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OBJECTIVE: To provide a comprehensive overview of treatment strategies for systemic lupus erythematosus, focusing on disease severity-based management, glucocorticoid utilization, and novel approaches to reduce treatment-related harm. METHODOLOGY: An extensive analysis of current guidelines, studies, and evidence-based recommendations related to systemic lupus erythematosus treatment. We examined strategies proposed by EULAR and GLADEL for achieving remission and low disease activity based on SLE Disease Activity Index (SLEDAI) scores and medication doses. RESULTS: The treat to target strategy, emphasizing complete disease remission, is central in systemic lupus erythematosus management. Low disease activity has shown sustained patient adherence and protection against relapse and organ damage. CONCLUSIONS: The optimal management of systemic lupus erythematosus entails aligning treatment with disease severity, judicious glucocorticoid use, and integration of emerging approaches to mitigate treatment-associated harm. Regular follow-up and adherence to established guidelines are crucial for achieving favorable outcomes in systemic lupus erythematosus patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the efficacy and safety of 8 cumulative grams of methylprednisolone combined with doxycycline 50 mg/day for 12 weeks in patients with active Graves orbitopathy. MATERIALS AND METHODS: Quasiexperimental, prospective, longitudinal, before and after, open study, done from November 1st, 2016 to April 30th, 2017 at Endocrinology Department of Centro Medico Nacional La Raza, Mexico City. Patients with Graves orbitopathy with CAS (Clinical Activity Score) ≥ 3 points of the EUGOGO scale were included. RESULTS: There were included 15 patients, 9 women and 6 men, mean age 51.06 ± 9.75 years. The mean decrease in CAS was 2 points (95% CI, p < 0.001), the mean proptosis was 1 mm (95% CI, p = 0.002), the final GO-QOL total was 40-48% (95% CI, p < 0.001), 2 patients had sinusitis (95% CI, p = 0.14), 2 patients uroinfection (95% CI, p = 0.14) and 4 patients hyperglycemia (95% CI, p = 0.03); other side effects of medications there were not observed. CONCLUSIONS: The combined scheme of methylprednisolone plus doxycycline causes a decrease in the severity and activity of Graves orbitopathy and improvement in quality of life without serious side effects. [ABSTRACT FROM AUTHOR]

BACKGROUND: Evans' syndrome is the association between autoimmune hemolytic anemia and primary immune thrombocytopenia. OBJECTIVES: To describe an Evans' syndrome population's characteristics and its response to treatment. MATERIALS AND METHODS: A retrospective, analytic study including cases diagnosed from January 2008 to December 2018 at Regional Hospital PEMEX, Tamaulipas, Mexico; we evaluated the clinical and biochemical characteristics, as well as their outcomes after treatment. RESULTS: We observed 9 cases with similar clinical and biochemical characteristics, 4 primary and 5 secondary Evans' syndrome. All of them received glucocorticoids as first line of treatment; 6 presented global response; 2 of them complete response, 4 partial response, and 3 no response, regardless the scheme prescribed. An average of 2.78 ± 1.3 lines of treatment were prescribed and four patients required more than three; 3 patients developed systemic autoimmune diseases after mean time of 4.6 years (range: 0.55-9), whose Evans' syndrome had responses after treating the systemic autoimmune disease. CONCLUSIONS: Evans' syndrome is an infrequent entity where an important immunologic imbalance participates and which responses to the first line treatments are torpid with frequent relapses; those patients with more relapses have been associated with the development of systemic autoimmune diseases and most of the cases are secondary, so, we must investigate the background for improving the treatment. [ABSTRACT FROM AUTHOR]

Preventive management or early detection of adrenal insufficiency in patients with chronic glucocorticoid use is vital in the context of stress situation. The purpose of this article is to know the different situations in which this disease could present, as its management and prevention. The above with the objective of generating greater awareness about this entity and avoiding associated complications. [ABSTRACT FROM AUTHOR]

Idiopathic thrombocytopenic purpura (ITP) is a clinical syndrome characterized mainly by widespread petechiae with a high rate of bleeding associated with antibody-mediated platelet destruction (peripheral blood platelets less than 100X109 /L). Has an incidence of 1.6 to 3.9 cases per 100,000 people per year. Its diagnosis is made by exclusion, ruling out other causes of thrombocytopenia. The primary goal of treatment is to prevent bleeding by controlling the number of platelets. It is recommended to treat patients with bleeding and figures below 30 000 platelets/mcL. The duration of treatment should be until there is an increase in the platelet number. The initial treatment should be steroids (prednisone, dexamethasone or methylprednisolone). You need to add another treatment in patients with severe thrombocytopenia, platelet counts with less than<10000/mcL, and when symptomatic despite treatment by two or three weeks with glucocorticoids. In patients refractory to steroids may be used other drugs. Cyclosporine has a platelet response up to 44 to 75% of patients. Of erythropoietin receptor agonists, romiplostim has shown promising results, as it increases the platelet, with fewer adverse effects and less need for splenectomy. Cyclophosphamide with complete response is only obtained in 10-20% of patients with chronic ITP and 40% of them achieved partial remission. Vinca alkaloids (vincristine and vinblastine), danazol, and splenectomy are other options. [ABSTRACT FROM AUTHOR]