The topic this month is Lupus. An overview – Lupus is a serious complex disease that occurs when your body’s immune system attacks its 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. This attack causes inflammation, and in some cases causes permanent tissue damage which can be widespread. Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other medical conditions. Lupus is a global disease that affects an estimated 5 million people worldwide, with 16,000 new cases being discovered per year in the United States alone. The Lupus Foundation of America estimates that 1.5 million Americans have Lupus, another study showed 1 in 2,000 Canadians are affected with SLE. Famous people who have/had Lupus: Lady Gaga, Paula Abdul, Toni Braxton, Selena Gomez (required a kidney transplant due to Lupus), Kristen Johnston, Charles Kuralt, Seal, Ray Walston. The most distinctive sign of Lupus – a facial rash that resembles the wings of a butterfly unfolded across the nose and cheeks. It occurs in many, but not all cases of Lupus. Some people are born with a tendency toward developing Lupus, which may be triggered by infections, certain drugs or even sunlight. While there’s no cure for Lupus, treatments can help control symptoms. Lupus is not contagious – you can’t “catch” it or give it to someone else.
Factors that may increase the risk of Lupus include: (a) gender – it is more common in women, Lupus can also make other health problems happen earlier in life compared to women who do not have Lupus; (b) age – although Lupus affects people of all ages, it’s most often diagnosed between the ages of 15 and 45; (c) race – it is more common in women of African Americans, Hispanics, Asians, Native American and Alaska Native descent; (d) the environment – sunlight, stress, smoking, certain medicines, viruses may trigger symptoms in people who are most likely to get Lupus due to their genes; (e) hormones such as estrogen which is more common in women during their childbearing years when estrogen levels are highest. Research suggests that a diet rich in fresh fruits, vegetables, protein, and polyunsaturated fats may help reduce disease activity and improve symptoms in patients with SLE, while those items high in sugars, alcohol and tobacco may worsen disease activity and symptoms.
There are different types of Lupus: (A) Systemic Lupus Erythematosus (SLE) is the most common and most serious type of Lupus. SLE affects all parts of the body. (B) Cutaneous Lupus Erythematosus, (CLE) which affects only the skin. This type of Lupus is a skin disease that can affect people with or without SLE. There are two major kinds of Cutaneous Lupus: (a) Discoid Lupus Erythematosus (DLE). A discoid rash usually begins as a red raised rash that becomes scaly or changes color to a dark brown. These rashes often appear on the face and scalp, but they may affect other areas, they are circular, coin or disk-shaped red patches that are thick and scaly. Many people with DLE have scarring. Sometimes DLE causes sores in the mouth or nose. If you have DLE there is a small chance that you will later get SLE. (b) Subacute Cutaneous Lupus Erythematosus causes skin lesions that appear on parts of the body exposed to sun. These lesions do not cause scars. (c) Drug-induced Lupus, a short-term type of Lupus caused by certain medicines, and which rarely affects major organs.
Signs and Symptoms: No two cases of Lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, may be temporary or permanent, and will depend on which body systems are affected by the disease. 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. These flares can be mild to serious,and are unpredictable.
The most common signs and symptoms include: low blood cell counts, including red blood cells, white blood cells, and platelets, fatigue, fever, joint pain, sores – usually painless in the nose and mouth and most often are on the roof of the mouth, stiffness and swelling, a red “butterfly” shaped rash on the face covering the cheeks and bridge of the nose or rashes elsewhere on the body, often appearing after or worsening following exposure to sunlight. Fingers and toes may turn white or blue when exposed to cold or during stressful periods. Hair loss, shortness of breath, chest pain, dry eyes, headaches, confusion and memory loss.
As an autoimmune disease, Lupus occurs when the immune system attacks healthy tissue in the body, believed to be the result from a combination of genetics and the environment. Research has shown 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 the condition. The cause of Lupus in most cases, however, is unknown. Some potential triggers include: (a) Sunlight – exposure to the sun may bring on Lupus skin lesions or trigger an internal [organ] response in susceptible people; (b) Infections – having an infection can initiate Lupus or cause a relapse in some people; (c) Medications – Lupuscan 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.
Complications – Inflammation caused by Lupus can affect many areas of the body, including: (a) Kidneys – possible serious kidney damage, and kidney failure which is one of the leading causes of death among people with Lupus; (b) Brain and central nervous system – if the brain is affected it can possibly cause headaches, dizziness, behavior changes, vision problems, and even strokes or seizures. Many people with Lupus experience memory problems and may have difficulty expressing their thoughts; (c) Blood and blood vessels – may lead to blood problems, including a reduced number of healthy red blood cells (anemia) and an increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels; (d) Lungs – increased chances of developing an inflammation of the chest cavity lining, which can make breathing painful. Possible bleeding into lungs and pneumonia can also occur; (e) Heart – possibly cause inflammation of the heart muscle, the arteries or heart membrane. The risk of cardiovascular disease and heart attacks increases greatly as well. This is partly because people with Lupus have more coronary artery disease (CAD) risk factors which include high blood pressure, high cholesterol, and type 2 diabetes, and atherosclerosis, when fat and other materials attach to the blood vessel wall and form plaque. This can happen in blood vessels throughout the body.
Other Lupus complications increase the risk of : (a) Infection – people with Lupus are more vulnerable to infection because both the disease and its treatments can weaken the immune system; (b) Cancer – having Lupus appears to increase the risk of cancer, however, the risk is small; (c) Bone tissue death – this occurs when the blood supply to a bone declines, often leading to tiny breaks in the bone and eventually having the bones collapse. Some medicines that treat Lupus may cause bone loss, which can lead to osteoporosis – condition that causes weak and broken bones.
Lupus is a chronic autoimmune disease with no cure. It can be managed with treatment, but it will not go away. Treatment can help improve the symptoms, manage/reduce prevent “flares” and deal with the other health problems often caused by Lupus. People with Lupus often need to see different specialist doctors, depending on what part of the body /organ is involved with this medical condition, such as: a Rheumatologist – a doctor who specializes in diseases of the joints and muscles, a Cardiologist if the heart and blood vessels are involved, a renal doctor if the kidneys are affected, etc. Your primary care provider (family doctor) should coordinate care between all of the other health care specialist providers and treat other problems as they come up. You and your primary care provider will develop a treatment plan to fit your unique medical needs and you both will need to review the plan often to make sure that it is working.
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