Good News: Lupus Expert Declares Me Unimpressive

By Kate Rope

Good news, dear readers, my new rheumatologist listened to my long and detailed history, asked me a battery of questions (”Do you have any joint pain?” “What about rashes?” “Do your eyes ever feel dry?”) and declared herself “unimpressed.” As an expert on lupus and pregnancy, she quickly pointed out that I did not meet the criteria for that autoimmune disease or any others. “Even if I wanted to enroll you in a clinical trial, I couldn’t,” she announced cheerfully.

Yes, my one and only symptom—sporadic inflammation around my heart—was sometimes a symptom of lupus and other autoimmune diseases, but that alone was not enough to say I had any of them. My blood tests for the biggies continued to turn up nothing. But the fact that my heart pain had returned after pregnancy did mean my body was doing something to cause it. Steroids had been keeping it at bay, but, what with their laundry list of icky side effects, I had to switch to something new. Read More

Immune Cell Insights Could Fight Arthritis, Lupus

(HealthDay News) -- Regulatory T cells, which "police" the immune system, are produced in the thymus and not from other circulating T cells, researchers report.

The study also provides new information about how mistakes made by regulatory T cells may contribute to autoimmune disease.

The findings suggest that it may one day be possible to control the early education of regulatory T cells in children in order to prevent autoimmune diseases, according to a team from the Medical College of Georgia.

It may also be possible to introduce new regulatory T cells into people with autoimmune disease, they said.

The thymus, a small organ located in the upper/front portion of the chest, is involved in the production and maturation of T cells during fetal development and childhood. Regulatory T cells direct the immune systems' roaming T cells.

Before regulatory T cells leave the thymus, they learn to distinguish between normal body tissue and invaders such as bacteria and viruses.

However, in some cases, regulatory T cells fail to learn how to recognize all the different kinds of normal body tissue, the Georgia group explained. This, along with environmental and other factors, can result in autoimmune diseases, where the body attacks its own tissues, the researchers said.

Lupus, arthritis, and type 1 diabetes are types of autoimmune diseases.

The MCG team found that, in mice, the regulatory T cell learning process in the thymus peaks in the first six weeks of life. That's about equivalent to the first 15 years of life in a human.

The early lessons, correct or not, learned by the regulatory T cells seem to last a lifetime.

The few cells that develop later in life will likely behave like the earlier cell.
The study was published in the August issue of the journal Immunity.

More information
The U.S. National Institute of Allergy and Infectious Diseases has more about the immune system.

Research Yields Clues to Lupus, Rheumatoid Arthritis

(HealthDay News) -- Scientists say they've spotted potential new cellular targets for treating lupus, rheumatoid arthritis and other autoimmune disorders.

In research with mice, Japanese scientists found that blood platelet function plays an important role in an autoimmune kidney disease called crescentic glomerulonenephritis.

Their study, published in the September issue of the journal Arthritis & Rheumatism, also sheds light on the involvement of BLOC-1, which controls lysosomes, tiny organelles that contain digestive enzymes needed to maintain healthy cells function.

"The profound role of BLOC-1 appears to be platelet-specific among immuno-inflammatory cell types. BLOC-1 is a possible therapeutic target for suppression of platelet functions without compromising physiologic immune responses," said researchers at Tohoku University Graduate School of Medicine.

In another study, Finnish scientists identified a new type of adhesion molecule (amine oxidase, copper containing 3 - AOC3) that's highly expressed on vessels of inflamed human joint tissue.

AOC3, also called vascular adhesion protein 1, spurs inflammation by interfering with the infiltration of leukocytes (white blood cells) into rheumatoid joints, the study authors said.

More information
The U.S. National Women's Health Information Center has more about autoimmune diseases.

Spleen Cells May Prove Effective Target for Lupus Treatment

(HealthDay News) -- Research done on mice specially bred to develop lupus has uncovered an area of the spleen that may give rise to the disease.

