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)

To study the distribution of ocular involvement among persons with rheumatic disease, a cross-sectional survey was performed in 224 patients attending the Division of Rheumatology, Department of Medicine, Maharaj Nakorn Chiang Mai Hospital. Of these patients, 102 presented with rheumatoid arthritis, 74 systemic lupus erythematosus, 39 systemic sclerosis, 6 mixed connective tissue disease, 2 polymyositis and 1 juvenile rheumatoid arthritis. It was found that the ocular involvement probably related to diseases including dry eye (19.9%) and uveitis (0.4%). The ocular involvement was presumably related to treatment including retinopathy (7.6%), cataract (6.3%), and glaucoma (0.9%). Rapid recognition of these complications would lead to early and appropriate management, which would prevent their sequelae.
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PMID:Ocular diseases in patients with rheumatic diseases. 1240 5

Ocular complications of long-term chloroquine therapy were observed in 18 of 45 patients so treated. This therapy was used in patients with rheumatoid arthritis, lupus erythematosus, sarcoidosis, discoid lupus and other chronic "collagen disease". Thirteen patients had reversible corneal opacifications, and seven had irreversible retinal changes, with visual loss and visual field defects. Pathological evidence of chloroquine retinopathy was obtained in one patient. Physicians are therefore warned to use this drug only after careful consideration. If it is used, repeated ocular examinations should include assessment of visual acuity, visual fields on a tangent screen and fundus examination through a dilated pupil.
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PMID:OCULAR COMPLICATIONS OF CHLOROQUINE THERAPY. 1427 38

Antimalarials are very useful drugs in the treatment of various rheumatic diseases. One of their main side effects is ocular toxicity, specifically retinopathy. Our objective was to identify risk factors associated with chloroquine retinopathy. A single, trained evaluator reviewed patient records with rheumatic diseases. They were taking chloroquine and identified by the ophthalmology department as having retinopathy during their routine eye evaluation. These cases were classified according to clinical evaluation, visual fields and fluorangiographic study. Up to four controls were selected for each case, matched by age, gender, diagnosis and similar time on chloroquine. In all, 34 variables were studied, among these: weight, age, disease duration, keratopathy, total cumulative dose (TCD), mean daily dose (MDD), lean body weight adjusted daily dose (LBWDD) and laboratory tests. Descriptive and inferential statistics comparing cases and controls in all patients and subgroup analysis were carried out. Significance was set at the 0.05 level. Odds ratio and 95% confidence intervals were calculated. Sixteen cases of chloroquine retinopathy were identified, eight patients with rheumatoid arthritis (RA), seven with systemic lupus erythematosus (SLE) and one with dermatomyositis. All were female. Mean age was 47.3 +/- 12.2 years; weight 59.5 +/- 10.7 kg; disease duration 12.8 +/- 6.0 years; time on chloroquine 54.1 +/- 27.8 (min-max: 30-197) months. There was a significant difference in the following variables in all patients: MDD 212.3 +/- 52.6 versus 170 +/- 51.3, p = 0.009; and LBWDD 5 +/- 1 versus 4.2 +/- 1.5, p = 0.03, for cases and controls, respectively. In subgroup analysis the MDD remained significantly different (235.5 +/- 45.8 versus 169.7 +/- 46.1, p = 0.004) only in RA, whereas LBWDD was different both in SLE and RA. Keratopathy increased the risk for retinopathy: OR, 95% CI: 5, 1.4-17.6, p = 0.01. In conclusion, in accordance with previous studies, the MDD, LBWDD and keratopathy were risk factors associated with chloroquine retinopathy. Periodic ophthalmologic evaluations are mandatory.
Lupus 2004
PMID:Factors associated with chloroquine-induced retinopathy in rheumatic diseases. 1546 95

The retina is relatively protected from systemic drug administration because of the blood-retinal barrier, a highly selective mechanism adapted to providing a regulated homeostatic environment for this highly specialised tissue. However, a number of drugs have been associated with retinal toxicity. Vigabatrin, as an adjunctive therapy for the management of partial epilepsy, is associated with visual field defects in approximately 40% of patients. Hydroxychloroquine, used in the treatment of rheumatoid arthritis and systemic lupus erythematosus, is also associated with a retinopathy. In view of this, ophthalmological screening and monitoring is recommended during prescription of both of these drugs. In these cases, the retina is the site for an adverse drug reaction and the dose of therapy may be important in determining the likelihood of retinal toxicity. However, in the case of cytomegalovirus retinitis, the retina is the intended site for pharmacological action. The treatment of this condition with the antiviral agents ganciclovir, valganciclovir, foscarnet and cidofovir, can also be associated with significant systemic toxicity.
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PMID:Drugs and the retina. 1515 52

