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Anesthesia and Analgesia Sep 2010Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disorder, with a heterogeneous presentation. Disease severity is wide ranging, with most... (Review)
Review
Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disorder, with a heterogeneous presentation. Disease severity is wide ranging, with most suffering milder forms; however, it is potentially fatal depending on organ involvement. The disorder was recognized as early as the Middle Ages, with the 12th-century physician Rogerius being the first to apply the term lupus to the classic malar rash, and in 1872, Moric Kaposi first recognized the systemic nature of the disease. Perioperatively, SLE can present major challenges to the anesthesiologist because of accrued organ damage, coagulation defects, and complex management regimes. In this article I highlight adult SLE manifestations and treatments pertinent to the anesthesiologist and discuss perioperative management of these complex patients.
Topics: Anesthesia; Humans; Lupus Erythematosus, Systemic; Monitoring, Physiologic
PubMed: 20601448
DOI: 10.1213/ANE.0b013e3181e8138e -
Anales de Pediatria (Barcelona, Spain :... Oct 2005Pediatric systemic lupus erythematosus (pSLE) is a chronic mutisystemic autoimmune disease with complex clinical manifestations. Although the presentation, clinical... (Review)
Review
Pediatric systemic lupus erythematosus (pSLE) is a chronic mutisystemic autoimmune disease with complex clinical manifestations. Although the presentation, clinical manifestations, immunological findings and treatment issues of pSLE are similar to those of adult SLE patients, there are special issues which need to be considered when dealing with SLE in children. During the last decade survival has improved remarkably as a result of earlier diagnosis, recognition of milder disease and better approaches to therapy. However, pSLE remains a potentially serious condition. Although the pathogenesis of SLE remains poorly understood, susceptibility involves a combination of environmental, hormonal and genetic factors. Better understanding of SLE pathogenesis will hopefully lead to more specific and less toxic therapies for this disease.
Topics: Child; Humans; Lupus Erythematosus, Systemic
PubMed: 16219253
DOI: 10.1157/13079833 -
Rheumatic Diseases Clinics of North... Aug 2014Genetic factors seem to play a more important role early in the course of systemic lupus erythematosus (SLE), whereas nongenetic factors seem to play a more important... (Review)
Review
Genetic factors seem to play a more important role early in the course of systemic lupus erythematosus (SLE), whereas nongenetic factors seem to play a more important role over the course of the disease. SLE is more frequent with less favorable outcomes in nonwhite populations. To overcome these differences and reduce the immediate-term, mediate-term, and long-term impact of SLE among disadvantaged populations, it is essential to increase disease awareness, to improve access to health care and to provide care to these patients in a consistent manner regardless of the severity of their disease.
Topics: Ethnicity; Genetic Predisposition to Disease; Health Status Disparities; Humans; Kidney; Lupus Erythematosus, Systemic; Patient Acuity; Pharmacogenetics; Prognosis; Renal Replacement Therapy
PubMed: 25034155
DOI: 10.1016/j.rdc.2014.04.001 -
Acta Reumatologica Portuguesa 2012Neonatal lupus erythematosus is a rare disease that can affect different organs, mainly the skin and heart. In either asymptomatic pregnant women or with autoimmune... (Review)
Review
Neonatal lupus erythematosus is a rare disease that can affect different organs, mainly the skin and heart. In either asymptomatic pregnant women or with autoimmune pathology who carry antibodies directed to Ro/SSA, La/SSB and RNP, the transplacentar passage of these autoantibodies after the 16th week of gestation may cause transient lesions in target organs. The majority regress as the maternal antibodies are cleared from the circulation, except for heart lesions where fibrosis can induce definitive lesions. Although the importance of these antibodies in the pathophysiology of neonatal lupus is well recognized, their presence is not sufficient for the development of the disease and other factors, such as genetic and environmental factors, must be recognized. Most manifestations are benign and limited. Atrioventricular block is an exception because it carries a significant mortality and morbidity, emphasizing the value of an early diagnosis. The disease can carry a higher risk of autoimmune disease in the child and its mother when asymptomatic. Currently, the main focus of the investigation of neonatal lupus erythematosus lies on the search for reliable markers that predict the specific involvement of fetal organs and for a safe and effective treatment to prevent definitive lesions.
