Natural Ways to Treat Lupus

Proven Lupus Treatment System by Dr. Gary Levin

Natural Lupus Treatment by Dr. Gary Levin is an easy-to-understand e-book and comes together with a quick start guide and the audio version of the system. With the method that Lupus patients will learn in Natural Lupus Treatment, they will not need pills, injections, and other risky methods to take their lupus away. Patients just need to follow the steps laid out in this system and they can cure their lupus and enjoy a normal life again. This Natural Lupus Treatment is addressed first to those who want to learn more about Lupus, and those who are familiar with this area and have a fairly comprehensive knowledge base. Continue reading...

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Application Guidelines Systemic Lupus Erythematosus

If a malar rash is present at onset, it usually appears abruptly. Photosensitivity can be present but is not as prominent a feature in SLE as in cutaneous lupus erythematosus. Although skin lesions occur in 80 of SLE patients during the course of their disease, they are a presenting sign in only about 13 . Joint and other visceral symptoms predominate. Cutaneous lesions are nevertheless important because they constitute four of the 11 criteria used by the American Rheumatism Association to establish a diagnosis of SLE. The four defining cutaneous signs that can be present at onset are the following

Ficolins and Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with of unknown cause, but immune dysfunction is clearly one of its central features. H-ficolin was firstly identified as a serum antigen target for an autoantibody present in the sera of some patients with SLE. That might participate in the pathogenesis of SLE. Anti-H-ficolin antibody appears during the active hypocomplementemic phase in some SLE patients and its concentration was found to correlate positively with diseases activity in SLE (Yoshizawa et al. 1997).

Lupus Erythematosus

Lupus Ana Levels

INTRODUCTION Lupus erythematosus is a chronic inflammatory autoimmune disease with a spectrum of clinical forms ranging from a benign chronic cutaneous variety (discoid lupus erythematosus) to an often-fatal systemic type with nephritis (systemic lupus erythematosus). Intermediate types, variously known as disseminated discoid lupus erythematosus and subacute cutaneous lupus erythematosus, are characterized by various combinations of widespread cutaneous lesions and mild to severe systemic manifestations. The role of immune complexes in the inflammatory manifestations of lupus is well recognized, and in about 4 of cases an associated vasculitis may be seen from small vessel involvement. Lupus erythematosus occurs most commonly in women in the third to fifth decades. When skin lesions occur they typically appear in areas exposed to the ultraviolet rays of the sun. Rarely discoid lupus can degenerate into squamous cell carcinoma. Common nonscarring eyelid lesions include a pruritic...

Modeling The Diagnostic Process And The Establishment Of Standardized Diagnostic Criteria

Diagnostic criteria are usually based on traditional teaching that may be influenced through time by the literature. The literature often reflects an informal distillation of diagnostic concepts held by clinical experts in the field. However, a few examples exist where an ad hoc declaration of diagnostic criteria for a condition have been widely accepted. For instance, the Jones criteria for the diagnosis of rheumatic fever, although revised intermittently (6), have been the accepted standard for the identification of this disease entity for more than 50 years (7). Other examples include the criteria used for the diagnosis of essential hypertension (8) and systemic lupus erythematosus (9,10).

HIV and Kidney Disease

HIV-associated immune complex disease (HIV-ICD) occurs less frequently than HIV-AN. There is a higher incidence in Caucasians. Four different categories have been described (1) immune-complex mediated glomerulo-nephritis (with diffuse proliferative and crescentic forms), (2) IgA nephritis (with diffuse or segmental mesangial proliferation), (3) mixed sclerotic inflammatory disease, and (4) lupus-like syndrome. The precise role of HIV infection in the pathogenesis of these entities has not been established, and glomerular inflammation may be due to the abnormal immune responses associated with HIV infection, or secondary to superinfections. The clinical presentation is often very different from HIV-AN. Patients present with hematuria and mild proteinuria. The course is more indolent, with low rates of progression to end-stage renal disease.

Negative and Positive Selection and Ignorance of the Developing Immature B Cell Repertoires

Genetic deficiencies in complement components such as CIq, C4, serum amyloid protein, and complement receptor 2 (CR2), as well as secreted natural serum IgM (Boes et al. 1998,2000 Chan et al. 1999), lead to systemic autoimmune disease (systemic lupus erythematosus, SLE) with a preponderance of autoantibodies against single- and double-stranded DNA and a variety of other nuclear antigens. Such high avidity autoantibodies are not found in normal, nondiseased individuals.

Discharge And Home Healthcare Guidelines

AI may result either from an abnormality of the aortic valve or from dilation and distortion of the aortic root. AI can be congenital or acquired. Congenital abnormalities are associated ventricular septal defect, bicuspid aortic valve, subvalvular aortic stenosis, dysplasia of valve cusps, or the absence of two or three aortic valve leaflets. Acquired AI results from conditions such as endocarditis, trauma, systemic diseases like rheumatic fever or systemic lupus erythematosus, and connective tissue syndromes.

