 |
|
|
Immunosuppressants Render Flu Vaccination Less Effective in People With Lupus Friday, January 22, 2010 Immunosuppressants Render Flu Vaccination Less Effective in People With LupusStudies of cell-mediated immune responses to influenza vaccination in systemic lupus erythematosus. Authors: Holvast A, van Assen S, de Haan A, Huckriede A, Benne CA, Westra J, Palache A, Wilschut J, Kallenberg CG, and Bijl M. (2009). Arthritis & Rheumatism 60: 2438-2447. What is the topic? The immune system fights off the flu in different ways. One way is by making antibodies (immune proteins) that recognize the flu virus and attack it. Another way is by activating certain white blood cells to fight the virus; this is called “cell-mediated immunity.” Both antibodies and cell-mediated immunity play important roles in the body’s normal response to a flu shot. Lupus patients might have decreased antibody responses to the flu shot as compared to healthy people. Since cell-mediated responses to the influenza vaccine also influence how well the vaccine will work, it is important to understand how lupus may affect the body’s cell-mediated response to the vaccine. What did the researchers hope to learn?The researchers wanted to measure the cell-mediated responses (or responses of certain white blood cells) to a flu vaccine in lupus patients. Who was studied? 54 lupus patients and 54 healthy people, similar in age and about the same percent of women and men, were studied. Most of the lupus patients had relatively few active symptoms. Pregnant women were not studied. How was the study conducted? Lupus patients were randomly picked to either get a flu shot or not. All the healthy people got a flu shot. The flu shot was a "subunit" vaccine, meaning that it had parts of the dead flu virus that help to trigger an immune response but was missing other parts of the virus. Blood samples were taken at the beginning of the study and again 28 days later. What did the researchers find? As compared to healthy people, lupus patients had less cell-mediated responses to the flu shot, which may have been influenced by the fact that many of them were taking prednisone and/or azathioprine (Imuran) when they got the shot. Influenza vaccination did not increase lupus disease activity, but minor side effects occurred more frequently in lupus patients than in healthy people. What were the limitations of the study? This was a small study. Given that there were not that many patients in the first place, the fact that they were taking a wide variety of medications make it difficult to sort out the results. Finally, more of the lupus patients than the healthy people had gotten a flu shot in the previous year, which could have influenced the results when comparing these two groups. What do the results mean for you? It may be that lupus patients have decreases in both antibody and cell-mediated responses to the flu shot as compared to most people. This may make it easier for lupus patients to get the flu and harder to fight it off when they do, especially when taking prednisone or other treatments that suppress the immune system. Appropriate caution to prevent the flu should be taken by all lupus patients, such as avoiding contact with infected people and washing hands frequently, even if the flu shot has already been given. Labels: flu
~~~ A Second Flu Shot Might Be More Effective in Some People With Lupus A Second Flu Shot Might Be More Effective in Some People With Lupus Effect of a second, booster, influenza vaccination on antibody responses in quiescent systemic lupus erythematosus: an open, prospective, controlled study. Authors: Holvast A, van Assen S, de Haan A, Huckriede A, Benne CA, Westra J, Palache A, Wilschut J, Kallenberg CG, and Bijl M. (2009). Rheumatology 48: 1294-1299 What is the topic? One of the ways that the immune system fights off the flu is by making antibodies (immune proteins) that can recognize the flu virus and attack it. The immune system can also make little chemicals called "cytokines" that signal to the white blood cells to make more of these antibodies when there is a virus in the bloodstream. The flu shot is made with dead virus that can help a patient make protecting antibodies but won’t cause the full flu infection to start up. In this way, individuals can be protected in advance before they are exposed to the flu that is "going around" in their community. Some lupus patients make fewer antibodies to the flu shot than most people, and there is some concern that medications for lupus can reduce the response to the flu shot since they can suppress the immune system in other ways. If there was a way to increase these responses, then the flu shot might be more effective for people with lupus. What did the researchers hope to learn? The researchers wanted to find out whether a second, "booster" flu shot could increase antibody responses in lupus patients. Who was studied? The study included 52 lupus patients and 28 healthy people of about the same age and the same percentage of women and men. The lupus patients were not flaring at the time and thus their lupus symptoms were relatively quiet. Most of them were taking some immune-suppressing treatments. No one in the study had cancer or was taking more than 30 mg/day of prednisone. Most people in both groups had gotten a flu shot the previous year. How was the study conducted? The flu shot that was used is called a "subunit" vaccine, which means that it has enough pieces of the flu virus to cause antibodies to be made, but may be missing other parts of the flu virus. All of the people participating in this study got at least one flu shot. Four weeks later, the lupus patients, but not the other people, got a second booster flu shot. Antibodies against the flu virus were measured before each shot, and again four weeks after the time of the second shot. What did the researchers find? The researchers found that a second flu shot did not increase the overall amounts of flu antibodies if you looked at the whole group of lupus patients compared to healthy people. However, a sub-group of the lupus patients who had not gotten the flu shot in the previous year did show an increased antibody response with the booster vaccination. Neither the first nor second flu vaccination increased lupus disease activity, but both caused more frequent minor side effects in lupus patients than in healthy people. The kinds of side effects seen in lupus patients were similar after the first and second flu shots. What were the limitations of the study? This was a small study. Also, it did not include a group of lupus patients given only one flu shot, which could have been useful to compare to those who got two shots. What do the results mean for you? Increased antibody responses to a second, booster flu shot were seen only in lupus patients who had not received a flu shot in the previous year. Therefore, the additional benefit for lupus patients who get a second flu vaccination may be just for those not vaccinated against influenza in the previous year. Labels: flu
~~~ A Second Flu Shot Might Be More Effective in Some People With Lupus A Second Flu Shot Might Be More Effective in Some People With Lupus Effect of a second, booster, influenza vaccination on antibody responses in quiescent systemic lupus erythematosus: an open, prospective, controlled study. Authors: Holvast A, van Assen S, de Haan A, Huckriede A, Benne CA, Westra J, Palache A, Wilschut J, Kallenberg CG, and Bijl M. (2009). Rheumatology 48: 1294-1299 What is the topic? One of the ways that the immune system fights off the flu is by making antibodies (immune proteins) that can recognize the flu virus and attack it. The immune system can also make little chemicals called "cytokines" that signal to the white blood cells to make more of these antibodies when there is a virus in the bloodstream. The flu shot is made with dead virus that can help a patient make protecting antibodies but won’t cause the full flu infection to start up. In this way, individuals can be protected in advance before they are exposed to the flu that is "going around" in their community. Some lupus patients make fewer antibodies to the flu shot than most people, and there is some concern that medications for lupus can reduce the response to the flu shot since they can suppress the immune system in other ways. If there was a way to increase these responses, then the flu shot might be more effective for people with lupus. What did the researchers hope to learn? The researchers wanted to find out whether a second, "booster" flu shot could increase antibody responses in lupus patients. Who was studied? The study included 52 lupus patients and 28 healthy people of about the same age and the same percentage of women and men. The lupus patients were not flaring at the time and thus their lupus symptoms were relatively quiet. Most of them were taking some immune-suppressing treatments. No one in the study had cancer or was taking more than 30 mg/day of prednisone. Most people in both groups had gotten a flu shot the previous year. How was the study conducted? The flu shot that was used is called a "subunit" vaccine, which means that it has enough pieces of the flu virus to cause antibodies to be made, but may be missing other parts of the flu virus. All of the people participating in this study got at least one flu shot. Four weeks later, the lupus patients, but not the other people, got a second booster flu shot. Antibodies against the flu virus were measured before each shot, and again four weeks after the time of the second shot. What did the researchers find? The researchers found that a second flu shot did not increase the overall amounts of flu antibodies if you looked at the whole group of lupus patients compared to healthy people. However, a sub-group of the lupus patients who had not gotten the flu shot in the previous year did show an increased antibody response with the booster vaccination. Neither the first nor second flu vaccination increased lupus disease activity, but both caused more frequent minor side effects in lupus patients than in healthy people. The kinds of side effects seen in lupus patients were similar after the first and second flu shots. What were the limitations of the study? This was a small study. Also, it did not include a group of lupus patients given only one flu shot, which could have been useful to compare to those who got two shots. What do the results mean for you? Increased antibody responses to a second, booster flu shot were seen only in lupus patients who had not received a flu shot in the previous year. Therefore, the additional benefit for lupus patients who get a second flu vaccination may be just for those not vaccinated against influenza in the previous year. Labels: flu
~~~ Potential New Indicators of Lupus Being Studied in Children Potential New Indicators of Lupus Being Studied in Children Adipokines as novel biomarkers in paediatric systemic lupus erythematosus. (2009). Authors: Al M, Ng L, Tyrrell P, Bargman J, Bradley T, and Silverman E.Rheumatology 48: 497-501. What is the topic? Since the 1970s, researchers have known that lupus patients are at risk for hardening of the arteries ("atherosclerosis"). Some of this risk may be from the increased inflammation that lupus patients have in the bloodstream over many years, but some of it is from the same reasons that hold true for everybody: especially high blood pressure, high blood sugar, or low levels of "good cholesterol." Taken together, these risk factors are known as "metabolic syndrome," a condition that puts people at high risk for heart disease, diabetes, or both. Some of the medications that lupus patients may take can increase the likelihood that a person will develop metabolic syndrome, especially prednisone. Cells in the body release specialized chemicals called "cytokines," molecules that carry messages between nearby cells, and some of these messages work specifically to influence body weight and how fast food is burned or whether it turns into fat. If the cytokine messengers are sent out by fat cells, they are called "adipokines." The names of some of these adipokines (fat cell messengers) are leptin, adiponectin, and ghrelin. What did the researchers hope to learn? The researchers wanted to find out whether the amount of leptin, adiponectin, or ghrelin in children with lupus might be different than in children without lupus. Who was studied? 105 children with lupus and 77 healthy children from Toronto, Canada took part in this study. About 20% of the lupus patients were boys and about 80% were girls. The healthy children were a little younger and about 27% of them were boys. How was the study conducted? The researchers collected blood samples from the children after they had not eaten overnight. They measured the levels of leptin, adiponectin, and ghrelin (fat cell messengers). It was important to do these studies on blood samples taken from participants who had not eaten for a number of hours, because the nutrients that enter the bloodstream from food can have a big effect on the levels of these fat cell messengers. What did the researchers find? The researchers found that children with lupus have more leptin in the blood than healthy children. This was not affected by how severe the lupus disease activity was at the time the blood sample was collected, or by the dose of prednisone being taken. There was no difference between the groups in the levels of adiponectin or ghrelin. Adiponectin levels were affected by the cholesterol levels in the blood or the dose of prednisone being taken. What were the limitations of the study?The finding that levels of two possible risk factors for atherosclerosis may be higher in children with lupus could be very important, but does not differentiate whether this results from lupus or its treatments. The effects of the diet a child was eating over an entire month, their kidney function, or other medications they might have been taking could not be looked at in a study this size, but might have had some impact on the outcome. What do the results mean for you? Hardening of the arteries takes a long time to develop, and some studies suggest that some of the risk factors can begin to have an impact in childhood. The finding of these risk factors in children with lupus may begin to explain why some lupus patients develop heart disease relatively early in life and, most importantly, could provide a marker to follow so that preventative measures can begin early. Labels: flu
~~~ People Who Have Both Lupus and Antiphospholipid Syndrome Might Have Higher Risk of Thyroid Disease People Who Have Both Lupus and Antiphospholipid Syndrome Might Have Higher Risk of Thyroid Disease Antithyroid antibodies in antiphospholipid syndrome: prevalence and clinical associations. Authors: Mavragani CP, Danielides S, Zintzaras E, Vlachoyiannopoulos PG, and Moutsopoulos HM. (2009). Lupus 18: 1096-1099. What is the topic? The thyroid is a gland in the neck which helps the body keep order over how food and nutrients are handled and how fast people grow, gain or lose weight, how the heart beats, or how blood pressure and cholesterol levels in the blood respond to these changes. A protein called "thyroid peroxidase" helps to modify other proteins that the thyroid produces that perform all of these functions. Some people make antibodies (immune proteins) against their own thyroid peroxidase (these are called "anti-TPO"). People with anti-TPO sometimes have an underactive thyroid; this causes weight gain, fatigue, and a tendency to feel cold when other people around you do not. The antiphospholipid syndrome is a blood clotting disorder where antibodies are made against proteins that help to control how fast or slowly the blood clots. Many people with lupus have the antiphospholipid syndrome, although it can occur without other features of lupus. What did the researchers hope to learn? The researchers wanted to find out if there is a connection between thyroid disease and the antiphospholipid syndrome or lupus. Who was studied? 75 patients with antiphospholipid syndrome, 75 patients with lupus, and 75 healthy people were studied. 35 of the 75 patients who had antiphospholipid syndrome also had other features of lupus. There was no difference between the groups in terms of age, how long people had been diagnosed, or the ratio of women to men. How was the study conducted? Antibodies against the thyroid (anti-TPO) were measured in the blood of all the people participating in the study, and were compared among the different groups. What did the researchers find? Anti-TPO antibody was found more often in patients who had both antiphospholipid syndrome and lupus than in healthy people. What were the limitations of the study? This was a small study. Sometimes, if a study is too small, there will be a slanting of the outcomes just from a sort of "luck of the draw." These findings are interesting, but larger studies are needed to be more sure about them. This study was also conducted by looking back in time; this is called a "retrospective study." Studies that follow patients forward in time to see what happens to them are more accurate in finding cause and effect; those are called "prospective studies." In a prospective study, you know how many patients move away or stop coming to the clinic during the time you are studying them, and you can try to track them down and find out what happened to them. When you are looking backwards, all you know is information about the people who are left at the end of the time period you are studying them; you are missing a lot of information. Also, in a prospective study, you can decide in advance exactly what information you want to study and make sure you get that information at regular intervals for all the participants. In a retrospective study, you are limited to whatever ended up, without any advanced planning, in the medical chart. Therefore, this current study, being a small, retrospective study, raises an interesting question about the relationship between thyroid antibodies and the antiphospholipid syndrome and lupus, but should be confirmed with a larger, prospective study. What do the results mean for you? Patients with both antiphospholipid syndrome and lupus may be at increased risk for having thyroid antibodies. This is important to know because sometimes these antibodies can interfere with the functions of the thyroid gland and there are good treatments for this. Labels: flu
~~~ People Who Have Both Lupus and Antiphospholipid Syndrome Might Have Higher Risk of Thyroid Disease People Who Have Both Lupus and Antiphospholipid Syndrome Might Have Higher Risk of Thyroid Disease Antithyroid antibodies in antiphospholipid syndrome: prevalence and clinical associations. Authors: Mavragani CP, Danielides S, Zintzaras E, Vlachoyiannopoulos PG, and Moutsopoulos HM. (2009). Lupus 18: 1096-1099. What is the topic? The thyroid is a gland in the neck which helps the body keep order over how food and nutrients are handled and how fast people grow, gain or lose weight, how the heart beats, or how blood pressure and cholesterol levels in the blood respond to these changes. A protein called "thyroid peroxidase" helps to modify other proteins that the thyroid produces that perform all of these functions. Some people make antibodies (immune proteins) against their own thyroid peroxidase (these are called "anti-TPO"). People with anti-TPO sometimes have an underactive thyroid; this causes weight gain, fatigue, and a tendency to feel cold when other people around you do not. The antiphospholipid syndrome is a blood clotting disorder where antibodies are made against proteins that help to control how fast or slowly the blood clots. Many people with lupus have the antiphospholipid syndrome, although it can occur without other features of lupus. What did the researchers hope to learn? The researchers wanted to find out if there is a connection between thyroid disease and the antiphospholipid syndrome or lupus. Who was studied? 75 patients with antiphospholipid syndrome, 75 patients with lupus, and 75 healthy people were studied. 35 of the 75 patients who had antiphospholipid syndrome also had other features of lupus. There was no difference between the groups in terms of age, how long people had been diagnosed, or the ratio of women to men. How was the study conducted? Antibodies against the thyroid (anti-TPO) were measured in the blood of all the people participating in the study, and were compared among the different groups. What did the researchers find? Anti-TPO antibody was found more often in patients who had both antiphospholipid syndrome and lupus than in healthy people. What were the limitations of the study? This was a small study. Sometimes, if a study is too small, there will be a slanting of the outcomes just from a sort of "luck of the draw." These findings are interesting, but larger studies are needed to be more sure about them. This study was also conducted by looking back in time; this is called a "retrospective study." Studies that follow patients forward in time to see what happens to them are more accurate in finding cause and effect; those are called "prospective studies." In a prospective study, you know how many patients move away or stop coming to the clinic during the time you are studying them, and you can try to track them down and find out what happened to them. When you are looking backwards, all you know is information about the people who are left at the end of the time period you are studying them; you are missing a lot of information. Also, in a prospective study, you can decide in advance exactly what information you want to study and make sure you get that information at regular intervals for all the participants. In a retrospective study, you are limited to whatever ended up, without any advanced planning, in the medical chart. Therefore, this current study, being a small, retrospective study, raises an interesting question about the relationship between thyroid antibodies and the antiphospholipid syndrome and lupus, but should be confirmed with a larger, prospective study. What do the results mean for you? Patients with both antiphospholipid syndrome and lupus may be at increased risk for having thyroid antibodies. This is important to know because sometimes these antibodies can interfere with the functions of the thyroid gland and there are good treatments for this.
~~~ A Potential New Treatment for Severe Discoid Lupus Thursday, February 05, 2009 Discoid lupus is a form of lupus that affects the skin (cutaneous lupus). In most cases the discoid lupus rash appears on the face, neck, or scalp, though it can also show up on other areas of the skin. Severe discoid lupus may result in scarring. The treatments that are used most often for severe discoid lupus are strong immunosuppressants that may have significant side effects, especially when used over long periods of time. Efalizumab (trade name, Raptiva™) works by interfering with the function of overactive immune cells that are causing disease activity. The researchers in this study wanted to see if Raptiva could be effective in treating discoid lupus.Read more : http://www.lupus.org/webmodules/webarticlesnet/templates/new_empty.aspx?articleid=2141&zoneid=76 Labels: discoid, threatment
~~~ Masa Depan Penderita Lupus Thursday, March 27, 2008 Kompas, 23 maret 2008 - by dr samsuridjal djauziSaya, perempuan (24), baru saja lulus sarjana ekonomi dan sedang mencari pekerjaan. Sewaktu menyelesaikan skripsi, saya mengalami demam lama. Tadinya saya mengira demam tersebut diakibatkan terlalu keras belajar, tetapi setelah beristirahat, demam tetap timbul disertai pegal-pegal di otot. Saya memeriksakan diri ke dokter spesialis penyakit dalam dan dianjurkan menjalani sejumlah pemeriksaan yang biayanya cukup mahal. Hasil tes menunjukkan saya terkena lupus. Saya amat terkejut dan khawatir karena menurut pemahaman saya lupus penyakit yang berbahaya dan tak dapat disembuhkan. Padahal saya baru saja menyelesaikan kuliah dan bersiap bekerja dan berkeluarga. Apakah semua harapan saya akan lenyap begitu saja? Menurut dokter, lupus termasuk penyakit autoimun dan pengobatannya memerlukan waktu lama. Saya harus berkonsultasi dan diperiksa teratur. Sekarang saya menggunakan obat steroid. Karena obat generik, harganya tidaklah mahal. Apalagi sekarang saya cukup meminum obat tersebut dua tablet per hari. Semula karena mengalami anemia saya mendapat obat 12 tablet. Kemudian setelah anemia membaik, penggunaan tablet steroid diturunkan secara bertahap. Saya juga mengalami kebocoran protein melalui ginjal. Untunglah sekarang kebocoran tersebut dapat diatasi dan urine saya sudah kembali normal. Meski sudah dalam kondisi sehat, sekarang saya masih diliputi rasa khawatir. Apakah penyakit lupus dapat disembuhkan? Apa yang dimaksud dengan penyakit autoimun? Mungkinkah saya bekerja dan berkeluarga? Dapatkah penderita lupus berkeluarga? Apakah boleh punya anak dan jika punya anak apakah mereka nanti juga akan terkena lupus? Maaf pertanyaan saya agak banyak karena sedang memikirkan masa depan. Terima kasih atas perhatian Dokter. M di S Dewasa ini kasus lupus semakin meningkat. Mungkin ini disebabkan kesadaran masyarakat yang juga meningkat mengenai penyakit ini dan kemampuan dokter mendiagnosis penyakit lupus menjadi lebih baik. Lupus pada umumnya menyerang perempuan muda. Meski jarang, lupus juga dapat menyerang laki-laki. Memang benar lupus digolongkan ke dalam penyakit autoimun, yaitu penyakit yang timbul akibat zat antibodi di tubuh yang sebenarnya fungsinya melindungi tubuh dari kuman atau sel kanker berubah fungsi menyerang organ tubuh penderita sendiri. Pada lupus, organ tubuh yang dapat diserang antara lain kulit, sendi, jantung, paru, ginjal, otak, sistem pembuluh darah. Jika hanya terbatas pada kulit dan sendi biasanya penyakit lupus ini lebih ringan. Jika mengenai ginjal atau sistem pembuluh darah seperti yang Anda alami, maka penyakit lupus tersebut lebih berat dan disebut lupus sistemik. Pada sistem pembuluh darah akan terjadi anemia hemolitik. Pada keadaan ini sel darah merah mudah pecah. Sedangkan pada ginjal terjadi pengeluaran berlebihan protein melalui ginjal dan dalam waktu lama (sekitar sepuluh tahun) ginjal akan terganggu fungsinya. Keadaan yang sering kita hadapi di Indonesia penderita datang dalam keadaan organ tubuh sudah amat terganggu. Misalnya, anemia amat berat atau gagal ginjal. Upaya untuk mengatasi keadaan organ tubuh yang mengalami kerusakan berat ini tidaklah mudah. Karena itulah pengobatan lupus di negara kita dianggap kurang berhasil. Sebenarnya terapi lupus di Indonesia dan negara maju hampir serupa, tetapi di negara maju penderita lupus berhasil didiagnosis jauh lebih dini sehingga hasil terapi juga lebih baik. Jika di Indonesia kita mampu menemukan lupus pada keadaan dini, maka hasil terapi juga akan lebih baik. Untuk dapat mendiagnosis lupus secara dini, kesadaran masyarakat atas penyakit ini perlu ditingkatkan dan kepedulian dokter terhadap lupus juga harus lebih baik. Umumnya penderita lupus datang ke dokter penyakit dalam dan dokter spesialis kulit karena gejalanya lebih sesuai untuk kedua spesialis tersebut, yaitu demam lama, pegal pada sendi, seriawan mulut, anemia, protein urine, dan lesi kulit muka. Penyakit lupus dapat dikendalikan dengan obat. Artinya kita dapat mengetahui seorang penderita lupus tidak mempunyai gejala dan dalam keadaan sehat dengan obat. Umumnya obat yang digunakan adalah obat jenis steroid, tetapi sekarang tersedia beberapa obat lain untuk mendukung pengobatan lupus. Keadaan tanpa gejala ini disebut remisi dan keadaan remisi ini dapat berlangsung lama. Risiko kekambuhan (relaps) memang ada, tetapi jika dikenali secara dini relaps akan dapat diatasi. Dengan demikian, penderita lupus diharapkan dapat hidup normal. Dia dapat bekerja produktif di masyarakat, menikah, dan mempunyai anak. Umumnya anak dari penderita lupus sehat dan lupus bukan penyakit yang berisiko ditularkan kepada anak. Meski demikian, tidak berarti lupus tak pernah dijumpai pada anak. Meski jarang, lupus juga dapat dijumpai pada anak. Saya merasa ikut gembira karena kerja sama Anda dan dokter berhasil mencapai keadaan lupus remisi. Pertahankanlah keadaan tersebut dengan berobat teratur. Salah satu faktor penting kegagalan terapi lupus adalah penderita menghentikan pengobatan. Mudah-mudahan Anda akan berhasil terus dalam keadaan remisi dan dapat mewujudkan semua cita-cita Anda selama ini. source
~~~ Cardiovascular disease activity in lupus -- even during remission? Wednesday, March 26, 2008 What is the topic?Lupus is a disease that has periods of obvious activity and apparent remission. However, even during what seems like quiet periods when there are no clearcut symptoms, it is possible that changes are occurring below the surface that can cause complications later. What did the researchers hope to learn? Lupus patients are at increased risk for cardiovascular disease (CVD), which involves hardening of the arteries and can lead to heart attacks or strokes later in life. The bone marrow makes special cells that help repair damaged blood vessels (endothelial progenitor cells, EPCs); people with CVD may have fewer of these repair cells in their blood stream, and this may contribute to the damage of the blood vessel walls, increasing the risk for cardiovascular disease. This group of researchers wanted to learn if lupus patients had lower levels of these helper cells, even when they were in remission. Who was studied? Fifteen women with lupus and 15 healthy women of the same age and similar smoking histories were recruited for this study. The lupus patients all were in remission for at least one year, and used low doses of prednisone or hydroxychloroquine alone or in combination with other lupus medications. How was the study conducted? The researchers took blood samples from all of the study participants and measured the EPCs and other cells that help produce them, called hematopoetic stem cells (HSCs). They compared the levels of EPCs and HSCs in the lupus patients and the healthy controls, and they also looked for relationships between the levels of these repair cells and other factors. To see whether the patients were developing CVD, the researchers measured the "stiffness" of the patients’ arteries with tests for blood pressure and blood flow. What did the researchers find? The levels of the EPC and HSC repair cells were lower in the lupus patients than in the controls. There was no correlation between the levels of these cells and measures of active lupus such as anti-dsDNA antibodies or antiphospholipid antibodies. Prednisone use did not appear to affect the number of the EPCs or HSCs, but hydroxychloroquine use did -- higher doses of this medication were associated with increased numbers of EPCs. Also, lupus patients who used hydroxychloroquine tended to have lower stiffness scores for their arteries than other lupus patients, which the researchers took as a sign that their blood vessels were staying healthier than others. All of these findings led the researchers to conclude that for some lupus patients, the ability to repair damaged blood vessels may be impaired, even if the patients are in remission and on medication, and it might be that continuing to take hydroxychloroquine even when otherwise well could help to protect the arteries from future risk. What were the limitations of the study? The size of the study population was very small, which makes it difficult for these preliminary findings to be thought of as proven. The researchers didn’t examine past use of medications, which may have had an impact on the lupus patients’ status when the study was conducted. Also, the lupus patients as a group had more traditional CVD risk factors than the controls, such as higher cholesterol, and it is possible that these other risk factors could have been affecting the levels of EPCs rather than lupus -- as could other things going on in the blood vessels and elsewhere they didn’t account for. What do the results mean for you? This study suggests the possibility that lupus might be contributing to future blood vessel damage even when there is no visible sign of the disease. At the same time, it suggests that finding a way to boost levels of EPCs and the HSCs might help prevent CVD from occurring in some lupus patients. It also offered further evidence suggesting that hydroxychloroquine might be useful in preventing CVD in lupus patients. It would be helpful to have a "before and after" study to see whether hydroxychloroquine raises EPCs in patients after it is given, compared to what is found in the same patients before it is given. source Labels: blood vessle damage, cardiovascular disease, CVD, endothelial progenitor cells, Haematopoietic, SLE
~~~ Risk Factors for Pneumonia What is the topic? Pneumonia is the most common form of lung disease in lupus patients. The first defense against pneumonia is a person’s immune system, which is called to action and directed by a number of genes. What did the researchers hope to learn? The researchers for this study wanted to see if they could identify specific risk factors for pneumonia among lupus patients. Were older patients at greater risk? African Americans more than Caucasians? Did it matter how long a person had lupus, or what medications they had taken? Along with these variables, the researchers were particularly interested in examining how very small differences in the structure of several genes involved in the body’s immune system might increase a lupus patient’s chances of getting pneumonia. Who was studied? The researchers analyzed clinical and genetic information on 282 patients (251 women, 31 men) who were part of the Lupus Genetics Project of the University of California, San Francisco. Nearly half (45 percent) were Caucasian, and other ethnic groups represented were Hispanic (18.4 percent), African American (11.7 percent), Asian/Pacific Islander (19.5 percent), and Other/mixed ethnicity (5.3 percent). Of the 282 patients studied, 42 were identified as having had pneumonia sometime after they were diagnosed with lupus. How was the study conducted? The researchers compared the patients in the study who had pneumonia with those who did not; the factors they compared were sex, ethnicity, socioeconomic status, age at lupus diagnosis, duration of disease, lupus medications, renal disease, and low white blood cell count (leucopenia). They also looked at small inherited differences in three genes that have previously been associated with high rates of infection. The researchers used complex statistical techniques to weigh the impact of the different factors on the rate of pneumonia. What did the researchers find? Being male, having had lupus nephritis or leucopenia, and treatment with immunosuppressive drugs were all associated with a higher risk for getting pneumonia, but the strongest association was a specific variation in a gene that plays a role in the production of a molecule called tumor necrosis factor (TNF). TNF helps cells recognize and defend themselves against foreign bacteria, including the bacteria that cause pneumonia, so any change in the genes that promote TNF may affect the body’s ability to fight off the infection. The researchers did not find evidence linking variations in the other two genes they studied with higher risk for pneumonia. What were the limitations of the study? This study relied on data that had already been provided to the Lupus Genetics Project, so the researchers were limited in the categories of information they could examine. They weren’t able to consider such potentially important factors as patient’s immunization histories, the doses of their steroid or immunosuppressant medicines, which increase the risk for infections. Also, they may not have identified all of the patients who had pneumonia owing to incomplete records. The relatively small size of the study population also meant that they may not have had as much genetic variation as they might have needed for important distinctions to show up. What do the results mean for you? This research does identify some important risk factors that need to be studied more thoroughly. If, as their findings suggest, specific variations in the TNF gene they studied -- or perhaps another gene yet to be identified -- can be shown to raise a lupus patient’s chances of getting pneumonia, doctors could use this information and recommend a number of measures -- such as pneumonia vaccines or antibiotics -- to help prevent some of these infections in those patients at risk. source Labels: genetic, male, pneumonia, SLE
~~~ As Teenage Girls with Lupus Mature What is the topic? Women with lupus may have problems with their menstrual cycle, such as increased blood flow, irregular periods, missed periods and even premature ovarian failure (POF) which means that women go into menopause earlier than normal. Early menopause is often the result of treatments for lupus, in particular the immunosuppressant cyclophosphamide (CYC). What did the researchers hope to learn? Almost all of the studies about menstrual problems in lupus have been on adult women. This study wanted to see if adolescent females with juvenile lupus were also at risk for these kinds of problems, and if there were any differences in their symptoms from those of older women with lupus. Who was studied? Three-hundred fifteen adolescent girls with lupus from 12 different medical centers in Brazil were studied for this research. All were over 10 years old and had reached puberty, having had at least one menstrual period. Thirty-five of these patients had episodes of missed periods. How was the study conducted? The researchers reviewed patients’ records and medical histories for all of the patients in the study: how old patients were when they were diagnosed with lupus, how long they had been diagnosed, how old they were when they had their first period, their lupus symptoms, and the medications they had taken. If the patients had missed periods, the researchers noted when it developed and how long it lasted. They compared the information for those patients who had missed periods with those who didn’t, to see if there were any differences. They also took blood samples from each of the patients to study the levels of different hormones. What did the researchers find? The researchers found several significant differences between the patients who had missed periods and those who did not. Patients who had missed periods tended to be younger (average age 15.04 years-old versus 17.8 ), had their lupus diagnosis for shorter periods of time (3.2 years versus 6.1), and were closer in age to their first period (3.4 years into puberty versus 6.7). They also had more serious lupus disease activity when they started missing their periods and were more likely to have kidney involvement. Unlike the studies on adults, the researchers found no relationship between cyclophospamide therapy and missed periods in the juvenile patients. Also, none of the juvenile patients in this study had premature ovarian failure. This is not a surprising finding, since cyclophosphamide kills eggs, and younger women have many more eggs to spare than older women. What were the limitations of the study? This study focused only on the patients’ adolescent years: there is no way to know if some of the patients who didn’t have menstrual problems during those years might not develop these symptoms later in life. Also, this study was done by looking at past records of patients, so the research could only be based on information that had already been obtained; there may have been other questions the researchers would have addressed if they were examining the patients at the time the symptoms occurred. The researchers did not divide the study patients by ethnicity: there may be important differences in how these menstrual problems occur depending on ethnic background. For all of these reasons, more studies will be needed to understand how lupus affects younger women. What do the results mean for you? Lupus patients in their teens—and their parents and health care team—should be aware that menstrual abnormalities can occur. However, this research confirms some earlier studies which suggest that cyclophosphamide is less likely to put younger patients into menopause than older women. Even when adolescent lupus patients had missed periods, their ovaries continued to function later on; that might relieve a younger patient of some worry about their chances to become pregnant later in life. source Labels: Brazil, girl, JSLE, juvenile, SLE, teenage
