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In
the Spotlight
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| May
24, 2000 |
Lupus
Erythematosus: Under Attack By Your Own Immune System
By
Adam Brochert, MD
Personal
MD.com Advisory Board
|
 Systemic
lupus erythematosus, SLE or lupus for short, is one of a group of diseases
known as autoimmune disorders. The exact cause is usually unknown, though
the disease primarily affects women of childbearing age. It can range
in severity from mild to life threatening.
Lupus
is classified as an autoimmune disorder which means that a person's
immune system attacks his or her own body for poorly understood reasons.
Other autoimmune disorders include rheumatoid arthritis, polymyositis
and scleroderma. With lupus, the immune system can attack any organ in
the body, and the prognosis often depends on what organs are involved
and how severely they are affected.
The large majority of affected individuals are women between 16 and 45
years old, though persons of any age and sex can develop lupus.
What are the symptoms?
The initial symptoms of lupus are wide-ranging
and thus often frustrating to patients and doctors alike because the initial
symptoms may be so non-specific as to not suggest any particular diagnosis
or treatment. The most common symptoms of lupus include:
- fatigue
- fever
- anorexia
- nausea
- weight
loss
- joint
pain and arthritis
- muscle
pain
- facial
or other skin rash, often made worse by sun exposure (commonly a "butterfly
rash" that occurs over the nose and cheeks of the face)
- hair loss
- depression
- confusion
- headache
- chest
pain
- dry eyes
and/or dry mouth
- repeated
miscarriages
As you can
see, this is a long list and several of the symptoms are quite common.
Often, multiple symptoms must occur before a doctor becomes suspicious
of lupus as the possible cause of a person's complaints.
There are also several blood tests that can be abnormal in lupus and raise
suspicion of the condition. For example, unexplainable anemia or low blood
count occurs frequently in lupus.
How is it diagnosed?
The diagnosis of lupus is not always straightforward.
There is no exact test that makes the diagnosis. There is a degree of
overlap between the different autoimmune disorders, but, an experinced
doctor will usually be able to tell that some type of autoimmune disorder
is present. Certain tests can detect abnormal antibodies that are secreted
by the immune system when lupus occurs and these are often used to confirm
the diagnosis of lupus.
Although lupus can affect just about any organ in the body, the overall
prognosis is often related to the degree of kidney and brain involvement.
Kidney damage is a common cause of disability and death in persons with
severe lupus. Affected persons may need dialysis or a kidney transplant
if their kidneys fail. Brain involvement may cause confusion, personality
changes, seizures or even psychosis.
How is it treated?
Treatment for lupus may be again simple or complex depending on the severity
of disease and response to initial treatment. Patients with mild disease
may need only aspirin or ibuprofen to control their symptoms. However,
many of the medications used for the treatment of moderate to severe lupus
have multiple side effects. Some of the medications given to patients
with lupus are also used in cancer chemotherapy. These medications suppress
the immune system. This reduces the amount of inflammation and damage
the immune system can cause the rest of the body. Unfortunately, this
makes the person more susceptible to infections, another common cause
of death in lupus patients.
One of the more common medications used, prednisone, is in a class called
corticosteroids. Prednisone is fairly mild as far as lupus treatments
are concerned, but can cause weight gain, diabetes, osteoporosis, depression
and other problems. A medication called hydroxychloroquine is also effective
for some aspects of lupus but may cause vision problems, rash or muscle
inflammation.
Fortunately, death is a relatively rare result of lupus, with roughly
70 percent of persons still alive 20 years after the diagnosis is made.
Often, however, the quality of life is severely reduced in those with
moderate to severe disease and disability is frequent. Family support
and outside patient support groups are, of course helpful to many with
the disease.
| Living
With Lupus |
|
| Many
physical and emotional issues confront people with lupus, both in
the beginning and throughout the course of their disease. The most
common issues include the following: |
| |
Fatigue:
Fatigue
is a chronic problem that is usually accompanied by joint pain and
stiffness. It can affect many aspects of your daily life.
Changes
in personal appearance:
You
may experience changes in your personal appearance. Discoid lupus
(a form of lupus) may cause sores, blotches or scarring on the face,
arms, shoulders, neck or back. The medications for lupus can also
sometimes change your appearance. For example, corticosteroids can
cause weight gain, excessive hair growth or swelling. Some drugs may
cause hair loss. These changes in the way you look can be emotionally
challenging to deal with.
Changes in physical
ability: Many people with lupus feel isolated because
their fatigue and need to rest keep them from maintaining normal work
and social schedules. You may feel frustrated if you can't participate
in outdoor activities with family or friends because of sensitivity
to the sun. There will be times when you may feel it is easier to
stay home than to make plans and later cancel them because you are
too tired or not feeling well.
Psychological effects of corticosteroids: Corticosteroids
are used to treat many of the symptoms of lupus that result from inflammation.
Their use can cause anxiety, mood changes, forgetfulness, depression,
personality changes and other psychological problems. You need to
know about the possible side effects of these drugs while you are
taking them. It is also important that your family and friends understand
the effects of these drugs so that they can be supportive if you should
experience any side effects.
Depression: You may feel sad or
depressed at times in your struggle to control lupus or because of
the medications you take. Good communication with your doctor and
health care team, as well as with your family and friends, is important
in helping you cope with these feelings.
Concern for the future:
Because the future and course of your disease
are unknown, planning for your job, your family and life in general
can be difficult at times.
Family concerns: Like you,
your family can be overwhelmed about your diagnosis and may have a
difficult time understanding and adapting to your disease. They may
feel confused, helpless and afraid. Because of your physical limitations,
traditional roles and responsibilities within the family may need
to change. It is important that everyone talk openly and honestly
with each other. It is also important that your family learns about
your disease so they can better understand your physical and emotional
condition and the changes in your family that may result. |
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| Source:
From LUPUS: A Patient Care Guide for Nurses and Other Health Professionals,
National Institute of Arthritis and Musculoskeletal and Skin Diseases/National
Institutes of Health |
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© 2000 PersonalMD.com. All rights reserved.
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