The Best Ways to Treat Lupus

Proven Lupus Treatment Ebook

This book written by Dr. Gary M. Levine discusses the autoimmune disease lupus and just how the writer discovered natural treatments through his own time of hardship. This e-book also features the simple steps regarding how to beat this ailment. The step-by-step treatment involves Directed Nutrition and a vitamin regime, helps the patient to lose weight, get rid of hair loss and it reduces the constant aches and pain, numbness and tiredness. This Natural Lupus Treatment is addressed first to those who want to learn more about Lupus, and those who are familiar with this area and have a fairly comprehensive knowledge base. More here...

Proven Lupus Treatment By Dr Gary Levin Summary


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Author: Dr. Gary M. Levin
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My Proven Lupus Treatment By Dr Gary Levin Review

Highly Recommended

All of the information that the author discovered has been compiled into a downloadable book so that purchasers of Proven Lupus Treatment By Dr Gary Levin can begin putting the methods it teaches to use as soon as possible.

When compared to other ebooks and paper publications I have read, I consider this to be the bible for this topic. Get this and you will never regret the decision.

The Lupus-reversing Breakthrough

Heres just a few things youll learn about how to get back into health and conquer Lupus: Those not-so innocent yet everyday substances that are currently attacking your body, perpetuating and aggravating your Lupus. What to do and what Not to do to overcome your Lupus effectively and permanently. How to create the energy you need to be able to work full time and feel confident you will be able to take care of your loved ones. How the pharmaceutical and food industry are conspiring to poison you and make you sick (Hint: American medical system is now the leading cause of death in the US). Which food industries use advertising to encourage doctors to tell you that their food is good for you just like those cigarette ads in the 1950s! The single most effective fruits and vegetables in cleaning up excess acidic waste and how to cleanse your inner terrain completely from systemic acidosis. Why, what your Doctor has told you is wrong, and why many medications actually increase the side effects and complications of Lupus (primarily by depleting vital vitamins, minerals and nutrients from your body). Which supplements every patient must take to decrease inflammation and boost your body's ability to fight Lupus. How to naturally reduce your cravings for toxic foods. Lifestyle and food choices to reverse your Lupus fast, naturally, and for good. Why treating the symptoms of disease is like using an umbrella inside your house instead of fixing the roof. The most powerful creator of health (Hint: its not a food or vitamin!) The best way to simplify the task of making a health-conscious lifestyle adjustment. A miraculous scientific discovery that jump-starts your body to do its natural work, which is to heal itself and restore your Health.

The Lupusreversing Breakthrough Summary

Contents: Ebook
Author: Matt Traverso
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Price: $47.00

Progress in the Treatment of Proliferative Lupus Nephritis

Summary Lupus nephritis (kidney inflammation associated with systemic lupus erythematosus, or SLE) is often well developed at the time of diagnosis. This article reviews progress in the treatment of proliferative lupus nephritis. High dose corticosteroids are universally accepted as the initial approach to the control of severe inflammation in the kidney. Long term disease control and the minimization of iatrogenic (physician caused) risk usually require adjunctive therapies that target the more fundamental immunoregulatory disturbances of lymphoid cells. Of the available cytotoxic drugs, cyclophosphamide is currently among the most effective, although it cannot be considered ideal in terms of efficacy or toxicity. New prospects for the treatment of proliferative lupus nephritis include novel immunosuppressive agents (e.g., mycophenolate, cyclosporine, fludarabine), combination chemotherapy (e.g., cyclophosphamide plus fludarabine), and sequential chemotherapy (e.g., cyclophosphamide...

Treatment of Lupus Nephritis

Summary Patients with lupus nephritis pose a therapeutic challenge and stimulate investigation of innovative treatment strategies. This article reviews those current and potential strategies that may optimize management of lupus nephritis. The clinical presentations of lupus nephritis can vary from asymptomatic hematuria (blood in the urine) or proteinuria (protein in the urine) to acute nephritic or nephrotic syndromes and from rapidly progressive glomerulonephritis to insidious chronic renal insufficiency. Although patient survival and renal function outcomes have improved over the last 4 decades, contemporary immunosuppressive regimens are not consistently effective and often require extended courses (resulting in negative drug effects and toxicity). Several strategies are under investigation to induce remissions more rapidly and to reduce the risk of long courses of cytotoxic drug therapy. The combination of pulse methylprednisolone and pulse cyclophosphamide may be more effective...

