Lupus
Other Names: Discoid Lupus, SLE, Subacute Cutaneous
Lupus, Systemic Lupus Erythematosus, Drug-Induced
Lupus Erythematosus, Lupus Nephritis (when Lupus effects
the kidney), Disseminated Lupus Erythematosus
Lupus is a connective tissue autoimmune
disease that can either stay contained to the cutaneous
areas (skin mainly) or cam be a full systemic disease
affecting any organ or tissue system. Lupus causes
inflammation wherever it attacks and can lead to severe
complications of the heart, kidney, lungs and other
major organ systems. It can take months to years before
the disease comes to a point where it is recognizable
and can be diagnosed/treated properly. It can range
from a mild to sever disease and can even be life-threatening
if not treated or diagnosed properly and in a timely
manner.
There are three types os Lupus: Discoid and Systemic
Lupus Erythematosus also known as SLE.
Discoid Lupus is contained to the skin and upper
body, and usually presents only as rashes and disc-shaped
lesions.
SLE can is systemic and can affect any organ or tissue
system and is the more severe form of Lupus.
There is also a form of Lupus that is drug-induced,
caused by reactions to certain medications, Typically,
once the offending medication is stopped, this form
of Lupus will clear up on it's own.
Initial symptoms of Lupus may include a fever, vascular-headaches,
a “butterfly-shaped” rash across the nose
and cheeks of the face, personality changes and other
cognitive changes.
The underlying cause of Lupus is still non known,
but it has been known to overlap with other conditions
and autoimmune diseases and is more common in women
then men.
Symptoms:
Bruising easily
Chest pain
Delusions
Disc-shaped lesions on the face
Disc-shaped lesions on the scalp
General body pain
General joint pain and stiffness
Hallucinations Headaches
Joint pain with swelling and redness
Pain in mouth
Psychosis
Purplish colored areas on fingers and palms of hands
Rash across nose and cheeks
Seizures
Sensitivity to sunlight
Swelling in ankles
Swelling in legs
Swollen eyes
Swollen lymph nodes
Diagnosis:
Diagnosing Lupus can be difficult because signs and
symptoms fluctuate and vary from patient to patient.
Lupus is very much an individual disease and may not
affect one patient the same as another. The
American College of Rheumatology* has established
diagnosing criteria to better diagnose Lupus effectively.
“The 1997 Update of
the 1982 American College of Rheumatology Revised
Criteria for Classification of Systemic Lupus Erythematosus”
| CRITERION |
DEFINITION |
| 1. Malar Rash |
Fixed erythema, flat or raised, over the malar
eminences, tending to spare the nasolabial folds |
| 2. Discoid rash |
Erythematous raised patches with adherent keratotic
scaling and follicular plugging; atrophic scarring
may occur in older lesions |
| 3. Photosensitivity |
Skin rash as a result of unusual reaction to
sunlight, by patient history or physician observation |
| 4. Oral ulcers |
Oral or nasopharyngeal ulceration, usually painless,
observed by physician |
| 5. Nonerosive Arthritis |
Involving 2 or more peripheral joints, characterized
by tenderness, swelling, or effusion |
| 6. Pleuritis or Pericarditis |
a) Pleuritis--convincing history of pleuritic
pain or rubbing heard by a physician or evidence
of pleural effusion
OR
b) Pericarditis--documented by electrocardigram
or rub or evidence of pericardial effusion |
| 7. Renal Disorder |
a) Persistent proteinuria > 0.5 grams per
day or > than 3+ if quantitation not performed
OR
b) Cellular casts--may be red cell, hemoglobin,
granular, tubular, or mixed |
| 8. Neurologic Disorder |
a) Seizures--in the absence of offending drugs
or known metabolic derangements; e.g., uremia,
ketoacidosis, or electrolyte imbalance
OR
b) Psychosis--in the absence of offending drugs
or known metabolic derangements, e.g., uremia,
ketoacidosis, or electrolyte imbalance |
| 9. Hematologic Disorder |
a) Hemolytic anemia--with reticulocytosis
OR
b) Leukopenia--< 4,000/mm3 on = 2 occasions
OR
c) Lyphopenia--< 1,500/ mm3 on = 2 occasions
OR
d) Thrombocytopenia--<100,000/ mm3 in the absence
of offending drugs |
| 10. Immunologic Disorder |
a) Anti-DNA: antibody to native DNA in abnormal
titer
OR
b) Anti-Sm: presence of antibody to Sm nuclear
antigen
OR
c) Positive finding of antiphospholipid antibodies
on: 1. an abnormal serum level of IgG or IgM
anticardiolipin antibodies,
2. a positive test result for lupus anticoagulant
using a standard method, or
3. a false-positive test result for at least
6 months confirmed by Treponema pallidum immobilization
or fluorescent treponemal antibody absorption
test |
| 11. Positive Antinuclear Antibody |
An abnormal titer of antinuclear antibody by
immunofluorescence or an equivalent assay at any
point in time and in the absence of drugs |
Blood Tests may also show:
Elevated Blood Urea Nitrogen
Elevated Immunoglobulin G
Elevated C-Reactive Protein
Low Platelet Count
Low White Blood Cell Count
Positive Lupus Anticoagulant Antibody
Positive Anti-Nuclear Antibody
Elevated Creatinine
Elevated Immunoglobulin G
Elevated Creatine Phosphokinase
Elevated Erythrocyte Sedimentation Rate
Low Albumin
Low Red Blood Cell Count
Positive Syphilis Test
Positive Anti-Phospholipid Antibody
Chest X-rays may be used to determine if there is
fluid retention or inflammation in the lungs and an
Electrocardiogram may be show irregular rhythms of
the heart.
Treatment:
There is no cure for Lupus so treatment is aimed
at symptom management and to prevent damage. Treatment
is also very individual.
The most common initial treatments for Lupus include
Non-Steroidal Anti-Inflammatories such as Ibuprofen
and Naproxen to help reduce the inflammation being
caused by the Lupus. Antimalarials such as hydroxychloroquine,
are also used, though it's not known why Lupus has
a positive response to the medication. There are side-effects
to the antimalarial that can affect the eyes, though,
so constant monitoring of the vision and retina of
the eyes are required while on antimalarial therapy.
Corticosteroids may also be used on an as-needed
basis since they, too, carry a risk when used. Corticosteroids
are a powerful antinflammatory and may be used when
there is no response to previous therapies. Immunosuppressant
therapy may be used to reduce the immune response
against the healthy tissues of the organs and tissues.
Symptom management is also aimed at reducing pain,
increasing mobility and is done case-by-case based
on the patients history and risks.
Prognosis:
The outlook for Lupus patients is quite good and
greatly improved over the years. With proper treatment,
monitoring and lifestyle adjustments, Lupus patients
can maintain some resemblance of a normal life with
some limitations. When complications do arise, if
they are caught early enough they, too, are treatable.
Support is very high recommendation by the medical
community as Lupus can be a debilitating disease and
many times and can relapse over and over again. Support
can help you maintain a better sense of mental health
to better deal with a chronic illness and depression
that naturally comes with a chronic illness.
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