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)

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

Pulse therapy with methylprednisolone (Solu-Medrol, Upjohn), 1000 mg daily over three successive days, was administered to patients in two randomized groups of 14 patients in each (23 patients with systemic lupus erythematosus, 5 with rheumatoid arthritis). In one of the groups the drug was taken per os, the other received it intravenously. There was no significant difference between the two groups in terms of clinical effectiveness and incidence of side effects However, the time-related course of such indices as erythrocyte sedimentation rate, the level of leukocytes, of total protein, urea, the blood antioxidant potential, permeability of erythrocytic membranes and capillary and tissue barrier proteinuria as well as the content of immune complexes in the arterial and venous blood was more striking with per os intake. Of the 14 patients, 11 demonstrated short-continued asymptomatic 35% rise in the activity of alaninaminotransferase.
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PMID:[A comparative evaluation of the efficacy of peroral and intravenous pulse therapy with methylprednisolone in rheumatic diseases]. 1005 Apr 56

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease of unknown cause, characterized by multisystemic involvement. Its occurrence in children is rare, and acute pancreatitis is exceptional in this matter. Its diagnosis is clinical, biological, and radiological. Its treatment is based on corticosteroid therapy, and its progress is generally lethal. We report two cases of acute pancreatitis in the course of SLE, highlighting its life-threatening severity despite well-conducted treatment. Case 1: 14-year-old patient, admitted to the pediatric ICU for altered state of consciousness. This child, an outpatient since 2009 for chronic arthralgia, was hospitalized five days previously in the pediatric ward for suspicion of severe SLE, before presenting abdominal pain and vomiting. Hyperlipasemia was found, and an abdominal CT scan confirmed the diagnosis of acute pancreatitis. The patient was put under immunosuppressive therapy composed of high-dosage of corticosteroid and cyclophosphamide cures. She died 20 days after her hospitalization by severe lupus flare with multiorgan failure. Case 2: 14-year-old child, admitted to the Pediatric ward for prolonged fever associated with polyarthralgia (nondeforming, immovable, and additive) that had been progressing since 6 months with altered general state; his symptoms got worst 15 days before his hospitalization by having behavioral disorders and epigastralgia with vomiting. Pancreatitis was strongly suspected in the absence of improvement on symptomatic treatment and confirmed by hyperlipasemia 6 times the normal value and a swollen pancreas on the abdominal CT scan. The child was treated with Solumedrol and cyclophosphamide without improvement and then died after one month of hospitalization by a septic shock.
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PMID:Systemic Lupus Erythematosus-Related Pancreatitis in Children: Severe and Lethal Form. 3069 30