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Lupus: The Great Pretender

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Category: Systemic Lupus Erythematous Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD
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Lupus is an autoimmune disease, which means that the immune system appears to attack the body causing inflammation in the joints, skin and other organ systems. Lupus, the Latin word for wolf, hunts its prey in a pack, disguising itself and making it difficult for its victim to see it coming. Lupus got its name from its telltale facial rash that marks the cheeks and bridge of the nose with a wolf-like mask.

Our immune system is a highly complex defense network that protects our bodies from harmful invaders such as bacteria, viruses, other infectious microorganisms, and even cancer. For the most part, our immune system performs these tasks well, and is particularly successful at repelling invaders. When the immune system detects an antigen (foreign invader), the white blood cells trigger a release of antibodies and other chemical mediators to fight the antigen. This process is what causes inflammation, pain, redness, and swelling in the affected tissue. Normally, inflammation is part of a protective response by the immune system, which helps our body fend off infection and heal injury.

However, our immune system can sometimes overreact and make a mistake, and in some cases, resort even to mutiny. This condition, which occurs when the body fails to recognize its own components and attacks them with auto-antibodies (auto meaning self), is known as autoimmune disease (self-destruction). The results are self-perpetual inflammation and tissue damage.

The immune system of people with systemic lupus erythematous (SLE) goes astray, mistaking its own tissue for a foreign invader. Antinuclear antibodies (ANA) are autoantibodies that are produced by lupus. The cause of lupus is unknown. However, it is likely that there is no single cause, but rather a combination of genetic, environmental, and possibly hormonal factors that determines one’s risk.

Approximately 70 percent of the people who have lupus have systemic lupus erythematous (SLE). SLE can affect the joints, skin, kidneys, nervous system, heart, or blood-forming organs. Approximately 15 percent of people with lupus have cutaneous lupus, also called discoid lupus. This type is characterized by a red, raised rash that appears on the face, scalp, or elsewhere and is usually limited to the skin and not organs. Approximately 5 percent of people with SLE have drug-induced lupus, which typically subsides when the drug is stopped. Studies have shown that a small percent of people with discoid lupus have or will develop SLE.

Although SLE usually first appears between the ages of 15 and 45, it can occur during childhood or later in life. Nine out of ten people affected by lupus are women, especially African American women, who are three times more at risk than Caucasian women. Other races commonly affected are Hispanic/Latino, Asian, and American Indian.

WHAT TO LOOK FOR?

Lupus is a challenging disease for the physician and is sometimes called the “Great Pretender”, because its wide range of symptoms deviously makes it difficult to differentiate it from other conditions. The common symptoms of lupus include a butterfly shaped or wolf-like rash over the cheeks and across the bridge of the nose, sores on the tongue and mouth, joint pain and swelling, discoloration of the fingertips and other symptoms related to different organs.

HOW IT'S DIAGNOSED:

The most significant blood test called antinuclear antibody (ANA), which is found in the blood of 95% of people with lupus, is what is ordered to help diagnosis lupus. Unfortunately, ANA may be found as a result of other diseases and even in a number of healthy people, particularly in the elderly. Therefore, the presence of ANA alone does not mean that a person has lupus.

HOW IT'S TREATED:

Treatment of lupus varies, depending upon which organ systems are affected and how severe your symptoms are. In general, the less severe the disease, the more conservative the medication. These milder forms of lupus usually are treated with non-steroidal anti-inflammatory drugs (NSAIDs), which help reduce pain and inflammation. When you have a potentially serious involvement of a major organ system, your doctor will usually prescribe corticosteroids to suppress inflammation.

Anti-malaria drugs such as hydroxychloroquine (Plaquenil) can suppress parts of the immune response. These drugs help treat symptoms of discoid lupus and some of the manifestations of SLE, especially fever, fatigue, skin rash, joint pain. Also, clinical studies have found that continuous treatment with anti-malaria drugs may prevent flare-ups from recurring.

Immuno-suppressant drugs such as azathioprine (Imuran) and cyclophosphamide (Cytoxan) are effective in severe cases, especially with kidney or central nerve system involvement. These very potent drugs are required to suppress the immune system, but may have serious side effects. This is why patients taking these drugs require frequent blood test monitoring.

HOW TO PROTECT YOURSELF:

In addition to drug treatment, patients are advised to limit their exposure to sunlight, which can aggravate lupus and make symptoms worse. Using sunscreen and sun block with a SPF of 15 or higher and avoiding the sun between 11 a.m. and 2 p.m., when ultraviolet light is strongest, are great ways to protect yourself.

Lupus may flare during pregnancy. There may be an increased chance of having a miscarriage either early, or late in the pregnancy. If you have lupus, be sure to consult your doctor about any plans to become pregnant. With careful planning, many women with lupus can have normal pregnancies and healthy babies.

Due to the autoimmune process, people with lupus are at greater risk of developing infection. For some people, infections can trigger disease flares. It is essential to seek medical attention early if you develop symptoms such as fever or yellowish sputum in order to receive treatment as soon as possible.

At present, there is no cure for lupus. However, with the appropriate drugs, treatment can be very successful and most people can lead active and healthy lives. The most difficult task is detecting its presence and catching the wolf.

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