Lupus Holistic Treatments
A second genetically determined risk factor for the development of autoimmune disease is the genetic deficiency of an early complement component. The relative risks for the deficiencies are C1q greater than C4 greater than C2.56 A mild form of systemic lupus erythematosus (SLE) is associated with C2 deficiency, moderated SLE disease is associated with C4 deficiency, while a pernicious SLE-like syndrome is almost invariably associated with C1q deficiency.57 There are at least two potential reasons why the absence of an early complement component predisposes to autoimmunity (1) it is more difficult to clear potential autoantigens and (2) it is more difficult to clear antigen-antibody immune complexes once they are formed.58 Additional risk factors for autoimmune disease include the genetically determined upregulation of costimula-tory molecules and a functional deficiency of TR.
The antinuclear antibody (ANA) is an autoantibody that reacts against cellular nuclear material. The presence of antinuclear antibodies is highly indicative of systemic lupus erythematosus (SLE) because 95 of individuals with SLE will test positive for ANA. It must be noted that antinuclear antibodies can occur in other rheumatic diseases, and therefore it is not a specific test for SLE. Antinuclear antibodies are identified via IFA.
Rheumatic mitral regurgitation is becoming rare in the last ten years, and is often complicated by an associated mitral stenosis. Other -rare- causes are lupus erythematosus, the antiphospholipid antibody syndrome and the after-effects of infective endocarditis. Acute mitral regurgitation due to ruptured chordae tendinae or valve perforation due to bacterial endocarditis is very rare during pregnancy, but always very severe.2 Women with mitral regurgitation in the childbearing age, usually still have a well-functioning adaptive cardiac mechanism to volume overload. Their disease has rarely progressed to severe states. However, in few cases, the constant unloading of the left ventricle into the left atrium has already resulted in a reactive pulmonary hypertension, left ventricular enlargement and right-sided heart failure. The presence of cardiomegaly, atrial fibrillation and right-sided decompensation is associated with elevated maternal risks. In these patients, it might be...
Decreased diffusion rates are associated with pulmonary diseases such as emphysema, pulmonary fibroses, asbestosis, and even pneumonia. Other diseases that cause a decreased diffusion rate are scleroderma, systemic lupus erythematosus, and anemia. Increased diffusion rates are associated with polycythemia, an increase in the number of red blood cells.
Surgery to the abdomen, pelvis, and lower extremities, as well as patients with congestive heart failure, myocardial infarction, stroke, and fractures of the pelvis and lower extremities are all at risk for prolonged immobility. Prior venous thrombosis and the presence of indwelling venous catheters result in endothelial damage and increase the risk of further thromboembolism. Many clinical conditions predispose patients to a hypercoaguable state. Among these are the presence of cancer, estrogen use, and several hemostatic abnormalities including lupus anticoagulant, protein C and protein S deficiencies, antithrombin III deficiency, and factor V Leiden mutation. The ACCP Consensus Conference report cites the incidence of DVT in general surgery patients to be as high as 29 , and the incidence of PE to be as high as 1.6 (fatal PE 0.9 ). Current recommendations for prophylaxis include the use of low dose unfractionated heparin (LDUH), low molecular weight heparin (LMWH), or intermittent...
Positive urine protein tests can be attributed to diseases such as nephrosis, glomerulonephritis, pyelonephritis, and polycystic kidney disease. Urinary tract infection, diabetes, systemic lupus erythematosus (SLE), as well as poisoning from various chemicals and drugs, can result in proteinuria. The Bence-Jones protein is associated with neoplastic disorders such as multiple myeloma, lymphoma, and lymphocytic leukemia.
The two most frequent infectious causes that can mimic a PICCP are syphilitic and tuberculous choriore-tinitis. The neoplastic cause that has to be excluded is intraocular lymphoma and any systemic vasculitis, in particular systemic lupus erythematosus, can cause choroidal ischaemia. On the other hand, it is easy to exclude central serous chorioretinopathy that produces choroidal hyperfluorescence and not hypofluo-rescence on ICG angiography.
