Best Practice & Research Clinical Rheumatology
Volume 21, Issue 6 , Pages 971-987 , December 2007

Systemic lupus erythematosus: modern strategies for management – a moving target

  • Jennifer K. King, MD (Rheumatology Fellow)

      Affiliations

    • Corresponding Author InformationCorresponding author. University of California–Los Angeles, Division of Rheumatology, 1000 Veteran Avenue, Rehab Center 32-59, Los Angeles, CA 90095, USA. Tel.: +1 310 825 7992; fax: +1 310 206 8606.
    • ,
  • Bevra H. Hahn, MD (Chief of Division of Rheumatology, Professor of Medicine)

References 

  1. Food and Drug Administration (FDA). Guidance for Industry on Systemic Lupus Erythematosus Developing Drugs for Treatment. From http://wwwfdagov/ohrms/dockets/dockets/05d0106/05d0106htm.
  2. Karsh J, Kimberly RP, Stahl NI, et al. Comparative effects of aspirin and ibuprofen in the management of systemic lupus erythematosus. Arthritis & Rheumatism. 1980 Dec;23(12):1401–1404
  3. Wallace DJ, Metzger AL, Klinenberg JR. NSAID usage patterns by rheumatologists in the treatment of SLE. The Journal of Rheumatology. 1989 Apr;16(4):557–560
  4. Ballas ZK, Donta ST. Sulindac-induced aseptic meningitis. Archives of Internal Medicine. 1982 Jan;142(1):165–166
  5. Ruppert GB, Barth WF. Tolmetin-induced aseptic meningitis. Journal of American Medical Association. 1981 Jan 2;245(1):67–68
  6. Weksler BB, Lehany AM. Naproxen-induced recurrent aseptic meningitis. DICP. 1991 Nov;25(11):1183–1184
  7. Brezin JH, Katz SM, Schwartz AB, Chinitz JL. Reversible renal failure and nephrotic syndrome associated with nonsteroidal anti-inflammatory drugs. The New England Journal of Medicine. 1979 Dec 6;301(23):1271–1273
  8. Shoenfeld Y, Livni E, Shaklai M, Pinkhas J. Sensitization to ibuprofen in systemic lupus erythematosus. Journal of American Medical Association. 1980 Aug 8;244(6):547–548
  9. Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. The New England Journal of Medicine. 2000 Nov 23;343(21):1520–1528
  10. Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors. Journal of American Medical Association. 2001 Aug 22-29;286(8):954–959
  11. Fessler BJ, Alarcon GS, McGwin G, et al. Systemic lupus erythematosus in three ethnic groups: XVI. Association of hydroxychloroquine use with reduced risk of damage accrual. Arthritis & Rheumatism. 2005 May;52(5):1473–1480
  12. Hodis HN, Quismorio FP, Wickham E, Blankenhorn DH. The lipid, lipoprotein, and apolipoprotein effects of hydroxychloroquine in patients with systemic lupus erythematosus. The Journal of Rheumatology. 1993 Apr;20(4):661–665
  13. Petri M, Lakatta C, Magder L, Goldman D. Effect of prednisone and hydroxychloroquine on coronary artery disease risk factors in systemic lupus erythematosus: a longitudinal data analysis. American Journal of Medicine. 1994 Mar;96(3):254–259
  14. Wallace DJ, Metzger AL, Stecher VJ, et al. Cholesterol-lowering effect of hydroxychloroquine in patients with rheumatic disease: reversal of deleterious effects of steroids on lipids. American Journal of Medicine. 1990 Sep;89(3):322–326
  15. Edwards MH, Pierangeli S, Liu X, et al. Hydroxychloroquine reverses thrombogenic properties of antiphospholipid antibodies in mice. Circulation. 1997 Dec 16;96(12):4380–4384
  16. Jancinova V, Nosal R, Petrikova M. On the inhibitory effect of chloroquine on blood platelet aggregation. Thrombosis Research. 1994 Jun 1;74(5):495–504
  17. Costedoat-Chalumeau N, Amoura Z, Hulot JS, et al. Very low blood hydroxychloroquine concentration as an objective marker of poor adherence to treatment of systemic lupus erythematosus. Annals of the Rheumatic Diseases. 2007 Jun;66(6):821–824
