Lupus is a chronic “autoimmune” disease in which the immune system, for unknown reasons, becomes hyperactive and attacks normal tissue, resulting in inflammation and symptoms. Lupus strikes nine women to every man, and can be very difficult to diagnose.
There are three forms of lupus. The first is cutaneous lupus, which only affects the skin. The symptoms include skin rashes, photosensitivity (where exposure to light triggers a rash), and sometimes ulcers on the inside of the nose or mouth.
Treatment of cutaneous lupus includes corticosteroid creams or ointments applied to the rash or infections into the lesions. Oral corticosteroid or antimalarial medications may also be prescribed, and sunscreen is important as well.
In addition to cutaneous lupus, there is systematic lupus erythematosus (SLE), which attacks multiple systems in the body, which can include the skin, joints, lungs, blood, blood vessels, nervous system and organs. Systematic lupus is much more difficult to diagnose, largely because it affects so many different parts of the body and because it develops slowly over time. Symptoms can include fatigue, achy or swollen joints, rashes, fever, hair loss, sores in the mouth or nose, and other conditions. These symptoms usually come and go in “flares”. SLE also mimics many other diseases and conditions, and there is no single diagnostic test for it.
Physicians do use a list of 11 criteria to assist in the diagnosis of SLE. These include past medical history, laboratory tests, and current symptoms. The anti-nuclear antibody test (ANA) is used as a screening test, since 95% of people with SLE have a positive ANA. A positive ANA, however, does not prove someone has SLE, since it is also seen in a number of other illnesses and conditions. The ANA is only an indicator that points in several possible directions.
The final form of lupus is drug-induced lupus (DIL). DIL may develop after taking certain prescription medications but disappears when the drugs are discontinued. So far five medications have been shown to be associated: procqainamide and quinidine (for heart rhythm abnormalities), hydralazine (for high blood pressure) , isoniazid (for tuberculosis), and phenytoin (for seizures). Months or years of frequent medication exposure, however, are necessary to produce DIL.
Most of the symptoms of lupus are due to inflammation, therefore, treatment is aimed at reducing the inflammation. Four families of medications are used for this purpose: nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen: corticosteroids, such as prednidone, cortisone and medrol; antimalarials, which help the joint pain, skin rashes and ulcers (there is no relationship between lupus and malaria); and immunosuppressants and chemotherapy, generally reserved for persons with severe flares that affect organ function.
With proper treatment and close follow-up by a physician, 80 to 90% of people with lupus can expect to live a normal life span. “Lupus is a disease that we can treat and hopefully one day cure,” explains E. H., M.D., immunologist at The University Hospital. Lupus does vary in intensity and degree, however, and for people with severe flare-ups, lupus can be life-threatening.
For more information about lupus, including clinical research trials, contact the Lupus Foundation of America.
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