Hemolytic uremic syndrome looks similar to thrombotic thrombocytopenic purpura (TTP), but TTP occurs in young women and affects the central nervous system. Patients with TTP also have fever, decreased platelets, and cutaneous symptoms. Lupus and malignant hypertension should also be considered in the differential because both may have acute renal failure and anemia. Bilateral renal vein thrombosis has a similar presentation to hemolytic uremic syndrome (gastroenteritis, pallor, dehydration), but children with renal vein thrombosis have large kidneys.
Antiphospholipid syndrome (APS) is a commonly acquired cause of hypercoagulation. It appears in 1 to 15 of the population, this rate increasing with age (to 50 in patients over the age of 80 years) 28 . APS affects patients with lupus anticoagulant or anticardiolipin antibodies. These antibodies react with endothelial cells, platelets and phospholipids. Recurrent venous thrombosis is one of its clinical manifestations 20 . Thrombotic complications, estimated to be as high as 50 , have also been reported after vascular reconstruction procedures 1 . A further common manifestation of APS is miscarriage. Its diagnosis should include the identification of lupus anticoagulant and anticardiolipin antibodies.
Nonviral causes of myocarditis include bacteria such as Borrelia burgdorferi (Lyme disease), parasites such as Trypanosoma cruzi (Chagas' disease), hypersensitivity reaction (systemic lupus erythematosus, drug reaction), radiation, and sarcoidosis may also be idiopathic (giant cell myocarditis). causes include coxsackievirus A and B, tuberculosis, staphylococcal or pneumococcal infection, amebiasis, or actinomycosis noninfectious causes include chronic renal failure, collagen-vascular disease (systemic lupus erythematosus, scleroderma, and rheumatoid arthritis), neoplasms, myocardial infarction, and trauma. Long-term sequelae include chronic constrictive pericarditis.
Clinically similar, but New World infections are more severe and chronic. Both affect areas exposed to insect bites such as the face, trunk, and extremities. The incubation period varies from 1-4 weeks, but it may be several years. The lesion is a painless erythematous nodule, 1-10 cm in diameter. It can be psoriasiform or hyperkeratotic (dry or urban form), or it can ulcerate in 1-3 months (moist or rural form). It heals spontaneously in 6 months to 4 years. It leaves a depressed and dyschromic scar with telangiectasias (Fig. 46.1). Regional lymphangitis is rare. In endemic areas 33 of the patients present with re-infections and autoinoculation is also possible. The recurrent, lupoid or tuberculoid form is atypical. It may last many years and does not respond well to treatment. It is confused with lupus vulgaris (Fig. 46.2). Leishmaniasis recidiva cutis may represent a reactivation of an initial infection, probably due to the persistence of parasites and is considered by some authors...
Red blood cell casts and protein may be found on urinalysis. There should be evidence of a past infection with group A (3-hemolytic streptococcus. The best method for determining this is the deoxyribonuclease (DNase) B antigen. In addition, the patient may have mild anemia and a decreased serum C3. An antinuclear antibodies (ANA) test may be obtained to rule out systemic lupus erythematosus. A renal biopsy is usually not needed in classic cases (acute nephritic syndrome plus evidence of streptococcal infection plus low C3 level). Differential Diagnosis. Systemic lupus erythematosus should be considered in the differential diagnosis and an ANA may be obtained to rule it out. Entities that cause hematuria (hemolytic uremic syndrome, membranous glomerulopathy, etc.) should also be considered in the differential diagnosis.
The antiphospholipid syndrome (APS) is a hypercoagulable state associated with the presence of anticardiolipin antibody, lupus anticoagulant and possibly other antibodies. In the 1950s, some patients with SLE were observed to have a long clotting time but a paradoxical thrombotic tendency. In the 1970s, the responsible substance became referred to as the lupus anticoagulant (LA). Subsequently, LA was observed in other (especially autoimmune) diseases and even in some healthy people, so that it was then referred to as the 'lupus-like anticoagulant' (LLA). This 'anticoagulant' was later found to be closely related to antibodies to negatively charged phospholipids such as cardiolipin, so that the syndrome was then Although the anticardiolipin antibody (which is responsible for a false positive syphilis test) and the lupus anticoagulant are both antiphospholipids, the immune response appears to be directed to modified proteins rather than to lipids, since a cofactor (most commonly, beta-2...
