Foods you can eat with Lupus
Pregnancy in systemic lupus erythematosus (SLE) is associated with an increased risk of preeclampsia (Khamashta and Hughes, 1997). However, this risk is largely attributable to the presence of certain risk factors, particularly the presence of antiphospholipid antibodies (APAs), renal involvement of the lupus with or without hypertension, and active disease at the time of conception (Nelson-Piercy and Khamashta, 2003). Thus for women with SLE without antiphospholipid antibodies, lupus nephritis, or hypertension whose disease is quiescent at the time of conception, the risk of pre-eclampsia is probably not increased compared to the background rate. One exception to this may be women Antiphospholipid syndrome (APS) is discussed below. Women with proteinuria (as above for diabetes) or renal impairment (see below) from any cause have an increased risk of super-imposed pre-eclampsia. Even quiescent renal lupus is associated with an increased risk of fetal loss, pre-eclampsia and IUGR,...
All forms of cutaneous lupus may manifest photosensitivity. Cases with acute SLE may present with the characteristic butterfly facial rash in addition to constitutional symptoms, whereas subacute cutaneous lupus occurs in about 10 of patients with lupus erythematosus. Common skin presentations include an annular scaly erythematous, psoriasiform rash involving light-exposed areas, which may present abruptly, extensor surfaces of arms, dorsa of hands, V of chest and upper back and face. Patients may also manifest a diffuse nonscarring alopecia. The treatment of choice is topical steroids in mild cases but systemic therapy with antimalarials, corticosteroids,
'The masqueraders can be grouped into primary and secondary groups. The primary (most common) masqueraders are depression, diabetes mellitus, drugs, anemia, thyroid disease, spinal dysfunction, and urinary tract infection. A secondary (less common) list includes chronic renal failure, HIV AIDS, rare bacterial infections (e.g. subacute bacterial endocarditis, tuberculosis), systemic viral infections (e.g. infectious mononucleosis, hepatitis A, B, C, D, E), neurological dilemmas (e.g. Parkinson's disease, multiple sclerosis), connective tissue disorders (e.g. systemic lupus erythe-matosus, polymyalgia rheumatica).
A number of maternal medical conditions are associated with an increased risk of indicated preterm birth (Table 5-1). Maternal medical illnesses such as chronic hypertension, pre-pregnancy diabetes mellitus, or systemic lupus erythematosus can alter or limit the placental delivery of oxygen and nutrients to the developing fetus, possibly resulting in fetal growth restriction. These same maternal medical illnesses also increase the risk of preeclampsia and, thus, the risk of indicated preterm birth. The mechanism(s) that places a woman at increased risk for preeclampsia is unknown. Acute maternal medical conditions may also result in preterm birth. For example, severe trauma and shock are acute conditions that could create a nonreassur-ing fetal status or placental abruption and thus lead to indicated preterm birth. The progressive course of some medical illnesses could mandate indicated preterm birth to preserve the health and well-being of the mother. Functional or structural...
Such, food or prey items are ranked by profitability and added to the diet as long as there is an increase in net energy intake. The optimal diet model provides several useful predictions. If handling times (the time needed to pursue, capture, and consume) are typically short, the consumer should be a generalist (use a wide range of foods or prey). On the other hand, if handling times are long, the consumer should specialize on the most profitable foods. Consider prey selection by wolves (Canis lupus) that are usually in close proximity to large ungulates, such as moose. The time and energy required to capture a moose may be considerable. As a result, wolves may specialize on the most profitable or vulnerable segments of the population (juveniles and older animals in poor condition). Optimal foraging theory also predicts that a consumer should have a broader diet in an unproductive environment or during lean periods than in a productive environment or periods of food abundance (Gray...
For the sake of simplicity, we divide the etiology of autoimmune-like disease into thymic origin and or peripheral tissue origin (76,81,82). Many reports implicated TGF-P in the pathogenesis of autoimmune-like disease. Systemic administration of TGF-P suppressed the symptoms of experimental encephalomyelitis, whereas antibodies to TGF-P enhanced the disease (82,83). Mice null for TGF-P 1 developed autoimmune-like syndrome, including enhanced expression of MHC class I and II antigens, circulating systemic lupus erythema-tosus (SLE)-like IgG antibodies to nuclear antigens, pathogenic glomerular IgG deposits, and progressive infiltration of lymphocytes into multiple organs (84,85). Development of autoimmunity is normally resulted in selection processes in the thymus or through mechanisms that maintain tolerance in peripheral tissues. In the thymus, negative selection takes place at the CD4+ CD8+ double-positive stage (86). Because TGF-P regulates the maturation of these double-positive...