Systemic Lupus Erythematosus Emerging Concepts Part 1 Renal Neuropsychiatric Cardiovascular Pulmonary and Hematologic

Summary This article reports on a review of advances and controversies in the diagnosis and management of systemic lupus erythematosus with visceral involvement (renal, neuropsychiatric, cardiopulmonary, and hematologic disease). The authors reviewed more than 400 English language articles in the medical literature. They note that recent debates pertaining to lupus nephritis have focused on the value of kidney biopsy data and the role of cytotoxic drug therapies. Many studies have shown that estimates of prognosis are enhanced by consideration of clinical, demographic, and histologic features. For patients with severe lupus nephritis, an extended course of pulse cyclophosphamide therapy is more effective than a 6-month course of pulse methylprednisone therapy in preserving renal function. They conclude that the optimal duration and intensity of cytotoxic therapy remain undefined. 3 figures. 3 tables. 124 references.

Treatment of Lupus Nephritis A Work in Progress editorial

Summary Until the pathogenesis (development of disease state) of nephritis (kidney infection) due to systemic lupus erythematosus (SLE) is unraveled, optimal treatment for patients with this disease remains an elusive goal. This article outlines one option for treatment of lupus nephritis, serving as an introduction to a separate article in this issue of the Journal. The author first reviews the differing presentations of SLE, noting that in some patients the kidneys are not involved but in others, there is rapidly progressive destructive kidney disease. This difference may be due in part to genetic risk factors, to environmental factors (such as exposure to ultraviolet light, infectious pathogens, and silica dust), race, or socioeconomic factors. In general, the treatment of lupus glomerulonephritis depends on the severity of the disease. Intravenous cyclophosphamide is given, in addition to oral glucocorticoids, for the aggressive forms of the disorder. However, the adverse effects...

Natural History and Treatment of Lupus Nephritis

Summary Renal involvement occurs in most patients with systemic lupus erythematosus (SLE). This article discusses the natural history and treatment of lupus nephritis. Contemporary therapeutic regimens for immunosuppression and for the treatment of hypertension, hyperlipidemia, infections, and seizures have likely contributed to improvements in the prognosis of these patients over the past four decades. Corticosteroids usually ameliorate the manifestations of lupus nephritis but achieve less complete and sustained remissions than cytotoxic drugs. Among the cytotoxic drugs, pulse cyclophosphamide has one of the best profiles of efficacy and toxicity. Because each episode of lupus nephritis exacerbation results in cumulative scarring, atrophy, and fibrosis, the authors recommend continued maintenance treatment for 1 year beyond the point of complete remission of proliferative lupus nephritis. Studies are in progress to determine whether innovative treatment strategies will enhance...

Efficacy of Mycophenolate Mofetil in Patients with Diffuse Proliferative Lupus Nephritis

Summary The combination of cyclophosphamide and prednisolone is effective for the treatment of severe lupus nephritis (kidney inflammation associated with systemic lupus erythematosus or SLE) but has serious adverse effects. This article reports on a study that investigated the efficacy of mycophenolate mofetil in patients (n 42) with proliferative lupus nephritis. The authors compared the efficacy and side effects of a regimen of prednisolone and mycophenolate mofetil given for 12 months (group 1) with those of a regimen of prednisolone and cyclophosphamide given for 6 months, followed by prednisolone and azathioprine for 6 months (group 2). Of the patients in Group 1 (n 21), 81 percent had a complete remission, and 14 percent had a partial remission, as compared with 76 percent and 14 percent, respectively, of the 21 patients in Group 2. The improvements in the degree of proteinuria (protein in the urine) and the serum albumin (protein levels in the blood) and creatinine...

Advances in the Treatment of Lupus Nephritis

Summary Systemic lupus erythematosus (SLE) is an autoimmune disease that leads to the formation and deposition of immune complexes throughout the body, which are pathogenic (causing disease) for SLE. Different forms of glomerulonephritis (inflammation of the filtering units of the kidney) can occur in patients with SLE and can contribute significantly to the associated morbidity (illness and complications) and, ultimately, mortality (death) from the disease. Over the past two decades, there have been significant strides in the understanding of the disease and in treatments that attempt to control the formation and deposition of anti-DNA auto-antibodies and immune complexes, as well as the subsequent inflammatory cascade mediated through various cellular and humoral pathways leading to progressive renal (kidney) damage and end stage renal disease (ESRD). This article reviews the current understanding of the pathogenesis and treatment of lupus nephritis in its various stages and...

