Stop Lupus Naturally

Natural Lupus Treatment System

Dr. Gary M. Levin is not a miracle-worker, but a health expert with reputation and expertise that put him at the top of the US medicine field. He has been treating Lupus patients for decades now, and has found that conventional treatments didnt offer real relief, aside from temporarily easing the symptoms. With this system, Lupus patients will discover the process that rehabilitates their immune system and boosts supporting body systems to eliminate the symptoms and types of lupus. It will show Lupus patients a natural, safe, and simple way to reduce or permanently get rid of lupus in just a few short weeks. Actually there is no cure yet discovered for lupus, however, you will find methods to control and manage its signs and symptoms. The aim of the treatments of lupus generally would be to let the patient experience more comfort and lesser pain. Read more here...

Proven Lupus Treatment By Dr Gary Levin Summary


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Highly Recommended

This is one of the best e-books I have read on this field. The writing style was simple and engaging. Content included was worth reading spending my precious time.

As a whole, this book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

HDAC Inhibitors in Models of Inflammatory Diseases 321 Models of Lupus Erythematosus

An unexpected finding of HDAC inhibitors was the reduction in disease severity of models of murine autoimmune disease. The mouse model for systemic lupus erythematosus is the lpr lpr mouse that develops a spontaneous disease characterized by nephritis, proteinuria and early death. Trichostatin A was injected into these mice before the onset of significant disease for 5 weeks. Because trichostatin A in water is insoluble, the vehicle was also used for 5 weeks of treatment. Trichostatin A treatment resulted in significantly less proteinuria in addition, there was histolog- These mouse studies were consistent with a similar effect of tricho-statin A in peripheral T cells from patients with systemic lupus erythe-matosus (Mishra et al. 2001). In T-helper cells from patients with the disease, there is overexpression of the T-helper 2 cytokine IL-10 and the pro-inflammatory cytokine CD40 ligand (also known as CD154). However, incubation of the cells from these patients with trichostatin A...

Systemic Lupus Erythematosus

Crocodile Drug Before And After

The most obvious lesions of the head and neck that can be seen in SLE are those involving the skin. The most characteristic dermatologic feature of lupus is the malar rash (Fig. 1). Also known as the butterfly rash, because of its shape across the cheeks and bridge of the nose, the malar rash is an erythematous and edematous eruption that classically spares the nasolabial folds. A similar rash may be seen on the forehead and chin. It may or may not result from exposure to sunlight, but is often abrupt in onset and can last for days. Malar rashes occur in 30 to 60 of patients. Discoid lupus (Fig. 2) is less frequent, occurring in 15 to 30 of patients. It too may occur in a malar distribution however, discoid lesions can occur anywhere on the face or scalp, in the pinnae, behind the ears, or on the neck. Discoid lesions tend to be discrete plaques, often erythematous with an adherent scale that extends into hair follicles. They can progress to lesions with indurated margins of erythema...

Lupus Systemic Lupus Erythematosus SLE

Lupus is an autoimmune disease, which means the immune system is confused and attacks the body's own tissues. Damage from lupus may affect the kidneys, lungs, and vascular system. The illness can cause arthritis and is characterized by a red rash, painful and sore joints, weak ness, and fatigue. Discoid lupus erythematosus is a milder form of the disease.

Finding Out Whether You Have Fibromyalgia

Part II is about discovering whether you have fibromyalgia, and part of that process is ruling out medical problems that may be impostors for your real problem of fibromyalgia. These conditions include chronic fatigue syndrome, myofascial pain syndrome, thyroid disease, forms of arthritis, and a few other illnesses that may surprise you, such as Lyme disease, lupus, and Raynaud's phenomenon (all discussed in Chapter 6). Then I move into diagnosing fibromyalgia. A good doctor is crucial to diagnosing and treating fibromyalgia, and I discuss the important role that doctors play in Chapter 7. I also offer advice on working with your regular doctor and, if that doesn't work, finding a new doc. Then I cover what actually happens (or should happen) during your physical exam to find out whether you have fibromyalgia.

Mixed Connective Tissue Disease

Mixed connective tissue disease is characterized by a combination of overlapping features of systemic lupus erythematous, scleroderma, and polymyositis. Typical presentation is with Raynaud's phenomenon, arthralgias, inflammatory myopathy, lymphadenitis, skin or mucosal lesions, and serositis. A key distinguishing factor of the disorder is a high titer of antibody to ribonucleoprotein, a finding absent in any of these three disorders (SLE, scleroderma, and polymyositis). Neurologic dysfunction is present in approximately 10 to 15 of cases, usually presenting with facial pain, facial paresthesias, or aseptic meningitis (96,97). Facial nerve involvement, although far less common than trigeminal nerve involvement, has been described and is felt to be an early manifestation of the disorder (98). Although CSF analysis has suggested an inflammatory involvement of

Focal Central Nervous System Disorders

Sjogren Brain Mri

The clinical profile of CNS abnormalities described in association with pSS is similar to that reported in CNS lupus, and includes optic neuropathy, hemiparesis, movement disorders, brainstem and cerebellar syndromes, recurrent transient ischemic attacks, and motor neuron syndrome. Differentiation between SLE and pSS with CNS involvement can be particularly difficult, as focal neurologic deficits, oligoclonal bands in the cerebral spinal fluid (CSF), and abnormalities on MRI are detected in both SLE and SS patients.4,5,34 The prevalence of serious focal and multifocal CNS involvement is low, in the range of 2 to 10 in multiple studies, particularly in those studies that

Inflammatory Mediators

Evidence linking IFN-a with neuropsychiatry symptoms in cancer and HCV suggests a potential role for interferon inducible inflammatory cytokines in mediating the cognitive and affective disorders in medically ill patients, particularly persons with rheumatic disorders however, the data exploring the relationship between neuropsychiatry symptoms and IFN-a or inflammatory cytokines in autoimmune disease are very limited. Levels of IFN-a were increased in the CSF of five of six patients with lupus psychosis, and in four of these five patients, the levels in CSF were higher than those in serum. IFN-a levels decreased when the manifestations of lupus psychosis subsided.124 Investigators in the Division of Rheumatic and Autoimmune disease at the University of Minnesota have demonstrated abnormal regulation of type I interferon (IFN-a) inducible genes in association with both SLE and with SS.125,126 Three molecules in the inflammatory IL-1 cytokine pathway regulated by interferon were...

Leukotriene Modifiers Safety Considerations

There have been single-case reports of drug-induced lupus (166) and of tubulointerstitial nephritis (167) with some of these drugs, but of most concern is the potential association with the Churg-Strauss syndrome (CSS). Within six months after the release of zafirlukast, eight patients who received the drug for moderate to severe asthma developed eosinophilia, pulmonary infiltrates, cardiomyopathy, and other signs of vasculitis, which are characteristic of CSS (168). All of the patients had discontinued highdose corticosteroid use within three months of presentation, and all developed the syndrome within four months of zafirlukast initiation the syndrome dramatically improved in each patient upon reinitiation of corticosteroid therapy. Since that report, there have been several similar cases in other patients receiving zafirlukast (169-171), as well as with montelukast (172-175) and pranlukast (176). While many potential mechanisms for this association have been postulated, including...

