LUPUS

DEFINITION

Lupus is a disease in which a person's immune system attacks the body's own organs and tissues (see autoimmune disorders entry). The complete medical name for lupus is systemic lupus erythematosus (SLE; pronounced LOO-puhs er-uh-THEM-uh-tuhs).

DESCRIPTION

The immune system is a network of cells and tissues that protect the body against foreign organisms, such as bacteria and viruses. One mechanism used by the immune system is the release of antibodies. Antibodies are molecules that attack and destroy foreign organisms. For each type of organism, the immune system produces a special kind of antibody.

In a patient who has lupus, the immune system functions incorrectly. It thinks that the body's own cells are foreign organisms and releases antibodies to attack these cells the way it would attack bacteria and viruses. This causes tissues to become inflamed (red and swollen). They may even be killed by the attacking antibodies.

Lupus occurs in both males and females of all ages, but it is much more common in women. About 90 percent of all lupus cases occur in women. The majority of these women are of childbearing age. African Americans are more likely to develop lupus than Caucasians (whites).

CAUSES

The cause of lupus is unknown. Some researchers think that heredity may be a factor. Environmental factors also may be involved. In some cases, the symptoms of lupus become worse after exposure to sunlight, alfalfa sprouts, and certain medications. On rare occasions, a form of lupus can be caused by medications. Some drugs used to treat heart problems are among these medications. The lupus usually disappears when the person stops taking the drug.

SYMPTOMS

The symptoms of lupus vary in seriousness. Sometimes they are quite mild, and sometimes they are quite severe. Typical symptoms include fever, fatigue, muscle pain, decreased appetite, and weight loss. The spleen and lymph nodes are often swollen. Other areas that may be affected by lupus include:

• Joints. Joint pain and disorders, such as arthritis (see arthritis entry), are common. About 90 percent of all lupus patients have such problems.
• Skin. Lupus may cause skin rashes on any part of the body. They usually occur on the face, scalp, chest, ears, back, arms, and legs. When they occur in the mouth, they form ulcers (open sores). Hair loss is common.
• Lungs. Lupus may cause inflammation of the pleura, the tissue that lines the lungs. The patient may experience coughing and shortness of breath.
• Heart and circulatory system. Lupus may cause inflammation of the tissue surrounding the heart (pericarditis; pronounced per-i-kar-DIE-tiss) or of the heart itself (myocarditis; pronounced my-o-kar-DIE-tiss). When this happens, various heart problems may develop, such as an irregular heartbeat (arrhythmia; pronounced uh-RITH-mee-uh), heart failure, and even sudden death. Blood clots often form in the blood vessels. These blood clots can break loose and cause a stroke (see stroke entry) or other complications.
• Nervous system. Headaches, seizures, personality changes, and psychosis (confused thinking) may occur.
• Kidneys. During a lupus attack, the body's kidney cells may begin to die. When this happens, the kidney can no longer filter blood. Toxins (poisons) may build up in the kidney, causing it to stop functioning.
• Gastrointestinal (digestive) system. Patients may experience nausea, vomiting, diarrhea, and abdominal (stomach) pain. The lining of the stomach may also become inflamed.
• Eyes. The eyes may become red, sore, and dry. Inflammation of nerves in the eye may cause vision problems and blindness.

DIAGNOSIS

Lupus is usually difficult to diagnose, especially since many of its symptoms are similar to other diseases, such as rheumatoid arthritis (see arthritis entry) and multiple sclerosis (see multiple sclerosis entry). There is no one test that can be used to diagnose the disease. Blood tests can be used to look for certain kinds of antibodies. The most dependable of these tests may be correct 70 percent to 80 percent of the time.