We report a case of branch retinal artery occlusion (BRAO) in a patient with iron-deficiency anemia. Various ophthalmological and laboratory studies were performed. A 32-year-old man had a sudden decrease of vision in his left eye to counting fingers at 30 cm two days ago. The left fundus showed a cherry-red spot and milky-white edema, except for the upper temporal region of the macula, and an optic disc malformation. Fluorescein angiography revealed leakage from the disc and a slightly delayed filling time in the left eye but an arterial filling defect was not noted. The differential diagnosis in this young patient includes polycythemia, hypercoagulopathy, coagulation abnormalities, trauma, hypertension, and autoimmune diseases such as systemic lupus erythematosus. Laboratory examinations revealed no abnormalities except for iron-deficiency anemia. The patient was treated with stellate ganglion block, hyperbaric oxygen, and ferrous sulfate. His visual acuity never recovered to better than 0.08. He had a coincidental rectal carcinoid and the tumor was excised surgically. No metastasis was observed. BRAO can be a complication of anemic retinopathy and can lead to severe visual loss without early medication.
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PMID:Branch retinal artery occlusion: a complication of iron-deficiency anemia in a young adult with a rectal carcinoid. 1521 50

The antimalarials, mainly chloroquine and hydroxychloroquine, derive from the quinoleine core of quinine. Their initial therapeutic indication was the treatment of malaria attacks but, because of anti-inflammatory and immuno-modulatory activities, they have been since used to treat many other pathologies, in particular dermatological ones. For some of these pathologies, lupus or porphyria cutanea tarda for example, the use of these molecules is based on obvious scientific evidence. For other pathologies (cutaneous sarcoidosis, polymyositis, polymorphous light eruption...), the data on the medical literature corroborating the daily clinical practice are extremely poor. Their toxicity is limited. Their most common toxic effects are gastrointestinal (mild nausea or diarrhea) or mucocutaneous (reversible skin or mucosal pigmentation). Their most serious and dreaded side effect, retinopathy, can be largely prevented by using amounts of APS adapted to the weight of the patients. The recommended "safe" daily dose for hydroxychloroquine is 6.5 mg per kilogramme of body weight and for chloroquine 4 mg per kilogramme of body weight. However, at 6- to 12 months intervals, follow-up eye examinations should be performed.
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PMID:[Synthetic antimalarials]. 1623 Sep 16

P-glycoprotein (P-gp) expels various drugs from cells, resulting in multidrug resistance, including against glucocorticoids. Here, we present a case of systemic lupus erythematosus (SLE) that suggests the importance of initial intensive treatment in overcoming unresponsiveness due to P-gp overexpression on activated lymphocytes. A 28-year-old woman had been diagnosed with highly active SLE including severe pericarditis, hemolytic anemia, lupus nephritis, and retinopathy. The disease activity of SLE progressed despite 1 mg/kg per day oral prednisolone. At the time, P-gp expression was extremely high, as evaluated by flow cytometric analysis on peripheral lymphocytes. After intensive treatment with three courses of methylprednisolone pulse therapy and plasmapheresis, we succeeded in controlling disease activity in association with marked reduction of P-gp overexpression; namely, the clinical symptoms immediately improved along with the reduction of P-gp expression. These results imply that patients with highly active SLE might have drug unresponsiveness that is mediated by P-gp overexpression on lymphocytes. Therefore, downregulation of P-gp by initial intensive immunosuppressive therapy might be important for overcoming glucocorticoid resistance. We also propose that measurement of P-gp on lymphocytes is a useful test for prediction of drug resistance and may assist in the selection of appropriate initial treatment.
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PMID:Overcoming treatment unresponsiveness mediated by P-glycoprotein overexpression on lymphocytes in refractory active systemic lupus erythematosus. 1702 18

Ocular manifestations of lupus are fairly common, may be the presenting feature of the disease and can be sight-threatening. Almost any part of the eye and visual pathway can be affected by inflammatory or thrombotic processes. Ocular pain and visual impairment require urgent assessment by an ophthalmologist. Infection should be excluded. Optic neuritis and ischaemic optic neuropathy may be difficult to distinguish. Scleritis and severe retinopathy require systemic immunosuppression but episcleritis, anterior uveitis and dry eyes can usually be managed with local eye drops. Vaso-occlusive disease, particularly in the presence of antiphospholipid antibodies, requires treatment with anticoagulation and proliferative retinopathy is treated with laser therapy. Hydroxychloroquine rarely causes ocular toxicity at doses under 6.5 mg/kg/day. When this has occurred, it has been associated with more than 5 years of drug exposure.
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PMID:Ocular manifestations of systemic lupus erythematosus. 1768 81

The aim of the study was to assess ocular manifestations in patients with systemic lupus erythematosus (SLE). The following, were included in the evaluation: clinical condition, duration of the disease and treatment used. The study was performed in 100 patients with SLE. Evaluation of the clinical condition and opththalmoscopic findings in patients with SLE demonstrated abnormal Schirmer tests in 41% patients, scleritis 2%, retinopathy 7% and neuritis 1%. Inflammatory changes in the anterior segment of the eyeball, neuritis and retinopathy occurred solely in the phase of exacerbation. Adverse events observed after treatment with chloroquine or prednisone (chloroquine maculopathy,cataract, glaucoma) are related to dosage and duration of the treatment.
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PMID:[Ocular changes and general condition in lupus erythematosus (SLE)--own observation]. 1768 4

We have described an unusual presentation of lupus retinopathy in the form of macular arterio-arterial and arterio-venular shunts with extensive macular ischemia as a presenting sign.
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PMID:An unusual presentation of lupus retinopathy. 1815 11


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