~~~ New Tests for Lupus Kidney Disease? What is the topic? The kidneys remove impurities from the blood. If the kidneys are damaged, they can lose their ability to filter out those waste products, and serious health complications can occur. Lupus patients can develop inflammation in their kidneys, which is known as lupus nephritis (LN). Rarely, the LN is so severe that all of the function is lost in the kidneys and the patient would need to go on dialysis until they could get a kidney transplant. What did the researchers hope to learn? The researchers in this study hoped to learn if the presence of specific antibodies in a patient’s blood could be linked to the more severe kinds of kidney disease. In particular they were interested in anti-dsDNA and anti-nucleosome antibodies. Who was studied? The researchers collected information from three different groups of lupus patients in Calgary Canada: 14 LN patients who had received a kidney transplant; 22 patients who had LN stabilized without needing dialysis; and 66 lupus patients without nephritis, to compare with these other groups. The control patients were selected to match the two groups of LN patients as closely as possible in age, sex, and ethnicity. How was the study conducted? The researchers obtained blood samples that had previously been taken from the three groups of patients and stored at a serum bank. They also had access to kidney tissue biopsies for the LN patients (12 of 14 transplant patients, 17 of the 22 other LN patients). They compared the antibody profiles for the three different groups, and also looked to see if particular antibodies were associated with the different degrees of kidney damage that showed up on the biopsies. What did the researchers find? Ninety-six of the 100 patients had antibodies which are associated with lupus, but there was no significant difference in the frequency of most kinds of antibodies in the three groups of LN patients, except for the anti-nucleosome antibodies. Anti-nucleosome antibodies were observed in much higher frequency (79 percent) and at significantly higher levels in the transplant group than in the other LN patients (18 percent) or the controls (9 percent). In addition, the researchers calculated that lupus patients were seven times more likely to develop lupus nephritis if they had anti-nucleosome antibodies present. They felt that these findings provided strong evidence that the presence of anti-nucleosome antibodies could be a reliable test for picking out people at risk for severe lupus nephritis that might lead to the loss of kidney function without aggressive treatments. What were the limitations of the study? There were only 100 patients in this study, so additional research with many more patients will be needed to see if anti-nucleosome antibodies can be used as a good test to predict risk of severe LN. Larger studies will also help researchers see if there are differences in the antibodies in LN in people of different genetic backgrounds. Also, even though 79% of the LN patients who had kidney transplants had anti-nucleosome antibodies, the other 21% of the ESRD patients did not; similarly, there were patients who didn’t develop any lupus nephritis who had anti-nucleosome antibodies in their blood tests: this points out that even when two lupus patients have the same symptoms, different disease activity may be at work—which is why every case of lupus and every lupus patient is unique. What do the results mean for you? Doctors find some blood tests useful to help them manage their individual patients’ care. If, as this research suggests, the presence of anti-nucleosome antibodies can identify those patients with higher risk for serious LN, doctors can use this information to provide early and aggressive therapy in hopes of keeping the disease under control before the patient’s kidneys are badly damaged. source Labels: kidney, lupus neprithis, renal transplantation
~~~ When Platelet Counts are High What is the topic? The spleen is an important organ in both the body’s immune system and its blood circulation. The spleen makes antibodies that protect against infections. It also filters the blood, removing old and damaged red blood cells. In some medical conditions the spleen can be damaged, and this can increase the risk for infections. This is sometimes seen in lupus patients, though this is rare. What did the researchers hope to learn? The researchers wanted to see if there were specific lupus symptoms that showed up more often in patients whose spleens weren’t functioning well. They were particularly interested in lupus patients with an unusually high number of platelets. Platelets are components of blood cells that can stick together to form clots at wounds, and thus help stop the loss of too much blood when an injury occurs. High platelet counts are much less common in lupus patients than low platelet counts. Who was studied? The researchers studied 465 consecutive lupus patients at a rheumatology clinic in Italy. All of the patients -- 387 women and 78 men -- were Caucasian and over 20 years of age. How was the study conducted? Blood samples from each of the patients were tested for antibodies and platelet counts over a period of years. Patients who had high platelet counts in 3 consecutive blood draws taken 3 months apart were further studied with an additional kind of test called a blood smear, which could detect signs of spleen problems. If the blood smear was abnormal, the patients had imaging studies, including ultrasound exams and CT scans to determine whether their spleens were damaged. Twenty patients who did not have high platelet counts also had blood smear tests done in order to compare the results. What did the researchers find? Of the 465 patients studied, 16 women and 1 man were diagnosed with thrombocytosis, and this diagnosis came when their lupus disease was inactive. When the blood smears were done on these patients, three showed signs that their spleen was not functioning properly, and this was confirmed by ultrasound and CT scans. Each of these three patients had antiphospholipid antibodies (aPL), which have been linked to blood clots. One of these three patients developed high platelet counts after previously having abnormally low platelet counts. None of the 20 blood smears from control patients with normal platelet counts showed any indication of spleen problems. To the researchers these findings suggested that when lupus patients have high platelet counts, the damage to the spleen could be caused by blood clots related to antiphospholipid antibodies. They recommended that lupus patients who have high platelet counts should be examined for these antibodies. What were the limitations of the study? While 3 of the 17 patients with high platelet counts were determined to have spleen problems, fourteen others did not. So most people with high platelet counts do not have problems in the spleen. Also, even in those three patients, there was no way to determine if the spleen problems occurred before or after the patients developed high platelet counts. What do the results mean for you? The spleen plays a very important role in fighting bacterial infections, so even though only a minority of patients with elevated platelet counts have spleen problems, this is the group that should be further tested to see if their spleen is functioning properly. This may be particularly important in lupus patients who had previously been diagnosed with thrombocytopenia (low platelet counts) and then show up with thrombocytosis (high platelet counts). Also, since all three of the patients who had spleen damage had aPL, doctors whose lupus patients have aPL may want to keep an eye out for changes in platelet counts as a sign of potential spleen damage. source Labels: Autosplenectomy, Platelet, Thrombocytosis
~~~ The Many Faces of Cutaneous Lupus Tuesday, March 25, 2008 by Elizabeth Thompson BeckleyRachelle Pamela sought medical attention for a mouth ulcer when she was 19 years old. It took several biopsies, many incorrect conclusions, various treatments, and another eight years before, at age 27, Pamela received the correct diagnosis of discoid lupus erythematosus. Discoid lupus is the most common of the skin diseases that fall under the umbrella of cutaneous lupus. "Cutaneous" means "of the skin." Only about 10 percent of people with discoid lupus go on to develop systemic lupus, but about 80 percent of people with systemic lupus will also have skin problems. Cutaneous lupus can affect the skin in many ways. Rashes, mucosal ulcers (sores in the mucous membranes of the mouth and nose), bumps, and dimpling can be painful or itchy. In some cases, the effects on the skin may result in permanent discoloration, scarring, and hair loss -- aspects of appearance that also can take a toll on the psyche. The various eruptions of cutaneous lupus usually are referred to as lesions. A lesion is an abnormality in tissue or an organ caused by disease or injury. Lesion Lesson There are three types of cutaneous lupus, but not all of them cause scarring. According to David Fiorentino, M.D., Ph.D., assistant professor in the department of dermatology and the department of medicine’s division of immunology and rheumatology at Stanford University School of Medicine in Palo Alto, CA, the main type of scarring is caused by lesions from discoid lupus. Acute cutaneous lupus, which frequently appears as a rash across the nose and face (often called the "butterfly" rash), doesn’t scar, Fiorentino says. Subacute cutaneous lupus doesn’t scar, but can leave white areas where there was a rash and the skin’s pigment has been lost (hypopigmentation) or darker areas where the skin’s pigment has become discolored (hyperpigmentation). "Even though skin problems often are associated with lupus, we can’t always assume the skin rash is related to lupus," Fiorentino says, "but the type of rash can be a signal of how active or inactive the internal lupus is." Further analysis is required to determine an individual’s overall health. Often a biopsy of the affected tissue -- done by taking a tissue sample and examining it under a microscope -- can give more information. For Pamela, now age 40 and an office manager for a trucking company in Concord, CA, aggressive treatment has kept her discoid lupus at bay. She now maintains her skin’s health with a manageable drug regimen of antimalarials and a topical steroid. "I take two pills [chloroquine and quinacrine] in the morning and use a cream [fluocinonide] at night," she says. They’re paid for by insurance, and Pamela reports experiencing no side effects. "That’s the great part," she says. The not-so-great parts are the scarring and discoloration that remain from previous flares, which she describes as "a lot of pits and indented scars" around her lips, chin, ears, and scalp. Treatment Strategies for Skin Fortunately, several effective treatments for cutaneous lupus are available. There also are new drugs in the research pipeline, as well as new techniques for dealing with scars and hair loss. source Labels: Cutaneous Lupus, discoid, skin, ulcer
~~~ Another benefit of hydroxychloroquine? What is the topic? The antimalarial drug hydroxychloroquine—and to a lesser degree a similar but older medication chloroquine—is used in the treatment in lupus. Hydroxychloroquine, also known by its trade name Plaquenil®, is often prescribed for mild to moderate cases of lupus, and may be effective in preventing skin flares and possibly blood clots. Doctors also give hydroxychloroquine to lupus patients who are taking steroids, which helps them use lower doses of steroids. What did the researchers hope to learn? A study recently reported from Spain found that antimalarial drugs not only helped control lupus disease, but patients who took either of these drugs also lived longer than other lupus patients—even when discounting other factors. However, almost all of the patients in that study were Caucasian, so researchers here in the United States wanted to see if lupus patients from other ethnic backgrounds who were treated with hydroxychloroquine also lived longer. Who was studied? Since the early 1990s, the LUMINA (LUpus in MInorities: NAture vs. nurture) study has been tracking a group of lupus patients in the United States of different ethnic backgrounds. At the time this study was conducted, the LUMINA study included information on 218 Hispanics, 220 African Americans, and 170 Caucasian patients; of those 608 patients, 61 had died from various causes. How was the study conducted? The researchers focused on the records of the 61 patients who had died, comparing those who were taking hydroxycholoroquine (17) to those who had not (44). For every one of the deceased patients, they also examined the information for 3 surviving patients who had been diagnosed with lupus for the same amount of time. The researchers looked at demographic factors (such as income, education, and age when diagnosed) and also lupus disease symptoms, medications, lab tests. Using some statistical techniques that allowed them to account for the impact of these different variables, they came up with a way to measure if hydroxychloroquine on its own, independent of other factors, provided a protective effect that kept patients living longer. What did the researchers find? Like the previous study in Spain, the researchers in this LUMINA study found that hydroxychloroquine had a clear effect in terms of the survival of lupus patients. Although this might have been explained by the fact that hydroxychloroquine was used more often in people with less severe disease, they accounted for that in their analysis. By applying statistics, they found that hydroxychloroquine had an independent impact on survival. What were the limitations of the study? Even though the researchers designed their study to account for the effect of factors other than hydroxychloroquine, there may be other features that they didn’t account for that also were influencing the outcomes. Also, the study didn’t indicate if hydroxychloroquine’s protective benefit was the same for Caucasians, African Americans, and Hispanics. What do the results mean for you? Hydroxychloroquine has been shown to be an effective medicine for treating lupus, and previous studies have shown that it is associated with fewer flares of disease. Monitoring for rare complications to the eyes is important, but with such monitoring, this treatment can be used safely for long periods of time for most patients. source Labels: Association of socioeconomic and demographic factors with utilization of rheumatology subspecialty care in systemic lupus erythematosus, hydroxychloroquine, LUMINA, multiethnic, steroid
~~~ Have you seen a rheumatologist lately? What is the topic? Although a number of studies have found that specialty care is associated with improved outcomes, there are reports that certain groups of lupus patients -- especially the elderly and African American women often do not have even annual visits with a rheumatologist. That may contribute, in part, to the more severe manifestations of disease seen in African Americans with lupus. Little is known about the use of rheumatology services by other groups of lupus patients (e.g., younger patients, other ethnic minority group members) or how the use of specialists relates to the type of medical insurance a lupus patient may or may not have. What did the researchers hope to learn? The researchers wanted to examine the socioeconomic and/or demographic factors that might affect lupus patients’ use of rheumatology physician services. The primary outcome was whether or not patients had seen a rheumatologist at least once in the prior 12 months. The researchers also sought to determine what kind of physicians (e.g., family practice physicians, internists, rheumatologists, other specialists) were primarily responsible for managing lupus patients’ care. Who was studied? The participants in this study were already part of the Lupus Outcomes Study (LOS), which has been following nearly 1,000 English-speaking patients with lupus over a number of years. This study included 867 people with lupus, more than 91% of whom were women. The racial/ethnic backgrounds of the study participants, as self-identified by the subjects, were: Caucasian (69%), Hispanic/Latino (11%), African American (8%), Asian/Pacific Islander (10%), and some other race/ethnicity (2%). How was the study conducted? Trained survey workers conducted hour-long telephone interviews with the study participants. They collected data on age, sex, disease status, race/ethnicity, income, education, type of health insurance, and how they had come to participate in the LOS (either through a referral from a rheumatology practice or community outreach). The results were analyzed to weigh the relative impact of different variables. What did the researchers find? The researchers found that older participants, males, and those with lower incomes were less likely to visit a rheumatologist, even after taking other variables into account such as race/ethnicity, health insurance, and disease status. They guessed that this underuse of rheumatology services was probably caused by barriers to accessing care, such as lack of rheumatologists nearby, lack of awareness of rheumatology expertise, less frequent referrals to rheumatologists, or inadequate follow-up by rheumatologists once care is established. The researchers did not find a discrepancy in specialty care use by race/ ethnicity in this study, a finding that contrasted with a prior study that showed African Americans with lupus had significantly fewer rheumatology visits compared with Caucasians. What were the limitations of the study? The participants in this study were not randomly selected, but rather had already been enrolled in the LOS. It is possible that the respondents may have had increased access to care compared to lupus patients in general; in particular, study participants identified as members of ethnic/racial minorities were more likely to have been recruited for the original study from rheumatology practices. Also, the study relied on self-reported medical histories, which are not as reliable as detailed clinical information, and this could have masked important differences about the severity of disease in the different groups. What do the results mean for you? The study results point to the need for greater access to rheumatology specialty care for particular groups of lupus patients. In many patients, lupus symptoms may become less severe as they grow older, and this may account in part for why older lupus patients are less likely to see a rheumatologist. However, this is not true for all patients, and some of these patients may still need the particular expertise of physicians who have special training in the management of lupus. source Labels: demographic, socioeconomic, systemic lupus erythematosus, utilization of rheumatology subspecialty
~~~ Particular immune molecules and NPSLE What is the topic? Despite the fact that a significant percentage of lupus patients (estimates run from 14% to 75%) have signs of neurological involvement, doctors still don’t have a single test that can definitely indicate when lupus is affecting the central nervous system (NPSLE). What did the researchers hope to learn? The researchers sought to determine if the presence of particular factors in the spinal fluid (CSF) of lupus patients are associated with NPSLE, which might help determine NPSLE diagnosis. Who was studied? The study had four different groups of subjects who were patients at the same hospital in Mexico City: 42 lupus patients who had symptoms of NPSLE; six lupus patients with septic meningitis; 16 lupus patients with no symptoms of NPSLE; and 25 patients with no autoimmune disease and no neurological manifestations who were undergoing elective surgery. How was the study conducted? All of the patients agreed to participate in the study and to undergo a spinal tap. Six months after hospitalization, a second spinal tap was done on 30 of the 42 NPSLE patients. The researchers compared the CSF samples of the NPSLE patients with those of the other groups They also compared the samples of the NPSLE patients that were taken six months later, after the patients had undergone medical treatment and no longer had any NPSLE symptoms. What did the researchers find? The researchers found increased concentrations of several inflammatory proteins in the CSF of lupus patients during a flare of NPSLE including interleukin 6 (IL-6) and several other proteins. At the six-month follow-up, levels of these inflammatory proteins had decreased significantly, but not completely, and were now similar to lupus patients who did not have NPSLE. What were the limitations of the study?The researchers did not study any group of patients with neurologic symptoms but no autoimmune disease, so it is impossible to determine if the high levels of the compounds they identified were present because of the NPSLE or the general fact that there was neurological involvement. What do the results mean for you? Though further studies are required, this research does suggest a particular blood test that could be useful in determining when lupus involves the nervous system. It also provides an interesting perspective on the different ways lupus can affect tissues and cells depending on where they are located in the body and the functions they perform. source Labels: chemokines, Interleukin-6, neuropsychiatric, NPSLE, systemic lupus erythematosus
~~~ Medication use and infertility in men with lupus What is the topic? Because lupus can affect almost every organ system in the body, men who develop lupus may have concerns about their fertility, especially since the presence of antisperm antibodies has been observed in a significant percentage of lupus patients. What did the researchers hope to learn? The researchers sought to determine the frequency and possible causes of sperm damage in men with lupus. Who was studied? The researchers studied sperm development and sexual function in 35 males diagnosed with lupus and 35 healthy males. How was the study conducted? Each of the study participants underwent an examination by a urologist. Sperm samples were obtained to compare sperm count, shape, and motility (the ability of the sperm to move) between the two groups. The lupus patients also had their sex hormone levels determined, their medical histories collected (including data on the duration and dosages of medications they had taken for lupus), and their sperm samples tested for antisperm antibodies. What did the researchers find? The researchers found a high frequency of sperm abnormalities in men with lupus, including lower sperm counts and reduced sperm mobility. Both of these conditions are linked to male infertility. They also noted that the volume of the testes of the men with lupus was reduced compared to the controls. Their analysis showed, however, that these sperm and testicular abnormalities were not the result of lupus disease activity but stemmed from prolonged use (more than five years) of the immunosuppressant drug cyclophosphamide (CYC, trade name, Cytoxan®). What were the limitations of the study? Though the researchers showed that sperm abnormalities occurred much more frequently in males with lupus, the researchers were unable to predict which patients might become infertile. What do the results mean for you?It is already known that CYC is associated with infertility. This research confirms the possibility of infertility among men with lupus who receive CYC therapy. Men with lupus who must receive this treatment may want to consider freezing sperm samples first. source Labels: Gonad evaluation, infertility, male, systemic lupus erythematosus
~~~ Why Certain Patients Don’t Respond to Steroids: One Possible Explanation Monday, March 17, 2008 What is the topic?Steroid medications are often prescribed for people with lupus or other autoimmune diseases such as rheumatoid arthritis. Although steroids have many undesirable side effects, they work quickly and very well to control lupus. However, for a small percentage of lupus patients, steroids don’t provide relief; these patients are said to be "steroid resistant" (SR), and must take other medicines, most of which are not as rapidly active, to treat their disease flares. What did the researchers hope to learn? The researchers in this study wanted to see if they could find out what makes people steroid resistant. In particular, they were interested in learning about the immune cells of SR individuals, to see how they might be different from the immune cells of people for whom steroids are effective. They performed a study in patients with ulcerative colitis, so it is important to understand that the results may or may not be relevant to lupus patients who are steroid resistant. Previous studies had shown that steroids slow down the reproduction of certain kinds of immune cells called CD4+ T cells. By limiting the number of these cells, steroids help reduce inflammation and other signs of autoimmune disease. But not all CD4+ T cells are the same. Some CD4+ T cells produce large amounts of a protein called CD25; these cells are called CD4+CD25high; others produce none, so they are called CD4+CD25- ("negative"). In between these two extremes is a group that produces an intermediate amount, and those cells are called CD4+CD25int. Who was studied? The researchers obtained blood samples from 23 healthy individuals and 6 patients with ulcerative colitis who had a history of steroid resistance. All of the people in the study were Caucasian, and men outnumbered women by 2 to 1 in both the healthy group and the SR patients. How was the study conducted? Blood samples were taken, and the blood was processed so that the researchers had collections of immune cells to work with. They treated these immune cells with chemical techniques so they would show up under a microscope, and so that it could be determined how much CD25 they had. They also measured how many times the cells divided, which is a measure for their reproduction (more dividing cells are seen in inflammatory states). They then exposed these cells to different doses of a steroid medicine called dexamethasone to see which kinds of cells responded and which did not, and compared the responses from the cells of the healthy individuals and the SR ulcerative colitis patients. What did the researchers find? Very weak doses of dexamethasone had little effect on the reproduction of either the CD4+CD25- T cells or the CD4+CD25int T cells, both of which continued to divide and multiply at the same rate that was seen without any steroids. However, as the researchers increased the doses of dexamethasone to the levels usually given to treat patients, the two different kinds of T-cells responded quite differently. Reproduction of the CD4+CD25- T cells slowed down considerably and was even more limited as the dose was further increased. The CD4+CD25int T cells did not appear to be affected by the dexamethasone and continued to divide and create more cells regardless of the dose of the steroid. When comparing the two groups from whom the samples were obtained, the researchers noted that the percentage of CD4+CD25int T cells was much higher in the SR ulcerative colitis patients than in the healthy subjects. There were some healthy subjects (17%) whose T cells also showed high steroid resistance, which led the researchers to conclude that steroid resistance was not necessarily a function of the disease, but a characteristic of the individual person whether or not they were ill. This may be a benign factor until a person has an illness that would benefit from steroid treatment. What were the limitations of the study? This study was conducted not on lupus patients, but rather on ulcerative colitis patients, which is a different autoimmune disease entirely. These findings may or may not apply to people with lupus who do not respond to treatment, but would certainly be worth studying in lupus patients. Also, the study participants were all Caucasian. This is both an asset and a detriment to the study. It is an asset because ethnic differences in normal steroid responsiveness would not confuse the picture as much (of course all Caucasians are not alike as proven by this study). It is a detriment because it is not yet possible to apply the results to people from other genetic backgrounds. Also, in this study men outnumbered women, which is precisely the opposite of what occurs in lupus. Another limitation is the fact that the researchers focused only on the T cell populations, which are only a minority of immune cells. Though their findings did seem to indicate a role for CD4+CD25int T cells in promoting steroid resistance, there could still be other factors involved that also contribute. What do the results mean for you? Although their number is small, lupus patients who do not respond to steroid medicines face a number of challenges. Steroids are one of the most immediately effective treatments for lupus flares, despite the fact that they have distressing side effects. So although most patients (and their doctors) prefer to avoid steroids, they are often extremely effective in moderate to severe flares and can even be life-saving. Against that background, this study holds out a possible way for doctors to use blood tests to identify which of their lupus patients may or may not respond as well to steroids, which might lead to more aggressive dosing in emergencies or earlier introduction of other strong immune suppressants. In addition, if researchers can know for sure which factors contribute to steroid resistance, there is the possibility that treatments can be developed to overcome those problems. For those reasons, this study offers hope that more sophisticated approaches can be developed in the future to provide safer and more effective (and individualized) treatments. source Labels: Glucocorticoids, Inflammatory Diseases, research, steroid
~~~ A Clue to Congenital Heart Block What is the topic? Neonatal lupus is a condition that can occur when anti-SSA/Ro antibodies cross the placenta in pregnancy from the mother to her developing baby. Babies born to women who are positive for anti-SSA/Ro antibodies (even women who do not have lupus) are at greater risk for neonatal lupus, although this remains rare. A number of symptoms are seen in infants who are born with neonatal lupus, most commonly skin rashes or liver involvement, which go away over time as the infant’s own immune system develops, and the mother's antibodies are cleared from the baby’s system. Even more rarely, however, there is a potentially life-threatening heart condition that these babies can be born with, called congenital heart block (CHB). It is possible to diagnose this condition in the baby while it is still in the womb (usually in the second trimester of the pregnancy) by picking up an irregular heartbeat using a special kind of sonogram called a fetal echocardiogram. Early CHB may be reversible with treatment, but in the later stages a baby may require a pacemaker at the time of birth. Just because a pregnant woman has anti-SSA/Ro antibodies does not automatically mean that her baby will develop CHB. In fact, the first offspring of only 2 percent of pregnant women who test positive for anti-SSA/Ro develop CHB; furthermore, in those women whose first babies did have CHB, there is only a 20 percent recurrence in future pregnancies. Also, when an anti-SSA/Ro mother has identical twins, more often one will develop CHB and the other will not. All of this evidence suggests that there are other additional factors besides anti-SSA/Ro that determine whether a baby will develop CHB. What did the researchers hope to learn? One important piece in the puzzle for the researchers in this study was the fact that CHB tissue has a lot of scarring; this was surprising because fetal tissue is supposed to heal without permanent scarring. They hoped that they could learn what was causing this scarring, and whether it could shed further light on the development of CHB. Previous work had led them to focus on the possibility that the heart cells were not receiving an adequate supply of oxygen, a condition called hypoxia. Who was studied? Studying changes at the cellular level that may be involved in CHB is especially challenging. Only a very small percentage of the cases of CHB result in the death of the fetus, and when death does occur, it is usually several weeks or more after the irregular heart beat that is characteristic of CHB is first detected. Tissue samples taken at that time may not accurately reflect the changes that brought on the abnormal rhythm. The researchers in this study, however, had access to the hearts of two fetuses that died within days of showing the initial signs of CHB, one during the 20th week of the pregnancy and the other during the 22nd week. Tissue from these two hearts provided a picture of the state of the cells very close in time to the moment when the irregular heart beats were detected. They also had heart tissue from a fetus with no sign of CHB that had died at age 23 weeks. In addition, the researchers obtained samples of cord blood from 67 babies whose mothers were positive for anti-SSA/Ro antibodies; 31 of these babies had CHB, while 36 did not. Cord blood is the baby’s blood that remains in the umbilical cord after the baby is delivered. They also had heart tissue samples from seven other fetuses and both heart and lung tissue samples from three other fetuses. They treated cells from these tissues with chemicals that simulated the conditions that would occur if they did not receive a sufficient supply of oxygen in the womb. Following those treatments, the researchers used other techniques to get the treated cells to replicate over and over, to see if there were any changes after the exposure to low oxygen conditions. How was the study conducted? All of the work was done by examining cells and tissue samples with microscopes. Some of the cells were treated with chemicals to create changes similar to those that might occur under conditions of hypoxia in the womb. The cord blood was analyzed to measure the level of erythropoietin in the cells; because erythropoietin helps cells make use of oxygen, the researchers used increased levels of erythropoietin as a sign that the cells were not otherwise receiving enough oxygen, and therefore hypoxic. What did the researchers find? Examining the heart tissue from the 20- and 22-week-old fetuses with CHB, the researchers found cell types that cause scarring, and it appeared to have developed fairly recently, especially around the area of the heart that is responsible for regulating the heart rhythm. They also found chemicals in the tissue that are produced in reaction to hypoxia. The heart tissue from the 23-week-old fetus without CHB did not exhibit scarring, or signs of hypoxia. The researchers used the heart and heart and lung tissues from the other fetuses to observe how the different tissues responded to hypoxic conditions. The fetal heart tissue showed changes in the activity of the cells, including making proteins associated with scarring. This was not found in the lung tissue, which continued to produce fetal cells that did not promote scarring. Among the chemical changes that followed hypoxia in the heart tissue, the researchers found one compound was released that stimulated the production of cAMP, a chemical which helps to protect cells from producing scar tissue. However, it did not appear that even the higher levels of cAMP could fend off all of the scarring when CHB begins to develop. The researchers noted significant differences in the levels of erythropoietin in the cord blood between infants born with CHD and those without, suggesting that the cells in the CHD infants were struggling, and needing more oxygen. When they began this study, the researchers already had a theory of how CHB develops. They saw CHB resulting from a succession of immune response processes. One of those steps involved changes in heart tissue that would lead to the production of cells that cause scarring. The researchers see the findings of this study as supporting that theory, citing hypoxia as adding to the forces that cause scarring in fetal heart cells. What were the limitations of the study? The researchers for this study discuss some of the limitations of this study in their paper. Though this team of scientists was fortunate to obtain access to hearts of two rare fetuses that died soon after their CHB showed up, tissue samples from many more cases of CHB would need to be analyzed to see if their findings about hypoxia and scarring hold up. What do the results mean for you? Most women with lupus will deliver healthy babies. For the very small number of those with anti-SSA/Ro antibodies who are at risk for their baby developing neonatal lupus, CHB remains a concern, since, although it is rare, it can be life-threatening to the baby. This study offers an interesting perspective on what may be taking place to cause the baby’s abnormal heart rhythm, and contributes one more potentially important link in the progress towards defeating this complicated illness. One biq question revolves around cause and effect: does the hypoxia cause the scarring of the heart tissue, or does the damaged tissue cause the heart to be unable to provide enough oxygen? And when does the damage occur? The change in the heart rhythm that indicates CHB may show up close to the 20th week of pregnancy, but that doesn’t mean the damage hadn’t begun weeks before. Also, the researchers don’t have the answer to why the increased cAMP doesn’t prevent the scarring, since that is one of its functions. Is it too little too late? Perhaps there is some damage to the heart that makes it unresponsive to cAMP. These and other questions will probably remain unresolved for some time, however, because of the difficulty in obtaining enough tissue samples from different cases when CHB is developing. source Labels: cAMP, heart, Human Fetal Cardiac Fibroblasts, Hypoxia, neonatal, pregnancy