From Animal to Human

Patients in an attempt to identify those most likely to respond to treatment. Developing accurate and robust biomarkers for different diseases is a major challenge, with many false positives revealed when a biomarker fails to change as expected when there is improvement in the condition. Thus while disease association of a biomarker provides a retrospective assessment, it is the prospective use of a biomarker in disease progression and response that provides objective value. In systemic lupus erythematosus (SLE), double-stranded DNA (dsDNA) autoantibodies are a well-established biomarker of SLE and a component of the SLE Disease Activity Index (SLEDAI) used to diagnose and assess disease progression. However, in a Phase III SLE trial of abetimus, a synthetic double-stranded oligodeoxyribonucleotide that modulates B lymphocyte function, while anti-dsDNA antibody levels were reduced, there was no effect on prolonging time to renal flare, a key marker of SLE pathophysiology, in...

Roles Of Estrogen In Angiogenesis

In premenopausal women, estrogen promotes angiogenesis in association with some diseases like Takayasu's arteritis and lupus erythematous.27 Together, the studies indicate that angiogenesis can be regulated by estrogen. A role for estrogen in angiogenesis is further supported by our studies on the rat pituitary that indicated estrogen as the sole etiological agent for the development of tumor angiogenesis during the development of estrogen-induced tumorigenesis.13 Some additional observations, such as inhibition of angiogenesis by antiestrogens, also support estrogen as a positive regulator of angiogenesis.107110

Cyclooxygenase expression in renal inflammation

Large amounts of prostanoids have been described to be synthesized in experimental models of glomerulonephritis. The data obtained from in vitro studies with mesangial cells in culture suggested COX-2 to be the major COX isoform involved in glomerular inflammation. Data on COX isoform expression in animal models are still limited but suggest a role for both isoforms. In a rat model of glomerulonephritis induced by anti-thymocyte antiserum, COX-2 expression was very transiently upregulated during the first hours of the inflammation, whereas there was a prolonged upregulation of COX-1 over several days 33 , A similar increase in COX-1 was also observed in other rat models of glomerulonephritis and in biopsies obtained from patients with immunoglobulin A (IgA) nephritis (A. Hartner and M. Goppelt-Struebe, unpublished results). In a very recent study, COX-2 was found to be upregulated in kidney biopsies obtained from patients with active lupus nephritis 34 , Enhanced COX-2...

Antiphospholipid Syndrome And Antiphospholipid Antibodies

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent venous and arterial thrombosis, fetal loss and thrombocytopenia in association with elevated titers of circulating auto-antibodies directed against phospholipids, including lupus anticoagulant.1 Antiphospholipid antibodies (aPL) are crucial for diagnosis and represent a very heterogeneous group, as multiple specificities against various phospholipids are found. The anti-cardiolipin ELISA assay, introduced in 1983, is the most established and standardized method for detecting aPL, since other aPL directed to phosphatidylserine, phos-phatidylethanolamine, phosphatidylcholine, phos-phatidylglycerine, phosphatidylinositol and recently lysobisphosphatidic acid2 have been investigated less frequently. Moreover, in 1990 three independent groups reported the requirement of a protein cofactor, p2 glycoprotein I (p2-GPI), for efficient binding of 'autoimmune' antibodies to the phospholipids, in contrast to...

Vasculitis Versus Vasculopathy

Although CNS involvement in APS has been recognized for more than 15 years, its exact etiopathol-ogy is still not well defined. The strong association of neuropsychiatric lupus (NPSLE) with cutaneous vasculitis9,10 may imply an underlying vasculitic process in the CNS, particularly in APS secondary to SLE. However, the most common neuropatho-logic findings in autopsy studies of NPSLE as well as in pAPS are thrombosis and small-vessel noninflammatory proliferative vasculopathy.11-13 APS is mostly characterized as a thrombotic micro-angiopathy with endothelial cell swelling and thrombosis, depositions of fibrin and or platelets and proliferation of myointimal cells, without immunoglobulin (Ig) or complement deposition and the cell infiltrate usually found in classical systemic autoimmune vasculitis. The vasculopathy in NPSLE is characterized by hyalinization, occasionally associated with occlusion, pericapil-lary microglia, microinfarcts and microhemor-rhages. Vasculitis of the brain...

