Thesis+Based+Research+Assignment


 * [[file:theis based research.doc]][[file:findings.doc]]

Rationale for Research/Introduction**

Why did you go down this research path? I chose this topic because I have been a member of the Lupus Committee for 5 years and I am interested in learning more about the disease I have been raising funds for. Also, I wanted to know what sorts of treatments the funds I have been raising are going towards.

What driving question guided your research? What are the new treatments being developed for lupus? How do they differ from old treatments?

What more specific questions had to be answered before finally answering this driving question? I need to answer the questions of “What medicines are used to treat lupus? How do these treatments affect the body? And How do these treatments differ from old medication?

 Research A) "Treatments for Lupus." // Lupus Foundation of America // . N.p., 2009. Web. 8 Oct. 2009. .  1)  “ It is not unusual for the prescribed medications to change during a person’s lifetime with lupus. However, it can take months, and sometimes years, before your health care team finds just the right combination of medicines to keep your lupus symptoms under control” (Treatments for Lupus). 2) “There are many categories of drugs for the treatment of lupus. Of all these drugs, only a few are approved specifically for lupus by the Food and Drug Administration (FDA): corticosteroids, including prednisone, prednisolone, methylprednisolone, and hydrocortisone; the antimalarial, hydroxychloroquine (Plaquenil®); and aspirin. However, many medications are used to treat the symptoms of lupus” (Treatments for Lupus). 3)  “ People with lupus are generally treated by a rheumatologist, a doctor who specializes in diseases of the joints and muscles. If lupus has caused damage to a particular organ, other specialists will be consulted as well, such as a dermatologist for cutaneous lupus (skin disease), a cardiologist for heart disease, a nephrologist for kidney disease, a neurologist for brain and nervous system disease, or a gastroenterologist for gastrointestinal tract disease. An obstetrician who specializes in high-risk pregnancies will be needed when a woman with lupus is considering a pregnancy” (Treatments for Lupus). 4) People with lupus often require other drugs for the treatment of conditions commonly seen with the disease. Examples of these types of medications are diuretics for fluid retention, antihypertensive drugs for high blood pressure, anticonvulsants for seizure disorders, antibiotics for infections, and bone-strengthening drugs for osteoporosis” (Treatments for Lupus). B)  "Medications to Treat Lupus." // Lupus Foundation of America //. N.p., 2009. Web. 8 Oct. 2009. . 1) Anti-inflammatory medications help to relieve many of the symptoms of lupus by reducing inflammation and pain. i)  “ Anti-inflammatories are the most common drugs used to treat lupus, particularly symptoms such as fever, arthritis or pleurisy, which generally improve within several days of beginning treatment” (Medications to Treat Lupus). (1) All of the anti-inflammatory medications have some sort of negative side effect. 2) Corticosteroids (also known as glucocorticoids, cortisone or steroids) are synthetic (man-made) drugs designed to work like the body’s naturally occurring hormones produced by the adrenal glands, in particular cortisol. i)  “Cortisol helps regulate blood pressure and the immune system, and it is the body’s most potent anti-inflammatory hormone. Corticosteroids prescribed for autoimmune diseases are different from the anabolic steroids that weightlifters and other athletes sometimes take to increase strength” (Medications to Treat Lupus). (1) “Steroids can produce a variety of side effects. The most common are changes in appearance (acne, a round or moon-shaped face, weight gain due to increased appetite, and hair growth)” (Medications to Treat Lupus). 3) Antimalarials are used in combination with steroids and other medications, in part to reduce the dose required of the other drugs. i)  “Antimalarials are most often prescribed for skin rashes, mouth ulcers, and joint pain, but also can be effective in mild forms of lupus where inflammation and blood clotting are a concern. Antimalarials improve lupus by decreasing autoantibody production, protecting against the damaging effects of ultraviolet light from the sun and other sources, and improving skin lesions” (Medication to Treat Lupus). (1) In high doses certain antimalarial drugs may damage the retina of the eye, causing vision problems. 4) Immunosuppressive medications are used to control inflammation and the overactive immune system, especially when steroids have been unable to bring lupus symptoms under control, or when a person cannot tolerate high doses of steroids. i)  Immunosuppressive drugs reduce your body’s ability to fight off infections, and increase the chances that you could develop viral infections such as shingles (chicken pox, or herpes zoster). These drugs may also increase your risk for developing cancer” (Medications to Treat Lupus). 5) Medications which were originally developed for cancer are now being used to treat lupus. i)  “Cyclophosphamide (Cytoxan®) was developed to fight cancer. Although in its early years of use it was taken in pill form, today Cytoxan is taken through the vein (intravenously, or IV). It has been shown to improve kidney and lung disease, but can affect a woman’s menstrual cycle and can cause bladder problems, hair loss, and sterility” (Medications to Treat Lupus) ii) “Methotrexate (Rheumatrex™), also developed to fight cancer, is known as the "gold standard" -- the best drug -- for the treatment of rheumatoid arthritis. It has also been shown to be very effective in treating skin lesions, arthritis, and pleuritis in people with lupus” (Medications to Treat Lupus). C)  Dellapena, Deb. "Old drug--new hope. (On The Horizon).(cyclophosphamide)(Brief Article)." // Prevention. // 55. 7 (July 2003): 164(1). // Student Resource Center - Health Module //. Gale. Springfield Township High School. 12 Oct. 2009 . 1) Now, doctors at Johns Hopkins' University School of Medicine's Lupus Center report amazing results with high doses of cyclophosphamide, a cancer drug that's also used in lower doses as a lupus treatment. 2)  When 14 people with severe lupus received the high-dose therapy for 4 days, symptoms eased for most. More than 2 1/2 years later, 5 of 14 patients remained free of lupus (Arthritis & Rheumatism, Jan 2003). 3) “This high-dose therapy seems to work first by suppressing immunity. Then the immune system bounces back but stops overreacting, says researcher Michelle Petri, MD, MPH” (Dellapena). D)  Fackelmann, Kathy A. "Gene therapy corrects mouse lupus. (results of research may help human lupus erythematosus patients)." // Science News. // v145. n12 (March 19, 1994): p180(1). // Student Resource Center - Health Module //. Gale. Springfield Township High School. 12 Oct. 2009 < http://find.galegroup.com/srcx/infomark.do ? &contentSet=IAC- Documents &type=retrieve &tabID=T003 &prodId=SRCHlth &docId=A14947824 &source=gale &userGroupName=erde79591 &version=1.0>. 1) “The mice that star in the new study develop a lupuslike condition also characterized by kidney disease, arthritis, and lung disease. John D. Mountz of the University of Alabama at Birmingham and his colleagues started that investigation with the knowledge that these mice suffered from a defect in a gene called Fas. They wondered whether this routant gene and its protein product caused the massive autoimmune disease afflicting these mice” (Fackelmann). 2)  The new findings indicate that the flawed gene is responsible for the destructive symptoms in mice, comments Michael D. Lockshin of the National Institute of Arthritis and Musculoskeletal and Skin Diseases in Bethesda, Md. 3)  “If researchers can pinpoint the exact defect in humans, they might develop a targeted way to initiate cellular suicide. "If you could correct [the defect] at any point, you could potentially terminate the disease," Lockshin says, noting that such a therapy remains far from reality as yet” (Fackelmann). E) "Supplement Shows Promise for Treating Lupus." // Tufts University Health & Nutrition Letter // 21.2 (2003): 6. // Health Source - Consumer Edition // . EBSCO. Web. 12 Oct. 2009.  1)  DHEA, a steroid hormone that's available over the counter, has erroneously been hailed as an anti-aging agent, a sexual enhancer, a cancer preventive, and everything in between. But when it comes to mitigating the pain and inflammation of // lupus //, a type of arthritis in which the body's immune system attacks its own healthy cells, Timothy McAlindon, MD, Chief of Rheumatology at the Tufts-New England Medical Center, says, "I think there is an emerging role for it. 2)  “How DHEA works is not known with certainty, but it can be converted by the body to the male hormone testosterone as well as to the female hormone estrogen. And some women with // lupus // (who make up 90 percent of // lupus // cases) have an estrogen/testosterone imbalance” (Supplement Shows Promise for Treating Lupus).  3)  Like any substance that works as a drug in the body, DHEA comes with a number of potential problems, including elevated blood cholesterol and an increased risk for breast, ovarian, and uterine cancers in women and an increased risk for prostate cancer in men. That's because, as a precursor to both male and female hormones, it might influence the development of sex-based cancers that require those hormones to develop.

