What is Lupus?

Systemic lupus erythematosus, also known as just lupus, is an autoimmune disease that happens when the immune system attacks its tissues, causing inflammation, swelling, pain, and damage. Lupus symptoms include fatigue, joint pain, fever, and a rash, all of which are cause of a number of unpleasant and disabling symptoms. The cause of lupus is not fully known, but we know that there is an important genetic component involved. You might be asking why do genetic testing? The reason is simple. Despite contribution, gene expression can be influenced by the environment.

That being said, the report offers a healthier chance of life. If lupus comes to manifest, the customer will be prepared, and will be checked early and will have less limiting consequences.

Lupus is occasionally called the “chameleon” of diseases, because it can virtually affect any organ or tissue, and is present in many different ways. It affects 40-150 out of every 100,000 people, and is 10 times more prevalent in women than in men.

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Symptoms

The patient, usually female, produces substances harmful to her system. The antibodies, which are a defense mechanism, become a self-harm mechanism. Therefore, what characterizes the autoimmune disease is the formation of antibodies against its own constituents.

These multiple forms of clinical manifestation can sometimes confuse and delay diagnosis. Lupus requires careful treatment by medical specialists. People adequately addressed, are able to lead normal lives, but those not treated, may end up having serious complications, sometimes incompatible with life.

The typical patient has small joint inflammation, spots on the skin, which are exposed to sunlight, fever and fatigue. But the disease can vary in presentation, making diagnosis sometimes difficult.

There have been great misdiagnosis regarding lupus in the past, until the American Society of Rheumatology enunciated eleven diagnostic criteria in 1971. An individual who fills only four of them surely has the disease.

The first two refer to the oral mucosa. Among other important oral lesions, there will appear sores in the mouth, and in the initial phase, may require a differential diagnosis with pemphigus, a common disease in tropical countries. What may also occur, is mucositis, an inflammatory lesion caused by factors such as aphthous stomatitis repetition, as one example. The second, is characterized by the presence of discoid rash in the oral cavity.

The third criteria involves the so-called butterfly rash, or butterfly wing, which many acknowledge as the most important sign, but it is not necessarily. There is a lesion which appears in the lateral regions of the nose and extends horizontally into the malar region, as a butterfly winged shape. It becomes reddish by erythema, which generally presents a clinical appearance desquamation, i.e. when the lesion is scraped, it flakes off profusely.

The fourth criteria is photosensitivity. This is why the physician should always investigate whether the patient has presented problems when exposed to sunlight, and will know that minimum exposure may cause very severe skin burns, especially to the face, the back, and other parts of the exposed body that the sun reaches while at the beach or in the pool.The fifth criteria is articular pain, or pain in the joints. It is an asymmetrical joint pain that shifts, and that manifests itself preferably in the upper and lower members on one side of the body, and migrates from one joint to another. Generally, it is a pain without heat or flushing (redness) or edema (swelling), which are the three signs of inflammation. There are cases, however, that when those three symptoms are present, as well as arthritis, there may also occur an inflammation in the first outbreak 90% of patients.

The sixth criteria, and one of the most important is renal damage. Patients with renal impairment accompanied by hypertension in the first outbreak end up with a poor outcome. Hypertension denotes the inflammatory process that appears on the membranes of the structures involved in blood filtration systems, that crosses the kidneys and then the patient is affected by glomerulonephritis.

If this disorder is not appropriately treated, the patient will develop a rapidly progressive renal failure. Indeed, the kidneys dictate the prognosis of 90% of cases, and it will be worse if accompanied with the seventh criteria: a brain injury. Its first sign is a seizure, a common seizure that can be mistaken as a characteristic of an exclusively convulsive disease and confuse the diagnosis and treatment of lupus background.

The eighth criterion relates to disorders of the blood test, also changes in the blood, such as – anemia (low red blood cell count), leukopenia (low white blood cell count), lymphopenia (low level of specific white blood cells), or thrombocytopenia (low platelet count).

The ninth criteria says it is the immunologic criteria. SLE patients present a falsely positive reaction for syphilis, and manifest lupus anticoagulant syndrome characterized by thrombosis, embolism and recurrent miscarriages.

The tenth test cite, the incidence of pericarditis (inflammation of the pericardium, a membrane that externally surrounds the heart) and pleuritis (inflammation of the pleura, the membrane covering the lungs) can also occur in patients with lupus. In 70% of cases, The pericarditis was subclinical and is only diagnosed at the autopsy.

The eleventh is the antinuclear factor, ANA, this result can be positive up to nine years before the first manifestation.

Lupus can manifest in other organs with diffuse symptoms as well, and this makes rapid diagnosis and medical history of the patient crucial for better treatment and subsequent prognosis.

General symptoms include fever, joint pain and fatigue.

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Treatment

Most drugs lead to serious side effects and their use is the result of an analysis of the potential risks versus benefits. These are the main ones: cortisone (prednisone, prednisolone, dexamethasone, methylprednisolone, hydrocortisone, etc.); immunosuppressant (cyclophosphamide, methotrexate, azathioprine, mycophenolate mofetil, cyclosporine); antimalarial drugs (chloroquine diphosphate, hydroxychloroquine); anticoagulants (warfarin, heparin), among others. Recently a number of new medications, listed as “biological” calls, have been brought to market, bringing hope to those with the most aggressive forms of the disease. Its effectiveness, however, is still being studied.

The lupus patients have, depending on the disease and treatment, increased risk for cardiovascular diseases such as heart attack and stroke. We should therefore always be assisted in reducing risk factors such as cholesterol, hypertension, and smoking. Osteoporosis is also common in these individuals and their prevention is part of a comprehensive approach.

