Nefritis Lúpica

Professor Graham Hughes The London Lupus Centre The London Bridge Hospital

1970 ,[object Object],[object Object]

July 1969 ,[object Object],[object Object]

Serological Changes 1909 1948 1959 1966-70 1976 1983 WR LE Cell ANA DNA ENA aPL

Antibodies predicting disease Anti-Topo1 …………… Scleroderma…………… 11 yrs Rh factor/ccp ………… RA ……………………… 14 yrs Anti-Ro & La ………… Sjogrens ………………. 5 yrs Anti-DNA …………….. SLE ……………………. 11 yrs Anti-cardiolipin ………. Hughes Syndrome ….… 32 yrs ---------------------- Anti-thyroid ………….. Thyroid ………………… 10 yrs Anti-mitochondrial ….. PBC ……………………. 25 yrs

Lupus Diagnosis Professor Hughes’ “alternative” criteria ● Childhood migraine ● Childhood ‘growing pains’ ● Teenage prolonged ‘glandular fever’ ● Agoraphobia ● Septrin allergy ● Chronic fatigue ( ‘fibromyalgia’) ● Intermittent alopecia ● Lupus patients don’t catch colds

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LUPUS “- the new diabetes”

Lupus Nephritis ,[object Object],[object Object]

What’s still bad in Lupus? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Compliance? Plaquenil blood levels Ann Rheum Dis: 66,621, 2007

Lupus pregnancy and the kidney

Flares in pregnancy? ,[object Object],[object Object]

Anti-malarial treatment and lupus survival ,[object Object],[object Object],[object Object]

The Case for Conservative Management ,[object Object],[object Object],[object Object],[object Object],[object Object]

NIH Regime ,[object Object],[object Object],[object Object],[object Object]

The St Thomas’ Hospital Regime (1985) ,[object Object],[object Object],[object Object]

Euro-Lupus Nephritis Trial Conclusion ,[object Object],Houssiau et al. A&R 2011

New therapies for SLE ,[object Object],[object Object]

Expenditure for drugs for lupus ,[object Object],[object Object]

Mycophenolate-mofetyl (cellcept ® )

24 hour Proteinuria in Class V Lupus Nephritis Ferro et al. Abstract ACR 2003

MMF and teratogenicity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Could MMF play a protective role in vascular disease in SLE?

Primate cardiac xenografts Inhibition of chronic vascular rejection by MMF O’Hair et al. Ann Thorac Surg, 1994

1988………………..................…..…BLyS 23 years 2011...Benlysta approval in U.K.

Belimumab BLISS 52 & 72 Results ,[object Object],[object Object],[object Object],[object Object],[object Object]

- but RTX in lupus trials has had a bumpy ride………………..

In defence of Rituximab ……………

Off-label use of RTX in lupus ,[object Object],[object Object],[object Object],[object Object],[object Object]

RTX may even allow a “no-steroid” regime ……………..

“ No-Steroid” Regime: ,[object Object],[object Object],[object Object],[object Object],[object Object]

“ No-Steroid” Regime: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RTX and pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Ocrelizumab ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

SUCCESS Eric Liddell: 1923 Olympic Gold Medallist

SUCCESS Lupus and Pregnancy 50 years of progress

Don’t Believe the Textbooks!

… eventually it usually kills the patient...

Nefritis Lúpica

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