Lupus

Description

Lupus is a disease that occurs when the body's immune system attacks its own tissues and organs (autoimmune disease). Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs.

Lupus can be difficult to diagnose because its signs and symptoms often are similar to those of other diseases. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly is unfolding across both cheeks — occurs in many but not all cases of lupus.

Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. Although there is no cure for lupus, treatments can help control the symptoms.

Symptoms

No two cases of lupus are exactly alike. The signs and symptoms may appear suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. The majority of people with lupus have mild disease characterized by episodes-called flares — when signs and symptoms get worse for a while, then improve or even disappear completely for a time.

The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. The most common signs and symptoms include:

  • Fatigue
  • Fever
  • Joint pain, stiffness, and swelling
  • Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes of the skin in other parts of the body
  • The skin lesions that appear or worsen with sun exposure
  • Fingers and toes that turn white or blue when exposed to cold or during stressful periods
  • Shortness of breath
  • Pain in the chest
  • Dry eyes
  • Headaches, confusion and memory loss

When to see a doctor

Consult your doctor if you develop an unexplained rash, fever, continuous, persistent pain or fatigue.

Causes

As an autoimmune disease, lupus occurs when the immune system attacks healthy tissues in your body. It is likely that lupus results from a combination of your genetics and your environment.

It seems that people with an inherited predisposition for lupus may develop the disease when they come in contact with something in the environment that can trigger lupus. The cause of lupus in most cases, however, is unknown. Some of the possible triggers are:

  • The light of the sun. Exposure to the sun can cause lupus skin lesions or trigger an internal response in susceptible people.
  • Infections. Having an infection can start the lupus or cause a relapse in some people.
  • Drugs. Lupus can be triggered by certain types of blood pressure medications, anti-seizure medications, and antibiotics. People who have drug-induced lupus usually get better when you stop taking the medication. Rarely, symptoms may persist even after stopping the medication.

Risk factors

Factors that may increase your risk of lupus are:

  • Your sex. Lupus is more common in women.
  • Age. Although lupus affects people of all ages, it is most often diagnosed between the ages of 15 and 45.
  • Of the race. Lupus is more common in african americans, Hispanics and Asian-Americans.

Complications

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

  • Kidneys. Lupus can cause serious damage to the kidneys, and kidney failure is one of the leading causes of death among people with lupus.
  • The brain and the central nervous system. If your brain is affected by lupus, you may experience headaches, dizziness, behavior changes, vision problems, and even strokes or seizures. Many people with lupus experience memory problems, and may have difficulty expressing their thoughts.
  • The blood and the blood vessels. Lupus may lead to blood problems, including a reduced number of red blood cells (anemia) and an increased risk of bleeding or clotting of the blood. It can also cause inflammation of the blood vessels.
  • Lungs. Lupus increases the chances of developing an inflammation of the chest cavity lining, which can make breathing painful. Bleeding in the lungs, and pneumonia are also possible.
  • Heart. Lupus can cause inflammation of the heart muscle, arteries, or the heart of the membrane. The risk of cardiovascular diseases and heart attacks increases greatly as well.

Other types of complications

Lupus also increases the risk of:

  • Infection. People with lupus are more vulnerable to infection because both the disease and its treatments can weaken the immune system.
  • Cancer. Lupus appears to increase the risk of cancer; however, the risk is small.
  • The tissue of the bones of the death. This occurs when the blood supply to the bone decreases, which often leads to small breaks in the bone and eventually, the bone of the collapse.
  • Complications in pregnancy. Women with lupus have an increased risk of spontaneous abortion. Lupus increases the risk of high blood pressure during pregnancy and preterm delivery. To reduce the risk of these complications, doctors often recommend delaying pregnancy until their disease has been under control for at least six months.

Lupus

Diagnosis

The diagnosis of lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders.

There is No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis.

Laboratory tests

Blood and urine tests may include:

  • 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. The 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.
  • The erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle in the bottom of a tube in one hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate is not specific for any disease. Can be high if you have lupus, an infection, other inflammatory condition, or cancer.
  • The kidney and liver assessment. Blood tests can determine how well your kidneys and liver are functioning. Lupus can affect these organs.
  • Analysis of urine. A review of a sample of urine may show a higher level of protein or red blood cells in the urine, which can occur if lupus has affected the kidneys.
  • Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies produced by the immune system — indicates that stimulates the immune system. While the majority of people with lupus have a positive antinuclear antibody (ANA) test, the majority of people with a positive ANA do not have lupus. If you test positive for ANA , your doctor may advise you to more specific antibody test.