Conditions That May Simulate Psoriasis Vulgaris

Cutaneous Lupus Erythematosus Discoid and subacute lupus erythematosus (LE) can occasionally resemble PV in onset, distribution, and lesional morphology. Lupus lesions usually have a deeper hue with telangectasias. Scarring, which is absent in psoriasis, tends to occur early in discoid LE. Arthralgias and systemic symptoms may be present, especially with subacute LE. When suspected, a skin biopsy is helpful along with an antinuclear, anti-Ro (SS-A), and anti-La (SS-B) antibodies.

Dermatologic Physical Exam

This test is indicated when the disease is strongly suspected but the diagnosis is clinically uncertain. Although LP and LP-like drug eruptions may show identical histology, subtle differences can sometimes point toward the latter diagnosis. Biopsy is particularly helpful for differentiating lichen planus and lupus erythematosus. Although rarely needed, this test can be helpful in supporting a diagnosis of LP where other parameters are confusing. The pattern is quite different from that of lupus erythematosus however, it is identical in an LP-like drug eruption.

Complement Mediated Cell Clearance

Complement deposition on the surface of pathogens greatly increases the rate at which these opsonized pathogens are phagocytosed and destroyed (Mevorach 1999). Studies have also demonstrated that early complement components such as C1q, C3, and C4 play a critical role in facilitating the clearance of apoptotic cells (Fishelson et al. 2001 Mevorach 1999, 2000, 2003 Mevorach et al. 1998). This may explain why genetic complement deficiencies strongly predispose individuals to develop autoimmune diseases, such as lupus, which are generally considered to result in part from the failure to clear apoptotic cells that spill cellular debris after acute tissue injury (Elward and Gasque 2003 Fadok 1999 Fadok and Henson 1998 Fadok et al. 1998a,b Fishelson et al. 2001 Mevorach 2003).

Danger Transmission Mediated Through The Anaphylatoxic Peptides C3a And C5a

Serine proteases generated in response to activation of the three pathways of the complement system, as well as allergen- and tissue-derived proteases, can cleave the low-molecular-weight anaphylatoxic peptides (AT) C3a and C5a from C3 and C5, respectively. The ATs act as potent mediators of inflammatory effector functions, such as phagocyte and mast cell recruitment and activation, including the release of granule enzymes, reactive oxygen species, cytokines, and chemokines, as well as upregulation of adhesion molecules11. Most of these properties are mediated through ligation of specific and distinct C3a and C5a receptors (see below). Consonant with the proinflammatory properties, ATs have been implicated in the pathogenesis of several infectious, autoimmune, and allergic diseases such as pneumonia61, sepsis62, rheumatoid arthritis63,64, systemic lupus erythematosus9, multiple sclerosis65, and allergic asthma66-68. In short, the

Conditions That May Simulate Tinea

Because this form of tinea occurs on a sun-exposed area and subjective symptoms exacerbate with sun exposure, it is not infrequently confused with discoid lupus and other light eruptions that affect the face. The similarity can be striking. Look carefully for an active advancing margin and for follicular pustules. A simple KOH exam of the scale can prevent an important misdiagnosis.

Self versus Modified Self Discrimination

The apparent contradiction between the two opposing functional effects of PTX3 might be resolved if the context of the protein production is taken into account. In fact, on one hand cell-bound PTX3 might serve to enhance the elimination of apoptotic cells before loss of their cell-membrane permeability and release of self-antigens and alarmins (Jaillon et al. 2009). On the other, rapid production and secretion of PTX3 during inflammation might avoid capture of apoptotic cells in a pro-inflammatory setting that is likely to trigger an immune response against self antigens (Jeannin et al. 2008). Data obtained in vivo actually support the hypothesis that PTX3 plays a protective role in a murine model of systemic lupus erythemato-sus (Lech et al. 2011).

Starvation And Immune Responses 41 Models of Starvation in Normal Mice

Starvation causes significant immune impairment (83). It has been shown that acute starvation in mice reduces the number of CD4+ T-cells and suppresses the development of T-cell-mediated immunity (84). Furthermore, starvation causes delayed repopulation of the lymphoid compartment following an insult, such as sublethal irradiation (85). The timing of the acute starvation appears to be crucial in terms of influencing immune responses. Starvation around the time of priming to an antigen has the greatest effect on reducing the subsequent T-cell immune response to that antigen. Starvation around the time of rechallenge also reduces the immune response, although by not to as great an extent (82). Food restriction can also impair immune responses such that it can prevent death from autoimmune nephritis in the NZB x NZW Fj model of murine lupus (86).