Inflammatory Disorders

The development of an inflammatory response is an important defensive mechanism. The inflammatory response is characterized by the movement of fluid, plasma proteins, cytokines, and other factors to the site of injury. However, this normal protective mechanism can cause problems if it is inadequate, uncontrolled, or inappropriate. Many chronic diseases, such as rheumatoid arthritis and systemic lupus erythematosus, involve chronic inflammation, and long-term anti-inflammatory treatment is required. These treatments, which include steroids, nonsteroidal anti-inflammatory drugs, and specific inhibitors of cycloxygenase, often bring their own problems (156,157).

Peculiarities Of The Clinical Spectrum Of Ss

At present there is no treatment capable of modifying the natural course of the disease and the therapeutic approach is based on symptomatic replacement or stimulation of glandular secretions, using tear and saliva substitutes and muscarinic agents. Extra-glandular features are empirically treated with corticosteroids and immunosuppressive agents in a similar manner to what is commonly done for similar clinical manifestations in lupus patients. The availability of new biological agents that are potentially able to target molecules and receptors that appear to play a relevant role in the etiopathogenesis of SS may herald a new era in the management of patients with this disease.15 Whatever new therapeutic approaches warrant testing in patients with SS, some critical points remain to be defined. First, strict criteria should be preliminarily defined for the selection of patients to be included in specific trials. Different subsets of patients can be carefully identified from large...

Cordyceps Acts On The Immune System

In contrast to the above-mentioned different lines of evidence, Cordy-ceps was shown to suppress immunity function. In cultured T lymphocytes, the application of either natural or cultured Cordyceps onto the cultures inhibited the lymphocyte blastogenesis stimulated by concanavalin A (Con A), and that effect was in a dose-dependent manner. Cultured Cordyceps also significantly inhibited E-rosette formation in humans and prolonged the survival of skin allografts and cardiac tissue transplantation in mice (39,40). Systemic lupus erythematosus is an important autoimmune disease, characterized by the presence of multiple autoantibodies in serum, of which antinuclear antibodies are the predominant species and anti-dsDNA antibodies are the disease-specific species. Female NZB NZW F1 mice, a typical lupus animal model, were fed with Cordyceps at dosages of 0.025, 0.05, and 0.10 g day from the time they were 6 weeks old. Mice treated with C. sinensis at 0.1 g day had a longer survival time...

Fibromyalgia and Men It Isnt Just a Woman Thing

One study, reported in the Journal of Clinical Rheumatology in 2006, looked at the incidence of fibromyalgia based on actual diagnoses made in medical claims from 1997 to 2002. The results were surprising The researchers found that although women were more likely to have been diagnosed with fibromyalgia than men, it was by a much lower ratio (by 1.64 times) than reported in many other studies. They also found that patients with FMS (male and female) were from two to seven times more likely than patients without fibromyalgia to also have other conditions, such as headaches, depression, anxiety, irritable bowel syndrome, rheumatoid arthritis, and lupus.

Sglv Insulin Medications

Darby And Walsh Human Needs Model

The precise function of CgA remains unknown, but it is thought to be involved in the packaging and processing of neuropeptide precursor and peptide hormones. It may also play a role in the organization of the secretory granule matrix. Moreover CgA has diverse physiological interactions CgA (or its derivatives) is an inhibitor of catecholamine, insulin, and leptin, having a role in carbohydrate and lipid metabolism moreover it inhibits parathormone secretion on the other hand, CgA increases glucagon and amylase release. In addition to its effects on endocrine organs, CgA also regulates reproductive functions and has a role also in the regulation of cardiovascular function CgA elevations have been reported in essential hypertension (CgA levels correlates with the severity of hypertension) and in chronic heart failure correlating with grade of cardiac dysfunction and mortality. A role of CgA in the regulation of inflammatory response has also been described. In fact increased CgA levels...

Head and Neck Manifestations

Skin disease occurs in 20 to 25 of patients with sarcoidosis, including lesions on the head and neck. Sarcoid skin lesions may appear as a maculopapular eruption of the alae nares, lips, eyelids, forehead, posterior neck, and at sites of trauma pink nodular facial lesions and plaque-like lesions, such as lupus pernio, a violaceous discoloration of the nose, cheeks, chin, and ears (30,33). Other cutaneous manifestations outside the head and neck region include erythema nodosum changes in old scars alopecia subcutaneous nodules and psoriaform, hypopigmented, morpheaform, and rosacea-like lesions (30,33). The simultaneous development of erythema nodosum, hilar adenopathy, migratory polyarthralgias, and fever is referred to as Lofgren's syndrome and occurs primarily in women.

Catching Fibromyalgia

Interestingly, some people (mostly women) have an immune system that apparently becomes hyperactive, turning on itself. This is called an autoimmune reaction, and it may be a cause of fibromyalgia. This may explain why a large number of patients with the autoimmune disease systemic lupus ery-thematosus (SLE) also have fibromyalgia. Conversely, other people may have lethargic immune systems that are basically run down. Both extreme paths may ultimately lead to fibromyalgia. This theory makes particular sense, especially when considering that many people with an already-diagnosed autoimmune disease, such as lupus, may also suffer from a form of fibromyalgia. Therefore, all people being diagnosed with fibromyalgia should have an evaluation to make sure that they don't have a recognized autoimmune disorder that's precipitating their FMS symptoms.

FIGURE 1 Glottic and subglottic stenosis in a patient with Wegeners granulomatosis

Arthritis may also occur in patients with other rheumatoid diseases such as Sjogren's syndrome or systemic lupus erythematosus (SLE). Laryngoscopy in cricoarytenoid arthritis reveals inflammation of the overlying mucosa and limited vocal-fold mobility. Diagnosis is established by palpation during direct laryngoscopy, which can demonstrate mechanical restriction of joint motion. Computed tomography (CT) imaging often demonstrates erosion of the cricoarytenoid joint, with surrounding soft-tissue edema. Cricoarytenoid arthritis may be asymptomatic because many RA patients have cricoarytenoid joint abnormalities on CT but no laryngeal problems (2). Tracheotomy is often required for acute airway obstruction however, cricoarytenoid arthritis usually responds dramatically to steroid treatment.

Medication generictrade Alprazolam Xanax

Symptoms to the typical demands of caring for a new baby. Now both of her children are in elementary school, and none of her friends have the same amount of pain and disrupted sleep that Florinda still endures. She saw a rheumatologist because she thought she might have lupus and was diagnosed by the rheumatolo-gist with FM due to her widespread pain and tender points on physical exam. Lupus was ruled out based on a negative history of sun-exposure rash, nonelevated liver or kidney enzymes, no history of fluid around her heart or lungs, or other signs common in lupus. She also had a negative ANA and normal sedimentation rate. She tried Amitriptyline first but found she gained weight, had difficulty thinking clearly and multitasking, and experienced dry mouth and constipation. She now orders Apo-zopliclone from Her doctor gives her a prescription for three months, which she faxes to the Canadian Web site. A pharmacist at the Web site contacted her for a medical...

Symptoms And Diagnosis

In 1990, based on a multisite research study, the American College of Rheumatology adopted the classification criteria for FM. The research study compared patients with FM to people with other chronic pain conditions, such as lupus and rheumatoid arthritis, and then considered the symptom findings in FM against people with no known disease (called healthy controls). In addition to a body pain diagram and Tender Point Survey exam, all research subjects completed questionnaires about many other symptoms associated with FM. Interestingly, it was the combination of widespread pain on the body diagram and at least eleven of eighteen tender points on the physical exam that differentiated the FM patients from not only the healthy controls but those with other pain conditions.