~~~ Are Increased Levels of Nitric Oxide a Sign of Kidney Damage in Lupus? What is the topic? Lupus disease activity often occurs without any apparent signs or symptoms. This is especially true when lupus affects the kidneys, which is known as lupus nephritis. It is possible for lupus to cause significant kidney damage even before a patient is diagnosed. However, though there may be no visible symptoms, there are chemical changes occurring in the cells and tissues that can be measured. Therefore, a major emphasis among lupus researchers is to find simple laboratory tests can be used to detect otherwise silent lupus disease activity. A laboratory test that can be used in this way is called a biomarker. One potential biomarker that is being investigated is nitric oxide (chemical symbol, NO), since NO is one of the chemicals involved in the body’s immune response. What did the researchers hope to learn? The researchers wanted to see if there was any relation between the level of NO and lupus, and if increased levels of NO were related to lupus nephritis. Who was studied? Eighty-three adult lupus patients and 40 healthy people of similar age and background were recruited for this study. Ninety five percent (95%) of the lupus patients were women; 80% were African American; both percentages were higher than those in the healthy group. The researchers divided the 83 lupus patients into three groups: (1) lupus patients with no history of nephritis; (2) lupus patients with history of nephritis but no active kidney disease; and (3) lupus patients with active kidney disease that required a biopsy (a biopsy involves removing tissue from the kidney and studying it with a microscope and with other special laboratory techniques). Among the 83 lupus patients, 49 either had a history of nephritis or had active nephritis over the course of the study. How was the study conducted? At their first visit, all of the patients had blood samples taken, and these blood samples were tested for levels of nitrates and nitrites, which are indications of nitric oxide production; together the nitrates and nitrites are called NOx. The researchers compared the NOx levels of the lupus patients and the controls. They also did further comparisons of the lupus patients’ NOx levels with other standard laboratory measures used to evaluate lupus, such as the presence of certain antibodies and other immune system agents (called complement) in the blood, or protein in the urine. The lupus patients had regularly scheduled visits every 3 months for at least one year (some were seen for as long as two years). During those visits further blood tests were taken to measure NOx levels at that time, and other tests conducted to evaluate their lupus disease. Patients who had signs of active lupus nephritis had biopsies of their kidneys. Since both smoking tobacco and certain foods can raise the blood levels of NOx, participants in the study agreed not to smoke and to eat only a low-NOx diet 24 hours before each visit. What did the researchers find? As expected, the researchers found that the blood levels of NOx in the lupus patients were significantly higher than those without lupus at the first visit. Furthermore, among the lupus patients, those with active lupus nephritis had higher levels than in the other groups. Also, higher levels of NOx were associated with several of the standard laboratory measurements for lupus, including elevated levels of protein in blood and urine (which are signs of kidney disease) and lowered complement, especially the C3 form of complement. Over time, higher NOx levels were associated with greater lupus disease activity. Turning their attention to the group of patients who had undergone a biopsy for active lupus nephritis, the researchers found that the patients with the highest level of NOx also had the most serious degree of kidney damage. They also looked at how the patients with kidney disease responded to medical treatment; those patients who did not get better (“non-responders”) had higher levels of NOx than those who did respond. There are two reasons why a chemical can be increased in the bloodstream: either the body is making increased amounts, or the body is not efficiently eliminating the chemical which is being made. The researchers did another series of tests to make sure that the NOx levels were a result of higher production and not because the kidneys were less able to remove the NOx compounds from the blood. Those tests showed that it was, indeed, increased production and this appeared to be related to the activity of C3 complement. All of these findings led the researchers to conclude that elevated levels of NOx in the blood could be a potential useful marker for lupus disease activity. They also suggested that any medication that aimed to prevent kidney damage in lupus patients might have to limit the production of NO. However, just because something is a marker for disease activity does not necessarily mean that all effective treatments would have to eliminate it. If NO is triggering something else that damages the kidney, then a treatment aimed at that second thing might be effective for nephritis regardless of the NO level. What were the limitations of the study? The size of the study group -- 83 lupus patients -- was small, especially considering how different the inflammation of lupus can be from one person to the next. Also, nearly 80% of the lupus patients in the study were African Americans; that is a good aspect of the study, since people of African descent may have worse kidney involvement and have previously not been studied well enough. However this does limit the ability to draw conclusions about people with lupus who might be from different genetic backgrounds. There are also some limitations to the measurements used. As the researchers themselves pointed out, lupus activity rises and falls over time, and measurements taken at three-month intervals really may not capture important information during the intervening months. Of less concern, but something that should be noted, the researchers didn’t really measure the levels of NO itself, but used the blood levels of nitrate plus nitrite as indicators of NO production. This measurement seems to be useful, but much more could be learned about the specific chemical changes that are going on and in what way they may impact the kidney. What do the results mean for you? A number of previous studies had pointed to increased NO production as an important factor in lupus, but those studies were "after the fact"; they only looked back at the records of lupus patients to see if there were any associations. This was the first study to examine the relationship going forward, following lupus patients over time, and gathering information about NO levels in the course of their treatment and evaluation. Thus, it adds strength to the notion that NO may be a useful biomarker for lupus disease activity that could help doctors know what is going on when their patients may not have obvious symptoms. Their suggestion that limiting NO production might be important to consider for new medications for lupus nephritis is also very intriguing. Both of these points -- the value of NOx as a biomarker and its role as a target for new medications -- are definitely worthy of further studies. source Labels: kidney, lupus neprithis, Nitric Oxide, research
~~~ Kidneys Affected in 40 Percent of People with Lupus Wednesday, March 05, 2008 March 3, 2008It is estimated that as many as 40 percent of all people with the autoimmune disease lupus, and as many as two-thirds of all children with lupus, will develop kidney complications that require medical evaluation and treatment. Because there are so few symptoms of kidney disease, significant damage to the kidneys can occur before a person is actually diagnosed with lupus. Lupus nephritis is the term used when lupus causes inflammation in the kidneys, making them unable to properly remove waste from the blood or control the amount of fluids in the body. Abnormal levels of waste can build up in the blood, and edema (swelling) can develop. Left untreated, nephritis can lead to scarring and permanent damage to the kidneys and possibly end-stage renal disease (ESRD). People with ESRD need regular filtering of their body’s waste done by a machine (dialysis), or a kidney transplant so that at least one kidney is working properly. This occurrence greatly affects the person’s quality of life and life expectancy. In the early stages of lupus nephritis, there are very few signs that anything is wrong. Often the first symptoms of lupus nephritis are weight gain and puffiness in the feet, ankles, legs, hands, and/or eyelids. This swelling often becomes worse throughout the day. Also, the urine may be foamy or frothy, or have a red color. Diagnosis Often the first signs of lupus nephritis show up in clinical laboratory tests on the urine. That is why a urine test, or urinalysis, is an important screening tool. In addition, certain blood tests can provide information about kidney damage and how well the body is filtering waste. A physician also may order a kidney biopsy in which a tiny piece of tissue from one of the kidneys is removed for testing. Treatments Even though lupus nephritis is among the more serious complications of lupus, there are effective treatments. Prednisone and other corticosteroids are generally prescribed to stop the inflammation. Immunosuppressive drugs may also be used (with or in place of steroid treatments), such as cyclophosphamide (Cytoxan®), azathioprine (Imuran®), cyclosporin A, and mycophenolate mofetil (CellCept®). Medications developed for other illnesses are also being studied as treatments for lupus nephritis, including rituximab (Rituxan®), eculizuimab (Soliris™), and abetimus sodium (Riquent™). source Labels: kidney, lupus neprithis
~~~ Early signs of lupus, even before a diagnosis can be made? Friday, October 26, 2007 Clinical criteria for systemic lupus erythematosus precede diagnosis and associated autoantibodies are present before clinical symptomsWhat is the topic? Diagnosing lupus is can sometimes be difficult. Because lupus symptoms may come and go and resemble other illnesses, it may take months or even years before a doctor can sort out what is going on. During this run-up period, most doctors agree, lupus disease activity is probably taking place, and lupus-related antibodies may be present even before symptoms occur. What did the researchers hope to learn? The researchers wanted to find out which symptoms tended to appear early on in most lupus patients and what antibodies might be present before certain clinical symptoms appear. They hoped this kind of analysis might provide clues about lupus disease activity and what course the disease might take even before symptoms are apparent. Who was studied? The researchers selected 130 patients who were diagnosed with lupus while they were in the United States military. Whenever someone joins the military, he or she has a baseline medical examination that includes an in-depth physical examination, medical history, and blood tests. The researchers would be able to use that information to look for signs of lupus and run tests for antibodies that were present before the diagnosis was made. How was the study conducted? Medical records for each of the 130 patients in the study were reviewed, and the researchers collected information about various features of lupus if and when they occurred, and if they appeared before the lupus diagnosis was made, how many months/years before. They also ran antibody tests on the blood samples to see what antibodies might have been present before clinical symptoms appeared. The researchers compared all of this information for patients based on their ethnic background, age when they were diagnosed with lupus, and the time frame separating symptoms’ appearance and diagnosis. What did the researchers find? Of the 130 patients studied, 104 had at least one clinical feature present before the diagnosis was made. Most of these patients (74) had only a single feature. The initial feature varied widely from patient to patient, but the most common early symptom was arthritis. In terms of time, discoid rash and seizures tended to be the earliest findings, occurring nearly two years before the diagnosis was made; interestingly, central nervous system involvement, which was one of the earliest problems to appear in patients in the study, did not commonly appear after the diagnosis. There were also interesting differences across populations. Men were more likely than women to have kidney disease as a first symptom, and Caucasians more likely than African Americans to have early rash on the cheeks and rashes that were made worse in the sun. Of the 104 patients who had clinical symptoms before their diagnosis, antibodies were often detectable before these symptoms. Antinuclear antibodies (ANA) showed up in 81 before the initial symptom. Seventeen patients had rheumatoid factor present when their blood was tested; arthritis developed later in 16 of them. As for anti-dsDNA and anti-C1q antibodies, which have been associated with kidney disease in lupus, 80 patients were positive for anti-dsDNA, and 38 of these patients had kidney disease; in 92 percent of these cases, the anti-dsDNA antibodies were detected prior to or at the same time as the diagnosis of kidney disease. About half of the patients who had anti-C1q antibodies developed kidney disease, but half did not; however, among the 18 anti-C1q patients who did have kidney disease, in 13 cases the antibodies showed up before the kidney disease was diagnosed, on average nearly one and a half years beforehand. What were the limitations of the study? The study was limited by the fact that the researchers had to rely on previously collected data, which had been provided for other purposes rather than specifically to look at lupus symptoms and lupus disease. Therefore, some lupus symptoms (like mouth sores) might not have been recorded because they weren’t really being looked for and they weren’t considered important in the overall health record of the patient at the time. Since the doctors following these patients before they were known to have lupus would not usually have been rheumatologists, there might have been many features of lupus that were simply missed. Also, though the researchers had at least one pre-diagnosis blood sample for each patient in the study, for some that was all they had, and the time intervals between that blood test and the lupus diagnosis varied greatly. For some patients there may have been changes in the antibody profile during that interval that the researchers wouldn’t have known about. What do the results mean for you? This study reinforces the notion that a lot of lupus disease activity may be taking place without patients’ or their doctors’ knowing it, in many cases long before the patient is diagnosed with lupus. However, the presence of certain antibodies may be a sign that later clinical symptoms are likely to appear, and so finding these antibodies early on when a patient has only one or a couple of symptoms may help doctors decide how they manage different patients, both before and after they have enough clinical criteria to determine a patient has lupus. On the other hand, it is also known that many family members of patients with lupus have lupus-related antibodies for many years without ever developing lupus. Some people can have these antibodies detectable temporarily during a viral illness or for unknown reasons, and then they go away. And as people age, they sometimes develop lupus-like antibodies as well, without becoming ill. The development of certain autoantibodies is probably one of several events that have to occur before a person develops lupus.
~~~ New symptom related to neonatal lupus What is the topic? Neonatal lupus erythematosus (NLE) is a rare but serious condition that can occur in newborn babies, and is related to anti-Ro (SSA) and/or anti-La (SSB) antibodies, which can cross the placenta in pregnancy from the mother to the fetus. A number of symptoms are seen in infants with NLE, most commonly a skin rash or liver involvement, both of which go away over time as the infant’s own immune system replaces the mothers circulating antibodies. However, a potentially serious heart condition called congenital heart block also can develop and will require medical attention. Developing babies of women with anti-Ro antibodies need to be monitored in the womb for heart block, though only a small number of pregnancies in women with lupus will result in this serious complication. In addition, some reports point to neurological symptoms that may be present in rare cases of NLE. What did the researchers hope to learn? The researchers sought to determine if infants born with NLE were at greater risk for hydrocephalus, a condition characterized by excess spinal fluid in or around the brain, which in turn contributed to macrocephaly, an enlarged head size. Who was studied? The study followed 87 infants born to selected, high risk women with anti-Ro antibodies and who were seen at the Hospital for Sick Children (HSC) in Toronto. Of the 87 infants studied, 47 were diagnosed as having NLE. How was the study conducted? Each of the 87 infants enrolled in the study was seen at least once in a follow-up visit, and more than 90% were seen more than once. What did the researchers find? The researchers found that the infants born to anti-Ro positive mothers developed hydrocephalus and macrocephaly at higher rates than would be expected. The rate of hydrocephalus was higher in both the group of infants with NLE and those identified as otherwise healthy. The researchers suggest that hydrocephalus be considered a new and independent manifestation of NLE, which may occur in association with other symptoms of NLE or alone. It is also important to point out that four of the five NLE infants who developed hydrocephalus were neurologically healthy, and in all but one of the infants, the abnormalities in head size and fluid volume resolved spontaneously over the course of time after their second birthday. What were the limitations of the study? The results of this study were similar to other investigations that showed an association of macrocephaly with NLE. It would have been better to compare this outcome to babies born to other lupus patients without anti-Ro antibodies and to the babies born to a group of healthy mothers attending this same hospital. Specialist hospitals such as this one could be attracting an overall more high risk group of patients with or without the Ro antibodies. What do the results mean for you? Women with lupus who have anti-Ro antibodies who are pregnant or intend to become pregnant need to be aware of the possibility their baby may develop NLE, which can have serious complications, albeit the serious complications are rare. These women should receive specialist high risk prenatal care and their babies should be monitored after birth by knowledgeable pediatricians.
~~~ Antidepressant Use Linked to Bone Loss Thursday, October 25, 2007 Older men and women who take the most widely used type of antidepressant medication may be at increased risk for bone loss, according to the results of 2 large studies.Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are often the first line of defense in treating depression, a condition increasingly diagnosed in the elderly. SSRIs help to alleviate depression by blocking the action of proteins in the brain known as serotonin transporters. In recent years, scientists have discovered that serotonin transporters are also present in bone cells. Animal and clinical studies suggest that the protein plays an as-yet unknown role in bone health. To see how SSRIs and other types of antidepressants might affect bone density in older patients, researchers drew on data collected for 2 large ongoing studies of osteoporosis-related bone fractures in people age 65 and older. The studies—one focusing on women and the other on men—are jointly funded by NIH’s National Institute on Aging (NIA) and National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The findings from both studies were published in separate papers in the June 25, 2007, issue of the Archives of Internal Medicine. For the women’s study—led by Dr. Susan J. Diem at the University of Minnesota—the researchers evaluated bone mineral density in participants' hip bones over a 5-year period. Of the 2,722 women under study, about 7% were taking SSRIs, 4% were taking tricyclic antidepressants and the rest were taking neither. After adjusting for other factors—such as the severity of depression and use of calcium supplements—the researchers found that bone mineral density in SSRI users dropped by 0.82% each year, compared to an annual loss of 0.47% among those taking either tricyclic antidepressants or no antidepressants. In the other study—led by Dr. Elizabeth Haney at the Oregon Health and Science University—the scientists looked at bone density in the hips and the spines of 5,995 men. About 3% of the men were taking SSRIs, and about 3% were taking other antidepressants. Bone mineral density among SSRI users was 3.9% lower at the hip and 5.6% lower in the spine than in the other participants. Although the researchers linked SSRIs to bone loss, they stress that this work doesn’t prove that SSRIs are responsible. Their findings need to be confirmed by additional studies, and other possible contributing factors, like depression itself, need to be definitively ruled out. “Depression is a serious condition, and it’s important not to stop antidepressants abruptly or without talking to your physician,” Haney says. “However, it may be worth paying special attention to the things we know can prevent osteoporosis, such as exercise, taking adequate calcium and vitamin D.”—by Vicki Contie Labels: antidepressant, bone, depression
~~~ A potential therapy for lupus nephritis when other medications fail Saturday, September 01, 2007 From Arthritis & Rheumatism, April 2007Lupus nephritis (kidney disease) is a serious complication of lupus. Researchers in Sweden tested to see if providing rituximab (Rituxan) in combination with cyclophosphamide (CYC) would be a safe and effective therapy for lupus nephritis patients who had previously not responded to CYC. The researchers found that rituximab, in combination with CYC, was effective in treating lupus nephritis in patients who had previously not responded to CYC. Read more > Labels: CYC, kidney, lupus neprithis, research, rituximab
~~~ Results of a preliminary study of rituximab for difficult NPSLE From the Annals of the Rheumatic Diseases, April 2007 Lupus may affect the central nervous system (NPSLE), with estimates varying widely (from 12% to 75%) for the number of lupus patients who experience minor or moderate flares in the nervous system. Researchers from Japan found that the cancer drug rituximab was effective in treating the NPSLE symptoms in a small group of 10 patients. Read more Labels: nervous system, NPSLE, research
~~~ Novel antibodies as markers for lupus activity in the nervous system Novel antibodies as markers for lupus activity in the nervous system From the Annals of the Rheumatic Diseases, April 2007' Diagnosing lupus can be difficult because the symptoms are sometimes similar to those of other conditions. Researchers hoped to learn if antineuronal antibodies (anti-Ns) could be used to diagnose central nervous system involvement in lupus (NPSLE). After looking at blood samples from 198 people, patients who had been diagnosed with lupus had higher levels of anti-Ns in their blood samples than was seen in other study participants. Read more > Labels: nervous system, novel, research
~~~ Lupus and HPV Lupus and HPV From Arthritis & Rheumatism. May 2007 Previous studies have suggested that women with lupus may not be able to produce an effective immune response to HPV. Researchers wanted to determine whether lupus patients are at enhanced risk of HPV infections. In this study of 112 women, researchers found that the women with lupus had a very high rate of infection with a particular sub-type of HPV-16, and those lupus patients who had large amounts of this virus had a higher rate of abnormal cervical smears. Read more >
~~~ Anti-Sm antibodies and lupus disease activity may be important in predicting outcomes Anti-Sm antibodies and lupus disease activity may be important in predicting outcomes From Lupus, March 2007 It is still not possible to predict in advance who will develop lupus and, what course each patient's disease may take. The researchers hoped to sort through several of the probable contributing factors that could help predict the progression and severity of disease activity among lupus patients.Researchers in Canada studied the records of 330 patients from three different racial and ethnic groups who were diagnosed with lupus in Manitoba, Canada, over a period spanning more than 20 years and noted a number of differences among the three ethnic groups. Read more >
~~~ At risk for thrombosis: FXII autoantibodies and the antiphospholipid syndrome At risk for thrombosis: FXII autoantibodies and the antiphospholipid syndrome From the Annals of the Rheumatic Diseases, April 2007 People with lupus who have antiphospholipid antibodies (aPL) are at risk for blood clots, including heart attacks, strokes, clots in the legs, lungs, or other organs, and pregnancy complications. Researchers for this study of 127 patients found antibodies to Factor XII (FXII), a protein that plays a role in preventing blood clots, were present in 40% of the lupus patients as opposed to only 7% of the healthy people. Read more > Labels: research, thrombosis
~~~ Low bone density in African American women with lupus Low bone density in African American women with lupus From Arthritis & Rheumatism, May 2007 Women with lupus are at risk for osteoporosis and fractures. It is estimated that as many as 25% of pre-menopausal women with lupus may have osteopenia, or low bone mineral density (BMD), an early sign of osteoporosis. The researchers wanted to determine if African American women with lupus, like their Caucasian counterparts, were at risk for low bone density. In this study of 298 women, the researchers found that African American women were much more likely to have low BMD in the lower back (or lumbar spine) than Caucasian women. Read more
~~~ Puasa Positif Bagi Penyandang Lupus Wednesday, October 11, 2006 Penderita harus hindari makanan asam dan pedas.Ramadhan memang bulan yang paling penuh berkah dan karunia Allah SWT untuk umat Islam. Termasuk juga, para penderita Lupus atau disebut juga dengan penyakit misterius alias penyakit seribu wajah itu. Pasalnya, dengan berpuasa, tubuh penyandang Lupus akan terasa lebih sehat. Bagi penderita Lupus, akan kambuh penyakitnya, bila sistem imun atau kekebalan tubuhnya naik. Akibatnya, antibodi pada tubuh penderita justru menyerang sel-sel jaringan organ tubuh yang sehat. Kelainan ini disebut autoimunitas. Namun, saat berpuasa, sistem imun akan turun sehingga pasien Lupus akan merasa lebih sehat. Menurut Pakar Reumatolog dari Rumah Sakit Hasan Sadikin (RSHS) Bandung, dr Rachmat Gunadi Wahjudi SpPD-KR, berdasarkan hasil survei yang dilakukannya pada pasien Lupus, dari 350 pasien yang menjalankan pengobatan, sekitar 70 persen menyatakan tubuhnya lebih enak dengan berpuasa. Ternyata, kata dia, puasa justru membuat penyakit mereka tidak kambuh. Oleh karena itu, pihaknya menganjurkan kepada pasien Lupus yang dalam keadaan remisi (penyakit dalam keadaan paling ringan atau terkontrol obat) lebih baik menjalankan puasa. ''Dari 350 pasien yang melakukan pengobatan, hanya 30 persen yang tidak dianjurkan berpuasa karena penyakitnya tergolong berat,'' ujar Rachmat kepada Republika. Rachmat mengatakan, pasien Lupus yang penyakitnya tergolong berat adalah mereka yang mengalami gangguan ginjal, gangguan susunan saraf pusat, gangguan hematologi dan lain-lain. Khusus pasien tersebut, kata dia, sebelum menjalankan puasa, harus berkonsultasi ke dokternya apakah kondisinya dalam keadaan baik atau tidak. ''Penyakit Lupus bisa timbul karena gabungan beberapa faktor, baik faktor genetik ataupun dipicu oleh zat kimia yang membahayakan tubuh. Lupus tidak akan bisa sembuh, tapi ada masa remisi,'' ujarnya. Menurut Rachmat, pemicu penyakit Lupus itu banyak, salah satunya penggunaan bahan pengawet pada makanan misalnya formalin, pewarna makanan rhodamin B, penggunaan MSG pada makanan, borax dan benzoate. Zat-zat itu, bila diserap tubuh akan mempengaruhi struktur tubuh jadi autoimun. Kalau kondisi tubuhnya dalam keadaan remisi, Rachmat menganjurkan, sebaiknya berpuasa agar kondisinya bisa lebih baik lagi. ''Saat menjalankan puasa, sebenarnya pola hidup penderita Lupus biasa saja, sama seperti hari biasa. Namun, untuk penderita yang berat, harus menjalankan pola hidup yang lebih hati-hati lagi,'' katanya. Namun, sambung Rachmat, bila penyakit Lupusnya dalam keadaan aktif, sebaiknya tidak berpuasa. Pasalnya, dikhawatirkan bisa membuat penyakit semakin parah. Hal ini, kata dia, karena dalam masa pengobatan, pasien harus mengonsumsi obat secara berlanjut dan tidak teputus. Khusus untuk makanan, kata dia, sangat dianjurkan untuk mengonsumsi makanan empat sehat lima sempurna. Buah-buahan dan sayuran segar harus diutamakan untuk menjaga kondisi tubuh. Untuk penderita Lupus, tidak ada pantangan makanan asalkan mengandung protein, karbohidrat, kalsium, vitamin dan mineral boleh dimakan. ''Semua penderita Lupus saat puasa harus meminum air yang cukup, bisa air putih, teh atau jus buah-buahan. Kalau tidak bisa, sehari delapan gelas, minimal harus meminum air 4-6 gelas sehari karena sangat baik untuk tubuh,'' ujarnya. (kie ) - republika
~~~ Penyakit ini Telah Mengubah Hidup Saya Tuesday, October 03, 2006 Setiap hari kita terpajan jutaan kuman. Namun, kita tetap sehat dan afiat, karena tubuh kita punya sistem kekebalan. Tapi bagaimana jika sistem pertahanan itu tak lagi bisa membedakan kawan dan lawan? Wow, sendi-tulang diserang, ginjal dijegal, sel darah merah dipecah, otak dirusak, kulit pun dibuat sakit!"Penyakit ini betul-betul mengubah pola hidup saya," kata Rusnita Saleh (33), seorang penulis dan konsultan lepas. Wanita yang akrab dipanggil Upay ini mengaku, dulu ia orang yang sangat aktif, produktif, dan bahkan cenderung workaholic. "Dalam sehari saya paling-paling tidur tiga jam," akunya. Tahun 2002, kariernya sebagai trainer di sebuah perusahaan terkemuka sedang menanjak. Tapi ia merasa ada masalah dengan kesehatannya. Satu kali, ia bangun pagi dan kaget melihat wajahnya bengkak sebelah. Badannya demam, tenaganya hilang. Jika terkena sinar Matahari sebentar saja, rasanya mau pingsan. Sebelum itu, ia sudah beberapa kali berurusan dengan rumah sakit. Tiap Lebaran, kakinya mengalami nyeri dan meradang. Tapi waktu itu dokter menduga penyebabnya hanya karena kecapaian. Buktinya, begitu minum obat, artritisnya hilang. Saat hamil pertama, kandungannya gugur. Hamil kedua, ia harus lima kali dirawat inap. Tanpa sebab jelas, badannya gampang sekali merasa lemas. Dari pemeriksaan darah diketahui, hemoglobinnya rendah, padahal ia selalu menyantap makanan bergizi dan rutin berolahraga. Lebih aneh lagi, hemoglobinnya tetap saja rendah, meskipun telah minum obat-obat antianemia. Bukan cuma dia yang dibikin bingung, dokter pun kerepotan mendiagnosis. Dikira tifus, ternyata bukan. Disangka anemia, ternyata bukan juga. Setelah berkali-kali ke dokter dan menjalani berbagai tes, November 2002 ia dinyatakan menderita lupus nefritis (salah satu bentuk lupus eritematosus sistemik, yang biasa disebut "lupus" saja). Sejak itu, ia harus berjuang melawan penyakit yang belum bisa disembuhkan secara medis. Jika si lupus sedang mengamuk, seluruh jarinya terasa nyeri hebat, meskipun hanya dipakai untuk mengetik di komputer. Jika berjalan, ia harus menyeret salah satu kakinya, karena rasa nyeri yang tak tertahankan. Salah satu dokternya bahkan memperkirakan, harapan hidupnya tinggal sekitar tiga tahun. Pada saat yang sama, seorang kawannya meninggal dunia akibat penyakit ini. Nyalinya seolah diuji setiap mendengar berita tentang kawannya sesama ODAPUS (orang dengan lupus) meninggal satu demi satu. Februari 2003, menjelang berangkat haji, ia menulis surat wasiat, berjaga-jaga jika sewaktu-waktu Tuhan memanggilnya. "Saya tidak menyerah, tapi pasrah," ungkapnya. Lima bulan setelah diagnosis itu, ia mengundurkan diri dari pekerjaannya dan merevisi semua ambisi karier berikut ritme hidupnya. Jika sebelumnya ia terbiasa tidur hanya tiga jam sehari, setelah positif lupus, ia harus istirahat sekitar 12 jam sehari dan menjalani pola hidup yang ketat. Gejalanya bermimikri Rusnita hanyalah salah satu dari jutaan orang di dunia yang dibuat sakit oleh antibodi tubuhnya sendiri. Kalangan medis menyebutnya penyakit autoimun. Penyakit ini sedikit seksis, karena lebih banyak menyerang wanita daripada pria. Di seluruh dunia ada jutaan orang yang menderita penyakit autoimun. Menurut Karnen Garna Baratawidjaja, dalam buku Imunologi Dasar (terbitan FKUI), angka kejadiannya diperkirakan sekitar 3,5% dari populasi. Salah satu penyakit autioimun yang populer adalah lupus. Pada orang sehat, antibodi bertindak sebagai tentara yang melindungi tubuh dari serangan kuman. Sedangkan pada ODHA (orang dengan HIV/AIDS), sistem kekebalan itu melemah, sehingga mereka sangat rentan terinfeksi. Pada penderita gangguan autoimun, antibodi menjadi hiperaktif dan liar. Bukan hanya bakteri yang diserang, organ tubuh sendiri pun menjadi sasaran. Karena menyerang kawan sendiri, mereka disebut autoantibodi. Jika sedang liar, autoantibodi ini bisa menjadi ganas. "Manifestasi penyakitnya bermacam-macam," kata dr. Nanang Sukmana, Sp.PD, KAI, pengajar pada Divisi Alergi dan Imunologi Klinik FKUI/RSUPN Cipto Mangunkusumo, Jakarta. Pada sebagian orang, autoantibodi ini menyerang organ tertentu saja, misalnya pankreas atau kelenjar tiroid. Jika menyerang sel pankreas (penghasil hormon insulin), ia bisa menyebabkan diabetes tipe satu (diabetes yang tergantung insulin). Jika menyerang kelenjar tiroid, ia menyebabkan tiroiditis. Sementara pada sebagian orang yang lain, autoantibodi menyerang secara membabi buta, bukan organ tertentu saja. Pada penderita lupus, misalnya, autoantibodi menyerang banyak organ, sehingga gejalanya sangat baragam. Ketika menyerang kulit, ia bisa menyebabkan ruam di wajah dan sekujur tubuh. Dalam kondisi parah, kulit bisa bersisik dan mengelupas, sehingga tampak seperti ular yang sedang berganti kulit. Jika menyerang mukosa mulut, ia menimbulkan seriawan yang tak sembuh-sembuh. Saat menyerang persendian, ia menyebabkan artritis rematoid. Artritis inilah yang menyebabkan Rusnita hanya bisa berjalan dengan satu kaki. Ini pula yang menyebabkan jari-jarinya terasa nyeri, meskipun hanya dipakai untuk mengetik. Lalu jika autoantibodi menyerang sel darah merah, ia menyebabkan anemia. Ini pula yang menjelaskan mengapa anemia Rusnita tak sembuh-sembuh, meskipun ia telah mimun obat-obatan penambah darah. Selanjutnya, jika menyerang ginjal, fungsi filter darah akan menurun. Pada kasus Rusnita, hal itu menyebabkan proteinuria (protein lolos lewat urine) Karena sifatnya yang pandai bermimikri itulah, dokter pun bisa berkali-kali terkecoh. Bisa dikendalikan Hingga kini, penyebab-penyakit di atas masih belum berhasil diungkap tuntas. Obat yang benar-benar menyembuhkan pun belum ditemukan. Obat yang kini tersedia sebatas meredam gejala. Sepertinya kabar buruk. Meski begitu, penyandang penyakit autoimun tetap punya kabar bagus. Walaupun tak bisa sembuh, "Penyakit ini bisa dikendalikan sehingga penderita punya kualitas hidup yang baik," jamin Nanang Sukmana. Ia tidak sekadar asal bicara, tapi telah membuktikan sendiri. Saat awal didiagnosis lupus nefritis, penyakitnya sudah stadium tiga, stadium gawat. Tapi dengan perubahan total pola hidup dan disiplin ketat, kini ia bisa menjalankan aktivitas sehari-hari secara normal. Ia tetap bisa berkebun, memasak, mengurusi anaknya yang masih berumur lima tahun, menulis, menjadi konsultan, bahkan melakukan kegiatan kampanye peduli lupus. Penderita bisa memperoleh kualitas hidup yang baik, asalkan disiplin menjalani terapi farmakologis dan pengaturan pola hidup. "Keduanya sama penting. Jangan sampai hanya mengandalkan obat saja," saran Nanang. Supaya antibodi tidak hiperaktif, ia harus diredam dengan obat-obat imunosupresan. Susahnya, ketika sistem kekebalan ditekan, tubuh jadi lebih gampang terkena infeksi. Ditambah lagi, terapi ini juga menimbulkan efek negatif lain, misalnya risiko pengeroposan tulang dan peningkatan kadar gula darah. Obat-obat tertentu menyebabkan pemakainya mengalami perubahan psikologis menjadi sensitif: gampang marah dan sedih. Karena banyaknya efek negatif ini, terapi penyakit autoimun harus betul-betul menimbang rasio antara risiko dan manfaat. Untuk mencegah pengeroposan tulang, pasien harus mendapat cukup asupan kalsium, baik dari makanan maupun dari suplemen. Selain terapi farmakologis, penderita penyakit autoimun juga harus sungguh-sungguh memerhatikan pola hidupnya. Semua pemicu harus dihindari sejauh-jauhnya. Salah sedikit saja, autoantibodinya bakal mengamuk. Nanang Sukmana dan Rusnita punya beberapa resep. Pertama, hindari stres. Urusan ini memang gampang diucapkan, tapi praktiknya tak semudah bicara. Berdasarkan pengamatan Nanang, kebanyakan pasiennya mengalami perubahan kejiwaan setelah 3 - 6 bulan sejak didiagnosis menderita lupus. Bentuknya mulai dari stres ringan sampai depresi. Umumnya, mereka sedih karena memikirkan penyakit yang mereka derita. Maklum, penyakit ini tergolong berat dan membutuhkan perawatan jangka panjang atau bahkan seumur hidup. Belum lagi masalah sosial akibat penyakit ini. Pada lupus yang menyerang kulit, penderita (terutama wanita) bisa mengalami depresi karena merasa tak cantik lagi. Keadaan itu bakal diperparah oleh fakta, bahwa penderita tidak bisa seproduktif semula. Seperti yang terjadi pada Rusnita yang terpaksa mengundurkan diri dari pekerjaannya. Kondisi itu persis seperti lingkaran setan. Lupus membuat penderita stres. Sedangkan stres membuat lupus semakin berat. Pada pasien dari kelas ekonomi pas-pasan, vonis lupus bisa menimbulkan problem fulus. Sebagai gambaran, saat awal mendapat terapi, Rusnita harus menyiapkan minimal Rp 5 juta tiap bulan. Itu hanya untuk obat, belum biaya perawatan tubuh untuk menghindari efek negatif lupus di kulit. Sekarang, di masa remisi (tahap penjagaan), ia masih harus merogoh kocek minimal Rp 2 juta per bulan. Karena masalah-masalah itulah, dokter, keluarga, dan lingkungan harus turut memberi pengertian dan dukungan agar pasien tetap tenang. Ketenangan jiwa bisa diperoleh lewat banyak cara. Sebagian orang mungkin menemukan ketenangan lewat meditasi dan belajar memahami makna hidup. "Kalau saya, meditasinya salat tahajud," kata Rusnita. Resep kedua, hindari kelelahan. Mirip stres psikis, kelelahan fisik juga bisa membuat autoantibodi tak terkendali. "Orang seperti saya harus strategis mengatur jadwal, jangan sampai capek. Jangan terlalu banyak bikin janji," kata Rusnita. Dalam berolahraga pun, penderita sebaiknya menghindari jenis olahraga yang terlalu membebani tubuh. Yang penting, tubuh terlatih tanpa menimbulkan rasa capek yang berlebihan. Resep ketiga, kembali ke alam. Kita tahu, makanan masa kini banyak mengandung bahan-bahan tambahan sintetis. Bagi tubuh bahan-bahan yang tidak alami itu dianggap sebagai benda asing. Semakin banyak bahan makanan sintetis masuk ke dalam tubuh, semakin besar risiko autoantibodi kembali aktif. "Kalau pingin jeruk, ya makan buah jeruk saja," kata Nanang mencontohkan. Resep keempat, hindari faktor-faktor pemicu lain seperti asap rokok, infeksi, sinar Matahari antara pukul 09.00 - 16.00, dan kontrasepsi oral (pil KB). Yang tak kalah penting, penyakit ini harus dideteksi sedini mungkin. Jika terlambat, dikhawatirkan organ-organ vital telanjur rusak. Dengan mengetahui lebih awal, kerusakan bisa dicegah. Jika memang sudah suratan, autoantibodi boleh ada di dalam badan. Tapi jangan sampai mereka punya alasan untuk menjadi senjata makan tuan. *** Penulis: M. Sholekhudin source : kompas diterbitkan juga di Intisari, Juni 2006
~~~ hidup sehat Many "fat-free" foods actually have the same number of calories as theirregular counterparts. Food manufacturers often replace fat with sugar --leaving the calories the same. And if you're trying to lose weight, that'sno bargain: All calories count. Always check the calories, sugar andcarbohydrate totals on fat-free cookies, cakes and other similar foods.While they are generally better for you than higher-fat products, don'texceed the serving size -- those "fat-free" calories are easily convertedinto fat in your body if you eat too many of them. _____ Which sounds more appealing: dried plums or prunes? Manufacturers have takento calling the tasty prune (which had acquired an indisputable reputation asa digestive cure), the dried plum. It's a terrific source of both solubleand insoluble fiber, magnesium, potassium, and antioxidants. Whatever youcall them, they make a terrific on-the-go snack, mix-in for yogurt, or saladextra! _____ Don't get mad next time someone tells you to "Take a hike!" -- thank themfor the good fitness advice! Hiking gets you out in a natural environment,promotes relaxation and enhances creativity, not to mention toning yourlegs, buttocks and back muscles _____ PARIS (AFP) - Calcium supplements fail to provide long-term strengthening ofbones, according to a study that touches on osteoporosis, a disease commonlyfacing woman after the menopause. The paper, published online by the British Medical Journal (BMJ), is areview of 19 major studies that involved nearly 2,900 healthy children agedbetween three and 18. They included children who were given calcium supplements for at least threemonths and whose bone health was then monitored more than six monthsafterwards. Children taking the supplements only had 1.7-percent better bone density intheir upper limbs compared to counterparts who did not take the extracalcium.This small benefit did persist in the upper limbs, but there was nosignificant effect on the rest of body, particularly at sites such as thehip and lower spine that are prone to fracture later in life.Bone density diminishes among women after the menopause, so doctors are keento boost bone mass early in life through diet and exercise."The small effect of calcium supplementation on bone mineral density in theupper limb is unlikely to reduce the risk of fracture, either in childhoodor later life, to a degree of major public health importance," the papersays. It suggests other dietary paths, such as taking more vitamin D -- producednaturally by the skin's exposure to the Sun and present in oily fish -- andeating more fruit and vegetables.
