RESEARCH - Long-wave ultraviolet radiation beneficial in systemic lupus erythematosus?

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Long-wave ultraviolet radiation beneficial in SLE?

Rheumawire

May 25, 2006

Zosia Chustecka

Leiden, the Netherlands - Although sunlight can exacerbate systemic lupus

erythematosus (SLE) and patients who protect themselves regularly against

sunlight seem to have fewer complications, rather paradoxically, one part of

sunlight-long-wave ultraviolet radiation (UVA-1)-appears to have beneficial

effects on the disease [1]. Data showing beneficial effects are reviewed in

an editorial in the June 2006 issue of Rheumatology by Dr Stan Pavel (Leiden

University, the Netherlands), and he tells rheumawire that his

photodermatology department already treats SLE patients with UVA-1 on a

routine basis.

Pavel says that UVA-1 therapy can fulfill the role of a routine supportive

therapy with a steroid-sparing effect. " We and others have shown in

controlled studies that low-dose UVA-1 therapy can be beneficial for SLE

patients, " he comments. In addition, " there are no indications whatsoever

that this therapy would have some significant side effects, in particular if

you compare it with treatment alternatives like systemic glucocorticoids or

cyclophosphamide. "

However, Pavel says he can understand why some physicians may hesitate to

recommend this treatment to their patients. " All physicians have learned

from their studies that patients with systemic lupus erythematosus (SLE)

should avoid sunlight because it can be harmful for them and it can cause

worsening of their disease, " he comments. As UVA-1 is a part of sunlight,

" physicians have to appreciate first that there is a difference between

sunlight and long-wave radiation, and this will probably take some time. "

Beneficial effects on many symptoms

The beneficial effects of UVA-1 therapy in SLE can be wide-ranging. In a

series of 12 patients with moderately active SLE that Pavel's group reported

on two years ago, a daily dose of 12 J/cm2 UVA-1 over three weeks led to

improvements in arthritis (in 6/9 patients), myalgia/myositis (5/7), dyspnea

(4/4), fatigue (4/11), headache (4/4), leukocyturia /erythrocyturia (4/7),

and blood pressure (7/7) [2]. Another group using the therapy reported that

the sustained relief of fatigue was the most gratifying feature for the

patient, since many improved enough to return to work and noted marked

improvement in their quality of life [3]. There have also been two case

reports of patients with neuropsychiatric SLE showing improvements in

central-nervous-system symptoms, and one of these cases [4] was confirmed

with positron emission tomography, which showed complete clearing of the

brain abnormalities that had been observed earlier, Pavel notes.

He tells rheumawire that his group has recently obtained results (as yet

unpublished) that " seem to confirm this positive experience, and

consequently, we would like to extend this clinical investigation to a

larger group of patients suffering from cerebral SLE. "

In the editorial, Pavel also reviews experimental evidence that suggests

that the systemic effect of long-wave UVA-1 therapy in SLE patients can be

(at least in part) ascribed to the effects of irradiation on the function of

the peripheral T and B lymphocytes.

The original teaching about sunlight being harmful in SLE remains true,

however: the damage is done by short-wave ultraviolet light, which can cause

sunburn, and it appears that this leads to the formation of neoautoantigens

in the skin, which can induce the production of antibodies against

autoantigenic nuclear material.

" It is absolutely essential that the irradiation apparatus used for the

treatment of SLE patients does not emit short-wave (up to 340 nm)

ultraviolet [uVB] radiation, " Pavel writes. " Even a low dose of UVB could

cause epidermal damage that could lead to the induction of antibody

production. " But with the appropriate apparatus, UVA-1 therapy can become a

valuable adjuvant therapy for SLE patients without detrimental side effects,

he concludes.

Pavel tells rheumawire that his department uses UVA-1 apparatus produced by

a German company, BioSun, and has been doing so successfully for the past

few years. He has heard that this company has started to produce new

machines with almost no UV radiation, " which, in my opinion, could be even

safer for SLE patients. These apparatuses are relatively large investments,

but the advantage is that they can be shared by rheumatologists and

dermatologists. " It is also possible that patients with other autoimmune

diseases could benefit from UVA-1 therapy in the future, he adds.

Sources

1. Pavel S. Light therapy (with UVA-1) for SLE patients: is

it a good or bad idea? Rheumatology 2006; 45:653-655.

2. Polderman MC, le Cessie S, Huizinga TW, Pavel S.Efficacy

of UVA-1 cold light as an adjuvant therapy for systemic lupus erythematosus.

Rheumatology 2004; 43:1402-1404.

3. Molina JF, McGrath H Jr. Long-term ultraviolet-A1

irradiation therapy in systemic lupus erythematosus. J Rheumatol 1997;

24:1072-1074.

4. Menon Y, McCarthy K, McGrath H Jr. Reversal of brain

dysfunction with UV-A1 irradiation in a patient with systemic lupus. Lupus

2003; 12:479-482.

http://www.jointandbone.org/viewArticle.do?primaryKey=705557 & nl_id=janb25may06

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