American College of Rheumatology Criteria for a Diagnosis of Definite SLE

The diagnosis of definite SLE requires that the child fulfill four of the eleven American College of Rheumatology criteria for the diagnosis of definite lupus. However, there are many children with SLE who initially fulfill fewer than four criteria. If children have several findings that suggest SLE but do not fulfill criteria for a definite diagnosis of SLE, they should be monitored carefully. It really does not matter whether they are said to have SLE, possible SLE, or probable SLE. The key to proper care for these children is to treat appropriately whatever problems they are having.

Cardiovascular Health

One method of measuring the earliest development of accelerated atherosclerosis is by examining the carotid intimal-media wall thickness using sophisticated ultrasonagraphy. In one study of pediatric patients with SLE, patients were shown to have a significantly higher carotid intimal-wall thickness (IMT) compared with healthy controls (28). Children with nephrotic range proteinuria were found to have the highest IMT measurements. These data suggests that aggressive attempts should be undertaken to treat children and adolescents with nephrotic lupus nephritis, in order to help prevent later CHD.

Heart Involvement in SLE

Another problem for children with SLE is the development of arteriosclerosis, the hardening of the arteries that occurs normally as people get older. In its severe forms, it causes narrowing of the coronary arteries, which leads to heart attack. Chronic use of corticosteroids promotes the development of arteriosclerosis, so children who have received a lot of corticosteroids may develop arteriosclerosis in their teens or twenties. High cholesterol levels (which may occur in children with severe kidney damage) also promote arteriosclerosis. High blood pressure may be a consequence of corticosteroids and or kidney disease. Inflammation in the blood vessels promotes high blood pressure and arteriosclerosis, too. Some children with SLE have all of these factors. As a result, a number of children with lupus who have been treated with moderate doses of corticos-teroids for many years will have a heart attack in their twenties or thirties. This is one of the strongest arguments for using...

Inflammatory Diseases

Numerous clinical trials have investigated the effects of fish oil supplementation in several inflammatory and autoimmune diseases, such as rheumatoid arthritis, Crohn's disease, ulcerative colitis, lupus erythematosus and migraine headaches (Belluzzi 2002, Belluzzi et al 1996, Miura et al 1998, Simopoulos 2002). Although not all trials have produced positive results, many of the placebo-controlled trials reveal significant benefit in chronic disease, including decreased disease activity and sometimes, reduced requirement for anti-inflammatory medicines (Adam et al 2003). Rheumatoid arthritis Of the inflammatory diseases, the use of fish oil supplementation is most widely seen in RA. According to multiple randomised, controlled studies, fish oil supplements have been consistently shown to reduce symptoms in RA, such as the number of tender joints on physical examination and the amount of morning stiffness (Adam et al 2003, Cleland et al 2003, Kremer 2000, Ulbricht & B sch 2006, Volker...

Differential Diagnosis Of Lyme Disease

Systemic lupus erythematosus and other forms of collagen vascular disease may also begin with the rapid onset of arthritis involving the large and small joints. The key to distinguishing these diseases is their different clinical appearance and use of appropriate laboratory testing. In areas where there is a high frequency of exposure to Lyme disease, the situation may be complicated by a positive Lyme test in a child who is suffering from another illness. All children with positive Lyme tests should be treated for Lyme disease, but if there is not

Oral Immunosuppressive Agents

Azathioprine has been used widely to suppress allograft rejection and to treat a variety of autoimmune disorders, including systemic lupus erythematosis (SLE), RA, and autoimmune hepatitis. The NZB NZW F1 hybrid mouse, often used as model of systemic lupus erythematosus, also develops lymphocytic infiltrates in the salivary and lacrimal glands similar to that seen in SS. Yeoman and Franklin15 studied the responsiveness of lymphocytic sialadenitis developing in NZB NZW mice to treatment with azathioprine early in the course of disease (14 weeks of age) and late in the disease course (26 weeks of age). A dosage equivalent to 2 to 2.5 mg kg per day in humans was used.

Treatment of Th1Mediated Autoimmune Diseases

Commercially available TNF-a antagonists have brought many serious complications, such as systemic lupus erythematosus, reactivation of latent TB, liver problems, alopecia, lymphoma, and others (Michel et al. 2003 Cunnane et al. 2003 CDC 2004 Ettefagh et al. 2004 Hamilton 2004).

Jia And The Relationship To Adult Arthritides

A WHO International League Against Rheumatism (ILAR) report in 1995 (7,8) proposed the now widely accepted classification based on clinical patterns, including seven different subtypes of JIA. These subtypes include systemic onset arthritis, oligo-arthritis and extended oligo-arthritis, rheumatoid factor positive polyarthritis, rheumatoid factor negative polyarthritis, enthesitis-related arthritis and psoriatic arthritis (Table 1). An eighth category other is also included in the classification. The criteria that exclude an individual from one of the subtypes above and place them in the other category have been the cause of some debate. Exclusion criteria include specific disease states causing joint inflammation, such as systemic lupus erythematosus, rheumatic fever, septic arthritis and neoplasia.

Surgery and children See hospitalization

Systemic lupus erythematosus (SLE) The more serious and potentially fatal form of the chronic autoimmune disease lupus erythematosus that affects many systems of the body. The milder form is discoid lupus erythematosus (DLE). Systemic lupus erythematosus (SLE) is probably not one but several conditions while many systems of the body may be affected, it is also possible that the disease may affect just the skin. Although typically a disease of girls and young women, it can affect either sex and all age groups without regard to race. The disease commonly waxes and wanes, and its etiology is affected by heredity, autoimmu-nity, certain drugs, sex hormones, ultraviolet light, and viruses. SLE accounts for about 70 percent of all lupus patients as well as a higher percentage of pediatric patients. Although SLE typically develops during the 20s, 30s, or 40s, about 15 to 17 percent of patients with systemic lupus first notice symptoms during childhood or adolescence. Most of these symptoms...

What Doctors And Health Professionals Should Know About Young People

Other doctors must understand that rheumatology doctors are well qualified and equipped for their job of looking after care of teenagers with lupus. Teenagers with lupus need a doctor who can explain clearly what is happening and going to happen. Young people with lupus need a doctor as well as a friend.

RLS and rheumatic diseases

In the rheumatoid arthritis (RA) patient population, increased prevalence of RLS has been reported by several investigators. Reynolds et al studied hospitalized RA patients employing a 'control' group of osteoarthritis (OA) patients, and found a 30 prevalence of RLS in RA compared to 3 in OA (Reynolds G et al, 1986). A subsequent study again comparing RA and OA found comparable prevalence rates for RLS of 25 in RA and 4 in OA (Salih AM, et al, 2004). Auger et al in their study of MS patients employed a RA patient group for contrast, finding a prevalence rate for RLS of 31 in their RA group (Auger C, et al, 2005). A more recent study employing the 2003 IRRLSG criteria for RLS found a prevalence of RLS of 27.7 in RA and a prevalence of 24.4 in OA patients (Taylor-Gjevre, et al, 2009). Increased frequency of RLS has also been reported in other rheumatic disease populations, including Sjogren's Syndrome, scleroderma and fibromyalgia patients (Taylor-Gjevre, et al, 2011). A recent study of...

