PubMed · 5455446
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M Coculescu. 1970. [The natriuretic third factor].. https://pubmed.ncbi.nlm.nih.gov/5455446/
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"Stress" is being increasingly implicated in the pathogenesis of a variety of psychological and somatic disturbances. Because responses to stress can vary widely, the absence of a suitable, pathophysiologically based taxonomy of stress responses has hindered physicians in their efforts to devise treatments tailored to deal with specific stress-related problems. It is proposed herein that classical endocrinologic criteria be employed to characterize stress responses in terms of the associated hormonal secretion ratios and their temporal evolution. Ratios of the responses to stressors of the sympathoadrenal system (SA) and the hypothalamo-pituitary-adrenal (HPA) axis can be either unity (ratio = 1) or dissociated in varying degree, with SA or HPA dominance and for more or less prolonged periods. Published reports of studies in both laboratory animals and patients with stress-associated illnesses (eg, post-traumatic stress disorder [PTSD]) suggest that such hormone-secretion ratios together with their temporal patterns can be used to characterize the particular stress response under examination, thereby providing strong support for further study of the proposed taxonomy. Such a classification of responses to stress stimuli will make it possible to test the overall concept by establishing a correspondence between the suggested hormonal profile and the associated clinical/psychological picture, as well as enable assessment of the benefit of a therapeutic strategy designed to fit the particular category of stress response exhibited by the patient.
This article reviews and cites only publications relating to the management of lupus that have appeared since 1999. The data in these publications demonstrate that preventive and proactive strategies are as important as medication in improving the quality of life and life span of the patient with lupus. The use of lasers and thalidomide represents major advances in cutaneous lupus. The first major study over 25 years using nonsteroidal anti-inflammatory drugs to manage lupus suggests benefits. Further evidence was presented showing that dehydroepiandrosterone, leflunomide, and methotrexate are effective in treating mild to moderate disease. Various iterations and modifications of traditional cyclophosphamide therapy with or without mycophenolate mofetil, cyclosporine, and azathioprine continue to be studied for treating organ-threatening disease. Intravenous gamma globulin and selective apheresis are niche therapies appropriate in a few, highly selected patients. Immunoablative doses of cyclophosphamide appear to be as effective as stem cell transplantation for serious disease resistant to conventional doses of cyclophosphamide. Twelve biologic agents have been studied in lupus since 1999, with only LJP-394 showing clear-cut, convincing efficacy.