Rheumatic Disease : Article and Solution

David Isenberg
United Kingdom

B lymphocytes are an essential component of the adaptive immune response. The surface antigen CD20 is expressed throughout B cell differentiation except at the very earliest and plasma cell stages. It is thought to act as a cross membrane calcium ion channel and to play a key role in B cell activation. In consequence it has been hypothesised that targeting CD20 may prove therapeutic in the management of diseases like lupus that are largely B cell mediated. B cell depletion using rituximab, a chimeric human-mouse monoclonal antibody, was first utilized for the treatment of non-Hodgkin’s lymphoma in 1997. For the past six years my colleagues and I have been treating patients with severe SLE who have failed conventional immunosuppressive therapy (N=40) and although our studies remain open label the results have been extremely encouraging. Our preferred therapeutic regime is 1g rituximab IV, 750mg of cyclophosphamide IV and 250mg of Methylprednisolone IV - each infusion is given on two occasions two weeks
apart. Our results (1,2) have indicated that this combination of drugs will achieve B cell depletion in virtually every case and that mean period of B cell depletion is approximately six months. (more…)

CC Mok (MD, FRCP, FHKCP, FHKAM)
Department of Medicine, Tuen Mun Hospital
Hong Kong SAR, China

Therapy of lupus nephritis can be divided into an induction phase and a maintenance phase. Initial treatment is usually more aggressive and aims at inducing remission of nephritis while maintenance therapy is needed to prevent renal flares. Mycophenolate mofetil (MMF) has been shown by randomized controlled trials to be superior to, or at least as effective as, oral or intravenous pulse cyclophosphamide (CYC) as induction therapy for severe lupus nephritis. Adverse effects such as amenorrhoea and major infections are less frequent with MMF than CYC. (more…)

David Isenberg
United Kingdom

Systemic lupus erythematosus (SLE) is a complex autoimmune rheumatic disease whose outlook has improved significantly from the 1950’s when 50%, 4 year survival was noted, to the present when around 80%, 15 year survival is generally recorded. However significant numbers of patients continue to die early from lupus and its morbidity is also significant in some patients. In a cohort of 442 patients with lupus followed up in the Centre for Rheumatology at University College London between 1978 and 2005, 65 patients died with an average age of 47.1 years. The major causes of death were infection, cancer and atherosclerosis. We have recorded deaths in several young teenagers and others in their early twenties. Thus, although the outlook for patients with lupus is much improved and newer, principally biological agents, now offer the prospect of far more focussed and appropriate treatment for this disease, there is a continuing need to understand rather better its precise aetiopathogenesis. (more…)

INFLAMASI MIOPATI IDIOPATIK

Polimiositis dan dermatomiositis adalah inflamasi miopati idiopatik (IMI). Walaupun penyakit tersebut diakui dapat dibedakan dari penyakit jaringan ikat lainnya, namun sulit dibedakan dengan inflamasi otot yang menyertai penyakit otoimun. Polimiositis dan dermatomiositis jarang terjadi, insiden pertahun 5-10 kasus per sejuta. Peningkatannya terjadi pada dua dekade terakhir ini¹. Penyakit ini lebih sering dijumpai pada wanita dari pada pria pada semua kelompok umur. (more…)

Sakit tulang sendi atau arthritis dialami oleh 95% penderita Lupus. Kenyataannya, sakit pada tulang sendi biasanya adalah gejala awal Lupus. Berbeda dengan Rheumatoid Arthritis, Arthritis Lupus terjadi sewaktu-waktu. Gangguan pada tulang sendi ini biasanya menyerang jari-jari, pergelangan tangan, dan lutut. Sikut, pergelangan kaki, dan bahu jarang terjadi. Ketika gangguan tulang sendi terjadi pada satu sisi bagian tubuh, tulang sendi sisi lainnya biasanya juga berdampak.
Arthralgia : Arthralgia adalah sakit pada persendian tulang. Kaku di pagi hari, bengkak, atau panas di persendian juga dapat terjadi. (more…)