Lupus Diagnosis and Treatment Progress
By Mariana Kaplan, M.D., Chief of the Systemic Autoimmunity Branch of the National Institute of Arthritis and Musculoskeletal and Skin Diseases
Significant progress in the diagnosis and treatment of lupus has been made over the last several decades. Discoveries have been recently accelerated due to exciting advances in molecular biology, new technologies, etc. There has been a significant improvement in understanding potential mechanisms that lead to lupus and its associated complications and, for the first time in decades, a drug was specifically approved by the FDA for the treatment of lupus. We also understand better how chronic complications of lupus develop and we are becoming more aware of the variables that need to be monitored in patients to diagnose and prevent these complications more effectively. There are still many challenges and many questions that remain to be answered and that is why it is so important to continue to support research efforts that are focusing on answering these problems.
Although this is not entirely clear, there is recent evidence indicating that the incidence of lupus (diagnosis of new cases) has remained stable over the last decade. On the other hand, data obtained through epidemiologic studies funded by the CDC suggest that the ratio of prevalent (existing cases) to incident cases (new cases) seems to be higher than before, which may suggest that survival has increased in lupus, thereby increasing overall number of cases in the population. There may be significant variation by region of the world, ethnicity, etc.
Lupus patients have significant increases in the risk of developing vascular complications such as myocardial infarction, angina, stroke, etc. It appears that having lupus poses by itself a significant risk for these complications. Many patients with lupus also have other risk factors for vascular disease such as smoking, hypertension, diabetes, etc. As such, management of these patients needs to include measures for improving vascular health and proper control of disease activity. We need to identify what the best cardiovascular preventive strategies are for these patients and we need to establish clear preventive guidelines. As many patients develop lupus when they are young, these strategies should ideally be implemented early on during the course of the disease to have the chance of higher impact to prevent devastating consequences due to vascular disease.
Currently, our research focuses on studying how the immune system contributes to the development of chronic complications of lupus, with emphasis on cardiovascular complications. In addition, we are trying to understand how the innate immune system (the part of the immune system that functions as first line of defense) may contribute to the development of lupus, flares, and associated organ damage. We are hoping to identify novel treatments that target these complications.
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