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Medical Forum / Diseases and Disorders / Lupus / July 2009Lupus And Iron Overload
"Lupus is independently associated Porphyria cutanea tarda" "Porphyria cutanea tarda has been associated with hemochromatosis" That means .. again .. the question of "iron deficiency in everyone with Lupus" comes into question .. http://mayoclinproc.highwire.org/content/84/7/639.full 66-Year-Old Woman With Painless Vesicular Lesions Aditya Bardia, MBBS, MPH*, Elizabeth A. Swanson, MD† and Kris G. Thomas, MD‡ +Author Affiliations *Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN †Resident in Dermatology, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN ‡Advisor to residents and Consultant in Primary Care Internal Medicine, Mayo Clinic, Rochester, MN Individual reprints of this article are not available. Address correspondence to Kris G. Thomas, MD, Division of Primary Care Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (thomas.kris@mayo.edu). See end of article for correct answers to questions. A 66-year-old woman presented to the internal medicine clinic with a 1- month history of painless vesicular lesions on her hands. A tense blister was first noted on the lateral aspect of her right index finger. This lesion lasted for about 7 days and then spontaneously resolved. Subsequently, 2 similar lesions appeared on her left index finger. She denied lesions elsewhere on her body, including palmar surfaces, soles, and mucosal areas. She denied trauma to the lesions of concern. She denied fevers, chills, night sweats, abdominal pain, arthralgias, joint swelling, rash, pruritus, photosensitivity, neurologic symptoms, and constitutional symptoms. On detailed questioning, she acknowledged that her urine appeared red- tinged with her first morning void. Her medical history was notable for depression, impaired fasting glucose, osteopenia, and hypertension. She had no known history of rheumatologic conditions, liver disease, or diabetes. Her medications, all long-term, included mirtazapine, metoprolol, a multivitamin, calcium, and aspirin. She did not smoke or drink alcohol, had no history of intravenous drug use, and was in a monogamous relationship with her husband. Family history was remarkable for similar symptoms in her mother and sister. Her occupation involved office work, and she denied activities involving constant rubbing. Her hobbies included gardening. Physical examination revealed a 9-mm × 6-mm tense blister on the lateral surface of the left index finger. A 2-cm-wide patch of erythematous hyperpigmentation surrounded this blister and was focused at the site of her previously healed blister (Figure). Excessive fine hair growth was observed on her lateral face. The remainder of her examination was unremarkable. Who loves ya. Tom Jesus Was A Vegetarian! http://tinyurl.com/2r2nkh Man Is A Herbivore! http://tinyurl.com/4rq595 DEAD PEOPLE WALKING http://tinyurl.com/zk9fk Rusty the 'Tard appears to suffer not only from OCD's but schizophrenia, megalomania and masochism, coupled with low self-esteem and a hignly confused sexuality. No wonder he's unable to function in society and lives on the public dole Obsessions are repeated, persistent and unwanted ideas, thoughts, images or impulses that you have involuntarily and that seem to make no sense. These obsessions typically intrude when you're trying to think of or do other things. Compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors are meant to prevent or reduce anxiety or distress related to your obsessions. You may also make up rules or rituals to follow that help control the anxiety you feel when having obsessive thoughts. On Jul 10, 7:39 am, Ken <flakey...@earthlink.net> wrote: snip << "Lupus is independently associated Porphyria cutanea tarda" "Porphyria cutanea tarda has been associated with hemochromatosis" That means .. again .. the question of "iron deficiency in everyone with Lupus" comes into question .. http://mayoclinproc.highwire.org/content/84/7/639.full 66-Year-Old Woman With Painless Vesicular Lesions Aditya Bardia, MBBS, MPH*, Elizabeth A. Swanson, MD† and Kris G. Thomas, MD‡ +Author Affiliations *Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN †Resident in Dermatology, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN ‡Advisor to residents and Consultant in Primary Care Internal Medicine, Mayo Clinic, Rochester, MN Individual reprints of this article are not available. Address correspondence to Kris G. Thomas, MD, Division of Primary Care Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (thomas.k...