Lupus

Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years.

Any part of the body can be affected by lupus as it has an array of clinical manifestations affecting the skin, joints, brain, lungs, kidneys, blood vessels and other internal organs. Systemic lupus erythematosus or SLE is the most common form of lupus. This article focuses on SLE and will refer to SLE as “lupus” throughout.

What is Lupus?

The immune system normally fights off dangerous infections and bacteria to keep the body healthy. An autoimmune disease occurs when the immune system attacks its own body because it confuses it for something foreign. In lupus, the immune system malfunctions and cannot distinguish between foreign invaders and healthy tissue. Antibodies are then produced against the body’s healthy cells and tissues, causing inflammation, pain and damage in various parts of the body. These antibodies, called autoantibodies, contribute to the inflammation of numerous parts of the body and can cause damage to organs and tissues. The most common type of autoantibody that develops in people with lupus is called an antinuclear antibody (ANA) because it reacts with parts of the cell’s nucleus (command center).

The autoantibodies circulate in the blood, but some of the body’s cells have walls permeable enough to let some autoantibodies through. These can then attack the DNA in the cell’s nucleus. This is why some organs can be attacked during a flare-up while others are not.

Generally, lupus develops slowly, with symptoms that come and go. Women who get lupus most often have symptoms and are diagnosed between the ages of 15 and 45. But the disease also can happen in childhood or later in life. For some people, lupus is a mild disease. But for others, it may cause severe problems. Even if your lupus symptoms are mild, it is a serious disease that needs constant monitoring and treatment. It can harm your organs and put your life at risk if untreated.

Types of Lupus –

Although the term “lupus” commonly refers to SLE, there are several types of lupus –

• Systemic lupus erythematosus, or SLE – SLE can be mild or severe and can affect various parts of the body.
• Cutaneous lupus erythematosus – “Cutaneous” means “skin.” can be limited to the skin or seen in those with SLE.
• Discoid lupus erythematosus – Also called DLE mainly affects the skin. The discoid rash usually begins as a red raised rash that becomes scaly or changes color to a dark brown.
• Subacute cutaneous lupus erythematosus – This causes skin lesions on parts of the body exposed to sun. These lesions do not cause scars.
• Drug-induced lupus is a form of lupus caused by certain medicines.
• Neonatal lupus is a rare disease in infants that is caused by certain antibodies from the mother. These antibodies can be found in mothers who have lupus.

Who is at risk?

Anyone can get lupus. About 9 out of 10 adults with lupus are women ages 15 to 45. African-American women are three times more likely to get lupus than white women. Lupus is also more common in Latina, Asian, and Native American women. Men are at a higher risk before puberty and after age 50. Despite an increase in lupus in men in these age groups, two-thirds of the people who have lupus before puberty and after age 50 are women.

Causes

The following are the causes of Lupus –

• Environment (sunlight, stress, smoking, certain medications, and viruses might trigger symptoms in people who are prone to getting lupus). Following are the environmental causes –

• Ultraviolet rays from the sun – UVB in particular
• Ultraviolet rays from fluorescent light bulbs
• Exposure to silica dust in agricultural or industrial settings
• Infections – including the effects of Epstein-Barr virus
• Cold or a viral illness
• Exhaustion
• Injury
• Emotional stress, such as divorce, illness, death in the family or other life complications
• Anything else that causes stress to the body such as surgery, physical harm, pregnancy or giving birth
• Smoking.

• Hormones such as estrogen (lupus is more common in women during childbearing years)
• Problems with the immune system
• Genes play an important role, but are not the only reason a person will get lupus. Even someone who has one or more of the genes associated with lupus has a small chance of actually getting the disease. And only 10 percent of people with lupus have a parent or sibling who also has it.
• Lupus can be triggered by certain types of anti-seizure medications, blood pressure medications and antibiotics. People who have drug-induced lupus usually see their symptoms go away when they stop taking the medication.
  • Sulfa drugs, which make a person more sensitive to the sun: trimethoprim-sulfamethoxazole (Bactrim and Septra); sulfisoxazole (Gantrisin); tolbutamide (Orinase); sulfasalazine (Azulfidine); diuretics
  • Sun-sensitizing tetracycline drugs: minocycline (Minocin)
  • Penicillin or other antibiotic drugs: amoxicillin (Amoxil); ampicillin (Ampicillin Sodium ADD-Vantage); cloxacillin (Cloxapen)

 

Symptoms

Symptoms of lupus vary, but some of the most common symptoms of lupus are:

• Pain or swelling in joints
• Muscle pain
• Fever with no known cause
• Red rashes, most often on the face
• Chest pain when taking a deep breath
• Hair loss
• Pale or purple fingers or toes
• Sensitivity to the sun
• Swelling in legs or around eyes
• Mouth ulcers
• Swollen glands
• Feeling very tired.
• Less common symptoms include:
• Anemia (a decrease in red blood cells)
• Headaches
• Dizzy spells
• Feeling sad
• Confusion

Symptoms may come and go. The times when a person is having symptoms are called flares, which can range from mild to severe. New symptoms may appear at any time.