Imaging tests

If your doctor suspects that lupus affects the lungs or the heart, he or she may suggest:

  • X-ray of the chest. An image of the chest may reveal abnormal shadows that suggest fluid or inflammation in the lungs.
  • The echocardiogram. This test uses sound waves to produce real-time images of your beating heart. You can check if there are problems with the valves and other parts of your heart.

Biopsy

Lupus can harm your kidneys in many different ways, and the treatments may vary, depending on the type of damage that occurs. In some cases, it is necessary to test a small sample of kidney tissue to determine what the best treatment might be. The sample can be obtained with a needle or through a small incision.

Skin biopsy is sometimes performed to confirm the diagnosis of lupus that affects the skin.

Treatment

Treatment for lupus depends on your signs and symptoms. The determination of whether you should be treated and what medications to use requires a careful analysis of the risks and benefits with your doctor.

As the signs and symptoms flare and subside, you and your doctor may find that you'll need to change the medicine or the dose. The most commonly used medications to control lupus are:

  • Nonsteroidal anti-inflammatory drugs (Nsaids). Over-the-counter nonsteroidal anti-inflammatory drugs (Nsaids), such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), can be used to treat the pain, swelling, and fever associated with lupus. Stronger Nsaids are available by prescription. Side effects of Nsaids can include stomach bleeding, kidney problems and an increased risk of heart problems.
  • Anti-malarial drugs. The medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), affect the immune system and may help to decrease the risk of flare-ups of lupus. Side effects can include stomach upset and, very rarely, damage to the retina of the eye. Regular eye exams are recommended while taking these medications.
  • Corticosteroids. Prednisone and other corticosteroids can counter the inflammation of lupus. High doses of steroids, such as methylprednisolone (Medrol) is often used for the control of severe disease involving the kidneys and the brain. The side effects include weight gain, easy bruising, thinning of the bones, high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and long-term therapy.
  • The immunosuppressants. Medications that suppress the immune system may be helpful in serious cases of lupus. Examples include azathioprine (Imuran, Azasan), mycophenolate (Cellcept), methotrexate (Trexall, Xatmep, others), cyclosporine (Sandimmune, Neoral, Gengraf), and leflunomide (Arava). Possible side effects may include an increase in the risk of infection, liver damage, decreased fertility and an increased risk of cancer.
  • Biological products.A different kind of drug, belimumab (Benlysta) is given intravenously, it also reduces the symptoms of lupus in some people. The side effects include nausea, diarrhea, and infections. Rarely, worsening of depression may occur. Rituximab (Rituxan, Truxima) may be beneficial for some people in whom other drugs have not helped. Side effects include allergic reaction to the intravenous infusion and infections.

Biological products. A different kind of drug, belimumab (Benlysta) is given intravenously, it also reduces the symptoms of lupus in some people. The side effects include nausea, diarrhea, and infections. Rarely, worsening of depression may occur.

Rituximab (Rituxan, Truxima) may be beneficial for some people in whom other drugs have not helped. Side effects include allergic reaction to the intravenous infusion and infections.

In clinical trials, voclosporin has been shown to be effective in the treatment of lupus.

Other potential drugs to treat lupus, which are currently being studied, including abatacept (Orencia), anifrolumab, and others.

Self-care

Take steps to care for your body if you have lupus. Very simple measures that can help prevent flare-ups of lupus and, if they do occur, to better cope with the signs and symptoms that you experience. Try:

  • See your doctor regularly. Have regular check-ups instead of just seeing your doctor if your symptoms get worse, you can help your doctor prevent flares, and may be useful in the approach of the routine health problems, such as stress, diet, and exercise, which may be useful in the prevention of the complications of lupus.
  • Be sun smart. Due to the uv light can trigger an outbreak, wear protective clothing, like a hat, long-sleeved shirt and long pants — and the use of sunscreen with a sun protection factor (SPF) of at least 55 every time I go out to the street.
  • Get regular exercise. Exercise can help to keep your bones strong, reducing the risk of heart attack and promote the general well-being.
  • Do not 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 is based on fruits, vegetables and whole grains. Sometimes you may have restrictions in the diet, especially if you have high blood pressure, kidney damage or gastrointestinal problems.
  • Ask your doctor if you need vitamin D and calcium supplements. There is some evidence to suggest that people with lupus may benefit from supplemental vitamin D. A calcium supplement can help you meet the daily recommended dietary allowance of 1,000 milligrams to 1,200 milligrams — depending on your age — to help maintain healthy bones.

