“It’s not lupus, it’s never lupus!” says Gregory House in an episode of the hit television series HOUSE, M.D. it was a line that made fun of the fact that the diagnostics team that the show often focuses on always brings up lupus as the patient’s possible medical condition, a diagnosis that has been proven wrong time and time again. The line was, of course, an instant sensation among the fans of the show and the fact that there is an actual web page one that has a YouTube video featuring all the times the team had diagnosed a patient with lupus embedded on it is proof of that. Since the utterance of that line, “It’s never lupus” has had so many people quoting it and putting it on t-shirts that even people who don’t actually watch the show have come to know it.
One thing that some people have started to wonder about is why the writers of the show favored mentioning lupus over all the other possible illnesses. Is lupus really that commonc Or, perhaps, the better question would have to be “Is lupus really that interestingc” After all, the bulk of an episode of HOUSE, M.D. is mainly focused on the unusual conditions of the patients and the diagnostics team’s race against time to figure what is wrong with the patients so that they may be given the appropriate treatment. Given that little tidbit, it wouldn’t be too hard to imagine that lupus is thrown into the script a lot of times because of all the medical mishap possibilities that the diagnosis could bring up.
Having said that, it should perhaps be pointed out that the writers of HOUSE, M.D. should be considered smart for using lupus as a “throw-away” diagnosis in many cases. Why, you askc Because the reasoning is nevertheless completely plausible even if the almighty and all-knowing Gregory House proves them wrong in the end. After all, lupus does indeed create so many complications that could explain some of the symptoms that the patients featured on the show display and the creepy part is that there are real medical cases upon which the cases in HOUSE, M.D. is based (but let’s not get into that).
The point to be made here is that lupus causes so many other health problems that one has to wonder why it DOESN’T become a standard part of the diagnostics process in the really weird and potentially fatal cases that could be encountered in reality. Lupus is an autoimmune disease, which in layman’s terms means that the body attacks and destroys its own tissues and cells because it cannot understand the difference between those and the “alien” materials that make us sick. Your joints, your heart, your lungs, your kidneys, your skin and even your brain get attacked by your immune system when you have lupus, and and it is inevitable that at some point when it gets too much your body may begin to shut down as well.
Because it is a disease affecting the immune system, some people believe that lupus is a blood disorder (because white blood cells are an essential component of the immune system). This is a mistaken assumption lupus is not in itself a blood problem; however, lupus CAUSES a number of blood disorders because it attacks blood cells as well; of course, these blood disorders help in determining the approach to treating the lupus. Because of this, blood experts are brought in when a case of lupus is discovered which is possibly why some people are so sure that lupus is a blood disorder when it in fact only brings about blood problems like too much blood clotting (thrombosis), and low red blood and hemoglobin levels (anemia).
Yes, everyone should be able to understand the irony of our own “anti-sickness” system being an actual cause of sickness one of the things that makes lupus a very interesting condition to ponder. Whether or not you knew much about it before it was constantly mentioned in HOUSE, M.D. doesn’t matter anymore. In the end, lupus has become part of popular culture’s consciousness and more people have become aware of it.
One last thing: while many people expected that “the condition” that changes in every episode would never be lupus, an episode in the current season ended up with a patient actually HAVING lupus, prompting Gregory House to say “I finally have a case of lupus.” So while some of you may have started to think that in real life, “it’s never lupus”, remember that even in the show that coined the phrase, lupus happens.
Lupus is an auto immune disease which means that the bodys immune system attacks its own tissue. The result of these attacks is chronic inflammation and although the severity of Lupus can vary greatly, it can ultimately be a fatal disease. Lupus is a condition where the immune system creates anti bodies, which circulate in the blood stream and attack various tissues and organs in the body. Some times only the tissue of the skin is affected but in other cases the internal organs become targeted. Cases where only skin tissue is affected is called discoid lupus, but the more pervasive and serious form is referred to as systemic lupus erythematosus or SLE for short. SLE commonly attacks the heart, lungs, kidneys, joints and nervous system.
Systemic lupus erythematosus has an unpredictable evolution. People with the disease can experience short periods of symptomatic remission between episodes of symptomatic intensification. Most lupus treatments are focused upon extending the periods of remission and on ameliorating the symptoms of the disease. Although there is no effective cure for lupus, most medical treatments can keep the disease under control. However, due to the pronounced chronic character of the disease, patients require ongoing lupus treatment.
Lupus can affect almost any part of your body, including your joints, skin, kidneys, heart, lungs, blood vessels, and brain. There is no way to know what part of your body will be affected. For most people though, lupus are a mild disease affecting only a few parts of your body, and some patients don’t get inner organ problems (like in the heart and lungs), but do have skin and joint problems.
The treatment of lupus greatly differs from a patient to another, lupus sufferers receiving a certain type of medications according to their experienced symptoms and the seriousness of the disease. Thus, the treatment of lupus is often personalized, comprising many different types of medications and therapies. Lupus patients (especially patients diagnosed with systemic lupus erythematosus) are commonly administered combination treatments, targeted at countering the occurrence and aggravation of the multitude of symptoms characteristic to this type of autoimmune disease.