  18. Bernstein HN. Ophthalmologic considerations and testing in patients receiving long-term antimalarial therapy. American Journal of Medicine. 1983 Jul 18;75(1A):25–34
  19. Easterbrook M. Dosage of hydroxychloroquine should be based on ideal body weight: comment on the letter by Alarcon. Arthritis & Rheumatism. 2003 Mar;48(3):863–864author reply 4
  20. Feldmann R, Salomon D, Saurat JH. The association of the two antimalarials chloroquine and quinacrine for treatment-resistant chronic and subacute cutaneous lupus erythematosus. Dermatology. 1994;189(4):425–427
  21. Wallace DJ. Antimalarial Therapies. In:  Wallace DJH, BH  editor. Dubois' Lupus Erythematosus. 7th edn. Philadelphia, PA: Lippincott Williams & Wilkins; 2007;p. 1152–1174
  22. Lahita RG, Bradlow HL, Ginzler E, et al. Low plasma androgens in women with systemic lupus erythematosus. Arthritis & Rheumatism. 1987 Mar;30(3):241–248
  23. Straub RH, Zeuner M, Antoniou E, et al. Dehydroepiandrosterone sulfate is positively correlated with soluble interleukin 2 receptor and soluble intercellular adhesion molecule in systemic lupus erythematosus. The Journal of Rheumatology. 1996 May;23(5):856–861
  24. Suzuki N, Suzuki T, Sakane T. Hormones and lupus: defective dehydroepiandrosterone activity induces impaired interleukin-2 activity of T lymphocytes in patients with systemic lupus erythematosus. Annales de médecine interne. 1996;147(4):248–252
  25. Verthelyi D, Petri M, Ylamus M, Klinman DM. Disassociation of sex hormone levels and cytokine production in SLE patients. Lupus. 2001;10(5):352–358
  26. Chang DM, Lan JL, Lin HY, Luo SF. Dehydroepiandrosterone treatment of women with mild-to-moderate systemic lupus erythematosus: a multicenter randomized, double-blind, placebo-controlled trial. Arthritis & Rheumatism. 2002 Nov;46(11):2924–2927
  27. van Vollenhoven RF, Engleman EG, McGuire JL. Dehydroepiandrosterone in systemic lupus erythematosus. Results of a double-blind, placebo-controlled, randomized clinical trial. Arthritis & Rheumatism. 1995 Dec;38(12):1826–1831
  28. Petri MA, Lahita RG, Van Vollenhoven RF, et al. Effects of prasterone on corticosteroid requirements of women with systemic lupus erythematosus: a double-blind, randomized, placebo-controlled trial. Arthritis & Rheumatism. 2002 Jul;46(7):1820–1829
  29. van Vollenhoven RF, Park JL, Genovese MC, et al. A double-blind, placebo-controlled, clinical trial of dehydroepiandrosterone in severe systemic lupus erythematosus. Lupus. 1999;8(3):181–187
  30. Pollak VE, Dosekun AK. Evaluation of treatment in lupus nephritis: effects of prednisone. American Journal of kidney diseases. 1982 Jul;2(1 supplement. 1):170–177
  31. Pollak VE, Pirani CL, Schwartz FD. The natural history of the renal manifestations of systemic lupus erythematosus. The Journal of laboratory and clinical medicine. 1964 Apr;63:537–550
  32. Kirou KA, Boumpas DT. Systemic Glucocorticoid Therapy in Systemic Lupus Erythematosus. Dubois' Lupus Erythematosus. In:  Wallace D,  Hahn BH editor. 7th edn. Philadelphia, PA: Lippincott, Williams & Wilkins; 2007;p. 1175–1197
  33. Austin HA, Klippel JH, Balow JE, et al. Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs. The New England Journal of Medicine. 1986 Mar 6;314(10):614–619
  34. Boumpas DT, Austin HA, Vaughn EM, et al. Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. Lancet. 1992 Sep 26;340(8822):741–745
  35. Gourley MF, Austin HA, Scott D, et al. Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial. Annals of Internal Medicine. 1996 Oct 1;125(7):549–557
