HEALTH: LUPUS - SYMPTOMS - LUPUS

HEALTH: LUPUS (AUTOIMMUNE DISEASE) SYMPTOMS & TREATMENT Arthritis>>

What is Lupus?

Lupus is an autoimmune disease characterized by acute and chronic inflammation of various tissues of the body. Autoimmune diseases are illnesses that occur when the body's tissues are attacked by its own immune system. The immune system is a complex system within the body that is designed to fight infectious agents, such as bacteria and other foreign microbes.

One of the ways that the immune system fights infections is by producing antibodies that bind to the microbes. Patients with lupus produce abnormal antibodies in their blood that target tissues within their own body rather than foreign infectious agents. Because the antibodies and accompanying cells of inflammation can affect tissues anywhere in the body, lupus has the potential to affect a variety of areas.

Systemic lupus erythematosus (SLE) is the most common and serious form of lupus. Systemic lupus is an autoimmune disease. This means there is a problem with the body's normal immune system response. Normally, the immune system helps protect the body from harmful substances. But in patients with an autoimmune disease, the immune system can't tell the difference between harmful substances and healthy ones. The result is an overactive immune response that attacks otherwise healthy cells and tissue. This leads to chronic (long-term) inflammation.

Sometimes lupus can cause disease of the skin, heart, lungs, kidneys, joints, and/or nervous system. When only the skin is involved, the condition is called lupus dermatitis or cutaneous lupus erythematosus. A form of lupus dermatitis that can be isolated to the skin, without internal disease, is called discoid lupus erythematosus (DLE).

Types of lupus
Four types of lupus exist. Though similar, each type of lupus has a different prognosis and treatment.

Systemic lupus erythematosus (SLE) can affect nearly any part of your body. Body systems most commonly involved include the skin, joints, lungs, kidneys and blood. When people talk about lupus, they're usually referring to systemic lupus erythematosus.

Discoid lupus erythematosus (DLE) affects only the skin. People with discoid lupus, also called cutaneous lupus, experience a circular rash on the face, neck and scalp. A small number of people with discoid lupus may develop systemic lupus erythematosus, though it isn't possible to predict who will develop the more serious form of lupus.

Drug-induced lupus erythematosus occurs after you take certain prescription medications. Not everyone who takes these medications develops lupus. Drug-induced lupus affects a wide variety of body systems. Signs and symptoms usually go away when you stop taking the medication that caused your lupus.

Neonatal lupus is a rare form of lupus that affects newborn babies. A mother with certain antibodies that are linked to autoimmune diseases can pass them to the developing fetus — even if the mother has no signs or symptoms of an autoimmune disease. The antibodies can cause neonatal lupus. A baby with neonatal lupus may experience a rash in the weeks following birth. Neonatal lupus may last about six months before disappearing.

The outlook for people with lupus was once grim, but diagnosis and treatment of lupus has improved considerably. With treatment, most people with lupus can lead active lives.

Both discoid and systemic lupus are more common in women than men (about eight times more common). The disease can affect all ages but most commonly begins from 20 to 45 years of age. Statistics demonstrate that lupus is somewhat more frequent in African Americans and people of Chinese and Japanese descent.

Health: Causes and Rick Factors of Lupus (Autoimmune)

The underlying cause of autoimmune diseases is not fully known. Some researchers think autoimmune diseases occur after infection with an organism that looks like certain proteins in the body. The proteins are later mistaken for the organism and wrongly targeted for attack by the body's immune system.

Inherited genes, viruses, ultraviolet light, and certain medications may all play some role.

Some scientists believe that the immune system in lupus is more easily stimulated by external factors like viruses or ultraviolet light.

While doctors don't know what causes lupus in many cases, they have identified factors that may increase your risk of the disease, including:

Sex. Lupus is more common in women than in men. It also is known that some women with systemic lupus can experience worsening of their symptoms prior to their menstrual periods. This phenomenon, together with the female predominance of systemic lupus, suggest that female hormones play an important role in the expression of systemic lupus. This hormonal relationship is an active area of ongoing study by scientists.

Age. Although lupus affects people of all ages, including infants, children and older adults, it's most often diagnosed between the ages of 15 and 45.

Race. Lupus is more common in blacks and in Asians.

Genetic factors increase the tendency of developing autoimmune diseases, and autoimmune diseases such as lupus, rheumato id arthritis, and autoimmune thyroid disorders are more common among relatives of patients with lupus than the general population.

Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people. Exactly why ultraviolet radiation has this effect isn't well understood, but scientists suspect that sunlight may cause skin cells to express certain proteins on their surface. Antibodies that are normally present in the body then latch onto these proteins, initiating an inflammatory response. Damaged skin cells also seem to die more frequently in people with lupus, leading to even more inflammation.

Certain prescription medications. Drug-induced lupus results from the long-term use of certain prescription drugs. Although many medications can potentially trigger lupus, examples of drugs most clearly linked with the disease include the antipsychotic chlorpromazine, high blood pressure medications such as hydralazine, the tuberculosis drug isoniazid and the heart medication procainamide, among others. It usually takes several months or years of therapy with these drugs before symptoms appear, and even then, only a small percentage of people will ever develop lupus.

Infection with Epstein-Barr virus. Almost everyone has been infected with a common human virus called Epstein-Barr virus. Epstein-Barr virus causes nonspecific signs and symptoms, such as fever and sore throat. Once the initial infection subsides, the virus remains dormant in the cells of your immune system unless something reactivates the virus. For reasons that aren't clear, recurrent Epstein-Barr infections seem to increase the risk of developing lupus.

Enzyme factor. More recently, research has demonstrated evidence that a key enzyme's failure to dispose of dying cells may contribute the development of systemic lupus.

Exposure to chemicals. It's difficult to prove that chemicals can cause or increase the risk of a disease. But some studies have shown that people who work in jobs that involve exposure to mercury and silica may have an increased risk of lupus.

Health: Symptoms of Lupus (Autoimmune)

Symptoms vary from person to person, and may come and go. The condition may affect one organ or body system at first. Others may become involved later. Almost all people with systemic lupus have joint pain and most develop arthritis. Frequently affected joints are the fingers, hands, wrists, and knees. Symptoms of lupus that you experience will depend on which body systems are affected by the disease.

In general, the symptoms of lupus include:

Fatigue
Arthritis
Fever
Weight loss or gain
General discomfort and uneasiness
Joint pain, stiffness and swelling
Muscle aches
Butterfly-shaped rash (malar rash) on the face that covers the cheeks and bridge of the nose. The rash gets worse when in sunlight, and may also be widespread.
Skin lesions that appear or worsen with sun exposure
Mouth sores
Hair loss (alopecia)
Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon)
Shortness of breath
Nausea and vomiting
Seizures
Chest pain
Dry eyes
Easy bruising
Anxiety
Depression
Memory loss

Additional symptoms that may be associated with lupus:

Sensitivity to sunlight
Swollen glands
Abdominal pain
Blood disorders, including blood clots
Numbness and tingling
Coughing up blood
Nosebleed
Skin color is patchy
Blood in the urine
Difficulty in swallowing
Visual disturbance

Health: Diagnosis and Tests of Lupus (Autoimmune)

Since patients with systemic lupus can have a wide variety of symptoms and different combinations of organ involvement, no single test establishes the diagnosis of systemic lupus. To help doctors improve the accuracy of the diagnosis of lupus, 11 criteria were established by the American Rheumatism Association. These 11 criteria are closely related to the symptoms discussed above. Some patients suspected of having systemic lupus may never develop enough criteria for a definite diagnosis. Other patients accumulate enough criteria only after months or years of observation.

When a person has four or more of these criteria, the diagnosis of systemic lupus is strongly suggested. Nevertheless, the diagnosis of systemic lupus may be made in some settings in patients with only a few of these classical criteria, and treatment may sometimes be instituted at this stage. Of these patients with minimal criteria, some may later develop other criteria, but many never do.

The 11 criteria used for diagnosing systemic lupus erythematosus are:

malar "butterfly" rash, covers the bridge of the nose and spreads across the cheeks.

discoid skin rash - patchy redness with hyperpigmentation and hypopigmentation that can cause scarring.

photosensitivity - skin rash in reaction to sunlight [ultraviolet light] exposure.

mucous membrane ulcers - spontaneous ulcers of the lining of the mouth, nose, or throat.

arthritis - two or more swollen, tender joints of the extremities.

pleuritis or pericarditis - inflammation of the lining tissue around the heart or lungs, usually associated with chest pain upon breathing or changes of body position.

kidney abnormalities - abnormal amounts of urine protein or clumps of cellular elements called casts detectable with a urinalysis.

brain irritation - manifested by seizures [convulsions] and/or psychosis).

blood-count abnormalities - low counts of white or red blood cells, or platelets, on routine blood testing.

immunologic disorder - abnormal immune tests include anti-DNA or anti-Sm [Smith] antibodies, falsely positive blood test for syphilis, anticardiolipin antibodies, lupus anticoagulant, or positive LE prep test.

antinuclear antibody - positive ANA antibody testing [antinuclear antibodies in the blood].