Summario In Interlingua

Un numero de si-appellate tests pathognomonic esseva etiam examinate con respecto a lor specificitate diagnostic. Istos include (1) tests biochimic pro cancere e pregnantia, (2) le test a acido p-tolueno-sulfonic pro lupus erythematose, (3) amino-peptidase de leucina pro carcinoma del pancreas, (4) amylase pro pancreatitis acute, (5) phosphatase acidic pro carcinoma del glandula prostatic, (6) porphobilinogeno pro porphyria acute, (7) absorption de rubee Congo pro amyloidosis, e (8) proteina Bence Jones pro myeloma multiple,

Diagnostic Specificity

Proposed diagnostic tests with no plausible scientific basis should be regarded with skepticism until a rational explanation is forthcoming. A more recent example is the p-toluenesulfonic acid test for acute systemic lupus erythematosus.100 This test consisted of mixing 0.1 ml. of serum with 2 ml. of a 12 per cent solution of p-toluenesulfonic acid in glacial acetic acid and observing for a clot or precipitate after 20 min. Numerous subsequent studies have demonstrated that the test is nonspecific and will not distinguish between lupus and rheumatoid arthritis. The positive reactions seem to correlate with increased serum beta or gamma globulins and with other nonspecific compounds, such as C-reactive protein and serum mucopro-tein.11'25*52 129,171

Effects Of Cordyceps On The Kidney

F2, a fraction isolated from the methanol extract of Cordyceps, significantly inhibited the proliferation of human mesangial cells in cultures that were activated by IL-1 and IL-6. The immunoglobulin A nephropathy (IgAN) mice (a mouse model for Berger's disease) when fed with 1 F-2 in diet showed a reduction of hematuria and proteinuria together with histo-pathological improvement. The F2 fraction was then further purified by silica gel column chromatography and high-performance liquid chromatography (HPLC), and a purified compound H1-A (Fig. 5) was achieved, which suppressed the activated mesangial cells and alleviated the immunoglobulin A nephropathy in mice with clinical and histological improvement (24). Histological analysis of the kidney indicated that H1-A could inhibit the proliferation of mesangial cells that was evident in lupus nephritis (53).

The British Experience

Contemporaneous with the Italian group, a British group initiated the development and validation of an activity index to assess systemic features of SS,21 based on a modified version of the previously developed BILAG (British Island Lupus Activity Group) index for systemic lupus.22 BILAG is a multidimensional nominal scale that includes eight domains that are scored separately according to changes that have occurred since the previous observation. The stratification of the domains included in the scale is performed according the rater's intention to treat. The BILAG-derived Sjogren's Systemic Activity Index (SCAI) is constituted by a nine-domain structure. A factor analysis of the correlation matrix has shown the presence of a number of intercorrelated variables. This may reduce this instrument to a six-factor model. Construct validity of SCAI was also proved by measuring the correlation of this scale with the PGA, while its sensitivity to change was tested by comparing SCAI-derived...

Immunosuppressive Drugs

Or one of the newer biologics discussed below (although the biologics are classified separately, they are in fact immunosuppressive). The majority of children with arthritis do not require immunosuppressive drugs, but children with more severe arthritis will do much better if they are appropriately treated and their disease is brought under good control. Stronger immunosuppressive drugs are commonly used for children with illnesses such as systemic lupus erythematosus, dermatomy-ositis, scleroderma, polyarteritis nodosa, and Wegener's granulomatosis.

The Italian Experience

An effort was first made by an Italian group to define activity and damage criteria for SS.19 To accomplish this, the method used to develop ECLAM (European Consensus Lupus Activity Measurement) was applied.20 Data was collected on a total of 206 patients recruited in 12 Italian centers. This data was used to build two multivariate

Measurement Of Disease Activity And Damage In Different Systemic Autoimmune Diseases

During the past 30 years, several activity criteria have been developed for the majority of the systemic autoimmune diseases.4 While a plethora of activity criteria have been proposed for systemic lupus erythematosus,5 a more restricted number has been validated and recommended for use in clinical and therapeutic trials and in daily practice.8 A more restricted number of instruments are available to measure cumulative disease damage. A scoring system to assess the degree of damage in systemic lupus has been produced by an ad hoc committee of the American College of

Now that I have been diagnosed with MS how do I learn to cope with this disease

System lupus erythematosus (SLE) The first step in dealing with MS is acceptance of the diagnosis (i.e., what does the diagnosis mean ). A diagnosis may be easy for the neurologist, but the affected person may not react positively or may even be suspicious about the seeming ease of establishing the diagnosis. Obviously, the confidence in the physician is a prerequisite in accepting the diagnosis. Although physicians other than neurologists may suspect the diagnosis, the diagnosis of MS must be made by a neurologist. It is also assumed that appropriate clinical neurologic examinations and tests such as MRIs of the brain and spinal cord, cerebrospinal fluid (CSF) examination, and certain blood work will be performed and the results reviewed. These tests are usually needed to eliminate other diseases. Illnesses that can sometimes mimic MS, such as syphilis, system lupus erythematosus (SLE) , and vitamin B12 deficiency, must be eliminated from consideration. Occasionally, patients will...

Acquired Immune Deficiency Syndrome AIDS

In the case of lupus, care is required when handling as skin lesions may be tender and joint pain and tenderness may be present. Avoid contact if you are suffering from any infectious illness, as medication that clients may be taking for this condition can suppress immunity and clients are therefore prone to infections.

Autoimmune Thyroid Disease

The overlap between systemic autoimmune diseases and autoimmune thyroid disease is well known. Most studies, however, are from a time before the publication of the AECC criteria for primary Sjogren's syndrome and thus difficult to compare. Among more recent publications, the prevalence of autoimmune thyroid disease was 10 among 400 patients with primary Sjogren's syndrome followed in Hungary. Seven percent had Hashimoto thyroiditis and 3 Graves disease, about twice as frequent as in the systemic lupus erythematosus cohort from the same center and more than 150 times higher than in the general nonautoimmune Hungarian population.40 Patients with autoimmune thyroid diseases had other systemic autoimmune diseases in 30 of the cases. Sjogren's syndrome was the most common associated systemic autoimmune disease (9.4 ) followed by mixed connective tissue disease. In contrast, a smaller study from Turkey could not confirm an increased prevalence of autoimmune thyroid diseases or even...

Partial Mastectomy and Axillary Dissection

The majority of patients with intraductal carcinoma or Stage I and II invasive cancer are candidates for a partial mastectomy. Absolute contraindications to the procedure are multicentric carcinoma, prior irradiation to the breast region, first or second trimester pregnancy, diffuse indeterminate microcalcifications on a mammogram, and the inability to achieve negative margins after an adequate number of surgical attempts. Relative contraindications are a large tumor-to-breast ratio and scleroderma or systemic lupus. Patients with invasive carcinoma who are clinically node negative should have their axillary nodal status determined by sentinel node biopsy or axillary dissection. Those who are clinically node positive require axillary dissection.

Implications For Handedness Research

A growing number of other studies support the importance of separating out weakly right-handed participants. Lahita evaluated the association of handedness and systemic lupus erythematosus (SLE) using the LQ scoring method (Lahita, 1988). When he divided the handedness range into three segments -100 to 0, 0 to +50, and +50, he found that the percentage of patients with SLE who had an LQ between 0 and +50 was double the frequency in normal controls. Bakan et al. showed that ambilateral participants were twice as likely as right handers to report pregnancy and birth complications (Bakan, Dibb, & Reed, 1973). Lindesay compared handedness scores of 94 homosexual and 100 heterosexual men. The distribution of handedness among the homosexual men was significantly shifted from strong right handedness to weak right handedness (Lindesay, 1987). These results have been replicated in one study (Holtzen, 1994), but not another (Satz, Miller, Selnes, Van Gorp, D'Elia, & Visscher, 1991). Dellatolas...