F) Mayo Clinic Staff. "Lupus: Treatments and drugs." // Mayo Clinic // . N.p., 5 June  2008. Web. 9 Oct. 2009. . 1)  “Researchers are developing new treatments for lupus in clinical trials. These studies give people with lupus the chance to try new treatments, but they don't guarantee a cure” (Mayo Clinic Staff). i) Stem cell transplant . A stem cell transplant uses your own adult stem cells to rebuild your immune system. Doctors hope this treatment can help people with life-threatening cases of lupus. ii)  Dehydroepiandrosterone (DHEA). Some clinical trials have shown that a synthetic form of the hormone DHEA may improve quality of life in people with lupus, though others haven't found this. Your body uses DHEA to make male and female sex hormones. Researchers are conducting further clinical trials to better understand whether DHEA may be useful for people with lupus. iii) Rituximab (Rituxan). Rituximab decreases the number of B cells, a type of white blood cell, in your body and has shown some promise in treating lupus in people who haven't responded to other immunosuppressants. However, rituximab has been linked to a fatal brain infection in two people with lupus. G)  Petri, Michele. "Lupus Information." // The Johns Hopkins //. John's Hopkins Arthritis Center, 2009. Web. 9 Oct. 2009. . 1) Since lupus attacks the entire body, researchers and doctors have been working with treatments non-specific to lupus. “Now, what about borrowing from other diseases? We have to do a lot of that in lupus” (Petri). i)  **Plaquenil** - “One of the smartest things we do for lupus is use drugs that tone down the immune system but don't predispose to infection. Plaquenil is the key to trying to control lupus long-term because it's such a safe, long-term drug” (Petri). ii) **Anti-DNA Antibody Inhibitor (LJP 394) ** – “There is a huge study of a compound called LJP394 to see if this can prevent the production of the anti-DNA antibodies in lupus. The hope would be that if you could get rid of the anti-DNA antibodies, people wouldn't get kidney disease. This study is not completed” (Petri).  iii)  **CellCept (Mycophenolate Mofetil)** - “What about new drugs for people who have really bad lupus? For those of you who have kidney lupus there has been a tremendous amount of progress in a drug called CellCept--mycophenolate mofetil. It's not quite as strong as chemotherapy, but it works very well in people with kidney disease. It doesn't cause infertility. It is usually well tolerated. So at least there's an alternative for people with kidney lupus” (Petri). H)  Khamsi, Roxanne. "Stem cell transplants offer hope against lupus ." // New //  // Scientist // . N.p., 2009 . Web. 9 Oct. 2009. .  1)  Stem-cell- Scientists claim that they have achieved landmark success with an experimental approach, using a patient's own stem cells, to fight the life-threatening autoimmune disease lupus. i) ‘The treatment substantially improved the condition of about half of the lupus patients, all of whom had stopped responding to standard therapy. But the treatment still carries real risks and medical experts caution against calling it a cure” (Khamsi) 2)  **Chemotherapy** - “Richard Burt of the Northwestern School of Medicine in Chicago, US, and his colleagues recruited 50 people with severe lupus for which standard treatment had failed” (Khamsi). i) “In an attempt to "reset" the immune system, researchers first harvested and separated bone marrow stem cells from the patient's own blood. These cells develop into immune cells” (Khamsi). 3)  “Once returned to the body, the stem cells repopulated the bone marrow and reform a functioning immune system. According to Burt, the transplanted stem cells can avoid developing into cells with dangerous autoimmune traits because their genes do not necessarily predetermine the disease” (Khamsi).