~~~ Simpler Measures for Predicting Kidney Function May Be Useful Tuesday, September 12, 2006 Simpler Measures for Predicting Kidney Function May Be UsefulIn order to measure how well the kidneys are functioning, doctors frequently use a measurement called the creatinine clearance (CrCl). Creatinine is a breakdown product of creatine, a component of muscles in the body. The way that the kidney eliminates creatinine reflects how well the kidneys are working. The CrCl test compares the level of creatinine in the urine with the creatinine level in the blood. The classic way of doing this takes measurements on a sample of urine that has been collected over a 24-hour period, and compares this to a blood sample drawn at the end of that time. Because creatinine is freely filtered through a well-functioning kidney and not reabsorbed into the bloodstream the way some other proteins are, creatinine clearance can be used to estimate how fast the kidney is filtering out wastes from the body (known as the glomerular filtration rate (or GFR). This is the gold standard by which kidney function is assessed. As kidneys become damaged, the GFR goes down and less creatinine is filtered out, leaving more creatinine in the bloodstream, along with other potentially toxic waste products. Researchers wanted to know whether creatinine clearance (CrCl) that is estimated by different, easier methods agreed with the CrCl measured, using a 24-hour collection of urine. Forty-three lupus patients with mild to moderate kidney disease were studied. For this study, the methods used to estimated creatinine clearances were (1) the Cockcroft-Gault (CG) equation, (2) the Modification of Diet in Renal Disease (MDRD) study equation, and (3) the abbreviated MDRD (aMDRD) study equation. These methods each were compared to the measured CrCl by 24-hour urine collection. The results were that the MDRD and aMDRD methods seemed more accurate than the CG equation. However, there seemed to be a tendency for the MDRD and aMDRD study equations to underestimate CrCl, making the kidneys appear to be functioning more poorly that was indicated using the 24-hour urine collection data. Some, however, would argue that there are some inaccuracies in all of the methods, including the 24-hour urine collection. The take-home message from these studies is that easier methods for measuring kidney function, although not perfect, are reasonably reliable. They certainly can be used and understood in evaluating how patients with kidney disease are doing and in examining the progress over time of people undergoing treatments. This could be of significant benefit in treating patients and also in running clinical trials of new medications. Read the Abstract: http://www.ingentaconnect.com/content/sage/lu/2006/00000015/00000005/art00004 Leung, Y.Y.; Lo, K.M.; Tam, L.S.; Szeto, C.C.; Li, E.K.; Kun, E.W. Source
~~~ Smoking May Be Related to Increased Risk for Developing Lupus Monday, September 11, 2006 Smoking May Be Related to Increased Risk for Developing LupusThat exposure to tobacco smoke is hazardous to health is by no means breaking news, but what may come as a surprise is that smoking has been associated with a number of autoimmune diseases, including rheumatoid arthritis, multiple sclerosis, and autoimmune thyroid disease – and may actually increase a person’s susceptibility to lupus. One current idea is that smoking-related damage to the genetic material in a cell (DNA) will lead to the formation of antibodies to double-stranded DNA (dsDNA), which may in turn have a role in the development of lupus. To examine the relationship between smoking and dsDNA, researchers at the University of California at San Francisco (UCSF) looked at the medical records of 410 lupus patients which had been collected for a large genetics study. These records included a complete self-report of each person’s smoking history and showed the antibodies that had been detected in these patients. The people in this study were all Caucasian. 91 percent were women (reflecting the percentage of lupus patients who are women). Participants were identified as “never smokers” (who had smoked fewer than 100 cigarettes in their lifetime), “former smokers” (who had smoked at least 100 cigarettes in their lifetime, but none in the year during which the antibody testing was performed), and “current smokers” (who had smoked at least 100 cigarettes in their lifetime and had smoked within the calendar year during which the dsDNA testing was performed). The combined group of “former smokers” and “current smokers” was also tagged as “ever smokers.” Antibodies to dsDNA were found in people from all groups, but current smokers had a higher rate (73%) of dsDNA autoantibodies than never smokers (54%) and former smokers (52%). The cumulative amount of smoking did not affect whether these antibodies were seen, nor did the age at which the “ever smokers” first began using tobacco. Since the current smokers in this study appeared to have more dsDNA antibody than former smokers, the researchers suggested that the mechanism by which tobacco smoke alters DNA could be an important factor in what causes these antibodies to be made. Tobacco smoke causes changes in DNA structure, and these altered DNA molecules — called DNA adducts — tend to trigger immune response activity more than “native” (unaltered) DNA. However, unless they are replenished, the DNA adducts eventually will disappear and are usually 50 percent gone after only 9–13 weeks, which means that the former smokers, having been tobacco-free for one year or more, would seem more like never smokers than current smokers. Knowing that at least some of the negative impact of smoking diminishes once a person stops using tobacco sends a strong message in support of programs to quit smoking. Interestingly, lupus patients have higher levels of DNA adducts than people who don’t have lupus, regardless of their smoking history. The findings of this study, though dealing with the relation between smoking and dsDNA autoantibodies, may therefore have implications for understanding what causes lupus in general. Read the Abstract: http://ard.bmjjournals.com/cgi/content/abstract/65/5/581 Freemer, M.; King Jr., T.; Criswell, L., Annals of the Rheumatic Diseases 2006; 65: 581-584
~~~ Open-Label Study of Epratuzumab Shows Promise for Lupus Open-Label Study of Epratuzumab Shows Promise for Lupus Epratuzumab, under development by Immunomedics, Inc., is a treatment that interferes with B cells, a type of white blood cell that is important in lupus. This small, preliminary study tested epratuzumab in 14 patients with moderately active lupus. This study, like many preliminary studies, was an “open label” study. This means that the patient, physician and study team all know for sure that the patient is receiving the treatment and what the dose is. The results are considered preliminary because they are not as scientific as “double-blind” studies in which patients are randomly selected to get the real treatment or a “dummy” treatment (placebo), and the patients and study team do not know which one they are getting. Double-blind studies make it a lot less likely that improvements in symptoms are from wishful thinking. Patients were given epratuzumab every 2 weeks for 18 weeks. The activity of their lupus was measured using a special index measure called the BILAG (which stands for British Isles Lupus Assessment Group). High BILAG scores reflect that a person has a lot of active inflammation or significant symptoms from lupus in one or more organ. In this study the BILAG scores decreased by 50 percent or more in all 14 patients at some point during the study. Almost all patients experienced improvements in disease activity after 6, 10 and 18 weeks of treatment, and 3 patients had no disease activity at all by 18 weeks. Also, it did look as if the drug managed to affect its intended target, since B cell levels decreased by an average of 35 percent at 18 weeks and remained low when measured 6 months after treatment. In this study, patients with mild to moderate active lupus tolerated epratuzumab well and showed some preliminary evidence of clinical improvement after the first dose. Further studies of epratuzumab are now underway. These studies will be larger and more scientific and will help to determine whether this drug is safe and effective. Click here to read the abstract. Thomas Dörner, Joerg Kaufmann, William A. Wegener, Nick Teoh, David M. Goldenberg, and Gerd R. Burmester, Arthritis Research & Therapy 2006;8:R74 Source
~~~ First National Study Shows Need to Monitor Lupus Pregnancies More Closely First National Study Shows Need to Monitor Lupus Pregnancies More Closely Researchers compared pregnancy outcomes in women with lupus and rheumatoid arthritis (RA) to pregnancy outcomes in women with diabetes and in healthy women. The researchers used a large collection of information from the 2002 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project to compare the number of pregnancies among women in these groups around the nation. They also compared the length of time people in each group were hospitalized, the numbers of women who developed high blood pressure or related complications during pregnancy, such as preeclampsia (toxemia), how many women developed premature rupture of membranes, and how many pregnancies in each group led to poor growth of the baby in the mother’s womb. Women with lupus, RA, and diabetes had significantly increased rates of high blood pressure complications compared with the general healthy group, as well as longer hospital stays and significantly higher risk of needing a cesarean section (surgical delivery of the baby). Because women with lupus and RA also have more pregnancy complications, close monitoring of these pregnancies is highly recommended. Click here to read the abstract. Eliza F. Chakravarty, Lorene Nelson, and Eswar Krishnan, Arthritis & Rheumatism 54;3:899-907 Source
~~~ Lupus Vasculitis Underlies Skin Denervation Lupus Vasculitis Underlies Skin Denervation To better understand why some lupus patients develop a loss of nerves in the skin, the researchers of this study measured density of nerve fibers within the skin and looked at the relationship of nerve density to lupus activity, the sensitivity of nerves to touch, and the electric activity associated with the use of different parts of the body. There were 45 lupus patients in the study (4 men and 41 women). Compared with healthy people of the same age and gender, the density of the nerves in the lupus patients was lower. Eleven patients (24.4%) were found to have a kind of inflammation of the blood vessels in the skin (cutaneous vasculitis) which is often found in lupus patients, and the severity and extent of this vasculitis seemed to be associated with lower nerve density. In addition, patients with active lupus had lower nerve density in the skin than those with inactive lupus. Loss of nerve density was found not only in the patients with skin symptoms, but also in the patients with symptoms that affected brain function. In the lupus patients, the sense of touch was less sensitive to the perception of warmth and coldness compared to healthy people. This loss of sensitivity to heat and cold was also associated with reduced nerve densities. In conclusion, blood vessel inflammation in the skin (cutaneous vasculitis) may lead to the loss of nerves in the skin in lupus patients, and this might lead to dysfunction in the perception of heat and cold. This suggests the importance of treating some symptoms of lupus that may otherwise be regarded as low grade and less important in some quarters. Click here to read the abstract. Ming-Tsung Tseng, Song-Chou Hsieh, Chia-Tung Shun, Kuang-Lun Lee, Chun-Liang Pan, Whei-Min Lin, Yea-Hui Lin, Chia-Li Yu, and Sung-Tsang Hsieh Brain 2006;129(4):977-985 Source
~~~ Study Suggests Cyclophosphamide May Be More Effective in Treating CNS Lupus Compared to Methylprednisolone Study Suggests Cyclophosphamide May Be More Effective in Treating CNS Lupus Compared to Methylprednisolone The authors of this paper conducted a systematic review of the scientific literature to assess the safety and effectiveness of cyclophosphamide compared to methylprednisolone to treat neuropsychiatric lupus (lupus that affects the central nervous system). They identified one study which involved thirty two patients that were randomly divided into two groups. One group was treated with cyclophosphamide by IV (intravenous or through a vein) and the other group was treated with steroids (methylprednisolone by IV). All participants were on oral steroids (prednisone) at the beginning of the study and their dose was decreased over the two-year duration of the study. Study results showed that more of the IV cyclophosphamide patients improved than did the patients on methylprednisolone. Eighteen of 19 patients (95 percent) on cyclophosphamide had at least a 20 percent improvement in their symptoms, compared to only six of 13 patients (46 percent) on methylprednisolone. Disease activity, seizures and central nervous system damage also decreased more among patients receiving cyclophosphamide. After six months of treatment, the patients on cyclophosphamide took less prednisone than the patients on methylprednisolone. Side effects, such as infections, high blood sugar and high blood pressure occurred about the same amount in people who took cyclophosphamide or methylprednisolone. The results of this small study suggest that cyclophosphamide may improve symptoms of central nervous system lupus more than methylprednisolone. However, due to the limitations of the study, these results must be confirmed by additional studies involving a larger number of patients. Click here to read the abstract. V.F. Trevisani, A.A. Castro, J.F. Neves Neto, A.N. Atallah, Cochrane Database System Review, 2006, April 19;(2) CD002265 Source
~~~ Kemajuan Pengobatan Penyakit Lupus Thursday, June 29, 2006 Kemajuan Pengobatan Penyakit Lupus
~~~ healthy life Tuesday, June 20, 2006 Monosodium glutamate, or MSG, is a flavor enhancer that adds a meaty orbroth-like flavor to certain foods. Some individuals are sensitive to thisenhancer. Limit your intake by asking for meals prepared without MSG andchecking the ingredient list on food labels. MSG has less sodium than salt,but it should still be avoided.(MSG can trigger migraines.)* Put just a few more veggies on your plate, and you can reduce your diseaserisk. People who live in regions where vegetable consumption is greatestlive the longest. How can you eat more veggies? Toss a bag of baby carrotsinto your bag or briefcase, and nibble on them throughout the day. Addfrozen vegetables to canned soup. Add crunch and brilliant green color tosalads with snow peas and sugar snap peas -- first cook them briefly, thenrefresh them under cold running water. * Dark meat chicken, or any chicken eaten with the skin, can have just as muchartery-clogging saturated fat as red meat. For the healthiest poultry meal,choose white meat and remove the skin before eating. For the best taste,though, cook the bird with the skin intact -- this will help retain themoisture in the meat, and won't affect the fat or calories.(When you roast a whole chicken or turkey, put it in breast side down. The most fat is in the back and when cooking it this way it will moisten thebreast meat naturally.)
~~~ chronic fatique syndrome Sunday, June 18, 2006 Orang dengan lupus seringkali dicap sebagai "si pemalas" karena seringnya sakit dan kecapekan.Berikut ada cerita resmi mengenai CFS (chronic fatique syndrome) - sindrom capek kronis yang sering menyerang odapus. For the full story: First official death from chronic fatigue syndrome http://www.newscientist.com/article.ns?id=dn9342 Their message: Hey all......I thought that this was extremely interesting and thought it warranted passing along. NewScientist.com is the world's leading online science and technology news service, with a global network of award-winning journalists. Visit www.newscientist.com now for constantly updated and authoritative reporting that's both fast and fascinating.
~~~ Mengenal Lupus Si Penyakit Misterius : Penderitanya Terus Bertambah Wednesday, May 24, 2006 Mengenal Lupus Si Penyakit Misterius : Penderitanya Terus BertambahGejala awal lupus yang sering menyerupai penyakit lain sehingga kerap di sebut ''penyakit seribu wajah''. Pertanyaan-pertanyaan tersebut, menandakan ketidaktahuan masyarakat terhadap penyakit lupus. Padahal, penyakit yang sudah dikenal oleh ahli kedokteran sejak abad ke-19 itu bisa menyebabkan kematian. Dunia internasional sudah menganggap penyakit lupus ini sebagai penyakit yang harus diwaspadai. Kepedulian itu, diperlihatkan dengan mulai mencanangkan hari Lupus Sedunia pada 10 Mei 2004. Yayasan Syamsi Dhuha berkampanye membagikan stiker Care for Lupus di tiga titik jalan yang ada di Kota Bandung untuk menyambut hari tersebut. Menurut hematolog dari Rumah Sakit Hasan Sadikin (RSHS) Bandung dan pemerhati lupus, dr Rachmat Gunadi Wacjudi Sp PD KR, lupus adalah penyakit autoimun yang terjadi karena sistem kekebalan tubuh beraksi berlebihan dan justru mengganggu kesehatan tubuh. Seharusnya, kata dia, sistem imun itu bertugas melindungi tubuh manusia dari serangan antigen (musuh berupa bakteri, virus, mikroba dan lain-lain). ''Belum ada yang mengetahui penyebabnya, pada lupus zat anti dan sel darah putih justru menjadi liar dan menyerang tubuh yang seharusnya dilindungi. Akibatnya, organ tubuh menjadi rusak dan gejala lupus muncul,'' katanya. Si peniru ulungGejala penyakit lupus, kata Rachmat, sering menyerupai penyakit lain. Sehingga, penyakit ini sering dijuluki ''si peniru ulung'' atau ''penyakit seribu wajah''. Untuk mendiagnosis penyakit lupus dengan pasti, diperlukan pemeriksaan darah atau biopsi kulit. Namun, lanjut Rachmat, gejala awal lupus yang sering timbul adalah ruam merah simetris pada wajah berbentuk seperti kupu-kupu, penebalan berbentuk koin pada kulit yang sering terkena matahari dan hipersensitif terhadap sinar matahari, sariawan yang hilang timbul, nyeri sandi, nyeri dada saat menarik nafas, kejang-kejang, terdapat kelainan darah, kelainan sistem kekebalan tubuh, dan tes ANA menunjukkan abnormalitas. ''Sampai sekarang, penyakit lupus belum bisa disembuhkan atau dicegah. Yang bisa dilakukan baru sebatas menghilangkan gejalanya. Yaitu, dengan mengkonsumsi obat-obatan seumur hidup, menjalani pola hidup tertentu dan menghindari stres,'' ujarnya. Jumlah penderita lupus, kata Rachmat, berdasarkan data terakhir di seluruh dunia sebanyak 5 juta. Sedangkan di Indonesia, jumlah penderitanya diperkirakan sekitar 200 ribu-500 ribu. Angka itu, diperoleh dari perbandingan 1:1.000, yang artinya dari 1.000 orang penduduk Indonesia di duga satu orang terkena lupus. Perkiraan jumlah penderita itu muncul karena, bangsa Indonesia adalah bangsa dengan kulit berwarna. ''Di Jabar sendiri jumlah penderita lupus saat ini yang terdata mencapai 700 orang. Setiap bulan misalnya di RSHS selalu ada 10 pasien lupus baru, pasien lupus di RSHS sampai sekarang sudah mencapai 380 orang,'' kata Rachmat. Harapan hidup penderita lupus, kata dia, tergantung dari kondisi pasien. Di Amerika Serikat dan Eropa pada 1955 harapan hidup penderita lupus dalam kurun waktu lima tahun, kurang dari 50 persen. Sementara, pada 1991 telah mencapai 89-97 persen. Hal itu, terjadi karena adanya diagnosis lebih dini dan metode pengobatan yang lebih baik. ''Penyakit lupus kalau menyerang ke otak, ginjal dan organ tubuh penting lainnya akan membutuhkan biaya yang mahal. Obatnya, sehari membutuhkan dana Rp 300-500 ribu,'' ujar Rachmat. Kelompok yang peduli terhadap penyakit lupus, kata dia, masih masing-masing belum terorganisir dengan baik. Padahal, penderita lupus membutuhkan penanganan yang menyeluruh tidak hanya menangani sakitnya saja. Berdasarkan hasil penelitian terbaru, dari 180 penderita lupus di RSHS yang diteliti sekitar 40 persennya mengalami depresi. Depresi itu terjadi karena cemas, ketakutan, bingung dan lain-lain. ''Di RSHS, kami mulai membentuk tim yang terdiri dari multidispliner. Anggota tim itu terdiri dari dokter, psikolog, dan semua stake holders yang peduli lupus,'' katanya. Selain mengalami depresi, kata dia, hasil penelitian terbaru pun menunjukkan 50 persen penderita lupus mengalami osteoporosis. Padahal, penderita lupus rata-rata masih berusia muda. Yaitu, paling banyak berusia 17-35 tahun. Meskipun, memang rentang penderita lupus itu pada usia 6-73 tahun. Namun, usia yang tergolong anak-anak dan manula kasusnya sedikit. Meneliti mahkota dewaSementara itu, menurut Sekretaris Program Farmasi ITB Dr I Ketut Adnyana, penelitian obat-obatan untuk penderita lupus masih jarang dilakukan. Karena, penyakit lupus masih asing untuk masyarakat termasuk peneliti. Namun, setelah mengetahui tentang penyakit itu ITB mulai mengembangkan penelitian untuk mencari obat yang bisa membantu meringankan penderita lupus. ''Salah satu tumbuhan yang sedang kami selidiki untuk obat radang penderita lupus adalah mahkota dewa,'' ujar Ketut. Mahkota dewa, sambung Ketut, memiliki senyawa yang sama dengan obat antiradang kimia. Kalau menggunakan obat antiradang kimia secara terus-menerus, kata dia, bisa menimbulkan efek samping. Sementara, kalau mengunakan mahkota dewa tidak akan ada efek samping sama sekali. Memang, Mahkota dewa tidak bisa mengobati penyakit lupus secara keseluruhan. Namun, bisa digunakan untuk terapi menyembuhkan radang. ''Penelitian kami sudah hampir selesai, yaitu tinggal melakukan uji klinis agar bisa diketahui seberapa besar keefektifan mahkota dewa itu. Namun, kami terhambat mengenai dana,'' katanya. Untuk melakukan uji klinis itu, kata dia, diperlukan dana sekitar Rp 150-200 juta. Kemungkinan besar, ITB akan bekerjasama untuk mendanai uji klinis itu. Setelah diuji klinis, kata dia, dalam waktu dua bulan obat sudah bisa dikonsumsi dan diproduksi secara masal. ''Indonesia itu kaya akan tumbuhan yang bisa menyembuhkan berbagai penyakit. Kami yakin pasti ada tumbuhan yang bisa menyembuhkan penyakit lupus atau mengendalikan sistem imun tubuh tapi tentunya harus dilakukan penelitian,'' ujarnya. (kie ) Minggu, 14 Mei 2006 - Republika
~~~ Sakit Lupus Ginjal Sakit Lupus Ginjal Yth Dr. Zubairi, Adik saya, 22 tahun, baru saja menikah, diketahui sakit lupus sejak setahun yang lalu. Waktu itu gejalanya, rambut rontok dan sakit pada sendi-sendi serta ditemukan jumlah sel darah putih yang kurang. Setelah berobat ke dokter kondisinya pulih, bisa bekerja normal kembali. Dua bulan lalu timbul bengkak-bengkak pada tungkai dan betisnya, serta perut. Menurut dokter, ditemukan kebocoran albumin pada ginjal. Dianjurkan untuk biopsi ginjal. Hasil patologi menunjukkan adik saya sakit lupus ginjal kelas V. Terus terang kami sekeluarga khawatir sekali karena menurut informasi yang kami dapatkan lupus ginjal termasuk lupus yang berat. Sedangkan lupus berat kelas V bayangan kami tentu saja lebih berat dari kelas di bawahnya. Bagaimana saran dokter? Beny, Jakarta Assalamualaikum wr wbKali ini pertanyaan yang dipilih, sekali lagi mengenai lupus, dalam rangka menyambut Hari Lupus Sedunia tanggal 10 Mei. Lupus ginjal adalah salah satu manifestasi yang serius dari penyakit lupus. Sebenarnya, jika dilihat dengan mikroskop sebagian besar pasien lupus mengalami kelainan pada ginjalnya, namun umumnya tidak menunjukkan gejala. Saya kira Anda sudah mengetahui bahwa penyakit lupus terjadi akibat senyawa kekebalan tubuh (antibodi) yang seharusnya melindungi tubuh malah merusak tubuh sendiri. Pada lupus ginjal, antibodi berkumpul membentuk kompleks antibodi. Kompleks ini menempel pada jaringan ginjal sehingga memicu respons peradangan dari ginjal. Respons inilah yang dapat dilihat gambarannya melalui biopsi kemudian dibuat kelas-kelasnya sesuai gambaran yang didapatkan. Walaupun lupus ginjal adalah hal yang serius, namun bukan berarti tidak dapat disembuhkan. Dahulu, memang harapan kesembuhannya kecil, tetapi dengan kemajuan pengobatan saat ini harapan hidup pasien dapat menjadi lebih lama. Angka harapan hidup 5 tahun adalah 85 persen dan 10 tahun sebesar 73 persen. Setelah saya konsultasikan dengan dokter penyakit dalam yang konsultan ginjal hipertensi, informasinya sebagai berikut. Lupus ginjal ternyata bukan satu kelompok penyakit yang seragam, ada yang relatif ringan, ada yang berat sekali. Lebih rincinya sebagai berikut, lupus ginjal dibagi menjadi 5 kelas, tergantung dari hasil biopsi. Itu berarti pasien dengan lupus ginjal, sebaiknya dibiopsi agar pengobatan lebih tepat. Untuk lupus ginjal kelas V, seperti hasil biopsi adik Anda, ternyata bukan jenis yang terberat. Pengobatannya seperti penyakit lupus sistemik yang lain, prednison selama 1-3 bulan, bila hasilnya baik, kemudian secara bertahap dosisnya diturunkan menjadi dosis rendah selama 1-2 tahun. Bila hasil bulan pertama kurang memuaskan, dapat dikombinasikan dengan obat lain, misalnya azatioprin, mikofenolat mofetil, siklofosfamid, klorambusil, atau siklosporin. Hal lain yang perlu diperhatikan dalam pengobatan lupus ginjal adalah mengobati hipertensi secara agresif. Hipertensi bila tidak diobati dapat memperberat kerusakan di ginjal, dan juga organ tubuh yang lain, misalnya otak dan jantung. Obat hipertensi golongan penghambat ACE, dianjurkan untuk mengurangi kebocoran ginjal, obat hipertensi golongan yang lain akan diberikan oleh dokter bila ditemukan gangguan fungsi ginjal yang nyata. Bila kolesterol tinggi, sebaiknya membatasi makanan yang berlemak. Selain itu, bila lupus ginjal belum terkontrol baik, sebaiknya adik Anda tidak hamil dulu, karena dapat memperburuk kondisi penyakitnya. Sekadar informasi, untuk lupus ginjal kelas I, tidak memerlukan pengobatan khusus. Untuk kelas II, dapat diberikan prednison dosis rendah atau menengah, kemudian diturunkan dosis bertahap. Lupus ginjal kelas III dan IV termasuk penyakit lupus yang mempunyai risiko untuk progresif memburuk dan karena itu memerlukan pengobatan yang agresif. Namun, untuk kelas ini pun, sekarang telah dicapai banyak kemajuan, artinya kondisi kesehatan dapat diperbaiki secara bermakna bila pengobatannya tepat. Yaitu kombinasi antara prednison dan obat-obat lain (siklofosfamid dan sebagainya) dan bila diperlukan disertai hemodialisis. Bila masih ada yang ingin ditanyakan, dapat konsultasi ke Divisi Ginjal Hipertensi, Departemen Penyakit Dalam FKUI-RSUPN Cipto Mangunkusumo, Jakarta. Source: Republika
~~~ Penanganan Lupus Harus Komprehensif Penanganan Lupus Harus Komprehensif Bandung, Kompas - Untuk hasil yang efektif, penanganan penyakit lupus atau systemic lupus erythematosus harus komprehensif. Untuk itu, Rumah Sakit Hasan Sadikin Bandung merencanakan membentuk tim penanganan lupus terpadu. Dokter Rachmat Gunadi SpPd, dokter pemerhati lupus dari Rumah Sakit Hasan Sadikin (RSHS) Bandung, Kamis (4/5), menjelaskan, lupus merupakan penyakit kelainan imunitas yang berpotensi menyerang seluruh bagian sistem tubuh manusia, baik jaringan, organ, darah, saraf, tulang, otak, maupun sel darah. Penyakit yang hanya bisa dikendalikan dan belum dapat disembuhkan ini berpotensi menimbulkan gejala atau varian baru seperti efek osteoporosis (penuaan tulang) hingga depresi. "Maka, tidak mengherankan jika disebut penyakit dengan seribu wajah," ujar Rachmat. Mengindentifikasi penanganan penyakit lupus tidak mudah. Setiap individu memiliki gejala (symptom) maupun faktor pencetus yang berbeda-beda tergantung jenis gen, daya imun ataupun sistem tubuh yang diserang. Penyakit ini tidak menular, melainkan dapat diturunkan melalui faktor genetik. "Penanganan idealnya komprehensif, tidak hanya dengan pendekatan reumatology (persendian), hematology (sel darah), nefrology (ginjal), dermatology (kulit), tetapi juga dengan ilmu neurologi atau psikologi. Sebab, 40 persen penderita lupus biasanya terkena depresi atau gangguan psikologis," katanya menambahkan. RSHS saat ini tengah membentuk tim penanganan lupus terpadu yang beranggotakan 21 dokter spesialis dari berbagai disiplin keahlian maupun fungsi. RSHS juga akan membuka klinik khusus penanganan lupus. "Ini memudahkan koordinasi dan peningkatan awareness. (kesadaran). Selain itu, melalui poliklinik dan pembentukan tim diharapkan dapat menghasilkan penelitian maupun kajian yang akan memberi sumbangsih terhadap ilmu penanganan penyakit lupus," ujar Rachmat. Namun, lanjut Rachmat, pembentukan tim tersebut jangan ditafsirkan bahwa penderita akan menjadi obyek penelitian. RSHS mencatat, terdapat sekitar 380 orang penderita lupus. Setiap bulan rata-rata bertambah 10 pasien baru. Menurut Dian Syarief, Ketua Yayasan Syamsi Dhuha (support group odapus), jumlah odapus (orang dengan lupus) di Jawa Barat lebih dari 700 orang. Tingginya angka kematian pada penderita lupus juga patut mendapat perhatian. Berdasarkan data RSHS, satu persen kasus lupus berakibat kematian. Sementara pada kasus lupus kronis, seperlima dari jumlah penderita lupus biasanya tidak mampu tertangani dan akhirnya meninggal. (jon) Source: http://www.kompas.com/kompas-cetak/0605/05/Jabar/1874.htm
