Lupus (Autoimmune disease)

An Overview

Lupus is a disease that occurs when your body’s immune system attacks your own tissues and organs (autoimmune disease). Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs. Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus  a facial rash that resembles the wings of a butterfly unfolding across both cheeks  occurs in many but not all cases of lupus.

Symptoms of Lupus

No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus have mild disease characterized by episodes — called flares — when signs and symptoms get worse for a while, then improve or even disappear completely for a time.
The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. The most common signs and symptoms include:

• Fatigue
• Fever
• Joint pain, stiffness and swelling
• Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body
• Skin lesions that appear or worsen with sun exposure
• Fingers and toes that turn white or blue when exposed to cold or during stressful periods
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches, confusion and memory loss

Causes for lupus

Doctors don’t know exactly what causes lupus. They think genetics, hormones, and your environment may be involved.
Your body’s immune system protects you from bacteria, viruses and other foreign invaders that can make you sick.
You could be born with a gene that makes you more likely to get lupus. Then you might be exposed to something in your environment, and that triggers the disease. It appears that people with an inherited predisposition for lupus may develop the disease when they come into contact with something in the environment that can trigger lupus.
The cause of lupus in most cases, however, is unknown. Some potential triggers include:
• Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people.
• Genetics: More than 50 genes associated with lupus have been identified. Additionally, having a family history of lupus may put a person at slightly higher risk for experiencing the condition.
• Infections. Having an infection can initiate lupus or cause a relapse in some people.
• Medications. Lupus can be triggered by certain types of blood pressure medications, anti-seizure medications and antibiotics. People who have drug-induced lupus usually get better when they stop taking the medication. Rarely, symptoms may persist even after the drug is stopped.
• Hormones: Some studies suggest that abnormal hormone levels, such as increased estrogen levels, could contribute to lupus.

Diagnosis

Healthcare providers don’t have a single blood test or imaging study to use to diagnose lupus. Instead, they consider a person’s signs and symptoms and rule out other potential conditions that could be causing them. Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders.
Research has shown that there are antibodies that are highly specific to lupus, including double-stranded DNA (ds-DNA) and the Smith (Sm) antibody. The Sm antibody is also associated with SLE-related renal disease (nephritis).
• Complete blood count. This test measures the number of red blood cells, white blood cells and platelets as well as the amount of hemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur in lupus as well.
• Urine tests: Using urinalysis can determine if there’s an elevated level of blood or protein in your urine. This can indicate that lupus may be affecting your kidneys.
• Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate isn’t specific for any one disease. It may be elevated if you have lupus, an infection, another inflammatory condition or cancer.
• Tissue biopsy: Your healthcare provider can take a biopsy or sample of cells — from an area of lupus – like rash to determine if cells typical of a person with lupus are present. If kidney damage is present, a kidney biopsy may be necessary to help determine an appropriate treatment.
• Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs.
• Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs.

Treatment

Treatment for lupus depends on your signs and symptoms. Determining whether your signs and symptoms should be treated and what medications to use requires a careful discussion of the benefits and risks with your doctor.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), may be used to treat pain, swelling and fever associated with lupus. Stronger NSAIDs are available by prescription. Side effects of NSAIDs include stomach bleeding, kidney problems and an increased risk of heart problems.
• Antimalarial drugs. Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), affect the immune system and can help decrease the risk of lupus flares. Side effects can include stomach upset and, very rarely, damage to the retina of the eye. Regular eye exams are recommended when taking these medications.
• Corticosteroids. Lupus makes parts of your immune system overactive, so it attacks healthy tissue by mistake. Corticosteroids weaken this immune response. Your doctor may prescribe them if lupus causes problems in your heart, lungs, kidneys, brain or blood vessels.

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