These include pregnanq' acute liver disease history of vascular disease (e.g., thromboembolism, deep venous thrombosis DVT , cerebrovascular accident CVA , systemic lupus erythematosus SLE ) and hormonally dependent cancer (e.g., breast, endometrium).
Coxsaclue B is most often implicated. Nonviral causes of myocarditis include bacteria such as Borrelia burgdorferi (Lyme disease), parasites such as Trypanosoma cruzi (Chagas' disease), hypersensitivity reaction (systemic lupus erythematosus, drug reaction), radiation, and sarcoidosis may also be idiopathic (giant cell myocarditis).
Although rare, true femoral aneurysms are the second commonest peripheral aneurysm after those affecting the popliteal artery. They occur in between 2 and 3 of patients with aortic aneurysms and tend to be a disease of elderly men (male-to-female ratio of 30 1). The condition is frequently bilateral and similar to popliteal aneurysms a coexistent generalized aneurysmal process may be manifest in other anatomical sites such as the aortoiliac or popliteal arteries. Multiple factors are implicated in their development including atherosclerosis, turbulent blood flow (at proximal major vessel bifurcations and infrainguinally), and repeated hip flexion. Other etiologies to exclude are infection, inflammation (e.g., systemic lupus erythematosus, Takayasu's disease), trauma, and connective tissue disorders (e.g., Marfan syndrome).
The role of screening for potential thrombophilic states in vascular surgical patients has been studied. Approximately 10 of all patients scheduled for a variety of vascular surgical procedures had test results indicating a potential hypercoagulable state. The three most common clotting disorders are heparin-induced platelet aggregation, lupus anticoagulants, and protein C deficiency. The incidence of infrainguinal graft occlusion within 30 days was 27 among patients who were in the hyperco-agulable group compared with 1.6 in patients who were not in this group. At present, an established screening program does not exist to exclude the wide variety of coagulation disorders present in vascular surgical patients. We depend on taking a careful history and clinical examination to identify those patients who may be at a risk of abnormal clotting due to an inherent thrombophilic status. At this time this is probably the more cost-effective and efficient means to establish a...
In general, class IA antiarrhythmic agents, such as disopyramide (Norpace), pro-cainamide (Pronestyl), and quinidine, are used first for medical conversion of AF, with the latter being the agent that has been most commonly selected. Although these medications are effective in converting AF to sinus rhythm initially, long-term therapy is not benign and has been associated with a threefold increase in mortality within two years. Quinidine is also associated with diarrhea and gastrointestinal intolerance, which can sometimes be lessened by using the gluconate form of the drug. On average, quinidine results in a doubling of serum digoxin levels, although many patients have either a much lower or higher serum level when given this drug. In practice, many physicians halve the dose of digoxin before beginning quinidine therapy. Others do not alter the daily digoxin dose, but instead follow the patient closely. Either approach is acceptable. Procainamide offers several advantages over...
The articular form is next most common. It results from trauma or surgery, usually affecting the retroolecranon as a bursitis with soft tissue inflammation and moderate to intense pain. The generalized or systemic form is the least common. It is seen as subcutaneous lesions or lesions affecting internal organs. It is associated with diabetes, renal transplantation, systemic lupus, cancer, AIDS, peritoneal dialysis, chemotherapy and radiotherapy. Prototheca has been isolated from blood, peritoneal abscess, kidney, synovial tissue, Hickman catheter, spinal fluid, and nasopharyngeal tissue.