Bladder painbladder pain syndrome

There may be genetic influences on the development of BPS IC as first-degree relatives of sufferers have a higher prevalence than the general population. It has been demonstrated that there is a particularly high proportion in the American Indians of Cherokee descent, approximately 17 14 . BPS IC is also reported to be associated with inflammatory bowel disease, systemic lupus erythematosus, irritable bowel syndrome and fibromyalgia 15 .

Differential Diagnoses

Like AFP and AO, BMS is a diagnosis of exclusion. Burning pain symptoms in the oral mucosa can be caused by systemic or local conditions, including anemia, vitamin B, folic acid, or iron deficiency, untreated diabetes, hormonal disturbances (menopausal complaints, estrogen deficiency), oral candidiasis, hyposalivation, Sjogren's syndrome, oral lichen planus, or systemic lupus.136,142 Furthermore, burning symptoms can be a side effect to some medications such as angiotensin-converting enzyme (ACE) inhibitors and also allergy to dental materials, dentures, toothpaste, etc., must be considered and excluded before a BMS diagnosis can be given.136,142

Inflammatory Kidney Diseases Main Indication Lupus Nephritis Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune inflammatory disease that can affect multiple organs in the body. In 30-40 of individuals with SLE, the kidney is the primary target organ. Glomerular inflammation with invasion of acute and chronic inflammatory cells is the hallmark of destruction in this organ, and evidence exists that MCP-1 may play a major role in attracting these cells to the kidney. Through this mechanism renal function is impaired, evident by rising serum creatinine levels, diminished creatinine clearance, loss of proteins in the urine and the presence of blood cells in the urine sediment. Therefore, stabilization and improvement of renal function are measurable and relevant clinical efficacy parameters recommended in the respective draft guidance for industry.36

Hydroxychloroquine And Chloroquine

Hydroxychloroquine (Plaquenil, Quineprox) is an older drug used to treat malaria that is used more often in the treatment of RA and lupus erythematosus. Although its mechanism of action is not known, its ability to interfere with lipopolysaccharide-induced TNF-a gene expression, thereby preventing TNF-a release from mononuclear phagocytes has been suggested.230 It is usually taken orally with food or milk to prevent stomach irritation and is preferred over chloroquine because of a lower incidence of ocular toxicity. However, long-term use of this medication requires periodic retinal examinations because of rare but potentially preventable retinopathy associated with its use, especially at a daily dose over 6.5 mg kg.231

Proteincoated artificial cells in immunoadsorption

Albumin can bind tightly to the ultrathin collodion membrane of adsorbent artificial cells, and was initially used to increase the blood compatibility of the adsorbent artificial cells for hemoperfusion (Chang, 1969a). This albumin coating has also been applied to synthetic immunosorbents, resulting in blood compatible synthetic blood group immunosorbents (Chang, 1980d). The albumin-coated synthetic adsorbent has been applied clinically for removing blood group antibodies from plasma for bone marrow transplantation (Bensinger et al., 1981). In addition, albumin-coated collodion activated charcoal (ACAC) was found to effectively remove antibodies to albumin in animal studies (Terman et al., 1977). This principle has become a basis of one line of research in which other types of antigens or antibodies are applied to the collodion coating of the activated charcoal to form immunosorbents. Other immonosorbents based on the same principle have also been developed for the treatment of human...

Pathophysiological aspects of necrotizing arteritis

Other humoral mechanisms may be involved in the pathogenesis of vasculitis, including anti-endothelial cell antibodies found in several connective tissue and systemic disorders, but the incidence of detection of anti-endothelial cell antibodies is very variable they are more often found in conditions that are seldom associated with peripheral nervous system involvement, such as scleroderma, Kawasaki's disease or systemic lupus erythematosus. Thus the role played by such antibodies and the usefulness of their detection in sera from patients with vasculitic neuropathy remain to be established.1011

Kidney eicosanoids and cardiovascular regulation

The renal protective effects of prostaglandin may be seen in the ischemic kidney, which in contrast to normal kidney is highly sensitive to NSAIDs. ASA inhibits COX, which is resynthesized in the kidney after 24-48 h. During ischemic stress NSAIDs compromise renal function, resulting in decreased renal blood flow and glomerular filtration and increased renal vascular resistance 92 . Diuretic-induced sodium excretion is attenuated and hyperkalemia may occur 93 , Adverse effects of NSAIDs have been demonstrated in animal models of haemorrhage, endotoxemia, increased venous pressure and low cardiac output and in humans with mild renal dysfunction with concomitant congestive heart failure, ascites and systemic lupus erythematosus 94 .