Indicated Supporting Diagnostic Data

EM minor is readily diagnosed on clinical exam, and in the absence of systemic signs, supporting diagnostic data are seldom indicated. Vesiculobullous EM and EM major may at times enter into the differential of drug eruptions, lupus erythematosus, cutaneous vasculitis, dermatitis herpetiformis, pemphigoid, toxic epidermal necrolysis, and other toxic erythemas. On these rare occasions, the following laboratory studies may be helpful. Otherwise, lab data are indicated mainly for the management of the complications of EM major.

Clinical Application Questions

What is the most likely diagnosis localized discoid lupus erythematosus (DLE), disseminated DLE, subacute cutaneous LE (SCLE), or systemic LE (SLE) 2. What other findings on physical exam would be helpful in distinguishing one form of lupus from another 3. What additional supplemental historical data would help to distinguish one form of lupus from another

Cytokine Gene Polymorphism Candidate Genes 21 Tumor Necrosis Factor

The rare allele TNF2 (A at position -308) was suggested to be linked to high TNF promoter activity (14). Autoimmune diseases like diabetes mellitus or lupus erythematosus did not show differences of allele frequencies or genotype distribution between patients and controls (20,21). In addition, patients with severe sepsis and a high proportion of Gram-negative infection also did not display altered allele frequencies concerning both biallelic promoter polymorphisms (positions -238 and -308) (22). Analysis of the TNF promoter by means of reporter gene constructs revealed contradictory results. A first report supposed a functional importance of the -308 G to A transition (14). Two articles could not confirm differences of the TNF promoter activity in relation to the -308 polymorphism (22,23). A recent article reported a possible influence on TNF promoter activity by the -308 G to A transition in a B-cell line (214). Data demonstrating an impact of this genomic polymorphism on...

Potential Negatives Of Complement Blockade Following Stroke

It has long been accepted that complement deposition on the surface of pathogens greatly increases the rate at which these opsonized pathogens are phagocy-tosed and destroyed62. More recently, a number of studies have demonstrated that complement, particularly early components such as C1q, C3, and C4, plays a critical role in facilitating clearance of apoptotic cells62-66. Additionally, the presence of genetic complement deficiencies strongly predispose to the development of autoimmune diseases, such as lupus, which are generally considered to result in part from the failure to clear apoptotic cells62,63. It is hypothesized that apoptotic cells that are not rapidly cleared progress to lysis with release of potentially damaging intracellular substances into the surrounding extracellular tissue space67-78. Most relevantly, in cases of acute tissue injury it is likely that necrotic cell debris from uncleared apoptotic cells exacerbate the pro-inflammatory response however, this...

Ficolins Structure Function and Associated Diseases

Innate immunity relies upon the ability of a few pattern recognition molecules to sense molecular markers. Ficolins are humoral molecules of the innate immune systems which recognize carbohydrate molecules on pathogens, apoptotic and necrotic cells. Three ficolins have been identified in humans L-ficolin, H-ficolin and M-ficolin (also referred to as ficolin-2, -3 and -1, respectively). They are soluble oligomeric defence proteins with lectin-like activity and they are structurally similar to the human collectins, mannan-binding lectin (MBL) and surfactant protein A and D. Upon recognition of the infectious agent, the ficolins act through two distinct routes initiate the lectin pathway of complement activation through attached serine proteases (MASPs), and a primitive opsonophagocytosis thus limiting the infection and concurrently orchestrating the subsequent adaptive clonal immune response. Recently a lot of reports showed that dysfunction or abnormal expressions of ficolins...

Interleukin1 Receptor Antagonist

The allele A2 has been associated with the incidence of autoimmune diseases like lupus erythematosus and insulin-dependent diabetes mellitus (44,45). In acute systemic inflammation, there is no difference between surviving or nonsurviving patients with severe sepsis. This finding is in contrast to the results concerning the biallelic NcoI polymorphism within intron 1 of LTa Homozygotes for the TNFB2 genotype revealed a high mortality when compared to heterozygotes and TNFB1 homozygotes. The overall group of patients with severe sepsis did not show an increase in the TNFB2 allele frequency. For the IL-1ra polymorphism, however, an increase of the allele A2 in the patients with severe sepsis was detected. Patients carrying the haplotype TNFB2 homozygous and A2 homo-zygous did not survive in this study.

Description Medical Coagulation Disorders

Acute ITP is thought to be a response to a viral infection. Generally, a viral infection, such as rubella or chickenpox, occurs 2 to 21 days before the onset of the disease. Acute ITP may occur after live vaccine immunizations and is most prevalent during the winter and spring months when the incidence of infection is high. It is also associated with human immunodeficiency virus (HIV). Chronic ITP generally has no underlying viral association and is often linked to immuno-logic disorders, such as lupus erythematosus, or to drug reactions. HISTORY. Ask if the patient has recently had rubella or chickenpox or a viral infection with symptoms such as upper respiratory or gastrointestinal (GI) symptoms. Ask if the patient was recently immunized with a live vaccine. Check for a history of systemic lupus erythematosus easy bruising or bleeding from the nose, gums, or GI or urinary tract. Because the symptoms of chronic ITP are usually insidious, patients may not have noticed an increase in...

