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)

Enlargement of the cheeks may be due to a multitude of disorders, congenital, neoplastic, and in particular inflammatory. Congenital facial anomalies include cutaneous (and osseous) hemihypertrophy of the face and unilateral angiomatous malformations (e.g. Sturge-Weber-Krabbe Syndrome). Buccal enlargement due to dermal tumours include localized haemangiomas and lymphangiomas, lipomas and other benign connective tissue neoplasms, generalized disorders of the lymphatic or reticuloendothelial system including mycosis fungoides, reticulum cell sarcoma and other soft tissue malignancies, and cutaneous manifestations of malignant haemoblastoses, in particular chronic lymphatic leukaemia. Within the very large group of inflammatory skin swellings of the face a review is made of some bacterial pyodermias, severe forms of acne vulgaris, herpes zoster, lupus vulgaris, erysipelas, rosacea, steroid dermatitis, lupus erythematosus (discoid and systemic), toxic dermatitis, allergic eczema, urticaria, Quincke's oedema, and the Melkersson-Rosenthal syndrome. The importance of prevention and early detection of steroid-induced dermatitis is emphasized. This disorder, which is a pseudo-inflammatory disfiguring complication of prolonged topical steroid abuse, ranks in frequency with the skin problems most often seen in dermatological practice.
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PMID:[Differential diagnosis of facial skin swellings (author's transl)]. 37 16

The hypothesis that corticosteroid therapy is responsible for the striking improvement in survival of patients with systemic lupus erythematosus (SLE) was investigated with two approaches: Of 250 published papers on SLE, 52 were chosen for the first analysis because they included sufficient information on diagnostic criteria and survival but were not limited to patients selected for a particular target organ. From each article percent survival by series, average duration to death, and 1 and 5 year survival curves were abstracted. Each statistic showed linear improvement in survival since the 1930s without a significant change (P greater than 0.10) in slope for the time period following the introduction of corticosteroids. The second analysis examined the effect of corticosteroid therapy on 142 patients with SLE followed at the Massachusetts General Hospital between 1922 and 1966. Although the steroid use was conservative, the patients' survival, from year of entry, was comparable to the 52 abstracted series. A prognostic index was used to stratify patients admitted in the steroid era (after 1950) for life table analysis of survival with and without steroids. Steroids had no discernible effect on overall survival in low and medium risk groups. Use of steroids was associated with improved survival among high rish patients (P less than 0.05).
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PMID:Does corticosteroid therapy affect the survival of patients with systemic lupus erythematosus? 47 73

Vasculitis due to immunological mechanisms is caused by attachment of immune-complexes to the wall of vessels. This occurs in capillaries causing dysfunction and damage or organs or in other vessels causing isolated vasculitis. Regularly, also serositis can be seen. Best known examples are systemic lupus erythematosus and serum-sickness. Diagnosis refers to the detection of antigen and antibody or of immune-complexes. Steroids and antiinflammatory as well as immunosuppressive drugs are used for therapy. During the acute phase also plasmapheresis is of benefit.
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PMID:[Immunological vasculopathies]. 714 66

While no one seems to doubt the importance of corticosteroids as potent anti-inflammatory and immunomodular agents, view about the dreaded complications are also rampant. There appears to be a wide variation in their use among various physicians depending on their individual beliefs, but generally there is a consensus in regard to their use in certain autoimmune/connective tissue disorders such as SLE, various vasculitides, etc., where no acceptable alternative medications exist. In these conditions relatively high doses of corticosteroids are needed until the disease activity is controlled and thereafter attempts should be made to taper down the dose to the lowest possible maintenance dose. In some situations such an attempt may not be successful because of exacerbation in disease activity. In such cases supplemental steroid sparing agents such as azathioprine and others should be considered. Other measures such as alternate day therapy should be considered if shown to be affective in controlling disease activity. Alternate day therapy has been shown to be associated with fewer side effects, notably HPA axis suppression, incidence of infection, myopathy and glucose intolerance. Pulsed i.v. Solumedrol has also been shown to be effective in certain situations such as rapidly progressive glomerulonephritis and renal transplant rejection. Steroids should not be used when an equally effective alternative medication is available such as NSAIDS and disease modifying agents in various inflammatory arthritis. Much of reported side effects in the literature are based on case reports and uncontrolled studies and there appears to be considerable individual variation in susceptibility. Some of the side effects are expected regardless of the size of the dose and cumulative dose whereas others are related to the dose. Certain side effects of steroids use, notably osteoporosis, have been shown to be significantly associated with long term use of corticosteroids whereas in others such as peptic ulcer disease, the association is tenuous with other variables playing a significant role. Potential for abuse/misuse also exists both by the physicians and patients. This, however, is relatively small here in the U.S. compared to developing countries where corticosteroids have been used irrationally and inappropriately in a wide variety of conditions, in high dosages.
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PMID:Uses, adverse effects of abuse of corticosteroids. Part I. 789 13

