Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Several instruments have been developed to assess disease activity in systemic lupus erythematosus. Any study of a new laboratory measure, any therapeutic trial, and any study of outcome and prognosis should include one of these validated measures of disease activity. The treatment of lupus is far from ideal. A controlled trial of plasmapheresis showed no benefit over standard regimens in lupus nephritis. A long course of pulse cyclophosphamide was shown to be better than pulse methylprednisolone or a short course of intravenous pulse cyclophosphamide. Despite the lack of ideal therapy, the prognosis of lupus, including 15-year survival rates, has improved over the past 4 decades. Specific organ damage continues to be an issue. Infection and vascular disease have emerged as important factors. With improved survival, other outcome measures, including specific organ function and health status, must be considered.
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PMID:Indicators of disease activity, prognosis, and treatment of systemic lupus erythematosus. 839 9

To analyze the outcome of systemic lupus erythematosus (SLE) associated with acute disseminated intravascular coagulation (DIC) and also to clarify the clinical factor(s) contributing to the outcome, we retrospectively investigated 120 SLE patients treated between 1981 and 1991. Eight of these patients (6.7%) developed acute DIC; four recovered and the other four died within 2 weeks of onset. Infection preceded acute DIC in all these patients. Acute DIC associated with atypical pneumonia was always fatal, while the patients with pharyngitis or urinary tract infection survived when they were treated adequately. Comparison of the dead and surviving groups revealed that the activity of SLE before the onset of DIC, the severity of DIC, and the treatment given for DIC and the coexistent infection were not significantly related to a fatal outcome. However, severe infection such as atypical pneumonia in patients with secondary immunodeficiency was likely to be fatal irrespective of the presence of DIC.
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PMID:Improved or fatal acute disseminated intravascular coagulation in systemic lupus erythematosus. 843 79

Infections are a major cause of morbidity and mortality in patients with connective tissue diseases. Infectious consequences are caused by systemic disorders by themselves and the immunosuppressive treatments. Systemic lupus erythematosus and Wegener's granulomatosis are associated with the higher risk of infection. Primary prophylaxis of Pneumocystis carinii pneumonia has to be systematically given in patients with Wegener's granulomatosis and in other patients with connective tissue diseases if their CD4-cell count is lower than 200/mm3. Intensitification of immunosuppression during the course of systemic disorders can not be performed before any infection has been eliminated.
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PMID:[Systemic diseases and infections: current questions]. 868 84

Several rheumatic illnesses may develop in adults with primary or acquired immunologic defects. Individuals with primary defects in B-cell antibody production, such as common variable immunodeficiency of selective IgA deficiency, and those with defects of complement components, have an increased prevalence of systemic lupus erythematosus--like syndromes or other autoimmune diseases. Defects in immunoglobulin production may be complicated by inflammatory or infectious arthritis. Infection with HIV-1 may be associated with diverse rheumatic conditions, including diffuse infiltrative lymphocytosis syndrome, myopathies, vasculitides, inflammatory arthritides, and infectious musculoskeletal complications. An approach to these disorders that takes into consideration the underlying mechanism of disease is presented. Appropriate strategies aimed at treatment of the underlying immunodeficiency may improve the clinical course of the associated rheumatic disorder.
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PMID:Adult immunodeficiency and rheumatic disease. 890 65

Infections are a common cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. The primary disease process and complications of drug management may contribute to this increased susceptibility. A high incidence of salmonella infections have been reported in SLE patients. We report an unusual case of a SLE patient who developed recurrent salmonella sepsis. The first episode with salmonella typhimurium was followed a few months later by an episode of salmonella enteritides sepsis.
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PMID:Recurrent salmonella sepsis with different species in a systemic lupus erythematosus patient. 892 81

Infection remains a leading cause of morbidity and mortality in patients with SLE. To investigate this, previously we assessed the host defense status of autoimmune MRL/lpr mice and found that elaboration of active TGFbeta suppressed neutrophil function and decreased survival in response to Staphylococcus aureus infection. The purpose of the present work was to elucidate the molecular form and the cellular source of the active TGFbeta involved. Here, we report for the first time that TGFbeta1 is found in the active form inside B cells and plasma cells and that it circulates in the plasma complexed with IgG in two murine models of systemic autoimmunity and in some patients with SLE. IgG-bound active TGFbeta1 is many times more potent than uncomplexed active TGFbeta1 for suppression of neutrophil function in vitro and host defense against S. aureus infection in vivo. These data indicate that TGFbeta1 is in the active form inside B cells and plasma cells, that the formation of a complex of IgG and active TGFbeta1 is greatly accelerated in autoimmunity, and that this complex is extremely potent for suppression of PMN function and host defense against bacterial infection.
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PMID:Intracellular demonstration of active TGFbeta1 in B cells and plasma cells of autoimmune mice. IgG-bound TGFbeta1 suppresses neutrophil function and host defense against Staphylococcus aureus infection. 895 12