Many doctors rely on a standard created by the American Rheumatism Association to diagnose lupus. According to this standard, a patient has to have four of eleven symptoms to be diagnosed with lupus. Those symptoms are:

• Butterfly rash, a distinctive type of facial rash
• Discoid rash, another distinctive type of facial rash
• Unusual sensitivity to light
• Ulcers in the mouth
• Arthritis
• Inflammation of the lining of the lungs or the lining around the heart
• Kidney damage
• Seizures or psychosis
• Low numbers of red blood cells or certain types of white blood cells
• The presence of certain kinds of immune cells
• The presence of certain kinds of antibodies

TREATMENT

Treatment of lupus depends on how serious a patient's case is. Mild cases may involve rashes and moderate pain. These cases can be treated with nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen (pronounced i-byoo-PRO-fuhn, trade names Motrin, Advil). More serious rashes and joint problems may be treated with drugs also used to treat malaria (see malaria entry).

More serious symptoms may have to be treated with steroids. Steroids can reduce inflammation and swelling. They have some serious side effects, however, so they must be used with caution.

The most seriously ill patients may be treated with immunosuppressant drugs. Immunosuppressant drugs cause the immune system to shut down partially or completely. These drugs also have very serious side effects. With a weakened immune system, a patient is at risk for many other kinds of infections.

Other lupus treatments are designed for specific systems affected by the disease. For example, substances that thin the blood can be used if blood clots have formed. A person whose kidneys have begun to fail may require kidney dialysis or even a kidney transplantation. Kidney dialysis is a process in which a machine artificially cleanses a person's blood.

Lupus can cause skin rashes on any part of the body. One that often occurs on the face is called a butterfly rash. (© 1993

NMSB

. Reproduced by permission of

Custom Medical Stock Photo

.)

Alternative Treatment

A number of alternative treatments have been suggested to help reduce the symptoms of lupus. These include acupuncture and massage for relieving the pain of sore joints and muscles. Patients can be taught to relax with techniques such as meditation and yoga. Hydrotherapy (water therapy) may also promote relaxation.

Proper nutrition may be an important factor in treating the symptoms of lupus. Some cases of the disease may be triggered by certain types of foods. Wheat, dairy products, and soy are the most common causes of the disease. Avoiding these foods may reduce the symptoms of lupus.

Some practitioners recommend nutritional supplements, such as vitamins B, C, and E, and minerals, such as magnesium, selenium, and zinc. They think these supplements may improve the general health of patients with lupus. Vitamin A can also be used to treat facial rashes.

Herbalists believe that certain herbs help relieve specific symptoms of lupus. They think that herbs can also help people develop a healthier outlook on life.

PROGNOSIS

The prognosis for lupus depends primarily on two factors: the systems affected and the degree of inflammation. Some patients experience mild symptoms or no symptoms at all over long periods of time. About 90 percent to 95 percent of all patients with lupus are still alive two years after diagnosis. Up to 75 percent of all patients survive twenty years or more.

The most common causes of death in the early years of lupus are infectious diseases and kidney failure. For people who have had the condition longer, the most common cause of death is blood clots.

PREVENTION

There is no way to avoid developing lupus. However, patients with the condition can often avoid the worst symptoms of the disease by maintaining a healthy diet, getting plenty of rest, avoiding stress, exercising regularly, and decreasing exposure to the sun. Patients can try to find out what factors seem to worsen their symptoms and then avoid those factors as much as possible.

FOR MORE INFORMATION

Books

Aaseng, Nathan. Autoimmune Diseases. New York: Franklin Watts, 1995.

Lahita, Robert G., and Robert H. Phillips. Lupus: Everything You Need to Know. Garden City Park, NY: Avery Publishing Group, 1998.

Wallace, Daniel J. The Lupus Book. New York: Oxford University Press, 1995.

Periodicals

Mann, Judy. "The Harsh Realities of Lupus." Washington Post (October 8, 1997): p. C12.

Umansky, Diane. "Living with Lupus." American Health for Women (June 1997): p. 92+.

Organizations

American College of Rheumatology. 1800 Century Place, Suite 250, Atlanta, GA 30345. (404) 633-3777. http://www.rheumatology.org

Lupus Foundation of America, Inc. 1300 Piccard Drive, Suite 200, Rockville, MD 20850–4303. (800) 558-0121. http://www.lupus.org.

Lupus Network. 230 Ranch Drive, Bridgeport, CT 06606. (203) 372-5795.