Inflammatory Muscle Disease

The presence of myositis in primary Sjogren's syndrome was studied by two groups in recent years While Lazarus and Isenberg5 detected only 1.8 of myositis overlap in their British cohort of Sjogren's syndrome patients, Lindvall and colleagues31 found that 14 of their Sjogren's syndrome patients suffer from myositis, when muscle involvement was studied both clinically and histologically. There are no reports from larger myositis cohorts that define the prevalence of Sjogren's syndrome in primary myositis. Some case reports exist on the coexistence of inclusion body myositis and Sjogren's syndrome.32,33 These Sjogren's syndrome-associated inclusion body myositis cases seem to differ from primary inclusion body myositis in demonstrating a better response to immunosuppressive therapy. We have recently observed an association of classical dermatomyositis, systemic lupus erythematosus, and Sjogren's syndrome (unpublished data). Generally, myositis is accepted as a relatively rare...

General Diagnostic Approach To Adolescent With Back Pain

Back pain in the adolescent is less likely to represent a serious problem compared to the younger child, and less likely compared to adults to represent spinal pathology compared to adults. Therefore, the majority of adolescents with back pain will have a mild, self-limited problem and will not need an extensive work-up. A careful history and physical exam should distinguish nonspecific back pain from more serious etiologies. Figure 3 is one algorithmic approach to back pain diagnosis. In general, an urgent evaluation is required in an adolescent with neurological signs and symptoms suspicious of a possible or impending spinal cord compression as can occur with tumor, epidural abscess, or fracture. Plain radiographs are indicated in those assessed to be likely to have a problem associated with radiographic changes or with a history of significant trauma prior to back pain onset. MRI is best for further investigation of a significant plain radiographic abnormality, or in those who have...

Systemic Forms Of Scleroderma Progressive Systemic Sclerosis

Other diseases may be associated with Raynaud's phenomenon or shortness of breath, but the combination of chronic or recurrent shortness of breath and Raynaud's is highly suggestive of PSS or CREST syndrome (see below). MCTD, dermatomyositis, systemic lupus erythematosus, and less frequently other rheumatic diseases may also have both symptoms. Typical cases of MCTD, PSS, and CREST syndrome can be easily differentiated, but there is a broad spectrum of overlap among these diseases. Over time, some children with obvious MCTD progress to having PSS.

Longterm Outcomes Of Juvenile Onset

Juvenile onset SLE can be life threatening during childhood and adolescence, can cause significant organ damage with subsequent long-term implications, and will continue to require monitoring and treatment into adult life. Therefore, this disease almost certainly has a significant long-term impact on affected children and adolescents. However, outcomes can be optimized with careful attention to factors relating to lupus disease activity, medication side effects, and healthy lifestyle choices (Table 3). Screening for bone density and treatment of patients with low density Aggressive treatment of lupus disease activity One method of measuring impact of SLE over time is to use a standardized tool which measures organ damage due to SLE and its treatments. The Systemic Lupus International Collaborative Clinics American College of Rheumatology Damage Index (SDI) has been developed to measure irreversible damage in a variety of organ systems due to SLE or its treat-ments(34,35). This tool...

Detection Of Circulating Nucleic Acids In Plasma Or Serum

The first description of DNA in plasma or serum was by Mandel and Metais in 1948.9 Using a perchloric acid precipitation method, they detected both DNA and RNA at a concentration of between 0.3 to 1.0mg l of plasma in healthy and sick individuals. This concentration is higher than that reported in more recent studies, probably reflecting both methodological and sample differences. It was not until the 1960s that the field was revisited when high levels of DNA were reported in the serum of patients with systemic lupus erythmatosis.10 Subsequent studies showed increased concentrations of free DNA in plasma or serum from patients with rheumatoid arthritis, pancreatitis, pulmonary embolism, ulcerative colitis, inflammatory bowel disease, peptic ulcer, and other inflammatory conditions.11-14 Increasingly sensitive assays were also able to detect small amounts of free DNA, up to 30 ng of soluble DNA ml, in the serum and plasma of healthy individuals.15

Autoimmune disorder of the skin

Lupus Knots Under Skin

Systemic lupus erythematosus (SLE) A form of lupus which primarily affects the skin is dicoid lupus erythematosus (DLE). This is where the skin forms round, firm lesions called discoids with red, raised bumps around the hair follicles. All forms of lupus are aggravated by sun exposure. Systemic lupus erythematosus Systemic lupus erythematosus

EPADHA and Immune Function

Numerous in-vitro, animal, and human studies have reported that omega-3 fatty acids, in particular EPA and DHA, can suppress immune cell activity.110-122 Omega-3 fatty acids are therefore potent anti-inflammatory agents, and for this reason EPA and fish oil (which contains EPA) have been reported useful in reducing the symptoms of autoimmune-related diseases such as lupus, rheumatoid arthritis, psoriasis, and colitis.114,123-125

Detection of Soluble Fragments

May reflect reduced shedding or strong binding of the soluble fragment to cell surface ligands or both (270). Higher serum levels of soluble L-selectin have been found in sepsis and in AIDS (Acquired Immune Deficiency Syndrome), sometimes to a concentration that completely inhibits leucocyte attachment to endothelial cells in vitro (271). Serum levels of soluble E-selectin are elevated in patients with diabetes, sepsis, arthritis, lupus erythematosus or breast, gastro-intestinal and head and neck cancers, indicating that the endothelium is activated (189, 271, 272). Soluble ICAM-1 still binds to leukocyte function associated molecule 1 (LFA-1) (273) and the serum levels are elevated in patients with inflammation, infection or metastatic cancer (272, 99, 275, 276, 277).

Other Modalities Plasmapharesis

At one point, plasmapharesis was considered a possible therapy for a wide variety of diseases. However, it was found to lack lasting beneficial effects. Today, plasmapharesis is not routinely used for the therapy of children with any rheumatic disease. However, it is occasionally beneficial for crisis management in children with systemic lupus erythematosus or antiphospholipid antibody syndrome. Controlled studies do not convincingly show any sustained benefit from plasmapharesis after the acute crisis. Over time, the toxic effects mount, while the therapeutic efficacy decreases.

Ordering up a round of lab tests

The pain of fibromyalgia may appear to the doctor to be the beginnings of rheumatoid arthritis or lupus, both very serious and deteriorating arthritic conditions. Another possibility is multiple sclerosis, also a serious disease. In addition, the doctor will often want to verify that you don't have a thyroid disease. Hypothyroidism, or below-normal levels of thyroid hormone, can also cause fatigue and muscle and joint pain. Sometimes these conditions can coexist with fibromyalgia. These diseases are known as autoimmune disorders, or diseases resulting from the body's immune system actually attacking itself. A blood test will reveal if your blood includes a special factor that indicates that you may have rheumatoid arthritis or lupus. If the blood test comes back negative, you're unlikely to have them. A spinal-fluid examination can detect antibodies that are characteristic of multiple sclerosis.