Infection is the major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Although various fungi account for a substantial number of these lethal infections, aspergillosis, an important opportunistic infection in immunosuppressed patients, is described rarely. Only 23 cases have been reported in the English-language medical literature. Risk factors for acquiring aspergillosis in these patients were high grade disease activity, granulocytopenia, use of steroids and other immunosuppressive treatment and presence of bacterial infection. The diagnosis in most patients was delayed and they died. Here, we describe three SLE patients with invasive aspergillosis. Features of our patients' diseases were similar to those reported previously. Aspergillosis appeared while they had active SLE treated with high dose corticosteroids. In 2 patients the fungal infection was systemic and diagnosed post mortem. Both were leukopenic and had concurrent bacterial infection and one received amphotericin B prior to death. In the third, the infection was localized to a transplanted kidney and was cured by nephrectomy. Aspergillosis should be suspected in patients with active SLE, who are immunocompromised and sustain concomitant bacterial infections. The currently poor prognosis may be improved with more aggressive diagnostic investigation and treatment.
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PMID:Aspergillosis in systemic lupus erythematosus. 898 8

In a prospective study conducted in the Institute of Postgraduate Medicine & Research (IPGMR), Dhaka, 212 patients with prolonged pyrexia were thoroughly evaluated clinically and with the help of laboratory investigations with a view to reaching the diagnosis. Their clinical and laboratory data were recorded. Clinical features pertaining to a particular organ gave appropriate clue in 52% cases. Imaging techniques were instrumental in 24%, microbiological or serological investigations in 35%, invasive procedures were diagnostic in 42%, laparotomy had to be resorted to in five cases. Infectious diseases were the commonest causes of prolonged pyrexia accounting for about 63.21% of cases followed by neoplasms (12.74%) and connective tissue disorders (10.85%). Tuberculosis was the most common infection (24.53% of all cases) followed by enteric fever (12.74%) and visceral leishmaniasis (9.43%). Pleura was the commonest seat for tuberculosis followed by lymph nodes and abdomen. Leukemias were the commonest neoplasm and SLE the commonest connective tissue disorder presenting with prolonged fever. Several fundamental observations were made in the study. Infections are the commonest cause of prolonged fever in our community, neoplasms and connective tissue disorders are also not rare. Secondly, patients with temperature between 100 to 101 degrees F should not be denied evaluation with the apprehension of unnecessarily investigating for habitual hyperthermia, as the condition was distinctly rare in the series. Thirdly, analysis of materials from organs or systems suspected to be abnormal clinically or by simple imaging techniques had high diagnostic yield. Finally, usual causes of prolonged fever are illnesses ordinarily encountered in clinical practice, pyrexia becomes protracted either because the presentation is atypical or incomplete, or because we fail to make proper use of available clinical or paraclinical information.
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PMID:A study of prolonged pyrexia in Dhaka. 903 43

We reviewed the side-effects of intravenous (i.v.) cyclophosphamide (CPM) pulse therapy in a group of 75 patients suffering from various autoimmune disorders (mostly systemic lupus erythematosus and vasculitis) who received a total of 451 i.v. CPM pulses, given on a monthly basis (mean +/- s.d. CPM dose per pulse: 764 +/- 217 mg; mean +/- s.d. follow-up period: 26.7 +/- 22.1 mon). Infection was the most common side-effect (30 episodes in 21 patients; 28% of the patients) but rarely required in-patient treatment (8 episodes in 7 patients; 9% of the patients). No relationship could be found between the occurrence of infection and the dose of CPM or of glucocorticoids. Other side-effects were rare. Only one patient suffered from neutropenia. Haemorrhagic cystitis was never observed nor did premature ovarian failure in the 25 female patients at risk. Four patients developed neoplasia and three died suddenly a few days after receiving a CPM pulse but the causal relationship between CPM therapy and these poor outcomes is speculative. Taken together, our data confirm in a large group of patients that i.v. CPM pulse therapy is relatively safe. In particular, the rate of severe infection requiring in-patient treatment is rare (1.8% of 451 pulses.).
Lupus 1997
PMID:Side-effects of intravenous cyclophosphamide pulse therapy. 910 32

Mediterranean spotted fever is a tick-borne disease that is endemic in the Mediterranean basin from spring to autumn. Usually mild, the disease can be severe in some cases, especially when risk factors are encountered in patients or when treatment is delayed. The correlation between these malignant forms and patients' immunological disorders remains unclear, while the pathophysiology of the disease seems well known. A case of a malignant form of Mediterranean spotted fever is reported which occurred 2 months prior to the diagnosis of polymyalgia rheumatica. Evidence of immunological disorders consisted only in an antiphospholipid antibody associated with a transient lupus anticoagulant. No underlying risk factors other than the primary undiagnosed phase of polymyalgia rheumatica has been observed.
Infection
PMID:Malignant boutonneuse fever and polymyalgia rheumatica: a coincidental association? 933 71


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