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Copyright 2012. Nova Science Publishers, Inc. All rights reserved.

. May not be reproduced in any form without permission from the publisher, except fair uses permitted under 14 Ana Maria Abreu Velez and Michael S. Howard

NIH U.S. Department of Health and Human Services


National Institutes of Health
DLE discoid lupus erythematosus
SCLE subacute cutaneous lupus erythematosus
DIL Drug-induced lupus
NSAID nonsteroidal anti-inflammatory drug
ANA antinuclear antibody
UV ultraviolet light
BUN blood urea nitrogen
eGFR estimated glomerular filtration rate
APS antiphospholipid antibody syndrome, or Hughes syndrome
ACR American College of Rheumatology
PGA Physician's Global Assessment
SLEDAI SLE Disease Activity Index; modified to exclude anti-dsDNA and
complement)
CTD connective tissue disease
SSc systemic sclerosis

Defining Lupus
Lupus is one of many disorders of the immune system known as autoimmune diseases. In
autoimmune diseases, the immune system attacks parts of the patients body, leading to
inflammation and injury in body tissues. Lupus may affect many areas of the body, especially
in systemic lupus erythematosus (SLE); potential areas of involvement include the joints,
skin, kidneys, heart, lungs, blood vessels, and brain. Although people with the disease may
present with variable symptoms, some of the most frequent ones include fatigue, painful or
swollen joints (arthritis), unexplained fevers, photosensitiviy, skin rashes, and renal
abnormalities [1-5].
Currently, there is no cure for lupus [6]. Nevertheless, lupus can be effectively treated
with medications [7-11]. Lupus is characterized by periods of illness, called flares, and
periods of wellness, or remission. Understanding how to prevent flares and how to treat them
when they do occur helps people with lupus maintain better overall health; however, ongoing
renal disease often remains an important issue [12].
Women present with lupus more often than men [12, 13]. Lupus is more common in
African American women than in Caucasian women, and is also more common in women of
Hispanic, Asian, and Native American background. African American and Hispanic women
U.S. or applicable copyright law.

are also more likely to develop severe disease, involving several organs [14-15]. Lupus is
common in several members of the same family [16]. In recent years, compelling evidence
has been gathered that supports a role for epigenetic alterations in the pathogenesis of SLE
[17]. Different populations of SLE patients are characterized by a global loss of DNA
methylation [17]. The demethylation has been associated with defects in ERK pathway
signaling, and consequent DNMT 1 downregulation [17]. Hypomethylation of gene
promoters has been described, which permits 1) transcriptional activation and resultant
functional changes within affected cells, and also 2) hypomethylation of the ribosomal RNA

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