  36. Illei GG, Austin HA, Crane M, et al. Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis. Annals of Internal Medicine. 2001 Aug 21;135(4):248–257
  37. Houssiau FA, Vasconcelos C, D'Cruz D, et al. Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide. Arthritis & Rheumatism. 2002 Aug;46(8):2121–2131
  38. Ballou SP, Khan MA, Kushner I. Clinical features of systemic lupus erythematosus: differences related to race and age of onset. Arthritis & Rheumatism. 1982 Jan;25(1):55–60
  39. Nissenson AR, Port FK. Outcome of end-stage renal disease in patients with rare causes of renal failure. III. Systemic/vascular disorders. The Quarterly Journal of medicine. 1990 Jan;74(273):63–74
  40. Ward MM, Studenski S. Clinical manifestations of systemic lupus erythematosus. Identification of racial and socioeconomic influences. Archives of Internal Medicine. 1990 Apr;150(4):849–853
  41. Dooley MA, Hogan S, Jennette C, Falk R. Cyclophosphamide therapy for lupus nephritis: poor renal survival in black Americans. Glomerular Disease Collaborative Network. Kidney International. 1997 Apr;51(4):1188–1195
  42. Houssiau FA, Vasconcelos C, D'Cruz D, et al. Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis: lessons from long-term followup of patients in the Euro-Lupus Nephritis Trial. Arthritis & Rheumatism. 2004 Dec;50(12):3934–3940
  43. Chan TM, Li FK, Tang CS, et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong-Guangzhou Nephrology Study Group. The New England Journal of Medicine. 2000 Oct 19;343(16):1156–1162
  44. Hu W, Liu Z, Chen H, et al. Mycophenolate mofetil vs cyclophosphamide therapy for patients with diffuse proliferative lupus nephritis. Chinese Medical Journal. 2002 May;115(5):705–709
  45. Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. The New England Journal of Medicine. 2004 Mar 4;350(10):971–980
  46. Ginzler EM, Dooley MA, Aranow C, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. The New England Journal of Medicine. 2005 Nov 24;353(21):2219–2228
  47. Chan TM, Tse KC, Tang CS, et al. Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis. Journal of the American Society of Nephrology. 2005 Apr;16(4):1076–1084
  48. Grootscholten C, Bajema IM, Florquin S, et al. Treatment with cyclophosphamide delays the progression of chronic lesions more effectively than does treatment with azathioprine plus methylprednisolone in patients with proliferative lupus nephritis. Arthritis & Rheumatism. 2007 Mar;56(3):924–937
  49. Chan TM, Tse KC, Tang CS, et al. Long-term outcome of patients with diffuse proliferative lupus nephritis treated with prednisolone and oral cyclophosphamide followed by azathioprine. Lupus. 2005;14(4):265–272
  50. Cush JJ, KA , Stein CM. Rheumatology Diagnosis and Therapeutics. 2nd edn. Philadelphia, PA: Lippincott Williams & Wilkins; 2005;
  51. Bertsias GK, Ioannidis JP, Boletis J, et al. EULAR recommendations for the management of Systemic Lupus Erytematosus (SLE) Report of a Task Force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)*. Annals of the Rheumatic Diseases. 2007 May 15;
  52. Barile-Fabris L, Ariza-Andraca R, Olguin-Ortega L, et al. Controlled clinical trial of IV cyclophosphamide versus IV methylprednisolone in severe neurological manifestations in systemic lupus erythematosus. Annals of the Rheumatic Diseases. 2005 Apr;64(4):620–625
  53. Mok CC, Lau CS, Chan EY, Wong RW. Acute transverse myelopathy in systemic lupus erythematosus: clinical presentation, treatment, and outcome. The Journal of Rheumatology. 1998 Mar;25(3):467–473
