Lupus is a disease with a unique and striking name. The name came up in the 13th century, attributed to physician Rogerius, who described facial injuries that resembled a wolf's bite. It was a long time before Kaposi understood in 1872 that the disease then known as lupus erythematosus could have very serious systemic manifestations. It was this doctor who proposed the existence of a discoid form (cutaneous) and a disseminated form (systemic). The 20th century allowed the genetic, molecular and immunological understanding of the complexity of the disease that allowed it to be better known, to define prognostic factors, to measure the activity and to adapt the therapeutic options, always being developed, to the characteristics of each patient.
It is important to note that the first truly effective therapy was only introduced by Hench in the 1950s. And it continues to be a key drug, in doses adapted to the manifestations of the disease. The history of therapeutic interventions was characterized by the adaptation to lupus of existing drugs for other diseases. Examples of this include antimalaria drugs, cytotoxic agents and even the first biological therapy used (without formal approval by the drug agencies), rituximab, a monoclonal antibody against B lymphocyte (anti CD20), imported from lymphoma therapy. Therapeutics created for lupus from scratch only came up in the last twenty years, with emphasis on the first biological drug approved for this disease, belimumab (anti BLYS), which reduces the activity of B lymphocytes.
Due to its heterogeneity and complexity, it has been difficult to document the efficacy and safety of new drugs in the context of clinical trials. Therefore, it has been an orphan disease in terms of therapeutic innovation, despite the visibility it has, such as the phrase “It’s not LUPUS”, in a television series about the disease. Due to the difficulty of having a correct perception of what this disease is for those who do not have biomedical training and the collective awareness of the weaknesses still existing in the available therapeutic options, this is still one of the diseases that induces most fear at the moment of diagnosis. It is important to highlight the relevance of early diagnosis and close monitoring of the disease, which significantly changes the prognosis and makes the available therapies more useful. Lupus is an incurable, but treatable, disease that allows a normal life as long as there is a "contract" for close monitoring between the patient and the doctor.
João Eurico Cabral da Fonseca
Rheumatology and Metabolic Bone Diseases Unit, Santa Maria Hospital, CHULN
Rheumatology Research Unit, Institute of Molecular Medicine
Faculty of Medicine, University of Lisbon
