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Systemic Lupus Erythematosus by Rick Alan

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Definition

Lupus is an autoimmune disease. It inflames:

Joints
Tendons
Skin
Other connective tissue and organs

It causes the immune system to make antibodies that attack the body's healthy cells and tissue.

Causes

The cause of lupus is unknown. Researchers believe it may be a combination of:

Genetic factors
Environmental factors, which may include:
- Sunlight (UV rays)
- Stress
Viral or other type of infection
Drug-induced ( methyldopa , procainamide , hydralazine , isoniazid , chlorpromazine , TNF-blocking drugs)

Risk Factors

These risk factors increase your chance of developing lupus. Tell your doctor if you have any of these risk factors:

Sex: female to male ratio: 10:1
Age: childbearing age (20-45 years)
Race: African American, Native American, Asian, and Hispanic

Symptoms

Symptoms can be mild or very severe. For some people, only part of the body (eg, skin) is affected. For others, many parts are affected. Though symptoms can be chronic, they can flare up and get better on and off.

Common symptoms:

Swollen and/or painful joints
Fever
Skin rashes over areas exposed to sunlight (especially on the nose and cheeks)
Extreme fatigue

Common Lupus Rash Sites

Other symptoms may include:

Hair loss
Chest pain, coughing up blood, shortness of breath, difficulty breathing
Kidney inflammation
High blood pressure
Anemia or other blood disorders
Sensitivity to sunlight
Raynaud's phenomenon
Ulcers in nose or mouth
Swollen glands
Headaches
Dizziness
Seizures
Stroke
Inflamed heart, heart vessels, or membrane surrounding the heart
Blood clots

Diagnosis

The doctor will ask about your symptoms and medical and family history, and perform a physical exam. The diagnosis is based on symptoms, especially for young women. No single test can determine if you have lupus. But, a number of blood tests for specific antibodies can confirm diagnosis.

Treatment

Treatment depends on symptoms.

Medication

Medications for mild symptoms:

Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve joint pain
Acetaminophen (eg, Tylenol) to relieve joint pain
Hydroxychloroquine or chloroquine to relieve joint pain, fatigue, balding, and skin rashes (Note: Regular eye exams are advised while on these medications.)
Topical corticosteroids for skin rashes

Medications for severe symptoms include:

Oral and intravenous corticosteroids to control and limit inflammation in kidney, brain, lung, and heart, as well as in cases of severe anemia
Immunosuppressive drugs to suppress the body's autoimmune system
Mycophenolate, azathioprine, and cyclophosphamide for kidney disease or other life- or organ-threatening conditions
Rituximab for refractory disease

Transplantation and Dialysis

You may consider transplantation and dialysis if you have end-stage kidney failure .

Prevention

You cannot prevent lupus because the cause is unknown.

To prevent flare-ups of symptoms:

Schedule regular check-ups.
Treat any and all infections quickly and vigorously.
Avoid sun exposure and wear sunscreen and protective clothing when outdoors .
Eat a healthful diet, one that is low in saturated fat and rich in whole grains , fruits, and vegetables .
Limit emotional stress .
Get adequate rest .
Exercise moderately (as much as your condition allows) with your doctor's permission.
Call your doctor if you think you will have a flare-up.
Avoid oral contraceptives, especially if you have had a blood clot.

RESOURCES:

Lupus Foundation of America, Inc. http://www.lupus.org/
Lupus Research Institute http://www.lupusresearchinstitute.org/
National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/

CANADIAN RESOURCES:

Lupus Canada http://www.lupuscanada.org/
Lupus Foundation of Ontario http://vaxxine.com/lupus/

References:

Beers MH, Fletcher AJ. The Merck Manual of Medical Information . New York, NY: Simon and Schuster, Inc; 1999.
Contreas G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med . 2004;350;971-980.
Dorner T, Lipsky PE. Immunoglobulin variable-region gene usage in systemic autoimmune diseases. Arthritis Rheum . 2001;44:2715-2727.
Gescuk BD, Davis JC Jr. Novel therapeutic agents for systemic lupus erythematosus. Curr Opin Rheumatol . 2002;14:515.
Hejaili Ff, Moist LM, Clark WF. Treatment of lupus nephritis. Drugs . 2003;63:257-274.
Lupus. National Institute of Arthritis and Muskuloskeletal and Skin Diseases, National Institutes of Health website. Available at: http://www.niams.nih.gov/Health_Info/Lupus/default.asp . Published September 1997. Updated August 2003. Accessed June 26, 2008.
Sherer Y, Gorstein A, Fritzler MJ, Shoenfeld Y. Auto-antibody explosion in systemic lupus erythematosus: more than 100 different antibodies found in SLE patients. Semin Arthritis Rheum . 2004;34:501-537.
Smolen JS. Therapy of systemic lupus erythematosus: a look into the future. Arthritis Res . 2002;4(suppl)3:S25.
Symptoms. Lupus Foundation of America website. Available at: http://www.lupus.org/webmodules/webarticlesnet/templates/new_aboutintroduction.aspx?articleid=74&zoneid=9 . Accessed June 26, 2008.

Last reviewed October 2009 by Jill D. Landis

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