Alternative medicine

Sometimes, people with lupus to search for alternative or complementary medicine. There are alternative therapies that have been shown to alter the course of lupus, although some can help to relieve the symptoms of the disease.

Discuss these treatment options with your doctor before you start on your own. He or she can help you weigh the benefits and risks, and to know if the treatments interfere negatively with your current lupus medications.

Complementary and alternative treatments for lupus are:

  • Dehydroepiandrosterone (DHEA). Taking supplements that contain this hormone, along with conventional treatment can help reduce flare-ups of lupus. dehydroepiandrosterone (DHEA) can cause acne in women.
  • The fish oil. Fish oil supplements contain omega-3 fatty acids, which can be beneficial for people with lupus. Preliminary studies have found that some promise, although more studies are needed. Side effects of fish oil supplements can include nausea, belching and a fishy taste in the mouth.
  • Acupuncture. This therapy uses small needles inserted under the skin. Can help to relieve the muscle pain associated with lupus.

Coping and support

If you have lupus, it is likely that you have a range of painful feelings about your condition, the fear of extreme frustration. The challenges of living with lupus increase the risk of depression and related mental health problems, such as anxiety, stress and low self-esteem. To help deal with the situation, try the following:

  • Learn all you can about lupus. Write down any questions you have about lupus as they occur to you so that you can do at your next appointment. Ask your doctor or nurse from reliable sources of additional information. The more you know about lupus, the more confident you will feel in your treatment options.
  • Gather support among your friends and family.Talk about lupus with your friends and family and explain the ways in which they can help when you are having flares. Lupus can be frustrating for your loved ones, because you usually can't see it, and you may not appear sick. Family and friends can't tell if you're having a good day or a bad day, unless you tell them. Be open about what they feel, so that your loved ones know what to expect.
  • Take time for yourself. To deal with the stress in your life by taking time for yourself. Use that time to read, meditate, listen to music or writing in a journal. Find activities that calm and renew you.
  • To connect with other people who have lupus. Talk with other people who have lupus. You can connect through support groups in your community or online through the message boards. Other people with lupus can offer unique support, as they face many of the same obstacles and frustrations they face.

Gather support among your friends and family. Talk about lupus with your friends and family and explain the ways in which they can help when you are having flares. Lupus can be frustrating for your loved ones, because you usually can't see it, and you may not appear sick.

Family and friends can't tell if you're having a good day or a bad day, unless you tell them. Be open about what they feel, so that your loved ones know what to expect.

Preparing for your appointment

It is likely to start by seeing your primary care physician, but he or she may refer you to a specialist in the diagnosis and treatment of the inflammation of joints and disorders of the immune system (rheumatologist).

Because the symptoms of lupus can mimic so many other health problems, you may need patience while waiting for the diagnosis. Your doctor must rule out a number of other diseases prior to the diagnosis of lupus. You may need to see a number of specialists, such as physicians who treat kidney problems (nephrologists), blood disorders (hematology), or disorders of the nervous system (neurologists), depending on their symptoms, to help with the diagnosis and the treatment.

What you can do

Before your appointment, you can write a list of answers to the following questions:

  • When did your symptoms begin? They do not come and go?
  • Is there something that seem to trigger your symptoms?
  • Your parents or siblings had lupus or other autoimmune diseases?
  • What medications and supplements that you take regularly?

You may also want to write down questions to ask your doctor, such as:

  • What are the possible causes of the symptoms or condition?
  • What tests do you recommend?
  • If these tests do not realize the cause of my symptoms, what additional tests might I need?
  • There are treatments or lifestyle changes that could help my symptoms?
  • I need to follow all the restrictions while we are in search of a diagnosis?
  • You should see a specialist?
  • If you are considering pregnancy, be sure to discuss this with your doctor. Some medicines cannot be used if you become pregnant.

In addition to the questions that you've prepared to ask your doctor, do not hesitate to ask questions during your appointment anytime you don't understand something.

What to expect from your doctor

Your doctor may ask you a series of questions. Be prepared to respond to them can stop the time to go through any of the points that you want to devote more time. Your doctor may ask:

  • Does sun exposure cause to develop rashes on the skin?
  • Do your fingers become pale, numb or uncomfortable in the cold?
  • Do your symptoms include problems with memory or concentration?
  • How your symptoms limit your capacity to function at school, at work or in personal relationships?
  • Have you been diagnosed with any other medical condition?
  • Are you pregnant, or planning to become pregnant?
Symptoms and treatment of Lupus