Our immune system is a highly complex defense network that protects our bodies from harmful invaders such as bacteria, viruses, other infectious microorganisms, and even cancer.  For the most part, our immune system performs these tasks well, and is particularly successful at repelling invaders.  When the immune system detects an antigen (foreign invader), the white blood cells trigger a release of antibodies and other chemical mediators to fight the antigen.  This process is what causes inflammation, pain, redness, and swelling in the affected tissue.  However, our immune system can sometimes overreact and make a mistake, and in some cases, resort even to mutiny.  This condition occurs when the body fails to recognize its own components and attacks them with auto-antibodies (auto meaning ‘self’), and is known as an autoimmune disease (self-destruction).  The results are self-perpetual inflammation and tissue damage.

Systemic lupus erythematous (SLE) is a systemic autoimmune disease which can affect skin, joint, kidney, heart and other organs.  Thanks to scientific breakthroughs in immunology, we have a better understanding of B lymphocytes which play a key role in developing lupus.  Antinuclear antibodies (ANA) and other autoantibodies are produced by B lymphocytes and can potentially cause tissue damage.  The cause of lupus is unknown.  However, it is likely that there is no single cause, but rather a combination of genetic, environmental, and possibly hormonal factors that determine one’s risk.

Treatment of lupus varies, depending upon which organ systems are affected and how severe your symptoms are.  The milder forms of lupus usually are treated with non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, which help reduce skin rash, joint pain and inflammation.  Anti-malaria drugs such as hydroxychloroquine (Plaquenil) can adjust the immune response.  Plaquenil help treat some of the manifestations of SLE, especially skin rash and joint pain.  Immunosuppressant drugs such as azathioprine (Imuran), mycophenolate mofetil (CellCept) and cyclophosphamide (Cytoxan) are effective in severe cases, especially with kidney or central nerve system involvement.  These very potent drugs are required to suppress the immune system, but may have serious side effects.

Last week, FDA approved a new drug for treating lupus, the first in more than 50 years.  Benlysta (belimumab), a new biologic agent, can reduce the disease’s level of activity by inhibiting a bodily protein called B-lymphocytes stimulator, which at elevated levels can contribute to the creation of autoantibodies.  Benlysta, when used with existing therapies, can reduce the need of corticosteroids.  However, Benlysta is not a miracle drug.  The treatment was successful in only 35 percent of North American patients, and is not recommended for patients with severe kidney or brain involvement.  Even lupus can be a debilitating disease; this new drug gives us good reason to be optimistic.

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