The area is called the marginal zone of the spleen and it appears that this is where B cells from the immune system go awry and turn into cells that attack the body's own tissues and organs, researchers say.

"This current work gives rise to new possibilities for targeted therapies that are perhaps much milder and more effective than current therapies," said the study's lead author, Thomas Enzler, a visiting scholar, internist and immunologist at the University of California, San Diego.

However, he was quick to add that it would be a long time before any such potential therapy could be available for humans.

Results of the study were published Thursday in the online edition of the journal Immunity.
Lupus is an autoimmune disease in which the immune system mistakenly attacks the body's tissues and organs. The disease can affect the joints, kidneys, lungs, brain, blood or skin.

As many as 1.5 million Americans have lupus, and the disease is far more common in women than in men, according to the Lupus Foundation of America (LFA).

Previously, researchers had developed a mouse version of lupus. These mice are bred to overproduce an immune system hormone (cytokine) known as B-cell activating factor (BAFF). In humans with lupus, the BAFF cytokine is often present in much higher-than-normal levels.

B cells produce antibodies. Normally, antibodies are produced to protect against viruses and bacteria. In the case of someone with lupus, however, the B cells produce autoreactive antibodies. This means the antibodies attack normal, rather than diseased, tissue.

When the mice overproduce BAFF, they develop lupus, though the mouse version isn't exactly the same as the human version.

The UCSD researchers transplanted some of the cells from the spleens of the marginal zone of the lupus mice into mice that didn't have their own B cells. Lupus-like antibodies began to develop in these mice immediately.

The researchers also removed the spleens of some of the lupus mice when they were in the early stages of developing the disease, or the scientists interrupted the production of the B cells. When they did this, lupus was diminished or prevented.

"It seems to be that the marginal zone is really important for developing autoimmune disease in transgenic mice," Enzler explained.

Dr. Joan Merrill, medical director of the Lupus Foundation of America and head of the clinical pharmacology research program at Oklahoma Medical Research Foundation, said, "This is an exciting scientific paper."

But, Merrill said, people with lupus shouldn't rush to their doctors to remove their spleens. "If a lupus patient has a splenectomy, the disease doesn't go away," she said, explaining that sometimes lupus patients have to have their spleens removed due to complications of the disease, and it doesn't cure lupus.

She also pointed out that this study was done in mice and the human immune system doesn't work in exactly the same way as the mouse immune system does.

Still, Merrill added that with this study and other research, "We're beginning to unravel some of the mysteries surrounding lupus, and I'm cautiously optimistic about the future. We're trying to find better targets and develop better and safer medicines."

More information
To learn more about lupus, visit the Lupus Foundation of America.

Lupus Biomarkers Discovered

(HealthDay News) -- People with lupus have certain molecular biomarkers that aren't present in those without the disease, a small, preliminary study has found.

"There are currently no defined biomarkers for lupus," said lead researcher Dr. Nilamadhab Mishra, an assistant professor of rheumatology at the Wake Forest University School of Medicine, in Winston-Salem, N.C.

But, in their new study, Mishra and his colleagues found that people with lupus have changes in their micro-ribonucleic acids (microRNAs) that aren't found in people who don't have lupus. "We found 40 are differently expressed between lupus patients and controls," he said.

"RNA acts like a mold for proteins," to help determine what the form and function of genes' proteins will be, explained Dr. Joan Merrill, medical director of the Lupus Foundation of America.

Mishra presented the findings on Friday at the American College of Rheumatology meeting, in Washington, D.C.

Lupus is a chronic autoimmune disease that can damage the joints, kidneys, heart, lungs, brain, blood and skin, according to the Lupus Foundation of America (LFA). The LFA estimates that about 1.5 million Americans have the disease. It occurs 10 to 15 times more often in women than in men.

The disease can vary greatly in severity from person to person, and even for an individual. Some people with lupus have periods of time when no symptoms are present. Common symptoms include achy joints, frequent fevers, extreme and lasting fatigue, a skin rash and anemia.

