ISSN:1040-8711    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Studies reported during the past year have added new knowledge to our understanding of cellular abnormalities in systemic lupus erythematosus: 1) Antigen-specific and “pathogenic” T cells display a limited T cell receptor repertoire in lupus. 2) The ratio of interleukin-10 to interferon gamma–secreting cells in the peripheral blood of patients with lupus is increased in patients with active disease. 3) CD3-mediated increases in free intracytoplasmic calcium occur specifically in lupus T cells and lines; this finding provides additional evidence that cell-signaling events are defective in patients with lupus. 4) Aberrant expression of adhesion molecules on the surface membrane of leukocytes and endothelial cells was shown, a finding with important mechanistic and therapeutic implications. 5) Lupus antigen-presenting cells fail to upregulate the expression of B7-1 (CD80) in response to interferon gamma; defective expression of B7-1 is responsible for the decreased response of lupus cells to recall antigens.

ISSN:1040-8711    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Lupus anti-DNA may have higher homology with germline than those from normal subjects. However, in NZB/NZW mice, bacterial DNA is more antigenic than mammal DNA, which could indicate an antigen-driven origin. High-affinity antibodies to double-stranded DNA cross-react with small nuclear ribonucleoprotein and ribosomal P proteins. These cross-reactive anti-DNA may penetrate live cells. Antibodies to ribosomal P proteins are associated with neuropsychiatric, renal, and hepatic lupus involvement. IgG antibodies to (H2A-H2B)-DNA complexes antedate procainamide-induced lupus. Autoantibodies to some La/Ro peptides in a mother indicates that her children may develop neonatal lupus and determine who will have congenital heart block. Perinuclear antineutrophil cytoplasmic antibodies are present in 25% of systemic lupus erythematosus patients without correlation with anti-DNA or disease activity. Different antiphospholipid antibodies require different protein cofactors for reactivity. Those to anionic phospholipids require β2-glycoprotein I, whereas anti-phosphatidylethanolamine antibodies require kininogen or its binding protein. Antibodies to phospholipid-free β2-glycoprotein I are associated more strongly with clinical antiphospholipid syndrome than are antiphospholipid antibodies.

ISSN:1040-8711    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Neuropsychiatric symptoms are recognized to occur in a significant percentage of systemic lupus erythematosus patients and to be a leading cause of morbidity and mortality in lupus. Recent findings regarding the clinical presentation, diagnosis, pathogenesis, and treatment of neuropsychiatric lupus erythematosus are reviewed. The study of neurocognitive deficits and psychosocial functioning in systemic lupus erythematosus patients continues to be an area of great research interest worldwide. Severe neuropsychiatric manifestations can be divided into diffuse, focal, and seizure presentations, which can each have a different etiopathogenesis. New techniques for magnetic resonance imaging and single-photon emission CT of the brain may improve the utility and sensitivity of these neuroradiographic tests. Certain combinations of serologic, cerebrospinal fluid, and neuroimaging tests appear to be most useful diagnostically when ordered based on the patient's neurologic presentation. The role of complement, cytokines, and endothelial cell activation in causing the vascular pathology observed in the brains of neuropsychiatric lupus erythematosus patients is an area of promising research. Treatment remains empiric, but intravenous pulse cyclophosphamide and intrathecal administration of immunosuppressive medications are new approaches that have been used successfully to treat patients with severe and refractory symptoms.

ISSN:1040-8711    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Both immune and nonimmune mechanisms are operant in lupus nephritis. Recent findings have begun to elucidate fundamental questions in the pathogenesis of the disease. Genetic linkage studies have identified susceptibility loci contributing to nephritis in lupus-prone mice. Polymorphisms of the FcyRlla gene have been found to correlate with the development of renal disease in black Americans and white Europeans. Genetic factors are important in determining both predisposition to nephritis and outcome (and likely response to therapy). In lupus nephritis, prevention of tissue injury involves effective immunosuppressive therapy and aggressive management of hypertension and hyperlipidemia. Although with intensive immunosuppressive therapy most lupus patients achieve remission, a substantial number of these patients either do not respond, respond partially, or relapse after discontinuation of therapy. Moreover, the toxicity of available immunosuppressive drugs is substantial, suggesting that alternative therapeutic regimens are needed. In the future, other inhibitors of inflammatory, immune, vasoactive, proteolytic, and growth-promoting mediators are likely to play a role in the management of lupus nephritis.

ISSN:1040-8711    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Fertility is usually normal in systemic lupus erythematosus. However, cyclophosphamide therapy has been associated with an increased risk for sustained amenorrhea in these patients. There is still debate as to whether pregnancy increases systemic lupus erythematosus activity. We have known for decades that systemic lupus erythematosus is associated with an increased risk for pregnancy loss. Now we know that most excess fetal loss in women with systemic lupus erythematosus occurs in association with antiphospholipid antibodies, which also are associated with pregnancy loss in otherwise healthy women. Prematurity, intrauterine growth retardation, and preeclampsia are common features of lupus pregnancy, especially in women with antiphospholipid antibodies. Pregnancy complicated by antiphospholipid syndrome requires expert care and a team approach involving obstetricians, obstetric physicians, rheumatologists, and clinical hematologists. Treatment and close monitoring including uterine artery Doppler scans and timely delivery may improve fetal outcome in these cases. Although there is no evidence that maternal prednisone should be used prophylactically, fluorinated steroids may be efficacious after in utero identification of congenital heart block, especially in fetuses with associated myocarditis.

ISSN:1040-8711    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This article summarizes the evidence for the improved prognosis in patients with systemic lupus erythematosus (SLE). It discusses the reasons for improved survival, as well as the risk for mortality, which still remains high for patients with this disease. Causes of death are reviewed, and prognostic factors examined. Other outcome measures for prognosis in SLE, including specific organ damage, accumulated damage index, and health status and quality of life are considered. Recent articles on therapy for SLE are discussed

ISSN:1040-8711    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Primary Sjögren's syndrome (SS) is a systemic autoimmune disease that is characterized by keratoconjunctivitis sicca and xerostomia resulting from lymphocytic infiltrates of the lacrimal and salivary glands. The criteria for the diagnosis of SS continue to be controversial, leading to confusion in the clinical and research literature. It is important to distinguish SS (an idiopathic autoimmune process) from other processes, including hepatitis C infection, autonomic neuropathy, and drug side effects, that can result in sicca symptoms. Recent studies on the pathogenesis of SS in humans and in animal models examine the clonality of the T cell infiltrates, cytokine production by lymphocytes and glandular epithelial cells, neuroendocrine and hormonal factors that affect glandular secretion, and the fine structure of antigens recognized by T and B cells. Studies of SS have allowed comparison of lymphocytes in blood and in the glandular tissue lesions; important differences in the gland microenvironment play an important role in the initiation and perpetuation of the autoimmune process. For example, apoptotic death depends on the balance of Fas, Fas ligand, nuclear factors (eg,bcl-2,bax, andmyc), cytokines, neuropeptides, and cell membrane interactions with extracellular matrix. Although increased rates of apoptosis may be present in the blood T cells of SS patients, some glandular T cells are resistant to apoptosis. Recent advances have led to improved understanding of signal transduction in response to cytokines and hormones that play a role in the local and systemic manifestations of SS. New approaches to therapy are designed to improve the qualitative properties of corneal epithelial surface, as well as increase tear volume.

ISSN:1040-8711    

出版商:OVID    

年代:1996

数据来源: OVID