Treatment options for Lupus have come a long way in the past ten years. There was a time when a systemic lupus diagnosis came with a three year life expectancy. Today, lupus is not expected to end in termination of life, but living with the chronic pain and the difficulties are tremendously difficult and even terrifying. Lupus is a sneaky disease, traveling from one part of the body to another seeking out enemy intruders that are nothing more than normal bodily organs. A confused immune system can do a lot of damage, and learning to cope with the inconsistent and blind siding pain is a daily struggle.
The natural ingredients used to make this medicine make it free from side effects. By using this medicine you will be able to get rid of the discomforts of Lupus without sacrificing your health. You will also be able to lead a trouble free life by avoiding the side effects that are common to other medications such as stomach upset, liver and kidney inflammation, weight gain, weakened bones, damage to arteries and high blood pressure.
Lupus is a common disease found in women, though it does not fail to attack men at times. It is mainly caused due to the development of undesirable antibodies inside the body. Unlike other diseases, the autoimmune system of the body induces lupus in human body, leading to inflammation of various body tissues.
Which Body Parts are targetedc
The development of antibodies can take place in any part of the body. Hence, lupus can target any body part from lungs, kidneys and heart to skin, nervous system and various body joints.
Who are Probable Victimsc
It has been estimated that 90% of the patients suffering from lupus are women. Women in the age group of 18-45 are more likely to be victimized by lupus. The women from regions like Native America, Latin America and of African American origin are at higher risks of obtaining this disease.
Why is Lupus of Concern among Womenc
Lupus is a disease that can further lead to a number of serious problems. For instance, women suffering from lupus become more prone to heart attacks, strokes, high blood pressure, diabetes, joint and muscle pains. Furthermore, lupus in women can also lead to weakening of bones and emergence of diseases like osteoporosis. So fatigue and pains are obviously most prominent problems induced in lupus patients.
How is Lupus Causedc
1-As mentioned in the beginning, immune system of human body is mainly responsible for introduction of lupus in human body. The unfavorable antibodies developed in the body can attack various tissues of the body, thereby leading them to have inflammations.
2-The second-most common cause of lupus is hormone change, especially during the period of pregnancy and during childbirth.
3-Another reason for occurrence of lupus is exposure to extreme environmental conditions like sunlight.
4-Stress is also one of the pertinent causes of the disease.
5-This disorder is often caused due to intake of certain medications, which can advance the development of bas antibodies.
6-Lastly, some types of viruses can also cause lupus in women.
Common Symptoms of Lupus
Lupus occurs in a number of variations, including systemic lupus erythematosus, discoid lupus, neonatal lupus and subacute cutaneous lupus erythematosus. The most common symptoms of all these variations are:
1-Pain and swelling in the body joints.
2-Appearance of skin rashes, which include rashes in the shape of butterfly over nose and cheeks and sores on neck and chest.
3-Pain in the chest, especially during heavy breathing.
4-Inflammation in body organs like heart, lungs and internal organs.
5-Fatigue and anemia.
7-Sensitivity to sunlight.
8-Loss of memory, lack of agility and presence of mind and confusion.
9-Abnormalities related to the nervous system, kidneys and abdomen.
Blood tests, x-rays and other recommended laboratory tests are often used to diagnose lupus. The correct diagnosis and subsequent treatment from a medical expert can easily solve your problem. It is highly recommended that you consult your doctor on the appearance of early signs and symptoms of this disease to get the best treatment.
Pleurisy, also called pleuritis, is an inflammation of the pleura. Pleurisy can be generated by a variety of infectious and non-infectious causes. Pleurisy is caused by swelling and irritation of the membrane that surrounds the lungs. Certain autoimmune diseases (such as systemic lupus erythematosus) can irritate the pleura. It is usually a symptom of another illness. It is also called Pleuritic Chest Pain. Pleurisy can develop from many things, including bacterial or viral infections of the lungs (such as pneumonia), TB, lupus, chest injury or trauma, a blood clot in the lung, or cancer. Sometimes a cause cannot be found. The effects of pleurisy can often be felt long after the condition has gone away.The hallmark of pleurisy is severe chest pain that starts suddenly.
The pain is often strong or stabbing when you take a deep breath. It usually subsides or disappears between breaths. It’s usually felt on one side of the stomach area or lower chest. Deep breathing and coughing often make it worse. Pleurisy causes fluid to collect inside the lung area. Breathing may be rapid and shallow because deep breathing induces pain; the muscles on the painful side move less than those on the other side. When an accumulation of fluids (pleural effusion) is associated with pleurisy, the pain usually disappears because the fluid serves as a lubricant. Treatment depends on what is causing the pleurisy. Bacterial infections are treated with antibiotics. Viral infections normally run their course without medications. Fluid in the lungs may be removed by thoracentesis and checked for signs of infection.
Early treatment of bacterial respiratory infections can prevent pleurisy. In the case of heart, lung, or kidney disease, management of the underlying disease can help prevent the fluid collection. Nonsteroidal anti-inflammatory drugs (NSAIDs) may help relieve some of the signs and symptoms of pleurisy. Prescription codeine may help control a cough as well as the pain. Anti-inflammatory drug such as ibuprofen (Motrin), indomethacin (Indocin), or naproxen (Naprosyn) also helpful against pleurisy. You may even receive stronger medicine, such as codeine, hydrocodone (Vicodin), or oxycodone (Percocet). Most pleurisy is caused by infection and is unavoidable. You can avoid severe pleuritic chest pain by early diagnosis and treatment with anti-inflammatory drugs.
