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Author: Martina Frodlund
Publisher: Linköping University Electronic Press
ISBN: 9179298958
Category : Electronic books
Languages : en
Pages : 80
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Book Description
Systemic lupus erythematosus (SLE) has an exceptionally heterogeneous clinical spectrum, ranging from mild disease limited to skin and joints to severe manifestations with renal disorder, central nervous system disease, severe cytopenias and thromboembolic events. Important clinical challenges include the prediction of disease flares and the identification of individuals that are likely to evolve severe disease with accrual of organ damage and worse prognosis. Autoantibodies, i.e. antinuclear antibodies (ANA) and antiphospholipid antibodies (aPL), and interferon alpha (IFN-?) that contribute to formation of immune complexes with nuclear antigens, are hallmarks considered to drive the disease in a vicious circle of antigen exposure, autoantibody production, inflammation and organ damage. There are few good biomarkers to predict severe SLE and organ damage. The aim of this PhD project was thus to increase the knowledge regarding ANA as well as aPL, and other potential biomarkers in relation to clinical features and disease outcomes in SLE. As expected, we found that the homogeneous ANA staining pattern was most common, and that it was associated with the occurrence of the ‘immunological disorder’ criterion. Speckled ANA was the second most common staining pattern, and it was inversely associated with arthritis, the ‘immunological disorder’ criterion and organ damage (Paper I). We also demonstrated that a considerable proportion of the patients lost ANA-positivity over time, whereas consistent staining patterns were most frequent (Paper V). Survival of patients with SLE has improved. Yet, in comparison to the general population, irreversible organ damage and increased mortality remains a critical concern. In Paper II, our cross-sectional analysis showed that more than a quarter of the patients had any aPL isotype (IgG, IgM or IgA class), and 14% were classified with antiphospholipid antibody syndrome (APS). A positive lupus anticoagulant (LA) test and/or IgG aPL tests were associated with most APS-related events and organ damage. Lupus nephritis, tobacco smoking, LA-positivity and the use of statins and/or corticosteroids were strongly associated with damage accrual, while hydroxychloroquine seemed to be protective. IgA aPL was not uncommon (16%) in Swedish cases of SLE, and analysis of IgA aPL may add information among clinically suspected APS-patients testing negative for LA and other aPL isotypes. Despite modern management and tax-funded health care with universal access, almost two thirds of the patients accrued organ damage over time, and the main causes of death were identified as malignancy, infection, and cardiovascular disease. We could confirm well established risk factors for organ damage such as APS, hypertension, and/or the use of corticosteroids, but we also observed that other factors such as pericarditis, haemolytic anaemia, lymphopenia and myositis seems to be of importance in this view (Paper IV). We also demonstrated that levels of the extracellular matrix protein osteopontin (OPN) was correlated with disease activity in patients with recent-onset SLE. In addition, OPN levels reflected global organ damage and were associated with APS and could have potential as a valuable biomarker in SLE (Paper III). Additional studies are warranted to further establish the clinical and mechanistic relevance of ANA seroconversion, OPN, as well as the importance of IgA aPL. Vigilance for malignancies, a restricted use of corticosteroids and prevention of cardiovascular disease and APS events are among modifiable factors to prevent organ damage and premature mortality. This thesis emphasizes the importance of autoantibodies in the pathogenesis, and diagnosis, of SLE. The autoantibody profile can be of great importance for tailored therapy in order to minimize the risk of organ damage accrual, morbidity as well as mortality.
Author: Martina Frodlund
Publisher: Linköping University Electronic Press
ISBN: 9179298958
Category : Electronic books
Languages : en
Pages : 80
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Book Description
Systemic lupus erythematosus (SLE) has an exceptionally heterogeneous clinical spectrum, ranging from mild disease limited to skin and joints to severe manifestations with renal disorder, central nervous system disease, severe cytopenias and thromboembolic events. Important clinical challenges include the prediction of disease flares and the identification of individuals that are likely to evolve severe disease with accrual of organ damage and worse prognosis. Autoantibodies, i.e. antinuclear antibodies (ANA) and antiphospholipid antibodies (aPL), and interferon alpha (IFN-?) that contribute to formation of immune complexes with nuclear antigens, are hallmarks considered to drive the disease in a vicious circle of antigen exposure, autoantibody production, inflammation and organ damage. There are few good biomarkers to predict severe SLE and organ damage. The aim of this PhD project was thus to increase the knowledge regarding ANA as well as aPL, and other potential biomarkers in relation to clinical features and disease outcomes in SLE. As expected, we found that the homogeneous ANA staining pattern was most common, and that it was associated with the occurrence of the ‘immunological disorder’ criterion. Speckled ANA was the second most common staining pattern, and it was inversely associated with arthritis, the ‘immunological disorder’ criterion and organ damage (Paper I). We also demonstrated that a considerable proportion of the patients lost ANA-positivity over time, whereas consistent staining patterns were most frequent (Paper V). Survival of patients with SLE has improved. Yet, in comparison to the general population, irreversible organ damage and increased mortality remains a critical concern. In Paper II, our cross-sectional analysis showed that more than a quarter of the patients had any aPL isotype (IgG, IgM or IgA class), and 14% were classified with antiphospholipid antibody syndrome (APS). A positive lupus anticoagulant (LA) test and/or IgG aPL tests were associated with most APS-related events and organ damage. Lupus nephritis, tobacco smoking, LA-positivity and the