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Natural Lupus Treatment Ebook by Dr. Gary Levin

Dr. Gary Levin is helping lupus patients with a step-by-step system that rehabilitates your immune system and boosts the bodys natural supporting systems to begin eliminating all lupus symptoms. The healing process of Natural Lupus Treatment is carried out through a simple step-by-step method that rehabilitates your immune system and boosts your supporting body systems to eliminate all lupus symptoms, the joint pains and swelling etc. Actually there is no cure yet discovered for lupus, however, you will find methods to control and manage its signs and symptoms. The aim of the treatments of lupus generally would be to let the patient experience more comfort and lesser pain. Continue reading...

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Acute cutaneous lupus erythematosus

Lesions Face Aids

Acute cutaneous lupus erythematosus (ACLE) usually occurs in association with systemic manifestations preceding by weeks or months the onset of a multisystem disease (Watanabe and Tsuchida, There are localized and generalized manifestations of ACLE (Costner et al., 2003 Fabbri et al., 2003). The localized form commonly presents as the classic malar rash'' or ''butterfly rash'' on the central portion of the face and may only affect the skin transiently. Therefore, at the onset of disease, the patient may mistake this rash for sunburn. It usually begins with small, discrete erythematous macules and papules, occasionally associated with fine scales and gradually becomes confluent and hyperkeratotic. Facial swelling may be severe in some patients with ACLE however, it mostly disappears without scarring and pigmentation (Norden et al., 1993 Yell et al., 1996). Similar lesions have also been found to occur on the forehead, the V-area of the neck, the upper limbs, and the trunk. In addition,...

Photosensitivity in Lupus Erythematosus

Lupus erythematosus (LE) represents an autoimmune disease with great clinical variability in which photosensitivity is a common feature for all forms and subsets. Cutaneous LE lesions often arise in sun-exposed areas and it is well reported and recognized that sun exposure may also exacerbate or induce systemic manifestations of this disease (Dubois and Tuffanelli, 1964 Nived et al., 1993 White and Rosen, 2003). The original concept of photosensitivity in LE dates back to the first description by Cazenave (1851) and early observations since the beginning of the 19th century, where the role of environmental factors were related to disease activity and even induction of the disease. Of the different external factors that have detrimental effects on disease activity, the sun's radiation has been best studied. Hutchinson (1888) reported in his Harveian Lectures on Lupus, that patients with LE did not tolerate the sun. The term ''Lupus erythematosus subacutus'' was first described by Fuhs...

Lupus Erythematosus

A premenstrual exacerbation of the cutaneous manifestations of lupus erythema-tosus (LE) was described in 25 of patients with systemic LE (34) and in 13 to 16 of patients with discoid LE (34,35). There are several indications that estrogen is an important cofactor for the development or exacerbation of LE. This is corroborated by the facts that the disorder affects females predominantly, that it is well known that estrogen-containing oral contraceptives may cause an exacerbation, as well as by the described association of LE with Klinefelter syndrome. In an in vitro study, the administration of estrogen was shown to lead to an upregulation of the binding capacity of antiRo SSA antibodies to keratinocytes (34).

Differential diagnosis

As far as pSS cutaneous involvement is concerned, cutaneous xerosis is an extraordinarily common problem, especially in the elderly, affecting at least 75 of the population aged 64 and older. Moreover, besides from elderly xerosis, pSS xerosis has also to be differentiated from dry skin secondary to underlying malignancy, renal insufficiency, obstructive biliary disease, hypothyroid-ism and idiopathic conditions (Vivino, 2001). Cutaneous vasculitis differential diagnosis includes both secondary vasculitis, due to infective agents, drugs or malignancies, and primary systemic vasculitis (mainly Mixed Crioglobulinaemia) (Gonzalez-Gay et al., 2003). Finally, annular erythema has to be differentiated from sub acute cutaneous lupus erythematosus (Katayama et al., 1991).

Calcineurin inhibitors

Topical tacrolimus is licensed for the treatment of moderate and severe atopic eczema in children (0.03 ) and adults (0.1 ) and, more recently, it has also been applied to other inflammatory dermatoses such as contact dermatitis, erosive lichen ruber planus, steroid-induced rosacea, pyoderma gangrenosum, vitiligo, and psoriasis (Assmann and Ruzicka, 2002 Gupta et al., 2002 Nasr, 2000). In single case reports, topical tacrolimus has also been shown to be effective in treating cutaneous lupus erythematosus (CLE). According to

LEspecific immunomodulation

Handled properly and, instead, localize to organs such as the kidneys. This results in various degrees of cellular proliferation, inflammation, and fibrosis leading in some patients to renal failure. Numerous clinical studies have investigated anti-dsDNA antibodies and their relationship to flare and lupus nephritis. Experiments in mice have confirmed the association between anti-DNA antibodies and lupus nephritis Administration of these antibodies to non-autoimmune mice has been shown to produce nephritis, and transgenic mice expressing a secreted form of an anti-DNA antibody develop lupus nephritis.

