Systemic lupus erythematosus (SLE), also known simply as "lupus," is an autoimmune disorder that can affect multiple organs. The kidneys, which are part of the renal system, are often affected and the damage lupus can cause to the kidneys can be severe. Now, scientists funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) have confirmed that a drug originally developed to fight malaria has the potential to provide a protective effect for the renal system.
According to a study authored by Dr. Graciela S. Alarcón, M.D., M.P.H., at the University of Alabama at Birmingham, along with a geographically diverse group of colleagues, renal symptoms occur in 50 to 70 percent of lupus patients. Despite advances in therapy, the degree of illness and the death rate among lupus patients with inflammation of the kidneys (known as lupus nephritis) remain high. Lupus nephritis leads to the development of end-stage renal disease in 17 to 25 percent of patients.
Dr. Alarcón and her colleagues knew from previous studies that the drug hydroxychloroquine, an antimalarial also used in the treatment of lupus and other autoimmune diseases, was associated with a reduced risk of overall tissue damage. The team wanted to more precisely define whether the drug could delay the development of kidney damage. They used several tools in their inquiry.
First, they tapped an existing database of lupus patients called LUMINA, which is an acronym for LUpus in MInorities, NAture versus Nurture. LUMINA, an NIAMS-funded project begun in 1994, was designed to study lupus patients of Hispanic, African American and Caucasian descent, over time. Dr. Alarcón and her colleagues at the University of Alabama at Birmingham, the University of Texas Health Science Center at Houston, and the University of Puerto Rico Medical Sciences Campus, measured renal damage in LUMINA patients by using a standard index called the Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (also known as the SLICC/ACR Damage Index, or simply the SDI). Participating patients enrolled in this study had lupus nephritis - kidney inflammation - but had not developed actual kidney damage. After controlling for other variables and performing exhaustive statistical analyses of the results, the researchers determined that participants from LUMINA's three ethnic groups who had been on hydroxychloroquine had a diminished probability of renal damage in comparison with those who did not take hydroxychloroquine. The results indicate a high likelihood that hydroxychloroquine retards the development of renal damage in lupus nephritis patients. The researchers published their study in the journal Arthritis & Rheumatism.
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The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services' National Institutes of Health, is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at 301-495-4484 or 877-22-NIAMS (free call) or visit the NIAMS Web site at http://www.niams.nih.gov.
Reference: Pons-Estel GJ, Alarcón GS, McGwin G, Danila MI, Zhang J, Bastian HM, Reveille JD, Vilá LM. Protective Effect of Hydroxychloroquine on Renal Damage in Patients with Lupus Nephritis: LXV, Data From a Multiethnic US Cohort. Arthritis & Rheumatism. 2009 Jun 15;61(6):830-9. PMID: 19479701.