  54. Stojanovich L, Stojanovich R, Kostich V, Dzjolich E. Neuropsychiatric lupus favourable response to low dose i.v. cyclophosphamide and prednisolone (pilot study). Lupus. 2003;12(1):3–7
  55. Neuwelt CM, Lacks S, Kaye BR, et al. Role of intravenous cyclophosphamide in the treatment of severe neuropsychiatric systemic lupus erythematosus. American Journal of Medicine. 1995 Jan;98(1):32–41
  56. Lewis EJ, Hunsicker LG, Lan SP, et al. A controlled trial of plasmapheresis therapy in severe lupus nephritis. The Lupus Nephritis Collaborative Study Group. The New England Journal of Medicine. 1992 May 21;326(21):1373–1379
  57. Zhou HQ, Leng XM, Zhang FC. [Neuropsychiatric manifestations in systemic lupus erythematosus and the treatment of intrathecal methotrexate plus dexamethasone]. Zhonghua Yi Xue Za Zhi. 2006 Mar 21;86(11):771–774
  58. Carneiro JR, Sato EI. Double blind, randomized, placebo controlled clinical trial of methotrexate in systemic lupus erythematosus. The Journal of Rheumatology. 1999 Jun;26(6):1275–1279
  59. Rahman P, Humphrey-Murto S, Gladman DD, Urowitz MB. Efficacy and tolerability of methotrexate in antimalarial resistant lupus arthritis. The Journal of Rheumatology. 1998 Feb;25(2):243–246
  60. McCune W, Marder W, Riskalla M. Immunosuppressive Drug Therapy. In Dubois' Lupus Erythematosus. Philadelphia, PA: Lippincott Williams and Wilkins; 2007;
  61. Petri M. Arava in Lupus. American College of Rheumatology 65th Annual Scientific Meeting. Arthritis and Rheumatism. 2001;44:S1364
  62. Sato EI. Methotrexate therapy in systemic lupus erythematosus. Lupus. 2001;10(3):162–164
  63. Morton SJ, Powell RJ. An audit of cyclosporin for systemic lupus erythematosus and related overlap syndromes: limitations of its use. Annals of the Rheumatic Diseases. 2000 Jun;59(6):487–489
  64. Wallace D. Additional Therapies Used in the Management of Lupus. Dubois' Lupus Erythematosus. In:  Wallace DJ,  Hahn BH editor. 7th edn. Philadelphia, PA: Lippincott Williams and Wilkins; 2007;
  65. Kreuter A, Gambichler T, Breuckmann F, et al. Pimecrolimus 1% cream for cutaneous lupus erythematosus. Journal of the American Academy of Dermatology. 2004 Sep;51(3):407–410
  66. Lampropoulos CE, Sangle S, Harrison P, et al. Topical tacrolimus therapy of resistant cutaneous lesions in lupus erythematosus: a possible alternative. Rheumatology (Oxford). 2004 Nov;43(11):1383–1385
  67. Anonymous. http://www.fda.gov/fdac/departs/2006/206_upd.html#eczema. Journal [serial on the Internet]. Last accessed April 2006. Date.
  68. Wallace DJ. What's new in the management of lupus since 2000?. Journal of Clinical Rheumatology. 2006 Dec;12(6):307–313
  69. Sontheimer RD, MD . Lupus - Specific Skin Disease (Cutaneous LE). In:  Wallace D, HB  editor. 7th ed.. Philadelphia, PA: Lippincott Williams & Wilkins; 2006;
  70. Leandro MJ, Edwards JC, Cambridge G, et al. An open study of B lymphocyte depletion in systemic lupus erythematosus. Arthritis & Rheumatism. 2002 Oct;46(10):2673–2677
  71. Looney RJ, Anolik JH, Campbell D, et al. B cell depletion as a novel treatment for systemic lupus erythematosus: a phase I/II dose-escalation trial of rituximab. Arthritis & Rheumatism. 2004 Aug;50(8):2580–2589
  72. Sfikakis PP, Boletis JN, Tsokos GC. Rituximab anti-B-cell therapy in systemic lupus erythematosus: pointing to the future. Current Opinion In Rheumatology. 2005 Sep;17(5):550–557
  73. Leandro MJ, Cambridge G, Edwards JC, et al. B-cell depletion in the treatment of patients with systemic lupus erythematosus: a longitudinal analysis of 24 patients. Rheumatology (Oxford). 2005 Dec;44(12):1542–1545
