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)

The authors report the case of a young 17 year-old girl with acute systemic lupus erythematosus who presented with purulent arthritis due to Group A hemolytic streptococcus in the knee, and perhaps other joints. She had not yet received any treatment. The purulent arthritis was cured by antibiotics. In spite of corticosteroids and immuno-suppressive agents (Chlorambucil), the patient died one year later. Spontaneous purulent arthritis is rare during systemic lupus erythematosus. We found only 8 other cases in the world literature. Contrary to our case, these were patients already treated with corticosteroid or immuno-suppressive agents. In our patient, the absence of previous treatment permitted us to incriminate the lupus itself in the onset of this infection. The conditions of onset of infection during lupus erythematosus are discussed.
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PMID:[Spontaneous septic arthritis in disseminated lupus erythematosus]. 18 57

There is good, controlled evidence which suggests that cyclophosphamide, and perhaps related drugs, have a definite role in the treatment of nephrotic children with the minimal change lesion. This role is one of secondary treatment, and the drugs should not be used as a first line of attack; they should be employed only when corticosteroid resistance or toxicity is a problem. In a few patients, azathioprine or 6-mercaptopurine may have a role in minimising corticosteroid toxicity, but the remission induced in relapsing children is no more durable than that after corticosteroids. Chlorambucil must be given in doses, and for periods long enough to run the risk of neoplasia, particularly leukaemia; there does not appear to be a place for its use in nephrotic children unless the duration of remission can be shown to be longer than that obtainable with cyclophosphamide. There is no evidence that any immunosuppressive agent has a place in the management of children with idiopathic glomerular disease showing structural alterations in the glomeruli. Children with systemic lupus erythematosus and nephritis may benefit from the addition of cytotoxic agents to their corticosteroid regime, although the indications for this are not clear, and controlled evidence is lacking.
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PMID:Immunosuppressive agents in the treatment of the nephrotic syndrome and glomerulonephritis in children. 39 8

Six female patients with systemic lupus erythematosus (S.L.E.) have been treated with chlorambucil. In five the decision was taken after failure by corticosteroids to control progressive renal disease in the face of unacceptable corticosteroid toxicity. After the introduction of chlorambucil renal function improved and all patients remain well six, six, five, three, and two-and-a-half years later, respectively. On renal biopsy five had focal proliferative glomerulonephritis. Repeat biopsy in two cases showed quantitative improvement. The sixth patient was treated with chlorambucil because of failure by corticosteroids to control peripheral vascular lesions and haemolysis and she remains well four years later. In four patients is it probable that amenorrhoea was related to chlorambucil treatment, but there were no other important side effects although one patient developed a degree of marrow depression during treatment. Chlorambucil may hold advantages over the immunosuppressive drugs normally recommended in this condition, azathioprine and cyclophosphamide, as it appears less liable to cause important marrow suppression and, unlike cyclophosphamide is not associated with alopecia and haemorrhagic cystitis.
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PMID:Treatment of patients with systemic lupus erythematosus including nephritis with chlorambucil. 470 7

Glucocorticoids, cytostatic agents and cyclosporin are frequently employed in the treatment of glomerular diseases of immunologic origin. In order to assess the efficacy of these drugs, we retrieved--with the help of a Medline-based search--and analysed all controlled studies published since 1966 dealing with immunosuppressive therapy of glomerulonephritis. Of the 34 identified controlled studies, only 27 had a prospective and randomized design. In patients with minimal-change glomerulonephritis, proteinuria decreases and disappears during therapy with prednisone. A comparable effect can be obtained with cyclosporin. Occasionally, there is a relapse of proteinuria after cessation of the immunosuppressive therapy in some patients. These relapses can be controlled with a chlorambucil-based regimen. Chlorambucil may be successfully utilized in the treatment of focal-segmental glomerulosclerosis, a form of glomerulonephritis which is more refractory to glucocorticoid therapy and is probably pathogenetically related to minimal-change glomerulonephritis. Patients with membranous glomerulonephritis and a nephrotic syndrome seem to benefit from an alternate month prednisone and chlorambucil regimen. However, an indiscriminate treatment of all patients with this regimen is not legitimate, because some patients would be overtreated as the disease may undergo spontaneous remission. There are no well-documented valuable therapies for the IgA-associated glomerulonephritis and the membranoproliferative glomerulonephritis. The combination of prednisone with cytotoxic substances, particularly cyclophosphamide and azathioprine, seem to remarkably improve the renal prognosis of the diffuse proliferative lupus glomerulonephritis. The efficacy of cyclophosphamide and prednisone with or without plasma exchange in the treatment of the rapidly progressive glomerulonephritis due to other systemic diseases (M. Wegener, panarteritis nodosa, Goodpasture syndrome) is a widely accepted therapeutic modality, although controlled studies are lacking. Immunosuppressive therapy of glomerulonephritis bears notable risks and sometimes questionable efficacy. Thus, before prescribing any immunosuppressive therapy, it is mandatory to evaluate in every single patient the prognostic factors of the underlying disease, the probability of the onset of severe side effects and the possible acceptance of a renal replacement therapy, including renal transplantation.
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PMID:[Immunosuppressive therapy of glomerulonephritis--controlled studies]. 845 16