Differential diagnosis of papulosquamous SCLE

Lupus Rash Forearms

Chronic cutaneous lupus erythematosus The non-scaling pattern of early CCLE lesion presents as an erythematous plaque, sharply demarcated, with minimal scaling. Lupus tumidus, in which the papular component is predominant, can be considered as an extreme of the spectrum of the non-scaling pattern of CCLE manifestations. The diseases, which we may consider in differential diagnosis with the non-scaling pattern of early CCLE, are polymorphic light eruption, Jessner's benign lymphocytic infiltration of the skin, lympho-cytoma cutis, granuloma faciale, pernio (chilblain), and lupus pernio (sarcoidosis). The same diseases may also be considered in the differential diagnosis with tumid LE. Some CCLE patients may develop chilblain lesions on the extremities that evolve to form characteristic discoid LE (DLE) plaques, with a typical clinical appearance and a diagnostic pathology, for which the term 'chilblain lupus' or 'perniotic LE' has been proposed. This phenomenon might represent a...

Differential diagnosis of localized ACLE

Seborrheic Dermatitis Images Eyebrow

The diseases, which we may consider in the differential diagnosis with localized ACLE, are acne rosacea, contact dermatitis and photodermatitis, seborrheic dermatitis, dermatomyositis, erysipelas, and delusion of lupus. 2.3.7. Delusion of lupus vs ACLE Delusional beliefs of having a butterfly rash occasionally induce some otherwise healthy subjects to ask for a rheumatological consultation (Fig. 6). In these cases, the differential diagnosis is easier than convincing the patient and sometimes the relatives that share the same delusional beliefs. Figure 6. Delusion of lupus slight erythema on the malar areas in a perfectly healthy subject with delusional beliefs. Figure 6. Delusion of lupus slight erythema on the malar areas in a perfectly healthy subject with delusional beliefs. DIF IgM and C3 around blood vessels in the superficial dermis and C3 along the dermo-epidermal junction can be present in erythema multiforme as compared to the lesional lupus band test observed in SLE. In...

Detection of antiphospholipid antibodies aPL in dermatology

Although new tests have become available, determination of lupus anticoagulant LAC and measurement of anticardiolipin antibodies aCL by Alarcon-Segovia, D., Delez , M., Oria, C.V., et al. 1989. Antiphospholipid antibodies and the antiphospholipid syndrome in systemic lupus erythematosus. A prospective analysis of 500 consecutive patients. Medicine 68, 353. Alarcon-Segovia, D., Perez-Vazquez, M.E., Villa, A.R., et al. 1992. Preliminary classification criteria for the antiphospholipid syndrome within systemic lupus erythematosus. Semin. Arthritis Rheum. 21, 275. Asherson, R.A., Derksen, R.H.W.M., Harris, E.N., et al. 1986. Large vessel occlusion and gangrene in systemic lupus ery-thematosus and lupus-like disease a report of 6 cases. J. Rheumatol. 13, 740. systemic lupus erythematosus. Scand. J. Rheumatol. 30, 235. Black, M.M., Hudson, P.M. 1976. Atrophie blanche lesions closely resembling malignant atrophic papulosis (Degos' disease) in systemic lupus erythematosus. Br. J. Dermatol....

Dermatologie aspects of Antiphospholipid Antibody Syndrome

The first definition of the antiphospholipid antibody syndrome (APS) described recurrent arterial and venous thrombosis and miscarriages in association with positive tests for the lupus anticoagulant, antibodies to negatively charged phospholipids (mainly cardiolipin) and to one of the bodies natural anticoagulants, a glycoprotein (B2GP1) (Harris et al., 1987). These remain the leading clinical features of this syndrome although its spectrum has broadened and has been expanded considerably over the last 15 years (Asherson and Cervera, 1992). Among these, a wide variety of dermatologic manifestations have been reported (Table 1) (Frances et al., 1996). Their clinical significance is highly variable and their management depends on their clinical aggressivity and the presence of other APS manifestations requiring therapeutic intervention. was evaluated systematically by the attending physicians and confirmed by a senior dermatologist. Dermatologie manifestations were present in 49 of our...

Diagnostic investigations and differential diagnoses

When cutaneous signs are associated with general symptoms and or other organ or system involvement of vasculitis, differential diagnoses are primarily other systemic diseases, like systemic lupus erythematosus, and secondary vasculitides, attributed to infections, neoplasia, hematologic malignancies or drugs. Indeed, many drugs have been reported to be potential causative agents of vasculitis (Table 5). Differential diagnoses of isolated purpuric lesions are numerous and relatively easy to make (thrombotic and or thrombocytope-nic purpuras idiopathic thrombocytopenic purpura, disseminated intravascular coagulopathy, thrombopathies vascular purpuras, with exclusion of vasculitides Ehlers-Danlos disease, scorbut, amyloidosis, Bateman's purpura, etc.). Embolic or atheromatous thromboses should also be ruled out when confronted with isolated distal necrosis or necrotic purpura. McDuffie's hypo-complementemic urticarial vasculitis is a rare systemic disease, characterized by the presence...