Pleurisy Treatment and Prevention Tips
1. Rest is also important to aid in the recovery process.
2. (NSAIDs) may help relieve some of the signs and symptoms of pleurisy.
3. Codeine-based cough syrup will be prescribed to control a painful cough.
4. Avoid severe pleuritic chest pain by early diagnosis and treatment with anti-inflammatory drugs.
5. Traditional Chinese medicine uses the herb ephedra (Ephedra sinica), which acts to open air passages
6. Large doeses of vitamin C, may also provide health benefits to people with pleurisy.
7. Eating fresh fruits and vegetables, adequate protein, and good quality fats help to heathy body.
Peyronie’s disease consists of hard, fibrous tissue, called plaques, developing within the penile shaft. The plaques are hard, thickened and stiff areas, actually a kind of internal scarring. In this fibroid tissue also calcium compounds can accumulate, making the plaques even harder.
The Peyronie’s disease is also called cavernositis, and also sometimes plastic induration. There is probably a chronic inflammation process that leads to this scarring.
The thickened area has less blood flow than normal penile tissue, and do not fill with blood and swell as the normal spongy areas in the inside of the penis. Therefore the penis swells more at the opposite side, and gets a curvature towards the side containing the plaques when erected.
If the plaques are found at several places, more complex deformations will develop. The abnormal bending, twisting or swelling within the penis, often also lead to painful erections.
Any man from the age of 18 and upwards can develop Peyronie’s disease. The average age of men suffering from Peyronie’s disease is 50.
THE SYMPTOMS AND CONSEQUENCES OF THE CONDITION
The three main characteristics of cavernositis are:
One or more small hard lumps underneath the skin, or a continuous hard, stiff and thickened area.
Abnormal bent or crooked penis when erect. All penises have some curvature, but by this disease, the penile bend increases, and one may get a very curved penis. The penis may be bent as a banana or in an angular fashion. The penile bending is most often up, but may be down, to the left side, to right or sloping.
-The bending is usually to the same side as that of the hard thickened area when the penis is erected.
-The hard areas in the erected penis may look like bumps, making the penis irregular.
Sometimes the penis bends greatly enough to make sexual intercourse difficult, or impossible.
Pain during erections caused by the pressure from the hard areas in the penis, or from the stretched skin at the opposite side of the penis.
One may not notice the bend immediately, as it tends to develop over one to three months and later than the hardness and stiffness of the indurations.
The plastic induration may progress and cause impotence. Sometimes the Peyroni’s disease will clear up by itself, but this may take several years.
THE CAUSES OF PEYRONIE’S DISEASE
The exact cause of the induration is unknown. It’s not a sign of an underlying serious condition, and it is not a sexually transmitted infection. It is possible that the disease can begin with an inflammation in the penile tissue. An inflammation may be caused by an allergic or auto-immune reaction. Although the Peyronie’s disease is not an infection, an initial infection can damage the penile tissue and cause an inflammation that develops into Peyronie’s disease. Men having the inflammatory condition called Systemic Lupus Erytematosus more often get Peyronie’s disease.
Vitamin E deficiency seems to be a contributing factor in causing the disease. Diabetes may cause damage of blood vessels, and if this damage occurs in the erectile bodies of the penis, Peyronie’s disease can develop. Peyronie’s disease is sometimes a side effect of the drug Inderal (propanolol) used against high blood pressure.
Sometimes a physical injury to the penis that causes internal bleeding, or a series of such injuries, is the initial cause. A habit of violent sexual activity may cause such injuries. It is thought that some men may have a genetic disposition to the condition.
Plastic induration of the penis is not a cancer, and cannot cause cancer, however a lump or deformation in your genitals that develops, must be examined.
TREATMENT OG PEYRONIE’S DISEASE
Not all men with Payronie’s disease require treatment. The disease sometimes go away by itself. If the condition is pronounced, it is also difficult to find a remedy that can cure every sign of the disease, but several methods can take away most penis changes associated with Peyronie’s. Here is a survey of treatment methods used today.
Tamoxifen – In its early stages of the disease a medication called Tamoxifen has been shown to prevent the formation of the fibrous plaque by Peyronie’s disease. This drug is also used in the treatment of breast cancer, but the two conditions are not related.
Vitamin E and B – Vitamin E and B is sometimes effective in easing the pain and as a treatment for the penile deformity by Peyronie’s disease.
Verapamil – Verapamil, often used in the treatment of high blood pressure, has been shown to decrease the size of the plaque and decrease the pain when injected directly into the plaque, and thus also improve the penis shape distortion by peyronie’s disease.
Shock wave therapy – Extracorporeal shock wave therapy, or ESWT, a new treatment, is being used in some hospitals for the Peyronie’s disease. Although the initial results of this new approach to treat Peyronie’s disease have been promising, the long-term outcome is still undetermined.
