This project started more than one year ago, it was intended to generate an issue of the Journal with current topics on a disease whose study is amazing: systemic lupus erythematosus (SLE), and the tasks began.
Professors and colleagues interested in this complex disease were convened, and the response was impressive, review and original articles about multiple aspects and concerns generated by SLE were received, coming from different places of the world.
Thus, it was decided to develop two issues in order to be able to disclose new, known and established aspects about the pathogenesis, associated diseases, special situations and management challenges. In this second issue there are five review articles and three original articles.
The use of antimalarial drugs in SLE is always a topic of interest, in this issue there is an original work1 which shows, in a group of patients with nephritis better outcomes in those patients under treatment with antimalarial drugs and strict control of their blood pressure. Previous evidences have demonstrated the importance of these two aspects as coadjuvants in the management of the nephritis, but this finding in the Latino population, known its severe renal involvement, is of utmost importance. In addition to this original work, it includes a topic review which emphasizes the safety of the antimalarial agents, the low frequency of retinal toxicity and also, the importance of early detection of adverse events in order to take advantage of their reversibility; likewise, recommendations are made on diagnostic aids for the follow-up of these patients, and how these aids should be implemented five years after the drug is started, since after this time the risk of toxicity increases.2
Another great challenge in lupus is its association with the antiphospholipid syndrome; this issue includes an excellent review by the experts of the Hospital Clinic de Barcelona which illustrates on the importance of this syndrome, its association with SLE and its incidence in morbidity and mortality.3
The predominant lupus affection in women of reproductive age implies to consider special situations during the period of illness, such as pregnancy, birth control and breastfeeding. In this issue there is an in-depth review4 of these aspects, including management guidelines. It is worth highlighting that it is a topic of such interest that two articles in this regard were included in these two monographic issues on lupus.
Similarly, a very current topic is the relationship between environmental events and the onset of the disease, this issue includes a review article5 in which the evidence of hormonal and infectious factors associated with the onset of SLE is presented; in addition, the associations described with the exposure to silica, mercury and other chemical agents are reviewed. The information on the possible participation of retroviral agents draws attention, information on their possible role is presented and the technical difficulties for the study of these components in the pathogenesis of this entity are described.
In this monographic issue it could not be forgotten to take a look at basic science topics, for this reason an excellent review about the role of cytokines in the pathogenesis of lupus was included, in which the evidence of the participation of multiple cytokines involved in different aspects of the disease is presented. Reviewing the function of these molecules in the pathogenesis opens the possibility of observing how cytokines can be therapeutic targets in lupus, as is currently the case with BAFF and interferon.6
An original work conducted by an Indonesian group which evaluates the association of micro RNA-146a and its target molecule IRAK in the pathogenesis of SLE is also included. As an interesting finding, it is one of these articles with negative findings that are rarely published, since the associations were given as a protective factor against the disease, and not as an inducer thereof.7
Aspects such as the quality of life cannot be missed when talking about SLE, for this reason, it was included an original article in which the quality of life was assessed in 200 patients with rheumatoid arthritis and SLE in Egypt. In order to evaluate this aspect, validated instruments such as the SF36 questionnaire, tools for the evaluation of anxiety and depression such as the HAM-A and the Zung self-rating depression questionnaire were used. Aspects of sexuality are also evaluated and an interesting finding in which the degree of sexual dysfunction in patients with lupus was not associated with the disease activity was described, in contrast to the findings in rheumatoid arthritis, in which it was positively associated with the disease activity.8
This introductory editorial can be concluded with the following words: there is much, much to learn on this disease and, although it is considered to be a butterfly with its spectrum of colors, sizes and variations, it is still in the caterpillar stage, and we must learn a lot about this disease and its multiple challenges.
