Lupus

Definition:
Lupus is a chronic inflammatory disease that occurs when the body’s natural defence against infections – goes wrong.When your body’s immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different body systems, including your joints, skin, kidneys, blood cells, heart and lungs.

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Lupus occurs more frequently in women than it does in men, though it isn’t clear why. 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.

Causes:

The exact cause is not known, but certain triggers, such as viral infections and changes in hormone levels at puberty, the menopause and following pregnancy, have been linked to lupus. Often other family members will also have lupus or other immune system-related illnesses, known autoimmune diseases, such as rheumatoid arthritis. Autoimmune disease means that instead of just attacking foreign substances, such as bacteria and viruses, your immune system also turns against healthy tissue. This leads to inflammation and damage to various parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels and brain.In lupus the immune system becomes overactive and produces an excess of antibodies that harm the body itself.Lupus is not infectious or contagious.

Doctors don’t know what causes autoimmune diseases, such as lupus. It’s likely that lupus results from a combination of your genetics and your environment. Doctors believe that you may inherit a predisposition to lupus, but not lupus itself. Instead, people with an inherited predisposition for lupus may only develop the disease when they come into contact with something in the environment that can trigger lupus, such as a medication or a virus.

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

* Systemic lupus erythematosus 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 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.

Symptoms:
No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus experience episodes — called “flares” — of worsening signs and symptoms that eventually improve or even disappear completely for a time.

The two most common groups of symptoms are joint and muscle aches and pains and extreme fatigue and weakness.With systemic lupus, almost any part of the body can be affected so there are many other symptoms that can arise.The skin may have a rash, characteristically a so-called “butterfly rash” that covers the cheeks and bridge of the nose.Often, the rash is made worse by exposure to sunlight.

If a rash is the only symptom a person has then this form of lupus is called cutaneous or discoid lupus.In comparison, a person with systemic lupus (sometimes called systemic lupus erythematosus or SLE) may also experience dry eyes, hair loss, chest and abdominal pains, depression, kidney problems, headaches, flu-like symptoms, swollen glands and poor circulation.Women with lupus may also experience recurrent miscarriages.

The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. But, in general, lupus signs and symptoms may include:

* Fatigue
* Fever
* Weight loss or gain
* Joint pain, stiffness and swelling
* Butterfly-shaped rash (malar rash) on the face that covers the cheeks and bridge of the nose
* 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
* Chest pain
* Dry eyes
* Easy bruising
* Anxiety
* Depression
* Memory loss

Outlook:

Some people with lupus have only minor symptoms that need no treatment. Others can have multiple symptoms that are severe.The course of the disease is different for each person. In some it will disappear completely, for others the condition waxes and wanes or gets progressively worse.Lupus can be difficult to diagnose because the symptoms and disease pattern varies so much from person to person.However, there are blood tests available to help spot the condition.Decades ago people used to die from lupus, partly because it was often diagnosed late and partly because treatments were not as effective as they are today.Now most people with lupus can expect to live a normal life span.

Complications:
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.

Risk factors:

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.
* 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.
* 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.
* 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.

Diagnosis:
Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may change over time and overlap with those of many other disorders. For these reasons, doctors may not initially consider lupus until the signs and symptoms become more obvious. Even then, lupus can be challenging to diagnose because nearly all people with lupus experience fluctuations in disease activity. At times the disease may become severe and at other times subside completely.

American College of Rheumatology criteria for a lupus diagnosis
The American College of Rheumatology (ACR) has developed clinical and laboratory criteria to help physicians diagnose and classify lupus. If you have four of the 11 criteria at one time or individually over time, you probably have lupus. Your doctor may also consider the diagnosis of lupus even if you have fewer than four of these signs and symptoms. The criteria identified by the ACR include:

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* Face rash, which doctors call a malar rash, that is butterfly shaped and covers the bridge of the nose and spreads across the cheeks
* Scaly rash, called a discoid rash, which appears as raised, scaly patches
* Sun-related rash, which appears after exposure to sunlight
* Mouth sores, which are usually painless
* Joint pain and swelling that occurs in two or more joints
* Swelling of the linings around the lungs or the heart
* Kidney disease
* A neurological disorder, such as seizures or psychosis
* Low blood counts, such as low red blood count, low platelet count (thrombocytopenia), or a low white cell count (leukopenia)
* Positive anti-nuclear antibody tests, which indicate that you may have an autoimmune disease
* Other positive blood tests that may indicate an autoimmune disease, such as a positive double-stranded anti-DNA test, positive anti-Sm test, positive anti-phospholipid antibody test or false-positive syphilis test

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.

Modern Treatment:
Treatment for lupus depends on your signs and symptoms. Determining whether your signs and 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.

The aim of treatment is to relieve the symptoms and prevent permanent damage to organs such as the kidney.Some patients are given low dose aspirin to help ease the joint and muscle pains and reduce any inflammation.Anti-malaria drugs also help with the inflammation and have the added bonus of helping to guard the skin against rashes triggered by exposure to sunlight.

Immunosuppressant drugs can be used to dampen down the overactive immune response, as can steroids.People with lupus may be more likely to develop other medical conditions such as blood clots, osteoporosis and coronary artery disease.Drugs are available to help treat these.Those with lupus can also help themselves by avoiding direct sunlight and getting plenty of rest, as well as following a healthy lifestyle in general, with a well balanced diet and regular exercise.

Alternative Medication:
If your medications aren’t controlling all of your signs and 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 treatments will interfere with your current lupus medications.

Some common complementary and alternative treatments 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 treatments are available. Discuss the options with your doctor.

Lifestyle and Home Remedies
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 signs and symptoms you experience. Try to:

* 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.

Coping and support:

Coping with lupus can be stressful. People with lupus often experience anxiety, depression and frustration because the disease is unpredictable. Knowing you have a serious disease can also be scary. To help you cope with lupus, try to:

* Learn all you can about lupus. Write down all the questions you have about lupus and ask them at your next appointment. Ask your doctor or nurse for reputable sources of further information. The more you know about lupus, the more confident you’ll feel in your treatment choices.
* Gather support among your friends and family. Talk about lupus with your friends and family. They may have questions about lupus and how it affects your life. Answer their questions honestly. Explain ways your friends and family can help out when you’re having flares. Lupus can be frustrating for your loved ones because they usually can’t see it and you may not appear sick. They can’t tell if you’re having a good day or a bad day unless you tell them. Be open about what you’re feeling so that your friends and family know what to expect.
* Take time for yourself. Cope with stress in your life by taking time for yourself. Use that time to read, meditate, listen to music or write in a journal. Find activities that calm and renew you.
* Connect with others who have lupus. Talk to other people who have lupus. You can connect with other people who have lupus through support groups in your community or through online message boards. Though your friends and family love you, sometimes you’ll feel as if they can’t quite understand what you’re feeling. Other people with lupus can offer unique support because they’re facing many of the same obstacles and frustrations that you’re facing.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://news.bbc.co.uk/2/hi/health/medical_notes/4806634.stm
http://www.mayoclinic.com/health/lupus/DS00115/DSECTION=coping%2Dand%2Dsupport

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