Case examples and scoring sheets

The patient, a 27-year-old woman, was admitted to the department of gastroenterology for the evaluation of diarrhea. There are several reasons for the admission. First, in the last month extensive diagnostic evaluations have been made, but a final diagnosis is still to be determined. Second, the patient's condition has declined, and she has lost about 10 kg in the last month. Third, the patient has informed her doctor that she is almost incapable of doing anything at home. She has suffered from systemic lupus erythematosus (SLE) for about 4 years and is being treated by a nephrolo-gist, because her kidneys were the primary location of the disease. There is a gradual decline of the kidney function. A relationship between the diarrhea and the SLE is expected but has not yet been confirmed. During the admission the following information is obtained. Although the patient is silent during the admission process, she starts to cry when the nurse suggests that she must have been in an awful...

Chronology of Problems

Arthritis, diabetes, high blood pressure, heart disease, osteoporosis, alcoholism, ulcers, kidney disease, liver disease, migraine, tuberculosis, stroke, psychiatric problems, epilepsy, lung disease, venereal disease, sciatica, drug dependency, thyroid disease, hepatitis, skin disorders, AIDS, fractures, multiple sclerosis, endometriosis, lupus, cancer, heart attack, carpal tunnel, breast implants, irritable bowel, Sjogren's, asthma, posttraumatic stress, sinusitis, vasculitis

Differential Diagnosis

Multiple diseases can present with findings similar to those seen with Adamantiades-Behget's disease and should be considered when a patient presents with recurrent oral or genital ulcers, inflammatory eye disease, or other manifestations of vasculitis. Included in the differential diagnosis are systemic lupus erythematosus (Chapter 1), seronegative spondyloarthropathies, inflammatory bowel disease (Crohn's or ulcerative colitis) (Chapter 20), herpes or other viral infections (Chapter 10), other forms of vasculitis (Chapter 8), and inflammatory skin diseases such as pemphigus vulgaris or pemphigoid lesions (Chapter 37). All patients presenting with oral and genital ulcerations should undergo testing for herpes simplex virus using culture or polymerase chain reaction methods, to ensure that viral infection is not present. aFindings applicable only in the absence of other clinical explanations (systemic lupus erythematosus, inflammatory bowel disease, seronegative spondyloarthropathies,...

TNF Blockade An Inflammatory Issue

Army Leadership Requirements Model

Tumor necrosis factor (TNF), initially discovered as a result of its antitumor activity, has now been shown to mediate tumor initiation, promotion, and metastasis. In addition, dysregulation of TNF has been implicated in a wide variety of inflammatory diseases including rheumatoid arthritis, Crohn's disease, multiple sclerosis, psoriasis, scleroderma, atopic dermatitis, systemic lupus erythematosus, type II diabetes, atherosclerosis, myocardial infarction,

Cerebrospinal Fluid Testing

In diseases such as lupus that may affect the brain, the child may start acting strangely. Often no one is sure whether the strange behavior is due to the drugs being used to treat the lupus, the child's being upset about being ill, the illness itself, or an infection. Examining the spinal fluid is the only way to be sure there is not an infection. Oligoclonal bands are another finding that suggests irritation of the central nervous system. They are sometimes found in lupus and sometimes in multiple sclerosis, but there may be other causes. If the doctors are worried about infections such as Lyme in the central nervous system, they will measure the concentration of antibodies to Lyme in the CSF and compare it with the concentration in the blood. Higher levels of antibodies in the CSF than in the blood suggest Lyme infection of the central nervous system.

Management Of Juvenile Slegeneral Concepts

The treatment of juvenile SLE should incorporate medical management with pharmacologic agents, and attention to general health issues such as diet, sun exposure, exercise, and participation in school, and peer activities. Education for the adolescent and family is a very important consideration. Optimal care for the adolescent with SLE should include the family and patient as an active member of the health care team, with a pediatric rheumatologist, clinical nurse specialist, psychologist, nutritionist, physiotherapist, and occupational therapist as part of the team. The health care providers involved with the adolescent should not only have expertise in the area of lupus treatment but should also have expertise and interest in the care of adolescents with chronic health conditions.

Overlap Syndromes

Children and adolescents can present with signs and symptoms that are characteristic of more than one connective tissue or inflammatory disorder. This occurrence is more common in children and adolescents compared to adults. In our experience, children's signs and symptoms may evolve over time from those of one connective tissue disease to another. For example, combinations of features of JIA, systemic lupus erythematosus, juvenile dermatomyositis, scleroderma, and vasculitis are seen. These children are best described as having overlap syndromes or undifferentiated connective tissue disease. Treatment should be tailored to organ involvement and underlying pathophysiology rather than be disease specific.

Specialized Tests

The pattern of ANA test results can be significant. Homogeneous pattern ANA occurs in many different people and is not disease-specific. Speckled pattern ANA is also common at low titer, but at higher titer it may be associated with mixed connective tissue disease or scleroderma. Rim pattern (also called shaggy pattern) is almost always a sign of active lupus. Another early finding was that some of the antibodies detected by the ANA test were directed against DNA and that people with high titers of anti-DNA antibodies were often sicker. These tests used to be separated into tests for single-stranded DNA (ssDNA) and tests for double-stranded DNA (dsDNA). Tests for ssDNA have mostly disappeared, as these antibodies are very nonspecific and occur in a wide variety of situations. Most anti-DNA tests today measure dsDNA. High titers of anti-dsDNA are much more specific for lupus than a positive ANA. However, there are children with anti-dsDNA antibodies who have other diseases. Sometimes a...


Systemic lupus erythematosus (SLE) A chronic inflammatory autoimmune disorder that may affect many organ systems including the skin, joints and internal organs. The disease may be mild or severe and life-threatening. African-Americans and Asians are disproportionately affected. The ANA test helping in the diagnosis of SLE is positive in about one half of MS patients.


Epidemiology is complicated by genetic diversity and environment, which play an important part in inflammatory musculoskeletal disease. For example, large regional variations in epidemiology exist among distribution of subsets of juvenile idiopathic arthritis (JIA), probably due to human leucocyte antigen (HLA) alleles and environment (4). Likewise, lupus is three to five times more common in African-American females compared to white females, and twice as common in African-American males (5). Need knowledge of medications and what to do if become unwell when away. Holiday insurance. Vaccinations. Spare supplies of medication in hand luggage. Informing airline of need to travel with needles. Need awareness that sun exposure may lead to a flare of dermatomyositis or lupus stress need for sun block, hats and sleeves. Increased risk taking behavior when away with peers

Indications Garlic

LIB TGP) Bacillus (1 LAW X10548758) Bacteria (1 JFM PH2) Bite (f FAY JFM) Boil (f1 DAA) Bronchiestasis (1 KAL) Bronchosis (f12 FAD PHR PH2 BOD WHO) Burn (f12 KAL) Callus (f JFM PH2) Cancer (f12 AKT FAD PH2) Cancer, abdomen (f1 AKT FNF JLH) Cancer, bladder (f1 FNF JLH X11341051 X11238811) Cancer, breast (f1 BRU JN131 989s) Cancer, colon (f1 AKT (f1 FNF JLH)) Cancer, esophagus (f1 JN131 1075s) Cancer, gland (1 X11238818) Cancer, liver (f1 BO2 PR14 564) Cancer, lung (f1 BRU FNF JLH JN131 989s) Cancer, prostate (f1 X11102955) Cancer, skin (f1 FNF JLH) Cancer, stomach (f1 AKT VOD X11238811) Cancer, uterus (f1 FNF JLH) Candidiasis (f12 CAN KAL TRA VOD) Carbuncle (f FAY) Cardiopathy (f123 BGB EGG FAD SKY VOD) Caries (f1 FNF KAB) Catarrh (f1 AKT BGB) Celiac (1 KAL) Chilblain (f EGG) Childbirth (f JFM KAB) Cholecocystosis (f APA) Cholera (f1 PNC TRA) Chronic Fatigue (f JFM) Circulosis (f DLZ) Coccidiosis (1 KAL) Cold (f12 AKT FAD GHA PHR PNC) Colic (f1 GHA WHO) Colosis (1 KAL LAW) Congestion...