@mayo.edu). See end of article for correct answers to questions. A 66-year-old woman presented to the internal medicine clinic with a 1- month history of painless vesicular lesions on her hands. A tense blister was first noted on the lateral aspect of her right index finger. This lesion lasted for about 7 days and then spontaneously resolved. Subsequently, 2 similar lesions appeared on her left index finger. She denied lesions elsewhere on her body, including palmar surfaces, soles, and mucosal areas. She denied trauma to the lesions of concern. She denied fevers, chills, night sweats, abdominal pain, arthralgias, joint swelling, rash, pruritus, photosensitivity, neurologic symptoms, and constitutional symptoms. On detailed questioning, she acknowledged that her urine appeared red- tinged with her first morning void. Her medical history was notable for depression, impaired fasting glucose, osteopenia, and hypertension. She had no known history of rheumatologic conditions, liver disease, or diabetes. Her medications, all long-term, included mirtazapine, metoprolol, a multivitamin, calcium, and aspirin. She did not smoke or drink alcohol, had no history of intravenous drug use, and was in a monogamous relationship with her husband. Family history was remarkable for similar symptoms in her mother and sister. Her occupation involved office work, and she denied activities involving constant rubbing. Her hobbies included gardening. Physical examination revealed a 9-mm × 6-mm tense blister on the lateral surface of the left index finger. A 2-cm-wide patch of erythematous hyperpigmentation surrounded this blister and was focused at the site of her previously healed blister (Figure). Excessive fine hair growth was observed on her lateral face. The remainder of her examination was unremarkable. Who loves ya. Tom Jesus Was A Vegetarian! http://tinyurl.com/2r2nkh Man Is A Herbivore! http://tinyurl.com/4rq595 DEAD PEOPLE WALKING http://tinyurl.com/zk9fk "Lupus is independently associated Porphyria cutanea tarda" "Porphyria cutanea tarda has been associated with hemochromatosis" << Effect of an oral iron chelator or iron-deficient diets on uroporphyria in a murine model of porphyria cutanea tarda. Hepatology. 2007 Sep 13; Gorman N, Zaharia A, Trask HS, Szakacs JG, Jacobs NJ, Jacobs JM, Balestra D, Sinclair JF, Sinclair PR. Veterans Affairs Medical Center, White River Junction, VT. Porphyria cutanea tarda is a liver disease characterized by elevated hepatic iron and excessive production of uroporphyrin (URO). Phlebotomy is an effective treatment that probably acts by reducing hepatic iron. Here we used Hfe(-/-) mice to compare the effects on hepatic URO accumulation of two different methods of hepatic iron depletion: iron chelation using deferiprone (L1) versus iron- deficient diets. Hfe(-/-) mice in a 129S6/SvEvTac background were fed 5- aminolevulinic acid (ALA), which results in hepatic URO accumulation, and increasing doses of L1 in the drinking water. Hepatic URO accumulation was completely prevented at low L1 doses, which partially depleted hepatic nonheme iron. By histological assessment, the decrease in hepatic URO accumulation was associated with greater depletion of iron from hepatocytes than from Kupffer cells. The L1 treatment had no effect on levels of hepatic cytochrome P4501A2 (CYP1A2). L1 also effectively decreased hepatic URO accumulation in C57BL/6 Hfe(-/-) mice treated with ALA and a CYP1A2 inducer. ALA- treated mice maintained on defined iron-deficient diets, rather than chow diets, did not develop uroporphyria, even when the animals were iron-supplemented either directly in the diet or by iron dextran injection. Conclusion: The results suggest that dietary factors other than iron are involved in the development of uroporphyria and that a modest depletion of hepatocyte iron by L1 is sufficient to prevent URO accumulation. (HEPATOLOGY 2007.). PMID: 17854053 Who loves ya. Tom Jesus Was A Vegetarian! http://tinyurl.com/2r2nkh Man Is A Herbivore! http://tinyurl.com/4rq595 DEAD PEOPLE WALKING http://tinyurl.com/zk9fk > That means .. again .. the question of > "iron deficiency in everyone with Lupus" [quoted text clipped - 67 lines] > > DEAD PEOPLE WALKINGhttp://tinyurl.com/zk9fk On Jul 11, 7:59 am, ironjustice <teamtan...