A 24-year-old woman was admitted to our hospital because of pulmonary hypertension. Five years earlier, she had been given a diagnosis of systemic lupus erythematosus. The pulmonary hypertension was believed to have been caused by pulmonary vasculitis, because pulmonary angiography, nuclear perfusion scans, and axial magnetic resonance imaging of the pulmonary artery showed no evidence of pulmonary thromboembolism. Steroids, a calcium antagonist, and home oxygen therapy did not reduce the patient's pulmonary hypertension. The level of thromboxane B2, a stable metabolite of thromboxane A2, in the pulmonary artery was abnormally high (140 pg/ml). This suggested that vasoconstriction of the pulmonary artery and microthrombosis would cause continuous pulmonary hypertension. Beraprost sodium (120 micrograms/day, p.o.) was administered. This analogue of prostaglandin I2 is a potent relaxer of vascular smooth muscle, and it inhibits platelet aggregation. The pulmonary artery pressure was normal eight months after the start of therapy with beraprost sodium.
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PMID:[Systemic lupus erythematosus with pulmonary hypertension--normalization of pulmonary artery pressure by long-term administration of beraprost sodium]. 858 27

A case of aortic valve replacement for aortic insufficiency complicated with enterococcal endocarditis in a patient with systemic lupus erythematosus (SLE) is described. The cardiac complications of SLE may involve the endocardium, myocardium, pericardium, and coronary vessels. Steroids which are used for treatment probably increase the incidence of valve incompetence. Aortic insufficiency or infective endocarditis complicating Libman-Sacks endocarditis is rarely observed and may require valve replacement. Echocardiography is an important diagnostic tool. Renal function, pulmonary status, and cerebral complications require special attention in these patients.
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PMID:Aortic insufficiency and enterococcal endocarditis complicating systemic lupus erythematosus. 861 Feb 95

Optimal management of patients with the antiphospholipid syndrome (APS) remains a problem. There is now good evidence that those with thrombosis will be subject to recurrences and require long-term, possibly lifelong, oral anticoagulation. Steroids and immunosuppressive drugs aiming at a reduction of the antibody levels have not provided long-term benefit. Only prospective and controlled clinical trials can give a definitive answer to the optimal thrombotic prophylaxis in patients with the APS.
Lupus 1996 Oct
PMID:Management of thrombosis in the antiphospholipid syndrome. 890 83

Therapeutic guidelines are progressively emerging in the antiphospholipid syndrome (APS). For primary APS, prevention of recurrent miscarriages is frequently achieved by a combination of heparin plus aspirin. Steroids should not be used in the absence of associated systemic lupus erythematosus. Long term warfarin aimed at an INR of 3-3.5 is effective for the secondary prevention of thrombosis. However, some doubt is raising regarding the pertinence of INR monitoring in patients with a lupus anticoagulant. Education is an important part of the management of patients with APS. Coincident risk factors for thrombosis have to be suppressed or controlled. Psychological aspects also need to be carely considered during the course of this chronic disorder.
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PMID:Management of the antiphospholipid syndrome. Main trends, unsolved questions, practical and educational aspects. 895 57

Therapeutic guidelines are progressively emerging for the antiphospholipid syndrome (APS). In the absence of associated systemic lupus erythematosus, i.e. in primary APS, the prevention of recurrent miscarriages is frequently achieved by a combination of heparin plus aspirin. To date, there is no agreement about the type and the dose of heparin to use. Steroids should not be proposed for the prevention of miscarriages in primary APS. Long term warfarin aimed at an International Normalized Ratio (INR) of 3-3.5 is effective for secondary prevention of thrombosis. However, the appropriateness of INR for warfarin monitoring has been recently questioned in the presence of a lupus anticoagulant. Education plays an important role in the management of patients with APS. Particularly, coincident risk factors for thrombosis have to be suppressed or controlled.
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PMID:[Antiphospholipid syndrome. A better codified treatment]. 908 24

Eight patients with resistant and/or relapsing nephrotic syndrome or renal insufficiency were empirically treated with mycophenolate mofetil (MMF). The underlying glomerular diseases were membranous nephropathy (N = 3), minimal change disease (n = 2), focal segmental glomerulosclerosis (n = 1), and lupus nephritis (N = 2). Treatment with MMF 0.75 to 1.0 g twice daily, either as monotherapy or in combination with low-dose steroid treatment, resulted in substantial reductions in proteinuria or stabilization of serum creatinine. In relapsing patients following withdrawal from cyclosporin A, MMF achieved suppression of proteinuria equivalent to or better than that which occurred during cyclosporin A treatment. Steroids were successfully withdrawn in each of the non-lupus patients. MMF was well tolerated with no evidence of hematologic, hepatic, or other toxicity. These clinical anecdotes demonstrate the short-term clinical efficacy of MMF treatment. In addition, they suggest that MMF may have major steroid-sparing effects and might represent an alternative to cyclosporin A in appropriate patients.
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PMID:Successful mycophenolate mofetil treatment of glomerular disease. 946 13


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