The History of Lupus Erythematosus

Abstract

This article explores the history of lupus erythematosus from the origins of the name to the most modern therapeutic advances. The review includes information about the origin of the name "lupus," the first clear description of the skin lesions, the discovery of the systemic and discoid forms, and further advances which define our current view of this illness. The classical descriptions of Hippocrates, Paracelsus, Manardi, Rudolph Virchow, Cazenave, Robert Willan, and Moritz Kaposi are chronologically described. Later, the contributions of Sir William Osler, Jonathan Hutchinson, Sequira and Balean, Kraus and Bohac, Libman and Sacks, Malcolm Hargraves, and Edmund L. Dubois are highlighted. The major breakthroughs of the modern period, including the diagnostic tests, animal models, and genetics, are briefly described. The article ends with the history of drug-induced lupus, diagnostic criteria, and the history of the therapy of lupus erythematosus. With modern therapeutic advances, the mortality rate from lupus erythematosus has decreased substantially. It is hoped that current research will further improve the prognosis of this disease in the near future.

The Place of William Osler in the Description of Systemic Lupus Erythematosus

“…Some of this recognition is and was mostly undeserved, as has been well documented (11). For instance, in 2007, Osler was given credit for coining the term systemic lupus erythematosus (6). This is clearly not case.…”

“…Beginning in the middle of the nineteenth century with Kaposi, there was recognition that some patients with lupus erythematosus had involvement of organs other than the skin. Some have given a great deal of credit to Osler in the march towards an understanding of the disseminated nature of lupus erythematosus (6), while others have minimized his contribution (11). With the simultaneous reprinting of Osler’s classic article from 1904 (2), we attempt to put the contribution of William Osler into a perspective of the 21 st century.…”

Pathways leading to an immunological disease: systemic lupus erythematosus

“…Comprehensive discussions of the history of SLE have been described previously [6, 7]. An important step in determining that SLE is a disease of the immune system, or an immunological disease, was taken in 1948 by Dr Hargraves, who discovered the LE cell or LE body.…”

“…The presence of these cells is indicative of SLE or other connective tissues disorders. Later, the LE cell phenotype was defined as an ANA reaction because it could be reproduced from bone marrow preparations with the addition of SLE serum [7]. This observation and test provided the key to linking SLE to immunological dysfunction.…”

Destructive discoid lupus erythematosus (Wolf bite)

“…It was probably thought that the damage caused by the disease resembled the result of an attack by a ravenous wolf. [2] Atrophy, liquefaction degeneration, oedema, hyalinization of connective tissue, marked lymph mononuclear cell infiltration are characteristically found in histology of DLE, such infiltration may have involved the skin with its appendages, subcutaneous tissue and vessels in the dermis and underlying cartilages of ears. [34] Same mechanism of dermal and subcutaneous necrobiosis with some element of vasculitis might have played leading to mutilation and deformity in our case.…”