Human Neurological Diseases Studied by Microarray Technology

In addition, several investigators have turned to studying PBMCs in patients with MS, which are far more easily accessible than brain tissue. Expression studies of PBMCs have been revealing in other autoimmune disorders including lupus erythematosus and RA, as noted earlier. Sturzebecher et al. (2003) studied expression profiles of PBMCs in patients treated with interferon- (IFN- 3). This study included a design in which such PBMCs were exposed to IFN- 3 in vitro (called ex vivo experiments by the authors). Ten female patients in three classes were studied six responders to IFN- 3, two initial responders who developed neutralizing antibodies (Nab) and lost their responsiveness, and two who initially failed to respond (INR). The definition of significant differential expression was nonstandard either twofold in at least three of the six responders and not twofold decreased in four nonresponders (in so-called ex vivo experiments), or twofold in at

Various Molecules Are Involved in the Clearance of Dying Cells

One major eat me signal for phagocytes on both apoptotic and necrotic cells is the exposure of phosphatidylserine (PS) 28 . Many receptors and adaptor molecules have been shown to contribute to the recognition and uptake of apoptotic cells by phagocytes (reviewed in 59 ) collectin receptors, calreti-culin CD91, Fcy-receptors, c-Mer, the p2-glycoprotein-1-receptor, integrins, lectins, CD14, the putative PS-receptor, ABC transporters, and scavenger receptors including CD36. Most of these receptors do not directly bind to apoptotic cells, rather the dying cells are engaged via bridging molecules (reviewed in 25 ). Normally, apoptotic cells are efficiently taken up by phagocytes in the early phase of apoptosis. Defects in important recognition molecules for apoptotic cells can lead to autoimmunity 25 . Impaired clearance of apoptotic cell material or increased apoptosis has been implicated in the pathogene-sis of systemic lupus erythematosus (SLE) 27,38,43 . Several gene-targeted mice...

AID haploinsufficiency

Bcl-xL transgenic AID+ - mice developed tumors after pristane treatment, their incidence was significantly reduced when compared to their AID wild-type counterparts (Takizawa et al., 2008). In addition, AID+ - mice exhibit a delayed production of high affinity antibodies against pathogens and in the development of autoimmune disease in a lupus prone model (Jiang et al., 2007 Jiang et al., 2009). These latter findings highlight the relevance of AID gene dose for B cell neoplasia generation and autoimmune susceptibility in vivo. Together these results indicate that physiological AID expression levels are limiting for its function, probably allowing an efficient diversification of antibodies while preventing unwanted DNA lesions. However, the interplay between this and other AID regulatory mechanisms can be unexpectedly complex.

Clinical manifestation

Transient, superficial vesicles and bullae, transforming into crusted or scaly eroded plaques on an erythematous base, mainly in seborrhoic areas, with little or no involvement of mucous membranes pemphigus erythematosus (Senear-Usher) variant features of cutaneous lupus erythematosus and pemphigus foliaceus red scaly plaques on the bridge of the nose and malar area exfoliative erythroderma with extensive involvement pemphigus herpetiformis variant pruritic grouped papules and vesicles, suggestive of dermatitis herpetiformis occasional oral erosions drug-induced variant may occur with penicillamine or cap-topril therapy, usually after at least 2 months of use relatively mild signs and symptoms

Differential diagnosis

Plaque and guttate variants pityriasis rubra pilaris seborrheic dermatitis tinea cor-poris lupus erythematosus pityriasis rosea syphilis lichen planus parapsoria-sis pityriasis lichenoides cutaneous T-cell lymphoma nummular eczema Pustular variant subcorneal pustular dermatosis acute generalized exanthematous pustulosis septicemia generalized atopic and or seborrheic dermatitis dyshidrotic eczema contact dermatitis autosensitiza-tion reaction vesicular dermatophyte infection

Antibody Mediated Translocation

Been shown to be mediated by antibody interaction with antigens expressed on the cell surface. Following endocytosis, changes in cell functions have been observed for antibodies to nuclear RNP and DNA.58 Other groups have confirmed these results and have demonstrated that anti-RNP antibodies from human systemic lupus erythematosus (SLE) patients, IgG anti-DNA antibodies, and anti-neural antibodies (anti-Hu) from patients with neuropathy can penetrate lymphocytes, epithelial cells, and hepatocytes.59,60 A key characteristic of antibodies possessing this ability is polyreactivity against self antigens such as double-stranded and single-stranded DNA and various proteins (actin, myoglobin, myosin, tubulin, histones).61 Although various germ-line VH gene families are used, an overrepresentation of tyrosine, lysine, and arginine is found in the CDR3 of anti-DNA mAb with the capacity to enter cells. Haptens (biotin, fluorescein, oligonucleotides) and macromolecules (peroxidase, IgG)...