  74. Ng KP, Leandro MJ, Edwards JC, et al. Repeated B cell depletion in treatment of refractory systemic lupus erythematosus. Annals of the Rheumatic Diseases. 2006 Jul;65(7):942–945
  75. Tokunaga M, Saito K, Kawabata D, et al. Efficacy of rituximab (anti-CD20) for refractory systemic lupus erythematosus involving the central nervous system. Annals of the Rheumatic Diseases. 2007 Apr;66(4):470–475
  76. Sfikakis PP, Boletis JN, Lionaki S, et al. Remission of proliferative lupus nephritis following B cell depletion therapy is preceded by down-regulation of the T cell costimulatory molecule CD40 ligand: an open-label trial. Arthritis & Rheumatism. 2005 Feb;52(2):501–513
  77. Ng KP, Cambridge G, Leandro MJ, et al. B cell depletion therapy in systemic lupus erythematosus: long-term follow-up and predictors of response. Annals of the Rheumatic Diseases. 2007 Sep;66(9):1259–1262
  78. Edwards JC, Szczepanski L, Szechinski J, et al. Efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis. The New England Journal of Medicine. 2004 Jun 17;350(25):2572–2581
  79. Vallerskog T, Gunnarsson I, Widhe M, et al. Treatment with rituximab affects both the cellular and the humoral arm of the immune system in patients with SLE. Clinical Immunology. 2007 Jan;122(1):62–74
  80. Alert F., Rituximab (marketed as Rituxan) Information. 12/18/2006 [updated 12/18/2006; cited]; Available from: http://www.fda.gov/cder/drug/infosheets/hcp/rituximab.pdf.
  81. Dorner T, Kaufmann J, Wegener WA, et al. Initial clinical trial of epratuzumab (humanized anti-CD22 antibody) for immunotherapy of systemic lupus erythematosus. Arthritis Research & Therapy. 2006;8(3):R74
  82. Human Genome Sciences. Available at: http://www.hgsi.com/products/LSB.html, editor.
  83. Furie R, SW , Ginzler E, et al. Safety, pharmacokinetic and pharmacodynamic results of a phase 1 single and double dose-escalation study of lymphostat-B (human monocloncal antibody to BLyS) in SLE patients. Arthritis & Rheumatism. 2003;48(9 supplement):S377
  84. Furie R, LJ , Merrill JT, et al. Belimumab (fully human monoclonal antibody to B-lymphocyte stimulator [BLys]) improves or stabilizes SLE activity in a multicenter phase 2 trial. Arthritis and Rheumatism. 2006;54(9 supplement):S28
  85. In:  Silvermann GJ, aKK  editor. Latest Advances in B-Cell Science. April 20, 2007;
  86. Stohl W, WD , Merrill JT, et al. Changes in circulating B-cell counts, autoantibody levels and immunoglobulins that associate with therapeutic responsiveness in SLE to BLyS protein antagonism by belimumab. Arthritis & Rheumatism. 2006;54(9 supplement):S780
  87. Dall'Era M CE GM, et al. Trial of atacicept in patients with systemic lupus erythematosus. Abstract L19. ACR/ARHP Annual Scientific Meeting. November 2006.
  88. Genovese MC, Becker JC, Schiff M, et al. Abatacept for rheumatoid arthritis refractory to tumor necrosis factor alpha inhibition. The New England Journal of Medicine. 2005 Sep 15;353(11):1114–1123
  89. Westhovens R, Cole JC, Li T, et al. Improved health-related quality of life for rheumatoid arthritis patients treated with abatacept who have inadequate response to anti-TNF therapy in a double-blind, placebo-controlled, multicentre randomized clinical trial. Rheumatology (Oxford). 2006 Oct;45(10):1238–1246
  90. Daikh DI, Wofsy D. Cutting edge: reversal of murine lupus nephritis with CTLA4Ig and cyclophosphamide. Journal of Immunology. 2001 Mar 1;166(5):2913–2916
  91. Kalunian KC, Davis JC, Merrill JT, et al. Treatment of systemic lupus erythematosus by inhibition of T cell costimulation with anti-CD154: a randomized, double-blind, placebo-controlled trial. Arthritis & Rheumatism. 2002 Dec;46(12):3251–3258
