Lupus Fiasco

Lupus

Lupus Erythematosus

Arnold Chong and Randall Chua

What in the world is Lupus?

Lupus is a chronic, autoimmune disease that damages any part of the body (skin, joints, and organs inside the body). Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years. In lupus, the immune system fighting off viruses, bacteria, and germs (like the flu) is compromised and even ineffective. (immunocompromised) The cause of Lupus is still not completely understood, but it is thought to be triggered by genetic and environmental factors or developed spontaneously. Epstein-Barr syndrome is a known trigger in children Autoimmune means your immune system cannot tell the difference between these foreign invaders and your bodys healthy tissues ("auto" means "self") and creates auto antibodies that attack and destroy healthy tissue. These autoantibodies cause inflammation, pain, and damage to various parts of the body.

Forms of Lupus
Systemic Lupus Erythematosus (SLE)
Responsible for 70% of all lupus cases with half affecting vital organs Systemic lupus is the most common form of lupus, and is what most people mean when they refer to "lupus." Systemic lupus can be mild or severe. Some of the more serious complications involving major organ systems are: Inflammation of the kidneys (lupus nephritis), affects the bodys ability to filter waste from the blood and damages the kidney. An increase in blood pressure in the lungs may occurr (pulmonary hypertension) inflammation of the nervous system and brain, which can cause memory problems, confusion, headaches, and strokes from inflammation in the brains blood vessels, can also cause high fevers, seizures, behavioral changes, hardening of the arteries (coronary artery disease), which can lead to a heart attack

Neonatal Lupus
Neonatal lupus is a rare condition that affects infants of women who have lupus and is caused by antibodies from the mother acting upon the infant in the womb. Infant may have a skin rash, liver problems, or low blood cell counts, symptoms disappear completely after several months with no lasting effects. Some infants with neonatal lupus can also have a serious heart defect. 1% of infants born in the U.S. will develop neonatal Lupus and 75% of those babies will have the skin rash when born.

Cutaneous Lupus Erythematosus

Systemic Lupus focused on the skin Cutaneous refers to the skin, and this form of lupus is limited to the skin. Although there are many types of rashes and lesions caused by cutaneous lupus, the most common rash is raised, scaly and red, but not itchy. It is commonly known as a discoid rash, because of the disc-like rashes usually on the face. Approximately 10 percent of people who have cutaneous lupus will develop systemic lupus. Rash intensifies with exposure to the sun Most common rash is the butterfly rash. Skin rash occurs because UV light damages skin cells and in normal people, the cells are removed quickly. In some patients with lupus, the cells that remove the dead cells are non functional

Drug-induced Lupus Erythematosus (DIL)

Drug-induced lupus is a lupus-like disease caused by certain prescription drugs that produce an auto-immune response. The symptoms of drug-induced lupus are similar to those of systemic lupus. There are 38 known drugs that cause (DIL) Disease is reversible if medications causing symptoms are stopped Kidney and nervous system generally not affected The drugs most commonly connected with drug-induced lupus are hydralazine (used to treat high blood pressure or hypertension), procainamide (used to treat irregular heart rhythms), and isoniazid (used to treat tuberculosis). Drug-induced lupus is more common in men because they are given these drugs more often; however, not everyone who takes these drugs will develop drug-induced lupus. The lupus-like symptoms usually disappear within six months after these medications are stopped.

Symptoms of Lupus
Painful or swollen joints and muscle pain Unexplained fever Red rashes, most commonly on the face Chest pain Unusual loss of hair Pale or purple fingers or toes from cold or stress (Reynaud's phenomenon) Sensitivity to the sun Swelling in legs or around eyes Arthritis Swollen glands Extreme fatigue Pericarditis-inflammation of the heart in DIL patients

Who gets Lupus?

Lupus affects 1.5 million Americans, but 5 million worldwide 90% of lupus victims are women between the ages of 15-44 years old. It is notoriously known as the womans disease. Late Onset Lupus(similar to SLE) can occur in women ages 55 and younger Research found the prevalence of lupus in AfricanAmericans Hispanics and other minorities to be more frequent than those of Caucasian descent. Scientists are assuming it is due to environmental and genetic differences

 Currently, no drug can cure SLE, but many different drugs lessen the symptoms. The choice of drugs depends on the severity of the condition as well as other factors (Age, race). Patients with mild SLE may be helped by nonsteroidal anti-inflammatory drugs like ibuprofen (NSAIDs) while patients with more severe SLE may require corticosteroids or immunosuppressants. Immunosuppressants: limit activity of immune system Corticosteroids- medication used to reduce joint pain and arthritis

Treatment

Treatment
Therapy
Treatment depends on which organs are affected The severity of the lupus is not necessarily the same as the activity of the inflammation. Organs may be permanently damaged and scarred from lupus that caused inflammation in the past (called severe lupus). If lupus is not very active (sometimes called mild lupus), treatment may not need to be intensive but the goal is to reduce inflammation of the skin. Nonsteroidal anti-inflammatory drugs lie aspirin can reduce Lupus symptom related pain Plaquenil and Aralen-To lessen side effects of Lupus

Atabrine sometimes taken in combination, helps relieve joint and skin symptoms, especially Discoid Lupus. Sunscreen lotions (SPF 30) should be used, especially by people who have skin rashes.

