scholarly journals Art Therapy for Adjustment Disorders in Adolescent with Systemic Lupus Erythematosus (SLE) and Pulmonary Tuberculosis (TB)

2021 ◽  
Vol 13 (2-3) ◽  
Author(s):  
Karina Oclaudya ◽  
Rr Indah Ria Sulistyarini

This study presents an experimental Single Case-Single Subject ABA design of a 17-year-old female patient suffering from Systemic Lupus Erythematosus (SLE) and Pulmonary Tuberculosis (TB) who experience adjustment disorders. The purpose of this study is to reduce adjustment disorders in the patient with SLE and pulmonary TB by using art therapy. The assessment methods are observation, interviews, and psychological testing tools. Data analysis was carried out using the qualitatively and quantitatively. Quantitative analysis is performed using visual inspection by looking at the comparison of Depression Anxiety Stress Scale (DASS) scores. Initial measurements using DASS showed a level of depression with a score of 26 (severe), anxiety score at 23 (very severe), and stress score at 19 (moderate). Art therapy is given as a therapeutic intervention for the patient. After the therapy was given, there was a decrease in the DASS score with a depression score to 20 (moderate), anxiety score at 19 (severe), and stress score at 17 (mild). The patient also felt moreable to express and control emotions more precisely. These results indicate that art therapy is one of the interventions that can overcome psychological problems in the patient with adjustment disorders.

2021 ◽  
Author(s):  
Hui Ma ◽  
Lin Wang ◽  
Zilu Wen ◽  
Xinchun Chen ◽  
Haiying Liu ◽  
...  

ABSTRACTMetabolic activity in pulmonary lesion is associated with disease severity and relapse risk in tuberculosis. However, the nature of the metabolic activity associated with tuberculosis in humans remains unclear. Previous works indicate that tuberculosis bears resemblance transcriptionally with systemic lupus erythematosus in peripheral blood, except that the plasma cell component was absent in tuberculosis. Here we reported that the missing transcriptional component was present within the metabolic active tissues in the lung of patients with sputum culture-negative tuberculosis, within which increased levels of circulating immune complexes and anti-dsDNA antibodies were found relative to nearby non-metabolic active tissues. Histological examination revealed specific vascular deposition of immune complexes, neutrophil extracellular traps, and vascular necrosis in the metabolic-active tissue. Thus, tuberculosis-initiated metabolic activity was associated with hyperactive antibody responses and vascular pathology, and shared features with systemic lupus erythematosus and other autoimmune diseases. We discussed these observations in the context of earlier literatures demonstrating that similar effects could be induced in humans and animal models by complete freund’s adjuvant, the most potent antibody response inducer ever reported. Our small case series, if verified in a larger size study, might help inform host-directed therapies to alleviate disease progression and augment treatment efficacy.IMPORTANCEIn patients with pulmonary tuberculosis, lung tissues were destroyed by a hyperactive inflammatory response towards M. tuberculosis. The mechanisms underlying the inflammatory response are still poorly understood. Using 18F-FDG avidity as a surrogate marker of inflammation, we have identified that hyper-inflamed tissues possessed features associated with systemic lupus erythematosus: gene expression signatures of plasma cell and immunoglobulins and increased levels of anti-dsDNA antibodies, immune deposits, and vasculopathy. This observation might suggest an explanation to why patients with tuberculosis share more gene expression signatures with autoimmune diseases than infectious diseases and why they are more likely to develop autoimmune diseases. Defining the inflammatory responses at the lesion could help inform host-directed therapies to intervene disease progression or even accelerate cure.


2020 ◽  
Vol 65 (5-6) ◽  
pp. 35-40
Author(s):  
G. M. Tarasova ◽  
B. S. Belov ◽  
M. V. Cherkasova ◽  
S. K. Soloviev ◽  
E. A. Aseeva ◽  
...  