In their urine after a lot of physical activity, especially running. This is not significant either. However, people with nephrotic syndrome, a type of kidney damage, may constantly lose a lot of protein. This is determined by measuring the excretion of protein over a twenty-four-hour period or by comparing the ratio of protein to creatine in a urine specimen. Children with lupus may develop nephrotic syndrome. Children with amyloidosis, a rare complication of juvenile arthritis, often have protein in their urine and also may develop nephrotic syndrome.

Indications Cinnamon

WO2) Biliousness (f KAB) Bleeding (f KAB) Bloating (f1 BGB) Bronchosis (f12 CRC KAB PHR) Cancer (f1 COX CRC HOS) Cancer, abdomen (f1 COX HOS JLH) Cancer, bladder (f1 COX HOS JLH) Cancer, breast (f1 COX HOS JLH) Cancer, colon (f1 COX HOS JLH) Cancer, diaphragm (f1 COX HOS JLH) Cancer, ear (f1 COX HOS JLH) Cancer, gum (f1 COX HOS JLH) Cancer, kidney (f1 COX HOS JLH) Cancer, liver (f1 COX HOS JLH) Cancer, mouth (f1 COX HOS JLH) Cancer, neck (f1 COX HOS JLH) Cancer, rectum (f1 COX HOS JLH) Cancer, sinus (f1 COX HOS JLH) Cancer, spleen (f1 COX HOS JLH) Cancer, stomach (f1 COX HOS JLH) Cancer, vagina (f1 COX HOS JLH) Cancer, uterus (f1 COX HOS JLH) Candida (f1 CRC LIB JAR12 83) Cardiopathy (f1 EGG KAB LIB X14633804) Cerebrosis (f KAB) Childbirth (f LIB) Chill (f PHR PH2) Cholera (f1 CRC SKJ WO2) Cold (f12 CAN GAZ PHR ZUL) Colic (f1 APA CAN EGG TRA) Condylomata (f JLH) Conjunctivosis (f WHO) Convulsion (f LIB) Cough (2 CRC PHR) Cramp (f1 APA DEP VOD ZUL) Dandruff (1 JAR12 83) Debility (f...

Chemistry Panel

Albumin is a serum protein manufactured by the liver that serves as both a building block and a carrier molecule. If the level is low, it may be the result either of decreased production from liver disease or poor nutritional intake or of increased loss through the gastrointestinal system or the kidney. In either case, it needs to be investigated. Systemic lupus erythematosus and amyloidosis are among many diseases that may cause increased loss of albumin through the kidney. This is easily detected by urine tests for protein.

Lockjaw See tetanus

Lupus An autoimmune disease in which a person's immune system mistakenly works against the body's own tissues. Systemic lupus erythematosus (SLE), the most common type of lupus, typically develops during the 20s, 30s, or 40s mbut about 15 percent to 17 percent of people with systemic lupus first notice symptoms during childhood or adolescence. Most of these are children 10 years or older it is extremely rare in children under five. Experts estimate that between 5,000 and 10,000 children in the United States have SLE. Children diagnosed with lupus often have been ill for a longer period and are more likely to have significant internal organ involvement than most adults with lupus. This may be because many children are not recognized as having early lupus until the disease has become worse. As a result children with lupus often are required to begin aggressive therapy soon after diagnosis. While lupus can be a severe and life-threatening disease, many children with lupus will do very...


Anasarca Bladder Cancer

Autoimmune causes for vertigo include Cogan's syndrome (consisting of dizziness, progressive sensorineural hearing loss, and uveitis), systemic lupus erythematosus (Chapter 1) rheumatoid arthritis (Chapter 1) and steroid-responsive autoimmune hearing loss (Chapter 5). Characteristic ocular, cutaneous, and extremity findings in addition to serology are crucial to making the correct diagnosis.

Indications Melon

Acne (1 FNF MAR) Anasarca (f BIB) Anuria (f DEP) Apoplexy (f BIB) Ascites (f BIB KAB) Biliousness (f BIB) Bronchosis (f BIB) Bruise (f BIB) Burn (f BIB) Cancer (f BIB) Cancer, bladder (f1 FNF JLH) Cancer, liver (f1 FNF JLH) Cancer, stomach (f1 BIB JLH JNU) Cancer, uterus (f1 BIB JNU) Cardiopathy (1 FNF JNU) Childbirth (f HJP) Cold (f BIB) Coryza (f BIB) Cough (f BIB BOU) Cystosis (f FNF JLH) Dermatosis (f BIB) Diabetes (f BIB) Dyspepsia (f BIB) Dysuria (f BIB DEP NPM) Eczema (f BIB UPW WOI) Extravasation (f BIB) Fatigue (f BIB) Fever (f BOU) Freckle (f BIB) Fungus (1 UPW) Gastrosis (f JLH) Gonorrhea (f BIB) Hepatosis (f BIB JLH) Hyperkeratosis (1 FNF PAM DAS) Ichthyosis (1 FNF) Infection (1 UPW) Inflammation (f1 JLH X15261965) Insanity (f KAB) Jaundice (f BIB LMP) Leukoplakia (1 FNF PAM) Lupus (1 FNF MAR) Mastosis (1 FNF) Menorrhagia (f BIB) Mycosis (1 UPW) Nephrosis (f BIB) Oliguria (f BIB) Ophthalmia (f BIB) Pityriasis (1 FNF)


Jia Patterns Rheumatology

Adolescents with systemic lupus erythematosus (SLE), mixed connective tissue disease, chronic vasculitis, or dermatomyositis may also develop back pain. SLE and MCTD are most common in the adolescent female, while dermatomyositis is more common from mid childhood through early adolescence (86-89). Back pain in these patients may be secondary to arthritis, infection, osteoporosis, osteonecrosis, referred from pathology in the chest or abdomen, or transverse myelitis, but these patients can also develop other more common causes of back pain in adolescents such as mechanical problems, nonspecific back pain, or fibromyalgia. Arthritis as a cause of back pain is unusual in these patients who are more likely to have peripheral small joint arthritis rather than axial arthritis (86-89).

Laboratory Tests

A high MCV may indicate an increased number of young red blood cells called reticulocytes, which can be caused by iron deficiency, deficiency of the vitamin folate (which can be caused by the drugs sulfasalazine and methotrexate, commonly used by rheumatologists), or hemolytic anemia (in which the body rapidly destroys red blood cells because of a metabolic or autoimmune problem and the bone marrow attempts to compensate by releasing large numbers of reticulocytes, which are larger than mature red blood cells). Hemolytic anemia may be an isolated problem, but it may also be caused by a number of rheumatic conditions, including systemic lupus erythematosus. Hemolytic anemia can also be caused by medications, and occurs with increased frequency in children who lack an enzyme found in normal red blood cells called G6PD. G6PD deficiency, which can be detected with a separate test, is more common in children of African, Asian, Middle Eastern, or Mediterranean heritage. Hydroxychloroquine...