Treatment
Very active lupus (called severe lupus) is treated immediately with a corticosteroid such as prednisone. Can help with skin rashes, but the elevated cortisol in the blood may cause weight gain. Cortisol is produced in the adrenal glands and helps with metabolism Hydrocortisone-Commonly found as a topical cream that reduces inflammation in joints and skin. Can also be injected. Imuran-an immunosuppressant used to prevent rejection of kidney transplants and helps arthritis Cytoxan Lyophilized-(aka cyclophosphamide) is given to suppress the body's autoimmune attack. Cellcept is also an immunosuppressive drug. The combination of a corticosteroid and an immunosuppressive drug is most often used for severe kidney disease or nervous system disease and for vasculitis (destruction of blood vessels)

Treatment contd
People who take corticosteroids should be tested periodically and, if necessary, treated for osteoporosis (thinning of the bones), which can occur with chronic corticosteroid use. Other risk factors for coronary artery disease (for example, high blood pressure and high cholesterol levels) should be controlled as well as possible.

Diagnosis
Lupus is often difficult to diagnose but these tests may aid in the diagnosis of lupus. Blood tests Bone scans Lupus skin biopsy

Diagnosis
Doctors suspect lupus mainly based on a person's symptoms during a careful physical exam, particularly in young women. However its wide range of symptoms make it difficult to determine lupus from other diseases with similar symptoms. Indicated kidney damage is caused by inflammation of the filtering structure in the kidneys (glomeruli), a condition referred to as glomerulonephritis. Sometimes a kidney biopsy (removal of tissue for examination and testing) must be performed to help the doctor plan treatment. Glomerulonephritis is a type of kidney disease in which the part of your kidneys that helps filter waste and fluids from the blood is damaged. People who have lupus should be tested from time to time for kidney damage even if they have no symptoms. Testing includes blood and urine tests.

Living with Lupus

Avoid excessive sunlight exposure, and wear sunscreen (ultraviolet light is one of the main triggers of flares). Get plenty of rest (fatigue is another common SLE symptom). Engage in regular light-to-moderate exercise to help fight fatigue and heart disease, and to keep joints flexible.

Fun Facts
Lupus can kill you Lupus is lethal No one knows what exactly causes it, so essentially it throws you a surprise Lupus party In all seriousness, Lupus is not a fun disease but if you have it you can still live a normal life and walk dogs and stuff. Lupus patients can give birth to normal babies (though some believe that there may be a genetic correlation in passing down lupis, it is so insignificant that it is dismissed

What you should remember

1 - Lupus is an autoimmune, rheumatic disease 2 - There are five types of lupus. 3 - Ninety percent of lupus patients are women. 4 - There are 11 American College of Rheumatology criteria for Lupus. 5 - Lupus diagnosis may be difficult. 6 - Lupus treatment depends on symptoms and severity of symptoms. 7 - Up to 1.5 million people across the nation may have lupus. 8 - Certain races have an increased risk of developing lupus. 9 - The majority of lupus patients lead normal lives. 10 - A rheumatologist is a medical doctor who specializes in treating arthritis and other rheumatic conditions, including lupus. However, the term rheumatism might apply to the symptoms of numerous conditions that can cause pain and/or weakness.

Prognosis
Lupus tends to be chronic and relapsing, often without symptoms and can last for years. Intensity of lupus can be triggered by sun exposure, infection, surgery, or pregnancy. These flare-ups occur less often after menopause. Many people are being diagnosed earlier than in the past and because better treatment is available, the prognosis has improved markedly over the last two decades. Once lupus is acquired, it is for life. Early detection and treatment of kidney damage reduces the incidence of severe kidney disease. 10-20% of lupus patients will develop osteonecrosis(Death of bone tissue)

Lupics
Discoid facial rash

Common Misdiagnoses
Rheumatoid arthritis, an autoimmune disease that affects 4 million Americans is the only autoimmune rheumatic disease that is more common than lupus. It is difficult to differentiate it from Lupus in its first several months. Other common diseases with similar symptoms to lupus are scleroderma, vasculitis, polymyalgia rheumatica, and fibromyalgia

Myths
Lupus is contagious and can be sexually transmitted
Because lupus is not caused by a virus, bacterium, or any other infectious agent, it cannot be transmitted sexually or by any other method. While it has been passed from mother to fetus (vertical transmission), lupus has never been reported to transfer horizontally from one individual to another.

Women should not get pregnant due to an increased risk of passing down lupus
On rare occasions, women with System Lupus Erythematosus (the most common form of lupus) have given birth to babies who later developed lupus, about half of which were also born with a heart defect. However, the risk isnt any higher than it is for those without lupus. More than 50% of women with lupus deliver completely healthy and normal babies. Proper medical care (having an obstetrician who is experienced with high risk pregnancies) and preventing flares can greatly increase the chances of a normal pregnancy

. You cannot die from lupus

Most lupus cases, if caught early and treated aggressively, are not fatal . However, severe cases can cause kidney or heart failure, both of which can be fatal.

History
The term lupus (Latin for wolf) is attributed to the thirteenth century physician Rogerius who used it to describe erosive facial lesions that were reminiscent of a wolf's bite. The familial occurrence of systemic lupus was first noted by Leonhardt in 1954 and later studies by Arnett and Shulman at Johns Hopkins. Payne, in 1894, first reported the usefulness of quinine in the treatment of lupus.

Famous People with Lupus

Michael Jackson Trick Daddy Lady Gaga George Clooney does not have Lupus Seal Toni Braxton