Interstitial cystitis

The frequent association of IC with other chronic diseases and pain syndromes such as inflammatory bowel disease, systemic lupus erythematosus, irritable bowel syndrome, sensitive skin, fibromyalgia, and allergies55 speaks to the fact there may be multiple different pathophysiologies grouped together under one diagnosis. Recent studies have demonstrated some histopathological differences in bladder biopsies from patients with IC versus normal controls with increased expression of substance P-con-taining nerve fibers and substance P receptor-encoding mRNA,5657 increased nerve growth factor content,58 and altered mast cell activity.59 The meaning of these findings is still to be determined.

Surface Properties of Artificial Cell Membranes

Albumin can bind tightly to the ultrathin collodion membrane of adsorbent artificial cells. This is initially used to increase the blood compatibility of the adsorbent artificial cells for hemoperfusion (Chang, 1969a). This albumin coating has also been applied to synthetic immunosorbents, resulting in blood compatible synthetic blood group immunosorbents (Chang, 1980d). In addition, Terman etal. (1977) showed in animal studies that albumin-coated collodion activated charcoal (ACAC) can remove antibodies to albumin. This has become a basis of one line of his research in which other types of antigens or antibodies are applied to the collodion coating of the artificial cells to form immunosorbents. Other immunosorbents based on this principle have also been developed for the treatment of human systemic lupus erythematosus removal of antiHLA antibodies in transplant candidates treatment of familial hypercholesterolemia with monoclonal antibodies to low-density lipoproteins (Terman, 1980

Protein coated artificial cells in immunoadsorption

Albumin can bind tightly to the ultrathin collodion membrane of adsorbent artificial cells (Chang, 1969a). This was initially used to increase the blood compatibility of the adsorbent artificial cells for hemoperfusion (Chang, 1969a). We also applied this albumin coating to synthetic immunosorbents resulting in blood compatible synthetic blood group immunosorbents (Chang, 1980d).This albumin-coated synthetic adsorbent has been applied clinically for removing blood group antibodies from plasma for bone marrow transplantation (Bensinger et al., 1981). In addition, albumin-coated collodion activated charcoal (ACAC) was found to effectively remove antibodies to albumin in animal studies (Terman et al., 1977). This has become the basis of one line of research in which other types of antigens or antibodies are applied to the collodion coating of the activated charcoal to form immunosorbents. Other immonosorbents based on this principle have also been developed for the treatment of human...

Fistulating Crohns disease Treatment may not be

Cylic acid which cleaves in the lower bowel), the sul-phonamide-related side-effects of sulfasalazine are avoided, but 5-aminosalicylic acid alone can still cause side-effects including blood disorders (see recommendation below) and lupus-like syndrome also seen with sulfasalazine.

Miscellaneous Immunosuppressant And Antiinflammatory Agents

Dapsone is approved for use in dermatitis herpetiformis and leprosy. It is particularly useful in the treatment of linear immunoglobulin A (IgA) dermatosis, bullous systemic lupus erythematosus, erythema elevatum diutinum, and subcorneal pustular dermatosis. Thalidomide is FDA-approved for the treatment of erythema nodosum leprosum. There are reports suggesting its efficacy in actinic prurigo, aphthous stomatitis, Behfet's disease, Kaposi's sarcoma, and the cutaneous manifestations of lupus erythematosus, as well as prurigo nodularis and uremic prurigo. Thalidomide has been associated with increased mortality when used to treat toxic epidermal necrolysis. It also may cause an irreversible neuropathy. Because of its teratogenic effects, thalidomide use is restricted to specially licensed physicians who fully understand the risks. Thalidomide should never be taken by women who are pregnant or who could become pregnant while taking the drug.

Painful bladder syndrome interstitial cystitis

Painful bladder syndrome (PBS alternatively known as bladder pain syndrome) is a descriptive diagnosis that has been recently advocated for use on an international level as descriptive of a complex of urologic complaints including pain 59 . Thought to be an early form of the disorder interstitial cystitis (IC), there is an expectation that a majority of patients with PBS might have a common etiology. Notably, IC has no agreed etiology, pathophysiology or treatment and nor does the less defined PBS. The prevalence of IC is estimated to be 2 in 10,000 with a female to male ratio of 10 1. Patients with IC are 10-12 times more likely to report childhood bladder problems than the general population 60 . IC is frequently associated with other chronic disorders such as inflammatory bowel disease, systemic lupus erythematosus, irritable bowel syndrome, sensitive skin, fibromyalgia and allergies 61 .

