| LUPUS |
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Lupus is a chronic inflammatory disease that typically affects your joints. The disorder may affect virtually any organ system in your body. It tends to be episodic, with alternating periods of flares and remission.
There are several types of lupus, but systemic lupus erythematosus (SLE) is the most common and the type that causes the most difficulties. Lupus is an autoimmune disease, meaning that your body's own defenses attack your tissues, resulting in pain, swelling and inflammation. Lupus also is a rheumatic (arthritic) disease, and can affect the joints, muscles, skin, kidneys, nervous system, lungs and heart. The cause of lupus is unknown. Lupus affects between 40 and 50 out of every 100,000 Americans. The disease affects women eight to 10 times more frequently than men and often first appears in women of childbearing years (ages 18 to 45). Lupus more often affects women who are black, American Indian, Asian or Hispanic than who are white. Lupus also affects children and older people. Lupus can affect more than one family member, but there are no studies showing that lupus is an inherited disease. In the 1950s, if you had a diagnosis of SLE, the odds were 50-50 you'd die within 5 years. Today, more sensitive diagnostic tests and better treatment mean you have a 97 percent chance that lupus won't shorten your life span. Signs and Symptoms Signs and symptoms of systemic lupus erythematosus may include: Joint pain, swelling and redness that come and go from day to day, most often in your fingers and wrists Rashes, especially across your nose and cheeks Localized chest pain accompanied by coughing Sunlight sensitivity that produces rash and fever reactions Fatigue that you can't attribute to another cause Raynaud?s (ray-NOZE) phenomenon, in which your fingers, toes, cheeks, nose and ears may turn white on exposure to cold The disease can affect your kidneys without producing symptoms, although swelling (edema) of the legs can occur. Lupus affecting the kidneys may cause protein and blood in the urine and high blood pressure. People with lupus may experience depression or difficulty in concentrating, either due to the disease or as a reaction to living with a chronic disease. Rarely, seizures can occur. Diagnosis Lupus is often difficult to diagnose because manifestations vary from person to person and can fluctuate with time. Nearly all people with lupus experience changes in disease activity. At times, the disease may flare. At other times, there may be no evidence of lupus (remission). To diagnose systemic lupus erythematosus your doctor may use your clinical history, a physical examination and the results of these tests: Blood count. This test measures the amount of hemoglobin, red blood cells, white blood cells and platelets in your blood. Results may indicate you have anemia, which commonly occurs in lupus. Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube. A faster-than-normal rate may indicate a systemic disease such as lupus. Kidney and liver assessment. A blood test can assess how well your kidney and liver are functioning. Lupus may damage these organs. Urinalysis. An examination of a sample of your urine may show an increased protein level, which may occur if lupus has damaged your kidneys. Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies produced by your immune system indicates a stimulated immune system and is common if you have lupus or another autoimmune disease. Your doctor may advise more specific antibody testing and refer you to a rheumatologist. Chest X-ray. An image of your chest may reveal abnormal shadows or inflammation of your lungs, which may occur with lupus. Electrocardiogram. This test measures the pattern of electrical impulses generated in your heart. It can help identify irregular rhythms, damage to your heart, or enlargement of your heart, any of which may occur with lupus. Treatment Treatment of systemic lupus erythematosus depends on which organs are affected and how severely. Because lupus may assume many forms, finding the most effective treatment may take time. Treatment of lupus may involve a variety of medications: Nonsteroidal anti-inflammatory drugs. Aspirin or nonsteroidal anti-inflammatory medications (NSAIDs) may improve joint inflammation. Anti-malarial drugs. These medications may be useful for treating skin and joint problems and inflammation of the surface of organs such as your heart and lungs. These drugs also may prevent flares of the disease. There is no known relationship between lupus and malaria, and no one knows why anti-malarial drugs help improve lupus. Corticosteroids. These drugs counter the inflammation of lupus. Dosage depends on which organs are involved and how severely. Side effects of steroid use include weight gain, puffiness in your face, easy bruising, thinning of bones, high blood pressure, diabetes and increased risk of infection. Immunosuppressive medications. These drugs, such as azathioprine (Imuran) and cyclophosphamide (Cytoxan), reduce your normal immune response. Your doctor may prescribe them if lupus is widely affecting your organs, especially your kidneys. Other similar medications are methotrexate, chlorambucil and cyclosporine. Immunosuppressive medications may cause anemia and a low white blood cell count. They may also increase risk of infection and cancer. Your doctor may prescribe them if corticosteroids aren't effective, or with a lower dosage of corticosteroids (to reduce side effects). Sometimes, even with the use of corticosteroids and immunosuppressive drugs, your kidneys may fail. You may need kidney dialysis, or if kidney failure is permanent you may need a kidney transplant. Self Care For many people with lupus, the disease isn't a major illness. But for some, it's a serious condition. Recognizing when your symptoms are getting worse and knowing how to treat them can reduce your chance of permanent tissue or organ damage. Early treatment can also reduce the time you spend on higher doses of medications. Following your doctor's instructions and taking medications only as prescribed is important. Because ultraviolet light can trigger a flare, use sunscreens with an SPF of at least 15 and avoid tanning beds even if your skin isn?t involved. In addition, managing lupus means taking good general care of yourself, including these steps to improve the function of your immune system: Get adequate rest and regular exercise. Don't smoke. Limit alcohol. Eat a healthy, balanced diet. |
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