"A Person Like Me": Systemic Lupus Erythematosus, Gender, and Racial Immunity in the Twentieth-Century United States.

Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects mostly women and disproportionately Black women. Until the 1940s, SLE was rarely diagnosed in Black Americans, reflecting racist medical beliefs about Black immunity. In the 1940s and 1950s, SLE and its treatment were part of a patriarchal narrative of American industrialization. By the 1960s, newer diagnostic techniques increased recognition of SLE, especially among Black women; medical thinking about SLE shifted from external causes like infection or allergy to autoimmunity, which emphasized biological, genetically determined racial difference. In the 1970s and 1980s, an advocacy structure crystalized around memoirs by women with SLE, which emphasized the experiences of able-bodied, economically privileged white women, while Black feminist health discourse and SLE narratives by Black authors grappled with SLE's more complicated intersections. Throughout the twentieth century, SLE embodied immunity as a gendered, racialized, and culturally invested process.

Edmund Lawrence Dubois (1923-1985).

In the year 1950, Edmund Dubois was asked to evaluate eight patients who had positive results from a new blood test known as the LE cell prep. This was the springboard for him to launch a career that elucidated new and unique insights into the pathogenesis, clinical presentation, laboratory testing, and treatment of systemic lupus erythematosus. Between 1950 and 1985, he treated more than 2000 patients with the disorder and wrote the principal textbook on the subject.

Advances in the treatment of systemic lupus erythematosus: From back to the future, to the future and beyond.

There have been many advances in the diagnosis and therapeutic management of systemic lupus erythematosus (SLE) over the past decades. Following more than eleven centuries of therapeutic uncertainty, the discovery of the therapeutic properties of glucocorticoids is without any doubt one of the most significant advance in the field of autoimmune diseases. The many progresses made by rapidly growing chemical industry of the 19th century chemistry have allowed the identification of valuable therapeutic compounds such as anti-malarials, cyclophosphamide, azathioprine, cyclosporine and later mycophenolate mofetil, which have all profoundly changed the face of the disease. A very visible consequence of this is the profound improvement in the prognosis of the disease, with 10-year survival rates of more than 90% in most dedicated centres. Following the development of biotherapies in rheumatoid arthritis, the late 20th century has slowly opened a new era for the treatment of SLE, that of targeted therapies. With the approval of belimumab in 2011 and 74 targeted therapies in clinical development, we may expect great changes in the therapeutic management of SLE. Those molecules target inflammatory cytokines or chemokines and their receptors, B cells or plasma cells, intracellular signalling pathways, B/T cells co-stimulation molecules, interferons, plasmacytoid dendritic cells, as well as various other targets of interest. Current challenges are now slowly shifting from whether some new drugs will be available to how to select the most adequate drug (or drug combination) at the patient-level.

It's like a black woman's Charlie Brown moment: An autoethnography of being diagnosed with lupus.

This essay uses autoethnography to relate the experience of being diagnosed with lupus. By using my personal experiences and a discussion of illness and Black women's health, I critically examine larger critical race issues of race, gender, and the social barriers to health care. Specifically, the essay focuses on the ways in which race impacts my experiences with the healthcare system, from my own insecurities of being stereotyped to the ways that doctors interact with me. The essay is framed by popular quotes from Charlie Brown because they help mediate the very personal experiences I am recounting.

Adele Bloch-Bauer (1881-1925): Possible diagnoses for Gustav Klimt's Lady in Gold.

One of the most famous works by the Austrian symbolist painter Gustav Klimt and one of the most widely reproduced works of art worldwide, Adele Bloch-Bauer I which portrays the beautiful wife of Austrian magnate Ferdinand Bloch-Bauer. Adele was the only woman painted by Klimt on more than one occasion. Apart from the beauty and value of the painting, the daring sea of gold that surrounds Adele and the gentle intimacy with which her fragile figure is portrayed have shrouded the history of this painting in mystery. Beyond speculation as to a special bond between artist and model, observation of the painting with a keener, clinical gaze yields evidence of potential illness in the model: facial erythema which, if not produced artificially by makeup, could represent a malar rash; pallor or cyanosis of the hands; and her draped fingers, which seemingly attempt to hide a deformity. This paper seeks to provide a biographical review both of the painter, Gustav Klimt, and of the subject, Adele Bloch-Bauer; to analyse Klimt's two portrayals of her in a search for evidence of a potential intimate relationship between artist and muse and, finally, to compile clinical evidence of possible diagnoses for the Lady in Gold.