Surgery – This is sometimes considered if Payroni’s disease has lasted for a year or more and it hasn’t progressed or regressed for at least three months. By the Nesbitt procedure one removes tissue opposite to the curve to straighten the penis. Another procedure involves putting a graft or part of a vein within the fibrous plaque to lengthen this area. In certain cases of Pyrenees disease, surgical insertion of a penile prosthesis (implant) is recommended.
Radiation therapy – This treatment modality has been tried, but the results are unpredictable and sometimes the opposite of the intended one.
Traction devices – On the market, you can buy mechanical devices to use on the penis some time daily that gently pull upon the penile tissue to straighten out the penis, and thus mending the penis from the curvature caused by Peyronie’s disease.
If you suspect you have gout, it is critical to your future health that you get a proper diagnosis early on so you can learn to control your gout symptoms.
There are 4 diagnosis procedures to help determine if you have the disease…
1. Physical Exam
A physical exam is necessary in order to diagnose gout. Your medical history and your families medical history needs to be evaluated, as well.
The indications of gout are red and shiny skin on the affected area, which is caused by tophi below the skin.
2. Blood Test
A blood test can determine the levels of uric acid present in the blood; however, this is not a foolproof method for a good diagnosis. The reason for this is that if the patient is in a gout attack, the uric acid levels can register in a normal range.
High uric acid levels do not necessarily mean there is a gout presence in the body.
X-rays should be taken. They can help to determine whether there are tophi crystals around joints and under the skin. However, even x-rays will often show the joints to be normal.
This is a more reliable procedure for a correct diagnosis.
The procedure consists of drawing a sample of synovial fluid, with a syringe and needle, from the affected joint. A microscope is then used to analyze the fluid.
If there is a presence of monosodium urate (MSU) crystals in the fluid it will mean there is a presence of gout.
Are you or someone you care about suffering from gout?
While lupus can be a debilitating disease, it doesn’t have to be. If you can find a way to relieve the pain of lupus, you can continue on with most of your normal, day to day activities.
Here are some ways you can find Lupus Pain relief
Lupus can cause pain, swelling and stiffness of the joints. NSAIDs (or non-steroidal anti-inflammatory drugs) can relieve all of these symptoms.
Lupus can also cause chest pains, usually the result of swelling around the heart and lungs. NSAIDs can relieve this swelling and the resulting pain.
There are many NSAIDs available over the counter. Some of them include aspirin, naproxen sodium (found in Aleve) and ibuprofen (found in Motrin). There are also prescription strength NSAIDs that are much stronger and can be prescribed to you by a doctor. However, be careful. Taking these drugs can cause stomach problems. In fact, if you already suffer from stomach problems, like ulcers, you should avoid taking NSAIDs.
Ask Your Doctor about Antimalarial Drugs
Many people suffering from lupus can go for long periods when their symptoms decrease, or even disappear altogether. On the other hand, they can also experience flares, periods when their symptoms, including pain, are unusually severe.
Doctors have found that antimalarial drugs, drugs meant to prevent and treat malaria, can also be used to prevent flares. And while there can be some side effects (like muscle weakness and vision problems) many find them easier to deal with than the pain a lupus flare can cause.
There was a time when those suffering from lupus just had to suffer with the pain their condition caused. But thanks to advances in medical science, you can find lupus pain relief.
aIt’s not lupus, it’s never lupus!a says Gregory House in an episode of the hit television series HOUSE, M.D. – it was a line that made fun of the fact that the diagnostics team that the show often focuses on always brings up lupus as the patient’s possible medical condition, a diagnosis that has been proven wrong time and time again. The line was, of course, an instant sensation among the fans of the show and the fact that there is an actual web page – one that has a YouTube video featuring all the times the team had diagnosed a patient with lupus embedded on it – is proof of that. Since the utterance of that line, aIt’s never lupusa has had so many people quoting it and putting it on t-shirts that even people who don’t actually watch the show have come to know it.
One thing that some people have started to wonder about is why the writers of the show favored mentioning lupus over all the other possible illnesses. Is lupus really that common? Or, perhaps, the better question would have to be aIs lupus really that interesting?a After all, the bulk of an episode of HOUSE, M.D. is mainly focused on the unusual conditions of the patients and the diagnostics team’s race against time to figure what is wrong with the patients so that they may be given the appropriate treatment. Given that little tidbit, it wouldn’t be too hard to imagine that lupus is thrown into the script a lot of times because of all the medical mishap possibilities that the diagnosis could bring up.
Having said that, it should perhaps be pointed out that the writers of HOUSE, M.D. should be considered smart for using lupus as a athrow-awaya diagnosis in many cases. Why, you ask? Because the reasoning is nevertheless completely plausible even if the almighty and all-knowing Gregory House proves them wrong in the end. After all, lupus does indeed create so many complications that could explain some of the symptoms that the patients featured on the show display – and the creepy part is that there are real medical cases upon which the cases in HOUSE, M.D. is based (but let’s not get into that).