Agents targeting Tcells

Since T-helper cells may contribute directly to cutaneous tissue damage in LE by stimulating both macrophages and cytotoxic, specific inhibition of the T-helper cells using anti-CD4 was considered as a suitable approach to suppress disease activity (Owen and Harrison, 2000). Therefore, a recombinant chimeric CD4 monoclonal antibody (cM-T412) was investigated in clinical trials for its efficacy in the treatment of LE (Prinz et al., 1996). Treatment of five patients with chronic discoid LE including two patients with systemic involvement resulted in an immediate improvement in the skin lesions. Moreover, proteinuria as an index of lupus nephropathy was fully resolved and the antibody was well tolerated. Further controlled clinical trials are required to prove these very promising though preliminary results.

The Skin as an Immunologic Organ

States (e.g., allergic contact dermatitis, lupus erythematosus) thanks to the expression of specific chemokines on the surface of dermal endothelial cells. Dendritic cells are not only involved in the initiation of protective or immunopathologic immune responses, but also in the induction of immune tolerance. A low-grade migration of immature dendritic cells from the skin to the regional lymph nodes may indeed favour the activation of these T regulatory cells (Cavani et al., 2005).

The validation process

And the validation has not been published. In its current form, the instrument measures the degree of disease activity of extra-muscular organ systems and muscle. It is a combined tool that includes the myositis disease activity assessment visual analogue scales (MYOACT) and the myositis intention to treat activity index (MITAX). The MYOACT is modified from the vasculitis activity index (VAI) (Whiting-O'Keefe et al., 1999). The VAI grades nine presentations of vasculitis on a visual analogue scale, while the MYOACT grades the activity of a variety of signs and symptoms of myositis, among them the skin, on a 10-cm visual analogue scale. The other component of the assessment of each element of activity in the MDAAT is the MITAX. The MITAX is modified from the British Isle Lupus Assessment Group (BILAG) approach to assess disease activity in lupus (Hay et al., 1993). The MITAX is composed of a series of organ-specific questions relating to the presence or absence of the clinical feature...

Riccardo Rondinonea Stefania Banob Luca Iaccarinoa Andrea Doriaa

Lupus erythematosus (LE) is a multisystemic autoimmune disease that can occur with a wide spectrum of clinical manifestations. The skin is frequently involved, either as an isolated finding, i.e. when no other sign or symptom of systemic involvement can be disclosed, or as a part of a complex syndrome with multiple organ involvement. 2. Acute cutaneous lupus erythematosus

Clinical manifestations

Dermatomyositis occurs in both children and adults. It is a distinct clinical entity identified by a characteristic rash accompanying or, more often, preceding the muscle weakness. The skin manifestations include a heliotrope rash (blue-purple discoloration) on the upper eyelids with edema, a flat red rash on the face and upper trunk, and erythema of the knuckles with a raised violaceous scaly eruption (Gottron rash) (Dalakas 1990, 1991 Karpati and Carpenter, 1993 Engel et al., 1994 Dalakas and Hohlfeld, 2003). The initial erythematous lesions may result in scaling of the skin accompanied by pigmentation and depigmentation, giving at times a shiny appearance. In contrast to systemic lupus erythematosus, in which the phalanges are involved and the knuckles are spared, the erythema of DM spares the phalanges. The erythematous rash can also occur on other body surfaces, including the knees, elbows, malleoli, neck, and anterior chest (often in a V sign), or back and shoulders (shawl...

Other biological compounds

CTLA-4 is expressed on the surface of a subpopulation of activated T-lymphocytes and binds with high affinity to molecules of the B7 family that are present on B-cells and antigen-presenting cells. CTLA-4Ig is a fusion protein of the extracellular domain of CTLA-4 with the Fc portion of IgG1, which serves as a soluble receptor. Therefore, this molecule prevents CTLA-4 B7 interaction by blocking T-cell activation and T-cell-dependent B-cell functions in vivo. In animal studies, treatment of NZB W mice resulted in an improved survival rate as well as regression of nephritis (Finck et al., 1994). Clinical studies with CTLA-4Ig in patients with lupus nephritis are being initiated and one compound (BMS-188667) currently is investigated in clinical trials for patients with RA and psoriasis. Preliminary data indicate that treatment with CTLA-4 Ig appears to be an effective therapy for psoriasis and atopic eczema (Abrams et al., 1999 Najafian and Sayegh, 2000 Davenport et al., 2002 Davidson...