Clinical Indications For Complement Analysis

Ch50 Assay

Clinical and experimental evidence underlines the prominent role of complement in immunodeficiency disorders8 and in the pathogenesis of numerous inflammatory diseases including immune complex and autoimmune disorders, such as systemic lupus erythematosus9 and autoimmune arthritis10. Complement has also been implicated in neurodegenerative disorders, such as Alzheimer's Complement defects, particularly of the classical pathway, are frequently associated with systemic lupus erythematosus-like autoimmune disease26-28. The strength of the association of a complement deficiency with SLE increases from C2 (10 prevalence) over C1r s (57 prevalence), C4 (75 prevalence) to C1q (90 prevalence)29. Although complement deficiencies are frequently associated with autoimmunity, autoimmunity is only occasionally associated with complement deficiency. Therefore, in active SLE, particularly with renal involvement, low total complement activity and low C4 are more often due to increased in vivo...

Sebaceous Cell Carcinoma

Eyelid Papilloma Treatment

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes basal cell carcinoma, squamous cell carcinoma, papilloma, blepharitis, chalazion, ocular cicatricial pemphigoid, cutaneous horns, discoid lupus, pyogenic granulomas, lacrimal sac tumors, and superior limbic keratoconjunctivitis.

Introgressive hybridization hybrid speciation and the evolution of human food sources

As reflected by the quotes from Vila et al. (2005), C. familiaris is a paradigm for demonstrating the role of introgressive hybridization between introduced, domesticated food sources and wild relatives. In particular, genetic evidence suggests that domestic dogs have repeatedly hybridized with their sister species, Canis lupus (i.e. the gray wolf Figure 9.4 Vila et al. 1997, 2003, 2005). Such hybridization is expected, given the occurrence of introgression between a variety of Canis species, including the close relatives of C. familiaris, the gray wolf, and the coyote. For example, introgressive hybridization between coyotes and wolves likely promoted by human-mediated habitat modification in North America has resulted in an extensive hybrid zone (Lehman et al. 1991). Indeed, this case is illustrative for understanding the genetic exchange between the domestic and wild forms in North America that contributed to the evolution of the food source for Native Americans. Like the...

Histopathologic Terminology

Cytoid Bodies

Colloid bodies are also known as cytoid bodies, Civatte bodies, hyalin bodies, and apoptotic bodies. They are apoptotic epidermal cells (keratinocytes) lacking nuclei and appear as homogeneous, eosinophilic, and round structures. Colloid bodies are not specific for any disease, but they are commonly seen in lupus erythematosus, lichen planus, and graft-versus-host disease. The meaning of the term dyskeratosis varies depending on the disease. In acute graft-versus-host disease, lichen planus, and lupus erythematosus, dyskeratot-ic cells are cells undergoing apoptosis and are smaller than adjacent epidermal keratinocytes, have brightly eosinophilic cytoplasm, and shrunken hyper-basophilic nuclei (see Apoptosis). In acan-tholytic dermatosis, the dyskeratotic cells are also termed corps ronds and have a central, basophilic, pyknotic nucleus surrounded by a clear halo and enveloped within a basophilic or eosinophilic rim. Neoplastic dyskeratosis is manifest as brightly eosinophilic bodies,...

Cellbound Complement Activation Products

Measurement of R-C4d levels in patients with SLE, patients with other diseases, and healthy controls44 led to the following observations. First, a wide range of R-C4d was detected in SLE patients, but not in patients with other diseases and healthy controls. Second, the mean R-C4d level of SLE patients was significantly higher than that of patients with other diseases or healthy controls. Third, R-C4d levels correlated with clinical disease activity measured by the Systemic Lupus Erythematosus Disease Activity Index and Systemic Lupus Activity Measurement. These results support the hypothesis that C4d-bearing reticulocytes may serve as instant messengers, and provide clues about present and potential disease flares in SLE patients.

AIDdeficient autoimmuneprone mice

This is the first model combining autoimmunity with AID-deficiency. MRL lpr mice develop a lupus-like syndrome that shares many similarities with human SLE such as high levels of circulating autoantibodies, particularly to double-stranded DNA (dsDNA), deposition of immune complexes, particularly in the kidneys, and glomerulonephritis (Theofilopoulos and Dixon, 1985). When AID-deficient, these mice experience a highly significant decrease in kidney damage, and a dramatic increase in survival to levels that exceeded even mice lacking secreted antibodies, suggesting that improved survival did not result just from the lack of pathogenic IgG antibodies but that other factors also contributed. The proportion of activated autoreactive T cells were unchanged suggesting that the increase in survival did not come from the antibody-independent role of B cells in autoimmunity. These mice have very high levels of autoreactive IgM, not only demonstrating that autoreactive IgM...