use of statins and/or corticosteroids were strongly associated with damage accrual, while hydroxychloroquine seemed to be protective. IgA aPL was not uncommon (16%) in Swedish cases of SLE, and analysis of IgA aPL may add information among clinically suspected APS-patients testing negative for LA and other aPL isotypes. Despite modern management and tax-funded health care with universal access, almost two thirds of the patients accrued organ damage over time, and the main causes of death were identified as malignancy, infection, and cardiovascular disease. We could confirm well established risk factors for organ damage such as APS, hypertension, and/or the use of corticosteroids, but we also observed that other factors such as pericarditis, haemolytic anaemia, lymphopenia and myositis seems to be of importance in this view (Paper IV). We also demonstrated that levels of the extracellular matrix protein osteopontin (OPN) was correlated with disease activity in patients with recent-onset SLE. In addition, OPN levels reflected global organ damage and were associated with APS and could have potential as a valuable biomarker in SLE (Paper III). Additional studies are warranted to further establish the clinical and mechanistic relevance of ANA seroconversion, OPN, as well as the importance of IgA aPL. Vigilance for malignancies, a restricted use of corticosteroids and prevention of cardiovascular disease and APS events are among modifiable factors to prevent organ damage and premature mortality. This thesis emphasizes the importance of autoantibodies in the pathogenesis, and diagnosis, of SLE. The autoantibody profile can be of great importance for tailored therapy in order to minimize the risk of organ damage accrual, morbidity as well as mortality.
Author: Caroline Gordon
Publisher: Oxford University Press
ISBN: 0191059706
Category : Medical
Languages : en
Pages : 195
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Book Description
Systemic Lupus Erythematosus (often abbreviated to SLE or lupus) is a systemic autoimmune disease that can affect any part of the body, causing the immune system to attack the body's cells and tissue, and resulting in inflammation and tissue damage. This new addition to the Oxford Rheumatology Library series provides a practical approach to the assessment and management of patients with this complex, multisystem autoimmune disease to improve the diagnosis and treatment of the disease and its complications. It provides comprehensive but easy to assimilate reading for consultant rheumatologists, dermatologists, nephrologists, obstetricians and other specialists and their trainees, interested GPs, specialist nurses, and clinical trial teams both in hospitals and contract research organizations.
Author: Peter H. Schur
Publisher: Lippincott Williams & Wilkins
ISBN:
Category : Medical
Languages : en
Pages : 312
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Book Description
This volume is designed to provide clinicians with practical guidance on the diagnosis and management of systemic lupus erythematosus. Revised and updated to reflect diagnostic and therapeutic advances, the book offers advice on the day-to-day care of patients with the varied manifestations of this disease.
Author: Peter H. Schur
Publisher: Springer Science & Business Media
ISBN: 1461411890
Category : Medical
Languages : en
Pages : 266
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Book Description
Often considered the prototypic autoimmune disease, Lupus is characterized by protean manifestations and affects a wide range of organ systems. Despite widespread availability of anti nuclear antibody testing and other technological diagnostic advances, the diagnosis of lupus can be elusive, difficult, and inexact. Treatment of the disease can also be challenging. Advances in immunology and biotechnology have led to a burgeoning world of new therapies in development that offer patients the real possibility of new therapies and physicians and scientists novel insights into the pathogenesis of this complicated immunological disease. Lupus Erythematosus: Clinical Evaluation and Treatment summarizes the clinical aspects of lupus facing the general clinician in the 21st century. In this invaluable, practical book, the reader will find introductory chapters regarding general diagnostic and treatment principles, followed by chapters addressing the lupus-specific organ manifestations. Special topics regarding pregnancy and comorbidities are also presented. Written by highly experienced physicians with special expertise in lupus, Lupus Erythematosus: Clinical Evaluation and Treatment is an indispensable reference for the common and not so common problems affecting patients with lupus.
Author: Rohini Handa
Publisher: Springer Nature
ISBN: 9813348852
Category : Medical
Languages : en
Pages : 259
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Book Description
Clinical Rheumatology is a book written by a clinician for clinicians. It covers all the essential clinical aspects of Rheumatology in an engaging, clear, and concise manner, thereby fulfilling an unmet need. The focus of this book is to cover clinically pertinent and practically relevant issues while pruning unnecessary detail. Patient photographs, tables, and boxes enhance readability. The bedside clinical and investigative approach is discussed in a lucid fashion illustrated by clinical photographs, flowcharts, and algorithms. The evidence-based treatment is spelt out in an easy to comprehend fashion. Key messages have been listed at the beginning of each chapter. The book is intended for undergraduate and postgraduate medical students, residents, fellows, and clinicians who want to gain practical knowledge and clinical insight into rheumatic diseases. The book is likely to appeal to internists, rheumatologists, physiatrists, physiotherapists, occupational therapists, as well as orthopaedic surgeons. They will find their day to day questions answered in a knowledge format that can be applied straight away. Senior clinicians will find it a ready reckoner and a handy manual to refresh and update their knowledge. Basic scientists will find it useful to gain clinical insight into the rheumatic diseases they research without being intimidated by the size of the text. Teachers will find it full of helpful teaching messages. Clinical Rheumatology is a must-have book for all those who deal with rheumatic musculoskeletal diseases.