The point to be made here is that lupus causes so many other health problems that one has to wonder why it DOESN’T become a standard part of the diagnostics process in the really weird and potentially fatal cases that could be encountered in reality. Lupus is an autoimmune disease, which in layman’s terms means that the body attacks and destroys its own tissues and cells because it cannot understand the difference between those and the aaliena materials that make us sick. Your joints, your heart, your lungs, your kidneys, your skin and even your brain get attacked by your immune system when you have lupus, and and it is inevitable that at some point – when it gets too much – your body may begin to shut down as well.
Because it is a disease affecting the immune system, some people believe that lupus is a blood disorder (because white blood cells are an essential component of the immune system). This is a mistaken assumption – lupus is not in itself a blood problem; however, lupus CAUSES a number of blood disorders because it attacks blood cells as well; of course, these blood disorders help in determining the approach to treating the lupus. Because of this, blood experts are brought in when a case of lupus is discovered – which is possibly why some people are so sure that lupus is a blood disorder when it in fact only brings about blood problems like too much blood clotting (thrombosis), and low red blood and hemoglobin levels (anemia).
Yes, everyone should be able to understand the irony of our own aanti-sicknessa system being an actual cause of sickness – one of the things that makes lupus a very interesting condition to ponder. Whether or not you knew much about it before it was constantly mentioned in HOUSE, M.D. doesn’t matter anymore. In the end, lupus has become part of popular culture’s consciousness and more people have become aware of it.
One last thing: while many people expected that athe conditiona that changes in every episode would never be lupus, an episode in the current season ended up with a patient actually HAVING lupus, prompting Gregory House to say aI finally have a case of lupus.a So while some of you may have started to think that in real life, ait’s never lupusa, remember that even in the show that coined the phrase, lupus happens.
Hyperthyroidism. Autoimmune thyroid disease of the hypermetabolic type (Graves disease) is reflected by several visible changes. The skin is soft and moist. Scalp hair is thin in diameter, and evidence of diffuse alopecia may be present. Vitiligo occurs in 5% to 10%, and alopecia areata occurs in 1 % or 2% of the patients. Onycholysis of the fingernails is sometimes seen. Late in the course of the disease a few patients develop a peculiar form of clubbing (thyroid acropachy) or pretibial myxedema. The latter consists of thickened, pebbly, skin-colored plaques over the lower anterior shins. These plaques are usually asymptomatic.
Patients with diabetes mellitus may develop a number of cutaneous changes. The yellow plaques of necrobiosis lipoidica diabeticorum most often located on the anterior shins, are the most distinctive of these changes.Small, hypopigmented, slightly depressed scars (diabetic dermopathy) are also occasionally found on the anterior lower legs. These lesions probably represent obliterative small vessel disease in an area prone to trauma. Bullous lesions somewhat similar in appearance to those of pemphigoid may arise from otherwise normal-appearing skin around the feet and ankles. The cause of these blisters is unknown. Eruptive xanthomas consisting of small, smooth, pink, dome-shaped papules may appear in a sudden shower of lesions in those whose diabetes is grossly out of control. Staphylococcal bacterial infections and candidal yeast infections are seen with increased frequency in diabetic persons. Diabetes is also associated with a variety of other cutaneous and medical conditions.
The presence of sharply marginated, light brown patches (cafe-au-lait patches) is often the first clue to the presence of von Recklinghausen’s disease . In late childhood or during the teenage years, axillary freckling and cutaneous neurofibromas begin to develop. The latter are soft, smooth-surfaced, peduncuated papules 0.5 to 2 cm in diameter. They vary in number from several to hundreds and are distributed randomly over the trunk and extremities. Patients with the most severe forms of neurofibromatosis may develop large, grotesque, sack-like plexiform neuromas. A small proportion of these latter lesions undergo sarcomatous degeneration.
The earliest sign of tuberous sclerosis is generally the presence of small, faint white, oval patches (ash leaf spots) scattered randomly on the trunk and extremities . These lesions may be present at birth or may develop in early childhood. One or more thickened skin-colored plaques (shagreen plaques) may appear on the lower back in late childhood. Towards puberty, pinhead-sized, smooth, red, dome-shaped papules (adenoma sebaceum) begin to emerge on the central portion of the face. The upper lip is spared. Such lesions are easily mistaken for acne papules. Finally, in adult life, small, firm, skin-colored, subungual or periungual fibromas may be noted.
This dominantly inherited condition is characterized by the presence of small brown or blackfreckles that appear in clusters on and around the lips and on the fingertips. These pigmentary changes are accompanied by the development of intestinal polyps. Carcinomatous degeneration of these polyps is not common but does occur.
This dominantly inherited condition, also known as hereditary hemorrhagic telangiectasia, is characterized by the presence of small, dusky red, clustered manlles on the fingertips, lips, and mucosal surfaces. These macules are composed of multiple telangiectatic vessels that blanch on pressure. Lesions similar to these may also .occur in patients with the CRST (calcification, Raynaud’s phenomenon, scleroderma, and telangiectasia) variant of scleroderma. Patients with this disease have recurrent episodes of epistaxis and gastrointestinal bleeding. Arteriovenous fistulae are sometimes present in the lungs and liver.