Separate measurements of disease activity and damage

The validation of the CLASI is described in detail elsewhere (Albrecht et al., 2005). This process has confirmed content validity. Construct validity is assessed by comparing the instrument to the other outcome instruments for cutaneous lupus. These do not exist, but the measures used in the SLE instruments available correlate with the CLASI. We did not assess criterion validity because the reason for the development of the instrument was that there was no measurement available. Reliability studies demonstrated an intraclass correlation coefficient (ICC) for inter-rater reliability of 0.86 for the activity score 95 confidence interval (CI) 0.73-0.99 and of 0.92 for the damage score (95 CI 0.85-1.00). The Spearman's Rho for in-tra-rater reliability for the activity score was 0.96 Select the score in each anatomical location that describes the most severely affected cutaneous lupus-associated lesion Albrecht, J., Taylor, L., Berlin, J., et al. 2005. The CLASI (Cutaneous LE Disease Area...

Prevalenceepidemiology

The etiology of SSc still remains obscure. Certain features like lymphocytic infiltration in the skin, antinuclear antibodies, and the occurrence of overlap syndromes with lupus erythematodes, der-matomyositis or Sjogren's syndrome point toward an autoimmune pathogenesis. Several disease models hypothesize, that genetically predisposed

Mycophenolate mofetil

Mycophenolate mofetil (MMF) was initially evaluated in RA and several years later also licensed for the treatment of organ transplantation. Because MMF inhibits specifically T- and B-lymphocyte proliferation by interfering with the inosine monophosphate dehydrogenase, it has emerged as an alternative in SLE mainly for patients refractory to other treatments. The growing interest on MMF in SLE is reflected by a supplement of the journal 'Lupus' to this drug (Hughes and D'Cruz, 2005). In recent years, MMF is mostly described for the treatment of lupus nephritis. Chan et al. (2004) reported a comparable response to oral cyclophosphamide however, long-term follow-up of the small number of patients indicated a high number of relapses. The still not fully published study comparing MMF with the protocol of the National Institute of Health by Ginzler et al. (2003) indicates a higher remission rate using MMF in type III-V lupus nephritis over 6 months. Unfortunately, follow-up data of this...

Ciclosporin A

One of the first new immunosuppressive agents was ciclosporin (CSA), which is licensed and mostly used in organ transplantation. Although CSA has shown promising results in various diseases with disturbed immunoregulation, controlled studies in SLE are limited after nearly 20 years of experience. In open labelled trials, CSA is mostly well tolerated and reasons for discontinuation are side effects, such as hypertension, tremor, and ne-phrotoxicity. However, in lupus nephritis the antiprotein uric effect of CSA seems to be favourable, especially in type V nephritis. The largest and longest experience in lupus nephritis is documented by Dostal et al. (1998) reporting a clear reduction in proteinuria and disease activity with a complete remission in 5 of 11 patients of a group suffering mostly from nephrotic syndrome. The same authors presented data of response to CSA in patients with lupus nephritis refractory to cyclophosphamide and showed similar renal outcome comparing both drugs in...

Richard D Sontheimer

In the 1960-1970s, the study of human lupus ery-thematosus (LE) was undergoing a revolution resulting from the description and characterization of various autoantibody-autoantigen systems as disease markers (e.g., Ro SS-A, La SS-B, U1RNP, Sm).1 That such autoantibody systems were found to be associated with specific clinical features of LE and associated rheumatic diseases led to the idea of subsetting LE patients on the basis of shared clinical, pathological, laboratory, and immunogenetic findings (Urowitz, 1977 Provost, 1979). Today, sub-phenotyping would be a more modern designation for the exercise of ''sub-setting'' (Stewart, 2002). One example would be the increased risk of lupus nephritis in LE patients found to have high levels of double-stranded DNA autoantibody and low levels of complement (C3, C4, CH-50). Another example would be mixed connective tissue disease In the early 1970s, Dr. James N. Gilliam in the Divisions of Dermatology and Rheumatology at UT Southwestern...

Diagnosis

Localization and features of cutaneous lesions associated with joints and gastro-intestinal symptoms are very suggestive of HSP diagnosis. However, several other forms of leucocytoclastic vasculitis such as acute infantile haemorragic oedema (AIHE), hypersensitivity vasculitis, lupus erythe-matosus (LE), Wegener's disease and microscopic polyangiitis (MPA) can have a similar clinical presentation. None of the circulating IgA abnormalities described above are specific or constant. If specific immunological serological parameters can be used to differentiate HSP from LE, Wegener's disease and MPA, this is not the case for hyper-sensitivity vasculitis and AIHE. The AIHE is a rare cutaneous leucocytoclastic vasculitis generally without IgA deposits, clinically characterized by a symptom triad of fever, large purpuric skin lesions and oedema of hands, feet and face and taking place before the age of two (Caksen et al., 2002). It is a benign condition, which is confined to the skin and...

Deoxyspergualin

Deoxyspergualin (DSG) is a synthetic derivate of spergualin, originally isolated from Bacillus later-osporus, and licensed for reverse graft rejection in some countries. It is proven to be effective in animal models, such as experimental autoimmune encephalomyelitis and murine lupus. The precise mode of action is not known, but in vitro-studies indicate blocking of cell cycle progression in effector T cells following antigen stimulation and inhibition in the production of interferon gamma. Experiences in humans are limited and, in a few patients with primary vasculitis, DSG exhibited promising results. Actually, DSG is tested in a phase II III trial in moderate SLE.

