Treatment of severe CNS lupus with intravenous immunoglobulin.

We present a case of a 20-year-old woman admitted with new onset severe systemic lupus erythematosus (SLE) with multiple manifestations, including lupus nephritis with renal failure and significant central nervous system (CNS) lupus. She presented with a forbidding condition and deteriorated despite a regimen of high dose corticosteroids and cyclophosphamide administration. She had progressive CNS disease initially, with multiple generalized tonic-clonic seizures and later with dense left sided hemiparesis.

A double-blind, placebo-controlled, clinical trial of dehydroepiandrosterone in severe systemic lupus erythematosus.

Objective: To determine if dehydroepiandrosterone (DHEA) is beneficial in severe systemic lupus erythematosus (SLE).

Methods: A double-blinded, placebo-controlled, randomized clinical trial in 21 patients with severe and active SLE, manifestated primarily by nephritis, serositis or hematological abnormalities. In addition to conventional treatment with corticosteroids +/- immunosuppressives, patients received DHEA 200 mg/d vs.

Influence of hormonal events on disease expression in patients with the combination of systemic lupus erythematosus and rheumatoid arthritis.

The concurrent presence of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) ("rhupus" or "rufus") has been described in the literature. However, it has not been clear to what extent and under what circumstances clinical disease expresssion can undergo transitions from one disease to the other. We postulated that major hormonal events might have an influence on disease expression in such patients and conducted a retrospective study of 1507 patients with RA and 893 with SLE.

Dehydroepiandrosterone in systemic lupus erythematosus: relationship between dosage, serum levels, and clinical response.

Objective: To examine in women with systemic lupus erythematosus (SLE) who participated in a clinical trial the relationship between daily dose of dehydroepiandrosterone (DHEA), serum levels of DHEA and DHEA sulfate (DHEAS), clinical effectiveness, and side effects.

Methods: Twenty-three women with mild to moderate SLE were treated with DHEA for a 6 month period. The starting dose was 50 mg/day, and monthly stepwise increases were allowed.

Socioeconomic status and health in women with systemic lupus erythematosus.

Objective: Health outcomes of patients with chronic illnesses are commonly worse in people of lower socioeconomic status (SES). We investigated psychosocial factors that may mediate the relationship between SES and measures of morbidity in women with systemic lupus erythematosus (SLE).

Methods: We collected information on SES, psychosocial factors, and health status in a cross sectional survey of 100 women with SLE.

Treatment of systemic lupus erythematosus with dehydroepiandrosterone: 50 patients treated up to 12 months.

Objective: To determine whether longterm therapy (up to 1 year) with the weakly androgenic adrenal steroid dehydroepiandrosterone (DHEA) is feasible and beneficial in patients with mild to moderate systemic lupus erythematosus (SLE).

Methods: In a prospective, open label, uncontrolled longitudinal study 50 female patients (37 premenopausal, 13 postmenopausal) with mild to moderate SLE were treated with oral DHEA 50-200 mg/day.

Results: DHEA therapy was associated with increases in the serum levels of DHEA, DHEA sulfate, and testosterone and, for those patients who continued DHEA, with decreasing disease activity measured by SLE Disease Activity Index score (p < 0.

Corticosteroids in rheumatic disease. Understanding their effects is key to their use.

Corticosteroids can have tremendous therapeutic benefits but can also cause severe side effects and toxicities. Judicious use of these agents plays an important role in many rheumatic diseases. Careful selection of the initial dose, aggressive attempts to taper doses, prescription of supplemental calcium and vitamin D, and consideration of steroid-sparing agents in patients who remain dependent on corticosteroids for disease control are the foundation of proper use.

Rheumatoid arthritis. Designing and implementing a treatment plan.

Treating rheumatoid arthritis can be very satisfying when patients participate fully in designing and implementing their therapeutic strategy. However, the strategy's success depends on early intervention and disease modification. Many patients do well when education, rest, diet, exercise, and drug therapy are incorporated into an individualized regimen.

Skeletal status of men with early and late ankylosing spondylitis.

Purpose: To assess the influence of extent of disease on the skeletal status of men with ankylosing spondylitis (AS).

Patients And Methods: Fourteen men with AS were studied at entry and again after 15 months. Bone mineral density (BMD) was assessed by single photon absorptiometry (SPA), dual energy x-ray absorptiometry (DXA), and quantitative computed tomography (QCT).

Studies of dehydroepiandrosterone (DHEA) as a therapeutic agent in systemic lupus erythematosus.

Several lines of investigation led to the consideration of dehydroepiandrosterone (DHEA) as a candidate for hormonal therapy in systemic lupus erythematosus, including DHEA deficiency in patients with SLE, the effects of sex steroids on SLE, the immunomodulatory effects of DHEA, and the results of DHEA in animal models of SLE. Uncontrolled observations in 50 patients suggested that DHEA has overall benefits for lupus activity, alleviating specific lupus symptoms as well the systemic manifestations of lupus, with incremental benefits over 3 to 12 months of treatment. DHEA, which was very well tolerated and safe, appeared to decrease the number of lupus flares and to have a steroid sparing effect.

Systemic lupus erythematosus and pregnancy.

