Lupus

Lupus is a chronic, unpredictable disease. When you have lupus, your immune system can't tell the difference between your healthy cells and tissues and foreign substances, such as bacteria and viruses. Your body makes antibodies that break down its own tissues, causing injury, inflammation or pain. In lupus, these antibodies can attack many different organs. They often cause permanent damage.


Types of lupus
The most common types of lupus are discoid and systemic lupus erythematosus (SLE).
Discoid lupus only affects the skin. There is a red, raised rash that can be thick or scaly. The rash usually appears on the face, but it may develop anywhere on the body. The rash can last from a few days to a few years, and it may come and go. Some people with discoid lupus eventually develop systemic lupus.

Systemic lupus erythematosus (SLE) can affect many different organs, including the skin, joints, kidneys, lungs, heart, muscles, nervous system, blood and/or blood vessels. SLE affects everyone differently. Symptoms can range from mild to life threatening.

Causes/associated factors
The cause of lupus is unknown. Researchers suspect it may related to a combination of genetic, environmental and hormonal factors. For example:
Researchers have identified four specific genetic defects that may be involved.
Hormones are suspected to be at play because lupus is most common in women of childbearing age.
Certain immune system conditions may influence the development of lupus.
Environmental factors such as viruses, stress, diet and exposure to ultraviolet light may play a role.
Certain medications, such as hydralazine (Apresoline) or procainamide (Pronestyl), can trigger or aggravate lupus.
Lupus may develop anytime between ages 16 and 55, but it typically occurs between ages 30 and 50. Lupus is more likely to affect women, and it's more common among Asians, African Americans, Hispanics and certain Native American tribes, including Sioux, Crow and Arapaho.


Signs/symptoms
Again, lupus tends to come and go through cycles of flare-ups and remission. Symptoms vary widely, depending on the type of lupus and which organs are affected. The most common symptoms include:
fever
fatigue
weight loss
joint pain
butterfly rash (red rash across the bridge of the nose and cheeks)
kidney, heart, central nervous system, blood or lung problems
sensitivity to sun
hair loss
sores on the mouth and skin
swollen glands
Raynaudof time. To help make a diagnosis, your doctor may recommend the following tests:
complete blood cell count (a series of tests that analyze the cells in your blood)
blood chemistries (another series of tests to analyze other aspects of your blood)
blood tests to measure complement levels (a group of proteins that are part of the immune system)
antinuclear antibody test (a blood test that can detect antinuclear antibodies, which are present in nearly all people who have lupus and in many who do not have the disease; a negative antinuclear antibody result usually means you do not have lupus)
other antibody tests, such as anti-DNA, anti-Sm, anti-RNP, antiRo (SSA) and anti-La (SSB)
erythrocyte sedimentation rate (a blood test that measures how quickly your red blood cells settle)
urinalysis (urine tests that can help identify kidney damage caused by lupus)
skin or kidney biopsy (taking a tissue sample for microscopic examination)
Further diagnostic studies may be needed when SLE affects the central nervous system or other vital organs, such as the heart or lungs.


Treatment
Treatment is directed at your overall clinical situation, as well as the organs affected by lupus. Medication can help reduce symptoms and inflammation, as well as maintain normal organ function. Because of the changing nature of lupus, your doctor may change the type, amount and combination of medications often. Common medications include:
aspirin or nonsteroidal anti-inflammatory medications
corticosteroids, such as prednisone (These medications are another type of anti-inflammatory drug.)
antimalarial medications, such as hydroxychloroquine (Plaquenil)
cytotoxic medications, such as methotrexate (These medications suppress the immune system and inflammatory response.)
immunosuppressive medications, such as azathioprine (Imuran) or cyclophosphamide (Cytoxan), if the kidneys or central nervous system are affected
If necessary, your doctor may also suggest lifestyle modifications, such as getting enough sleep, eating healthfully, and exercising regularly. Managing stress is also important. The inability to handle normal daily activities or follow through on social roles, such as being a parent or employee, are common sources of stress for people who have lupus. To cope, enlist help from others and maintain a strong support network of friends and family. You may also want to consult a mental health professional.


Complications
With proper treatment, most people who have lupus have normal life spans. However, long-term treatment can have serious side effects and recurrent episodes of lupus can cause organ damage. Inflammation of various organs can lead to complications such as:
nephritis (inflammation of the kidney)
pleuritis (inflammation of the chest cavity lining)
vasculitis (inflammation of the blood vessels)
myocarditis (inflammation of the muscular layer of the heart wall)
endocarditis (inflammation of the heart lining)
pericarditis (inflammation of the sac around the heart)
Complications such as kidney failure or overwhelming infections can be fatal.


Pregnancy-specific information
If you have systemic lupus, consult an obstetrician with expertise in high-risk pregnancies before you get pregnant. Lupus increases the risk of miscarriage, premature birth and fetal death while in the uterus. When lupus flares up in pregnancy, the symptoms are similar to other potential complications of pregnancy, such as eclampsia or preeclampsia (a serious condition that causes elevated blood pressure and protein in the urine). While you're pregnant, your lupus medications may need to be adjusted.

Senior-specific information
Postmenopausal women with systemic lupus have a higher risk for heart disease and osteoporosis. This makes it especially important to discuss with your doctor whether estrogen therapy is right for you. Older adults have a higher percentage of false positive antinuclear antibody tests, which makes follow-up tests to verify the results essential. Finally, more men develop lupus with age.

Prevention
No one knows how to prevent lupus. However, carefully following your medical treatment plan can help prevent and limit recurrences and complications. Here are some other suggestions.
If you're photosensitive, stay out of the sun. Use sunscreen with an SPF of 15 or higher daily.

Get immunized against influenza and pneumococcal pneumonia.

Avoid certain medications, including penicillin, high-dosage birth control pills, sulfa drugs (sometimes used to treat bacterial infections) and photosensitizing medications, such as tetracycline hydrochloride. Ask your doctor for details.

Lead a healthy lifestyle. Don't use tobacco, exercise regularly, get plenty of rest, eat healthfully, and keep stress under control.