Because of the effect of certain medical conditions (for example, renal disease) or their treatments (for example, cyclophosphamide for systemic lupus erythematosus) on fertility, these issues related to assisted reproduction are extremely pertinent. Regrettably, however, the desire of women to have children tempers the assimilation of possible risks associated with assisted reproduction. It is the responsibility of the providers of assisted conception techniques to ensure that women and their partners understand these associated risks before embarking on fertility treatment.
Most patients with inherited defects are homozygous for the mutated allele these are very rare except for C2 deficiency, which affects about 1 10 000 white people. Defects in the early components of the classical pathway (C1, C2, C4) predispose to recurrent bacterial infection, but the main problem for affected patients is a susceptibility to immune complex disease such as systemic lupus erythematosus (SLE), glomerulonephritis and vasculitis. The rare patients with complete C3 deficiency suffer from severe bacterial infections from an early age, but are also prone to vasculitis and glomerulonephritis. Defects in the late components, which include the membrane attack complex, are associated with recurrent meningococcal and gonococcal infection, except for C9 deficiency, which is common in Japanese people and only occasionally predisposes to meningococcal meningitis. Recurrent meningococcal disease is a feature of complete deficiency of alternative pathway components (i.e. factors B, D,...
Cerebral lupus 60 , 113 , 414 , 433 , 610 , 914 , 1035 , 734 , 1193 Cerebrovascular diseases 407 , 841 , 953 , 955 Child's CSF, see Pediatric values 1310 , 928 , 447 , 1065 Lupus, see Cerebral lupus Lymphoma 588 , 1200 , 1263 Lysozyme 295 , 427 , 1119 Malignant tumor, see Tumors Subacute sclerosing panencephalitis 58 , 78 , 119 , 187 , 256 , 261 , 420 , 534 , 535 , 562 , 640 , 679 , 716 , 717 , 718 , 719 , 720 , 782 , 815 , 920 , 938 , 1037 , 1047 , 1048 , 1057 , 1074 , 1078 , 1104 , 1218 , 1219 , 1221 , 1225 , 1228 , 1261 , 1268 Syphilis, see Neurosyphilis Systemic lupus, see Cerebral lupus
TTP is one of a spectrum of microangiopathic hemolytic conditions that include pre-eclampsia, hemolytic uremic syndrome (HUS), acute fatty liver of pregnancy and autoimmune conditions such as systemic lupus erythematosus. TTP is a condition in which multimers of von Willebrand factor, derived from the endothelium, accumulate in the circulation due to lack (either functional or absolute) of a specific metalloproteinase enzyme that breaks down the multimers. Von Willebrand factor binds platelets to the endothe-lium and high concentrations are associated with peripheral platelet consumption and the formation of platelet microthrombi. Von Willebrand factor is usually broken down by a specific metalloproteinase but may accumulate if this enzyme is deficient or if endothelial damage
Skin tuberculosis affects individuals of all ages and both sexes, presenting with a wide variety of clinical pictures that frequently affect the lower limbs and particularly one or both feet (Chopra and Vega-Lopez, 1999) however, lupus vulgaris and papulonecrotic tuberculide are more common in females, whereas tuberculosis verrucosa cutis is rare in children. By far the main clinical presentation of cutaneous tuberculosis affecting the adult foot is called tuberculosis verrucosa cutis, whereas cases of lupus vul-garis are commonly observed on the face. The tuberculous bacilli cause disease following direct inoculation into the skin but clinical disease can also result from haema-togenous dissemination. Unilateral and asymmetrical involvement is the rule in almost all cases of skin tuberculosis. Commonly observed asymptomatic lesions include dry patches of atrophic skin, pigmentary changes, nodules, and plaques of verrucous lesions. The typical plaque of tuberculosis can measure...
To 90 when the red cell membrane of the reagent cells is modified with papain or another proteolytic enzyme. Antibody may also be eluted from the red cell membrane in a majority of cases and the specificity determined. A subtype of warm AIHA has been defined in which both warm- and cold-type antibodies are found. Both tend to be lytic, and this 'mixed type' AIHA tends to produce severe haemolysis with an intravascular component. It is most commonly associated with systemic lupus erythematosus (SLE) or lymphoproliferative disease.
Recurrence of the primary kidney disease is rare, accounting for only 1 of cases of late allograft dysfunction. In general, kidney recipients may develop recurrence of diabetic nephropathy, focal segmental glomerulosclerosis, mem-branoproliferative glomerulonephritis, immunoglobin A (IgA) nephropathy, he-molytic uremic syndrome, or systemic lupus erythematosus (see Chapter 21).