Author: Udi Nussinovitch
Publisher: Academic Press
ISBN: 0128032685
Category : Medical
Languages : en
Pages : 768
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Book Description
The prevalence of autoimmune diseases and rheumatic conditions is constantly increasing. Autoimmune diseases affect approximately 7-10% of the population of the United States, while more than 50,000,000 American adults suffer from some type of arthritis. The Heart in Rheumatic, Autoimmune and Inflammatory Diseases examines the complex mechanisms relating to cardiac diseases from a pathophysiological and clinical point of view. Autoimmune rheumatic diseases can affect the coronary vessels, myocardium, pericardium, heart valves and the conduction system. The diagnosis of these unique cardiac complications necessitates medical awareness and a high index of suspicion. Increased risk of advanced atherosclerosis plays a pivotal role in the development of cardiac diseases in systemic, rheumatic and autoimmune illnesses. Yet, other complex immune medicated mechanisms may contribute to the pathogenesis. Patients' optimal care requires coordination between the primary caregiver, the rheumatologist, immunologist and cardiologist. Screening for cardiovascular risk factors, recognition of high-risk patients and identification of subclinical cardiac conditions are of great importance. Moreover, regulation of inflammation, as well as abnormal immune responses and the initiation of early treatments should be the focus of patient management. A continuous attempt to identify novel therapeutic targets and change the natural history of the underlying disease and its cardiac manifestations is in progress. The book aims at providing the readers with a state of the art collection of up to date information regarding clinically important topics based on experts' perspectives. This book was a result of an extended coordinated collaboration of one-hundred and fifty-four distinguished scientists from thirty-one countries around the globe. A review of common, as well as unusual (yet clinically significant) medical cardiac complications of prevalent rheumatic, autoimmune and inflammatory diseases. Focuses on aspects of pathophysiological processes, clinical presentations, screening tests, prognostic implications and novel therapeutic approaches. Presents an up-to-date “level of evidence” and “strengths of recommendations” for suggested therapies and reviews all randomized clinical trials, meta-analyses and other supporting published clinical findings.
Author: Antonio Serrano
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
This eBook is a collection of articles from a Frontiers Research Topic. Frontiers Research Topics are very popular trademarks of the Frontiers Journals Series: they are collections of at least ten articles, all centered on a particular subject. With their unique mix of varied contributions from Original Research to Review Articles, Frontiers Research Topics unify the most influential researchers, the latest key findings and historical advances in a hot research area! Find out more on how to host your own Frontiers Research Topic or contribute to one as an author by contacting the Frontiers Editorial Office: frontiersin.org/about/contact.
Author: John H. Stone
Publisher: Springer Science & Business Media
ISBN: 1848009348
Category : Medical
Languages : en
Pages : 489
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Book Description
Important strides have been made in understanding the pathophysiologic basis of many inflammatory conditions in recent years, but rheumatology remains a discipline in which diagnosis is rooted in the medical history skillfully extracted from the patient, the careful physical examination, and the discriminating use of laboratory tests and imaging. Moreover, selection of the most appropriate therapy for patients with rheumatic diseases also remains heavily reliant upon clinical experience. Medical disciplines such as rheumatology that depend significantly upon clinical wisdom are prone to the development of systems of ‘Pearls’ and ‘Myths,’ related to the diseases they call their own, a ‘Pearl’ being a nugget of truth about the diagnosis or treatment of a particular disease that has been gained by dint of clinical experience and a ‘Myth’ being a commonly held belief that influences the practice of many clinicians – but is false. This book will pool together the clinical wisdom of seasoned, expert rheumatologists who participate in the care of patients with autoimmune diseases, systemic inflammatory disorders, and all other rheumatic conditions.
Author: Munther A Khamashta
Publisher: Springer Science & Business Media
ISBN: 1447136667
Category : Medical
Languages : en
Pages : 486
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Book Description
In 1983 Graham Hughes described a syndrome in which the blood has a tendency to clot. Hughes syndrome is at the root of diverse conditions such as stroke, leg vein thrombosis and recurrent abortion. Hughes Syndrome addresses the complete range of features produced by this common disorder, which is also known as antiphospholipid syndrome. The condition can affect any organ, and is treated using commonly available drugs including low-dose aspirin and warfarin. This timely book fulfils the need for a cross-disciplinary clinical textbook and contains contributions from the leading international authorities. Hughes Syndrome should be read by anyone who might have a clinical or scientific interest in this condition: rheumatologists, haematologists, obstetricians and neurologists.
Author: Xin J. Zhou
Publisher: Cambridge University Press
ISBN: 1316613984
Category : Medical
Languages : en
Pages : 691
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Book Description
An algorithmic approach to interpreting renal pathology, updated in light of recent advances in understanding and new classification schemes.