Macrodistribution

Less common patterns of PV may simulate bacterial intertrigo, tinea corporis, tinea pedis, intertriginous monilia, seborrheic dermatitis, pityriasis rosea, subacute cutaneous lupus erythematosus, and cutaneous T-cell lymphoma (mycosis fungoides). 3. Skin biopsy As noted above, PV can simulate several other inflammatory der-matitides. Unfortunately, the histology of SD can also show similar changes. For this reason, biopsy of PV is not always a definitive procedure and should not be undertaken routinely. If the disease is atypical, extensive, or refractory to treatment, the patient should be referred to a dermatologist to decide whether this expense is cost-effective. Biopsy readily distinguishes psoriasis from suba-cute lupus erythematosus. However, distinguishing PV from other diseases, especially cutaneous T-cell lymphoma, is tricky and requires special competence and experience. Even in the most experienced hands, this is not always possible.

What the clinician needs to know about chronic renal disease

Women with normal or only mildly decreased prepreg-nancy renal function (Scr < 125 mol l) usually have a successful obstetric outcome, and pregnancy does not appear to adversely affect the course of their disease. There are exceptions with most strongly advising against pregnancy in women with scleroderma and periarteritis nodosa. A few express reservations when the underlying renal disorder is lupus nephropathy, membranoprolif-erative glomerulonephritis, and perhaps IgA and reflux nephropathies. Human immunodeficiency virus with associated nephropathy (HIVAN) Systemic lupus erythematosus argued that diagnosis of a collagen disorder such as scleroderma or periarteritis would be grounds for terminating the pregnancy, or that classifying the type of lesion in a woman with lupus could determine the type and intensity of therapy.

Strength of BCR signal

Co-stimulator for B cell survival when coupled with B cell antigen receptor ligation. In this regard, it was reported that BAFF ligation increased bcl-2 expression and increased activation of NF-Kb, both of which increase B cell survival (Mackay and Browning 2002). BCMA or BAFF transgenic mice display mature B cell hyperplasia and develop an SLE-like disease, with anti-DNA antibodies, elevated serum IgM, vasculitis and glomerulonephritis (Mackay and Mackay 2002). Moreover, BAFF expression is elevated in MRLlpr lpr mice and lupus-prone (NZWxNZB)Fl hybrid mice and correlates with disease progression (Mackay and Browning 2002 Mackay and Mackay 2002). In this regard, elevated BAFF levels were found in the serum of some patients with SLE, Sj gren's and idiopathic thrombocytopenic purpura patients (Mackay and Browning 2002 Mackay and Mackay 2002) as well as in the synovial fluid of rheumatoid arthritis patients. Conversely, BAFF-deficient mice show a complete loss of follicular and...

Glomerulonephritis Introduction

Acute glomerulonephritis (AGN) is an alteration in renal function caused by glomerular injury, which is displayed by the classic symptoms of gross hematuria, mild proteinuria, edema (usually periorbital), hypertension, and oliguria. AGN is also classified as either a primary disease, associated with group A, beta-hemolytic streptococcal infection or a secondary disease, associated with various systemic diseases (i.e., systemic lupus erythema, sickle cell disease, Henoch's chorea purpura). The most common type of AGN is the primary disease, described as an immune-complex disease (or an antigen-antibody complex formed during the streptococcal infection which becomes entrapped in the glomerular membrane, causing inflammation 8 to 14 days after the onset of this infection). AGN is primarily observed in the early school-age child, with a peak age of onset of 6 to 7 years. The onset of the classic symptoms of AGN is usually abrupt, self-limiting (unpredictable), and prolonged hematuria and...

Nat And Disease

The role of NATs in human disease has recently been extensively reviewed. 3 The following is a summation of findings to date. The association between acetylator status and the risk of various diseases has been extensively reported. Altered risk with either the slow or rapid phenotype has been observed for bladder, colon and breast cancer, systemic lupus erythematosis, diabetes, age-related cataracts, Gilbert's disease, Parkinson's disease, and Alzheimer's disease. These associations imply a role for environmental factors that are metabolized by the NATs, in particular NAT2, in each disorder. However,

Ignorance

Deficiency in the expression of the TNF family member, BAFF (also called B-lys), or its receptor, BAFF-R blocks the maturation of immature B cells into conventional, B2-type B cells, but not to B1-type B cells (Schneider et al. 1999 Moore et al. 1999 Gross al. 2001 Schiemann et al. 2001 Rolink and Melchers 2002 Ng et al. 2005). In vitro BAFF induces polyclonal maturation of immature B cells from bone marrow and from spleen (T1, T2) without proliferation (Rolink et al. 2002). BAFF has been found in the sera of some lupus erythematosus patients, as well as in the sera of NZBxNZW SLE autoimmune disease-prone mice. In these mice, administration of BAFF-specific antibodies prevents, or at least delays the development of SLE disease. Therefore, excessive production of BAFF, administered at the sites of negative selection of immature B cells, could rescue autoreactive B cells from deletion, leading to autoimmune reactivities in the peripheral mature conventional B cell repertoires (Fig. 2)....

