-
Annals of Internal Medicine Jun 2020Systemic lupus erythematosus (lupus) is characterized by aberrant activity of the immune system, leading to variable clinical symptoms. Lupus is more prevalent in... (Review)
Review
Systemic lupus erythematosus (lupus) is characterized by aberrant activity of the immune system, leading to variable clinical symptoms. Lupus is more prevalent in African American women and women in other ethnic minority groups. Diagnosing, treating, and identifying novel therapies for lupus is challenging because of its genetic and phenotypic heterogeneity. Lupus nephritis is the most common target-organ manifestation and requires individualized care to minimize toxicity. A multidisciplinary approach to caring for pregnant patients with lupus is essential to optimize outcomes.
Topics: Diagnosis, Differential; Humans; Lupus Erythematosus, Systemic
PubMed: 32479157
DOI: 10.7326/AITC202006020 -
Biomolecules Jun 2021Systemic lupus erythematosus (SLE) is characterized by immune system dysfunction and is clinically heterogeneous, exhibiting renal, dermatological, neuropsychiatric, and... (Review)
Review
Systemic lupus erythematosus (SLE) is characterized by immune system dysfunction and is clinically heterogeneous, exhibiting renal, dermatological, neuropsychiatric, and cardiovascular symptoms. Clinical and physiological assessment is usually inadequate for diagnosing and assessing pathophysiological processes in SLE. Clinical and immunological biomarkers could play a critical role in improving diagnosis, assessment, and ultimately, control of SLE. This article reviews clinical and immunological biomarkers that could diagnose and monitor disease activity in SLE, with and without organ-specific injury. In addition, novel SLE biomarkers that have been discovered through "omics" research are also reviewed.
Topics: Biomarkers; Humans; Lupus Erythematosus, Systemic
PubMed: 34206696
DOI: 10.3390/biom11070928 -
Annual Review of Medicine Jan 2023Systemic lupus erythematosus (SLE) is a devastating autoimmune disease that can result in substantial morbidity and mortality. Diagnosis and treatment of SLE are... (Review)
Review
Systemic lupus erythematosus (SLE) is a devastating autoimmune disease that can result in substantial morbidity and mortality. Diagnosis and treatment of SLE are clinical challenges. Patient presentation and response to therapy are heterogeneous because of the complex immune dysregulation that results in SLE disease pathogenesis. An intricate interplay between genetic risk and skewing of adaptive and innate immune system responses leads to overproduction of type I interferons and other cytokines, complement activation, immune-complex deposition, and ultimately inflammation and tissue damage. Here, we review the classification criteria as well as standard and emerging diagnostic tools available to identify patients with SLE. We then focus on medical management, including novel therapeutics, nonpharmacologic interventions, and comorbidity management.
Topics: Humans; Immunity, Innate; Cytokines; Interferon Type I; Lupus Erythematosus, Systemic
PubMed: 35804480
DOI: 10.1146/annurev-med-043021-032611 -
Clinical and Experimental Rheumatology Jan 2022Systemic lupus erythematosus (SLE) is a chronic multisystem auto-immune disease with extremely varied clinical manifestations and a complex pathogenesis. New insights in... (Review)
Review
Systemic lupus erythematosus (SLE) is a chronic multisystem auto-immune disease with extremely varied clinical manifestations and a complex pathogenesis. New insights in SLE about pathogenetic pathways, biomarkers, and data on clinical manifestations are progressively emerging, and new drugs and new therapeutic strategies have been proposed to improve the control of disease activity. Thus, this review is aimed to summarise the most relevant data about SLE emerged during 2021, following the previous annual review of this series.
Topics: Biomarkers; Humans; Lupus Erythematosus, Systemic
PubMed: 35088691
DOI: 10.55563/clinexprheumatol/nolysy -
Medicina Clinica Dec 2020Systemic lupus erythematosus (SLE) is a complex autoimmune multisystemic disease of great clinical heterogeneity and significant potential morbidity and mortality.... (Review)
Review
Systemic lupus erythematosus (SLE) is a complex autoimmune multisystemic disease of great clinical heterogeneity and significant potential morbidity and mortality. Although the outlook for patients with SLE has greatly improved, many unmet needs remain. In this review we aim to summarize the most relevant data on SLE that have emerged in recent years. In particular we discuss the new classification criteria from the European League Against Rheumatism and American College of Rheumatology, new biomarkers, novel definitions of remission and low lupus disease activity and what has emerged on new drugs and new therapeutic strategies.
Topics: Biomarkers; Humans; Lupus Erythematosus, Systemic; Rheumatic Diseases; Rheumatology; United States
PubMed: 32586673
DOI: 10.1016/j.medcli.2020.05.009 -
Clinical and Experimental Rheumatology May 2023Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a wide range of clinical manifestations and a relapsing-remitting course. New data regarding... (Review)
Review
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a wide range of clinical manifestations and a relapsing-remitting course. New data regarding pathogenic pathways, biomarkers and clinical manifestations of SLE are emerging, and new drugs and therapeutic protocols have been proposed to improve the control of disease activity. Furthermore, new insights into comorbidities and reproductive health in SLE patients are constantly emerging.This annual review aims to summarise the most relevant data on SLE that was published in 2022.
Topics: Humans; Lupus Erythematosus, Systemic; Autoimmune Diseases; Comorbidity; Biomarkers
PubMed: 37133502
DOI: 10.55563/clinexprheumatol/4uc7e8 -
Current Opinion in Rheumatology Nov 2020To compare the recently published European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for SLE with the Systemic... (Review)
Review
PURPOSE OF REVIEW
To compare the recently published European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for SLE with the Systemic Lupus International Collaborating Centers (SLICC) criteria and the earlier ACR criteria, focusing on their key concepts.