@hotmail.com> wrote:The results suggest that dietary factors other than iron are involved in the development of uroporphyria and that a modest depletion of hepatocyte iron by L1 is sufficient to prevent URO accumulation. << And this "other substance" was vitamin C remember .. ? WHEN the iron GOT TO A CERTAIN POINT the vitamin C no longer could PREVENT the increased iron from causing the uroporphyria. Who loves ya. Tom Jesus Was A Vegetarian! http://tinyurl.com/2r2nkh Man Is A Herbivore! http://tinyurl.com/4rq595 DEAD PEOPLE WALKING http://tinyurl.com/zk9fk > "Lupus is independently associated Porphyria cutanea tarda" > "Porphyria cutanea tarda has been associated with hemochromatosis" << [quoted text clipped - 119 lines] > > - Show quoted text - a modest depletion of hepatocyte iron by L1 is sufficient to prevent URO accumulation. << This study showed CLEARLY increased porphyrin in lupus patients but when lupus patients are questioned .. ? .. They've never heard of a porphyrin. http://tinyurl.com/2qnmut Indian Journal of Dermatology, Venereology and Leprology Year : 1985 | Volume : 51 | Issue : 4 | Page : 217--218 A Profile of Porhyrins in Cases .of Discoid Lupus Erythematosus Jain C, Handa F, Sidhu KS Correspondence Address: Jain C Porphyrin levels in nineteen cases of discoid lupus erythematosus were compared with porphyrin levels in ten controls using Rimingto.in's technique. The erythrocyte protoporphyrin, urinary uroporphyrin and faecal coproporph rin and faccal protoporphyrin were found to be significantly raised as compared to the controls. ---------------------------- Original Article Heme metabolism and in vitro erythropoiesis in anemia associated with hypochromic microcytosis A. C. Brown 1, J. D. Lutton 1 *, H. A. Pearson 2, J. C. Nelson 1, R. D. Levere 1, N. G. Abraham 1 1Department of Medicine and Anatomy, New York Medical College, Valhalla, New York 2Department of Medicine, Yale University School of Medicine, New Haven, Connecticut *Correspondence to J. D. Lutton, Departments of Medicine and Anatomy, New York Medical College, Valhalla, NY 10595 Funded by: National Institute of Arthritis for Diabetes and Digestive Kidney Diseases; Grant Number: AM 29742 National Institutes of Health; Grant Number: AM 00781 Abstract Heme metabolism and in vitro erythropoietic growth (CFU-E, BFU-E) were examined in bone marrow cells taken from two siblings with apparent familial hypochromic microcytic anemia. Bone marrow cells from both patients grew adequate numbers of CFU-E and BFU-E colonies in culture in the presence of erythropoietin. In addition, small numbers of endogenous CFU-E were seen in 7-day cultures. Assays on bone marrow cells taken from both patients revealed that baseline -aminolevulinic synthase activity was considerably reduced, but increased six to seven fold (to normal levels) when patients' cells were exposed to pyridoxal phosphate (PLP). In both cases, ferrochelatase and -aminolevulinic acid dehydratase activities were normal. Bone marrow heme oxygenase showed no significant differences in activities between normals and patients values in the absence or presence of PLP. In contrast, heme synthesis by patients' bone marrow was less than that of normals. This study demonstrates that bone marrow cells from patients with this rare disorder have some disturbances in heme metabolism, whereas erythropoiesis appeared to be normal when cultured with adequate nutrients in vitro. Keywords pyridoxal phosphate · B-6 deficiency · hemoglobin · iron -------------------------------------------------------------------------------- Received: 30 December 1986; Accepted: 9 July 1987 Digital Object Identifier (DOI) 10.1002/ajh.2830270102 About DOI Who loves ya. Tom Jesus Was A Vegetarian! http://tinyurl.com/2r2nkh Man Is A Herbivore! http://tinyurl.com/4rq595 DEAD PEOPLE WALKING http://tinyurl.com/zk9fk > And this "other substance" was vitamin C remember .. ? > WHEN the iron GOT TO A CERTAIN POINT the vitamin C no longer could [quoted text clipped - 134 lines] > > - Show quoted text - |
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