There are no definitive diagnostic tests for lupus, and because symptoms can come and go, it often takes months, and possibly years, before a person can be diagnosed, according to LFA.

For the new study, the researchers compared the microRNA from five people with lupus to seven age- and sex-matched people without lupus. The people with lupus were not experiencing symptoms of the disease at the time of the study and were not taking commonly prescribed lupus medications during the study period.

The researchers found 40 microRNAs with a 1.5-fold difference in expression between the people with lupus and the control participants. Six microRNAs had a greater than 3-fold difference in expression.

"We hope we've found a biomarker that can be helpful for diagnosis and to help guide treatment," said Mishra, who added that it might also be possible to develop a new targeted treatment based on this and other research.

Said Merrill: "It looks like lupus patients are making funny RNA even when the disease isn't flaring."

Merrill cautioned that while this "novel research is very good research," it's a preliminary study done on a small group of people, and more work needs to be done.

Mishra said one of the next steps is to see if these microRNA changes are present in other autoimmune diseases, such as type 1 diabetes or rheumatoid arthritis, or if they are exclusive to lupus. He also agreed that the current work needed to be replicated in a larger trial.

"What's important is that there's a lot of research going on right now about the many tiny reactions that occur in lupus. Over the next few decades, we may develop medications that are strategic," said Merrill. "We're working on trying to fix a few small interactions between proteins, rather than wallop the whole immune system."

More information
To learn more about lupus, visit the Lupus Foundation of America.


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Aching with Arthritis?

Aching with Arthritis?
Provided by: DrWeil.com

Q: What is polyarthritis, and what tests are needed to diagnose it? -- Anonymous

A: Polyarthritis means inflammation of more than one joint and is most often associated with rheumatoid arthritis, an autoimmune disease (one that occurs when the immune system mistakenly attacks the body's own tissues). Polyarthritis is also associated with lupus, polymyalgia rheumatica, and sarcoidosis. All of these autoimmune disorders can be triggered by infection, tissue injury, or emotional trauma in people who are genetically predisposed to these conditions.

Polyarthritis, as well as its underlying cause, can be diagnosed by physical exam (the affected joints are swollen, stiff, painful or tender, and may feel warm and appear reddened) as well as by a variety of blood tests. These would include a measure of your erythocyte sedimentation rate (sed rate).

A high sed rate suggests the presence of acute inflammation and occurs with rheumatoid arthritis and other immune-mediated connective tissue diseases such as lupus. Conventional medicine treats autoimmune diseases including rheumatoid arthritis with steroids and other immunosuppressive medications, most of which are toxic when used long-term.

Patients dependent on these strong drugs are less likely to respond to natural treatments, which can moderate autoimmunity and help control symptoms.

Here are my recommendations:
Follow a low-protein, high-carbohydrate diet; minimize consumption of foods of animal origin.
Eliminate milk and milk products including commercial foods made with milk.

Avoid polyunsaturated vegetable oils, margarine, vegetable shortening and products made with partially hydrogenated oils of any kind.

Increase your intake of omega-3 fatty acids (eat more cold water fish, walnuts or freshly ground flaxseeds). Consider taking a fish oil supplement to help keep your protein intake low.
Eliminate or reduce intake of coffee and tobacco - both have been linked to an increased risk for rheumatoid arthritis.

Get regular aerobic exercise (swimming is best for those with rheumatoid arthritis).
Practice relaxation techniques. In addition, visualization can help moderate autoimmune responses, and psychotherapy can help alter emotional states that keep the immune system off balance.
Try hypnotherapy or guided imagery. Look for a therapist willing to take on an autoimmune disease. Meditation and yoga can help, too.

Avoid health care practitioners who make you feel pessimistic about your condition.
Take aspirin and other over-the-counter anti-inflammatory drugs to help relieve symptoms.
Take the anti-inflammatory herbs ginger and turmeric. I recommend Zyflamend, made by New Chapter Company, which includes both. You can safely take these herbs indefinitely.
Andrew Weil, MD