~~~ Takut Meninggal karena Lupus Takut Meninggal karena Lupus Yth. Dr. Zubairi, Saya sudah sakit lupus sejak 3 tahun yang lalu. Usia saya sekarang 28 tahun. Waktu itu gejala yang menyolok adalah rambut rontok, sakit sendi, dan sariawan hilang timbul. Trombosit turun sampai 70 ribu. Saat ini saya masih minum prednison 3 tablet tiap pagi, selang-seling, sehari minum sehari tidak. Kondisi saya saat ini baik sekali, saya bekerja di sebuah perusahaan elektronik dan dapat bekerja seperti teman-teman saya yang lain. Namun, satu bulan ini saya sangat khawatir takut meninggal. Ada 2 teman saya sesama odapus yang meninggal baru-baru ini. Pertanyaan saya: 1. Mengapa pasien lupus bisa meninggal? 2. Berapa lama sampai penyakit saya menjadi parah sehingga dapat meninggal? 3. Apa yang harus saya lakukan untuk mencegahnya? VitaJakarta Assalamu'alaikum wr.wb.Mbak Vita yang baik,Sebenarnya sebagian besar orang dengan lupus (odapus) dapat terkontrol baik dengan pengobatan, baik dengan prednison saja, ataupun dengan pengobatan kombinasi (prednison dikombinasikan dengan obat lain seperti siklofosfamid, azatioprin,dll). Bahkan sebagian kecil pasien dapat lepas obat, artinya tidak perlu minum obat lagi secara rutin. Sebagian kecil (kurang dari 10%) memang penyakitnya berat dengan komplikasi dan dapat berakhir dengan kematian. Penyebab kematian pada odapus adalah penyakit lupus berat yang menyerang ginjal, otak, paru, dan jantung. Beberapa kondisi yang sering menyebabkan kematian adalah sebagai berikut. Pertama, adalah lupus dengan manifestasi pada ginjal yang berat di mana terjadi kebocoran albumin di ginjal. Kadar albumin darah menjadi rendah sehingga kemudian timbul bengkak-bengkak pada kaki, perut dan mata. Kelompok yang disebut lupus nefritis ini ada yang dapat ditolong dengan prednison saja, namun sebagian perlu siklofosfamid dilanjutkan azatioprin atau mikofenolat mofetil. Untuk mengetahui pasien mana yang butuh pengobatan yang lebih agresif dibutuhkan biopsi ginjal. Masalahnya pengobatan yang tepat seringkali tidak dilakukan. Pertama, karena banyak yang tidak terdeteksi sebagai penyakit lupus sehingga pengobatan tidak tepat. Kedua, banyak pasien yang menolak biopsi ginjal. Manifestasi lupus lain yang dapat menyebabkan kematian adalah jika penyakitnya melibatkan susunan saraf pusat. Akibatnya terjadi kejang-kejang, suhu tubuh meningkat, dan penurunan kesadaran. Kelainan darah, yaitu tromboemboli (timbul bekuan darah yang menyumbat aliran darah di pembuluh darah) juga seringkali menjadi penyebab kematian pada odapus. Akibat bekuan darah tersebut dapat terjadi serangan jantung dan stroke pada odapus yang berusia muda. Penyakit jantung terjadi pada 6-9% odapus dan merupakan penyebab kematian sekitar 36% dari seluruh penyebab kematian pada lupus. Kadang-kadang, bekuan darah ini juga bisa menyebabkan abortus dan luka bergaung (borok yang dalam) di kaki. Dari data yang Mbak Vita kirimkan, Mbak Vita tidak termasuk kelompok risiko tinggi untuk terjadinya kematian akibat lupus. Jadi, tidak perlu khawatir. Yang harus dilakukan adalah selalu menjaga pola hidup sehat (makan bergizi dan teratur, istirahat cukup, olahraga teratur) serta selalu kontrol teratur ke dokter. Kontrol teratur perlu dilakukan agar setiap kelainan yang mungkin terjadi dapat segera dideteksi dan diberikan pengobatan yang tepat. Yang paling penting pula adalah selalu berpikir positif serta menjalin hubungan dan komunikasi yang baik dengan teman, saudara, dan keluarga. Prof dr Zubairi Djoerban SpPD KHOM Source: Republika
~~~ Let's Do It Healthy Wednesday, April 19, 2006 Let's Do It HealthySlow down your eating. Have you ever eaten one of your favorite foods without really tasting it? Many of us lead busy lives, juggling work and family. We function on autopilot? And wind up overeating. Pay attention to your body's signals of hunger and fullness. Eat slowly. Put your fork down between bites. Turn off the TV and ignore the phone. Savoring a healthy meal is truly caring for you. ------------------------------------------------------------------------ Want to tone your lower body, enhance circulation and strengthen your heart today? Ride your bike! Regular cycling also improves your cholesterol profile, lowers your blood pressure, reduces the risk of heart disease and colon cancer, and helps control your weight. ------------------------------------------------------------------------ So-called "enhanced" drinks may have less than meets the eye. The amountof ginseng in your water, ginkgo in your iced tea or Echinacea in your juice is far below the recommended levels claimed to affect energy, memory, immunity or anything else. The problem for drink makers: Often, adding enough would affect taste. ------------------------------ ----------------------------------------- Eating healthy doesn't mean you can never eat fast food again. The key understands what you're ordering. Grilled chicken sandwiches and salads with low-fat dressing are good choices to keep calories in check. Request nutrition information at the restaurant, which will help you make informed decisions. It may surprise you to learn a large burger with fries has more artery-clogging saturated fat than nutritional guidelines suggest you should eat in an entire day. ------------------------------------------------------------------------ I was asked to find a daily food intake diary. Here is one I found. http://www.low-fat-recipes.com/downloads/ Anyone use one they like better? taken from Lupus mailing list ..
~~~ Stem cell transplants offer hope against lupus Wednesday, February 01, 2006 Stem cell transplants offer hope against lupus21:00 31 January 2006 NewScientist.com news service Roxanne Khamsi Scientists claim that they have achieved landmark success with an experimental approach, using a patient’s own stem cells, to fight the life-threatening autoimmune disease lupus. The treatment substantially improved the condition of about half of the lupus patients, all of whom had stopped responding to standard therapy. But the treatment still carries real risks and medical experts caution against calling it a cure. The study offers “a potential ray of hope” for lupus sufferers who do not respond to standard measures, says Duane Peters at the Lupus Foundation of America. “We hope to see a follow-up study that can determine whether this treatment is superior to other aggressive types of care and to compare the safety of these alternatives,” he adds. Systemic lupus erythematosus is an autoimmune disorder in which patients’ immune cells start attacking their own tissues. Symptoms range from joint pains to organ failure. Doctors have tried treating this rare disease with drugs that suppress the immune system, but not all patients respond to such medications. High-dose chemotherapy Richard Burt of the Northwestern School of Medicine in Chicago, US, and his colleagues recruited 50 people with severe lupus for which standard treatment had failed. In an attempt to “reset” the immune system, researchers first harvested and separated bone marrow stem cells from the patient’s own blood. These cells develop into immune cells. The next step of the process – called autologous hematopoietic stem cell transplantation, or HSCT – involved intensive chemotherapy sessions. This high-dose chemotherapy destroys a person’s immune response and requires hospitalisation to avoid catching any viruses or bugs during this vulnerable period. Next, medical experts reintroduced the patient’s immune cells into their body intravenously. Only 48 of the 50 participants in the study made it to this step – one died of the illness itself before beginning HSCT and another died due to complications following the first step of the procedure. Mortality rate Once returned to the body, the stem cells repopulated the bone marrow and reform a functioning immune system. According to Burt, the transplanted stem cells can avoid developing into cells with dangerous autoimmune traits because their genes do not necessarily predetermine the disease. Of the patients who received this full treatment, the overall five-year survival was 84% and the probability of disease-free survival during those five years was 50%. This is not the first time that researchers have attempted HSCT therapy to fight lupus. A European trial published in 2004 reported similar levels of remission, but it also involved a much higher treatment-related mortality rate of 13%. The new study reports a treatment-related mortality rate of 2%. Burt and his colleagues attribute their success to a careful adaptation of the chemotherapy – typically used for cancer patients – to meet the specific needs of people with lupus. The team says that these preliminary results provide the justification for a randomised trial to compare HSCT for lupus with standard treatment. Journal reference: Journal of the American Medical Association (DOI: 10.1001_JAMA.295.5.527) Source: http://www.newscientist.com/article.ns?id=dn8657
~~~ healthy life Sunday, January 01, 2006 By changing the way you snack, you may make it easier to lose weight. Eating
~~~ Kemoterapi dan Lupus Wednesday, December 21, 2005 Assalamualaikum wr wb Tina, Bogor Waalaikumussalam wr wb Oleh karena itu, obat yang diberikan bisa sama, bisa pula diberikan tambahan obat yang berbeda, sesuai dengan gejala yang muncul. Prednison, yang merupakan obat golongan kortikosteroid, adalah obat yang cukup sering diperlukan oleh Odapus. Dosisnya tentu disesuaikan oleh dokter, tergantung dari gejala yang timbul dan respons dari pasien. Namun terkadang dibutuhkan obat-obat lain seperti obat antimalaria dan obat sitotoksik yang juga digunakan sebagai obat kemoterapi pada pasien kanker. Pemberian suatu obat, didasarkan pada mekanisme kerjanya. Jadi, mungkin saja obat yang sama digunakan untuk dua penyakit yang kelihatannya berbeda, misalnya parasetamol yang dapat digunakan untuk menurunkan demam juga menghilangkan nyeri. Yang digunakan sebagai dasar pemberian obat pada lupus adalah jika obat tersebut efektif untuk menekan sistem imun (kekebalan tubuh). Saya kira Mbak Tina sudah mengetahui bahwa penyakit lupus disebabkan karena adanya antibodi (zat kekebalan tubuh) yang bekerja berlebihan sehingga menyerang organ-organ tubuh yang sehat. Untuk itu, diperlukan obat yang dapat menekan sistem kekebalan tubuh tersebut agar tidak berlebihan bekerja. Obat sitotoksik pada Odapus berperan sebagai imunosupresan, artinya berperan untuk menekan sistem imun pada tubuh. Obat imunosupresan biasanya diberikan untuk mengatasi gejala yang berat, di mana dibutuhkan pemberian obat golongan kortikosteroid (prednison) dosis tinggi. Padahal, dosis prednison yang terlalu tinggi dapat menimbulkan efek samping yang berat, yang mungkin bisa lebih berbahaya dibandingkan penyakitnya. Oleh karena itu, diberikan obat imunosupresan dalam jangka waktu tertentu (biasanya paling lama enam bulan) untuk mengganti atau diberikan bersama-sama dengan prednison sehingga dosisnya tidak usah terlalu tinggi. Jadi, obat imunosupresan dalam pengobatan lupus berguna untuk mengontrol aktivitas penyakit pada organ-organ vital seperti ginjal, otak, jantung, dan paru, serta dapat mengurangi atau meniadakan kebutuhan akan obat kortikosteroid. Dokter tentu akan memberikan obat imunosupresan, juga obat-obat lain, dengan hati-hati, setelah mempertimbangkan manfaat dan risikonya. Jika penyakit telah terkontrol, dapat saja pemberian obat-obatan dihentikan dan yang perlu dilakukan adalah menjaga asupan nutrisi dan pola hidup.
~~~ healthy life ? why not!
Smoked pressed tofu products make it easier than ever to add near-perfect >>>
>>>
>>>
~~~ INCREASED PREVALENCE OF HEART ATTACKS IN LUPUS PATIENTS Thursday, December 01, 2005 INCREASED PREVALENCE OF HEART ATTACKS IN LUPUS PATIENTS
~~~ Immune Thrombocytopenic Purpura (ITP)
Immune Thrombocytopenic Purpura (ITP) is a disorder of the blood. Immune refers to the immune system's involvement in this disorder. Antibodies, part of the body's immunologic defense against infection, attach to blood platelet, cells that help stop bleeding, and cause their destruction. Thrombocytopenia refers to decrease in blood platelet. Purpura refers to the purplish- looking areas of the skin and mucous membranes (such as the lining of the mouth) where bleeding has occurred as a result of decreased platelet. Some cases of ITP are caused by drugs, and others are associated with infection, pregnancy, or immune disorders such as systemic lupus erythematosus. About half of all cases are classified as "idiopathic," meaning the cause is unknown. The main symptom is bleeding, which can include bruising ("ecchymosis") and tiny red dots on the skin or mucous membranes ("petechiae"). In some instances bleeding from the nose, gums, digestive or urinary tracts may also occur. Rarely, bleeding within the brain occurs. The physician will take a medical history and perform a thorough physical examination. A careful review of medications the patient is taking is important because some drugs can be associated with thrombocytopenia. A complete blood count will be done. A low platelet count will establish thrombocytopenia as the cause of purpura. Often the next procedure is a bone marrow examination to verify that there are adequate platelet-forming cells (megakaryocyte) in the marrow and to rule out other diseases such as metastatic cancer (cancer that has spread to the bone marrow) and leukemia cancer of the blood cells themselves). Another blood sample may be drawn to check for other conditions sometimes associated with thrombocytopenia such as lupus and infection. Acute and Chronic Form of Thrombocytopenic Purpura Acute (temporary) thrombocytopenic purpura is most commonly seen in young children. Boys and girls are equally affected. Symptoms often, but do not necessarily, follow a viral infection. About 85 percent of children recover within 1 year and the problem doesn't return. Thrombocytopenic purpura is considered chronic when it has lasted more than 6 months. The onset of illness may be at any age. Adults more often have the chronic disorder and females are affected two to three times more than males. The onset of illness may be at any age. If the doctor thinks a drug is the cause of the thrombocytopenia, standard treatment involves discontinuing the drug's use. Infection, if present, is treated vigorously since control of the infection may result in a return of the platelet count to normal. The treatment of idiopathic thrombocytopenic purpura is determined by the severity of the symptoms. In some cases, no therapy is needed. In most cases, drugs that alter the immune system's attack on the platelet are prescribed. These include corticosteroids (i.e., prednisone) and/or intravenous infusions of immune globulin. Another treatment that usually results in an increased number of platelet is removal of the spleen, the organ that destroys antibody-coated platelet. Other drugs such as vincristine, azathioprine (Imuran), Danazol, cyclophosphamide, and cyclosporine are prescribed for patients only in the severe case where other treatments have not shown benefit since these drugs have potentially harmful side effects. Except in certain situations, (e.g., internal bleeding and preparation for surgery), platelet transfusions usually are not beneficial and, therefore, are seldom performed. Because all therapies can have risks, it is important that overtreatment (treatment based solely on platelet counts and not on symptoms) be avoided. In some instances lifestyle adjustments may be helpful for prevention of bleeding due to injury. These would include use of protective gear such as helmets and avoidance of contact sports in symptomatic patients or when platelet counts are less than 50,000. Otherwise, patients usually can carry on normal activities, but final decisions about activity should be made in consultation with the patient's hematologist. Where Can I Obtain Further Information on ITP? Blood specialists (hematologists) are experts in the diagnosis and treatment of these disorders. These doctors practice in most mid- and large-size cities. A majority of medical centers have hematology divisions in their medicine or pediatrics departments, and patients who need evaluation, treatment, or information can often be referred there. source
~~~ Tidurlah.. Tuesday, November 29, 2005 Banyak orang menganggap kurang tidur merupakan hal biasa padahal menurut sebuah penelitian dari Universitas Pennsylvannia, kekurangan tidur sama berbahaya dengan tidak tidur.Para peneliti menemukan orang yang tidur hanya empat sampai enam jam per malam bereaksi lebih lambat dibanding mereka yang tidur selama delapan jam. Kondisi ini juga sama pada mereka yang tidak tidur selama dua malam walaupun mereka mengatakan tidak merasa lelah padahal ini adalah awal dari sebuah masalah. Menurut penelitian orang dewasa membutuhkan tidur selama delapan jam dalam satu hari. Jumlah ini akan bervariasi dari satu orang ke orang lain tergantung jumlah kegiatan yang dilakukan. Penelitian yang dilakukan pada 48 orang dewasa sehat yang berumur 21 sampai 38 tahun, usia dimana paling dikaitkan dengan kekurangan tidur akibat tuntutan pekerjaan. Kekurangan tidur mungkin tidak terlalu berpengaruh pada penampilan rutinitas sepanjang hari namaun dapat memicu masalah fisik seperti: Obesitas: Tidur memegang peranan dalam kemampuan tubuh untuk mengeluarkan neurohormon karena ketika jumlah pengeluaran hormon menurun, kesempatan bertambah berat badan meningkat. Tekanan darah: Tekanan darah secara alami akan turun selama tidur. Namun akibat kekurangan tidur dapat memicu hipertensi dan masalah kardiovaskular. Diabetes: Kemampuan tubuh menggunakan insulin dapat terganggu akibat kekurangan tidur sehingga memicu diabetes. Menurut National Sleep Foundation dalam sebuah polling tahun 2002 di Amerika ditemukan sebanyak 47 juta orang dewasa tidak mendapatkan jumlah minimal tidur yang mereka butuhkan setiap malam.
~~~ Healthy tips Monday, November 28, 2005 According to the American Dietetic Association, you can reduce the fatcontent of cooked ground beef by as much as 50 percent if you rinse the beefafter cooking! You still retain the nutrients such as iron, zinc, and Bvitamins, so enjoy this healthier version. So before you serve up thatburger, take the time to rinse off the extra fat. A small step will go along away.The key to six-pack abs is not 500 sit-ups a day; it's skipping the excesscalories. Improved muscle definition comes from losing body fat, not fromincreasing muscle size. For a healthy lean body, you need to find a balancebetween exercise and diet. Weight training will condition the muscle, butunless you address your total calorie intake, all that hard work will behiding under a layer of fat. Fresh raspberries are delicious -- but fragile. Here's how to treat themright. Because all fresh berries are highly perishable, they should berefrigerated (unwashed) as soon as possible after they're picked. Beforerefrigerating, spread the juicy, fragile berries in a single layer on alarge tray or baking sheet. Wash berries gently but thoroughly before youeat them or use them in a recipe. Juicy and sweet, raspberries arejam-packed with vitamin C, folate and potassium; one cup has more than athird of your daily requirement of fiber. Raspberries are particularlypowerful antioxidants. When researchers at Tufts University in Bostonmeasured levels of antioxidants in various fruits and vegetables, berriesconsistently cropped up at the top of the list. Simple starches and sugars provide none of the health benefits of wholegrains that are rich in fiber, vitamins, minerals and phytochemicals. For ahealthier diet, choose complex carbohydrates from fruits, vegetables andgrains close to their original form. Refined carbs are OK in small amounts,particularly for active people who can afford the empty calories, but don'tmake them the bulk of your carbs (pun intended). Emerging evidence findsthat people who eat too few whole grains and too many refined carbohydratesare at an increased risk of diabetes.
~~~ Lupus dan Herpes Zoster Sunday, November 20, 2005 Lupus dan Herpes Zoster
~~~ Amankah Minum Prednison Selama Hamil?
Amankah Minum Prednison Selama Hamil? Dokter Zubairi Yth, drop sampai 40.000/mm3. Yang saya khawatirkan adalah ia selalu mengonsumsi obat tersebut walaupun sedang hamil karena dokter berpesan obatnya tidak boleh digantikan. Saya sudah membaca referensi mengenai prednison, baik di buku-buku kedokteran maupun internet, yang semuanya menyimpulkan bahwa prednison bukan obat yang ringan. Pemakaiannya harus dalam pengawasan dokter. Yang ingin saya tanyakan, apakah adik saya sebaiknya terus minum prednison, atau bisa dihentikan selama kehamilan dan dilanjutkan kembali setelah melahirkan, atau adakah jalan keluar lain? Ruslan, Jakarta Pak Ruslan yang baik, Oleh karena itu, penderita ITP menjadi mudah mengalami perdarahan di bawah kulit yang terlihat seperti memar (purpura) dan perdarahan spontan seperti mimisan, perdarahan pada saluran cerna atau saluran kemih, menstruasi yang berlebihan dan lama pada wanita, bahkan dapat terjadi perdarahan otak. Memang pada saat hamil, idealnya tidak minum obat apa pun. Namun, pada kondisi-kondisi tertentu, obat terpaksa diberikan karena jika tidak, justru dapat membahayakan kehamilan. Prednison diperlukan agar jumlah dan fungsi trombosit normal atau mendekati normal. Prednison bekerja dengan menekan sistem imun. Seperti juga obat lainnya, prednison juga mempunyai efek samping seperti yang telah Anda baca, misalnya kembung, otot lemas, nyeri sendi, radang lambung, dan mudah tersinggung. Sementara pemakaian jangka panjang dapat menyebabkan osteoporosis, hipertensi, diabetes, kelelahan otot, dan lain-lain. Beberapa penelitian melaporkan bahwa penggunaan prednison pada masa kehamilan cukup aman. Prednison akan di-inaktifkan oleh enzim di plasenta, sehingga kadar yang ditemukan pada janin adalah sekitar 10 persen dibandingkan kadar obat pada ibu. Beberapa penelitian juga menyimpulkan bahwa pemberian dengan dosis sedang untuk pemeliharaan, seperti yang diberikan kepada adik Anda, tidak akan menimbulkan kecacatan janin. Jadi, jika dilihat dari keuntungan dan kerugiannya, saat ini pemberian prednison pada adik Anda yang sedang hamil masih lebih banyak manfaatnya yakni untuk menjaga agar tidak terjadi perdarahan spontan yang dapat membahayakan jiwa dan kehamilannya. Saya ingin mengingatkan bahwa selain mendiskusikan hal ini dengan dokter kebidanan dan dokter penyakit dalam, jangan lupa menginformasikan penggunaan prednison ini kepada dokter anak setelah melahirkan nanti. Saya doakan agar kehamilannya berjalan lancar, dan melahirkan anak yang sehat, beriman, serta pintar.
~~~ The 3 Shocking MYTHS About Sleep That You Don't Know
The 3 Shocking MYTHS About Sleep That You Don't Know
~~~ Selalu Lemas dan Susah Tidur
Selalu Lemas dan Susah Tidur Dokter Zubairi yth, Menurut beberapa teman, mungkin saya kurang darah. Saya lalu minum obat penambah darah seperti yang sering diiklankan di televisi. Tapi rasanya, keluhan saya tidak membaik. Orang-orang yang saya ceritakan mengenai keluhan saya menganggap, yang saya alami adalah hal biasa, mungkin saya terlalu jenuh dengan pekerjaan dan perlu berlibur. Namun, saya ragu apakah memang demikian karena saya menyukai pekerjaan saya dan tidak ada stres dengan pekerjaan akhir-akhir ini. Dok, apakah mungkin ada penyakit yang saya derita yang menyebabkan rasa lemas berkepanjangan ini? Selain rasa lemas, kadang-kadang saya juga sulit tidur. Untuk dokter ketahui, tiga bulan yang lalu saya cek ke laboratorium dan dinyatakan semuanya normal. Siska, Jakarta Mbak Siska yang baik Kurang darah atau anemia dapat menjadi salah satu penyebab. Jika hasil pemeriksaan darah menyatakan kadar hemoglobin normal maka tidak perlu minum obat 'penambah darah'. Rasa lelah dan lemas yang berkepanjangan dapat juga diakibatkan oleh gangguan tidur, nyeri kronik, alergi yang menyebabkan demam atau asma, hipotiroid, penggunaan alkohol atau narkoba, depresi, infeksi (misalnya infeksi parasit, AIDS, tuberkulosis), gagal jantung, diabetes, penyakit hati, penyakit ginjal, penyakit Addison, anoreksia atau gangguan makan lainnya, penyakit radang sendi, penyakit autoimun seperi lupus, malnutrisi, dan kanker. Jadi, memang penyebabnya banyak sekali. Jika memang disebabkan suatu penyakit, biasanya akan ada gejala-gejala lain yang dialami. Walaupun Mbak Siska merasa tidak ada gejala lain kecuali sulit tidur, ada baiknya Anda berkonsultasi ke dokter untuk menelusuri penyebabnya. Mungkin ada gejala yang Anda anggap tidak berarti, namun sebenarnya merupakan tanda penyakit tertentu. Dokter akan mengajukan pertanyaan yang lebih rinci dan melakukan pemeriksaan. Jika rasa lemas tidak kunjung hilang dan berkepanjangan selama lebih dari enam bulan serta setelah dilakukan evaluasi menyeluruh tidak ditemukan penyakit tertentu, mungkin Anda mengalami gejala yang disebut chronic fatigue syndrome. Gejalanya, selain rasa lemah adalah nyeri kepala, nyeri otot atau sendi, serta sulit konsentrasi. Sindrom ini lebih sering dialami wanita dan akan bertambah berat bila ada kelelahan fisik atau mental seperti depresi. Pengobatan rasa lemah harus disesuaikan dengan penyebabnya. Jika memang tidak ditemukan penyebab yang pasti, maka yang diatasi adalah gejala-gejala yang dialami. Misalnya, bagaimana memperbaiki pola tidur dan merelaksasikan otot. Caranya bisa bermacam-macam, baik melalui pola makan yang sehat, seimbang, dan teratur, rajin berolahraga, yoga, menekuni hobi yang mungkin tidak pernah lagi dikerjakan, membaca, dan lain-lain. Olahraga yang dilakukan tidak boleh yang terlalu melelahkan. Lakukan olahraga ringan seperti senam ringan dan jalan pagi.
~~~ Lupus Menyerang Ginjal
Lupus Menyerang Ginjal Tiga bulan yang lalu kaki saya mulai bengkak, demikian pula perut. Jika bangun tidur mata bengkak, saat siang hari menghilang dan besoknya muncul kembali. Setelah menjalani beberapa pemeriksaan, dokter mengatakan lupus sudah mengenai ginjal. Terdapat kebocoran protein dari ginjal yang cukup parah dan dinyatakan lupus nefritis. Saya sangat khawatir, karena seorang teman saya yang juga sesama anggota Yayasan Lupus Indonesia, dua tahun yang lalu mengalami masalah yang sama dan harus menjalani cuci darah. Pertanyaan saya: 1. Mengapa lupus saya bisa kambuh? Ratih, Jakarta Waalaikumussalam wr wb Tujuan pengobatan penyakit Mbak Ratih adalah untuk memperbaik kembali fungsi ginjal. Biasanya, selain pengobatan seperti dahulu (pemberian prednison/prednisolon), perlu dikombinasikan dengan obat lain, misalnya siklofofamid (EndoxanT) atau obat penekan sistem imun lainnya seperti azathioprine (ImuranT), mikofenolat mofetil (Cell CeptT). Untuk mengganti protein yang keluar melalui urine akibat kerusakan ginjal, kadang-kadang diperlukan juga infus albumin. Jenis terapi yang akan diberikan tentu tergantung evaluasi dokter. Seperti Mbak Ratih ketahui, penyakit lupus adalah penyakit di mana sistem imun (kekebalan tubuh) membentuk antibodi yang kemudian akan menyerang jaringan tubuh sendiri sehingga menimbulkan peradangan pada jaringan yang terkena. Untuk itu maka pada pengobatan lupus diberikan obat untuk menekan sistem imun yang berlebihan. Cuci darah dilakukan hanya jika sudah terjadi gagal ginjal yang berat. Cuci darah ini bisa bersifat sementara jika gagal ginjal bersifat akut atau berkala. Sedangkan cuci darah jangka panjang bila terjadi gagal ginjal kronik. Data fungsi ginjal yang Anda kirimkan (CCT, creatinin) menunjukkan fungsi ginjal Anda belum parah, jadi mungkin sekali tidak perlu cuci darah dan tidak usah terlalu khawatir, asal berobat teratur. Jadi, cukup banyak pasien lupus nefritis yang tidak memerlukan cuci darah. Mbak Ratih bisa menanyakan langsung kepada tim dokter yang menangani. Jika saat ini Mbak Ratih sudah merasa cocok dengan dokter yang merawat dan komunikasi berjalan dengan lancar, tidak perlu pindah ke dokter lain. Biasanya akan dikonsultasikan dengan dokter internis dengan subspesialisasi ginjal. Jadi yang menangani tim, yang terdiri dari dokter yang merawat Anda dari awal dan dokter lain yang menangani problem khusus, dalam hal ini dokter spesialis penyakit dalam, konsultan ginjal hipertensi. Demikian penjelasan saya, mudah-mudahan bermanfaat.