 * Thesis**

Based on this research what is your specific stance on this topic? It amazes me that there is so little treatment specifically for lupus, but also amazes me how doctors use medication for other diseases to treat lupus.

What is your initial thesis? Because there has not been a specific medication created for lupus in many years, doctors “borrow” medications from other illnesses to help treat lupus; which is appropriate because lupus attacks the whole body, causing a variety of other ailments, which may require one patient to have many treatments.


 * Findings & Support for Findings**

1) Since lupus is a disease which attacks the entire body and does not only affect those who have the disease in one way, many doctors and medications may be needed to treat one patient. a) Support: A3, A4 2) Anti-inflammatory drugs are one of the most commonly used drugs to treat lupus. They are so common because inflammation is one of the most common symptoms of lupus and these medications are readily available. This medication is not only used for lupus patients. a) Support: B1, B2, E1 3) Even though many medications to treat lupus are very affective, they have many side affects. Since lupus is a chronic disease, many patients need to use medication for a long period of time. When a single medication is used for a long period of time, it an have a negative affect on the body. a) Support: B1i1, B2i1, B3i1, B4i, E3 4) Medications used to treat lupus are not always only created for the treatment of lupus. Lupus patients sometimes “borrow” medications from other diseases. This is because lupus attacks the body in several different ways. a) Support: B5i, B5ii, E1, F1,F1i, F1ii, F1iii, G1i, G1ii, H1 5) To treat lupus, clinical trials are required in order to determine if a treatment solely made for lupus is affect and to see if other medications made for other diseases are affects in lupus patients. a) Support: C1, C2, D1, E1, F1,F1i, F1ii, F1iii, G1iii, H1


 * Process Reflection**

What did you learn from conducting this research? I learned that research can be more difficult than it seems and that it is difficult to find a lot of information on one narrow topic rather than a broad topic.

What higher-order thinking skills did you employ? I had to figure out which research was relevant and which was not, which required much thinking. I found a good amount of information on treatments, but I had to determine whether it was relevant to the narrow topic I am studying.

What research skills do you still need to improve? I need to improve on getting to know all of the databases that are out there rather than just sticking to ones I’ve previously used.

What information did you think you knew before researching that turned out to be either incorrect or incomplete of knowledge of your topic? I seemed to think that more treatments were being created specifically for lupus, but instead, doctors are “borrowing” treatments from other diseases.


 * Connections to the Overall Project**

So what? How do your findings fit back into the big picture of your project? These finding gave me a starting point for my paper. They make me realize all of the different medications from other illnesses that are used to treat lupus.

How will this research help you move forward with your project? This research gave me a basis of what I need to know to begin writing my paper. Now, since I know what I am looking for, I can go into more health databases and look for specific information on what I have found.