Inborn Errors of Metabolism

There are no specific anatomical brain abnormalities associated with GLUT1 deficiency syndrome, and brain imaging is usually normal or may show nonspecific findings. Electroencephalograph (EEG) changes include both focal and generalized epileptiform discharges and slowing, which may be reversible with food intake (47). Hypoglycorrhachia (low cerebral spinal fluid CSF glucose concentration) in the presence of a normal blood glucose (or a CSF blood glucose ratio 0.4) is the hallmark of the disease. The lumbar puncture should be performed during the metabolic steady state, such as 4-6 h after the last meal. In children, blood glucose should be determined before the lumbar puncture to avoid stress-related serum hyperglycemia. The CSF should be examined for cells, glucose, protein, and lactate and pyruvate concentrations. In GLUT1 deficiency syndrome, CSF concentrations of lactate are usually low to normal. For other causes of hypoglycorrhachia (meningitis, subarach-noid hemorrhage,...

Behavioral Effects Of Infectious Diseases And Cytokine Administration In Animals

Similar symptoms, as well as increased anxiety behavior were also reported, using a mouse model of autoimmune disease (systemic lupus erythematosus) (Schrott & Crnic, 1996), indicating that behavioral changes can also accompany non-infectious conditions.

Biological activity of leukotrienes in the kidney

Enhanced levels of renal cysteinyl leukotrienes were observed in animal models of glomerulonephritis, e.g. murine lupus nephritis 106 , nephrotoxic serum nephritis 100 or passive Heymann nephritis 107 . A functional role of the increased synthesis of cysteinyl leukotrienes was indicated by the use of a receptor antagonist that ameliorated the reduction in the glomerular filtration rate and renal blood flow in murine anti-GBM (glomelular basement membrane) nephritis 108 , nephrotoxic serum nephritis 109 and murine lupus 110 . In addition, there is an additive effect of 12-HETE (hydroxyeicosatetraenoic acid) released from activated platelets and cysteinyl leukotrienes on the glomerular filtration rate and renal blood flow in the model of nephrotoxic serum nephritis 111 .

Collagen Vascular Diseases in Critical Care An Overview

Conditions most frequently encountered are Goodpasture's syndrome (GPS) and glomerular basement membrane disease (GBH) Wegener's granulomatosis (WG) polyarteritis nodosa (PAN) and systemic lupus erythematosis (SLE). Other, less common, diagnoses include microscopic polyangiitis (MPA), Churg-Strauss syndrome (CSS), and antiphospholipid antibody syndrome (APS). Most of these disorders are inflammatory and have evidence of autoimmunity, which can range from targeting of a single specific organ to many organs in the body. The author briefly reviews the symptoms of each type, then summarizes general principles of treatment. Treatment should treat underlying infection support vital organs (lung and kidney failure are common to many of these conditions) ensure adequate nutrition modify the immune response with steroids, azathioprine or cyclophosphamide and remove immune complexes and antibodies, using plasma exchange. A brief posttest is appended to the article. 2 figures. 3 tables. 19...

Impediments To Pharmacogenetic Investigation

The other, but the majority of pharmacogenetic traits fall somewhere between these extremes. Changing environmental exposures and the diverse human genetic composition may make the relative contributions of genetic and environmental factors to the idiosyncrasy difficult or impossible to assess from clinical situations or from epidemiological observations alone. Further complications may arise for responses that result from more than one hereditary element. Although the inheritance of monogenic traits is predictable because it obeys Men-delian rules and Hardy-Weinberg expectations, the inheritance of traits caused by the combination of two or more monogenic traits would not follow Mendelian patterns. This point has been addressed for lupus erythematosus induced by hydralazine,57 and for red blood cell hemolysis induced by sulfones or sulfon-amides.58,59 Other examples of pharmacogenetic importance could arise in connection with responses to therapeutic agents whose actions are mediated...

