- Indian Rheumatology association
Kavita Krishna MD, DNB, Post-doc Fellowship in Rheumatology, EULAR(cert), GSMC-FAIMER
Professor & Head, Department of Clinical Immunology & Rheumatology
Bharati Vidyapeeth University Medical College & Hospital, Pune, India
The term “lupus,” Latin for “wolf,” first appeared around 850 AD to describe lesions thought to resemble wolf bites. Initially used broadly for ulcerative diseases, it became more specific in the 13th century when Rogerius described erosive facial lesions as lupus. The true turning point in the history of lupus occurred at the beginning of the 19th century when the distinction between lupus vulgaris (skin tuberculosis) and cutaneous lupus in its modern sense emerged slowly. Major subsequent contributions from Kaposi, Sequiera Balean, and Osler. In the 19th century, key figures like Robert Willan, Thomas Bateman, and Moriz Kaposi refined lupus classifications. Cazenave introduced “lupus érythémateux” in 1850.
During the neoclassical era (1872-1948) – Kaposi described the ‘butterfly rash’ in 1872; and identified discoid lupus as a separate entity in 1875. He first identified lupus erythematosus as potentially systemic, with severe symptoms beyond skin lesions – arthritis, nephritis, and central nervous system involvement. He distinguished between discoid and systemic forms. By 1904, Osler and Jadassohn confirmed the systemic nature of lupus. Subsequent studies, including those by Kemperer in 1941, identified additional systemic manifestations like Libman-Sacks endocarditis and wire-loop lesions in individuals with glomerulonephritis, leading to the concept of “collagen vascular disease.”
The American College of Rheumatology (ACR) established SLE classification criteria in 1971, revising them in 1982 and 1997. The Systemic Lupus International Collaborating Clinics (SLICC) updated these criteria in 2012. Over 40 years, immunological parameters and autoantibodies were incorporated, refining the criteria’s specificity. While the spectrum of manifestations remained similar, their weight adjusted. The EULAR/ACR 2019 criteria, evaluated broadly, now serve as the standard for randomized controlled clinical trials, emphasizing specificity and differential diagnosis.
The modern era of lupus research began with the discovery of LE cells by Hargraves in 1948, followed by the identification of antinuclear antibodies (ANAs) by Miescher in 1954 and the recognition of DNA as a key ANA target by Seligman in 1957. These discoveries revolutionized lupus diagnosis and treatment, especially with the introduction of cortisone. In the 1950s, advances included the biologic false-positive syphilis test and immunofluorescent ANA testing. The development of animal models, such as NZB/NZW mouse, and recognition of genetic predispositions further advanced the understanding of lupus pathogenesis and treatment.
The history of SLE therapy spans from medieval cauterization to modern biologics. Early treatments included radium and UV light. Significant advances began with quinine for lupus in 1894, followed by corticosteroids in the 1950s, which revolutionised treatment. Immunosuppressants like azathioprine and cyclophosphamide emerged in the 1960s, and mycophenolate mofetil was introduced in the 1980s. After the variable success of Cyclosporin in 1981, the arrival of Tacrolimus (2011) and Voclosporin (2021) looks promising in the treatment of lupus nephritis. The first biologic, rituximab, targeted B-cells, but it was belimumab, approved in 2011, that became the first drug specifically developed and approved for SLE. With the arrival of Anifrolumab(2021), CAR-T cell therapy, ongoing trials on deucravacitinib, and new biologics and therapies, we are hopefully moving closer to a cure.