RECENT FINDINGS
Although the SLICC criteria introduced numbers of new criteria items, the new EULAR/ACR criteria added only noninfectious fever, based on an early SLE cohort study and an SLE patient survey, and condensed hematological, mucocutaneous and neurological items. Whereas the SLICC criteria maintained the overall structure familiar from the ACR criteria, the EULAR /ACR criteria use antinuclear antibodies (ANA) as an obligatory entry criterion, have weighted criteria and group these in domains. Where the SLICC criteria greatly increased sensitivity, losing some specificity, the EULAR/ACR criteria increased specificity again, for excellent classification criteria performance.
SUMMARY
Despite differences in structure and statistical performance, the EULAR/ACR and SLICC criteria agree on the importance of both immunological and clinical findings, on the high impact of lupus nephritis by histology, and on most clinical items.
Topics: Antibodies, Antinuclear; Cohort Studies; Female; Humans; Lupus Erythematosus, Systemic; Male; Rheumatology
PubMed: 32925250
DOI: 10.1097/BOR.0000000000000740 -
Rheumatology (Oxford, England) Dec 2020The EULAR/ACR 2019 classification criteria for SLE constitute a current and optimized clinical approach to SLE classification. Classification is still not based on... (Review)
Review
The EULAR/ACR 2019 classification criteria for SLE constitute a current and optimized clinical approach to SLE classification. Classification is still not based on molecular approaches and the results from large studies using polyomics may be interpreted as demonstrating the relevance of the genetic and environmental background rather than splitting SLE into several entities. In fact, an association study within the EULAR/ACR classification criteria project found associations between manifestations only within organ domains. This independency of various organ manifestations argues for SLE as one disease entity. The current review article will therefore concentrate on the clinical and immunological manifestations of SLE and on what we have already learned in this century. Moreover, the structure and essential rules of the EULAR/ACR 2019 classification criteria will be discussed. While classification and diagnosis are distinct concepts, which have to remain clearly separated, information derived from the process towards the classification criteria is also useful for diagnostic purposes. Therefore this article also tries to delineate what classification can teach us for diagnosis, covering a wide variety of SLE manifestations.
Topics: Antibodies, Antinuclear; Humans; Lupus Erythematosus, Systemic; Lupus Nephritis; Musculoskeletal System; Skin
PubMed: 33280013
DOI: 10.1093/rheumatology/keaa379 -
Journal of the American Academy of... Dec 2022The word lupus (Latin term for the wolf) was used indistinctively since the Middle Ages for several types of diseases characterized by ulcerous lesions, mainly in the... (Review)
Review
The word lupus (Latin term for the wolf) was used indistinctively since the Middle Ages for several types of diseases characterized by ulcerous lesions, mainly in the lower limbs. In the middle of the 18th century, the French dermatologist Cazenave mentioned for the first time the term "lupus érythémateux," while Kaposi reported discoid lupus as a separate entity. The true turning point in the history of lupus occurred at the beginning of the 19th century, when the distinction between lupus vulgaris and cutaneous lupus in its modern sense emerged slowly. Major subsequent contributions from Kaposi, Sequiera and Balean, and Osler enabled the recognition of the systemic nature of the disease, with its modern history being marked by the recognition of DNA as the main target of antinuclear antibodies and the central role of interferons. Although many nonpharmacologic treatments have been used throughout the ages, glucocorticoids, hydroxychloroquine, and immunosuppressive agents mainly appeared in the second half of the 20th century. The beginning of the 21st century is now characterized by an in-depth understanding of the pathogenesis of the disease and the appearance of biologic and targeted treatments, paving the way for a better care of lupus patients.
Topics: Humans; Lupus Vulgaris; Antibodies, Antinuclear; Immunosuppressive Agents; Glucocorticoids; Hydroxychloroquine; Lupus Erythematosus, Systemic; Lupus Erythematosus, Discoid
PubMed: 32380218
DOI: 10.1016/j.jaad.2020.04.150 -
Lancet (London, England) Jun 2019Systemic lupus erythematosus (SLE) is an autoimmune disease characterised by the loss of self-tolerance and formation of nuclear autoantigens and immune complexes... (Review)
Review
Systemic lupus erythematosus (SLE) is an autoimmune disease characterised by the loss of self-tolerance and formation of nuclear autoantigens and immune complexes resulting in inflammation of multiple organs. The clinical presentation of SLE is heterogeneous, can involve one or more organs, including the skin, kidneys, joints, and nervous system, and take a chronic or relapsing and remitting disease course. SLE is most common in women and in those of non-white ethnicity. Because of the multitude of presentations, manifestations, and serological abnormalities in patients with SLE, diagnosis can be challenging. Therapeutic approaches predominantly involve immunomodulation and immunosuppression and are targeted to the specific organ manifestation, with the aim of achieving low disease activity. Despite many treatment advances and improved diagnostics, SLE continues to cause substantial morbidity and premature mortality. Current management strategies, although helpful, are limited by high failure rates and toxicity. An overreliance on corticosteroid therapy contributes to much of the long-term organ damage. In this Seminar, we outline the classification criteria for SLE, current treatment strategies and medications, the evidence supporting their use, and explore potential future therapies.
Topics: Adult; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Treatment Outcome
PubMed: 31180030
DOI: 10.1016/S0140-6736(19)30237-5