Regulatory Effect of Langchuang Serial Recipes on T-Lymphocyte Subsets Th and Tc in Patients with Systemic Lupus Erythematosus*
TAO Xiao-juan , ZHENG Hong-xia , YU Jian-ning MA Ji-lin , and ZHANG Wen
ABSTRACT Objective: To study the principle of clearing Fei , cooling blood, and detoxification as well as nourishing yin and moisening Fei (abbr. as CCD-NM) in regulating the levels of peripheral T-lymphocyte subsets Th and Tc cells to explore its mechanism for lowering the incidence of infection in patients with systemic lupus erythematosus (SLE). Methods: Sixty SLE patients without complicated infection were assigned to the treatment group and the control group, 30 in each group. The control group was treated with Western medicine alone, while the treatment group was treated with the same program of Western medicine, but additionally administered with either Langchuang No.1 or 2 , serial concerted Chinese recipes, applied respectively in patients in the active stage or in the resting stage. The total time of treatment for both groups was 1 year. Further, a healthy control group was set up with 20 healthy subjects. The expressions of Thl, Th2, and Tcl and Tc2 cells in peripheral blood were detected and compared with those in the healthy control group. Results: (1) As compared with the healthy control group, ratios of Thl/Th2 and Tcl/Tc2 in SLE patients, whether complicated with infection or not, were significantly lower (P<0.05 or P<0.01). (2) Comparison between patients with complications and those uncomplicated with infection showed that the two ratios and Thl expression were lower and Tc2 was higher in the former than those in the latter (all P<0.05). (3) Ratios of Thl/Th2 and Tcl/Tc2 increased after treatment in patients of both the treatment group and the control group (P<0.05 and P<0.01), but the changes in the treatment group were more significant (P<0.05).
Conclusion: The principle of CCD-NM could regulate the Th and Tc subsets toward equilibrium in SLE patients, which might be one of the mechanisms of action for alleviating complicated infection. KEY WORDS Langchuang No.l, Langchuang No.2, systemic lupus erythematosus, infection, Th and Tc subsets of T-lymphocyte
Systemic lupus erythematosus (SLE) is a kind of autoimmune disease involving multiple systems of the whole body. Along with the wide application of glucocorticoids and immunosuppressants, the prognosis of SLE patients has been obviously improving, but the infection is still an important factor that affects prognosis. Repeated clinical studies have shown that the complicated infection and its evoked serious complications remain the most common cause for a long time(1,2). From the point of view of TCM theory, the authors have used the principle of clearing Fei (?), cooling blood, and detoxification as well as nourishing yin and moistening Fei (abbr. as CCD-NM) in clinical practice, and have found that it shows an advantage in alleviating the complications of SLE(3), and could regulate the levels of the Th and Tc cell subsets, suggesting that it is possibly one of the mechanisms of action for preventing infection in SLE patients. The study is reported as follows.
METHODS Diagnostic Standard The SLE diagnostic standard issued by the American Association of Rheumatism (revised edition, 1982)(4) was adopted; the condition of illness was judged depending on the SLE activity index (AI) and calculated according to literature(5), AI ? 5 was regarded as in active stage, ? 4 as in resting stage.
The diagnosis of a complicated infection depended on: (1) confirmable signs and symptoms; (2) chest film showing infiltrative changes in the lung parenchyma, and cardiac pulmonary edema could be clinically excluded; (3) positive bacterial culture of throat swab, sputum, mid-stream urine (count of bacterial colonies over 1 x 106/L), stool, or fluid of hydrothorax and ascites. Patients could be judged as with infection when they fitted condition (1) and (2) or (1) and (3).
Only patients with no clinical or laboratory evidence of infection in the 1-week observation period after enrollment were included formally in the study, and their age had to be below 50 years old. Patients fitting the following criteria were excluded: patient’s diagnosis was not confirmed by renal biopsy; female patients in pregnancy or lactation, or intending to have a baby in the near future; patients with mental diseases; and patients with the complication of multiple organ dysfunction. Subjects
All the 60 SLE patients, inpatients or outpatients, were selected from the authors’ hospital, the Department of Rheumatology and Immunology, from 2004 to 2006. They were equally assigned to two groups according to selective sequencing. The 30 patients in the treatment group were 2 males and 28 females, 15-50 years old, average 34.2 ± 7.1 years; 7 patients had their course of disease ranging from 1 month to 1 year, 8 between 1-5 years, 10 between 5-10 years and 5 between 10-30 years; their AI was 12.4±2.3 on average. The 30 patients in the control group included 1 male and 29 females, 13-50 years old, average 36.5 ± 8.2 years; 9 patients had their course of disease ranging from 1 month to 1 year, 7 between 1-5 years, 10 between 5-10 years and 4 between 10-30 years; their AI was 11.2 ± 3.6 on average. The two groups were not significantly different in terms of sex, age, and course and condition of disease (P>0.05).
Further, a healthy control group was set up, which consisted of 20 healthy subjects selected from the staff of the hospital, 2 males and 18 females, aged between 15-50 years, 35.9± 5.4 years on average. The difference in terms of sex and age between the healthy control group and the SLE patient groups was insignificant (P>0.05).