Anthropocentrism

Many philosophers and social critics perceive anthropocentrism as a belief that, if it ever had a purpose, has now outlived its usefulness and become outmoded. Others maintain that anthropocentrism is in some sense inescapable. Just as spiders, if they could evaluate the world around them conceptually and articulate the result in language, would be arachnicentric (spiders are arachnids), so would wolves (genus Canis and species lupus) be lupucentric and cows (bovids) bovicentric. How, then, could humans be other than ho-mocentric But while we may, and perhaps must, accept that human values and experience determine the standpoint from which we project outward, it does not necessarily follow that overcoming our anthropocentrism is impossible. The human outlook is an essential reference point, but this does not mean that all values must be human centered. We cannot conclude that it is impossible to empathize (see EMPATHY FOR ANIMALS) and connect with nonhuman nature just because we...

Specific History

Diseases reported to provoke urticaria atopy, systemic lupus, dermatomyositis, lymphoma, dysproteinemias, hyper- and hypothyroidism. With the exception of hyperthyroidism, these are rare associations. Atopy and thyroid disease are associated with common hives while the others are usually associated with urticarial vasculitis, a disease distinct from common hives that will be covered in the differential diagnosis section.

Prolactin

Several studies of mice with deletions of molecules belonging to the BCR signal transduction pathway have demonstrated that a slight variation in the strength of the signal can dramatically compromise B cell maturation and promote autoimmune diseases 119-121 . BALB c R4A transgenic mice have an estrogen or prolactin inducible lupus-like serology, while C57B1 6 R4A are not responsive to exogenous estrogen or prolactin (Peeva, unpublished data). Why BALB c mice lose B cell tolerance while C57B1 6 mice do not is not known. It would appear that any component of the BCR-signaling pathway or co-stimulatory pathway that might be regulated by estrogen or prolactin could be decisive for the escape from the negative selection. The analysis of polymorphisms of these molecules in humans will be a major focus for research.

Clinical Relevance

A major goal of many studies of lupus is to identify genes directly or indirectly incriminated in the breakdown of B cell tolerance and to determine genes that lead to enhanced disease severity that are regulated by estrogen. The gender bias in SLE may not be explained solely by the contribution of estrogen but we believe that some women with SLE, like BALB c mice, have an enhanced susceptibility to estrogen. The identification of estrogen or prolactin-inducible genes will help to characterize the subpopulation of patients that may have a disease exacerbated by hormones. cohort of 378 Mexican patients and 112 Swedish simplex families 122 . Four polymorphisms, a SNP (-394) C T and a micro-deletion polymorphism (195) A CTGA in the promoter region, a missense SNP (541) G C in exon 1 (which changes the amino acid sequence G171A), and a SNP (903) C T in exon 2 have been described for the human shpl gene 123 , but no studies have been published demonstrating a linkage with SLE. Several...

Conclusion

It is clear that both estrogen and prolactin exert immunomodulatory effects, including effects on both immature and mature B cells. Their impact on lupus onset and disease exacerbation is well established in mouse models. The BALB c R4A transgenic mice are prone to develop lupus-like symptoms only upon hormone exposure. The breakdown of tolerance induced by estrogen correlates with the upregulation of molecules from both B cell apop-totic pathways and the BCR signalosome leading to survival of autoreactive cells and maturation to a MZ phenotype. This maturation and activation of autoantibody-secreting cells is due to an altered strength of BCR signaling. The absence of disease in C57Bl 6 R4A transgenic mice treated with estrogen emphasizes the role of genetic background in the breakdown of B cell tolerance and perhaps explains the controversial situation observed in the human disease. Moreover, the data suggest that only a subset of SLE patients is likely to have estrogen-exacerbated...

Laboratory Diagnosis

In clinical practice, e.g., for the planning of operations, diagnosis of congenital F XI deficiency is usually established by APTT-based assays, whereas molecular techniques are mostly restricted to scientific studies. However, there are conditions, such as consumption reactions or the presence of a high titer of lupus anticoagulant, where APTT-based tests may not be suitable and molecular methods are needed to identify a congenital deficiency state. For mutation analysis, genomic DNA is extracted and usually amplified by PCR with primers covering all 15 exons and the intron-exon boundaries. Frequently, primers are designed in such a way that a section of DNA encompassing a number of exons in close proximity to each other is amplified. 31,32 PCR may be directly followed by determination of nucleotide sequences of all PCR products, but frequently a mutation-screening technique such as single-stranded conformation polymorphism (SSCP) analysis is subsequently applied to avoid unnecessary...