Lupus nephropathy with acute tubular necrosis. Once the irreversibility of the process is clear, patients must be free of active infection (acute or chronic), active inflammatory glomerulonephritis (such as in active systemic lupus erythematosus SLE ), active uncontrolled psychiatric disorder, and untreated malignancy). In addition, the patient must have a reasonable life expectancy after transplant and must be physiologically able to tolerate the transplant procedure. ESRD patients are prone to develop sequelae of arteriosclerosis and coronary artery disease (CAD), due in part to the higher incidence of hypertension and DM. The workup outlined here should also aim at excluding the consequences of other end-organ damage from these causes. High levels of sensitization to donor tissues also precludes transplantation due to a high incidence of hyperacute rejection and graft loss. This is further explained later in this chapter. Finally, patients must be compliant, without active...
Chronic hypertension is subdivided into essential and secondary due to underlying causes such as renal disease (e.g. glomerulonephritis, reflux nephropathy, adult polycystic kidney disease), systemic disease with renal complications (e.g. systemic lupus erythema-tosus, diabetes), renal artery stenosis or endocrine disorders (e.g. cushings, phaeochromocytoma) (Brown et al., 2000).
O., Moerman, P., Vermylen, J., Van Assche, A. and Renaer, M. (1982). Decidual vasculopathy and extensive placental infarction in a patient with repeated thromboembolic accidents, recurrent fetal loss, and a lupus anticoagulant. Am. J. Obstet. Gynecol., 142, 829-34. Magid, M. S., Kaplan, C., Sammaritano, L. R., Peterson, M., Druzin, M. L. and Lockshin, M. D. (1998). Placental pathology in systemic lupus erythematosus a prospective study. Am. J. Obstet. Gynecol, 179, 226-34.
Adult respiratory distress syndrome (ARDS) is often cited as a complication of pre-eclampsia but is an unlikely primary complication of the disease although it may follow aspiration pneumonia or prolonged ventilation. Reporting the occurrence of ARDS in an obstetric intensive care unit, Mabie et al. found only 16 cases of respiratory distress attributable to ARDS over a 6-year period (Mabie et al., 1992). Only 4 of these 16 cases were linked to pre-eclampsia eclampsia. Three of these four cases had additional complications that may have contributed to the development of ARDS (including aspiration pneumonia, lupus nephritis, sepsis and a ruptured liver hematoma with massive blood transfusion). The fourth case had pulmonary edema that developed into ARDS after the patient had a respiratory arrest. These observations are important because most cases of respiratory distress will have a cardiogenic component amenable to intervention. ARDS should never be accepted as a primary diagnosis in...
21 What are the predisposing factors identified in human patients which are important in the immunemediated adverse effect lupus erythematosus caused by the drug hydralazine AMOS, H.E. (1979) Immunological aspects of practolol toxicity. Int. J.Immunopharmac., 1, 9. JIANG, X., KHURSIGARA, G. and RUBIN, R.L. (1994) Transformation of lupus inducing drugs to cytotoxic products by activated neutrophils, Science, 266, 810. PERRY, H.M. (1973) Late toxicity to hydralazine resembling systemic lupus erythematosus or rheumatoid arthritis. Am. J.Med., 54, 58. TIMBRELL, J.A., FACCHINI, V., HARLAND, S.J. and MANSILLA-TINOCO, R. (1984) Hydralazine-induced lupus is there a toxic metabolic pathway Eur. J. Clin. Pharmacol., 27, 555. UETRECHT, J. (1990) Drug metabolism by leukocytes and its role in drug-induced lupus and other
Borealis) and scrub jays (Aphelocoma coerulescens), however, extended family groups defend territories. Male offspring, or occasionally female offspring, remain in their parents' (fathers') territories (Walters et al. 1988, 1992). Wolves (Canis lupus), beavers (Castor canadensis), and dwarf mongooses (Helogale parvula) also defend territories as extended families (Jenkins and Busher 1979 Mech 1970 Rood 1986).
Glomerular injury is the primary cause of kidney disease. The kidney can be the primary organ involved, or one of the many organs damaged by systemic disease. The deposition or formation of antigen-antibody complexes is the principal mechanism of glomerular injury. Immune-mediated glomerular injury is associated with induction of inducible nitric oxide synthase (iNOS) and the production of large amounts of nitric oxide (NO). This has been well documented in a number of renal glomerular diseases, such as lupus nephritis, mesangioproliferative glomerulonephritis, and kidney transplant rejection. To better understand the potential role of polyamines in these and other diseases, we will look at the yin-yang relationship of these arginine-based NO and polyamine pathways.
