet definitely settled (4,6). LIP has been documented in SLE, but whether or not it was simply due to associated SjS is unknown (303-305). Isolated observations of OP have also been published (306-308). 

ILD in SLE may occur as a residual feature of acute lupus pneumonitis (278,288) or may present insidiously, often with mild flares of pulmonary activity (277,293,309). The symptoms are nonspecific with persistent dyspnea on exertion, occasional pleuritic chest pain, and non-productive cough. Physical examination may reveal fever, cyanosis, or bibasilar crackles. Clubbing is less common in SLE-ILD than in IPE (310). The pattern and severity of PFT impairment do not correlate with systemic disease activity, as judged by anti-DNA antibodies and serum complement levels (293,311,312). ELD can occur in the absence of active disease in other organs (282,312). Interestingly, the presence of scleroderma-like traits in SLE is associated with a higher prevalence of restrictive defects or reduced DLco (313). Progressive severe ELD rarely complicates SLE but is seen in some patients with SLE features as part of an overlap syndrome (314). 

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COPD, chronic obstructive pulmonary disease EAE, experimental autoimmune encephalomyelitis RSV, respiratory syncytial virus SLE, systemic lupus erythematosus. 

In infectious disease compounds such as ANA975 (phase I trials) and Resiquimod (phase II trails) have been developed to target Hepatitis C and genital herpes, respectively. DRS954 is a TLR-7 and 9 antagonist in pre-clinical trials for Systemic Lupus Erythematosus (SLE). 

The ghicocorticoids are used as replacement therapy for adrenocortical insufficiency, to treat allergic reactions, collagen diseases (eg, systemic lupus erythematosus), dermatologic conditions, rheumatic disorders, shock, and other conditions (see Display 50-1). The anti-inflammatory activity of these hormones make them valuable as anti-inflammatories and as immunosuppressants to suppress inflammation and modify the immune response... 

Use antineoplastic, immunosuppressive, multiple sclerosis therapeutic, antiangiogenic, disease modifying drug, systemic lupus erythematosus therapeutic... 

Hydantoln anticonvulsants may cause the appearance of positive L.E. cells and methemoglobinemia. Chloropromazlne has been Implicated In causing a syndrome like systemic lupus erythematosus with accompanying positive tests for L.E. cells and antinuclear antibodies (6). 

Immunological abnormalities were reported in 23 adults in Woburn, Massachusetts, who were exposed to contaminated well water and who were family members of children with leukemia (Byers et al. 1988). These immunological abnormalities, tested for 5 years after well closure, included persistent lymphocytosis, increased numbers of T-lymphocytes, and depressed helper suppressor T-cell ratio. Auto-antibodies, particularly anti-nuclear antibodies, were detected in 11 of 23 adults tested. This study is limited by the possible bias in identifying risk factors for immunological abnormalities in a small, nonpopulation-based group identified by leukemia types. Other limitations of this study are described in Section 2.2.2.8. A study of 356 residents of Tucson, Arizona, who were exposed to trichloroethylene (6-500 ppb) and other chemicals in well water drawn from the Santa Cmz aquifer found increased frequencies of 10 systemic lupus erythematosus symptoms, 5 (arthritis, Raynaud s phenomenon, malar rash, skin lesions related to sun exposure, seizure or convulsions) of which were statistically significant (Kilbum and Warshaw 1992). 

Isolated cases of dermal sensitivity and allergic responses in humans have been reported (Bauer and Rabens 1974 Conde-Salazar et al. 1983 Czirjak et al. 1993 Goh andNg 1988 Nakayama et al. 1988 Phoon et al. 1984 Schattner and Malnick 1990 Waller et al. 1994). An increase in the symptoms of systemic lupus erythematosus has been reported in persons exposed to trichloroethylene in their drinking water (Kilbum and Warshaw 1992). 

Kilbum KH, Warshaw RH. 1992. Prevalence of symptoms of systemic lupus erythematosus (SLE) and of fluorescent antinuclear antibodies associated with chronic exposure to trichloroethylene and other chemicals in well water. Environ Res 57 1-9. 

Vaarala, O., Alfthan, G., Jauhiainen, M., Leirisalo-Repo, M., Aho, K. and Palosuo, T. (1993). Cross-reaction between antibodies to oxidised low-density lipoprotein and to cardiolipin in systemic lupus erythematosus. Lancet 341, 923-925. 

SLE Systemic lupus erythematosus SLe Sialyl Lewis X antigen SLO Streptolysin-O SLPI Secretory leucocyte protease inhibitor... 

Systemic lupus erythematosus, Sjogren s syndrome, multiple myeloma, obstructive uropathy, cirrhosis, and sickle cell disease... 

Systemic lupus erythematosus Scleroderma Sleep apnea Drugs ... 

Carcinoid syndrome, anemias, systemic lupus erythematosus... 

Glomerular diseases (e.g., anti-glomerular basement membrane disease, focal segmental glomerularsclerosis, IgA nephropathy, hemolytic uremic syndrome, systemic lupus erythematosus, Alport s syndrome, amyloidosis, membranous nephropathy, and Goodpasture s syndrome)... 

Father died of a myocardial infarction at age 53, whereas mother is alive and living with HTN, systemic lupus erythematosus, DM, and osteoporosis at the age of 75. 

A decrease in erythrocyte production can be multifactorial. A deficiency in nutrients (such as iron, vitamin B12, and folic acid) is a common cause that often is easily treatable. In addition, patients with cancer and CKD are at risk for developing a hypoproductive anemia. Furthermore, patients with chronic immune-related diseases (such as rheumatoid arthritis and systemic lupus erythematosus) can develop anemia as a complication of their disease. Anemia related to these chronic inflammatory conditions is typically termed anemia of chronic disease. 

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. 

SLE Systemic lupus erythematosus TOD Target-organ damage... 

AOSD, adult onset Still disease AS, ankylosing spondylitis CA, crystal-induced arthritis ERA, enthesitis-related arthritis JA, juvenile arthritis PA, psoriatic arthritis RA, rheumatoid arthritis SE, synovium explants SLE, systemic lupus erythematosus SPCIA, solid phase 2 site chemiluminescent immunometric assay RP, relapsing polychondritis. 

Yang PT, Kasai H, Zhao LJ, Xiao WG, Tanabe F, Ito M. Increased CCR4 expression on circulating CD4(+) T cells in ankylosing spondylitis, rheumatoid arthritis and systemic lupus erythematosus. Clin Exp Immunol 2004 138(2) ... 

Narumi S, Takeuchi T, Kobayashi Y, Konishi K. Serum levels of ifn-inducible PROTEIN-10 relating to the activity of systemic lupus erythematosus. Cytokine 2000 12(10) 1561-1565. 

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