Persons having lupus erythematosus, one of the collagen diseases, have an abnormal plasma protein that causes swelling and breakdown of certain blood cell nuclei in vitro. This degenerated nuclear material attracts phagocytic cells, particularly segmented neutrophils, which engulf this nuclear mass. The resulting phagocyte and inclusion material is termed an L.E. cell. b. Two methods of demonstrating the L.E. cell and antinuclear antibodies are the rotary bead method and fluorescent antibody method. The rotary bead method is positive in 75-80 erythematosus. The fluorescent antibody method is positive in 95-100 patients with lupus erythematosus. The rotary bead method is presented in the next paragraph. The fluorescent antibody method requires equipment that limits its use to larger laboratories.
Positive or abnormal direct Coombs' test results are seen in autoimmune hemolytic anemia, transfusion reaction, and hemolytic disease of the newborn. Other diseases that can cause a positive direct Coombs' test are lupus erythematosus, infectious mononucleosis, and some types of lymphomas.
Lupus UK, St James House, Eastern Road, Romford, Essex, RM1 3NH, Tel 01708 731251. A self-help group, run by volunteers of whom the majority have Lupus, who hope to use their own experiences of the illness to assist those newly diagnosed in understanding their condition, and to provide support to those with established disease.
The answer is c. (Holmes, 3 e, p 489.) Lyme disease (caused by Borrelia burgdorferi, a spirochete) has been associated with false-positive treponemal FTA-ABS (Fluorescent Treponemal Antibody Absorption) tests which are designed for the diagnosis of Treponema pallidum infections (i.e., syphilis). The nontreponemal test is often negative in this disease. Other conditions associated with false-positive treponemal tests include yaws, pinta, leptospirosis, and lupus. Biological false-positive nontreponemal tests VDRL (Venereal Disease Research Laboratory), and RPR (Rapid Plasma Reagin) are classified as acute (reverting back to negative in six months) or chronic. Acute reactions can occur with recent immunization, mononucleosis, viral pneumonia, tuberculosis, malaria, and a variety of viral diseases. Chronic reactions can occur in users of intravenous drugs, with aging, and in autoimmune diseases, such as systemic lupus erythematosus. A positive nontreponemal test must always be...
Primary TB is transmitted by infected airborne particles and usually results in mild pneumonic illness that frequently is unnoticed. Following initial infection, a latent phase ensues. By the time genital disease arises, the primary infection site has healed. Rarely, primary infection by sexual transmission or contact may occur. The fallopian tubes are infected in almost 100 of genital tract cases. This is followed by the endometrium in approximately 50 of cases, the ovaries in about 20 of cases, the cervix in 5 of cases, and the vulva and vagina in less than 1 of cases (27). Clinically, patients with genital disease present with infertility, pelvic pain, or abnormal uterine bleeding. Menstrual irregularities occur secondary to direct effects on the endometrium as well as an antagonistic effect on gonadotrophic function. Generally, both fallopian tubes are severely affected. In the endometrium, significant scarring disease may mimic Asherman's syndrome. On the vulva, TB manifests as a...
Phenytoin, sulfonamides, barbiturates, and allopurinol. Finger pressure in the vicinity of a lesion in EM major leads to a sheetlike removal of the epidermis (Nikolsky sign). Pemphigus vulgaris is a chronic, bullous, autoimmune disease usually seen in middle-aged adults. The Nikolsky sign is positive in pemphigus vulgaris. Secondary syphilis appears 2 to 6 mo after primary infection and consists of round to oval maculopapular lesions 0.5 to 1.0 cm in diameter. The eruptions typically involve the palms and soles. Secondary syphilis lesions that are flat and soft with a predilection for the mouth, perineum, and perianal areas are called condylomata lata. The skin lesions of systemic lupus erythematosus (SLE) range from the classic butterfly malar rash to the discoid plaques of chronic cutaneous lupus erythe-matosus (CCLE). Urticaria is characterized by pruritic wheals typically lasting several hours.