~~~ Lupus, Penyakit Genetik?
Lupus, Penyakit Genetik? Masih menurut dokter, saya harus dibiopsi ginjal untuk menentukan pengobatan yang lebih tepat, namun saya masih takut melakukannya. Dokter memberikan hanya satu obat, yaitu prednison saja dan sekarang masih minum teratur. Kondisi fisik sudah lebih baik, namun menurut dokter masih cukup banyak protein yang lolos melalui ginjal saya. Yang mengganggu pikiran saya sekarang ini adalah, enam bulan lagi saya berencana untuk menikah. Saya khawatir kalau keturunan saya akan menderita lupus juga. Apakah benar lupus itu penyakit menurun? Apakah benar lupus itu penyakit genetik? Lalu, apakah manfaat biopsi ginjal untuk saya? Dita, Waalaikumussalam wr wb Hal yang mendasari kemungkinan pengaruh faktor genetika adalah fakta bahwa 24-59 persen pasangan kembar monozigot (satu telur) yang merupakan orang dengan lupus (Odapus) ternyata juga menderita lupus, sementara hanya 2-5 persen pasangan kembar dizigot (berasal dari dua telur) dan saudara kandung dari Odapus yang juga menderita lupus. Data ini menunjukkan, ada faktor lain di luar faktor gen, karena tidak 100 persen pasangan kembar satu telur yang sama-sama terkena lupus. Telah ditemukan gen-gen yang berhubungan dengan timbulnya penyakit lupus. Tidak hanya satu gen yang berperan dalam terjadinya lupus melainkan dibutuhkan interaksi dari beberapa gen. Risiko untuk menderita lupus relatif akan makin meningkat pada orang yang mempunyai lebih dari satu macam kelainan gen yang terkait lupus. Tidak semua orang yang memiliki kelainan genetik, otomatis akan menderita lupus. Mereka bisa tetap sehat atau hanya menampakkan gejala yang ringan. Jadi, Anda tidak perlu khawatir untuk memiliki keturunan. Pertama, jika memang ada kelainan genetik pada Anda maka belum tentu anak Anda otomatis akan mempunyai kelainan yang sama. Hanya tujuh persen anak yang terkena lupus dari ibu Odapus (orang dengan lupus). Kedua, jika pun ada kelainan gen yang diturunkan, belum tentu akan bermanifestasi menjadi penyakit lupus. Mengenai biopsi ginjal, menurut saya, sangat bermanfaat untuk dilakukan, terutama untuk menentukan jenis pengobatan yang tepat. Dengan biopsi ginjal, akan diketahui jenis kelainan ginjalnya, artinya ada beberapa jenis kelainan ginjal pada lupus (lupus nefritis), yang perjalanan penyakitnya berbeda-beda. Jadi, dengan biopsi ginjal dapat ditentukan obat apa saja yang perlu diberikan kepada Anda, yang manfaatnya lebih besar dari risikonya, sehingga pengobatan akan menjadi optimal. Bila memerlukan informasi lebih lanjut.
~~~ 'Produksi Obat Murah untuk Penderita Lupus'
'Produksi Obat Murah untuk Penderita Lupus' Bandung-RoL-- Hingga kini, penyakit Lupus belum ditemukan obatnya. Namun, berbagai obat yang dikonsumsi para penderita Lupus bisa membantu mengeliminir dampak lanjutan dari serangan penyakit yang telah merenggut banyak jiwa di dunia ini. Karena itu, Ketua Yayasan Syamsi Dhuha, Dian Syarief, berharap agar para produsen obat lebih kreatif dan variatif menciptakan obat yang bisa dikonsumsi oleh orang dengan penyakit Lupus (odapus). Yayasan Syamsi Dhuha adalah yayasan nirlaba berpusat di ''Memang sampai saat ini belum ditemukan obatnya, tapi kalau obat-obatan yang selama ini dikonsumsi untuk meminimalkan rasa sakit odapus bisa lebih banyak diproduksi, ini akan sangat membantu,'' kata Dian yang juga penderita Lupus, kepada Republika, pekan lalu. Diungkapkan Dian, selama ini, sebagian besar obat yang harus dikonsumsi oleh para odapus berharga mahal, jenisnya hanya sedikit sementara efek sampingnya cukup besar. Di sisi lain, sambung dia, para odapus pun tak punya pilihan lain selain mengonsumsi obat tersebut dalam upaya ikhtiar memperpanjang masa hidupnya. ''Kalau saja, produsen obat mau melakukan lebih banyak penelitian dan menemukan jenis obat yang lain, yang efek sampingnya tak terlalu banyak dan harganya murah, akan sangat membantu,'' ujar Dian. Sayangnya, sambung dia, sejauh ini kepedulian terhadap penyakit Lupus ini masih kurang, baik di kalangan pemerintah maupun masyarakat. Padahal, ungkap Dian, jumlah penderita Lupus dari ke tahun terus meningkat. Di sisi lain, indikasi dari penyakit ini pun tak mudah ditemukan. Bahkan, para dokter pun belum tentu bisa segera mengenali gejala penyakit ini. Diungkapkannya, sejak yayasan yang dipimpinnya dideklarasikan satu tahun lalu, pada 16 Mei 2004, jumlah orang yang diketahui menderita Lupus (orang dengan penyakit Lupus, odapus) meningkat hampir 10 kali lipat mencapai sekitar 120 orang. Mantan manager public relation salah satu bank swasta nasional di Jakarta ini mengungkapkan bahwa kondisi tersebut menunjukkan adanya fenomena gunung es yang kini mulai terkuak. ''Hal ini tentu saja disikapi dengan prihatin, namun bila ditelaah lebih jauh patut disyukuri karena justru Lupus dapat dideteksi lebih awal dan ditangani dengan tepat,'' katanya. Dikatakan Dian, Care for Lupus mencatat, selama satu tahun ini, tercatat 15 odapus meninggal. Rinciannya, 13 wanita dan dua pria dengan rentang usia termuda sembilan tahun dan yang tertua 47 tahun. Mereka berprofesi beragam, mulai dari ibu rumah tangga, pelajar/mahasiswa, guru maupun karyawan. Kenyataan itu, ungkap Dian, membuat dirinya dan semua pihak yang tergabung di yayasan yang dipimpinnya ingin berbuat lebih banyak. Terutama, bagi para odapus dengan kemampuan ekonomi terbatas. Pasalnya, kata dia, tak sedikit odapus yang harus menjalani cuci darah untuk mempertahankan hidupnya. ''Biarpun mereka dari kalangan mampu, kalau seminggu dua kali harus cuci darah atau sehari tiga kali harus menelan obat yang per butirnya Rp 80 ribu, Karena itu, Dian berharap kepedulian dari berbagai pihak, termasuk para produsen obat dan lembaga-lembaga nirlaba lain, bisa turut membantu meringankan kondisi tersebut. Pada bagian lain, Dian mengaku tetap optimis bahwa odapus bisa terus bertahan selama mereka berikhtiar mencari jalan untuk kesembuhannya. ''Ilmu Allah
~~~ Banyak Penderita Lupus dari Kalangan Menengah Bawah'
Banyak Penderita Lupus dari Kalangan Menengah Bawah' Bandung-RoL -- Banyak penderita Lupus di Kota Bandung yang berasal dari kalangan menengah ke bawah. Kemampuan secara ekonomi tersebut terkadang membawa masalah bagi para penderita dalam mendapatkan pengobatan atas penyakit lupus yang dideritanya. Ketua Kelompok Studi Lupus RS Hasan Sadikin Bandung, Dr Rachmat Gunadi Wachyudi, mengatakan, banyak kalangan penderita lupus di Bandung yang memang berkemampuan ekonomi di bawah rata-rata. Fenomena ini, kata dia, banyak menimbulkan masalah bagi para penderita Lupus. ''Mereka yang datang berobat, biasanya ada yang berprofesi sebagai buruh pabrik dan mahasiswi yang merantau di Bandung,'' ujar Rachmat seusai Acara kegiatan kelompok Edukasi Care For Lupus yang diselenggarakan Yayasan Syamsi Dhuha dan Dinas Kesehatan Kota Bandung, Ahad (19/6). Dalam acara itu dilakukan sosialisasi mengenai pengenalan awal indikasi Lupus kepada 100 dokter dari berbagai Puskesmas di Kota Bandung maupun para penderita Lupus. Masalah kemampuan ekonomi ini, menurut Rachmat, seringkali dihadapi oleh penderita Lupus ketika harus berhadapan dengan fasilitas kesehatan atau perawatan untuk penyakit yang dideritanya. Karena itu, kata dia, dapat dipastikan bahwa para penderita Lupus dengan kemampuan ekonomi yang rendah tidak bisa mendapatkan fasilitas kesehatan yang maksimal. Selain biaya perawatan kesehatan yang memang menjadi masalah besar, ungkap Rachmat, mahalnya obat yang harus dikonsumsi oleh para penderita juga menjadi persoalan. Bahkan, sambung dia, jika penderita Lupus terserang di organ vital seperti ginjal, maka proses cuci darah yang harus dilakukannya akan terus menjadi masalah. Pasalnya, kata dia, biaya untuk melakukan cuci darah ini berbiaya tinggi. ''Di Bandung ada sebuah kasus mengenai proses cuci darah, seorang penderita Lupus harus kehilangan nyawanya akibat terlambat melakukan proses tersebut. Itu hal yang sangat menyedihkan bagi saya,'' ujar Rachmat mengisahkan.
~~~ lupus pada laki-laki
Lupus pada Laki-laki Nina, Jakarta Waalaikumussalam wr wb Dalam hal ini, karena gejala yang menonjol hanya nyeri sendi, maka pemeriksaan rontgen menjadi sangat penting. Pemeriksaan rontgen berguna untuk membedakannya dengan artritis rheumatoid (AR). Pada AR, gambaran rontgen-nya sangat khas, jadi walaupun tes darahnya sesuai dengan lupus SLE, ia menderita AR bukan SLE. Jika gambaran rontgen tulang-sendi tidak sesuai dengan AR, berarti SLE. Pada kasus adik Mbak Nina, hasil rontgen yang dilampirkan memang tidak sesuai dengan AR, jadi ia sakit lupus. Lupus memang paling banyak dialami oleh perempuan usia dewasa muda. Namun, bukan berarti laki-laki tidak dapat terkena. Pada usia 15-40 tahun, memang sekitar 90 persen orang dengan lupus (Odapus) adalah perempuan, namun persentase ini mulai menurun dengan meningkatnya usia. Pada kelompok usia di atas 50 tahun, persentase Odapus perempuan menjadi sekitar 75 persen. Pasien lupus laki-laki di Indonesia sendiri saat ini jumlahnya sekitar 7 persen. Tidak ada perbedaan menonjol antara gejala lupus pada laki-laki dan perempuan. Beberapa penelitian melaporkan hasil yang bervariasi dan tidak konsisten, yaitu bahwa kemerahan kulit pada pipi lebih banyak ditemukan pada perempuan, sementara anemia hemolitik, gejala neurologis seperti kejang, dan antikoagulan lupus positif lebih banyak ditemukan pada laki-laki. Antikoagulan lupus adalah zat antibodi dalam tubuh yang menyebabkan peningkatan risiko terjadinya bekuan darah yang dapat menyumbat pembuluh darah, memudahkan timbulnya stroke atau bekuan di pembuluh darah balik tungkai. Lupus memang merupakan penyakit yang dapat kambuh kembali setelah sebelumnya gejalanya mereda dengan pengobatan. Namun, Anda tidak perlu khawatir. Sebagian besar pasien lupus dapat dikontrol dengan baik dengan minum obat-obatan. Bahkan adapula yang sembuh total sehingga tidak perlu minum obat lagi.
~~~ healthy life.. Sunday, November 13, 2005 A perfect food? Here are five good reasons it just might be lentils. 1) Lentils, a fine source of plant protein, don't take hours to cook, unlike other dried beans. 2) Lentils are rich in soluble fiber, which helps control blood cholesterol. 3) Lentils provide some calcium, iron and other trace minerals. 4) Lentils are one of the best sources for folic acid, a B vitamin critical for preventing neural tube defects. 5) Lentils may protect against some types of cancers and lower heart disease risk.
~~~ Living Healthy Sunday, November 06, 2005 According to the National Weight Control Registry, people who are most successful at losing weight and keeping it off have four things in common: they follow a low fat carbohydrate rich diet, eat breakfast almost every day, exercise regularly, and monitor their weight loss closely. Take one step at a time and work to incorporate all four strategies into your lifestyle.
~~~ Stem Cell Transplantation Saturday, November 05, 2005 NIH Conducting Two Clinical Trials on Hematopoietic Stem Cell Transplantation in Lupus More>
~~~ Azathioprine-Skin Cancer Link Not Found in Lupus
Azathioprine-Skin Cancer Link Not Found in Lupus To read a news report on this study go to: http://news.bbc.co.uk/2/hi
~~~ The Effect of Combined Estrogen and Progesterone Hormone
The Effect of Combined Estrogen and Progesterone Hormone Replacement Therapy on Disease Activity in SLE: A Randomized Trial Annals of Internal Medicine 142(12) part 1: 953-962 (June 21, 2005) Jill P. Buyon, MD, Michelle A. Petri, MD, MPH, Mimi Y. Kim, sCd, et.al. Clinicians sometimes avoid hormone therapy (HT) in women with lupus because they think estrogens activate the disease. In this multicenter, double-blind trial, 351 menopausal lupus patients were randomly assigned to HT or placebo for 12 months. Severe flares were infrequent in both groups and were not significantly increased in women taking HT. Women taking HT had more mild to moderate flares than those taking placebo (1.14 flares v. 0.86 flares/person/year). Four women taking HT and one woman taking placebo had thromboembolic (blood clotting) events. The researchers note that these findings are not generalizable to women with high levels of anticardiolipin antibodies, lupus anticoagulant, or previous incidences of thrombosis. The researchers conclude that adding a short course of hormone therapy is associated with a small risk for increasing the natural flare rate of lupus. Most of these flares are mild to moderate. The benefits of HT can be balanced against the flare risk because HT does not significantly increase the risk for severe flare compared to placebo. This is important information for many women who have been avoiding hormone therapy to ameliorate the unpleasant side effects of menopause for fear of exacerbating their lupus. To read the complete abstract go to:
~~~ Prematurity and Preeclampsia Complicate Lupus Pregnancies
Prematurity and Preeclampsia Complicate Lupus Pregnancies American Journal of Obstetrics and Gynecology 192:6, 1897-1904 (June 2005) This study of pregnancies in lupus patients over a 10-year period looked at 63 pregnancies in 48 women. Twelve pregnancies were complicated by preeclampsia (also known as toxemia, involving high blood pressure, weight gain, and protein in the urine after the 20th week of pregnancy). Rates of deaths of babies near the end of pregnancy or at the time of birth due to this condition are high. First-time pregnancies, African American background and a history of high blood pressure or kidney disease all increase the risk of preeclampsia, which makes this condition of special concern for women who have lupus. Currently, the only way to treat preeclampsia is to deliver the baby. However, complications can occur because of prematurity of an infant at time of delivery. The researchers in this study concluded that low platelet counts, high blood pressure, and the need for prednisone all may be predictive factors for problems occurring in pregnancies of women with lupus. Other factors found to be associated with premature delivery in lupus pregnancies included prednisone use at the time a woman gets pregnant, use of blood pressure medications, and a severe flare during pregnancy. Physicians managing lupus pregnancies, which are always considered high-risk, will want to monitor these factors in their patients. To read the complete abstract go to: http://www.mdlinx.com/Rheumatol
~~~ Flu Shots and Lupus Patients
Flu Shots and Lupus Patients Although some vaccines can make autoimmune diseases worse, use of the influenza vaccine (flu shot) appears to be safe in people with systemic lupus erythematosus (SLE). Because the flu shot is an inactivated virus vaccine (not a live virus vaccine), it can be given safely and it is recommended that lupus patients receive a flu shot every year. Please be aware that the Centers for Disease Control and Prevention (CDC) does not recommend the product "FluMist" for persons with compromised immune system disorders. Moreover, family members should not use this product if they are in contact with an individual with lupus. Lupus patients should always talk with their doctors before receiving any vaccine. The influenza vaccine (flu shot) is a highly effective inactivated virus vaccine that is given yearly to those at risk for complications of influenza infection. Several studies conducted in people with lupus who received the influenza vaccine found a protective antibody response, although the antibody levels tended to be lower than in the healthy control group. Side effects were not more frequent and disease flares were not more common. When present, the flares were usually mild. One person did develop diffuse proliferative glomerulonephritis (a class of kidney disease) following immunization received during a lupus flare; therefore, some researchers do not recommend vaccination during flares. Overall, though, influenza vaccine is considered to be safe and effective in people with lupus. Invasive pneumococcal infections occur more frequently in people with lupus. The Advisory Committee on Immunization Practices (ACIP) recommends vaccination of all healthy persons older than 65, and individuals between the ages of 2 and 64 who are at increased risk for pneumococcal infection due to certain chronic illnesses or immunosuppressant therapies. While lupus is not specifically listed, there are clinical situations that are common in lupus that may increase the risk of pneumococcal infection. These include: chronic kidney failure; nephrotic syndrome; dysfunction of the spleen; diabetes mellitus; and exposure to long-term systemic corticosteroids and alkylating agents. Despite this, the vaccine is highly effective in the majority of lupus cases. Patients may be revaccinated every six years, more frequently in those with a lengthy antibody response. As with most vaccines, the possibility of vaccine-related worsening of lupus activity has been a theoretical concern. There have been occasional reports of lupus flares following pneumococcal immunization, but large studies have not demonstrated a relationship.
~~~ Factors at Diagnosis Predict Subsequent Occurrence of Seizures in SLE
Factors at Diagnosis Predict Subsequent Occurrence of Seizures in SLE Neurology 2005; 64:2102-2107 (June 2005) Jamal This study followed 195 lupus patients for nine months and kept track of incidences and manifestations of neuropsychiatric SLE (NP-SLE) and seizures. Isolated seizures were found to be common (28 patients), while recurrent seizures, or epilepsy, although less frequent, did occur (12 of the 28). Predictors of seizures included disease activity (in particular, psychosis), moderate-to-high levels of anticardiolipin and anti-Sm antibodies, and damage accrual. Predictors of epilepsy were higher disease activity at baseline (when the study began), concurrent NP-SLE manifestations, prior strokes, and male gender. The researchers conclusion is that the risk of seizure and epilepsy in lupus is increased in those individuals with higher disease activity at baseline, prior neuropsychiatric lupus disease, and positive tests for both anticardiolipin and anti-Sm antibodies. The ability to better predict seizures in individuals with NP-SLE may be useful in determining caregiving needs and the ability to perform activities of daily living, which are determinants of disability status. Unlike other studies that have examined seizure risk factors after the fact, the goal of this study was to look for factors at the time of SLE diagnosis. These factors may help in understanding the pathogenesis of provoked seizures in SLE. It is believed that seizure occurrence is primarily related to increased disease activity, and that epilepsy may often be related to prior damage such as stroke. This information is vital for physicians in determining how best to treat lupus patients at higher risk for neurological manifestations like seizures. To read the complete abstract go to: http://www.neurology.org/cgi
~~~ Back to Healthy life Saturday, October 22, 2005 Change your toothbrush at least once a month, or right after a cold, flu or other illness. Germs that can live on a damp toothbrush for days; when you're sick, a damp toothbrush may reinfect you. Use two toothbrushes alternately to give each one a chance to completely dry out. "Brushing your teeth is a traumatic injury," says Dr. Charles J. Palenik, a microbiologist
~~~ Break for Healthy Mood! Thursday, October 20, 2005 Did you know magnesium is an essential mineral that activates more than 300 It's possible to eat out and still keep a healthy diet -- if you master a few key strategies. Start by getting the food you want in the amounts you need. If restaurants insist on serving gigantic portions, take advantage of appetizers, soups, salads, a la carte items and side dishes.
~~~ Stop for Snack! Monday, September 26, 2005 Bored with the same old foods? Kick it up a notch with salsa. Instead of fattening dressings and cream sauces, give this tomato-based palate-pleaser a try. Spice up everything from chicken and veggies to omelets and raw veggies. Mix with low-fat sour cream for a peppy dip for baked chips and spoon over mixed greens for a chunkier, more dramatic dressing. Nature packs a lot of vitamins A and C into these low-calorie appetizers. Half a medium-sized mango supplies 40% of the vitamin A and 50% of the vitamin C that most of us need daily. All for a mere 67 calories. And it tastes great! If p.m. coffee leaves you too perky to sleep, try cutting it off earlier rather than cutting it out completely. Coffee's stimulatory effects usually take 6 - 8 hours to wear off, so consider your bedtime when you reach for an afternoon or evening cup. The effects -- it can exacerbate insomnia, nervousness, anxiety and even panic attacks -- may last longer in women taking oral contraceptives and in older people. But coffee isn't a demon, either. Short-term studies have found that a cup's worth -- 100mg – can increase self-confidence, energy and motivation to work. Peppers rank surprisingly high on the list of healing foods. For instance, hot chile peppers contain capsaicin, a compound that acts as an anticoagulant and may help prevent heart attacks and strokes caused by blood clots. A half-cup of chopped red bell peppers provides 141mg of vitamin C and 4,250 IU of vitamin A -- more than an adult's daily needs for both. And whether they're mellow and sweet or fiery hot, all peppers are all good sources of potentially cancer-fighting antioxidants, especially vitamin C.
~~~ Kiat Sehat Ala Rasullullah Wednesday, September 21, 2005 HIDUP SEHAT SEPERTI RASULULLAH SAW1. SELALU BANGUN SEBELUM SUBUH Rasul selalu mengajak ummatnya untuk bangun sebelum subuh, melaksanakan sholat sunah dan sholat Fardhu, sholat subuh berjamaah. Hal ini memberi hikmah yg mendalam antara lain : - Berlimpah pahala dari Allah SWT - Kesegaran udara subuh yg bagus untuk kesehatan / terapi penyakit TB - Memperkuat pikiran dan menyehatkan perasaan. 2. AKTIF MENJAGA KEBERSIHAN Rasulullah SAW selalu sentiasa rapi & bersih, tiap hari kamis atau Jumaat beliau mencuci rambut-rambut halus di pipi, selalu memotong kuku, bersisir dan berminyak wangi. "Mandi pada hari Jumaat adalah wajib bagi setiap orang-orang dewasa. Demikian pula menggosok gigi dan memakai harum-haruman"(HR Muslim). 3.TIDAK PERNAH BANYAK MAKAN Sabda Rasulullah SAW : "Kami adalah sebuah kaum yang tidak makan sebelum lapar dan bila kami makan tidak terlalu banyak ( tidak sampai kekenyangan)" (Muttafaq Alaih) Dalam tubuh manusia ada 3 ruang untuk 3 benda : Sepertiga untuk udara, sepertiga untuk air dan sepertiga lainnya untuk makanan. Bahkan ada satu tarbiyyah khusus bagi ummat Islam dengan adanya Puasa Ramadhan untuk menyeimbangkan kesehatan. 4. GEMAR BERJALAN KAKI Rasulullah SAW selalu berjalan kaki ke Masjid, Pasar, medan jihad, mengunjungi rumah sahabat, dan sebagainya. Dengan berjalan kaki, keringat akan mengalir, pori-pori terbuka dan peredaran darah akan lancar.Ini penting untuk mencegah penyakit jantung. 5. TIDAK PEMARAH Nasihat Rasulullah SAW: "Jangan Marah"diulangi sampai 3 kali. Ini menunjukkan hakikat kesehatan dan kekuatan Muslim bukanlah terletak pada jasadiyah belaka, tetapi lebih jauh yaitu dilandasi oleh kebersihan dan kesehatan jiwa. Ada terapi yang tepat untuk menahan marah : - Mengubah posisi ketika marah, bila berdiri maka duduk, dan bila duduk maka berbaring - Membaca Ta 'awwudz, karena marah itu dari Syaithon - Segeralah berwudhu - Sholat 2 Rokaat untuk meraih ketenangan dan menghilangkan kegundahan hati 6. OPTIMIS DAN TIDAK PUTUS ASA Sikap optimis akan memberikan dampak psikologis yang mendalam bagi kelapangan jiwa sehingga tetap sabar, istiqomah dan bekerja keras,serta tawakal kepada Allah SWT. 7. TAK PERNAH IRI HATI Untuk menjaga stabilitas hati & kesehatan jiwa, mentalitas maka menjauhi iri hati merupakan tindakan preventif yang sangat tepat. :Ya Allah,bersihkanlah hatiku dari sifat sifat mazmumah dan hiasilah diriku dengan sifat sifat ahmudah.
~~~ The Challenge of Being Diagnosed with Lupus Tuesday, September 20, 2005 The Challenge of Being Diagnosed with Lupus by RemedyFind Columnist and Lupus Host - Suzanne Davis One thing I hear from people with auto-immune diseases is how frustrated they are when it comes to getting a precise diagnosis. Many have the diagnosis of Undifferentiated Connective Tissue Disease (UCTD), meaning that they have signs of an auto-immune disease, but that the doctor cannot tell which one yet. Many cases remain undifferentiated, but others will continue to evolve into a specific disease. Lupus is particularly hard to diagnose, as it can affect any part of the body, and it is different in each and every patient.
~~~ Research / News - Prolonged remission in systemic lupus erythematosus
Research / News - Prolonged remission in systemic lupus erythematosus August 2005. This study was designed to measure the frequency of prolonged remission in systemic lupus erythematosus (SLE). Patients registered in the Lupus Clinic database between 1970 and 1997 with visits no more than 18 months apart were identified. Prolonged remission was defined as a 5-year consecutive period of no disease activity (SLE disease activity index, SLEDAI = 0) and without treatment (corticosteroids, antimalarials, or immunosuppressants). CONCLUSION: Prolonged complete remission in lupus is rare. Therefore with current therapies continued vigilance for disease recurrence is necessary.
~~~ Lupus pada Laki-laki Lupus pada Laki-laki Source Assalamualaikum wr wb Nina, Jakarta Waalaikumussalam wr wb Dalam hal ini, karena gejala yang menonjol hanya nyeri sendi, maka pemeriksaan rontgen menjadi sangat penting. Pemeriksaan rontgen berguna untuk membedakannya dengan artritis rheumatoid (AR). Pada AR, gambaran rontgen-nya sangat khas, jadi walaupun tes darahnya sesuai dengan lupus SLE, ia menderita AR bukan SLE. Jika gambaran rontgen tulang-sendi tidak sesuai dengan AR, berarti SLE. Pada kasus adik Mbak Nina, hasil rontgen yang dilampirkan memang tidak sesuai dengan AR, jadi ia sakit lupus. Lupus memang paling banyak dialami oleh perempuan usia dewasa muda. Namun, bukan berarti laki-laki tidak dapat terkena. Pada usia 15-40 tahun, memang sekitar 90 persen orang dengan lupus (Odapus) adalah perempuan, namun persentase ini mulai menurun dengan meningkatnya usia. Pada kelompok usia di atas 50 tahun, persentase Odapus perempuan menjadi sekitar 75 persen. Pasien lupus laki-laki di Indonesia sendiri saat ini jumlahnya sekitar 7 persen. Tidak ada perbedaan menonjol antara gejala lupus pada laki-laki dan perempuan. Beberapa penelitian melaporkan hasil yang bervariasi dan tidak konsisten, yaitu bahwa kemerahan kulit pada pipi lebih banyak ditemukan pada perempuan, sementara anemia hemolitik, gejala neurologis seperti kejang, dan antikoagulan lupus positif lebih banyak ditemukan pada laki-laki. Antikoagulan lupus adalah zat antibodi dalam tubuh yang menyebabkan peningkatan risiko terjadinya bekuan darah yang dapat menyumbat pembuluh darah, memudahkan timbulnya stroke atau bekuan di pembuluh darah balik tungkai. Lupus memang merupakan penyakit yang dapat kambuh kembali setelah sebelumnya gejalanya mereda dengan pengobatan. Namun, Anda tidak perlu khawatir. Sebagian besar pasien lupus dapat dikontrol dengan baik dengan minum obat-obatan. Bahkan adapula yang sembuh total sehingga tidak perlu minum obat lagi.
~~~ Top patient-rated Lupus treatments Berikut ini adalah perawatan paling sering dilakukan oleh pasien Lupus. Coba simak, siapa tau bermanfaat: Top patient-rated Lupus treatments (As of September 17, 2005. Based on a minimum of 15 ratings. The first number is the averaged rating (0 = poorest; 10 = best). The number in parenthesis is the number of ratings the treatment has received.) Emotional Support: Online Discussion Groups 9.3 (26) Prayer / Spirituality 9 (27) Provigil etc. (Modafinil) 7.8 (17) DHEA (Dehydroepiandrosterone) 7.3 (25) Plaquenil etc. (Hydroxychloroquine) 6.7 (59) Deltasone etc. (Prednisone) 6.6 (45) Rheumatrex etc. (Methotrexate) 6.4 (18) Imuran etc. (Azathioprine) 5.6 (23) Bextra (Valdecoxib) 5.6 (16) Cytoxan etc. (Cyclophosphamide) 5.2 (23) Untuk lebih lengkapnya, silahkan sambangi link ini.
~~~ Lupus Awareness Campaign Sunday, September 04, 2005 What is Lupus Lupus is an autoimmune (AW-toe-ih-MYOON) disease, a type of self-allergy, whereby the patient's immune system creates antibodies which instead of protecting the body from bacteria & viruses attack the person's own body tissues. It is neither infectious nor contagious.