Treatment The Western medical treatment protocol was as follows: For patients with obvious general symptoms but without organ damage, 30-40 mg of prednisone was administered per day for 6-8 successive weeks, and then the dosage was reduced gradually to the maintenance dose of 10-15 mg per day. Patients with lupus nephritis type I were treated with the same protocol as above. For patients with lupus nephritis type I1 a, and with only some mild mesangial change, the same protocol was applied as above; when they were type ? b and accompanied with proteinuria of over 1.0 g/d, high titers of serum anti-dsDNA antibody and hypocomplementemia, tripterygium glycoside tablets were given additionally besides the daily administration of 30-40 mg of prednisone.
For patients with lupus nephritis type ?, 1V and V, a complex of prednisone and cyclophosphamide (CsA) was administered. (1) Prednisone, at a dosage of 0.8-1.0 mg/kg per day, was given through oral administration for 8 weeks, and then the dose was reduced gradually to 10-20 mg daily for maintenance. For patients with active type IVa or type IV and complicated with severe leucopenia, encephalopathy, pneumonia or myocarditis, etc, concussion therapy with methylprednisolone (MP) was applied by intravenous dripping of MP 0.5 g per day for 3 successive days as one course, and a second course could be given as necessary after an interval of 10 days. No more than two courses could be given. Prednisone 30 mg was then administered daily and the dose would be reduced gradually to the maintenance dose of 10 mg/d. (2) CsA, at a dosage of 1.0 g/m2, was administered by adding it to normal saline and given via intravenous drip slowly for over 1 h, once a month, for 6 successive months, and then it was reduced to once every 3 months.
Corresponding anti-bacterial drugs were administered respectively to patients with various infections occurring during the therapeutic process according to the outcome of drug sensitivity tests. The above-mentioned Western medical therapeutic protocol was carried out in all patients for one year.
Patients in the treatment group were additionally medicated with different TCM recipes, which are serial concerted Chinese recipes arranged in accordance with the stage of SLE. Namely, for patients in the active stage, the recipe was Langchuang No.1 ,mainly for clearing Fei, cooling blood, and detoxification, which consisted of mulberry bark 30 g, wolfberry root-bark 30 g, licorice root 3 g, white peony root 30 g, figwort root 30 g, southernwood 15 g, and wild weed 15g. For patients in the resting stage, the recipe, mainly with the action of nourishing yin and moistening Fei, was Langchuang No.2 ,and consisted of lily bulb 30g, asparagus root 15 g, lilyturf root 15 g, white peony root 15 g, Chinese angelica root 15 g, figwort root 30 g, fritillary bulb 10 g, balloonflower root 10 g, licorice root 3 g, and bamboo leaf 10g.
Both Langchuang No.1 and No.2 were prepared by water decoction by the pharmaceutical unit of the authors’ hospital and given as medication at one dose per day, taken in two portions, one in the morning and one in the evening, for one year, in synchrony with the whole course of Western medical treatment.
Indexes and Methods of Observation
Expressions of Thl, Th2, Tcl and Tc2 in the peripheral blood of all patients were determined before and after the therapeutic course, and they were also determined during the course of the infection. The method of determination was: 1 mL of venous blood was withdrawn and anti-coagulated with heparin, then 100 µ L of the blood sample was diluted with RPMI 1640 medium at a ratio of 1:1 (volume), mixed evenly, placed in a culture plate with stimulant phorbol 12-myristate 13-acetate (PMA, purchased from Sigma Co., USA) and ionomycin; protein transporting inhibitor monensin working fluid (purchased from Pharmingen Co., USA) was added as well. The ingredients were mixed evenly and incubated for 4 h at 37? in an incubator containing 5% CO2. After being stained with 4-color fluorescent staining, the plate was examined using a flow cytometer (Epics XL.MCL, Backman Coulter, USA) according to the instructions for the reagent.
Using SPSS 11.5 software, comparisons of the measurement data between the two groups of patients was conducted using the t-test, and that of the mean values among the three groups was carried out by variance analysis; while paired comparison between the mean values in the two groups was conducted by adopting the q-test.
RESULTS Comparison of T-Lymphocyte Subsets among Groups During the observation period, 21 patients had complications with their infection (SLE-C) and 39 did not (SLE-N). The comparisons of Th and Tc subsets showed that the ratios Thl/Th2 and Tcl/Tc2 were lower in the patients than those in the healthy subjects (P<0.05 or P<0.01); the Thl expression was lower but Tc2 was higher in SLE-C as compared to healthy subjects (P<0.01); and Thl expression was lower while Tc2 was higher and the ratios Thl/Th2 and Tcl/Tc2 were also lower in SLE-C than those in SLE-N (P<0.05, Table 1, Figure 1).
Comparison of T-Lymphocyte Subsets in Patients before and after Treatment
The ratios Thl/Th2 and Tcl/Tc2 increased after treatment, showing a significant difference (P<0.05 or P<0.01), but the increments were more significant in the treatment group than in the control group (P<0.05, Table 2).