CTL4Ig

Furthermore, abatacept was successfully applied to various lupus mouse models resulting in an improvement of survival and proteinuria however, data of patients with SLE are missing. A phase II trail is ongoing. Another costimulatory molecule, CD137, was successfully blocked in murine lupus models, and anti-CD80 (anti-B7) showed a moderate effect in treating patients with psoriasis.

Pathogenesis

Activation of complement induces the release of cytokines and chemokines, which, in turn, upreg-ulate the expression VCAM-I and ICAM-I on the endothelial cells (Stein and Dalakas, 1993). These molecules serve as ligands for the integrins VLA-4, LFA-I, and Mac-I expressed on T cells and facilitate their exit through the blood vessel wall to the perimysial and endomysial spaces. Various che-mokines have been upregulated at the protein and mRNA level (De Bleecker et al., 2002 Raju et al., 2003 Confalonieri et al., 2000). Immunophenoty-pic analysis of the lymphocytic infiltrates demonstrates B cells, CD4+ cells and plasmacytoid and dendritic cells in the perimysial and perivascular regions, supporting the view that a humoralmediated mechanism plays the major role in the disease. Other molecules upregulated in DM include TGF-beta (Amemiya et al., 2000) and (in the perifascicular regions) the cathepsins and STAT-I, probably triggered by interferon-gamma (Gallardo et al., 2001). After...

Selection and Interpretation of Laboratory Results

Antinuclear antibody and anti-DNA antibody titers are obtained to screen for collagen vascular disease, usually lupus. Low serum C4 concentrations reflect activation of the classical complement pathway, and C3 is decreased when either the classical or alternative pathway is activated. Such activation is most common in lupus or membranoproliferative

Project Title Fine Specificity Of Scleroderma Autoantibodies

Progressive fibrosis of specific target organs, such as the skin, lung, heart, gastrointestinal tract, and kidney. Although the underlying pathophysiology of this disorder remains an enigma, the presence of antinuclear antibodies in scleroderma patients is nearly universal. Targets of these autoantibodies include topoisomerase 1 (Scl-70), nuclear ribonucleoproteins (nRNP), centromere, PM-Scl, and Ku. Anti-topoisomerase-1 (topo-1) autoantibodies are quite specific for scleroderma. and are present in precipitating levels in 20-40 of patients. Anti-topo 1 is associated with diffuse skin thickening, lung involvement, and the development of lung, colon, and brain cancer. Scleroderma patients with anti-nRNP autoantibodies may have a more cutaneous form of the disease and universally suffer from Raynaud's phenomenon. Over the past decade we have extensively characterized the immunochemistry of lupus autoantigens. These previous studies provide the technical background for this proposal....

Cigarettes and the brain

Doctors usually diagnose the condition by excluding other illnesses with similar symptoms. As yet, there is no indicator or diagnostic test that can clearly identify the disorder. Overlapping symptoms can occur with several diseases, such as fibromyalgia, Gulf War illnesses, and multiple chemical sensitivities. Lupus, hypothyroidism, and Lyme disease also have similar symptoms and will need to be ruled out when making a diagnosis.

Cyclobut G See lobucavir

Cyclophosphamide (CY) An immunosuppressive drug that at high doses has been used in cancer chemotherapy regimens. In low doses, the drug has well-documented immunomodulatory properties and has been used to treat several immune disorders, including lupus and Wegener's granulomato-sis. In people with HIV, cyclosphosphamide is most commonly used in combination therapy for AIDS-related lymphoma. CY has a greater suppressive effect on b cells than on t cells, and CD8 cells are more sensitive to the drug than other T cell subsets.

Solute carrier family 22 organic cation transporter member 4 SLC22A4 and member 5 SLC22A5

As with PADI4, we initially identified RA-associated SNPs in a LD segment containing SLC22A4 and SLC22A5. Further dense-LD mapping identified RA-associated SNPs (OR 2.0) in the intronic region of SLC22A4 that disrupts the RUNX1-binding sequence 14 . Allele-specific effects of RUNX1 binding on SLC22A4 expression seem to produce RA-susceptibility as in the case with PDCD1 for systemic lupus erythematosus 47 and SLC9A3R1 or NAT9 for psoriasis 48, 49 .

Suicide and Medical Disorders

Medical disorders associated with an elevated risk of suicide are AIDS, cancer (especially head and neck), Huntington disease, multiple sclerosis, peptic ulcer disease, end-stage renal disease, spinal cord injury, and systemic lupus erythematosus. Any serious medical illness can raise the risk of suicide in elderly Caucasian men. In most cases, suicide in the context of a medical disorder occurs in conjunction with a depressive disorder or a history of alcohol abuse, or both.

