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Much about lupus remains unknown, including the cause. Researchers are working to find out what causes lupus and how it can best be treated.
Some of the questions researchers are trying to answer are:
A combination of factors may act together to cause lupus. Current scientific thinking focuses on three areas.
1. Because lupus can run in families, researchers believe that genes play a role. About 10% of people who have lupus also have a close relative (mother, father, sister or brother) who has lupus or will develop lupus. No single specific lupus gene has been identified.
2. Hormones may be involved. A link to hormones could explain why lupus occurs more often in females, particularly during their childbearing years.
3. Something in the environment may cause lupus. Some environmental factors are already known to make lupus symptoms worse. These factors include some prescription drugs and exposure to sunlight.
In addition, research continues on making treatment more effective and user friendly. For example, researchers are working to develop ways to limit the use of corticosteroids or offset side effects by using corticosteroids in combination with other, less potent drugs.
Basic research uses cells and animal, plant and computer models to better understand diseases and their causes. Because this type of research brings to mind the image of a researcher hunched over a laboratory bench to look through a microscope or conduct experiments with cells, it is also called bench research.
Understanding how disease changes molecules, cells and body tissues can lead to new ways to diagnose and treat or even prevent diseases such as lupus. Research using models, such as plants, insects and mice, has shown that the basic operating principles are nearly the same in all living things. This means a research finding in mice can provide insight into a biological process in humans and may someday translate into a new treatment or cure. Taking findings from basic or bench research and using them in human studies is known as translational research.
Clinical research involves patients, usually testing medications and other treatments to see how they work against diseases and other conditions. The basis of clinical research in observing and treating patients is what distinguishes clinical research from basic or bench research.
Clinical trials are special types of clinical research studies that involve patients to answer specific questions about new treatments or new ways of using known treatments. Carefully conducted clinical trials are the fastest and safest way to determine whether new drugs or other treatments work in people.
In clinical trials, one group of participants receives the experimental drug while another group, the control group, gets standard treatment or an inactive treatment known as a placebo. Studies that include control groups are known as controlled trials. Learn more about clinical trials being conducted at Cincinnati Children's Hospital Medical Center.
Members of the Lupus Center health care team at Cincinnati Children's lead or participate in many clinical studies of lupus. Here are some examples.
Measuring Flares: There is no commonly accepted standard for measuring how often flares occur among children with systemic lupus erythematosus (SLE). A study among 91 children with SLE found that tools used to measure flares in adults were not sensitive enough for use among children. Getting more accurate data in the future requires better tools for measuring flares among children.
Quality of Life Issues: Systemic lupus erythematosus (SLE) impacts many aspects of health-related quality of life (HRQoL). Measuring HRQoL can provide valuable information about the effects of lupus and treatment of lupus. The study involved 91 children, their parents and physicians. Patients reported that an increase in pain and a decrease in physical function were closely related to a decline in HRQoL associated with a flare . Both disease improvement and stable disease were associated with increases in HRQoL. Parents were considered acceptable overall when serving as proxies to report HRQoL, but their ratings were less sensitive to change than ratings from the patients themselves.
Identifying Kidney Involvement: The main factor in determining a poor prognosis for patients with systemic lupus erythematosus (SLE) is involvement of the kidneys. Two studies looked for biomarkers, substances in the body that could indicate the presence of kidney involvement. One study analyzed urine samples from people with lupus, some who had kidney involvement and some who did not, and from control patients who had a form of juvenile arthritis. The researchers found that concentrations in the urine of two substances represent new or novel biomarkers of kidney involvement in lupus patients. These substances are transferrin and ceruloplasmin. Another study found that levels of neutrophil gelatinase associated lipocalin (NGAL) in the urine and possibly in plasma represent new or novel biomarkers for pediatric SLE. NGAL is a member of the lipocalin family of proteins that has been studied in acute and other chronic kidney injury.
Predictors of Atherosclerosis: A study among 221 pediatric patients with systemic lupus erythematosus (SLE) investigated factors that could predict the development of atherosclerosis. This is a condition caused by the build-up of cholesterol and other substances in the lining of the arteries. Among the factors found to be possible predictors of atherosclerosis are being male and taking prednisone (Deltasone", Orasone") and azathioprine (Imuran"), two drugs used to treat SLE. Prednisone is a corticosteroid and azathioprine is an immunosuppressive.
Assessing Cognitive Dysfunction: A computerized battery of tests may be useful in determining if someone with childhood-onset systemic lupus erythematosus (SLE) has cognitive dysfunction—problems with thinking, reasoning, and other mental tasks. The series of tests, known as the Pediatric Automated Neuropsychological Assessment Metrics (Ped-ANAM, short version), can be completed in 15 to 25 minutes and can be repeated frequently without a learning curve. Traditional testing requires three or more hours testing with a licensed psychologist. The study involved 39 patients, ranging in age from 10 to 21 years old, with childhood-onset SLE. As with lupus, most were female. Participants took the test twice during one study visit.
Members of the Lupus Center health care team at Cincinnati Children's are the authors of many published reports in medical and scientific journals. Here is a sampling of those reports.
Evaluating Cognitive Function: Differences in brain activation patterns were noted in this study among 10 children with childhood-onset systemic lupus erythematosus (SLE) and members of a control group that did not have lupus. A technique known as functional magnetic resonance imaging (FMRI) was used to show the brain activation patterns. Based on these findings, FMRI may be a promising approach to show which areas of the brain may be involved in problems with thinking, reasoning and other mental tasks in childhood-onset SLE. This could help improve treatment strategies. Published in Arthritis and Rheumatism, 56, pgs. 4151-4163, 2007.
Preserving Reproductive Fitness: A computer-assisted review of medical literature through 2006 revealed that patients with juvenile systemic lupus erythematosus (SLE) are at risk for decreased reproductive fitness caused by lupus and the drugs used to treat it. These risk factors are not fully understood because large-scale studies have not been performed. In addition, the effects of newer immunosuppressive medications and biologic agents on reproduction have not been sufficiently evaluated. Possible strategies for preserving the reproductive potential of boys include preserving frozen sperm. A proposed option for girls is taking a drug designed to offer protection from the harmful effects of cyclophosphamide (Cytoxan"). This powerful drug used to treat lupus and other conditions may harm a developing baby.Published in Lupus, 16, pgs. 593-599, 2007.
Learn more about the cutting-edge research being conducted in the Division of Rheumatology at Cincinnati Children's.
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