Wednesday, August 27, 2014

Definition

Lupus is a chronic autoimmune disease in which the body's antibodies attack one's own tissues. Lupus attacks tissues such as the skin, muscles, tendons and ligaments as well as the kidneys, heart, lungs and brain.

Description

Lupus frequently strikes women of childbearing years, however, it can affect both sexes from youth to the elderly and range in severity from mild to disabling.

In lupus, the regulation of the immune system goes awry and the body produces autoantibodies (antibodies that attack the patient's own tissues). This reaction results in inflammation that causes redness, pain and swelling in the affected parts of the body.

Lupus usually appears in one of two forms - systemic lupus erythematosus (SLE) or discoid lupus erythematosus (DLE).

Systemic lupus erythematosus(SLE) is the most common form of lupus. "Systemic" means it can affect several parts of the body. A subtype of SLE is drug-induced lupus. Some medications uncommonly used for high blood pressure, heart disease and tuberculosis can cause this condition.

Discoid lupus erythematosus(DLE) involves inflammation of the skin only.

Causes

Although the causes of lupus are not completely understood, the disease is believed to result from an interplay of genetic, environmental (such as ultraviolet light, stress, infections, certain drugs and chemicals) and hormonal factors.

Symptoms

The symptoms of lupus may include:

  • skin rash
  • pain and swelling in joints
  • muscle aches
  • fatigue
  • weight loss
  • hair loss
  • loss of appetite
  • lesions over the bridge of the nose and cheeks, and sometimes on the scalp. Lesions dry into scales that fall off the body, leaving scars (DLE only)
  • Raynaud's syndrome (a condition in which a sudden, severe reduction in blood flow causes fingers to turn waxy, white and blue and painfully cold)

Diagnosis

A thorough medical history, a physical exam, laboratory testing and presence of several defining symptoms (listed below) will determine a positive diagnosis of lupus. According to the Lupus Foundation of America, there is no single laboratory test that can definitively determine whether a person has lupus. The following tests will aid in diagnosis of lupus by examining the status of the patient's immune system:

1. The anti-nuclear antibody test determines if the person has autoantibodies that react with components in cell nuclei. Almost all lupus patients will have a positive reaction to this test.

2. The anti-DNA antibody test determines if the patient has antibodies to DNA.

3. The anti-Sm antibody test looks for antibodies to a protein. While many lupus patients do not have anti-Sm antibodies, they are rarely found in people without lupus.

4. Tests for the presence of immune complexes (the combination of antibodies and the substances with which they react) in the blood are valuable, both for diagnosing and monitoring the disease.

5. An analysis of the serum complement level, which tends to fall when the disease is active, is also useful for both diagnosis and monitoring. The serum complement is a group of proteins involved in the inflammation that can occur in immune reactions.

The interpretation of the results of these tests is made even more difficult by the unpredictability of the disease. A test may be positive one time and negative the next, depending on whether the disease is active or in remission. Kidney and skin biopsies can also help with diagnosis. A kidney biopsy may show deposits of antibodies and immune complexes, and a sample of skin tissue may reveal deposits of antibodies and complement proteins.

According to the American College of Rheumatology, the presence of four or more of the following 11 symptoms and signs usually indicates a positive diagnosis of lupus:

  • Butterfly rash: a reddish eruption across the nose and cheekbones
  • Discoid lesions: reddish, raised, disk-shaped patches on the body
  • Photosensitivity of the skin: a red rash that results from sun exposure
  • Oral ulcers: sores in the mouth or nose that are usually painless but can be blister-like
  • Arthritis: inflammation characterized by tenderness and swelling in two or more peripheral joints
  • Chest/heart problems: breathing difficulty or chest pain, caused by inflammation of the lining of the chest cavity or heart, respectively
  • Neurological disorders: sudden onset of seizures or psychosis
  • Kidney disorders: kidney failure
  • Blood cell disturbances: hemolytic anemia (a deficiency in red blood cells, resulting from their abnormal destruction) or leukopenia (an excessively low white blood cell count)
  • Immunologic disruption: a dysfunctional immune system's attack on healthy cell tissue
  • Antinuclear antibodies (ANA): antibodies that battle cell nuclei

Treatment

Because the symptoms of lupus vary not only in type but also severity, the treatment may also need to vary. It may take time to find the right combination of treatments for each individual. Treatments may include:

  • rest
  • exercise
  • physical therapy for muscle weakness
  • avoiding sun exposure
  • using medications such as:
  • anti-inflammatory drugs such as aspirin for symptomatic relief
  • corticosteroid drugs such as prednisolone for inflammation
  • antimalarial drugs such as chloroquine phosphate or hydroxychloroquine for rashes, arthritis and malaise
  • immunosuppressive and cytotoxic drugs such as Immuran (azathioprine) and Cytoxan (cycyclophosphamide) are prescribed with vital organs are involved and/or corticosteroids aren't effective

Questions

Have all tests been run to determine whether it is lupus or another disease that mimics lupus?

How severe is the disease?

Is there damage to the kidneys, heart or other organs? If so, is it reversible?

Will you be prescribing any medication?

What are the side effects? How long will the medication have to be taken?

If over-the-counter aspirin is recommended, how much is safe to take?

What measures can be taken to prevent skin rash and scarring?

Are there any symptoms which should be reported to the doctor immediately?