Physiopathology and Risk Factors

Nella occurs, but they are not directly risk factors of en-dovascular infection such as aortitis. They are immunodeficiency, hypoacidity and gastric atrophy, long course antacid treatment, deterioration of endogenous digestive flora, extreme age, underlying malignancy, rheumato-logic inflammatory diseases and lupus erythematosus HIV infection with AIDS 76, 81 . In the new-born babies and in patients suffering from AIDS, which are two situations with risk of nontyphoid Salmonella bactere-mia, endovascular infection never occurs because of the lack of the primordial risk factor of vascular attack, which is atherosclerosis.

Young Woman with Postpartum Cerebral Venous Thrombosis and Abnormal Coagulation Tests

Lupus anticoagulant testing However, 10 weeks later, the patient presented with pleuritic chest pain. A spiral computed tomography scan and a ventilation-perfusion scan were indicative of pulmonary embolism. Admission laboratory studies showed that the PT-INR was not therapeutic (1.4), the aPTT remained prolonged, and the Staclot-LA test remained abnormal with a A value of 20.6 s (normal less than 9 s) indicative of the persistence of a lupus anticoagulant.

The Antiphospholipid Syndrome

Primary antiphospholipid syndrome refers to patients with the syndrome who do not have any other rheumatological or autoimmune conditions such as lupus erythematosus. Associated (but not defining) conditions include thrombocytopenia, vasculitic rashes, arthralgias, dermal necrosis of digits, livedo reticularis, and pulmonary hypertension. A thrombotic cause of these additional manifestations is unlikely since anticoagulant treatment does not result in a remission of these complaints. The presence of APL antibodies can be detected by either a phospholipid-dependent prolongation of a coagulation test lupus anticoagulant (LAC) or as anticardiolipin antibodies (ACA) in a b2-glycoprotein I (b2-GPI)-dependent enzyme-linked immunosorbent assay (ELISA). LAC activity and ACA are closely related but not identical. Patients should be tested with both types of assays (immunologic and clot-based) to rule out the diagnosis of antiphospholipid syndrome in a patient with a clinical presentation...

Diagnosis of Antiphospholipid Syndrome

Criteria for the definite diagnosis of APS were agreed on at an international workshop in 1999 and recently updated in 2005. These Sapporo criteria require at least one clinical criterium (vascular thrombosis or pregnancy-related morbidity (see Table 63.1) and one laboratory criterion (anticardiolipin antibodies isotype IgG or IgM at moderate or high levels, i.e., greater than 20 GPL or MPL units or a lupus anticoagulant (see Table 63.2). on two or more occasions separated by at least 12 weeks Lupus anticoagulant detected in the blood on two or more occasions separated by at least 6 weeks International Society of Thrombosis and Haemostasis criteria for lupus anticoagulant include Prolongation of a phospholipid dependent screening assay (e.g., aPTT, dilute prothrombin time,

Treatment of Antiphospholipid Antibody Syndrome

The optimal duration of anticoagulation for prevention of recurrent thrombosis in patients with APL antibodies is unknown. The risk of recurrence appears to peak in the first 6 months after discontinuation of anticoagulation, and is higher for patients with antiphospholipid antibodies compared to patients who are antibody-negative. Retrospective studies report recurrence rates as high as 53-69 . Therefore, the general consensus is to anticoagulate patients with APS and venous thrombosis indefinitely. It is unknown whether anticoagulation can be discontinued in patients whose lupus anticoagulant and or ACA testing has become negative, or if the only laboratory finding is a persistent low-titer ACA. Therefore, indefinite anticoagulation is recommended.

Pathophysiology Of

Occasional coexistence of pancreatitis with other autoimmune diseases suggests that there may be common target antigens in the pancreas and other exocrine organs such as the salivary gland, biliary tract, and renal tubules. We observed that several autoantibodies such as antinuclear antibody (ANA), antilactoferrin antibody (ALF), anticarbonic anhydrase-II antibody (ACA-II), rheumatoid factor, and antismooth muscle antibody were frequently detected in patients with AIP. LF, a nonenzymatic protein, is also detected in the various human tissues, including the lactating breast bronchial, salivary, and gastric glands and the pancreatic acinus.19 The high prevalence of these antibodies suggests that CA-II and LF may be the candidates for the target antigens in AIP. However, it is noted that these antibodies are not necessarily specific for AIP because ACA-II can be detected in some patients with SjS or systemic lupus erythematosus and ALF in ulcerative colitis or PSC.

Woman with a Rash and Lower Extremity Pain

The patient developed anorexia and lower extremity pain with weakness, nausea, and vomiting over the next week. On presentation to the emergency room, she also complained of fatigue, suprapubic pain, and fullness. The history was remarkable for frequent urinary tract infections over the prior 6 months, but no prior chronic health issues, surgeries, or pregnancies. Placement of a urinary catheter produced 1 L of clear output she was thus admitted with urinary retention and severe pain of the lower extremities. Further questioning revealed that the patient was involved in a long-term monogamous relationship (which included unprotected intercourse), that she had a cousin with lupus, that she smokes a pack per day, and that she had no known drug allergies. The admitting hospitalist consulted a rheumatologist for a possible diagnosis of systemic lupus erythematosus. Review of the patient's history and physical examination by the rheumatologist found that she had no evidence of current or...