In addition to the 11 criteria, other tests can be helpful in evaluating patients with systemic lupus to determine the severity of organ involvement.

Laboratory tests
Your doctor may order blood and urine tests to determine your diagnosis, including:

Complete blood count. This test measures the number of red blood cells, white blood cells and platelets as well as the amount of hemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur in lupus as well.

Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate isn't specific for any one disease, but it may be elevated if you have lupus, another inflammatory condition or an infection.

Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs.

Urinalysis. An examination of a sample of your urine may show an increased protein level or red blood cells in the urine, which may occur if lupus has affected your kidneys.

Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies — produced by your immune system — indicates a stimulated immune system, which is common in lupus and other autoimmune diseases. A positive ANA doesn't always mean that you have lupus, however. ANA levels can be elevated if you have an infection or if you're taking certain medications. If you test positive for ANA, your doctor may advise more-specific antibody testing and refer you to a rheumatologist, a doctor who specializes in musculoskeletal and autoimmune disorders such as arthritis or lupus.

Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs. It may also show an enlarged heart as a result of a buildup of fluid within the pericardium (pericardial effusion).

Electrocardiogram (ECG). This test measures the pattern of electrical impulses generated in your heart. It can help identify irregular rhythms or damage.

Syphilis test. A false-positive result on a syphilis test can indicate anti-phospholipid antibodies in your blood, another indication of lupus. The presence of anti-phospholipid antibodies has been associated with an increased risk of blood clots, strokes and recurrent miscarriages.

Health: Complications of Lupus (Autoimmune)

Inflammation caused by lupus can affect many areas of your body, including your:

Kidneys. Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus. A blood test called serum creatinine level is used to monitor kidney function. Signs and symptoms of kidney problems may include generalized itching, chest pain, nausea, vomiting and weight gain.

Central nervous system. If your central nervous system is affected by lupus, you may experience headaches, dizziness, memory problems, behavior changes, even seizures.

Blood and blood vessels. Lupus may lead to blood problems, including anemia and increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels (vasculitis).

Lungs. Having lupus increases your chances of developing an inflammation of the chest cavity lining (pleurisy) that can make breathing painful. You may also be more susceptible to a noninfectious form of pneumonia.

Heart. Lupus can cause inflammation of your heart muscle (myocarditis and endocarditis), your arteries (coronary vasculitis) or heart membrane (pericarditis). Having lupus also greatly increases your risk of cardiovascular disease and heart attacks. Controlling high blood pressure and high blood cholesterol, not smoking, and getting regular exercise are essential to help reduce the risk of heart disease.

Infection. People with lupus are vulnerable to infection because both the disease and its treatments — corticosteroid and cytotoxic drugs, in particular — affect the immune system. And in a vicious cycle, infection can bring on a lupus flare, increasing the risk of infection even more.

Cancer. Having lupus appears to increase your risk of cancer — especially non-Hodgkin's lymphoma, which affects the lymph system; lung cancer; and liver and bile duct cancers. Immunosuppressant drugs that are sometimes used to treat lupus also can increase the risk of cancer.

Bone tissue death (avascular necrosis). This occurs when the blood supply to a bone diminishes, often leading to tiny breaks in the bone and eventually to the bone's collapse. The hip joint is commonly affected, although avascular necrosis can occur in other bones as well. Avascular necrosis can be caused by lupus itself or by high doses of corticosteroids used to treat the disease.

Pregnancy complications. Women with lupus have an increased risk of miscarriage. Some women with lupus experience a flare during pregnancy. Lupus increases the risk of high blood pressure during pregnancy (preeclampsia) and preterm birth.

Health: Treatment of Lupus (Autoimmune)

There is no permanent cure for systemic lupus. The goal of treatment is to relieve symptoms and protect organs by decreasing inflammation and/or the level of autoimmune activity in the body. Many patients with mild symptoms may need no treatment or only intermittent courses of anti-inflammatory medications. Those with more serious illness involving damage to internal organ(s) may require high doses of corticosteroids in combination with other medications that suppress the body's immune system. Your individual symptoms determine your treatment.

Patients with systemic lupus need more rest during periods of active disease. Researchers have reported that poor sleep quality was a significant factor in developing fatigue in patients with systemic lupus.

Mild disease that involves a rash, headaches, fever, arthritis, pleurisy, and pericarditis requires little therapy. Nonsteroidal anti-inflammatory medications (NSAIDs) are used to treat arthritis and pleurisy. Corticosteroid creams are used to treat skin rashes. An anti-malaria drug called hydroxychloroquine) and low dose corticosteroids are sometimes used for skin and arthritis symptoms.

