What is Lupus?

The immune system is found to malfunction & is unable to distinguish between healthy tissue & foreign invaders in case of lupus. This results in production of antibodies which attack healthy cells & tissues so as to cause pain, inflammation & damage to various parts of the body. Most common type of autoantibody which is found to develop among lupus patients is known as antinuclear antibody (ANA). While most of these autoantibodies circulate the blood, some of these are able to permeate cells & attack DNA within the cell’s nucleus & result in damaging some organs during flare-ups. However, it is very important to note that lupus is non-contagious. It is a disease of flare-ups & remissions which creates chronic symptomatic conditions that can exacerbate & make patients feel ill before improving.

What Causes Lupus?

Exact causes of lupus are still unknown. However, experts understand that lupus is developed in response to a number of factors which are found inside the body (hormones & genetics) & in the environment outside.

  • Hormones – Almost 90 percent of occurrence of lupus are found in females. Researchers have therefore linked possible relationship between hormone estrogen & lupus. Since estrogen is considered as an ‘immune enhancing’ hormone, they provide stronger immune system to women when compared to men. Incidence of autoimmune disease is therefore generally higher among women. Moreover, studies reveal that women have lupus flare-ups prior to menstruation cycles & during pregnancy. This is exactly when estrogen production is increased in the female system.
  • Genetics – As of now, there is no specific gene or group of genes which has been found to be the cause of lupus. However, it is a fact that lupus is more prevalent in some families. Certain genes have also been identified to be contributing to developing lupus. However, these associations are yet inconclusive for causing lupus from the highlighted fact that only one of the twins are found to develop lupus. There is only a 25 percent chance that identical twins may develop lupus & 2 – 3 percent chance that fraternal twins develop this disease.
  • Biomarkers – This is another significant area of research for lupus. Biomarkers are molecules reflecting specific pathological or biological process or response to therapeutic intervention through which doctors can understand what is happening inside the body. The following potential biomarkers have been identified by researchers which can be helpful.
    • Anti-Double-Stranded DNA Antibodies for flares
    • Complement C3a for flares
    • Proteins in Urine of Lupus Patients with Renal Disease
    • C-Reactive Protein (CRP) made by Liver
    • C4d Protein in Blood indicating Lupus
  • Environment – Scientists consider environmental agents like chemicals & viruses to be contributing as triggers for lupus in people who are genetically susceptible. Some environmental agents triggering lupus may include the following.
    • Ultraviolet rays from sun – UVB in particular
    • Ultraviolet rays from fluorescent light bulbs used in tanning beds
    • Exposure to silica dust
    • Sulfa drugs which make people more sensitive to sun
    • Sun-sensitizing tetracycline drugs
    • Penicillin
    • Other antibiotic drugs
    • Injury
    • Exhaustion
    • Cold or viral illnesses
    • Infections, including effects of Epstein-Barr virus
    • Smoking
    • Stress to body like pregnancy, giving birth, physical harm or surgery
    • Emotional stresses like divorce, death in family, illness or other complications in life

Signs & Symptoms of Lupus

Generally characterized by production of antibodies to components of cell nucleus, lupus patients may experience the following.

  • Skin Rashes
  • Pain or Swelling in Joints
  • Fatigue
  • Confusion
  • Fevers
  • Headaches
  • Pain in Chest upon Deep Breathing
  • Unusual Hair Loss
  • Swollen Glands
  • Edema – Swelling in Leg or Around Eyes
  • Raynaud’s Phenomenon (pale or purple toes or fingers from stress or cold)

A wide range of clinical manifestations during lupus, include the following.

  • Arthritis
  • Oral Ulcers
  • Photosensitivity
  • Rashes
  • Pericarditis
  • Pleuritis
  • Seizures
  • Kidney Problems
  • Psychosis
  • Anemia
  • Vasculitis
  • Blood Cell Abnormalities
  • Endocarditis
  • Myocarditis
  • Thrombocytopenia
  • Leucopenia

Involvement of brain is a rare condition among people with lupus. This is generally found to cause seizures, depression, confusion & strokes on rare occasions.

Following systemic conditions in the body can also be affected by lupus.

  • Nephritis – Inflammation of kidneys.
  • Pleuritis – Inflammation of lining of chest cavity causing pain.
  • Pneumonia
  • Central Nervous System (CNS) – changes in behavior, stroke, seizures, problems with vision, memory disturbances, depression, dizziness & headaches.
  • Blood Vessels – affecting circulation of blood as blood vessels become inflamed.
  • Blood – decrease in number of platelets which cause clotting (thrombocytopenia) or decreased number of white blood cells (leucopenia) or anemia.
  • Heart – inflammation in heart or in the surrounding membrane causing chest pain & or other symptoms. Heart valve surfaces may thicken & develop growths leading to heart murmurs.
  • Infections – more vulnerable since both disease & treatments weaken the immune system. Infections include shingles, herpes, salmonella, yeast infections, respiratory infections & urinary tract infections.
  • Avascular Necrosis – this is bone tissue death which occurs when blood supply to bones diminish leading to tiny breaks & bone collapse. The hip joint is mostly affected.
  • Pregnancy Complications – increased risk of miscarriage among women. Preeclampsia or risk of high blood pressure during pregnancy & preterm birth. It is sensible to delay pregnancy until lupus is in control for at least 6 months of time.

Types of Lupus

There are several types of lupus. Some of these include the following.