Myositis and Myopathy

Hydroxychloroquine and chloroquine, anti-malarial drugs that are also used to treat systemic lupus erythematosus and RA, can rarely cause muscle disease, but this is not usually associated with much inflammation. The commonest symptom is weakness affecting proximal muscles such as the thigh and shoulder, without elevation of muscle enzymes. Even less common is inflammation of the muscles of the heart, cardiomyopathy, which if severe can cause heart failure.

Neuropsychological Dissociations Between Visual Working Memory And Spatial Working Memory

Corsi Block

The dissociation between visual- and location movement-based working memory gains support from the patterns of impairment observed in a number of individual case studies. Farah et al. (1988) reported patient L.H. who, as a result of a closed head injury in an automobile accident, suffered damage in both temporal occipital areas, in the right temporal lobe and in the right inferior frontal lobe. He performed well on tasks concerned with memory for locations and for pathways, such as letter rotation, 3-D form rotation, mental scanning, and recalling a recently described pathway, but was severely impaired in his ability to remember colours, the relative size of objects and shapes of States in the map of the USA. A similar case was reported more recently by Wilson et al. (1999). Their patient, L.E., was a professional sculptress who, following systemic lupus erythematosus, resulting in diffuse damage to both the cortex and the white matter, was unable to generate visual images of possible...

Genetic Susceptibilities And Resistance To Toxicants

Genetic susceptibilities exist to the chemically induced adverse effects of ultraviolet radiation and visible light, a condition known as photosensitivity. Porphyria, an abnormal extreme sensitivity to sunlight, can result from chemical exposure in genetically susceptible individuals. Lupus erythematosus, a heritable disease manifested by red, scaly skin patches, is characterized by abnormal sensitivity to ultraviolet radiation. Porphyrias in genetically susceptible individuals, which can be induced by chemicals such as hexachlorobenzene and dioxin, occur through the malfunction of enzymes involved in producing the porphyrin heme used in hemoglobin. This results in the accumulation of porphyrin precursors in the skin. Exposed to ultraviolet light at 400 to 410 nm, these precursors reach excited states (see Chapter 2), which may generate damaging free radicals through interaction with cellular macromolecules and O2. Phototoxicity can also be caused by xenobiotic substances either...

Definition of the Disease

Systemic lupus erythematosus is a chronic, inflammatory, often multisystem disorder characterized by humoral autoimmunity. Specific autoantibodies gradually accumulate for years prior to the onset of clinical disease,2 which reinforces data showing an increase in the concentration of autoantibodies as well as their epitope specificity preceding the diagnosis of SLE. Indeed, while self-reactive antibodies may be relatively common in the population, the prevailing wisdom indicates that antibodies must mature in their affinity for self-antigens before assuming a pathogenic role. The mechanisms responsible for systemic lupus erythematosus have not been well articulated, but likely represent a complex interplay of genetic and environmental factors that ultimately result in disease-causing autoantibodies. Recent studies report that lupus patients have elevated blood levels of interferon a (IFN-a), suggesting that this cytokine may be a component of the disease mechanism, and or a response...

Lung inflammation Pneumonia

Lupus anticoagulant An acquired coagulation inhibitor first noticed in patients with systemic lupus erythematosus but since found in association with other immune disorders, including HIV. It is typically silent, meaning it does not effect illnesses at all, but it may on occasion, paradoxically, cause excessive clotting.

Acquired Hypercoagulable Disorders

Lupus Anticoagulant Antiphospholipid Antibody Syndrome The term antiphospholipid syndrome was developed to describe the clinical manifestations of a hypercoagulable state associated with antiphospholipid antibodies. The most commonly identified antiphospholipid antibodies are lupus anticoagulant, anti-cardiolipin antibody, and anti-P2-glycoprotein I antibodies.21 This syndrome is divided into primary and secondary syndromes. The primary syndrome occurs in patients without associated autoimmune disorders and the secondary syndromes occur in patients with systemic lupus erythematosus and or other autoimmune disorders. The procoagulant effects of the antiphospholipid antibodies leading to thrombosis include inhibition of the activated protein C pathway, inhibition of antithrombin activity, inhibition of anticoagulant activity of P2-glycoprotein I, inhibition of fibrinolysis, potentiation of platelet activation, and enhanced platelet activation, among others.8,21 Antiphospholipid...