The aim of the work is to study the immunogenicity, tolerability, and clinical efficacy of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) in patients with systemic lupus erythematosus (SLE). Material and methods. The study included 61 patients with a confirmed diagnosis of SLE, including 53 women, 8 men, aged 19 to 68 years. The disease activity at the time of vaccination: in 9 patients — high, in 13 — medium, in 34 — low, in 5 — remission. Therapy outline: 59 patients received glucocorticoids (GC) 5–30 mg/day in terms of prednisolone, 45 — hydroxychloroquine (GC), 33 — cytostatics (CS), 22 — genetically engineered biological drugs (GEBD): 11 — rituximab (RTM), 10 — belimumab (BLM). 23-valent polysaccharide pneumococcal vaccine in an amount of 0.5 ml (1 dose) was injected subcutaneously. Follow-up period: 9 patients — 3 months, 52 — 1 year after the vaccination. Patients were examined before vaccination, as well as in 1, 3, and 12 months after the vaccination. Results and discussion. After a year of observation, the number of «responders» to vaccination was 61.5%, «non-responders» — 38.5%. There was a decreased response to vaccine in patients receiving GEBD compared with patients who did not receive GEBD (40% and 75%, respectively), p=0.02. No differences were found against the background of RTM and BLM therapy. Administering GC in a dose exceeding 10 mg/day did not lead to a more significant decrease in response to vaccine compared to other patients. Standard local vaccination reactions of mild to moderate severity were noted in 50.8% of the patients, general reaction of mild severity — in 1 patient (1.6%), hyperergic Arthus-like reaction — in 1 patient (1.6%), the symptoms of which were relieved in 7 days. During the observation period (1 year), not a single case of exacerbation of SLE, reliably associated with the vaccination, was registered, and no new autoimmune phenomena were identified. Clinically positive dynamics was noted in the form of a decrease in the number of episodes of pneumonia, as well as acute and exacerbated chronic bronchitis, sinusitis. Conclusion. Sufficient immunogenicity, good tolerance, and clinical effectiveness of PPV-23 in patients with SLE, incl. those, who received combined immunosuppressive therapy. Further studies are needed in large groups of patients with long follow-up periods.


2019 ◽  
Vol 14 (2) ◽  
pp. 99-104
Author(s):  
Jorge Loredo-Torres ◽  
Julio Albinez-Pérez ◽  
César Colunche-Narvaez ◽  
Jorge Cornejo-Portella

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Kamelia Okka ◽  
M Belghazi ◽  
A Dehimi ◽  
Z Benarab ◽  
S Bouabdallah ◽  
...  

Abstract Background Juvenile systemic lupus erythematosus (J-SLE) is a chronic autoimmune disease characterized by multi-visceral involvement with an unpredictable prognosis. The diagnosis is usually made in young women between the ages of 20 and 40, however, it can set in at any age and will be classified as juvenile (LESj) when it begins before the age of 16.We report the epidemiological, clinical, therapeutic and evolutionary characteristics of a retrospective series carried out at the level of the pediatric center—CHU de Sétif comprising 13 girls and one boy. Methods The mean age of onset is 12 years and 3 months, the mean time to diagnosis is 7 months. The clinical picture is made of e reached articulaire skin and e fever in 86% respectively 57% and 57% of cases, followed by kidney disease in 57% of cases. Cardiac involvement pulmon area ophtalmologiqu e is referred to in low percentages. The blood reached logic of étectée on blood counts in 85% of patient e s i and the syndrome nflammatoire was almost constant. A positive titer of antinuclear antibodies and anti- AD Nn is objectified, as well as a reduction in the level of complement. The anti-GP 2 and anti- cardio lopine antibodies are positive in 57% of cases. Has the present hue kidney in 42% of cases. A single case of overlap syndrome with dermatomyositis has been reported. As for the neurological form, only one adolescent presented it. With a single case of familial lupus and a single case of Rhupus. Results The diagnosis is based on the American College of Rheumatology (ACR) 1982 classification revised in 1997 and the new SLICC “Systemic Lupus International Collaborating Clinics” criteria. The clinical characteristics of our series are consistent with the overall data in the literature with a predominance of cutaneous and joint involvement. with however some specific characteristics which are individualized by a more advanced age of onset, of 13 years on average in our study vs 10 years and 12 years, the rarity of the familial forms (1 case), a lower percentage of renal damage (42% vs 63% and 80%). The therapeutic management was based on corticosteroids and Hydroxychloroquine in most cases, the use of immunosuppressants was reserved for x severe. Conclusion Lupus is an autoimmune disease with protean clinical manifestations, the prognosis of which is dominated by renal, neurological and thrombotic damage. Corticosteroid treatments and immunosuppressants markedly improved the vital prognosis.


2017 ◽  
Vol 68 (9) ◽  
pp. 2160-2161
Author(s):  
Paraschiva Postolache ◽  
Edith Simona Ianosi ◽  
Gabriela Jimborean

The present study describes a systemic lupus erythematous (SLE) flared up after Rifampicin during active pulmonary tuberculosis (TB). A 20-year-old female was hospitalized for cough, weight loss, and apical infiltrates. Microscopy from bronchial lavage confirmed TB. After 1 week of antituberculous treatment we noted diffuse purpura, oral/nasal ulcers, leukopenia, nephritis, antinuclear antibodies, low complement (criteria for SLE). We excluded Rifampicin and introduced immunosuppressive drugs and other reserve antibiotics for TB. Clinical status improved after 2 weeks and TB cured after 9 months. Rifampicin may flare up a subjacent unknown SLE. SLE is a risk factor for TB.


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