It is not known whether folic acid supplementation can help control these side effects without decreasing the effectiveness of methro-threxate. Low-dose methothrexate is used to treat a variety of diseases, such as rheumatoid arthritis, lupus, psoriasis, asthma, and inflammatory bowel disease. Low-dose treatment can deplete folate stores and cause side effects similar to folate deficiency. In this case, supplemental folic acid may help reduce the undesirable effects of low-dose methothrexate without decreasing treatment effectiveness.


It is now recognized the rituximab is effective in the treatment of rheumatoid arthritis, systemic lupus erythematosus, Wegener's granulomatosis, and der-matomyositis. It may prove effective in additional rheumatic diseases in the future. A number of studies are presently under way to determine the optimal regimen for the use of rituximab in each of these conditions. In adults with rheumatoid arthritis it is clear that rituximab may provide relief for severe cases that have not responded to TNF inhibitors. Rituximab has been very effective in children with rheumatoid-factor-positive arthritis when combined with cyclophosphamide or methotrexate. There is limited experience in other forms of juvenile arthritis, but it is likely to be beneficial. In adults with rheumatoid arthritis repeated treatment seems necessary, and this is likely to be true in children as well. In adults and children with systemic lupus erythematosus the combination of rituximab and cyclophosphamide has often...

TNF Inhibitors

Another concern is that all of the drugs that affect the immune system may lead to the development or worsening of other diseases. Some children receiving TNF inhibitors have developed minor serologic abnormalities related to lupus, and this needs to be monitored. However, medically significant problems appear to be extremely rare. For the majority of children, allowing the arthritis to continue is far more dangerous than the remote risk of a serious side effect from TNF inhibitors.


Fatigue is also commonly reported by patients with other rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus.2-4 Furthermore, fatigue is relatively common in the general population9 and can present in association with certain medical conditions (eg, hypothyroidism), or with psychiatric diseases (eg depression), or be medically unexplained (eg, chronic fatigue syndrome).9 One useful model, therefore, considers the interrelationships of biological (eg, disease activity,'' sleep), psychological (eg, depression and personality), and social factors (eg, family circumstances, life events).10 of inflammatory markers (erythrocyte sedimentation rate, C-reactive protein), antibodies (immunoglobulin levels, anti-Ro La antibody titres), or cytokines, such as IL-1 b, IL-2, IL-6, IL-10, and tumor necrosis factor a. These studies were unable to identify any associations.3,11,12 My colleagues and I,2 in our studies developing the Profile of Fatigue and Discomfort...

Raynauds Phenomenon

The importance of Raynaud's phenomenon lies in its association with a variety of rheumatic diseases. While Raynaud's is common in thin young women, it is often the first manifestation noticed in children with progressive systemic sclerosis (see Chapter 13). Raynaud's is also found frequently in children with other vasculitic diseases, such as lupus, dermatomyositis, and anticardiolipin antibody syndrome. It may occur in children with many other rheumatic conditions.

The Rheumatologist

The rheumatologist is a specialist who manages autoimmune rheumatic diseases, such as rheumatoid arthritis (an autoimmune disease causing joint pain and deformity), and degenerative joint diseases such as osteoarthritis (an inflammation that causes joint pain). It is common for patients with FM to have stiff joints that feel swollen, but they should not have inflammation, synovitis (fluid around the joints), or signs of major joint degeneration. FM patients who see rheumatologists may be given a blood test called the antinuclear antibody test (ANA) that diagnoses systemic lupus erythematosus (SLE, a chronic, inflammatory autoimmune disorder affecting any one of the following skin, joints, blood cells, kidneys, heart, lungs). There is a high false-positive rate for this test, which is a source of great stress for many FM patients who inaccurately assume that they have SLE. For this reason, ANA testing is best reserved for patients whose history and physical exam does specifically...


The immunosuppressant treatment for SLE will vary depending on the patient's clinical characteristics. Medications commonly used include aza-thioprine, mycophenolate mofetil, and intravenous cyclophosphamide (15). Many pediatric rheumatology centers will use intravenous cyclopho-sphamide for treating active lupus nephritis and other serious organ involvement of SLE (16). IV cyclophosphamide is generally given as a once monthly treatment for 6 to 7 months, with further treatments dependant on response. Among the many possible side effects of cyclophosphamide is thinning hair or significant hair loss this is often very distressing to the patients. It is very important, however, to stress with adolescents that they can still become pregnant while taking cyclophosphamide or afterwards being on cyclophosphamide is not an effective form of contraception In our clinic, we counsel adolescents about the need for regular and effective contraception while taking cyclophosphamide due to the...

Of North America

Sjogren's syndrome (SS) is atypical among the major autoimmune rheumatic diseases encountered by the rheumatologist. The predominance of ocular, oral mucosal, and exocrine gland pathology accompanied by the copresence of multiple organ-specific autoimmune disorders results in a somewhat unfamiliar diagnostic and therapeutic landscape. The lack of universally accepted diagnostic, classification, and outcome criteria, as well as the need for close collaboration with ophthalmologic, dental, and otolaryngologic subspecialists for optimal patient management, all contribute to challenges in management. Nevertheless, SS affords rheumatologists and immunologists an opportunity to understand the pathogenesis, long-term evolution, and outcome of an autoimmune disease that possesses both organ-specific and systemic features. In addition, the frequent co-occurrence of SS with other major rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosis, and scleroderma, affords a...

Past Medical History

Not long ago a child was sent to me because of blood in the urine and joint pains. The referring physician was worried about lupus. After I'd gotten all the relevant information from the mother and was asking about past medical problems, she told me the child had frequently been treated for an infected parotid gland. Then I asked the child whether he had trouble making tears or eating certain foods. As a result, I knew to evaluate him for Sjogren's syndrome. Despite several years of the child's being treated for various symptoms, the correct diagnosis had not been previously considered because no one obtained the pieces of information necessary to see how everything fit together to suggest this diagnosis.

Autoimmune Diseases

The systemic vasculitides may involve the labyrinth. Wegener's granulomatosis (Chapter 8) is a systemic vasculitis of medium and small blood vessels resulting in a triad of necrotizing granulomas of the upper airway, necrotizing glomerulonephritis, and systemic necrotizing angiitis. Chronic otitis media is the most common otologic manifestation of Wegener's, but sensorineural hearing loss will occur in a significant number of patients. Immune-mediated inner-ear disease can also be a component of polyarteritis nodosa (PAN). Postmortem temporal bone histopathologic studies on patients with PAN have demonstrated vasculitic changes within the labyrinth. Systemic lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome, and relapsing polychondritis have also been associated with cases of sudden hearing loss and histopathologic evidence of labyrinthitis.

Oxidative Stress

When the critical balance between generation of free radicals and other ROS or RNS and the antioxidant defenses is unfavorable, oxidative damage can accumulate. Oxidative stress is defined as a condition that is characterized by accumulation of non-enzymatic oxidative damage to molecules that threaten the normal function of the cell or the organism (Blomhoff, 2005). Compelling evidence has emerged in the past two decades demonstrating that oxidative stress is intimately involved in the pathophysiology of many seemingly unrelated types of disease. Thus, oxidative stress is now thought to make a significant contribution to all inflammatory diseases (arthritis, vasculitis, glomerulonephritis, lupus erythematosus, adult respiratory distress syndrome), ischemic diseases (heart disease, stroke, intestinal ischemia), cancer, hemochromatosis, acquired immunodeficiency syndrome (AIDS), emphysema, organ transplantation, gastric ulcers, hypertension and pre-eclampsia, neurologic diseases...

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