Antiphospholipids are a heterogeneous collection of IgG and IgM (and less frequently IgA) immu-noglobulins. Lupus inhibitors are detected on functional testing where they cause prolongation of phospholipid-dependent coagulation reactions. Anticardiolipins react with anionic phospholipids in solid phase immunoassays. Historically it was believed that antiphospholipids react with negatively charged phospholipids. Recently, however, it has been shown that they react not with phospho-lipids but with plasma proteins bound to suitable (not necessarily phospholipid) surfaces such as b2 glycoprotein 1(b2GP1), human prothrombin, annexin V and proteins C and S.
The differential diagnosis of seizure activity in pregnancy is extensive and includes epilepsy, systemic lupus erythematosus, acute fatty liver of pregnancy (hepatic encephalopathy), thrombotic thrombocytopenic purpura, amniotic fluid embo-lus, cerebral venous thrombosis, herpes encephalitis, malaria and cocaine intoxication (Clark et al., 1995 Hauser and Kurland, 1975 Towers et al., 1993). Late postpartum eclampsia (seizures first developing between 48 h and 4 weeks after delivery) require neuroradiological investigation to exclude alternative diagnoses (Douglas and Redman, 1994 Lubarsky etal., 1994 Tetzschner andFelding, 1994).
The spleen has not been identified as a site of production of other coagulation factors except, possibly, the lupus anticoagulant. It does, however, have a significant role in bleeding disorders, as its platelet pool is a source of platelet reserve so that patients with moderate thrombocytopenia are at risk of bleeding in the absence of normal splenic function. In immune thrombo-cytopenias, when the spleen is the focal organ of platelet destruction, splenectomy may induce remission but also removes the platelet pool as a reserve to protect the patient in the event of a recurrence of the thrombocytopenia.
The drug hydralazine is a vasodilator used for the treatment of hypertension. In a significant proportion of individuals it causes a serious adverse effect, drug-induced lupus erythematosus (LE). This toxic effect, believed to have an immunological basis, involves a number of interesting features. Thus, there are a number of predisposing factors which make it possible to identify patients at risk, although the mechanism(s) underlying some of these predisposing factors are unknown. When the occurrence in the exposed population is examined in the light of some of these factors the incidence can be seen to be extremely high. The predisposing factors identified to date are
Lupus anticoagulant The lupus anticoagulant has been described in patients infected with HIV. This circulating anticoagulant is an IgG or IgM Thrombotic events in patients with AIDS are rare when compared with patients with the lupus anticoagulant in other settings, where thromboembolic phenomena are common. Patients with a prolonged partial thromboplastin time secondary to a lupus anticoagulant do not appear to be at increased risk of bleeding. The pathophysiological basis for the development of the lupus anticoagulant in HIV disease is not understood, but an association with active opportunistic infection, especially with P. carinii has been suggested. Anticardiolipin antibodies have also been described in HIV disease but do not correlate with the presence of a lupus anticoagulant.
Repeated or chronic exposure is required for immunotoxic reactions as the immune system must first be sensitized as described above. The exposure to the compound need not be continuous and in fact repeated, discontinuous exposure is often more potent. There is no generalized, characteristic exposure time or sequence for immunotoxic reactions. In halothane hepatitis (see Chapter 7) the number of exposures seems to be important, with about four being optimal. With the hydralazine-induced Lupus syndrome exposure for a considerable length of time (average of 18 months), during which there is repeated exposure, is generally required for the development of the immune response (see Chapter 7). With some types of immune response exposure to minute amounts of the antigen, such as might occur with an environmental pollutant, may be sufficient to elicit a severe response in a sensitized individual.
The management of HELLP syndrome is delivery while the associated complications (renal failure, eclampsia and respiratory distress) may require critical care on their individual merits. Thrombocytopenia should reach a nadir within 72 h of delivery and if it is persistent beyond this point, a search for alternative diagnoses should commence (e.g. sepsis, folate deficiency, throm-botic thrombocytopenic purpura, systemic lupus erythematosus). Although steroids have been advocated as a means of accelerating the resolution of postpartum eclampsia, the studies involved are small and show no reduction in mortality.
Transplant recipients may be susceptible to recurrence of their original disease. Some recurrent diseases are mild, whereas others have a propensity to cause allograft failure. Liver transplant recipients may develop recurrence of hepatitis C, hepatitis B, hepatocellular carcinoma, alcoholic liver disease, or one of the autoimmune hepatitides (see Chapter 19). Kidney recipients may develop recurrence of diabetic nephropathy, focal segmental glomerulosclerosis, membranoprolifera-tive glomerulonephritis, immunoglobin A (IgA) nephropathy, hemolytic uremic syndrome, or systemic lupus erythematosus (see Chapters 19 and 21).
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