  • SLE – Systemic Lupus Erythematosus – This is the most common type of lupus which means that the disease is capable affecting most parts of the body. SLE symptoms can be mild or severe & most common among patients aged between 15 – 45 years. Additionally, SLE can also occur either during childhood or later in life.
  • DLE – Discoid Lupus Erythematosus – This is basically a chronic skin disorder which involves the appearance of red & raised rashes on scalp, face or somewhere else on the body. These raised areas which can last for days or years become thick & scaly & can also cause scarring. In some cases, they are also found to recur. Some people with DLE may also have or develop SLE.
  • Subacute Cutaneous Lupus Erythematosus – This type of lupus refers to skin lesions appearing on parts of the body which have been exposed to the sun. However, these lesions do not cause any scarring.
  • Drug-Induced Lupus – There are many medications which can cause lupus. These include some oral contraceptive pills, anti-fungals, antibiotics, thyroid medications, high blood pressure medications & antiseizure drugs. Drug-induced lupus symptoms usually totally disappear when consumption of the drug has been stopped.
  • Neonatal Lupus – This is a rare type of lupus which can occur in newborn babies of women having SLE along with or without Sjogren’s syndrome. However, most babies born to mothers with SLE are found to be healthy. It is advisable that women with SLE be under doctor’s care during pregnancy.

Treatment Options for Lupus

As of now, there is no cure for lupus. But lupus can be effectively treated & patients can thereby lead active & healthy lives. However, specialist doctors are required for treatment of lupus symptoms. The lupus healthcare team usually consists of the following medical professionals.

  • Family Doctor
  • Rheumatologist
  • Clinical Immunologist
  • Cardiologist
  • Neurologist
  • Dermatologist
  • Hematologist
  • Nephrologists
  • Endocrinologist
  • Psychologist
  • Occupational Therapist
  • Dieticians
  • Nurses
  • Social Workers

Doctors in the healthcare team will develop a treatment plan based on the lifestyle, symptoms, overall health, gender & age of the patient. Treatments are customized according to individual requirements & may be reviewed from time to time aiming to prevent & treat flares while reducing organ damage & other associated problems.

Drug treatments for lupus generally aim to achieve the following goals.

  • Reduce pain & swelling
  • Reduce or prevent flares
  • Assist the immune system
  • Reduce or prevent damage to joints
  • Balance the hormones

Medications Used in Treatment of Lupus

  • NSAIDs
  • Corticosteroids
  • Antimalarials
  • Immunosuppressants
  • BLyS-Specific Inhibitors
  • Hormonal Therapies like DHEA (Dehydroepiandrosterone)
  • Intravenous Immunoglobulin (proteins from human blood)

Special Medications Used in Treatment of Lupus

  • Derivatives of Cortisone (Prednisone)
  • Steroid Creams
  • Cyclophosphamide (Cytoxan)
  • Azathioprine (Imuran)
  • Methotrexate (Rheumatrex)
  • Mycophenolate Mofetil (CellCept)
  • Belimumab (Benlysta)
  • Rituximab (Rituxan)

Research is still unable to show that complementary & alternative therapies like homeopathy, chiropractic treatment, ointment & creams, fish oils, nutritional supplements & special diets can either affect or prevent organ damage or the disease process. However, these therapies may help lupus patients reduce or cope up with stress factors that are commonly associated with all types of chronic illnesses. Moreover, stress management for lupus patients varies from one person to another. In general, approaches like meditation & relaxation techniques, exercise & setting priorities for managing time & energy can help patients to cope up with stress.

Living with Lupus

There are quite a few measures lupus patients can take for coping up with the disease even though there is no cure.

  • Diet – Consume a nutritious & well-balanced diet which is limited on salt & sugar, especially when taking corticosteroids. While alfalfa sprouts are found to increase inflammation, there is evidence that fish can be anti-inflammatory.
  • Exercise – This can include cycling, aerobics, swimming & low-impact walking. It will lower risk of osteoporosis & also help in preventing muscular atrophy.
  • Pain Management – Jacuzzi, soak in a hot tub or apply moist heat to joints which are painful.
  • Protection from Sun – Block UVA & UVB rays with sunscreen SPF of at least 15.
  • Rehabilitation – Take help of vocational, occupational & physical therapists can help select the right assistive devices, lower stress, exercise, strengthen muscles & train for jobs which do not exacerbate symptoms.
  • Fatigue – Remaining active & resting for appropriate periods of time will help lupus patients control fatigue.
  • Pregnancy – In case you are or planning a pregnancy, it would be ideal to consult a doctor about lupus risks associated with pregnancy.
  • Cognitive Function – Cognitive therapists or psychologists can be helpful in case lupus is leading to memory loss or cognitive dysfunction.
  • Relationships – Be honest & take medications on time, while keeping appointments & good relationships with doctors who are helping with managing lupus.
  • Lifestyle – It would be sensible to quit smoking.

Nevertheless, most patients with lupus live normal or near-normal life spans & continue with normal daily activities. However, they may feel the need to cut back on activity levels, change ways to deal with fatigue, joint pain & other symptoms & obtain help for childcare if required. Sometimes they may also feel the need to completely take time off from normal daily activities. All of these lifestyle changes usually depend upon the severity of disease & whether the disease has affected vital organs like the kidneys. However, it is uncommon for lupus to cause deformity or damage to joints which usually happens among people having rheumatoid arthritis or some other type of autoimmune disease.

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