You should wear protective clothing, sunglasses, and sunscreen when in the sun.

Severe or life-threatening symptoms often require treatment by a rheumatologist and other specialists. Corticosteroids or medications to decrease the immune system response may be prescribed to control the various symptoms. Cytotoxic drugs (drugs that block cell growth) are used to treat people who do not respond well to corticosteroids or who might require long-term use of high doses of corticosteroids.

At the 2007 national Rheumatology meeting, there was a paper presented suggesting that low-dose dietary supplementation with omega - 3 fish oils could help patients with lupus by decreasing disease activity and possibly decreasing heart disease risk.

Treatment for lupus depends on your symptoms. Determining whether your symptoms should be treated and what medications to use requires a careful discussion of the benefits and risks with your doctor. As your signs and symptoms flare and subside, you and your doctor may find that you'll need to change medications or dosages.

Common medications used to treat lupus
Three types of drugs are commonly used to treat lupus when your signs and symptoms are mild or moderate. More aggressive lupus may require more aggressive drugs. In general, when first diagnosed with lupus, your doctor may discuss these medications:

Nonsteroidal anti-inflammatory drugs. Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin, others) may be used to treat a variety of signs and symptoms associated with lupus. NSAIDs are available over-the-counter, or stronger versions can be prescribed by your doctor. Check with your doctor before taking over-the-counter NSAIDs because some have been associated with serious side effects in people with lupus. Side effects of NSAIDs include stomach bleeding and an increased risk of heart problems.

Antimalarial drugs. Although there's no known relationship between lupus and malaria, these medications have proved useful in treating signs and symptoms of lupus. Antimalarials may also prevent flares of the disease. Hydroxychloroquine (Plaquenil) is the most commonly prescribed antimalarial. Side effects of antimalarial drugs include vision problems and muscle weakness.

Corticosteroids. These drugs counter the inflammation of lupus, but can have serious long-term side effects, including weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and longer term therapy. To help reduce these risks, your doctor will try to find the lowest dose that controls your symptoms and prescribe corticosteroids for the shortest possible time. Taking the drug every other day can also help reduce side effects. Corticosteroids are sometimes combined with another medication to help reduce the dose, and therefore the toxicity, of both drugs. Taking calcium and vitamin D supplements while using corticosteroids can reduce the risk of osteoporosis.

Treatment for specific symptoms
What treatment you may consider depend on your symptoms. Treatment for specific symptoms include:

Joint pain and swelling. Pain in your joints may be initially controlled with NSAIDs. If you experience more significant joint pain, you and your doctor may consider antimalarial drugs or corticosteroids.

Skin rashes. Avoid skin rashes by staying out of the sun, wearing sunblock year-round and keeping your skin covered. Despite your best attempts to avoid the sun, even indoor fluorescent lighting can trigger skin rashes in people with lupus. Skin rashes are sometimes treated with topical corticosteroids. These creams are applied to the affected area to reduce the inflammation in your skin cells. Oral steroids or antimalarial drugs also can be use.

Fatigue. Fatigue is treated by determining the underlying cause. Your fatigue may be caused by difficulty sleeping, depression or poorly controlled pain. In these cases, your doctor would treat the underlying cause. If you and your doctor can't determine a cause for your fatigue, you may consider medications such as corticosteroids and antimalarial drugs.

Swelling around the heart and lungs. Swelling around your heart and lungs that causes chest pain may be controlled NSAIDs, antimalarial drugs or corticosteroids.

Treatment for aggressive lupus
Life-threatening cases of lupus — those including kidney problems, inflammation in the blood vessels, and central nervous system problems, such as seizures — may require more aggressive treatment. In these cases, you and your doctor may consider:

High-dose corticosteroids. High-dose corticosteroids can be taken orally or administered through a vein in your arm (intravenously). A high-dose regimen of corticosteroids may help control dangerous signs and symptoms quickly, but can also cause serious side effects, including infections, mood swings, high blood pressure and osteoporosis. To minimize side effects, your doctor will give you the lowest dose needed to control your signs and symptoms and then reduce the dosage over time.

Immunosuppressive drugs. Drugs that suppress the immune system may be helpful in serious cases of lupus, but can cause serious side effects. The most commonly used immunosuppressive drugs include cyclophosphamide (Cytoxan) and azathioprine (Imuran). The drug mycophenolate mofetil (CellCept), another immunosuppressant, can be used to treat lupus-related kidney problems. All three of these drugs can be taken orally, and cyclophosphamide can also be given intravenously. Side effects include an increased risk of infection, liver damage, infertility and an increased risk of cancer.