Lupus is a disease that can affect many parts of the body & each person's profile or list of symptoms is different. Everyone reacts differently. One person with lupus may have swollen knees and fever. Another person may be tired all the time or have kidney trouble. Someone else may have rashes. Lupus can involve the joints, the skin, the kidneys, the lungs, the heart and/or the brain. If you have lupus, it may affect two or three parts of your body. Usually, one person doesn’t have all the possible symptoms. Lupus can mimic other diseases, such as multiple sclerosis & rheumatoid arthritis, making it difficult to diagnose. Currently there is no single test that can definitely say whether a person has lupus or not. Only by comprehensive examination and consideration of symptoms and their history can a diagnosis be achieved. There are three main types of lupus:
Lupus Awareness Campaign (LAC) is a program started by Rusnita Saleh, a writer-training and information specialist, who is also lupus sufferer (now remission phase – lupus nephritis) by collect, write and publish materials related to SLE in free website: http://care4lupus.blogspot.com and created a mailing list with same subject concern to share knowledge and information about SLE symptoms and guidance to cope and start healthy living. The program now start to broad not only limited to mailing list and web pages, but also broadcast through radios and now publish some booklets, pamphlets and books about lupus related topics. These publications will be spread to hospitals, community centers, resource centers with the access to public audiences. In the future, we hope we can go further educate productive ages audiences, most importantly women (since the sufferer 90% are women), by building special class /seminars to give potentials patients and sufferers themselves a real discussion and face to face with their friends in need.
Our long term program after some evaluation, hopefully we can enhance the program to phase II where awareness not only to help public acknowledge about SLE, but also take action to help sufferers directly managing and coping the illness.
Why is this campaign important?
Up until now, there is no cure yet for lupus. People diagnosed with lupus normally remain under medical care with continuing medication. Many symptoms have less impact as a result, but side effects can often occur. Lupus can adversely influence the lives of those who suffer the illness, their families & friends. Since handling this sickness is not an easy task, all sufferers, families and medication specialist need to know more about this unique sickness and techniques in how to manage health condition during and post attack. Up until now learning symptoms and best-worst practices in way to gain healthy living around SLE is the best way to cope and handle the situation.
What You can Do to help this program run well Since the program now is trying to publish materials and building training tools, it needs special budget and volunteers to help its smooth running. Please contact us for further details information. Your roles in helping lupus sufferers and their family can also start from now by spreading this program information to others and let generous hands work for good. Lupus Awareness Campaign Founder, Rusnita Saleh Kayu Putih Indah A-2 Jl. Kayu mas raya – Email: rusnitasaleh@gmail.com Cell: +62.8551000.672
~~~ Case - teenage sufferer Thursday, September 01, 2005 ADIK saya, gadis berumur 15 tahun, sekarang duduk d i kelas I SMU. Selama tiga bulan terakhir ini dia menderita demam yang hilang ti mbul disertai sariawan. Di kedua pipinya terdapat bercak merah dan salah seorang anggota keluarga saya mencurigai bercak merah tersebut sebagai tanda penyakit l upus.Saya berkonsultasi dengan seorang dokter penyakit dalam. Dari hasil pemeriksaan laboratorium, adik saya ternyata dinyatakan sebagai penderita lupus. Menurut ket erangan dokter penyakit dalam tersebut kami tidak usah khawatir, asalkan si pend erita patuh memakan obat steroid yang diberikan. Meskipun telah ditenangkan dokter, kami sekeluarga-terutama adik saya-teramat ta kut terhadap penyakit lupus. Saya pernah membaca bahwa penyakit lupus dapat meny erang ginjal dan bila tidak hati-hati dapat menimbulkan kematian. Saya berusaha untuk menenangkan adik saya dan menganjurkan agar dia memusatkan perhatian pada sekolahnya. Meskipun demikian, saya ingin informasi lebih rinci mengenai penyaki t lupus terutama yang menyangkut masalah di bawah ini : 1. Mengapa penyakit lupus banyak mengenai perempuan? 2. Betulkah penyakit lupus merupakan penyakit yang berbahaya dan belum dapat dis embuhkan? 3. Bagaimana masa depan seorang penderita lupus, apakah dia dapat bekerja, hamil , dan melahirkan selayaknya seperti perempuan lain? 4. Kepada spesialis manakah sebaiknya seorang penderita lupus berobat? Dewi, Jakarta Penyakit lupus (disebut juga lupus eritematosus sistemik) memang sering m enyerang perempuan muda dalam usia reproduktif. Di Rumah Sakit Cipto Mangunkusum o perbandingan penderita perempuan dan laki-laki 10 : 1. Ini mungkin disebabkan karena risiko untuk terkena penyakit ini salah satu di antaranya adalah berhubun gan dengan hormon estrogen yang terdapat pada wanita. Pada penyakit ini tubuh membentuk zat anti terhadap inti sel, DNA, RNA, sel dara h merah, sel darah putih, dan sel-sel lain di dalam tubuh penderita. Sekitar sep ertiga penderita memang hanya mengalami keadaan penyakit yang ringan, misalnya k e-lainan kulit atau sendi saja. Pengobatannya juga ringan, cukup menggunakan oba t antiradang yang tidak termasuk golongan steroid. Sementara, sebagian penderita lain dapat mengalami kerusakan berbagai organ tubuh seperti ginjal, sistem dara h, jantung, paru, dan lain-lain. Oleh karena itu, seorang dokter perlu menetapkan apakah penderita lupus tersebut mengalami gangguan pada organ tubuh yang penting seperti ginjal dan darah, atau terbatas hanya pada kulit dan sendi saja. Karena itulah diperlukan pemeriksaan laboratorium dan pemeriksaan penunjang lain yang cukup mahal. Jadi, bila penyaki t lupus tersebut hanya terbatas pada sendi atau kulit dan belum atau tidak ada g angguan pada organ tubuh lain, maka penyakit lupus tersebut tidak berbahaya. Bil a terdapat gangguan, misalnya pada ginjal atau sistem darah, maka gangguan terse but harus diatasi, sehingga fungsi organ-organ tersebut dapat dijaga dalam keada an baik. Penyakit lupus dianggap berbahaya, karena dapat menimbulkan kerusakan pada ginja l, sistem darah, dan organ tubuh lain. Tetapi bila ditemukan pada saat belum ada kerusakan organ tubuh tersebut, maka penyakit ini dapat diatasi. Bila penyakit lupus menyerang tidak hanya terbatas pada sendi dan kulit, maka diperlukan obat steroid. Bila yang terkena gangguan adalah organ tubuh yang penting, seperti gin jal dan sistem darah, obat steroid yang diperlukan dosisnya tinggi, sehingga mun gkin menimbulkan efek samping seperti moonface (muka bulat seperti bulan) , tetapi steroid dosis tinggi ini pelan-pelan akan diturunkan. Dengan pengobatan ini penyakit lupus akan mengalami remisi (bebas gejala). Pada penyakit lupus saat ini, tujuan pengobatan adalah mencapai keadaan remisi dan be lum sampai pada penyembuhan. Remisi ini dapat bertahun-tahun, tetapi memang dap at terjadi reaktivasi penyakit, misalnya jika berhenti makan obat sehingga diper lukan lagi dosis steroid yang tinggi. Dalam keadaan remisi, seorang penderita lupus dapat bekerja seperti biasa, terma suk hamil dan memiliki anak. Saya menganjurkan adik Anda tetap berkonsultasi den gan dokter penyakit dalam, karena sebagian besar permasalahan lupus termasuk bid ang keahlian penyakit dalam, meskipun dalam keadaan tertentu diperlukan konsulta si dengan dokter jantung atau paru. source: Kompas - dr Samsurizal
~~~ Protein find may lead to lupus therapy Wednesday, August 31, 2005 Reporter: Natasha JohnsonKERRY O'BRIEN: Even though the disease lupus affects around 20,000 Australians - at least as many as AIDS, multiple sclerosis or cerebral palsy - it remains much more of a mystery to most of us. It's a potentially fatal disease in which the body's own immune system attacks healthy tissue, causing inflammation anywhere from the brain to the skin. There's no known cause or cure, and there's a desperate need for new treatments because the current drug therapies have serious side-effects. Now scientists at Melbourne's Monash University have found that lupus patients have increased levels of a particular protein. It's a world-first discovery which they hope will lead to a new drug therapy to reduce symptoms and increase life expectancy. Natasha Johnson reports. KYLA FINLAY: It's like a part of yourself has died and you're never going to be the person you thought you might have been. And you just have to sort of come to terms with the fact that your whole life will have limitations. NATASHA JOHNSON: Thirty-eight-year-old mother of two Kyla Finlay has lupus, a potentially life-threatening auto-immune disease for which there is no cure. She was diagnosed at 21 when she came out in a rash similar to this after three years of feeling inexplicably tired and unwell. KYLA FINLAY: Fatigue, I guess, general malaise. I get joint pain, really cold extremities, where your extremities turn blue and you don't have any feeling in your feet and your hands. NATASHA JOHNSON: A cocktail of drugs reduces the symptoms, and enables her to work part-time and care for her two young children. But she needs lots of rest and must avoid sunlight and stress to prevent flare-ups. KYLA FINLAY: I don't go out as much as I'd like for fear of getting too tired. And then, you know, putting too much stress on my body and then getting sick. NATASHA JOHNSON: Lupus is an inflammatory disease in which the immune system mysteriously turns on itself. White blood cells are the frontline troops of the immune system and this video shows them moving through the bloodstream on the hunt for infection or other foreign bodies. DR MICHAEL HICKEY, MONASH UNIVERSITY: So this is a normal blood vessel and you can see white blood cells, these little blobs, they stick to the wall very briefly and then they decide there's nothing interesting there, they let go and they go back into the blood. NATASHA JOHNSON But this is what happens in the vessels of lupus sufferers. DR MICHAEL HICKEY: And you can see now how crowded this blood vessel is with these white blood cells. They're all sticking to the wall, and many of these cells are now going to go through that blood vessel and to the tissue. NATASHA JOHNSON: So the white blood cells now are attacking healthy tissue? DR MICHAEL HICKEY: That's right. NATASHA JOHNSON: These attacks can occur anywhere in the body from the brain to major internal organs, joints and skin. ASSOCIATE PROFESSOR ERIC MORAND, MONASH UNIVERSITY: People might present with kidney failure, people can present with stroke, or fitting, seizures or other forms of brain damage. People can present with fluid collections around the heart or lungs that that make it difficult to breathe. Basically lupus is thought of as the great imitator because it can affect any organ, it can do almost anything. NATASHA JOHNSON: A further problem is that the treatment of high doses of steroids and immune system suppressants can be almost as devastating as the disease. PAULINE FOLLETT: I have fluid detention in my face. It's very puffy. Also, weight gain is an issue. NATASHA JOHNSON: Without treatment, patients like Pauline Follett, who has lupus of the brain, would die within one to two years. But nowadays, they're more likely to die from the side-effects of medication. ASSOCIATE PROFESSOR ERIC MORAND: There has been no new treatment introduced for lupus for 30 to 40 years. Some of the drugs we need to use can actually cause diabetes, infertility, osteoporosis, cataracts and infections. NATASHA JOHNSON: Lupus affects mainly women of child-bearing age. While Kyla Finlay escaped fertility problems, she's developed osteoporosis. The brittle bone disease which usually affects the elderly. KYLA FINLAY: I guess it hit home when I had a spontaneous fracture in my leg from not doing anything. NATASHA JOHNSON: But now there's new hope. Researchers from Monash University have been hunting for a better treatment and may have found it through the identification of a protein called MIF. A protein which is present in all of us, but in studies on mice, the Monash scientists have discovered it's in much higher levels in lupus sufferers. ASSOCIATE PROFESSOR ERIC MORAND: The theories about lupus remind me a bit of the big bang theory of the universe. We know a lot about the history of the universe but we don't know exactly what happened in the first second. In lupus, we know a lot about what is happening in the disease when it's present but we don't know what was the thing that started it. MIF clearly is involved in the existence of the disease and blocking it appears to be beneficial. NATASHA JOHNSON: Their research has shown that by taking MIF out of the picture, the lupus symptoms are significantly reduced. DR MICHAEL HICKEY: This is an interesting protein. It turns on inflammation, it causes inflammation to get worse, and so our laboratory is the first to really show that if you take MIF away from animals that have lupus, then these animals get much less severe disease. So their survival rate is dramatically increased. NATASHA JOHNSON: It's a world-first discovery and the Monash researchers today presented it to the World Congress on Inflammation in Melbourne. The next step is to create a drug that can target the MIF protein in lupus patients. Pharmaceutical companies are already developing such an agent for use in other diseases, which could be available in about five years. And that's welcome news for Kyla Finlay. KYLA FINLAY: If you can target the right organ in the body and not get these side effects, it would be fantastic. source
~~~ Let's Do It Healthy Monday, August 22, 2005 Don't feel guilty for making time for yourself. It's not selfish to make yourself a priority. Neglecting yourself can mean having less than 100 percent to give back to everyone else. The first step toward more balance in life is to believe you are number one and your needs are important. So, congratulate yourself for identifying the fact that you are a priority.If weight loss is part of your plan, you've got good reasons to watch your portions. Don't deny yourself your favorite foods, but don't go overboard, either. Keep track of what you eat and each day focus on small successes. They can add up to a new you, and a lifetime of feeling better about yourself and your weight. Juicy, red watermelon is not only delicious, it may help men avoid prostate cancer. As long as you spit out the seeds, watermelon is the biggest supplier among fresh fruits and vegetables in the antioxidant lycopene, which is believed to play a big role in the prevention of the killer disease. Antioxidants such as lycopene work in your body by disarming free oxygen radicals, which are thought to contribute to the development of many cancers. A 2-cup serving of watermelon contains 15 - 20 milligrams of this vital plant pigment. Other sources include tomatoes, red grapefruits and guavas. Chocolate is good for you! At least it is if you stick to cocoa, or chocolate with little saturated fat. Cocoa has flavonoids -- the same health-boosting substances found in tea, red wine and soy foods. Studies suggest the flavonoids may help protect against heart disease and stroke. They slow blood's ability to clot, and reduce potential for arterial plaque. One problem: Most commercial chocolate is made with partially hydrogenated vegetable oils and cholesterol-raising trans fatty acids -- not to mention all the sugar and calories! For an occasional treat, choose dark chocolate, or cocoa made with low fat milk. It's easy to fit stretching into your day; try these 3 tips. Practice some stretches while waiting in shopping lines. Simple neck and shoulder rolls are a great way to release stress and relax tight muscles. And make use of the stairs -- a great tool for stretching out your calves. How important is it to stretch? The American College of Sports Medicine has added stretching to its fitness recommendations. Go mango. Nature packs a lot of vitamins A and C into these low-calorie appetizers. Half a medium-sized mango supplies 40% of the vitamin A and 50% of the vitamin C that most of us need daily. All for a mere 67 calories. And it tastes great! Tune into TV. Haul that treadmill or exercise bike out of the basement and put it smack dab in front of your television set. Or go for a more portable alternative and jump rope or lift light hand weights while you watch. Besides being too busy to eat, you may find that you're exercising for longer periods when you're distracted by the television. When yogurt's live active cultures colonize your digestive system, they draw a line in the sand against disease. The cultures -- especially acidophilus and bifida - muscle out potentially threatening bacteria. Low-fat or fat-free yogurt has a lot of other things going for it: It's easy to digest, especially for those who are lactose-intolerant and have difficulty digesting milk and many cheeses; it's an excellent source of calcium, protein, riboflavin (a B vitamin), vitamin B-12 (which may be low in vegetarian diets) and vitamin A; and provides selenium, potassium and magnesium. Don't drain that water! It can contain a good source of B vitamins! Steaming or microwaving vegetables is one of the best ways to retain the water-soluble B-complex and C vitamins. These preparation methods require very little liquid so fewer vitamins are leached out during the cooking process. If you boil vegetables, save the water for another part of the recipe if you can, that way you save the leached out nutrients. Inactive adults over age 30 lose about 3 - 5% of muscle tissue every 10 years; here's what you can do. Go to the weight room. Strength training prevents the reduction in muscle tissue that causes the body metabolism to slow and makes the bones more vulnerable to conditions like osteoporosis.
~~~ Pengobatan Lupus yang Tepat Bisa Pertahankan Hidup Thursday, August 18, 2005 Pengobatan Lupus yang Tepat Bisa Pertahankan Hidup Bandung, Kompas - Pengobatan yang tepat bagi penderita lupus bisa membantu meningkatkan kemampuan mereka bertahan hidup. Sayangnya, banyak orang dengan lupus (odapus) yang tidak sadar bahwa dirinya menderita lupus. Selain itu, tidak semua dokter bisa dengan cepat mendeteksi bahwa pasiennya menderita lupus. "Kalau lupus bisa diketahui lebih dini, penanganan yang tepat bisa dilakukan lebih cepat. Penanganan tepat bisa membuat Odapus bertahan hidup lebih lama," ujar Dian Syarief, pendiri Care for Lupus sekaligus penderita lupus di Bandung, Selasa (10/5). Tanggal 10 Mei merupakan Hari Lupus sedunia. Lupus adalah penyakit yang disebabkan sel imun di dalam tubuh terlalu aktif, bekerja melebihi fungsinya. Sel imun itu tidak hanya menyerang kuman yang merusak, tetapi juga menyerang organ- organ tubuh. Biasanya, lupus menyerang orang yang memiliki gen Human Leukocyte Antigens (HLA) tipe DR2 dan DR3. Menurut Dian, banyak Odapus baru mengetahui menderita lupus setelah beberapa tahun didiagnosa berbagai penyakit. "Ada seorang Odapus yang baru bergabung dengan Care For Lupus dalam kondisi yang sudah buruk. Beberapa hari dirawat di rumah sakit. Lalu meninggal," ujar Dian. Care For Lupus yang sudah didirikan dua tahun lalu memiliki 100 anggota yang merupakan Odapus. Dalam dua tahun, sudah 15 Odapus meninggal. Sebanyak 12 orang meninggal tahun 2004 dan 3 orang meninggal tahun 2005. Untuk menyebarkan pengetahuan tentang lupus, Care for Lupus aktif menyebarkan informasi tentang lupus pada masyarakat melalui anggotanya yang terdiri dari Odapus dan relawan. Penyebaran informasi juga dilakukan melalui media massa serta menyelenggarakan simposium pasien dengan dokter. Pada peringatan Hari Lupus Sedunia tahun ini, ujar Dian, Care For Lupus akan tetap meneruskan program sesuai tema peringatan Hari Lupus Sedunia tahun lalu, yaitu meningkatkan pengetahuan tenaga medis dan menemukan terapi lupus yang aman. "Kami tidak membuat kegiatan seremonial, tetapi langsung pada kasus nyata saja. Misalnya, mencari informasi tentang kemajuan terapi untuk lupus. Karena selama ini terapi untuk lupus belum aman," kata Dian yang pernah mengalami infeksi otak akibat menggunakan terapi tersebut. Dian Mustika (29), penderita lupus mengaku terlambat mengetahui penyakitnya. Sejak kecil, Dian mengaku sering didiagnosa berpenyakit tipus. Baru beberapa pekan lalu, ia mengetahui menderita lupus setelah melakukan tes Antinuclear Antibody (ANA). "Saya sempat syok selama dua minggu. Tapi sekarang saya merasa tenang. Setelah tahu penyakit saya sesungguhnya, saya tahu bagaimana harus hidup dengan lupus, apa yang harus saya lakukan dan hindari," ujar Dian Mustika yang berharap Hari Lupus Sedunia tahun ini bisa membuat para Odapus tidak merasa terpuruk dengan penyakitnya. (y09)
~~~ Seputar Penaklukan Lupus
Isi artikel ini hampir sama persis dengan yang saya sampaikan di Talkshow radio PasFM beberapa waktu lalu. Semoga bisa dijadikan acuan. Peniru Ulung yang Harus Ditaklukkan Kompas - 19 Agustus 2005 - Oleh: GESIT ARIYANTO Namanya mirip lakon film tentang remaja usil dan bandel yang ngetop pada era 1980-an. Namun, lupus yang satu ini adalah nama penyakit yang mengganggu sistem pertahanan tubuh. Hingga kini belum diketahui persis penyebab dan obat yang benar-benar manjur. Di seluruh dunia diperkirakan terdapat lebih dari 5 juta pasien lupus dan setiap tahun ditemukan lebih dari 100.000 pasien baru, baik usia anak-anak, dewasa, laki-laki maupun perempuan. Di Indonesia, tidak dapat diperkirakan persis berapa jumlah penderitanya. Diduga jumlah pasien lupus di Penyakit lupus disebut peniru ulung karena gejalanya muncul mirip dengan gejala-gejala beberapa penyakit lain. Sesama pasien lupus sangat mungkin dan sering dijumpai datang dengan keluhan awal yang berbeda. Seseorang bisa jadi datang ke dokter dengan keluhan peradangan sendi layaknya rematik. Pada waktu lain, datang pasien dengan demam tinggi layaknya gejala tifus. Atau, pasien dengan kaki dan perut bengkak akibat kerusakan ginjal. Karena sifat peniru tersebut, penyakit ini tergolong sukar dideteksi dokter. Kesabaran dan ketenangan pasien, keluarga, serta dokter mutlak dibutuhkan untuk memutuskan apakah pasien benar-benar terjangkiti lupus. Menurut Prof Dr Zubairi Djoerban SpPD KHOM dari Bagian Penyakit Dalam Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Cipto Mangunkusumo, penyakit lupus juga disebut dengan penyakit otoimun. Artinya, antibodi yang terbentuk di dalam tubuh pasien justru merusak organ tubuh sendiri, seperti ginjal, hati, sendi, sel darah merah, dan sel darah putih. Padahal, antibodi dalam tubuh seharusnya dibentuk untuk melindungi tubuh dari serangan bakteri atau virus yang berpotensi menimbulkan penyakit. Antibodi yang menyerang organ tubuh manusia muncul karena aktivitas sistem kekebalan tubuh yang berlebihan. Jenis-jenis lupus Terdapat tiga jenis lupus yang berhasil diidentifikasi, masing-masing diskoid lupus (DL), drug induced lupus (DIL), dan systemic lupus erythematosus (SLE). Jenis DL menyerang bagian kulit yang terlihat dari perubahan warna kulit di wajah, leher, kulit kepala, dan sekujur tubuh. Umumnya kemerahan, bersisik, dan gatal. Karena bentuknya yang khas, maka lupus sering diidentikkan dengan kupu-kupu. Untuk jenis DIL, diidentifikasikan karena efek samping obat yang dikonsumsi dalam jangka panjang. Terdapat 38 jenis obat yang dapat menyebabkan DIL, dua di antaranya obat darah tinggi (hidralazine) dan obat untuk detak jantung yang tidak teratur (prokainamide). Akan tetapi, tidak semua orang yang mengonsumsi obat-obat tersebut akhirnya terserang lupus jenis DIL. Kemungkinannya hanya sekitar 4 persen. Jenis terakhir adalah SLE. Jenis ini dikenal paling berbahaya karena menyerang beberapa organ dalam tubuh manusia sekaligus, seperti ginjal, jantung, paru-paru, saraf, dan otak. Akan tetapi, pada sebagian penderita hanya menyerang kulit dan sendinya. Perempuan lebih banyak Tanpa diketahui persis penyebabnya, kasus lupus lebih sering dijumpai pada pasien perempuan berusia produktif daripada pasien laki-laki. Persentasenya 90:10. Faktor hormon dituding sebagai pemicunya. Meningkatnya angka pertumbuhan penyakit lupus sebelum periode menstruasi atau selama kehamilan mendukung dugaan bahwa hormon estrogen memicu lupus. Kisaran usia pasien yang banyak dihinggapi lupus antara 15-44 tahun. Namun, pada prinsipnya lupus dapat menyerang siapa pun dan tak terbatas usia. Diungkapkan Zubairi, meskipun lebih banyak menyerang perempuan, bukan berarti laki-laki aman dari lupus. Pada laki-laki, gejala lupus akan lebih berat ”Yang jelas, perempuan masih boleh hamil dan punya anak,” kata dia. Selama ini, ibu hamil penderita lupus dapat melahirkan dengan aman. Bayi yang dilahirkan pun tidak tertular. ”Hanya 7 persen saja yang dijumpai menurun,” lanjut Zubairi. Bukti bahwa lupus bukan penyakit genetik salah satunya dijelaskan dengan bayi kembar yang dilahirkan dari ibu dengan lupus. Pada salah satu bayi lupus, hanya 30 persen kemungkinan mengenai bayi kembarannya. Hal ini menunjukkan bahwa ada faktor lingkungan lain yang lebih penting ketimbang faktor genetik. Faktor penyebab Selain faktor keturunan yang amat kecil kemungkinannya, faktor lingkungan juga diduga menyebabkan lupus, seperti infeksi, stres, makanan, antibiotik, sinar ultraviolet, dan penggunaan obat-obat tertentu. Faktor hormon estrogen pada perempuan juga disinyalir berperan dalam mencetuskan lupus, meskipun hingga kini belum diketahui jenis hormon penyebab besarnya. Penyebab lainnya adalah sinar ultraviolet yang dapat merangsang peningkatan hormon estrogen dan mempermudah reaksi otoimun. Beberapa hal di atas pula yang berpotensi memicu lupus kambuh. Karena itu, selain mengatur diri, kualitas hidup pasien lupus juga terkait erat dengan dukungan keluarga dan penanganan dokter yang tepat. Ditegaskan Zubairi, pengobatan yang tepat merupakan bagian yang tidak boleh terpisahkan demi kualitas hidup pasiennya. Persoalannya, mendiagnosa lupus tidak mudah dan tidak semua dokter jeli melakukannya. Padahal, salah memberi obat justru akan membuat pasien lupus makin menderita parah. ”Jangan sampai pasien lupus dengan keluhan seperti rematik, misalnya, diberi obat rematik. Fungsi dan dampaknya jauh beda,” katanya. Pengobatan Seiring kemajuan teknologi kedokteran, telah ditemukan jenis pengobatan baru. Salah satunya LymphoStat-B yang bekerja menghambat protein yang merangsang limfosit B. Limfosit B adalah sel yang berkembang menjadi sel plasma yang memproduksi antibodi yang salah arah dan merusak organ tubuh. Berkurangnya produksi antibodi membuat aktivitas penyakit lupus menjadi lebih mudah dikontrol. Selama ini, pengobatan memang lebih ditujukan untuk mengontrol penyakit sehingga tidak terus-menerus kambuh. Pengobatan intensif selanjutnya diteruskan dengan pemeliharaan dengan mengonsumsi obat-obatan tertentu sesuai jenis lupus yang dideritanya. Untuk jenis SLE, salah satu jenis pengobatan yang sedang diteliti adalah dengan pencangkokan sumsum tulang, yang hasilnya cukup memberi harapan. Kini, seiring temuan pengobatan yang lebih baik, daya bertahan pasien mencapai 80 persen dibandingkan dengan tahun 1970-an lalu yang hanya 50 persen. Di Indonesia, memang masih tertinggal dari negara-negara maju. Akan tetapi, seperti diungkapkan Zubairi, penanganan pasien lupus yang tepat sejak awal didukung keluarga dan pola hidup, pasien dapat sembuh total. Pendek kata, peniru ulung yang butuh penelitian lebih lanjut tersebut juga dapat ditaklukkan.
~~~ Flu Burung: Gejala, Penularan & Pencegahannya Tuesday, August 02, 2005 Jakarta, SeninTjandra Yoga Aditama,Bagian Pulmonologi & Kedokteran Respirasi FKUIdan RS Persahabatan, Jakarta Masyarakat kini ramai membicarakan flu burung yang telah nyata-nyatamenyerang manusia di negeri kita.Masyarakat tampaknya khawatir apakah penyakit ini dapat merebak luaspada manusia lainnya? Berikut akan disampaikan gambaran terjadinya flu burung pada manusia:gejala, cara diagnosisnya,penanganan, dan pencegahannya. GEJALA Gejala flu burung pada dasarnya sama dengan flu biasa. Laporan darikasus yang terjadi tahun 1999 menunjukkan adanya variasi gejalaberupa: -Demam sekitar 39 derajat Celsius-Batuk-Lemas-Sakit tenggorokan-Sakit kepala-Tidak nafsu makan-Muntah-Nyeri perut-Nyeri sendi-Diare-Infeksi selaput mata (conjunctivitis) Dalam keadaan memburuk, terjadi severe respiratory distress, yakni sesak napas hebat, kadar oksigen rendah sementara kadarkarbondioksida meningkat. Ini terjadi karena infeksi flu menyebar ke paru-paru dan menimbulkan radang paru-paru (pneumonia). Pengalaman tahun 1997 di Hongkong juga menunjukkan gejala: demam,batuk pilek, sakit tenggorokan, muntah, dan keluhan pusing. Namun, data dari Vietnam di tahun 2004 menunjukkan gejala berbeda. Pasien tidak mengeluh sakit tenggorokan atau pilek. Juga tak adakeluhan radang selaput mata. Separuh pasien malah menderita diaredengan tinja yang cair. FAKTOR RISIKO Setelah mengenali gejalanya, biasanya akan dicari informasi mendalamtentang faktor risiko yang ada: Apakah yang bersangkutan bekerja di peternakan atau habis berkunjungke pasar ayam dan lain-lain. Juga akan ditanya penyakit-penyakit lainyang mungkin akan memperburuk keadaan, seperti penyakit paru ataujantung, adanya riwayat alergi, dan sebagainya. Setelah itu dilakukan pemeriksaan fisik untuk melihat langsungkeadaan pasien, dilanjutkan dengan pemeriksaan laboratorium dan juga rontgen dada untuk melihat ada tidaknya gambaran pneumonia. PENULARAN Penularan dari unggas ke manusia terjadi lewat kontak air liur dankotoran unggas. Kontak ituterjadi lewat sentuhan langsung atau juga melalui kendaraan yangmengangkut hewan-hewan itu. Juga termasuk kandang, alat-alatpeternakan, pakan ternak, pakaian, sepatu para peternak. Unggas yang sudah dimasak tidak akan menularkan flu burung ke manusiasebab virus itu akan mati dengan pemanasan 80 derajat lebih darisatu menit. Selama ini kita selalu menggoreng ayam dengan suhu diatas 80 derajat dan lebih dari satu menit. Jadi inshaAllah aman. PEMERIKSAAN LABORATORIUM Pada dasarnya dilakukan untuk menilai keadaan kesehatan pasien danjuga untuk mendeteksi bakteri/virus apa yang menyerang pasien tersebut. Pemeriksaan untukmenilai keadaan kesehatan antara lain dengan menilai kadar leukosit,fungsi hati, fungsi ginjal, dan yang penting juga analisis gas darah arteri. Pada pemeriksaan ini, antara lain, akan dapat diketahui berapa kadaroksigen (O2) dan karbondioksida (CO2) di darah pasien. Kalau oksigennya rendah, nilai normalnya berkisar 85-95 mmHg, dan atau karbondioksidanya tinggi, nilai normalnya 35-45 mmHg, maka dapat terjadi keadaan gawat napas. Dari data yang ada, sebagian besar pasien flu burung meninggal karena gawat napas akut ini. Upaya menemukan virus flu burung dapat dilakukan dengan pemeriksaan serologi untuk menilai respons antigen antibodi dan atau mengisolasivirusnya sendiri. Pada kasus flu burung juga dapat dijumpai peningkatan titer netralisasi antibodi dan dapat pula dilakukan analisis antigenik dan genetik, antara lain untuk mengetahui apakahsudah ada mutasi dari virus tersebut. Kedua pasien di Hongkong (tahun 1999) menjalani pemeriksaan ELISA(enzyme liknk immuno sorbent assay), cairan saluran hidung tenggorok. Ternyata positif influenza A. Pada kedua kasus ini juga dilakukan kultur pada cairan saluran hidung tenggorok yang menunjukkan positifinfluenza A (H9N2). Pada kasus yang terjadi di Hongkong (tahun 1997), diagnosis infeksivirus H5N1 dipastikan dengan ditemukannya virus. Lokasi diisolasinyavirus ini ada pada usap tenggorok, cairan yang diisap dari trakea,aspirat saluran hidung tenggorok, dan ada pula virus yang ditemukandari cairan bronko alveolar yang didapat dengan pemeriksaan bronkoskopi (memasukkan alat ini ke paru pasien). OBAT YANG DIBERIKAN Obat yang diberikan dapat bersifat simtomatik, sesuai dengan gejalayang ada. Bila batuk, pasien dapat diberi obat batuk; kalau sesakdapat diberi obat jenid bronkodilator untuk melebarkan saluran napasyang menyempit. Selain itu, dapat pula diberikan obat antivirusseperti amantadine dan oseltamivire. Kalau keadaan pasien terusmemburuk, bukan tidak mungkin perlu dipasang alat ventilator untuk membantu pernapasannya. PENCEGAHAN Organisasi Kesehatan Dunia (WHO) menyatakan, secara umum prinsip-prinsip kerja yang higienis, seperti: 1. Mencuci tangan dan menggunakan alat pelindung diri -merupakanupaya yang harus dilakukan oleh mereka yang kontak dengan binatang,baik dalam keadaan mati, apalagi ketika hidup. 2.Karena telur juga dapat tertular, maka penanganan kulit telur dantelur mentah perlu dapat perhatian pula. 3.Daging unggas harus dimasak sampai suhu 70 derajat C atau 80derajat C selama sedikitnya satu menit. Kalau kita menggoreng ataumerebus ayam di dapur, tentu lebih dari itu suhu dan lamanya memasak.Artinya, sejauh ini bukti ilmiah yang ada mengatakan bahwa amanmengonsumsi ayam dan unggas lainnya asal telah dimasak dengan baik. 4.Pola hidup sehat. Secara umum pencegahan flu adalah menjaga daya tahan tubuh dengan makan seimbang dan bergizi, istirahat dan olahraga teratur. 5.Jangan lupa sering mencuci tangan. Pasien influenza dianjurkanbanyak istirahat, banyakminum. 6.Khusus untuk pekerja peternakan dan pemotongan hewan ada beberapaanjuran WHO yang dapat dilakukan: Semua orang yang kontak dengan binatang yang telah terinfeksi harus sering-sering tangan dengan sabun. Mereka yang langsung memegang dan membawa yang sakit sebaiknya menggunakan desinfektan untuk membersihkan tangannya. Mereka yang memegang, membunuh, dan membawa atau memindahkan unggas yang sakit dan atau mati karena flu burung seyogianya melengkapi diri dengan baju pelindung, sarung tangan karet, masker, kacamata.