Transcutaneous immunization

The skin performs a complex defense function that may be described as immunological. The immunological environment of the skin, including the humoral and cellular components, is given the acronym SIS (skin immune system). Dysregulations of this system can manifest as immunodermatolog-ical diseases, including atopic eczema, psoriasis, cutaneous lupus erythematosus, scleroderma, and autoimmune bullous disease.40-42

Clinical Findings

Nephrotic patients should be evaluated for a skin rash, which would raise the possibility of collagen vascular diseases such as systemic lupus erythematosus, and also for fever, which would suggest that the patient may have either renal inflammation or intercurrent infection. Nephrotic patients are susceptible to bacterial infections, mostly pneumococcal, including otitis, pneumonia, or primary peritonitis (the latter is more common in children). The absence of fever, especially after initiation of corticosteroid treatment, does not rule out infection.

Neuroimmunology

Specialists in neuroimmunology concentrate on patients with autoimmune neurologic disease, particularly multiple sclerosis. According to the AAN, roughly 350,000 to 500,000 people suffer from multiple sclerosis in the United States. The neuroimmunologist also evaluates and treats patient with other autoimmune neurologic problems, such as myasthenia gravis, lupus, and Sjogren disease. Due to the complexity of these diseases, neuroimmunologists are also knowledgeable in their complications, including depression, psychosis, spasticity, incontinence, sexual dysfunction, and pain.

Lockjaw See tetanus

Lupus An autoimmune disease in which a person's immune system mistakenly works against the body's own tissues. Systemic lupus erythematosus (SLE), the most common type of lupus, typically develops during the 20s, 30s, or 40s mbut about 15 percent to 17 percent of people with systemic lupus first notice symptoms during childhood or adolescence. Most of these are children 10 years or older it is extremely rare in children under five. Experts estimate that between 5,000 and 10,000 children in the United States have SLE. Children diagnosed with lupus often have been ill for a longer period and are more likely to have significant internal organ involvement than most adults with lupus. This may be because many children are not recognized as having early lupus until the disease has become worse. As a result children with lupus often are required to begin aggressive therapy soon after diagnosis. While lupus can be a severe and life-threatening disease, many children with lupus will do very...

Nephritic Syndrome

Rapidly progressive glomerulonephritis (RPGN) is a clinical syndrome with many causes. These may be divided into three groups postinfectious RPGN, RPGN associated with systemic disease, and idiopathic RPGN. The most common form occurring after infection is poststreptococcal. Common systemic diseases associated with RPGN include systemic lupus erythematosus, Wegener's granulomatosis, vasculitis, and Goodpasture's syndrome.1 The pulmonary findings of linear fluorescence along alveolar basement membranes confirm that this patient had Goodpasture's syndrome. Goodpasture's syndrome is associated with antibodies to a component of the a3 chain of type IV collagen preferentially expressed in basement membranes of pulmonary alveoli and renal glomeruli.2,3 This antibody explains the clinical picture of RPGN with associated pulmonary hemorrhage. In both organs there is an acute necrotizing inflammatory lesion resulting in loss of basement membrane integrity with subsequent hemorrhage.

Common descent

Dogs and wolves, for example, are different species because they are reproductively isolated, but they have countless other features in common and for this are classified in the same genus Canis (Canis familiaris and Canis lupus). In the same way, tigers and lions are two species of the genus Panthera (Panthera tigris and Panthera leo), as polar bears and grizzly bears are different species of the genus Ursus. Tigers and domestic cats, on the other hand, cannot be put in the same genus, but still have so many characters in common that they are classified, together with lions, in a single family (the Felidae). species tigris leo domesticus familiariaris lupus arctos maritimus melanoleuca species tigris leo domesticus familiariaris lupus arctos maritimus melanoleuca

Metabolic Disorders

Several other disorders of lipid metabolism have been reported that can lead to chylomicronemia or hypertriglyceridemia and are independent of the lipoprotein lipase system. They represent a significant risk factor for the development of pancreatitis when plasma triglyceride levels rise above 2000 mg dl. The incidence of such disorders is even higher than that of disorders in the lipoprotein lipase system and additional factors such as drug therapies including glucocorticoids, estrogens, diuretics or beta-adrenergic blockers, and also alcohol abuse or diabetes mellitus can contribute to a further increase of hypertriglyceridemia above the threshold level for developing pancreatitis. The most common familial disorders associated with chylomicronemia are Type I and Type V hyperlipopro-teinemias (according to Levy and Fredrickson) that comprise a diverse family of disorders with moderate to severe hypertriglyceridemia.8 A predisposition for increased plasma lipids is also found in...

Antimony

The alchemists were always fascinated by antimony and one of their names for the metal, which they obtained by heating stibnite with iron powder, was regulus (king) of antimony or martial regulus (king of Mars) implying an impure form of regal gold. Needless to say, they never achieved their objective of converting one into the other, but the spin-off from their researches greatly added to the store of knowledge about antimony. The alchemists had another name for antimony, lupus metallorum (wolf of metals), based on its remarkable ability to alloy with other metals and change their character. The alchemists were probably the first to discover butter of antimony, which they got by heating the metal with corrosive sublimate. They purified the product and then heated it in a sealed vessel for several

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