Cytotoxic And Immunosuppressant Drugs

Methotrexate The antimetabolite methotrexate suppresses immunocompetent cells in the skin, and it also decreases the expression of cutaneous lymphocyte-associated antigen (CLA)-positive T cells and endothelial cell E-selectin, which may account for its efficacy in psoriasis. It is useful in treating a number of other dermatological conditions, including pityriasis lichenoides et varioliformis, lymphomatoid papulosis, sarcoidosis, pemphigus vulgaris, pityriasis rubra pilaris, lupus erythematosus, dermatomyositis, and cutaneous T-cell lymphoma. Azathioprine (Imuran) is discussed in detail in Chapters 38 and 52. In dermatologic practice, the drug is used as a steroid-sparing agent for autoimmune and inflammatory dermatoses, including pemphigus vulgaris, bullous pemphigoid, dermatomyositis, atopic dermatitis, chronic actinic dermatitis, lupus erythematosus, psoriasis, pyoderma gangrenosum, and Behfet's disease. The usual starting dose is 1-2 mg kg day. Since it often takes 6-8 weeks to...

Musculoskeletal Pain Myofascial Disorders

This is a common presentation of pain in the orofacial region. Patients may present with diffuse aching pain affecting several muscle groups. Trigger points or tender points may be elicited and pain may radiate (e.g., masseter to the ear, temporalis to the frontal area). This type of pain presentation may be seen in patients with fibromyalgia and other systemic illnesses such as lupus erythematosus.

Intravenous Immunoglobulin In Dermatology

Intravenous immunoglobulin (IVIG) is prepared from fractionated pooled human sera derived from thousands of donors with various antigenic exposures (see Chapter 52). At the present time it is unclear if IVIG therapy is beneficial for treatment of dermatoses. Reports of successful use of IVIG in the treatment of autoimmune and inflammatory dermatoses are anecdotal. IVIG has been used to treat toxic epidermal necrolysis, dermatomyositis, chronic recalcitrant urticaria angioedema, atopic dermatitis, systemic lupus erythematosus, and autoimmune blistering disorders.


Some painful neuropathies can be diagnosed on the basis of history, family history, clinical features, and features of the primary disease. These include Guillain-Barre neuropathy, rheumatoid vasculitis, systemic lupus erythe-matosis, sarcoidosis, leprosy, malignancy, and drug toxicity. They do not require special tests for diagnosis, or special tests are not available. Other painful neuropathies can be diagnosed by detecting characteristic metabolites in the serum or urine (Table 12.4).68,69 Some


In the USA, aseptic meningitis or, rarely, fatal meningoencephalitis may result from lymphocytic choriomeningitis virus (LCM) infection. Glandular inflammation may accompany acute infection, similar to mumps.208 CSF may contain thousands of mononuclear cells and have low glucose. Diagnosis is made when choriomeningitis and seizures develop in mice injected with infected human CSF or when the human host develops anti-LCM antibody in the serum. One atypical case of LCM infection presented as a mimic of systemic lupus erythemato-sis both rash and circulating anticoagulant were


The safety and clinical and biological effects of CD5 + in patients with systemic lupus erythematosus (SLE) was studied by Stafford et al. (1994) in a Phase I study. A dose of 0.1 mg kg was administered intravenously on five consecutive days. A second course of immunoconjugate was given to patients who failed to show any clinical response 1-2 months later. Six patients (4 with glomerulonephritis and 2 with thrombocytopenia) were studied. Improvement was documented in 2 patients with nephritis no effect on thrombocytopenia was observed. Adverse effects were mild and transient. Relative to pretreatment lymphocyte counts, the mean reduction in CD3+ T-cell count was 69 at 2 weeks, 32 at 1 month and 34 at 6 months following initial treatment. There was a transient decrease in CD5 + B cells, but no persistent depletion of total B-cell numbers. Thus, anti-CD5 RTA immunoconjugate is well tolerated in patients with SLE, causes modest T-cell depletion which may persist for months, and may have...

Basic Science

Complex regional pain syndrome (CRPS) occurs in association either with medical diseases such as post-myocardial infarction, systemic lupus erythematosus (SLE), post-cerebrovascular accident (CVA), in association with diabetes mellitus (DM) or as a posttraumatic limb pain syndrome with autonomic abnormalities. Complex regional pain syndrome is often arbitrarily diagnosed based on a constellation of signs and symptoms and the diagnostic criteria can easily be misapplied to multiple conditions. Objective evidence of CRPS requires three-phase bone scans, quantitative sudomotor axon reflex testing, or other specific tests to increase diagnostic accuracy, but some of these tests (quantitative sudomotor axon reflex test (QSART)) are only available at specialized centers (see Chapter 27, Complex regional pain syndromes for additional information). Recent evidence suggests that CRPS may be due to minimal distal nerve injury. Axonal densities were diminished at test sites in 17 18 patients by...


