Lupus is present if you answer yes to some or all of the following questions
Do you have unexplained achiness or fatigue that has persisted for over three months? Do you have rashes that recur or develop after sun exposure? Do your joints swell or fingers turn white or blue in the cold? Do you get ulcers in your nose or mouth, pain with breathing, or muscle weakness? Have you had a blood test called the ANA or anti-nuclear antibody come back positive?
Lupus erythematosus (pronounced loo-pus air-re-them-atoe-sus) is an autoimmune disorder like RA. The disease was named by clinicians who observed that the skin problems, which are often a signal of the condition, resemble the facial markings of a wolf (lupus means wolf; erythematosus means redness). The cause is unknown.
Researchers theorize that the most likely culprit is a genetic disposition toward the disease, combined with a subsequent exposure to some environmental insult or infection that leads to a “confused” immune system that attacks the body’s tissues. Up to 5 percent of sisters and daughters of patients with lupus may also develop the disease. It is not uncommon for relatives of patients to have abnormal antibodies in their blood, but with no symptoms of the disease. Lower levels of anti-nuclear antibodies (ANA) are found when RA is also present.
It used to be that only the most severe cases were diagnosed; now, due to the sensitivity of newer ANA blood tests, milder cases are diagnosed more quickly. Most people live a normal life with few changes in lifestyle. Nevertheless, detecting the condition earlier allows patients to be monitored for evidence of more serious illness, and be treated appropriately.
Treatment of the underlying symptoms includes Plaquenil® (hydroxychloroquine sulfate), which is used in RA, may help to control the skin and joint symptoms of lupus, as well as the fatigue. When internal organs such as the kidneys, heart or lungs are involved, stronger medications are prescribed. These include Imuran® (azathioprine), CellCept® (mycophenolate mofetil) or Cytoxan® (cyclophosphamide). These drugs may be very effective, but they can pose an increased risk of potential side effects. Some do not have to take medications regularly. Prescription drugs (such as corticosteroids) are prescribed as needed for a flare-up of symptoms.
Four Types of Lupus
There are four types of lupus. All feature the telltale skin rash that is the hallmark of the disorder; none are infectious. Nor are they cancer or malignancy. Like RA, people with lupus have an overactive immune system. The number of cases in the United States is unknown, but experts estimate that up to 1.5 million people may be affected by the disease. Ninety percent of lupus patients are women.
- Drug Induced – Drug-induced lupus is a rare condition caused by long-term exposure to certain medications. The condition clears up once the offending medication is discontinued. However, the presence of anti-nuclear antibodies (ANA), a marker for lupus, may continue to show in blood tests for a year or more.
- Discoid – A skin rash with raised, red, scaling areas, identifies discoid lupus. These lesions sometimes leave scars and are typically seen on the face, scalp, and other sun-exposed areas. Most people with discoid lupus do not have internal organ involvement, as seen with the systemic form of the disease.
- Subacute – Like discoid lupus, subacute lupus is also associated with a skin rash with raised, red, scaly patches. However, unlike discoid lupus, this form of the disease doesn’t have a scar.
- Systemic Lupus Erythematosus SLE – In the 1890s, the famed physician Sir William Osler observed that internal organs — or systems — can also be involved in addition to skin changes associated with lupus. Thus, the term systemic lupus erythematosus (SLE) was coined. Symptoms of SLE include arthritis, rash, and flu-like symptoms such as aching joints and muscles and fatigue. Infection and sunlight may trigger lupus, but symptoms seem to come and go for no apparent reason making the condition harder to diagnose. SLE commonly affects the heart or lungs, where there is usually an inflammation of the organ’s lining, causing chest pain, especially with breathing. The kidneys may also be involved in SLE. Patients may have no symptoms, but a urine test can detect evidence of inflammation. Other systems and regions affected by SLE may include the bone marrow (blood cells), the brain and blood vessels.
Diagnosis of Lupus
The American College of Rheumatology established 11 criteria to help identify the disorder. Usually, there are four or more of the following symptoms:
- Malar “butterfly” rash on the cheeks
- Discoid skin lesions
- Sun sensitivity, where a rash develops from exposure to sun or UV light
- Mouth sores, usually on the roof or back of the mouth (typically not painful).
- Arthritis, with prolonged morning stiffness, usually up to an hour, improving as the day goes on
- Abnormal urine test showing large amounts of protein
- A history of seizures or psychiatric problems
- Sharp pain during breathing due to inflammation of the lining of the lungs or heart, which worsens with deep inhalations (pleurisy)
- Low white blood count, low platelet count or evidence of anemia
- The presence of antibodies to double-strand DNA (ds-DNA), or of Smith (Sm) antibodies which are specific for diagnosing lupus
- A positive anti-nuclear antibody (ANA) test. 98 percent of people with lupus have this antibody
Lupus is a treatable condition and in many cases, does not cause any serious medical problems. Proper diagnosis and treatment can be helpful to relieve symptoms and prevent progression.
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