scholarly journals Changing paradigms in the treatment of systemic lupus erythematosus

2019 ◽  
Vol 6 (1) ◽  
pp. e000310 ◽  
Author(s):  
Antonis Fanouriakis ◽  
George Bertsias
Keyword(s):  
Lupus Erythematosus ◽  
Personal Experience ◽  
Calcineurin Inhibitors ◽  
Routine Care ◽  
Retinal Toxicity ◽  
Future Perspectives ◽  
Systemic Lupus ◽  
High Quality ◽  
Everyday Clinical Practice ◽  
Immunosuppressive Medications

SLE poses formidable therapeutic challenges due to its heterogeneity and treatment decisions often cannot be guided by data of high quality. In this review, we attempt to provide insights regarding the treatment of SLE in everyday clinical practice, based on contemporary evidence and our own personal experience. We focus on common therapeutic issues and dilemmas arising in routine care, including monitoring for retinal toxicity associated with hydroxychloroquine, handling of glucocorticoid regimens in order to minimise their adverse events, choice of immunosuppressive medications based on prevailing disease manifestations and optimal use of available biological agents (belimumab and rituximab). We also provide our view on the position of calcineurin inhibitors in the management of lupus nephritis and conclude with remarks on the future perspectives for this challenging disease.

scholarly journals Sporotrichoid-Like Spread of Cutaneous Mycobacterium chelonae in an Immunocompromised Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Daria Marley Kemp ◽  
Anusha G. Govind ◽  
Jun Kang ◽  
Caroline C. Brugger ◽  
Young C. Kauh
Keyword(s):  
Lupus Erythematosus ◽  
Soft Tissues ◽  
Immunocompromised Patient ◽  
Immunocompromised Patients ◽  
Systemic Lupus ◽  
Mycobacterium Chelonae ◽  
Cutaneous Infections ◽  
Subcutaneous Nodules ◽  
Immunosuppressive Medications ◽  
Atypical Presentations

Mycobacterium chelonae is a rapidly growing mycobacterium found in water and soil that can cause local cutaneous infections in immunocompetent hosts but more frequently affects immunocompromised patients. Typically, patients will present with painful subcutaneous nodules of the joints or soft tissues from traumatic inoculation. However, exhibiting a sporotrichoid-like pattern of these nodules is uncommon. Herein, we report a case of sporotrichoid-like distribution of cutaneous Mycobacterium chelonae in a patient with systemic lupus erythematosus on significant immunosuppressive medications. Clinicians treating immunocompromised patients should be cognizant of their propensity to develop unusual infections and atypical presentations.

scholarly journals Retinal toxicity caused by hydroxychloroquine in patients with systemic lupus erythematosus

Medicine ◽  
2021 ◽  
Vol 100 (22) ◽  
pp. e25688
Author(s):  
Gang Wang ◽  
Ning Zhuo ◽  
Zheng Liao ◽  
Wei Qi ◽  
Feng Tian ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Retinal Toxicity ◽  
Systemic Lupus

scholarly journals 151 Retinal toxicity due to hydroxychloroquine in a single center systemic lupus erythematosus cohort

2019 ◽  
Author(s):  
Yesid J Portilla ◽  
Diego Marino ◽  
Sheyla Leal Castro ◽  
Ramiro Gomez ◽  
Diana Dubinsky ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Retinal Toxicity ◽  
Single Center ◽  
Systemic Lupus

scholarly journals Management of Neuropsychiatric Systemic Lupus Erythematosus: Current Approaches and Future Perspectives

Drugs ◽  
2016 ◽  
Vol 76 (4) ◽  
pp. 459-483 ◽  
Author(s):  
César Magro-Checa ◽  
Elisabeth J. Zirkzee ◽  
Tom W. Huizinga ◽  
Gerda M. Steup-Beekman
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Future Perspectives ◽  
Systemic Lupus ◽  
Neuropsychiatric Systemic Lupus Erythematosus

Retinal toxicity related to hydroxychloroquine in patients with systemic lupus erythematosus and rheumatoid arthritis

2017 ◽  
Vol 135 (3) ◽  
pp. 187-194 ◽  
Author(s):  
Hande Husniye Telek ◽  
Nilufer Yesilirmak ◽  
Gulten Sungur ◽  
Yaprak Ozdemir ◽  
Nesibe Karahan Yesil ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Retinal Toxicity ◽  
Systemic Lupus

scholarly journals The Pathology of T Cells in Systemic Lupus Erythematosus

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Anselm Mak ◽  
Nien Yee Kow
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Clinical Trials ◽  
T Cells ◽  
B Cells ◽  
Lupus Erythematosus ◽  
Calcineurin Inhibitors ◽  
Cell Receptor ◽  
Systemic Lupus ◽  
Autoantibody Production ◽  
Lupus Glomerulonephritis

Systemic lupus erythematosus (SLE) is characterized by the production of a wide array of autoantibodies. Thus, the condition was traditionally classified as a “B-cell disease”. Compelling evidence has however shown that without the assistance of the helper T lymphocytes, it is indeed difficult for the “helpless” B cells to become functional enough to trigger SLE-related inflammation. T cells have been recognized to be crucial in the pathogenicity of SLE through their capabilities to communicate with and offer enormous help to B cells for driving autoantibody production. Recently, a number of phenotypic and functional alterations which increase the propensity to trigger lupus-related inflammation have been identified in lupus T cells. Here, potential mechanisms involving alterations in T-cell receptor expressions, postreceptor downstream signalling, epigenetics, and oxidative stress which favour activation of lupus T cells will be discussed. Additionally, how regulatory CD4+, CD8+, andγδT cells tune down lupus-related inflammation will be highlighted. Lastly, while currently available outcomes of clinical trials evaluating therapeutic agents which manipulate the T cells such as calcineurin inhibitors indicate that they are at least as efficacious and safe as conventional immunosuppressants in treating lupus glomerulonephritis, larger clinical trials are undoubtedly required to validate these as-yet favourable findings.

scholarly journals The dawn of a new era of therapies in systemic lupus erythematosus

2020 ◽  
Vol 1 (1) ◽  
pp. 31-37
Author(s):  
Chi Chiu Mok
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Clinical Trials ◽  
Lupus Erythematosus ◽  
Mammalian Target Of Rapamycin ◽  
Calcineurin Inhibitors ◽  
Mtor Inhibitors ◽  
Phase Iii ◽  
Inflammatory Rheumatic Diseases ◽  
Systemic Lupus ◽  
Mortality And Morbidity

AbstractSystemic lupus erythematosus (SLE) is a complicated multisystem autoimmune disease that is associated with significant mortality and morbidity in the younger population. The development of novel therapies of SLE lag behinds other autoimmune inflammatory rheumatic diseases because of its clinical and immunological heterogeneities, the complexity of outcome assessments in multiple systems, and difficulty in optimizing the design of clinical trials. Despite the futility of quite a number of clinical trials, we are seeing the dawn of novel therapeutics in SLE, given the promising results of the newer-generation anti-CD20, anti-CD40L biologics, and calcineurin inhibitors (CNIs), as well as anti-cytokine biologics, Jakinibs, and the mammalian target of rapamycin (mTOR) inhibitors. The initial success of the Jakinibs and combination regimens in SLE illustrates the importance of targeting multiple pathogenetic mechanisms. The results of the ongoing phase III clinical trials in SLE are eagerly awaited.

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