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2.  New therapies 
Arthritis Research & Therapy  2012;14(Suppl 3):A4.
doi:10.1186/ar3938
PMCID: PMC3467481
3.  Regulatory T cells as therapeutic targets in rheumatoid arthritis 
Nature reviews. Rheumatology  2009;5(10):560-565.
Regulatory T cells (TREG) are a subset of CD4+ T cells with a critical role in the prevention of autoimmunity. Whether defects in TREG contribute to the pathogenesis of rheumatoid arthritis (RA) is unclear. However, a variety of approved and experimental drugs for RA may work, in part, by promoting the function or increasing numbers of TREG. Furthermore, animal studies demonstrate that direct injection of TREG ameliorates a wide range of experimental models of inflammatory and autoimmune diseases. Thus, cell-based therapy with TREG has the potential to produce durable disease remission in patients with RA.
doi:10.1038/nrrheum.2009.183
PMCID: PMC3086064  PMID: 19798031
4.  A Quality Indicator Set for Systemic Lupus Erythematosus 
Arthritis and rheumatism  2009;61(3):370-377.
Objective
To systematically develop a quality indicator (QI) set for systemic lupus erythematosus (SLE).
Methods
We used a validated process that combined available scientific evidence and expert consensus to develop a QI set for SLE. First, we extracted 20 candidate indicators from a systematic literature review of clinical practice guidelines pertaining to SLE. An advisory panel revised and augmented these candidate indicators, and through two rounds of voting, arrived at 25 QIs. These QIs advanced to the next phase of the project, in which we employed a modification of the RAND/UCLA Appropriateness Method. A systematic review of the literature was performed for each QI, linking the proposed process of care to potential improved health outcomes. After reviewing this scientific evidence, a second interdisciplinary expert panel convened to discuss the evidence and provide final ratings on the validity and feasibility of each QI.
Results
The final expert panel rated 20 QIs as both valid and feasible. Areas covered include diagnosis, general preventive strategies (e.g. vaccinations, sun avoidance counseling, screening for cardiovascular disease), osteoporosis prevention and treatment, drug toxicity monitoring, renal disease, and reproductive health.
Conclusions
We employed a rigorous multi-step approach with systematic literature reviews and two expert panels to develop QIs for SLE. This new set of indicators provides an opportunity to assess health care quality in SLE, and represents an initial step toward the important goal of improving care in this patient population.
doi:10.1002/art.24356
PMCID: PMC2748348  PMID: 19248127
5.  Influence of race/ethnicity on response to lupus nephritis treatment: the ALMS study 
Rheumatology (Oxford, England)  2009;49(1):128-140.
Objective. To compare the efficacy and safety of mycophenolate mofetil (MMF) and intravenous cyclophosphamide (IVC) as induction treatment for lupus nephritis (LN), by race, ethnicity and geographical region.
Methods. A total of 370 patients with active Class III–V LN received MMF (target dose 3.0 g/day) or IVC (0.5–1.0 g/m2/month), plus tapered prednisone, for 24 weeks. Renal function, global disease activity, immunological complement (C3 and C4) and anti-dsDNA levels are the outcomes that were assessed in this study.
Results. MMF was not superior to IVC as induction treatment (primary objective). There were important pre-specified interactions between treatment and race (P = 0.047) and treatment and region (P = 0.069) (primary endpoint). MMF and IVC response rates were similar for Asians (53.2 vs 63.9%; P = 0.24) and Whites (56.0 vs 54.2%; P = 0.83), but differed in the combined Other and Black group (60.4 vs 38.5%; P = 0.03). Fewer patients in the Black (40 vs 53.9%; P = 0.39) and Hispanic (38.8 vs 60.9%; P = 0.011) groups responded to IVC. Latin American patients had lower response to IVC (32 vs 60.7%; P = 0.003). Baseline disease characteristics were not predictive of response. The incidence of adverse events (AEs) was similar across groups. Serious AEs were slightly more prevalent among Asians.
Conclusions. MMF and IVC have similar efficacy overall to short-term induction therapy for LN. However, race, ethnicity and geographical region may affect treatment response; more Black and Hispanic patients responded to MMF than IVC. As these factors are inter-related, it is difficult to draw firm conclusions about their importance.
Trial registration. National Institutes of Health, www.clinicaltrials.gov, registration number NCT00377637.
doi:10.1093/rheumatology/kep346
PMCID: PMC2789586  PMID: 19933596
Cyclophosphamide; Lupus nephritis; Mycophenolate mofetil; Race; Randomized clinical trial
6.  Strategies for Treating Autoimmune Disease With Monoclonal Antibodies 
Western Journal of Medicine  1985;143(6):804-809.
There is no safe and reliable therapy for most serious autoimmune diseases, such as systemic lupus erythematosus. Severe cases usually require treatment with corticosteroids or cytotoxic drugs or both, which frequently provide inadequate disease control and can cause serious complications. These therapies are not restricted in their effects to cells of the immune system, but rather have a broad range of toxic effects on cells throughout the body. The development of monoclonal antibodies has led to new therapeutic strategies through which treatment can be focused more directly on specific cells (and functions) of the immune system. These strategies have already produced promising results in animal models for several important human autoimmune diseases. We will know soon whether treatment with monoclonal antibodies will be effective in persons with autoimmune disease.
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PMCID: PMC1306490  PMID: 3911593

Results 1-6 (6)