Systemic lupus

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Information, in part, from the Arthritis Foundation and the American College of Rheumatology

Lupus – short for “systemic lupus erythematosus,” is a chronic (long-lasting) autoimmune disease in which the immune system, for unknown reasons, becomes overactive and attacks normal tissue. This attack results in inflammation and brings about many symptoms.

Lupus is an autoimmune problem… meaning immune activity directed against the self. The immune system fights the body itself (Auto=self). In autoimmune diseases, the immune system makes a mistake and reacts to the body's own tissues.

Inflammation is a protective process the body uses when tissues are injured. Inflammation helps to eliminate a foreign body or organism (virus, bacteria) and prevent further injury. Signs of inflammation include; swelling, redness, pain and warmth. If the signs of inflammation are chronic, as they can be in lupus, then damage to the tissues can occur and normal function is impaired. This is why the treatment of lupus is aimed at reducing inflammation.

The immune system is designed to protect and defend the body from foreign intruders (bacteria, viruses). It contains several different types of cells, some of which function like "body guards" and are constantly on patrol looking for any foreign invaders. When they locate one, they take action, and eliminate the intruder.

In lupus, the immune system loses its ability to tell the difference between a foreign intruder and a person's own normal tissues and cells. So, in essence, the "body guards" make a mistake, and they mistakenly identify the person's own normal cells as foreign (antigens), and then start to destroy them.

Part of the response is to bring antibodies to the site that then attach to antigens (anything that the immune system recognizes as non-self or foreign) and form immune complexes. These immune complexes help to set in motion a series of events that result in inflammation at the site. These immune complexes may travel through the circulation (blood) and lodge in distant tissues and cause inflammation there.

Lupus is the Latin word for wolf. The term has been associated with the disease since the 10th century, though the reasons are unclear. Erythematosus means "redness." Speculation is that the name was given to describe the skin lesions (sores), which typically are red and perhaps at that time in history were thought to resemble the bite of a wolf.

Lupus can occur at any age, and in either gender. Nine out of ten people with lupus are women. During the childbearing years (ages 15-44) lupus strikes women 10-15 times more frequently than men.

People of all races can have lupus; however, African American women have a three times higher incidence (number of new cases) and mortality than Caucasian women. They tend to develop the disease at a younger age and to develop more serious complications. Lupus is also more common in women of Hispanic, Asian, and Native American descent.

Symptoms of lupus vary widely depending on the individual case and the form of lupus present. Most people with lupus do not experience all of these symptoms. This is a list of themost common symptoms:

• Achy or swollen joints
• Persistent fever over 100 degrees
• Prolonged, extreme fatigue
• Skin rashes, including a butterfly shaped rash across the cheeks and nose
• Pain in the chest on deep breathing
• Anemia
• Excessive protein in the urine
• Sensitivity to sun or ultraviolet light
• Hair loss
• Abnormal blood clotting problems
• Fingers turning white and/or blue in the cold
• Seizures
• Mouth or nose ulcers lasting longer than two weeks

There are four forms of lupus including:

Cutaneous lupus erythematosus affects the skin. There are many different types of cutaneous lupus including:

• Chronic cutaneous LE (CCLE) which is sometimes called discoid.
• Subacute cutaneous LE (SCLE)
• Acute cutaneous LE (ACLE).

Systemic lupus erythematosus (SLE) attacks multiple systems in the body which may include: the skin, joints, lungs, blood, blood vessels, heart, kidneys, liver, brain and the nervous system.

Drug-induced lupus may develop after taking certain prescription medications. Symptoms generally disappear, within weeks to months, after the drug is discontinued.

Neonatal lupus, a fourth type, is a rare condition. It is not the same thing as SLE. It occurs in infants whose mothers have abnormal antibodies and transfer them to the infant through umbilical blood flow.

Lupus as an overlap condition

The majority of people with lupus have lupus alone. Between five and thirty percent of people with lupus report having overlap symptoms characteristic of one or more connective tissue diseases. There are several well-recognized overlaps that may affect people with lupus including: lupus and rheumatoid arthritis (RA), lupus and myositis, lupus and systemic sclerosis (SSc or scleroderma), lupus and Sjogren's syndrome (SS).

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