OUGD603 - Research: History of Lupus

History of Lupus

Lupus is described as the illness of modern times. 

However, articles describing what we know as Lupus traced back to ancient Greek physician Hippocrates. 
Hippocrates: born 460 BC
Name origin 'Hippocratic Oath' which modern doctors adhere to (in its original form). 
It requires new physicians to swear by a number of healing gods to up hold specific ethical standards.

Lupus - latin for wolf. 
There are conflicting accounts of the origin of the term Lupus but it was first described by the physician Rogerius in the 1200s. He used it to describe erosive facial lesions. According to one account the distinctive butterfly rash associated with Lupus resembles bit marks of a wolf attack. Another of the facial marks is similar to markings on a wolfs face. 

Lupus 1800s
Research in western medicine began in earnest in the 19th century. 
In the mid 1800s Viennese physician Ferdinand Von Hebra and son in law Moritz Kaposi wrote 1st treatises recognising symptoms of Lupus extended beyond skin and affected organs of body too. 

1894 - Dr Thomas Payne, physician at St Thomas Hospital London recognised chloroquine general healing powers in Lupus. This treats join pain and fatique. This discovery paved the way for the century of 'antimalarial' use in various forms to treat Lupus. 

1851 - French physician Pierre Cazeriave, 1st used the term 'Lupus erythematosus'.
'Lupus' in latin = wolf.
'erythema' in Greek = redness/blush. 

Mid 1800s - As physicians saw more of the disease Moriz Kaposi used terms 'Lupus disseminated' and 'Lupus discoid' to describe the skin disorders. 
Lupus disseminated - an inflammatory disease of connective tissue with variable features including fever and weakness and fatiguability and joint pains and skin lesions on the face or neck or arms.
Lupus discoid - the most common type of chronic cutaneous lupus (CCLE), an autoimmune skin condition on the lupus erythematosus spectrum of illnesses.

1895 - 1903 - Canadian physician Sir William Osler wrote the 1st complete treatises on Lupus Erythematosus. He showed in addition to classic symptoms the central nervous system, muscles, skeleton, heart an lungs could all potentially be part of the disease.

Osler also identified Lupus could be systemic, i.e. could affect the entire body. Also the disease could relapse and flare periodically. 

Lupus 20th Century
1920s and 1930s - work began defining pathological (disease orientated) description of Lupus. 

1941 - Major breakthrough when pathologist Dr Paul Klemperer and colleagues at Mount Sinai Hospital in New York City wrote detailed pathological description of Lupus which coined the term 'collagen disease' which led to modern classification of Lupus as an autoimmune disorder.

1946 - Dr Malcolm Hargraves pathologist at renowned Mayo clinic published the description of Lupus etythematosus or LE cell. This identified the systematic inflammatory part of the disease. This allowed doctors to diagnose the disease faster and with greater reliability.

1949 - at the same clinic, Dr Philip Hench demonstrated a newly discovered hormone called cortisone could treat rheumatoid arthritis. It was used to treat SLE patients and found the cortisone immediately had a dramatic ability to save lives. 

In the 1950s LE cell was found to be part of the ANA (antinuclear antibody) reaction. This lead to test for antibodies allowing doctors/researchers to identify/define disease in a more rigorous way. The test which detects the antibodies are called 'fluorescent tests'. These antibodies attack the nucleus of cells - ANA

With further research on antibodies it was discovered Lupus patients have other antibodies present. Some were found to bind DNA itself. This led to test for anti DNA antibodies and has become one of the best tests available for diagnosing SLE. This test is still widely used today. 

9th March 2011 - Benlysta (Bellumimab) became the 1st new treatment developed to treat systemic Lupus in 50 years. It was approved by the FDA. It works by targeting a naturally occurring protein. This protein is believed to produce the antibodies which attack and destroy the bodies own healthy tissue. 

NICE (National Institute for Health and Clinical Excellence) did not approve the use of the drug in the UK on cost grounds. 

May 2016 - NICE approved Benlysta for limited use in the NHS. Patients must meet a specific criteria under a managed access agreement between GSK (GlaxoSmithKline) London based pharmaceutical company and NHS England. GSK will provide the drug at a discounted price as long as data can be collected to address remaining questions on the drugs efficiency. 

November 2017 - GKS recieved approval from FDA for a single dose prefilled pen administered weekly. Enabling patients to self-administer the medicine. It is not yet available in the UK.

Historically Lupus caused people to die young primarily from kidney failure. Today with careful treatment 80 to 90 percent expect to live a near normal lifespan.