Vaccines such as influenza, pneumococcus, tetanus, Haemophilus influenza and hepatitis-B provide less resistance than SLE to persons in general, but must be used and do not cause reactivation of the disease. Vaccines with live attenuated viruses (bp measles, mumps, rubella, polio, chicken pox, yellow fever) are dangerous and should not be used routinely in patients who are using immunosuppressant drugs.

So far there is no scientific evidence that vitamins for specific diets can modify the development of lupus, and major chronic inflammatory conditions can lead to weakness and weight loss. In these cases a high caloric diet may be helpful. Corticosteroids may lead to increased appetite, obesity and worsening cholesterol. A diet low in calories and cholesterol levels may be interesting for these patients. Two studies support the idea that fish oil with Omega-3 (eicosapentaenoic and docosahexaenoic acids) could reduce disease activity, and improve the function of blood vessels, but they are preliminary and small for what other definitive conclusions can be made. There is no scientific evidence to support the use of herbal medicines and some (bp echinacea) can be harmful.Most people with lupus may live a normal life, but the disease must be carefully monitored and adjusted as necessary during treatment to prevent serious complications.

Even with recent advances in treatment, lupus is chronic, potentially severe, and it disrupts the normal life of the individual forcing himself to a routine of frequent examinations, doctor visits, hospitals, side effects of medications, symptoms and sequelae disease, which these are sometimes permanent. This is particularly difficult to accept in the youth age group most affected by lupus. The uncertainty of its course, treatment failure, and inflammation hormones collaborate together and lead to anger, frustration, depression, loss of hope and the will to fight.

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dnaHow to diagnosis Lupus?

Diagnosis is difficult and time consuming. Suspected cases must be confirmed by a series of tests. The most famous of these is the ANA (antinuclear factor), which is present in about 99% of cases of Lupus, but also up to 30% of normal persons. Some antibodies are highly specific for lupus (anti-SM, double-stranded anti-DNA, anti-ribosomal P) and, if present in significant concentrations, lupus is virtually certain. As this does not happen very often (10-50% of cases), physicians have to deal with a puzzle of symptoms and tests to make the diagnosis.

Despite being a complex disease, genetic markers were identified during present Lupus Erythematosus. Variations on the X chromosome could explain the higher frequency of the disease in women. Currently more than 50 genetic alterations have been identified as predisposing lupus. Genome-wide genetic association studies (GWAS) have proven that preventive medicine can improve and advance the diagnosis of systemic diseases such as lupus, improving the quality of life and reducing the consequences that may be infringed by the progression of symptoms.

The development of lupus is also variable. Most progress with periods of worsening and then some improvement, and a part may go into remission. Unfortunately in rare cases, lupus can be aggressive and even fatal, even despite treatment. What drugs are used, and how many are a decision that should be taken into consideration by an experienced rheumatologist, based on onsets and severity of each patient.

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FAQ

I have just been diagnosed with lupus. will i die of it?

Lupus is not a universally fatal disease. In fact, today, with close follow-up and treatment, 80-90% of the people with lupus can expect to live a normal life span.

Lupus varies in intensity and degree. Some people have a mild case, others moderate and some severe, which tends to be more difficult to treat and control. For people who have a severe flare-up, there is a greater chance that their lupus may be life-threatening. People do die of this disease; however, the majority of people living with lupus today can expect to live a normal lifespan.

What exactly constitutes a flare?

When a symptom of lupus appears, whatever it may be, it is sometimes called a “flare”. For example, if someone has a new lupus rash, this is a “flare” of their skin disease. Since every person’s lupus is unique, this is what constitutes a flare.

We talk about the concept of flares in lupus because for most people, symptoms and signs of the disease come and go. Most people have periods when they feel fine and then other periods when their disease is more active or “flares”.

Many Doctors have informed me that I should not have any immunizations as it may cause a flare of my lupus. Is this true? If so, are there any that won’t cause such a reaction? This is a concern for tetanus, flu shots, and immunizations required for traveling to different countries.

We now have some good studies showing that most vaccines are safe in people with lupus and are not associated with significant flares. I recommend that my patients get a variety of vaccines, including the inactivated flu, pneumococcal, and tetanus vaccines. This is very important to prevent serious infections, especially if you are taking drugs that suppress your immune system, making these infections more serious if they occur. My recommendations are consistent with those of the Centers for Disease Control (CDC) in the United States.

There is one caveat to the above. Although most vaccines are safe for people with lupus, there is one type of vaccine that may pose a risk if you are receiving drugs that suppress your immune system: “live” vaccines. Live vaccines contain a weakened form of a live virus, which is not strong enough to cause problems in people with a normal immune system. However, in people who are taking medications that suppress the immune system, we worry that live vaccines might cause symptoms of active infection. Examples of live vaccines are measles, mumps and rubella (MMR), chicken pox (varicella), shingles (zoster), yellow fever and intranasal flu. If you need one of these vaccines, it is important to discuss this with your lupus doctor. In some instances, your doctor may decide to temporarily stop certain immune suppressing drugs before administering these vaccines.

Women with systemic lupus erythematosus can get pregnant?

Women with lupus tend not to have trouble getting pregnant. However, when conceiving, lupus is quiet and often results in healthier pregnancies. Lupus does cause some risk of going into labor early. If antibodies like SSA (Ro) or phospholipid are present, women will be seen by high-risk pregnancy specialists to prevent complications.

Because lupus is influenced by female sex hormones, pregnancy can affect the severity of a woman’s lupus. About a third of lupus patients experience a flare-up during pregnancy, a third experience no change, and a third actually see their symptoms improve.

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