Topics: Humans; Infant, Newborn; Lupus Erythematosus, Systemic
PubMed: 24126423
DOI: No ID Found -
The Ulster Medical Journal 1969
Topics: Female; Humans; Lupus Erythematosus, Systemic; Male
PubMed: 5345245
DOI: No ID Found -
BMJ (Clinical Research Ed.) Jun 2006
Review
Topics: Adaptation, Psychological; Counseling; Humans; Life Change Events; Lupus Erythematosus, Systemic; Physician-Patient Relations
PubMed: 16763250
DOI: 10.1136/bmj.332.7554.1374 -
Nursing Nov 2005
Review
Topics: Diagnosis, Differential; Education, Nursing, Continuing; Humans; Lupus Erythematosus, Systemic; Nursing Assessment
PubMed: 16280927
DOI: 10.1097/00152193-200511000-00049 -
Current Opinion in Rheumatology Oct 1991All physicians should be alerted to the many drugs and other agents that are associated with drug-related lupus, as there is an increasing number of such drugs. A wide... (Review)
Review
All physicians should be alerted to the many drugs and other agents that are associated with drug-related lupus, as there is an increasing number of such drugs. A wide range of immune responses and antibodies are being reported with this syndrome. A new concern is the perceived ability of new biologic treatments to induce these autoimmune phenomena. More in-depth studies of various environmental factors are providing new insights into possible mechanisms. These include the immune responses to the drugs, their metabolites, and drug-altered conjugates; bioactivation mechanisms of drug protein conjugation; the role of macrophages in antigen recognition and processing; and lastly, the important role of the acetylation of various drugs and the relationship to immunogenetic factors. Continued study of this human experimental model of lupus will help to clarify the etiology and mechanisms of systemic lupus erythematosus itself.
Topics: Antibodies, Antinuclear; Chlorpromazine; Drug Hypersensitivity; Eosinophilia-Myalgia Syndrome; Humans; Hydralazine; Interferon-alpha; Lupus Vulgaris; Models, Biological; Phenothiazines; Sulfhydryl Compounds
PubMed: 1751313
DOI: 10.1097/00002281-199110000-00010 -
Current Opinion in Rheumatology Sep 1995Studies on the long-term outcome of patients with systemic lupus erythematosus not only give us survival figures but also uncover flaws in our treatment strategies and... (Review)
Review
Studies on the long-term outcome of patients with systemic lupus erythematosus not only give us survival figures but also uncover flaws in our treatment strategies and reveal both disease-associated and other factors that affect prognosis. Among the latter, compliance with treatment and socioeconomic factors are noteworthy. The pathogenesis of neonatal lupus is under active investigation, and new approaches are being developed. This review also draws attention to a number of vasculitis syndromes that are common in adults but very rarely reported in children. Poststreptococcal reactive arthritis has been described as a new entity; however, such patients should probably receive the same attention as patients with rheumatic fever to avoid recurrences of the disease and cardiac sequelae.
Topics: Animals; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Lupus Erythematosus, Systemic; Lupus Vulgaris; Rheumatic Fever; Vasculitis
PubMed: 8519617
DOI: 10.1097/00002281-199509000-00012 -
Toxicology Apr 2005Autoantibodies and, less commonly, systemic rheumatic symptoms are associated with treatment with numerous medications and other types of ingested compounds. Distinct... (Review)
Review
Autoantibodies and, less commonly, systemic rheumatic symptoms are associated with treatment with numerous medications and other types of ingested compounds. Distinct syndromes can be distinguished, based on clinical and laboratory features, as well as exposure history. Drug-induced lupus has been reported as a side-effect of long-term therapy with over 40 medications. Its clinical and laboratory features are similar to systemic lupus erythematosus, except that patients fully recover after the offending medication is discontinued. This syndrome differs from typical drug hypersensitivity reactions in that drug-specific T-cells or antibodies are not involved in induction of autoimmunity, it usually requires many months to years of drug exposure, is drug dose-dependent and generally does not result in immune sensitization to the drug. Circumstantial evidence strongly suggests that oxidative metabolites of the parent compound trigger autoimmunity. Several mechanisms for induction of autoimmunity will be discussed, including bystander activation of autoreactive lymphocytes due to drug-specific immunity or to non-specific activation of lymphocytes, direct cytotoxicity with release of autoantigens and disruption of central T-cell tolerance. The latter hypothesis will be supported by a mouse model in which a reactive metabolite of procainamide introduced into the thymus results in lupus-like autoantibody induction. These findings, as well as evidence for thymic function in drug-induced lupus patients, support the concept that abnormalities during T-cell selection in the thymus initiate autoimmunity.
Topics: Animals; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans; Lupus Erythematosus, Systemic; Lupus Vulgaris; Oxidation-Reduction; Pharmaceutical Preparations; Thymus Gland
PubMed: 15767026
DOI: 10.1016/j.tox.2004.12.025