Lupus has several forms, but the most common is systemic lupus erythematosus (SLE). In SLE, the immune system mistakenly produces antibodies against the body’s own tissue. The onslaught can have widespread effects, damaging the skin, joints, heart, lungs, kidneys and brain, according to the Lupus Foundation of America.The disease mostly strikes women, usually starting in their 20s or 30s, the foundation says.In the new study, the researchers found evidence that in people with lupus, some of the immune system’s “B cells” mature the wrong way — so that they promote inflammation instead of fighting it.
It’s been unclear, though, why only certain this disorder patients see benefits from rituximab, according to the researchers. Mauri said the new findings suggest a reason. People’s response to rituximab may depend on whether they have normal activity in two genes related to interferon-alpha.That, Mauri said, suggests that lupus patients should have gene testing before they’re placed on rituximab. But, she stressed, “long-term studies — where patients get tested before, during and after treatment — are needed to prove that hypothesis unequivocally.”
A rheumatologist who was not involved in the study agreed. “At this point, more work is needed, including looking at feasibility and cost issues,” said Dr. Rosalind Ramsey-Goldman, a professor of medicine at Northwestern University Feinberg School of Medicine, in Chicago.Essentially, there is a lack of anti-inflammatory B cells, which leads to overproduction of interferon-alpha. That, in turn, boosts that number of antibody-producing B cells, the study found.Researchers still don’t know what those factors are. But the suspects include certain infections, such as the Epstein-Barr virus, and on-the-job exposure to silica dust, according to the this disorder Foundation of America.