"PRE-COLUMBIAN MOULAGES". HUACOS, MUMMIES AND PHOTOGRAPHS IN THE INTERNATIONAL CONTROVERSY OVER PRECOLUMBIAN DISEASES, 1894-1910.

By the late nineteenth century an international controversy arose referred to the probable existence of certain diseases such as leprosy, syphilis and lupus in pre-Columbian America. Led by the American physician Albert Sidney Ashmead (1850-1911), it brought together scholars from Europe and the Americas. In this context, certain types of Peruvian archaeological pottery and "mummies", along with series of photographs illustrating the effects of these diseases in contemporary patients, met a prominent role as comparative evidence. In this article we analyze how this type of collections were used as evidence in the debates about pathologies of the past, an issue that from a historical standpoint have received considerably little attention.

Queen Anne (1665-1714) and her health.

The contemporary records of Queen Anne's health and disease are reviewed, including the strange diagnoses made and the treatments prescribed. A correct diagnosis is suggested.

Autoimmunity: from black water fever to regulatory function.

Autoimmunity is a field that has only been around for a little over a century. Initially, it was thought that autoimmunity could not happen, that the body would never turn on itself (i.e. "horror autotoxicus"). It was only around the First World War that autoimmunity was recognized as the pathogenesis of various diseases, including rheumatoid arthritis. The discovery of Compound E led to successful treatment of patients with autoimmune diseases, but it was not till later that the adverse effects of this class of drugs were elucidated. The "modern" age of autoimmunity began around 1945 with the description of blackwater fever, and most of the subsequent research on hemolytic anemia and the role of an autoantibody in its pathogenesis led to a description of the anti-globulin reaction. The lupus erythematous (LE) cell was recognized in the mid-1940s by Hargreaves. His research carried on into the 1960s. Rheumatoid factor was also first described in the 1940s as yet another serum factor with activity against globulin-coated sheep red blood cells. The concept of autoimmunity really gained a foothold in the 1950s, when autoimmune thyroid disease and idiopathic thrombocytopenia were first described. Much has happened since then, and our understanding of autoimmunity has evolved now to include mechanisms of apoptosis, signaling pathway derangements, and the discovery of subsets of T cells with regulatory activity. The modern day study of autoimmunity is a fascinating area of research, and full understanding of the pathogenesis of autoimmune diseases is far from being completely elucidated.

Manifestaciones y evolución clínica de pacientes con LES en un hospital de referencia / Clinical manisfestations and evolution of SLE patientes in a reference center

Se revisaron las historias clínicas de 159 pacientes con LES (criterios ACR 1982), 91% mujeres, con una edad media a la primera consulta: 30 años y un tiempo medio de seguimiento de 73 meses. El 51% presentó compromiso musculoesquelético, el 50% compromiso renal y el 44% presentó rash malar fotosensible. AAN (+) se determinó en 59% de los pacientes, consumo de complemento en 49% y linfopenia en 34.5%. 94/100 pacientes en quienes estuvo disponible el SLEDAI estaban en la primera consulta (media: 8). Durante la evolución, 70% de los pacientes fueron tratados con antipalúdicos y esteroides V.O. 80% de los pacientes permanecían vivos en al última consulta; la mortalidad fue del 17% debido principalmente a infecciones, hemorragía pulmonar e insuficiencia respiratoria.

Manifestaciones y evolución clínica de pacientes con LES en un hospital de referencia / Clinical manisfestations and evolution of SLE patientes in a reference center

Se revisaron las historias clínicas de 159 pacientes con LES (criterios ACR 1982), 91% mujeres, con una edad media a la primera consulta: 30 años y un tiempo medio de seguimiento de 73 meses. El 51% presentó compromiso musculoesquelético, el 50% compromiso renal y el 44% presentó rash malar fotosensible. AAN (+) se determinó en 59% de los pacientes, consumo de complemento en 49% y linfopenia en 34.5%. 94/100 pacientes en quienes estuvo disponible el SLEDAI estaban en la primera consulta (media: 8). Durante la evolución, 70% de los pacientes fueron tratados con antipalúdicos y esteroides V.O. 80% de los pacientes permanecían vivos en al última consulta; la mortalidad fue del 17% debido principalmente a infecciones, hemorragía pulmonar e insuficiencia respiratoria.(AU)