~~~ Talkshow material Tuesday, July 26, 2005 This is my material used in Lupus Radio Talkshow.Hope you all can enjoy and give me some advise. On air PasFM Radio Bisnis, 92.4 FM - PasFM Healthcare: August 6, 2005 : 9.00 - 10.00 WIB. materials.. in pdf and word more, check Tabloid Senior, August 3, 2005.
~~~ Cancer Drug Also Fights Lupus, Rheumatoid Arthritis Monday, June 27, 2005 Immune-targeted rituximab shows good results in two trials
~~~ Reports Shed Light on Dangers of New MS Drug
Susceptibility to brain infection might be caught in patients in future
~~~ Discovery May Lead to Lupus Treatments
~~~ More Studies Link Painkillers to Heart Problems
Research builds on earlier findings surrounding anti-inflammatory drugs
~~~ Green Tea May Protect Against Autoimmune Diseases Tea compound suppressed immune-cell activity in skin and salivary glands By Kathleen Doheny, HealthDay Reporter FRIDAY, June 17 (HealthDay News) -- Green tea, already lauded for its cancer-fighting ability, may also protect against certain autoimmune diseases, new research suggests. Green teas inhibit the expression of antigens made by the body, substances that can trigger an immune response, explained study author Stephen Hsu, an associate professor in the School of Dentistry at the Medical College of Georgia in Augusta. He is to report on the research Sunday at the Arthritis Foundation's Arthritis Research Conference in Atlanta. He focused on EGCG, a substance found in green tea known to suppress inflammation, and its effect on skin and salivary gland cells. In one autoimmune disorder, Sjogren\'s syndrome, the salivary glands are affected, causing dry mouth. In another autoimmune disorder, lupus, the skin is affected. Hsu's team isolated 130 autoantigens from cells and exposed them to EGCG. Autoantigens are molecules in the body with useful functions, according to Hsu, but changes in either their amount or their location can result in an unwanted immune response. Of the 130 autoantigens “most were inhibited or without changes”; when exposed to the EGCG, he said. “Among them, a group of key autoantigens were inhibited.” While the research is very preliminary, he said, eventually green tea might help protect cells from being attacked by the autoantigens. Besides applications for the dry mouth that affects those with Sjogren's, Hsu said green tea might prove useful for the skin found in lupus. The Georgia researcher speculated that EGCG modulates the presence of the autoantigens, in addition to its ability to suppress inflammation. According to Hsu, other research with green tea in animal models has shown it can reduce arthritis. The new study is “a significant beginning” said Nihal Ahmad, an assistant professor of dermatology at the University of Wisconsin at Madison, who was part of a team in 1999 that showed that polyphenols (of which EGCG is one) in green tea could prevent induced arthritis in mice. The Hsu research, he said, “appears to have great potential,” though it “needs more work”. However, “based on the cell culture study, we can only say that we can be hopeful.” More information To learn more about tea and cancer prevention, visit the National Cancer Institute. content by: SOURCES: Stephen Hsu, Ph.D., associate professor, School of Dentistry, Medical College of Georgia, Augusta; Nihal Ahmad, Ph.D., assistant professor, dermatology, University of Wisconsin, Madison; June 19, 2005, presentation, Arthritis Foundation\'s Arthritis Research Conference, Atlanta
~~~ Honey and Cinnamon Friday, June 24, 2005 It is found that mixture of Honey and Cinnamon cures most of the diseases.Honey is produced in most of the countries of the world. Ayurvedic as well as Yunani medicine have been using honey as a vital medicine for centuries. Scientists of today also accept honey as a Ram Ban (very effective) medicine for all kinds of diseases. Honey can be used without any side effects for any kind of diseases. Today's science says that even though honey is sweet, if taken in the right dosage as a medicine, it does not harm diabetic patients also. A famous magazine named Weekly World News published in Canada dated 17 January, 95 has given a list of diseases that can be cured by Honey and Cinnamon as researched by western scientists. Arthritis Take one part honey to two parts of luke warm water and add a small teaspoon of cinnamon powder, make a paste and massage it on the itching part of the body slowly. It is noticed that the pain recedes within a minute or two. Or arthritis patients may daily, morning and night take one cup of hot water with two spoons of honey and one small teaspoon of cinnamon powder. If drunk regularly even chronic arthritis can be cured. In a recent research done at the Copenhagen University, it was found that when the doctors treated their patients with a mixture of one tablespoon Honey and half teaspoon cinnamon powder before breakfast, they found that within a week out of the 200 people so treated practically 73 patients were totally relieved of pain and within a month, mostly all the patients who could not walk or move around because of arthritis started walking without pain. Hair Loss Those suffering from hair loss or baldness, may apply a paste of hot olive oil, one tablespoon of honey, one teaspoon of cinnamon powder before bath and keep it for approx. 15 min. and then wash the hair. It was found very effective if kept for 5 mins. also. Bladder Infections Take two tablespoons of cinnamon powder and one teaspoon of honey in a glass of luke warm water and drink it. It destroys the germs of the bladder. Toothache Make a paste of one teaspoon of cinnamon powder and five teaspoons of honey and apply on the aching tooth. This may be done 3 times a day daily till such time that the tooth has stopped aching. Cholesterol Two tablespoons of honey and three teaspoons of Cinnamon Powder mixed in 16 ounces of tea water, if given to a cholesterol patient, it reduces the level of cholesterol in the blood by 10% within 2 hours. As mentioned for arthritic patients, if taken 3 times a day any chronic cholesterol is cured. As per the information received in the said journal, pure honey taken with food daily relieves complains of cholesterol. Colds Those suffering from common or severe colds should take one tablespoon luke warm honey with 1/4 teaspoon cinnamon powder daily for 3 days. This process will cure most chronic cough, cold and clear the sinuses. Infertility Yunani and Ayurvedic have been using honey for years in medicine to strengthen the semen of men If impotent men regularly take two tablespoon of honey before sleeping, their problem will be solved. In China, Japan and Far-East countries, women who do not conceive and to strengthen the uterus have been taking cinnamon powder for centuries. Women who cannot conceive may take a pinch of cinnamon powder in half teaspoon of honey and apply it on the gums frequently throughout the day, so that it slowly mixes with the saliva and enters the body. A couple in Merryland, America had no children for 14 years and had left hope of having a child of their own. When told about this process husband and wife started taking honey and cinnamon as stated above, the wife conceived after a few months and had twins at full term. Upset Stomach Honey taken with cinnamon powder cures stomach ache and also clears stomach ulcers from the root. GAS : According to the studies done in India & Japan, it is revealed that if honey is taken with cinnamon powder the stomach is relieved of gas. Heart Diseases Make a paste of honey and cinnamon powder, apply on bread or chappati instead of jelly and jam and eat it regularly for breakfast. It reduces the cholesterol in the arteries and saves the patient from heart attack. Also those who have already had an attack, if they do this process daily, are kept miles away from the next attack. Regular use of the above process relieves loss of breath and strengthens the heart beat. In America and Canada, various nursing homes have treated patients successfully and have found that due to the increasing age the arteries and veins which lose their flexibility and get clogged are revitalized. Immune System Daily use of honey and cinnamon powder strengthens the immune system and protects the body from bacteria and viral attacks. Scientists have found that honey has various vitamins and iron in large amounts. Constant use of honey strengthens the white blood corpuscles to fight bacteria and viral diseases. Indigestion Cinnamon powder sprinkled on two tablespoons of honey taken before food, relieves acidity and digests the heaviest of meals. Influenza A scientist in Spain has proved that honey contains a natural ingredient which kills the influenza germs and saves the patient from flu. Longevity Tea made with honey and cinnamon powder, when taken regularly arrests the ravages of old age. Take 4 spoons of honey, 1spoon of cinnamon powder and 3 cups of water and boil to make like tea. Drink 1/4 cup, 3 to 4 times a day. It keeps the skin fresh and soft and arrests old age. Life span also increases and even if a person is 100 years old, starts performing the chores of a 20 year old. Pimples Three tablespoons of honey and one teaspoon of cinnamon powder paste. Apply this paste on the pimples before sleeping and wash it next morning with warm water. If done daily for two weeks, it removes pimples from the root. Skin Infections Eczema, ringworm and all types of skin infections are cured by applying honey and cinnamon powder in equal parts on the affected parts. Weight Loss Daily in the morning, 1/2 hour before breakfast on an empty stomach and at night before sleeping, drink honey and cinnamon powder boiled in one cup water. If taken regularly it reduces the weight of even the most obese person. Also drinking of this mixture regularly does not allow the fat to accumulate in the body even though the person may eat a high calorie diet. Cancer Recent research in Japan and Australia has reveled that advanced cancer of the stomach and bones have been cured successfully. Patients suffering from these kinds of cancer should daily take one tablespoon of honey with one teaspoon of cinnamon powder for one month 3 times a day. Fatigue Recent studies have shown that the sugar content of honey is more helpful than detrimental to the body strength. Senior citizens who take honey and cinnamon power in equal parts are more alert and flexible. Dr. Milton who has done research says that half tablespoon honey taken in one glass of water and sprinkled with cinnamon powder, taken daily after brushing and in the afternoon at about 3.00 p.m. when the vitality of the body starts decreasing, increases the vitality of the body within a week. Bad Breath People of South America, first thing in the morning gargle with one teaspoon of honey and cinnamon powder mixed in hot water. So their breath stays fresh throughout the day. Hearing Loss Daily morning and night honey and cinnamon powder taken in equal parts restores hearing.
~~~ Banana and Banana .. Thursday, June 23, 2005 Bananas. Containing three natural sugars -sucrose, fructose and glucose combined with fiber, a banana gives aninstant, sustained and substantial boost of energy. Research has proven that just two bananas provide enough energy for a strenuous 90-minute workout. No wonder the banana is the number one fruit with the world's leading athletes. But energy isn't the only way a banana can help us keep fit. It can also help overcome or prevent a substantial number of illnesses and conditions, making it a must to add to our daily diet. Depression: According to a recent survey undertaken by MIND amongst people suffering from depression, many felt much better after eating a banana. This is because bananas contain tryptophan, a type of protein that the body converts into serotonin, known to make you relax, improve your mood and generally make you feel happier. PMS: Forget the pills - eat a banana. The vitamin B6 it contains regulates blood glucose levels, which can affect your mood. Anemia: High in iron, bananas can stimulate the production of hemoglobin in the blood and so helps in cases of anemia. Blood Pressure: This unique tropical fruit is extremely high in potassium yet low in salt, making it the perfect to beat blood pressure. So much so, the US Food and Drug Administration has just allowed the banana industry to make official claims for the fruit's ability to reduce the risk of blood pressure and stroke Brain Power: 200 students at a Twickenham (Middlesex) school were helped through their exams this year by eating bananas at breakfast, break, and lunch in a bid to boost their brain power. Research has shown that the potassium-packed fruit can assist learning by making pupils more alert.. Constipation: High in fiber, including bananas in the diet can help restore normal bowel action, helping to overcome the problem without resorting to laxatives, Hangovers: One of the quickest ways of curing a hangover is to make a banana milkshake, sweetened with honey. The banana calms the stomach and,with the help of the honey, builds up depleted blood sugar levels, while the milk soothes and re-hydrates your system. Heartburn: Bananas have a natural antacid effect in the body, so if you suffer from heartburn, try eating a banana for soothing relief. Morning Sickness: Snacking on bananas between meals helps to keep blood sugar levels up and avoid morning sickness. Mosquito bites: Before reaching for the insect bite cream, try rubbing the affected area with the inside of a banana skin. Many people find it amazingly successful at reducing swelling and irritation. Nerves: Bananas are high in B vitamins that help calm the nervous system. Overweight and at work? Studies at the Institute of Psychology in Austria found pressure at work leads to gorging on comfort food like chocolate and crisps. Looking at 5,000 hospital patients, researchers found the most obese were more likely to be in high-pressure jobs. The report concluded that, to avoid panic-induced food cravings, we need to control our blood sugar levels by snacking on high carbohydrate foods every two hours to keep levels steady Ulcers: The banana is used as the dietary food against intestinal disorders because of its soft texture and smoothness. It is the only raw fruit that can be eaten without distress in over-chronicler cases. It also neutralizes over-acidity and reduces irritation by coating the lining of the stomach. Temperature control: Many other cultures see bananas as a "cooling" fruit that can lower both the physical and emotional temperature of expectant mothers. In Thailand, for example, pregnant women eat bananas to ensure their baby is born with a cool temperature. Seasonal Affective Disorder (SAD): Bananas can help SAD sufferers because they contain the natural mood enhancer tryptophan. Smoking: Bananas can also help people trying to give up smoking. The B6 and B12 they contain, as well as the potassium and magnesium found in them, help the body recover from the effects of nicotine withdrawal. Stress: Potassium is a vital mineral, which helps normalize the heartbeat, sends oxygen to the brain and regulates your body's water balance. When we are stressed, our metabolic rate rises, thereby reducing our potassium levels. These can be rebalanced with the help of a high-potassium Banana snack. Strokes: According to research in "The New England Journal of Medicine, eating bananas as part of a regular diet can cut the risk of death by strokes by as much as 40%! Warts: Those keen on natural alternatives swear that if you want to kill off a wart, take a piece of banana skin and place it on the wart, with the yellow side out. Carefully hold the skin in place with a plaster or surgical tape! So, a banana really is a natural remedy for many ills. When you compare it to an apple, it has four times the protein, twice the carbohydrate, three times the phosphorus, five times the vitamin A and iron, and twice the other vitamins and minerals. It is also rich in potassium and is one of the best value foods around. So maybe its time to change that well-known phrase so that we say, "A banana a day keeps the doctor away!"
~~~ Cerita Penderita Lupus Sunday, May 15, 2005 Sabtu, 16 Oktober 2004 - Republika'Buta Mata Bukan Akhir Segalanya' Meski tergolong tuna netra, bukan berarti orang yang mengalami low vision tidak bisa melihat sama sekali. Hal itu dialami Ketua Yayasan Syamsi Dhuha, Dian Syarif. Ia mengalami low vision sebagai dampak dari pengobatan atas penyakit lupus yang dideritanya. Saat ini kemampuan penglihatan wanita berkerudung ini tinggal lima persen. Dengan keterbatasan penglihatannya, terkadang ia masih bisa menebak benda apa yang ada di dekatnya. Ketika low vision itu terjadi, menurut Dian, semula dirinya merasa terpukul dan shock. Pasalnya, mata yang menjadi alat utama penglihatan, tiba-tiba menghilang begitu saja. Pada awalnya, ia merasa tidak percaya diri kalau pergi ke mana-mana dan harus didampingi. Dian mencoba untuk mengenali kehidupan sesamanya yang ada di Wyata Guna. Di sanalah, timbul keberanian dan rasa percaya dirinya untuk melakukan sesuatu, bahkan bepergian seorang diri. ''Yang membuat aku bangkit ketika mengalami krisis, aku bertemu orang yang kondisinya lebih jelek dari aku. Sehingga, aku sadar kalau sebenarnya masih beruntung memiliki lima persen penglihatan lagi,'' katanya. Selain datang ke Wyata Guna, Dian juga sering belajar dari sebuah keluarga yang kedua orang tuanya buta sedangkan tujuh anaknya melihat semua. Namun, kata dia, si ibu tetap bisa memasak dan menyuapi anaknya. Setelah melihat ibu yang buta itu, kata dia, dirinya jadi berani memasak ke dapur. Padahal, kata dia, sebelumnya tidak ada keberanian untuk itu.''Saya belajar memasak, dengan membedakan panas untuk mengetahui sudah matang atau belum,'' tuturnya. Menurut Dian, ayahnyalah orang yang paling berperan memberikan dukungan di saat dirinya krisis. Ia selalu ingat akan kata-kata ayahnya yang mengatakan, tidak apa-apa kehilangan indera penglihatan karena akan digantikan oleh indera lain. Pada awalnya, lanjut Dian, dirinya tidak mengerti perkataan ayahnya itu. Namun, setelah berjalan beberapa lama, dirinya mulai sadar kalau mata hatinya bisa lebih tajam dibanding mata biasa. Ketajaman hati, kata dia, akan lebih berperan lagi kalau indera peraba (kulit) juga digunakan. Pengalaman serupa, juga dialami Disi Tarsidi, Ketua Umum Persatuan Tuna Netra Indonesia, yang juga dosen jurusan pendidikan luar biasa di Universitas Pendidikan Indonesia (UPI). Dia merupakan salah seorang yang dilahirkan dalam keadaan buta total. Namun, meskipun mempunyai keterbatasan dalam hal penglihatan, ia pulang pergi keluar negeri seorang diri tanpa pendamping. Negara-negara di Asean, seperti Singapura, Malaysia, Thailand, dan Vietnam, sudah beberapa kali dikunjunginya. Selain itu, negara Eropa seperti Kanada, Denmark, Norwegia, dan Italia sudah juga dia sambangi. Bahkan, di Norwegia, ia pernah tinggal selama tiga bulan. Didi mengaku pernah mengalami berbagai pengalaman penerbangan. Dari mulai penerbangan internasional yang sangat baik pelayanannya, sampai beberapa penerbangan domestik yang memperlakukan tunanetra dengan diskriminatif. Bahkan, menurut dia, temannya sesama tunanetra pernah menuntut salah satu maskapai penerbangan sebesar Rp 200 juta, karena pada saat akan ke Makassar, temannya tidak boleh naik ke pesawat karena tunanetra dan tidak membawa pendamping. ''Pada penerbangan dalam negeri, kami tunanetra selalu mengalami kesulitan ketika akan naik pesawat seorang diri. Bahkan, oleh Pelita Air, saya harus menandatangani surat tidak akan menuntut kalau terjadi sesuatu, kenapa saya saja yang harus menandatangani, itu namanya diskriminatif,'' kata Didi. Menurut Didi, pada awal perjalanannnya ke luar negeri, dirinya memang sempat stres ketika masih berada di dalam pesawat. Namun, kata dia, dirinya tidak memiliki pilihan lain, sehingga mau tidak mau harus dilakukannya. Pasalnya, kata dia, tiket yang diberikan untuk tugas hanya untuk satu orang, sehingga tidak bisa menggunakan pendamping. Semua tempat yang belum pernah dikunjunginya, sambung Didi, pasti akan asing meskipun berada di dalam negeri. Apalagi, kata dia, kalau tempat tersebut berada di luar negeri dan tidak ada pendampingnya. Oleh karena itu, sebelum pergi dirinya mencari tahu terlebih dahulu semua tempat yang akan didatanginya itu. (kie)
~~~ Dampak pemakaian obat : gatal-gatal Minggu, 07 Juli 2002 - Republika Gatal-gatal Karena Obat Lupus Dokter Zubairi Yth, Saya adalah seorang karyawati berumur 25 tahun. Setahun yang lalu, saya didiagnosis menderita penyakit lupus. Saat ini saya mendapat pengobatan prednison yang harus diminum sebanyak tujuh tablet setiap pagi. Tapi, sekitar dua minggu yang lalu saya mengalami gatal-gatal yang sangat hebat di lipat paha, juga di bawah payudara saya. Setelah ke dokter, saya diberi salep kulit dan keluhan gatal tersebut kini sudah semakin membaik. Kata dokter, gatal-gatal yang saya alami berhubungan dengan pengobatan yang saya jalani. Hal ini membuat saya khawatir. Apakah itu berarti suatu saat saya akan mengalami gatal-gatal itu lagi? Adakah cara untuk mencegahnya?Demikian pertanyaan saya. Atas jawaban dokter, saya ucapkan terima kasih. Katrin, Jakarta Mbak Katrin yang baik, Salah satu pengobatan lupus yang terpenting memang adalah pemberian obat golongan kortikosteroid seperti prednison. Mungkin sudah Anda ketahui bahwa pada penyakit lupus sel-sel dan jaringan tubuh dapat dirusak oleh antibodi atau kompleks imun dari tubuh sendiri. Oleh karena itu untuk menekan proses tersebut, diperlukan pemberian obat kortikosteroid. Hanya saja, obat kortikosteroid ini jika diminum dalam dosis yang besar dan jangka waktu yang lama dapat menyebabkan kekebalan tubuh menurun. Salah satu akibat dari kekebalan tubuh yang menurun ini adalah Anda menjadi mudah terkena infeksi jamur di kulit. Jamur mudah tumbuh di daerah lipatan-lipatan tubuh karena daerah ini cenderung lebih lembab. Pengobatan prednison saat ini tidak dapat dihentikan hanya karena gatal yang Anda alami. Dosis prednison kemudian akan dikurangi secara bertahap dengan melihat kondisi Anda. Memang gatal itu sangat menyiksa tetapi tentu yang lebih penting adalah menghindari kerusakan jaringan akibat penyakit lupus yang Anda derita. Untuk itu diperlukan upaya pencegahan. Kebersihan di daerah lipatan-lipatan tubuh harus dijaga, usahakan agar daerah tersebut selalu kering. Sebaiknya Anda memakai pakaian dalam yang terbuat dari bahan yang menyerap keringat seperti katun. Selain itu, pakaian dalam pun harus lebih sering diganti karena di Jakarta hawanya sangat panas sehingga mudah berkeringat. Usahakan pula untuk sekali-sekali minum obat antijamur. Tablet/kapsul antijamur yang ada di Indonesia sekarang ini seperti ketokonazol, flukonazol, atau itrakonazol terbukti efektif untuk menghilangkan jamur, apalagi bila dikombinasikan dengan salep atau krim antijamur. Sekali lagi jangan menghentikan minum prednison karena komplikasi jamur. Penghentian prednison secara mendadak dapat menyebabkan penyakit lupus aktif kembali dengan akibat dapat mengganggu fungsi ginjal, hati atau menyerang sel tubuh yang lain. Bila Mbak Katrin ingin mengetahui lebih jelas mengenai penyakit lupus ini, dapat menghadiri seminar yang diselenggarakan atas kerjasama Yayasan Lupus Indonesia dan Perhimpunan Hematologi dan Transfusi Darah Indonesia pada tanggal 20 Juli 2002. Untuk keterangan lebih lanjut bisa menghubungi telpon: 021-47868336. (Zubairi Djoerban)
~~~ sekilas lupus - penyegar :D Minggu, 28 Juli 2002 - Republika Lupus - Si Misterius yang Perlu Diwaspadai Penyakit dengan seratus wajah. Julukan ini rasanya pas benar untuk penyakit lupus. Gejalanya yang tidak khas serta penampilannya yang dapat menyerupai penyakit-penyakit lain bisa membuat orang terkecoh. Bukan cuma orang awam, tapi juga dokter. Banyak hal yang biasa dikeluhkan penderita lupus. Di antaranya demam namun bukan karena infeksi, penurunan berat badan, cepat lelah, nafsu makan menurun, rambut rontok, pegal linu di seluruh badan, radang sendi, gangguan darah, gangguan syaraf, tukak mulut, dan peka terhadap sinar matahari sampai timbul bercak kupu-kupu di muka. Tentu saja, keluhan antara penderita yang satu dengan lainnya berbeda-beda. ''Tapi sebagai patokan, apabila seseorang mengalami empat gejala itu saja, maka mereka sudah bisa dikatakan positif terjangkit lupus,'' kata dokter Yoga Iwanoff Kasjmir SpPD KR, penasehat medis Yayasan Lupus Indonesia (YLI). Dijelaskan, lupus dikelompokkan dalam penyakit auto-imun. Apa maksudnya? Secara sederhana bisa diterangkan, bahwa pada penderita lupus tubuh membuat antibodi dalam jumlah banyak yang sifatnya bukan untuk melindungi tubuh, namun justru menyerang tubuh sendiri. Sifat merusak diri sendiri inilah yang membuat lupus disebut penyakit auto-imun. Secara garis besar ada tiga jenis lupus, yaitu LES (lupus eritematosus sistemik), lupus diskoid, dan lupus obat. Sesuai namanya, lupus obat adalah lupus yang timbul akibat efek samping obat. Lupus jenis ini biasanya akan sembuh sendiri dengan memberhentikan obat yang menimbulkan efek samping itu. Lupus diskoid adalah lupus kulit dengan manifestasi beberapa jenis kelainan kulit. Berbeda dengan lupus diskoid yang menyerang bagian luar tubuh (kulit), maka LES menyerang dan menimbulkan komplikasi pada organ-organ dalam tubuh seperti ginjal, paru-paru, otak, jantung, sendi, dan lain-lain. Siapa saja yang bisa terserang penyakit ini? Menurut Yoga, setiap orang dapat terserang lupus. ''Namun kebanyakan adalah para wanita yang berada dalam usia produktif.'' Mengenai penyebab lupus, Yoga mengakui, sejauh ini memang belum diketahui. Hanya saja ada sejumlah faktor risiko yang berpotensi menimbulkan lupus yaitu faktor genetik dan lingkungan. ''Selain itu, bisa pula dipengaruhi oleh faktor hormonal, walau memang yang paling dominan adalah faktor genetik.'' Faktor genetik di sini artinya, jika seorang ibu menderita lupus maka anaknya atau anggota keluarga lainnya punya kecenderungan terjangkit penyakit serupa. ''Jadi tidak ada virus menular seperti halnya AIDS, yang kalau si anak lahir maka secara otomatis akan terkena juga penyakit tersebut.'' Sedangkan faktor lingkungan bisa berupa paparan sinar ultraviolet, infeksi, stres, dan obat-obatan. Tapi menurut Yoga, faktor lingkungan bukanlah faktor dominan karena masih bisa disiasati. ''Misalnya, kita dapat menyiasati paparan sinar ultraviolet dengan menggunakan tabir surya (sun block).'' Sementara dr Zubairi Djoerban SpPD KHOM, spesialis penyakit dalam dari FKUI/RSCM yang juga dikenal sebagai pemerhati lupus berpendapat, deteksi terhadap lupus sebenarnya mudah jika saja para dokter sudah memiliki kemampuan dasar untuk mendiagnosis penyakit ini. Sayangnya, hingga sekarang masih sedikit dokter yang memiliki kemampuan dalam mendiagnosis penyakit lupus. Akibatnya, semakin banyak anggota masyarakat yang terkena penyakit ini namun tidak mendapatkan penanganan yang semestinya. ''Pasien yang terdafar di Jakarta saja sudah mencapai sekitar 400 orang, belum lagi yang di luar Jakarta.'' Zubairi yang di ruang praktiknya cukup sering menangani pasien lupus mengatakan, pengobatan utama terhadap lupus adalah dengan memberikan kortikosteroid. Untuk penderita yang memerlukan pengobatan dalam dosis tinggi, perlu dipikirkan untuk memberi tambahan obat lain seperti imuran, endoxan, dan methotrexate. Ini dimaksudkan agar efek kortikosteroid tidak terlalu berat. Dengan pengobatan yang tepat dan terawasi, lupus kini tak lagi menjadi penyakit yang merenggut banyak nyawa penderitanya. ''Dulu sebelum kemampuan diagnosis dan pengobatan mengalami kemajuan seperti sekarang, angka kematian di antara penderita lupus mencapai 10 persen.'' Tapi kini, angka kematian sudah dapat ditekan hingga di bawah 10 persen. Bahkan sebagian penderita, dapat sembuh total. Sementara itu sebagian lagi tak sembuh secara total, namun kondisi penyakit terkontrol, seperti halnya pada penderita kencing manis atau tekanan darah tinggi. ''Para odapus (orang dengan lupus) pun tak perlu khawatir sebab lupus tak membuatnya terhambat dalam melakukan aktivitas sehari-hari. Bahkan tak sedikit dari mereka yang tetap eksis dengan kariernya walau didera penyakit Lupus,'' kata Zubairi. Bagaimana dengan hamil dan punya anak? Tentang hal ini pun, para odapus yang kebanyakan kaum wanita tak perlu khawatir. Mereka tetap bisa hamil dan punya anak. ''Pasien lupus yang tercatat di Yayasan Lupus Indonesia (YLI) hingga saat ini berjumlah sekitar 500 orang dan kebanyakan wanita. Hanya 20 orang saja yang belum dikaruniai anak, sisanya telah mendapatkan momongan.'
~~~ |
.:Find Me:. If you interested in content, please contact the Writer .:Want to Joint ?:. If you want to know more about lupus surferer's activities and want to donor your help and money, go here Need more consult ?, go here .:acquaintances:.
The Enterprise .:New Book:. .:talk about it:.
.:archives:.
.:Link-link website Lupus:.
Lupus Org .:credits:.
|