Treatment

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs) – NSAIDs are used to reduce pain and swelling in joints and muscles. They can help with mild lupus when pain isn’t too bad and vital organs are not affected. This includes – Aspirin, ibuprofen, and naproxen. The side effects may include – effects on gastrointestinal tract (which includes the stomach), blood, liver, and kidneys.
• Corticosteroids – Corticosteroids are hormones found in our bodies. Manmade versions, often called “steroids,” are used to reduce swelling, tenderness, and pain in many parts of the body. In high doses, they can calm the immune system. Side effects may include – a round or puffy face, acne, heartburn, increased appetite, weight gain, and mood swings. Severe effects include easy bruising, thinning skin and hair, weakened or damaged bones, high blood pressure, damage to the arteries, high blood sugar, infections, muscle weakness, and cataracts.
• Antimalarial drugs – Medicines used to prevent or treat malaria are used to treat joint pain, skin rashes, fatigue, and inflammation of the lungs.
• BLyS-specific inhibitors – The first medication approved by the Foodand Drug Administration under this new class of drugs is called belimumab.
• Immunosuppressive agents/ chemotherapy – These drugs are used in severe cases of lupus, when major organs are affected and other treatments do not work. These drugs suppress the immune system to limit the damage to the organ. Examples are azathioprine (Imuran), and cyclophosphamide (Cytoxan), mycophenolate mofetil (Cellcept), and methotrexate (Rheumatrex and Trexall).

 

Alternative medicine

• DHEA – DHEA is a steroid molecule manufactured by the cholesterol-pregnenolone pathway, and is an intermediate to androstenediol and androstenedione, which have the potential to become either estrone or testosterone. Supplements containing this hormone have been shown to reduce the dose of steroids needed to stabilize symptoms in some people who have lupus.
• Fish oil supplements that contain the Omega-3 fatty acid, may be beneficial for people with lupus. Nausea, belching, and a fish taste in the mouth are some side effects you may experience while taking fish oil supplements.
• Vitamin A – Vitamin A is an antioxidant and is commonly found in whole milk, liver, and some fortified foods. Beta-carotene is a pro-vitamin found in carrots and many colorful vegetables that are then converted to vitamin A in the body. Vitamin A protects against free radicals (harmful substances in your body) which can damage DNA and lead to cancer and other diseases, and has anti-inflammatory effects.
• Vitamin D – People with lupus have shown some benefits from taking Vitamin D supplements   In recent testing, high doses of vitamin D were safe and appeared to temper some of the destructive immune system responses believed to cause lupus. Research is pointing to an immune-regulating role for vitamin D.
• Vitamin E – This vitamin supplement comes in several different forms. The alpha-tocopherol type of Vitamin E may help prevent heart disease by slowing the release of inflammatory substances that damage the heart.* Alpha-tocopherol also might be effective for easing lung .inflammation related to allergies. However, because studies were conducted on animals, it’s not yet clear whether the results will translate to humans.
• Evening primrose oil – Used to treat inflammation, evening primrose oil is associated with alleviating rheumatoid arthritis.
• Flaxseed – Flaxseed contains a fatty acid called alpha-linolenic acid, which may decrease inflammation in the body. Some studies have found that kidney function may improve in lupus patients who have kidney problems, such as like lupus nephritis. Abdominal pain and bloating can be side effects of taking flaxseed.
• Herbal Medicine – Feverfew, goldenseal, and pau d’arco are just a few of the helpful herbs one can use, please consult your physician before adding any of these supplements as they may interfere with your other medications or have unwanted effects. *Echinacea should be avoided as it is primarily used to boost the immune system. In lupus patients, the immune system is over-active and taking this supplement could cause flares in disease activity.
• Hydrotherapy – Cold or hot compresses can be used for pain relief
• Mind/Body Medicine – Creative visualization, spirituality, relaxation techniques, biofeedback, and other mind/body treatments can strengthen the immune system, as well as reduce joint pain and easy accompanying depression.
• Traditional Chinese Medicine – Treatment may involve acupuncture, herbal therapy, dietary alterations, and exercise.
• Acupuncture – Acupuncture may help in treating lupus symptoms, although evidence is limited. Studies have shown that acupuncture may be useful in alleviating pain associated with lupus.
• Chiropractic therapy – This therapy relies on the manipulation of your spine to improve the mobility of your joints and reduce pain. Chiropractic therapy practitioners have to go through training and licensing exams, and chiropractic care is often covered by insurance.

Reference

http://www.niams.nih.gov/health_info/lupus/lupus_ff.pdf

http://www.webmd.com/lupus/guide/lupus-systemic-lupus-erythematosus-home-treatment

http://www.nhs.uk/Conditions/Lupus/Pages/Treatment.aspx

http://www.medicalnewstoday.com/info/lupus/types-of-lupus.php

http://www.altmedrev.com/publications/6/5/460.pdf

http://www.mollysfund.org/2013/03/alternative-lupus-treatments-and-therapies/

http://www.healthline.com/health/systemic-lupus-erythematosus#Overview1