The answer is c. (Murray, pp 912-918.) All of Koch's postulates have been verified for the relationship between infectious mononucleosis and Epstein-Barr virus, a herpesvirus. However, the relationship between this virus and Burkitt's lymphoma, sarcoid, and systemic lupus erythematosus (SLE) is less clear. Infectious mononucleosis is most common in young adults (14 to 18 years of age) and is very rare in young children. There is
The answer is d. (Fauci, 14 e, p 1771.) Individuals with C3 deficiency have recurrent serious pyogenic bacterial infections that can be fatal. The absence of C3 leads to the inability to generate the opsonin, C3b, which, when deposited on the surface of the bacteria, promotes phagocytosis. Membrane attack complex deficiencies can lead to disseminated Neisseria infections. A deficiency in C1 inhibitor is associated with hereditary angioneurotic edema (HANE). Individuals with C2 deficiency have a predisposition for immune complex disease such as systemic lupus erythe-matosus.
An abbreviated thrombophilia evaluation of lupus anticoagulant, antiphospho-lipid anticardiolipin antibody, factor V Leiden, prothrombin gene mutation, and homocysteine was negative. The remainder of the thrombophilia evaluation will be completed in 1-2 years, at which time it is anticipated that the patient's Coumadin will be discontinued.
The most common cause in this group of conditions is the antiphospholipid antibody (APA) syndrome (Fligelstone et al., 1995). These antibodies bind to plasma proteins that have a high affinity for phospholipid surfaces. The most common of these proteins are the lupus anticoagulant (LA), anticardiolipin (ACL) antibodies, and anti-b2-glycoprotein-1 antibodies (B2G). These are usually acquired. Lupus anticoagulant can be suspected if there is an elevated PTT, and ACL and B2G are detected only by immunoas-says. These conditions can be primary, that is, not associated with other autoimmune conditions. They can present with VTE or arterial thrombosis as well as fetal demise. Antiphos-pholipid antibodies may be associated with infections, cancer, and even certain drugs and hemodialysis, but these are usually IgM as opposed to IgG antibodies and are present in low levels. They do not seem to be associated with thrombotic events.
Side effects of IFN-a therapies are the development of anti-thyroid antibodies, sometimes leading to thyroiditis, and anti-DNA antibodies. Since increased IFN-a and anti-DNA antibodies are also found in patients with lupus erythema-todes, it is a major concern that IFN-a treatment even has the potential to induce SLE. Most patients experience flu-like symptoms, which resolve spontaneously.
Previously termed the lupus anticoagulant. However, the name was changed for two very good reasons. First, the anticoagulant referred to in this latter term reflects the behavior of the blood in the test tube, and in fact a pro-thrombotic effect is observed in vivo. Second, although it can be associated with the connective tissue disease systemic lupus erythemato-sus, this is by no means necessary and we are increasingly recognizing APS occurring in isolation.
The Ross procedure is a long procedure with an average aortic cross-clamp time of 2 hours. Therefore, if other procedures are to be performed simultaneously with aortic valve replacement, the Ross procedure is not always the best choice as myocardial ischemia time may become too long. Thus patients who also need coronary artery bypass grafting are usually not optimal candidates for the Ross procedure. Furthermore, most connective tissue disorders such as Marfan's syndrome and systemic lupus erythematodes form a contraindication for the Ross operation as the pulmonary valve may also be affected by these disorders. In rheumatic valve disease the pulmonary autograft has been reported to become involved in the inflammation process following the Ross procedure.11 Furthermore, following the Ross procedure two valvular replacements are at risk instead of only one. The long-term fate of the pulmonary autograft is not completely known as the number of long-term survivors is still limited.
A) Fixed or localized forms Tuberculosis colliquativa cutis colicuativa (Scrofuloderma, tuberculous pseudomycetoma, lymphangiitic gummas, hematogenous gummas). Lupus (Lupus vulgaris, lupus-warty tuberculosis, tuberculosis caused by BCG). Verrucous (prosector's wart, tuberculosis verrucosa cutis) Ulcerative, vegetative or ulcerovegetative, miliary.
Where Can I Get Proven Lupus Treatment Ebook by Dr. Gary Levin
The best part is you do not have to wait for Proven Lupus Treatment Ebook by Dr. Gary Levin to come in the mail, or drive to a store to get it. You can download it to your computer right now for only $37.99.