Observed to be increased in several forms of experimental hypertension in animals (17), and in some human subjects with essential hypertension (18), but a direct role for TXA2 is uncertain. Short-teim treatment with a combined thromboxane synthase TP receptor antagonist inhibited platelet aggregation induced by the TP receptor agonist U46619 (See IV. TP RECEPTOR FUNCTION, A. LIGAND BINDING below for structures of TP receptor agonists and antagonists) and decreased renal and extrarenal TXA2 synthesis in patients with mild essential hypertension, but it had no effect on arterial blood pressure (19). However, longer duration treatment with thromboxane synthase or TP receptor inhibitors has been effective in lowering the blood pressure of rodents with genetic hypertension (16,20). Data from animal and human studies indicate that intrarenal generation ofTXA2contributes to vasoconstriction that occurs in inflammatory and lupus-associated glomerular injury (21). The observation that TP...

The Diagnosis

None of the paroxysmal manifestations which have been reported in multiple sclerosis has a specific diagnostic value. This is obvious for trigem-inal neuralgia. Clinically, nothing may distinguish the multiple sclerosis-related and the idiopathic trigeminal neuralgia. As explained above, the Lhermitte sign has been reported in cases of radiation myelopathy, cord compression, acute combined degeneration of the cord, and other conditions. Tonic seizures have been described in neuro-Behqet, systemic lupus erythematosus and many other collagene diseases.

Calcium Release Assay

The most relevant model for lupus nephritis is established in rodents using MRLlpr lpr mice which develop symptoms that are similar to human SLE. The relatively low homology of ca. 55 between human and murine MCP-1 (Figure 9.6) means, however, that NOX-E36 does not show any binding to murine MCP-1. To be able to perform efficacy studies in rodents, it was necessary to identify a murine-specific Spiegelmer mNOX-E36. MRLlpr lpr Mouse ('Lupus Mouse') - Chronic Progressive Renal Inflammation Mice of the MRLlpr lpr strain spontaneously develop systemic autoimmunity characterized by skin lesions, enlargement of lymph nodes and progressive inflammatory lung and kidney disease similar to human SLE. Female MRLlpr lpr mice develop lupus nephritis-like symptoms at 12 weeks and die from endstage renal disease at 22-26 weeks of age. This allows mortality studies with therapeutic interventions that interfere with renal inflammation. Throughout progression of renal disease, MCP-1 is...


Daily morning dosing with prednisone generally is preferred, although divided doses are used occasionally to enhance efficacy. Fewer side effects are seen with alternate-day dosing, and if required for chronic therapy, prednisone is tapered to every other day as soon as it is practical. pulse therapy using large intravenous doses of methylprednisolone sodium succinate (solu-medrol) is an option for severe resistant pyoderma gangrenosum, pemphigus vulgaris, systemic lupus erythe-matosus with multisystem disease, and dermatomyositis. The dose usually is 0.5-1 g given over 2-3 hours. More rapid infusion has been associated with increased rates of hypotension, electrolyte shifts, and cardiac arrhythmias.

Antimalarial Agents

Therapeutic uses FDA-approved dermatological uses of hydroxychloroquine include treatment of discoid and systemic lupus erythematosus. Unapproved but first-line uses include treatment of dermatomyositis, porphyria cutanea tarda, polymorphous light eruption, sarcoidosis, eosinophilic fasciitis, lymphocytic infiltrate of Jessner, lymphocytoma cutis, solar urticaria, granuloma annulare, and some forms of panniculitis. Usual doses of antimalarials are hydroxychloroquine, 200 mg twice a day chloroquine, 250-500 mg day and quinacrine, 100-200 mg day. Usually, hydroxychloroquine is started first, and if no improvement is noted in 3 months, quinacrine is added. Alternatively, chloroquine is used as a single agent. Dosing should be adjusted for low-weight individuals so that chloroquine dosing is 2.5 mg kg day and hydroxychloroquine is 6.5 mg kg day. Antimalarial agents are the treatment of choice for widespread forms of cutaneous lupus that do not respond to topical glucocorticoids and...

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