SLE is an autoimmune condition primarily affecting females in their reproductive years. Advances in medical management of SLE, improved understanding of pregnancy complications and the improvement in neontal medicine have allowed females with SLE to have successful pregnancies.

Dehydroepiandrosterone in systemic lupus erythematosus. Results of a double-blind, placebo-controlled, randomized clinical trial.

Objective: To determine if dehydroepiandrosterone (DHEA) is beneficial in the treatment of systemic lupus erythematosus (SLE).

Methods: In a double-blind, placebo-controlled, randomized trial, 28 female patients with mild to moderate SLE were given DHEA 200 mg/day or placebo for 3 months. Outcomes included the SLE Disease Activity Index (SLEDAI) score, patient's and physician's overall assessments of disease activity, and concurrent corticosteroid dosages (which were adjusted as clinically indicated).

Adhesion molecules, sex steroids, and the pathogenesis of vasculitis syndromes.

The pathogenesis of the vasculitis syndromes slowly continues to yield its secrets. Over the past year, evidence has continued to accumulate, indicating that the endothelium exhibits a wide range of regulatory functions, mediated in large part through adhesion molecules. Several studies showed increased expression of such molecules in vasculitis.

An open study of dehydroepiandrosterone in systemic lupus erythematosus.

Objective: To determine if dehydroepiandrosterone (DHEA) has clinical benefits in patients with systemic lupus erythematosus (SLE).

Methods: Ten female patients with mild to moderate SLE and various disease manifestations were given DHEA (200 mg/day orally) for 3-6 months. The patients were given other medications as clinically indicated, and followed with respect to overall disease activity and specific outcome parameters.

Estrogen, progesterone, and testosterone: can they be used to treat autoimmune diseases?

Background: Sex hormones have marked immunomodulatory properties and may play important roles in the etiology of various autoimmune diseases.

Objective: To review the immunomodulatory effects of sex hormones, their roles in the etiology of autoimmune diseases, and their potential therapeutic applications.

Discussion: Progesterone and androgens suppress the immune system, prolactin stimulates it, and estrogens can do either.

Exposure of female mice to type II collagen reduces susceptibility to collagen-induced arthritis in offspring.

The effect of exposure of female DBA/1 mice to collagen II (CII) prior to breeding on the susceptibility of their offspring to CII-induced arthritis (CIA) was investigated. It was found that female offspring, born within 3 months after exposure of the mothers to CII, had a significantly reduced incidence of CIA, following immunization with CII. Just prior to this immunization, no anti-CII could be detected in the offspring.

Serum IgD levels in mice: effect of strain, age and autoimmune disease.

Serum IgD levels were studied in mice. Strain-related variability of serum IgD levels was noted, and advanced age was associated with markedly increased IgD levels in a large percentage of mice from all strains. Strains prone to spontaneously arising autoimmune disease had elevated IgD levels; in NZB mice this was already present very early after birth (one week), whereas in MRL mice the elevated serum IgD levels were first seen somewhat later (3 months).

The role of immunity to cartilage proteoglycan in adjuvant arthritis. Intravenous injection of bovine proteoglycan enhances adjuvant arthritis.

It has been suggested that autoimmunity to the proteoglycan (PG) component of cartilage plays a major role in the etiology of adjuvant arthritis (AA), which occurs in rats, but not in mice, after injection of CFA. In order to more directly investigate this role, bovine and human cartilage PG were used to modulate AA, and immunity to PG was assessed. Immunization of rats or mice with PG by itself does not induce arthritis.

Tolerance induction by a poorly arthritogenic collagen II can prevent collagen-induced arthritis.

Collagen type II (CII)-induced arthritis (CIA) can be induced in 78% of B10.RIII mice (H2r) by intradermal (id) immunization with CII of bovine origin in complete Freund's adjuvant (CFA), whereas immunization with CII of chick origin induces arthritis in less than 5% of these mice. Nevertheless, tolerization of B10.

A cross-reactive idiotype on anti-collagen antibodies in collagen-induced arthritis: identification and relevance to disease.

Immunization of mice with type II collagen (CII) leads to the production of anti-CII antibodies and, in susceptible strains, to the induction of arthritis. Specifically purified anti-CII antibodies from arthritic DBA/1 mice were used to prepare a rabbit anti-idiotypic antiserum. This antiserum recognizes a cross-reactive idiotype (CRI) present on 20-25% of anti-CII antibodies from DBA/1 mice immunized with bovine CII.

Physiology of IgD. IX. Effect of IgD on immunoglobulin production in young and old mice.

Weekly i.p. injections of IgD from birth in (SJL X BALB/c)F1 mice were found to accelerate the development of IgG- and IgA-secreting cells and to increase the numbers of Ig-secreting cells of all isotypes in 17-28-day-old mice, but not in 7-10-day-old mice.

A syngeneic MLR induced in vivo results in T-cell mediated immune suppression.

The proliferation of murine T lymphocytes in response to syngeneic Ia bearing non-T cells (syngeneic mixed lymphocyte reaction, SMLR) has been shown to generate regulatory T cells in vitro. An in vivo regulatory role has therefore been proposed for the SMLR. To study this role more directly, we examined the effects of repeated iv injection of mice with activated syngeneic B cells.