High-dose corticosteroids can be combined with immunosuppressive drugs to reduce the dosage of each drug, which may reduce the risk of side effects. Sometimes, even with aggressive treatment, your kidneys may fail. In that case, you may need kidney dialysis or, if kidney failure is permanent, a kidney transplant.

Health: Alternative Treatment Options for Lupus (Autoimmune)

If your medications aren't controlling all of your symptoms or if you're frustrated by lupus flares, you might turn to complementary and alternative medicine for solutions. Mainstream doctors are becoming more open to discussing these options with their patients. But, since few of these treatments have been extensively studied in clinical trials, it's difficult to assess whether these treatments are helpful for lupus. In some cases, the risks of these treatments aren't known.

If you're interested in trying complementary and alternative medicine therapies, discuss these treatments with your doctor first. He or she can help you weigh the benefits and risks and tell you if the treatment will interfere with your current lupus medications.

Some common complementary and alternative treatment for lupus include:

Fish oil. Fish oil supplements contain omega-3 fatty acids that may be beneficial for people with lupus. Preliminary studies have found some promise, though more study is needed. Side effects of fish oil supplements can include nausea, belching and a fishy taste in the mouth. Fish oil can interfere with medications, so check with your doctor first.

Flaxseed. Flaxseed contains a fatty acid called alpha-linolenic acid, which may decrease inflammation in the body. Some studies have found that flaxseed may improve kidney function in people who have lupus that affects the kidneys, though more study is needed. Side effects of flaxseed include bloating and abdominal pain. Flaxseed can also interfere with medications, so check with your doctor first.

Other complementary and alternative medicine treatment are available. Discuss the options with your doctor.

Health: Prevention of Lupus Flares (Autoimmune)

Systemic lupus is undoubtedly a potentially serious illness with involvement of numerous organ systems. However, it is important to recognize that most patients with systemic lupus lead full, active, and healthy lives. Periodic increases in disease activity (flares) can usually be managed by varying medications. Since ultraviolet light can precipitate and worsen flares, patients with systemic lupus should avoid sun exposure.

Sunscreens and clothing covering the extremities can be helpful. Abruptly stopping medications, especially corticosteroids, can also cause flares and should be avoided. Patients with systemic lupus are at increased risk of infections, especially if they are taking corticosteroids or immunosuppressive medications. Therefore, any unexpected fever should be reported and evaluated.

The key to successful management of systemic lupus is regular contact and communication with the doctor, allowing monitoring of symptoms, disease activities, and treatment of side effects.

Take steps to care for your body if you have lupus. Simple steps can help you prevent lupus flares and, should they occur, better cope with the

symptoms you experience. Do the following:

Get adequate rest. People with lupus often experience persistent fatigue that's different from normal tiredness and that isn't necessarily relieved by rest. For that reason, it can be hard to judge when you need to slow down. Many experts recommend eight to 10 hours of sleep a night and naps or breaks during the day as needed. Friends and family members need to understand and respect your need for rest.

Be sun smart. Because ultraviolet light can trigger a flare, wear protective clothing such as a hat, long-sleeved shirt and long pants, and use sunscreens with a sun protection factor (SPF) of at least 15 every time you go outside, even if it's just a quick trip to the mailbox. Be sure that your ears, scalp and the backs of your hands are protected. Avoid tanning beds and stay out of the sun entirely when it's strongest, from 10 a.m. to 4 p.m. Because fluorescent and halogen lights also can emit UV rays and thus aggravate lupus, you may need to wear sunscreen and protective clothing indoors or use plastic devices that block UV emissions from indoor lights.

Get regular exercise. Exercise can help you recover from a flare, reduce your risk of heart attack, help fight depression and promote general well-being. Exercise as much as your body allows — aim for 30 minutes of activity most days of the week. You'll likely feel fatigued and not up to exercising sometimes, and that's OK. Rest when you need to. Time outdoor activities so that you avoid the sun when it's most intense, and if you're having a flare, stay out of the sun entirely.

Don't smoke. Smoking increases your risk of cardiovascular disease and can worsen the effects of lupus on your heart and blood vessels.

Eat a healthy diet. A healthy diet emphasizes fruits, vegetables and whole grains. Sometimes you may have dietary restrictions, especially if you have high blood pressure, kidney damage or gastrointestinal problems. And although no specific foods have been shown to cause or worsen lupus, it's best to avoid any food that seems to make your symptoms worse.

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Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services

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