Studies in recent years have shown that SLE is a kind of auto-immune disease, and its immune function disorder is closely related to the disequilibrium of T-lymphocyte subsets, which could lead to deviation of cytokines with important regulatory effects synthesized or secreted by T-lymphocytes, thus producing a series of abnormal immune effects and pathological injuries(6). Therefore, studies on the levels of T-lymphocyte subsets and the cytokines secreted by T-lymphocytes will be helpful for exploring the immune regulatory mechanism at the level of the T-lymphocyte, and is of important value for immune intervention of the disease.
It was shown in this study that, compared with healthy subjects, the Thl/Th2 and Tcl/Tc2 ratios were lower in SLE patients (P<0.05 or P<0.01). As compared with SLE-N, the level of Thl was lower and Tc2 was higher in SLE-C (P<0.05), thus resulting in the two ratios lowering more significantly in SLE-C (P<0.01). These results suggested the existence of a de-equilibrium condition in the T-lymphocyte subsets, and it appeared in SLE-C mainly as a decrease in Thl and an increase in Tc2.
On the basis of TCM theory, the principle of CCD-NM was put forward and applied for the treatment of SLE by the authors, and its advantage in lowering the incidence of the infection rate has been proven by a clinical study(3). In this study, it was found that the Thl/Th2 and Tcl/Tc2 ratios increased more significantly after treatment in the treatment group compared to the control group (P<0.05), suggesting that the regulatory effect of the combined therapy on Th and Tc cell equilibrium was superior to that of Western therapy alone. It indicated that TCM treatment could enhance the equilibrium regulation to a certain extent, and it might be one of the mechanisms of action for reducing the infection rate in SLE.
Since SLE is an auto-immunological disease involving multiple systems of the whole body, always with a long illness course and an alternating repetition of the active stage and the resting stage, the treatment takes a long therapeutic course and a large dose of immunosuppressants, which is the main cause for the decreasing vital qi of the human body. TCM holds that when an external pathogen attacks, it intrudes into Fei first. Thus, the human body could only be protected from invasion of evil pathogens when one's Fei-qi is healthy.
SLE patients are prone to infectious complications during the therapeutic process, and investigations summarizing relevant Chinese literature in recent years show that the nosocomial infection rate in SLE patients reached 36.4%-60.6%(7-10). The authors' clinical study showed that the most commonly seen infection in SLE patients is respiratory infection, and secondary to that, the skin is another focus. Infection of the two sites accounts for 73.8% of all infections in SLE patients(3), which confirms the above-mentioned TCM theory on Fei and external invasion. It is therefore clear that, viewing the disease from either theoretical or practical clinical points, Fei is the most principal factor for the occurrence of infections in SLE patients.
On the basis of the above-mentioned consideration, the authors established the therapeutic principle of CCD-NM for preventing infections in SLE. Through another clinical study, the treatment has been confirmed to have the effect of reducing the infectious complication rate in SLE patients(3). In this study, it was found that Langchuang No.1 and No.2, the concerted recipes formulated according to this principle, are capable of correcting infections relevant to de-equilibrium of T-lymphocyte subsets, thus illustrating that there exists objective evidence supporting the principle of CCD-NM in reducing the infection rate in SLE patients. Since the equilibrium of T-lymphocyte subsets keeps the immune function of patients in a stable state, it is assumed that treatment depending on the principle could also play an active role in the rehabilitation of patients.
1. Cervera R, Khamashta MA, Font J, et al. Morbidity and mortality in systemic lupus erythematosus during a 5-year period. A multicenter prospective study of 1000 patients. European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore) 1999;78:167-175.
2. Mok CC, Lee KW, Ho CT, et al. A prospective study of survival and prognostic indicators of systemic lupus erythematosus in a southern Chinese population. Rheumatology (Oxford) 2000;39(4):399-406.
3. Tao X J, Zheng HX, Yu JN, et al. Clinical research on effect of TCM treatment beginning with Fei in treating systemic lupus erythematosus for reducing incidence of complicated infection. Chin J Integr Tradit West Med (Chin) 2007;27(1 ):33-36.
4. Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus (SLE). Arthritis Rheum 1982;25:1271 – 1277.
5. Hay E, Cordon C, Emery P, et al. Assessment of lupus. Where are we now? Ann Rheum Dis 1993;52:169-172.
6. Varadhachary AS, Peter ME, Perdow SN, et al. Seletive up-regulation of phosphatidylinositol 3′-kinase activity in Th2 cells inhibits caspase-8 cleavage at the death-inducing complex: a mechanism for Th2 resistance from Fas-mediated apoptosis. J Immuno11999;163:4772-4779.
7. Li ZJ, Wang CL, Fan XY, et al. Clinical study on the patients with systemic lupus erythematosus complicated by infections. Chin J Rheumatol (Chin) 2000;4(3): 165-168.
8. Xu G, Liu ML, Yu KM. A prospective study of nosocomial infection in patients with systemic lupus erythematosus. Chin J Rheumatol (Chin) 2003;7(4):216-219.
9. Xu G, Xu Q, Yu LM. An analysis of nosocomial infection in patients with systemic lupus erythematosus. Chin J Nosocomiol (Chin) 2000;10(5):362-364.
10. Yu Y, Chen J, Xie FA, et al. Clinical investigation of nosocomial infection cases with lupus nephritis. Chin J Nosocomiol (Chin) 2000;10(3): 174-176.