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Nefritis Lúpica

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consultareumatologia
consultareumatologia

Por: Dr. Graham Hughes XIII Congreso Colombiano de Reumatologia 2011 Barranquilla

Santé & Médecine
1  sur  79
Professor Graham Hughes The London Lupus Centre The London Bridge Hospital
Lupus and the kidney
 
 
History
1970 ,[object Object],[object Object]
 
July 1969 ,[object Object],[object Object]
 
Serological Changes 1909 1948 1959 1966-70 1976 1983 WR LE Cell ANA DNA ENA aPL
Antibodies predicting disease Anti-Topo1 …………… Scleroderma…………… 11 yrs Rh factor/ccp ………… RA ……………………… 14 yrs Anti-Ro & La ………… Sjogrens ………………. 5 yrs Anti-DNA …………….. SLE ……………………. 11 yrs Anti-cardiolipin ………. Hughes Syndrome ….… 32 yrs ---------------------- Anti-thyroid ………….. Thyroid ………………… 10 yrs Anti-mitochondrial ….. PBC ……………………. 25 yrs
Explosion of Lupus
 
 
Lupus Diagnosis Professor Hughes’ “alternative” criteria ● Childhood migraine ● Childhood ‘growing pains’ ● Teenage prolonged ‘glandular fever’ ● Agoraphobia ● Septrin allergy ● Chronic fatigue ( ‘fibromyalgia’) ● Intermittent alopecia ● Lupus patients don’t catch colds
[object Object],[object Object]
Failure
Failure
Failure
Sticky Blood and Headache
 
LUPUS “- the new diabetes”
Failure
Lupus Nephritis ,[object Object],[object Object]
What’s still bad in Lupus? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Compliance? Plaquenil blood levels Ann Rheum Dis: 66,621, 2007
 
Lupus pregnancy and the kidney
Flares in pregnancy? ,[object Object],[object Object]
Treatment options 2011
Antimalarials
 
Anti-malarial treatment and lupus survival ,[object Object],[object Object],[object Object]
 
Thalidomide analogues?
Steroids
The Case for Conservative Management ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cyclophosphamide
NIH Regime ,[object Object],[object Object],[object Object],[object Object]
 
The St Thomas’ Hospital Regime (1985) ,[object Object],[object Object],[object Object]
 
Euro-Lupus Nephritis Trial Conclusion ,[object Object],Houssiau et al. A&R 2011
New therapies for SLE ,[object Object],[object Object]
Expenditure for drugs for lupus ,[object Object],[object Object]
Mycophenolate-mofetyl (cellcept ® )
24 hour Proteinuria in Class V Lupus Nephritis Ferro et al. Abstract ACR 2003
MMF and teratogenicity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Could MMF play a protective role in vascular disease in SLE?
Primate cardiac xenografts Inhibition of chronic vascular rejection by MMF O’Hair et al. Ann Thorac Surg, 1994
1988………………..................…..…BLyS 23 years 2011...Benlysta approval in U.K.
Belimumab BLISS 52 & 72 Results ,[object Object],[object Object],[object Object],[object Object],[object Object]
Rituximab: ,[object Object]
- but RTX in lupus trials has had a bumpy ride………………..
In defence of Rituximab ……………
Off-label use of RTX in lupus ,[object Object],[object Object],[object Object],[object Object],[object Object]
RTX may even allow a “no-steroid” regime ……………..
“ No-Steroid” Regime: ,[object Object],[object Object],[object Object],[object Object],[object Object]
“ No-Steroid” Regime: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
RTX and pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Infections ?
Ocrelizumab ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
JC Virus
[object Object],[object Object]
SUCCESS Eric Liddell: 1923 Olympic Gold Medallist
Success ,[object Object]
SUCCESS Lupus and Pregnancy 50 years of progress
Success ,[object Object]
And finally …….
Don’t Believe the Textbooks!
 
Don’t Believe the Textbooks!
… eventually it usually kills the patient...
40 years later...
 
Lupus street, London
Perseverance!
 

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Nefritis Lúpica

Notes de l'éditeur

  1. Biologically false-positive WR (Reinhart 1909) L.E. Cell (Hargraves 1948) Antinuclear antibodies (Miescher 1954, Friou 1959, Beck 1961) DNA (Tan, Koffler, Kunkel, Pincus, Christian 1966-71) ENA (Reichlin 1976) Anti-phospholipid antibodies (Harris, Gharavi, Hughes 1983)
  2. Reference 9. David O'Hair D.P et al. Inhibition of chronic vascular rejection in primate cardiac xenografts using mycophenolate mofetil. Ann Thorac Surg 1994; 58: 1311-1315.