  92. Boumpas DT, Furie R, Manzi S, et al. A short course of BG9588 (anti-CD40 ligand antibody) improves serologic activity and decreases hematuria in patients with proliferative lupus glomerulonephritis. Arthritis & Rheumatism. 2003 Mar;48(3):719–727
  93. Freedman JE. CD40 ligand–assessing risk instead of damage?. The New England Journal of Medicine. 2003 Mar 20;348(12):1163–1165
  94. Alarcon-Segovia D, Tumlin JA, Furie RA, et al. LJP 394 for the prevention of renal flare in patients with systemic lupus erythematosus: results from a randomized, double-blind, placebo-controlled study. Arthritis & Rheumatism. 2003 Feb;48(2):442–454
  95. Furie RA, Cash JM, Cronin ME, et al. Treatment of systemic lupus erythematosus with LJP 394. The Journal of Rheumatology. 2001 Feb;28(2):257–265
  96. Mosca M, Baldini C, Bombardieri S. LJP-394 (abetimus sodium) in the treatment of systemic lupus erythematosus. Expert Opinion on Pharmacotherapy. 2007 Apr;8(6):873–879
  97. Furie R. Abetimus sodium (riquent) for the prevention of nephritic flares in patients with systemic lupus erythematosus. Rheumatic Diseases Clinics of North Americas. 2006 Feb;32(1):149–156x
  98. Teva Pharmaceuticals. Available at: http://www.tevapharm.com/research/products_ai.asp
  99. Aringer M, Graninger WB, Steiner G, Smolen JS. Safety and efficacy of tumor necrosis factor alpha blockade in systemic lupus erythematosus: an open-label study. Arthritis & Rheumatism. 2004 Oct;50(10):3161–3169
  100. Aringer M, Steiner G, Graninger WB, et al. Effects of short-term infliximab therapy on autoantibodies in systemic lupus erythematosus. Arthritis & Rheumatism. 2007 Jan;56(1):274–279
  101. Debandt M, Vittecoq O, Descamps V, et al. Anti-TNF-alpha-induced systemic lupus syndrome. Clinical Rheumatology. 2003 Feb;22(1):56–61
  102. Favalli EG, Sinigaglia L, Varenna M, Arnoldi C. Drug-induced lupus following treatment with infliximab in rheumatoid arthritis. Lupus. 2002;11(11):753–755
  103. Baechler EC, Batliwalla FM, Karypis G, et al. Interferon-inducible gene expression signature in peripheral blood cells of patients with severe lupus. Proceedings of the National Academy of Sciences of the United States of America. 2003 Mar 4;100(5):2610–2615
  104. Feng X, Wu H, Grossman JM, et al. Association of increased interferon-inducible gene expression with disease activity and lupus nephritis in patients with systemic lupus erythematosus. Arthritis & Rheumatism. 2006 Sep;54(9):2951–2962
  105. Braun-Moscovici Y, Furst DE. Stem cell therapy in scleroderma. Current Opinion In Rheumatology. 2002 Nov;14(6):711–716
  106. Burt RK, Traynor A, Statkute L, et al. Nonmyeloablative hematopoietic stem cell transplantation for systemic lupus erythematosus. Journal of American Medical Association. 2006 Feb 1;295(5):527–535
  107. Jayne D, Passweg J, Marmont A, et al. Autologous stem cell transplantation for systemic lupus erythematosus. Lupus. 2004;13(3):168–176
  108. Petri M, Jones RJ, Brodsky RA. High-dose cyclophosphamide without stem cell transplantation in systemic lupus erythematosus. Arthritis & Rheumatism. 2003 Jan;48(1):166–173
  109. Petri M, Brodsky R, Jones RJ, et al. Cyclophosphamide Vs. Monthly (NIH) Cyclophosphaide: Final Results. Arthritis and Rheumatism. 2006;54(9):S444;(abstract 1038)

PII: S1521-6942(07)00104-0

doi: 10.1016/j.berh.2007.09.002

Best Practice & Research Clinical Rheumatology
Volume 21, Issue 6 , Pages 971-987 , December 2007

Article Tools

* Image Usage & Resolution