Figure

Serum IgG antibodies to dsDNA, and ssDNA before (0 d), 30 and 60 days after treatment of 4 month old female SLE mice with 0 g g (placebo, white bars) or 15 g g (black bars) of rMuDNase I (n 10 mice group, *p < 0.05). (Adapted from Verthelyi, et al., Lupus, 7, 223-230, 1998. With permission.)

Domestication

The first species to undergo the change from wild to domestic life was probably the wolf (Canis lupus), the ancestor of the dog.* The oldest known archaeological remains of a probable domesticated wolf come from a 14,000-year-old site in central Europe. Wild sheep (Ovis orientalis) and goats (Capra aegagrus) appear to have been domesticated more or less simultaneously in the Near East around 11,000 years ago, while remains of domesticated cattle (Bos primigenius) and pigs* (Sus scrofa) first occur in the archaeological record around 8,000-9,000 years b.p. (before present) at various sites in Asia. Horses (Equus ferus), asses (Equus africanus), camels (Camelus spp.), water buffalo (Bubalus bubalis) and chickens* (Gallus gallus) all appear to have been domesticated in different parts of Asia and North Africa between 7,000 and 5,000 years ago, while the first domesticated cats* (Felis silvestris) appeared in ancient Egypt between 4,000 and 5,000 years ago. Meanwhile, in the New World,...

Fogo selvagem

Impetigo lupus erythematosus pemphigus vulgaris seborrheic dermatitis atopic dermatitis subcorneal pustular dermatosis epidermolysis bullosa glucagonoma syndrome erythema multiforme Other causes of erythroderma drug reaction cutaneous T-cell lymphoma psoriasis pityriasis rubra pilaris contact dermatitis

Thrombocytopaenia

Immune thrombocytopaenic purpura (ITP) Heparin-induced thrombocytopaenia (HIT) Post-transfusion purpura (PTP) Acute fatty Liver of pregnancy Pre-eclampsia (PET) HELLP syndrome Thrombotic thrombocytopaenic purpura (TTP) Haemolytic uraemic syndrome (HUS) Disseminated intravascular coagulation (DIC) Drug induced thrombocytopenia Systemic lupus erythematosis (SLE) antiphospholipid

Nephrotic Syndrome

Patients may report no illness before the onset of symptoms others have a history of systemic multisystem disease, such as lupus erythematosus, diabetes mellitus, amyloidosis, or multiple myeloma or have a history of an insect sting or venomous animal bite. Symptoms usually appear insidiously and may include lethargy, depression, and weight gain. The patient may describe gastrointestinal (GI) symptoms of nausea, anorexia, and diarrhea. Initially, patients report periorbital edema in the morning and abdominal or extremity edema in the evening.

Myasthenia Gravis

In the diagnostic criteria for neuropsychiatry systemic lupus erythematosus (one of many disorders associated with myasthenia gravis), there are diagnostic criteria for myasthenia gravis, but the extent to which the wider medical community or specialists in neuromuscular diseases adhere to this case definition is unclear.

Sarcoidosis

Sarcoidosis Disease

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes discoid lupus erythematosus, chalazia, hordeola, epidermal inclusion cyst, xanthelasma, lipoid proteinosis, amyloidosis, sebaceous cyst, lichen planus, erythema nodosum, tuberculosis, leprosy, syphilis and parasitic, fungal, viral (molluscum contagiosum, herpes simples and herpes zoster), or bacterial infections.

Madarosis

INTRODUCTION Madarosis refers to the loss of eyelashes. It may result from trauma, rubbing the eyelids, or it can follow eyelid surgery with injury to the lash follicles. Madarosis is also associated with systemic diseases such as alopecia areata, but here hair loss is usually seen in other parts of the body as well. Discoid lupus erythematosis involving the eyelids presents with erythema, scarring, and madarosis, but the latter can be the only presenting finding before any other

Host Range Virus

CDV can infect most carnivores but in some it may result in only a mild or subclinical infection, for example, in domestic cats. It causes severe disease in all members of the Canidae (dog, wolf, fox), Mustelidae (ferret, weasel, mink), Procyonidae (raccoon, panda), as well as in collared peccaries (Tayassu tajacu, order Artiodactyla). More recently, CDV has been shown to be responsible for high mortalities in both wild and captive big cats and in hyenas (Crocuta crocuta). Failure to recognise the disease earlier in these species may have been due to a lack of awareness of a possible viral etiology and or the availability of diagnostic tools to detect the virus. Outbreaks of CDV in Siberian and Caspian seals have extended its host range to include these species. PDV is known to infect many species of seal in the North Atlantic and Arctic oceans but its full host range is unknown. There is also serological evidence that terrestrial carnivores in Canada, including polar bear (Ursus...

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