ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;In systemic lupus erythematosus, autoantibodies have structural features that indicatein vivoselection by a T cell‐dependent, antigen‐driven process. The B‐cell component of these responses resembles a conventional antibody response, whereas the T‐cell component may involve diverse stimulatory mechanisms and levels of regulatory control. Characterizing T‐cell epitopes of autoantigens has been difficult because these molecules are ubiquitous and exist inside the cells as multicomponent, macromolecular complexes. Autoantibodies can mediate disease manifestations by various mechanisms, with variable region structures determining the pattern and severity of tissue injury.Current Opinion in Rheumatology 1993,5:549‐556

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Murine models of autoimmune disease exhibit heterogenous features that are now being understood in terms of their basic molecular defects. Defects in apoptosis genes or genes that contribute to B‐cell activation, T‐cell tolerance loss, and development of autoimmune disease, including glomerulonephritis, have been identified. The interaction of primary and secondary predisposing genes leads to a diverse spectrum of autoimmune features that is different in different strains of mice. The challenge in the future will be to correlate these primary and secondary autoimmune genes with specific environmental triggers to explain the diverse spectrum of autoimmune disease. The ability to correct the apoptosis defect and autoimmune disease in CD2‐Fastransgenic MRL‐lpr/lprmice brings hope that genetic therapy will eventually be possible in humans.Current Opinion in Rheumatology 1993,5:557‐569

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The process of autoantibody production in systemic lupus erythematosus is characterized by findings of both an antigen‐driven response and polyclonal B‐cell activation. Autoantibody production does not appear to be critically dependent on the presence of the CD5+B cell subset. Increasing evidence supports a role for T helper cell type 2 cytokines, such as interleukin‐4 and interleukin‐6, in promoting and perpetuating B‐cell hyperactivity and autoantibody formation.Current Opinion in Rheumatology 1993,5:570‐574

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Descriptive and analytic clinical research investigations dealing with systemic lupus erythematosus have focused on disease manifestations involving the heart, kidneys, and central nervous system, the complications of corticosteroid therapy, particularly cardiovascular and peripheral vascular disease, and outcomes of pregnancy. Studies exploring prognostic factors in patients with lupus nephritis as well as risk factors for the development of cardiovascular disease emphasize the importance of control of comorbid conditions, particularly hypertension and hyperlipidemia, in preventing poor outcomes in patients with systemic lupus erythematosus. The effectiveness of parenterally administered pulse cyclophosphamide has been demonstrated in patients with severe central nervous system involvement, and the effectiveness of plasmapheresis in patients with thrombotic thrombocytopenic purpura was reviewed.Current Opinion in Rheumatology 1993,5:575‐586

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Several instruments have been developed to assess disease activity in systemic lupus erythematosus. Any study of a new laboratory measure, any therapeutic trial, and any study of outcome and prognosis should include one of these validated measures of disease activity. The treatment of lupus is far from ideal. A controlled trial of plasmapheresis showed no benefit over standard regimens in lupus nephritis. A long course of pulse cyclophosphamide was shown to be better than pulse methylprednisolone or a short course of intravenous pulse cyclophosphamide. Despite the lack of ideal therapy, the prognosis of lupus, including 15‐year survival rates, has improved over the past 4 decades. Specific organ damage continues to be an issue. Infection and vascular disease have emerged as important factors. With improved survival, other outcome measures, including specific organ function and health status, must be considered.Current Opinion in Rheumatology 1993,5:587‐595

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The spectrum of clinical descriptions and clinicopathologic studies on patients with primary and secondary forms of antiphospholipid antibody syndrome continues to widen. Some differences exist for patients with lupus compared with those with Sjögren's syndrome. Some new thoughts regarding pathogenetic mechanisms and the cofactor &bgr;2glycoprotein I have been generated. Last year marked the first time the International Symposium on Anti‐Phospholipid Antibodies was held in the United States; new data regarding the heterogeneity of antiphospholipid antibodies and lupus anticoagulant were highlighted, as well as the growing concept that assay modifications should not only include attention to the cofactor but also to prothrombin and other phospholipids such as phosphatidylserine and phosphatidylethanolamine. Prognostic and predictive factors of both a clinical and serologic nature of antiphospholipid antibodies are the focus of much recent work, as is the controversial role of steroid therapy for specific patients. Murine models of antiphospholipid antibody syndrome have opened new avenues to explore pathogenesis and therapeutic efficacy.Current Opinion in Rheumatology 1993,5:596‐603

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The growing number of conditions associated with sicca manifestations and focal sialadenitis has shed further light on the heterogeneity of Sjögren's syndrome. Viral and retroviral infections, lymphopro‐liferative disorders, as well as various autoimmune syndromes, target the lacrimal and salivary glands and incite a local immune response. This awareness has not only intensified the search for a viral or retroviral cause of Sjögren's syndrome, but it has also provided a daunting challenge to investigators who are striving to improve diagnostic testing and classification. A better understanding of Sjögren's syndrome is needed to develop innovative and more effective therapies.Current Opinion in Rheumatology 1993,5:604‐612

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The etiology and pathogenesis of juvenile rheumatoid arthritis remains unknown; however, research using new techniques is revealing information on the roles of immunogenetics, cellular immunity, and humoral immunity in these disorders. Interest continues in infection as a potential trigger of juvenile rheumatoid arthritis, as reactivity to infectious agents in synovial lymphocytes is sought. Reactivity to heat‐shock proteins suggests a pathogenetic role for this class of proteins as well. Careful analysis of outcome in children with systemic‐onset juvenile rheumatoid arthritis has identified clinical features that may predict later clinical course; in related work, investigators have not been able to identify such features to predict the outcome of children with pauciarticular juvenile rheumatoid arthritis. Juvenile rheumatoid arthritis has a broad impact on the lives of patients and their families, and appropriate assessment and management of such problems as chronic pain, vocational readiness, and family financing have been addressed over the past year.Current Opinion in Rheumatology 1993,5:619‐628

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID