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Thread: General Answers to your Lupus Questions

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    Default General Answers to your Lupus Questions

    From....
    U.S Department of Health and Human Services
    National Institutes of Health
    National Institute of Arthritis and Musculoskeletal and Skin Diseases

    Defining Lupus
    Lupus is one of many disorders of the immune system known as autoimmune diseases. In autoimmune diseases, the immune system turns against parts of the body it is designed to protect. This leads to inflammation and damage to various body tissues. Lupus can affect many parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain. Although people with the disease may have many different symptoms, some of the most common ones include extreme fatigue, painful or swollen joints (arthritis), unexplained fever, skin rashes, and kidney problems.

    At present, there is no cure for lupus. However, lupus can be effectively treated with drugs, and most people with the disease can lead active, healthy lives. Lupus is characterized by periods of illness, called flares, and periods of wellness, or remission. Understanding how to prevent flares and how to treat them when they do occur helps people with lupus maintain better health. Intense research is underway, and scientists funded by the NIH are continuing to make great strides in understanding the disease, which may ultimately lead to a cure.

    Two of the major questions researchers are studying are who gets lupus and why. We know that many more women than men have lupus. Lupus is three times more common in African American women than in Caucasian women and is also more common in women of Hispanic, Asian, and Native American descent. In addition, lupus can run in families, but the risk that a child or a brother or sister of a patient will also have lupus is still quite low. It is difficult to estimate how many people in the United States have the disease because its symptoms vary widely and its onset is often hard to pinpoint.

    There are several kinds of lupus:
    • Systemic lupus erythematosus (SLE) is the form of the disease that most people are referring to when they say "lupus." The word "systemic" means the disease can affect many parts of the body. The symptoms of SLE may be mild or serious. Although SLE usually first affects people between the ages of 15 and 45 years, it can occur in childhood or later in life as well. This booklet focuses on SLE.
    • Discoid lupus erythematosus is a chronic skin disorder in which a red, raised rash appears on the face, scalp, or elsewhere. The raised areas may become thick and scaly and may cause scarring. The rash may last for days or years and may recur. A small percentage of people with discoid lupus have or develop SLE later.
    • Subacute cutaneous lupus erythematosus refers to skin lesions that appear on parts of the body exposed to sun. The lesions do not cause scarring.
    • Drug-induced lupus is a form of lupus caused by medications. Many different drugs can cause drug-induced lupus. Symptoms are similar to those of SLE (arthritis, rash, fever, and chest pain) and they typically go away completely when the drug is stopped. The kidneys and brain are rarely involved.
    • Neonatal lupus is a rare disease that can occur in newborn babies of women with SLE, Sjφgren's syndrome, or no disease at all. Scientists suspect that neonatal lupus is caused by autoantibodies in the mother's blood called anti-Ro (SSA) and anti-La (SSB). Autoantibodies ("auto" means self) are blood proteins that act against the body's own parts. At birth, the babies have a skin rash, liver problems, and low blood counts. These symptoms gradually go away over several months. In rare instances, babies with neonatal lupus may have a serious heart problem that slows down the natural rhythm of the heart. Neonatal lupus is rare, and most infants of mothers with SLE are entirely healthy. All women who are pregnant and known to have anti-Ro (SSA) or anti-La (SSB) antibodies should be monitored by echocardiograms (a test that monitors the heart and surrounding blood vessels) during the 16th and 30th weeks of pregnancy.

    It is important for women with SLE or other related autoimmune disorders to be under a doctor's care during pregnancy. Physicians can now identify mothers at highest risk for complications, allowing for prompt treatment of the infant at or before birth. SLE can also flare during pregnancy, and prompt treatment can keep the mother healthier longer.

    Understanding What Causes Lupus
    Lupus is a complex disease, and its cause is unknown. It is likely that a combination of genetic, environmental, and possibly hormonal factors work together to cause the disease. Scientists are making progress in understanding lupus, as described here and in the "Current Research" section of this booklet. The fact that lupus can run in families indicates that its development has a genetic basis. Recent research suggests that genetics plays an important role; however, no specific "lupus gene" has been identified yet. Studies suggest that several different genes may be involved in determining a person's likelihood of developing the disease, which tissues and organs are affected, and the severity of disease. However, scientists believe that genes alone do not determine who gets lupus and that other factors also play a role. Some of the factors scientists are studying include sunlight, stress, certain drugs, and infectious agents such as viruses.

    In lupus, the body's immune system does not work as it should. A healthy immune system produces proteins called antibodies and specific cells called lymphocytes that help fight and destroy viruses, bacteria, and other foreign substances that invade the body. In lupus, the immune system produces antibodies against the body's healthy cells and tissues. These antibodies, called autoantibodies, contribute to the inflammation of various parts of the body and can cause damage to organs and tissues. The most common type of autoantibody that develops in people with lupus is called an antinuclear antibody (ANA) because it reacts with parts of the cell's nucleus (command center). Doctors and scientists do not yet understand all of the factors that cause inflammation and tissue damage in lupus, and researchers are actively exploring them.

    Each person with lupus has slightly different symptoms that can range from mild to severe and may come and go over time. However, some of the most common symptoms of lupus include painful or swollen joints (arthritis), unexplained fever, and extreme fatigue. A characteristic red skin rash-the so-called butterfly or malar rash-may appear across the nose and cheeks. Rashes may also occur on the face and ears, upper arms, shoulders, chest, and hands. Because many people with lupus are sensitive to sunlight (called photosensitivity), skin rashes often first develop or worsen after sun exposure.

    Common Symptoms of Lupus

    • Painful or swollen joints and muscle pain
    • Unexplained fever
    • Red rash or color change on the face
    • Chest pain upon deep breathing
    • Unusual loss of hair
    • Pale or purple fingers or toes from cold or stress (Raynaud's phenomenon)
    • Sensitivity to the sun
    • Swelling (edema) in legs or around eyes
    • Mouth ulcers
    • Swollen glands
    • Extreme fatigue

    Other symptoms of lupus include chest pain, hair loss, anemia (a decrease in red blood cells), mouth ulcers, and pale or purple fingers and toes from cold and stress. Some people also experience headaches, dizziness, depression, confusion, or seizures. New symptoms may continue to appear years after the initial diagnosis, and different symptoms can occur at different times. In some people with lupus, only one system of the body, such as the skin or joints, is affected. Other people experience symptoms in many parts of their body. Just how seriously a body system is affected varies from person to person.

    The following systems in the body also can be affected by lupus.

    • Kidneys:
    Inflammation of the kidneys (nephritis) can impair their ability to get rid of waste products and other toxins from the body effectively. There is usually no pain associated with kidney involvement, although some patients may notice swelling in their ankles. Most often, the only indication of kidney disease is an abnormal urine or blood test. Because the kidneys are so important to overall health, lupus affecting the kidneys generally requires intensive drug treatment to prevent permanent damage.
    • Lungs:
    Some people with lupus develop pleuritis, an inflammation of the lining of the chest cavity that causes chest pain, particularly with breathing. Patients with lupus also may get pneumonia.
    • Central nervous system:
    In some patients, lupus affects the brain or central nervous system. This can cause headaches, dizziness, memory disturbances, vision problems, seizures, stroke, or changes in behavior.
    • Blood vessels:
    Blood vessels may become inflamed (vasculitis), affecting the way blood circulates through the body. The inflammation may be mild and may not require treatment or may be severe and require immediate attention.
    • Blood:
    People with lupus may develop anemia, leukopenia (a decreased number of white blood cells), or thrombocytopenia (a decrease in the number of platelets in the blood, which assist in clotting). Some people with lupus may have an increased risk for blood clots.
    • Heart:
    In some people with lupus, inflammation can occur in the heart itself (myocarditis and endocarditis) or the membrane that surrounds it (pericarditis), causing chest pains or other symptoms. Lupus can also increase the risk of atherosclerosis (hardening of the arteries).

    Diagnosing Lupus
    Diagnosing lupus can be difficult. It may take months or even years for doctors to piece together the symptoms to diagnose this complex disease accurately. Making a correct diagnosis of lupus requires knowledge and awareness on the part of the doctor and good communication on the part of the patient. Giving the doctor a complete, accurate medical history (for example, what health problems you have had and for how long) is critical to the process of diagnosis. This information, along with a physical examination and the results of laboratory tests, helps the doctor consider other diseases that may mimic lupus, or determine if the patient truly has the disease. Reaching a diagnosis may take time as new symptoms appear.

    No single test can determine whether a person has lupus, but several laboratory tests may help the doctor to make a diagnosis. The most useful tests identify certain autoantibodies often present in the blood of people with lupus. For example, the antinuclear antibody (ANA) test is commonly used to look for autoantibodies that react against components of the nucleus, or "command center," of the body's cells. Most people with lupus test positive for ANA; however, there are a number of other causes of a positive ANA besides lupus, including infections, other autoimmune diseases, and occasionally as a finding in healthy people.

    The ANA test simply provides another clue for the doctor to consider in making a diagnosis. In addition, there are blood tests for individual types of autoantibodies that are more specific to people with lupus, although not all people with lupus test positive for these and not all people with these antibodies have lupus. These antibodies include anti-DNA, anti-Sm, anti-RNP, anti-Ro (SSA), and anti-La (SSB). The doctor may use these antibody tests to help make a diagnosis of lupus.

    Some tests are used less frequently but may be helpful if the cause of a person's symptoms remains unclear. The doctor may order a biopsy of the skin or kidneys if those body systems are affected. Some doctors may order a test for anticardiolipin (or antiphospholipid) antibody. The presence of this antibody may indicate increased risk for blood clotting and increased risk for miscarriage in pregnant women with lupus. Again, all these tests merely serve as tools to give the doctor clues and information in making a diagnosis. The doctor will look at the entire picture-medical history, symptoms, and test results-to determine if a person has lupus.

    Other laboratory tests are used to monitor the progress of the disease once it has been diagnosed. A complete blood count, urinalysis, blood chemistries, and the erythrocyte sedimentation rate (ESR) test can provide valuable information. Another common test measures the blood level of a group of substances called complement. People with lupus often have increased ESRs and low complement levels, especially during flares of the disease. X rays and other imaging tests can help doctors see the organs affected by SLE.

    Diagnostic Tools for Lupus

    • Medical history
    • Complete physical examination
    • Laboratory tests:
    o Complete blood count
    o Erythrocyte sedimentation rate (ESR)
    o Urinalysis
    o Blood chemistries
    o Complement levels
    o Antinuclear antibody test (ANA)
    o Other autoantibody tests (anti-DNA, anti-Sm, anti-RNP, anti-Ro [SSA], anti-La [SSB])
    o Anticardiolipin antibody test
    • Skin biopsy
    • Kidney biopsy

    Treating Lupus

    Diagnosing and treating lupus are often a team effort between the patient and several types of health care professionals. A person with lupus can go to his or her family doctor or internist, or can visit a rheumatologist.

    A rheumatologist is a doctor who specializes in rheumatic diseases (arthritis and other inflammatory disorders, often involving the immune system).

    Clinical immunologists (doctors specializing in immune system disorders) may also treat people with lupus.

    As treatment progresses, other professionals often help. These may include nurses, psychologists, social workers, nephrologists (doctors who treat kidney disease), hematologists (doctors specializing in blood disorders), dermatologists (doctors who treat skin disease), and neurologists (doctors specializing in disorders of the nervous system).

    The range and effectiveness of treatments for lupus have increased dramatically, giving doctors more choices in how to manage the disease. It is important for the patient to work closely with the doctor and take an active role in managing the disease. Once lupus has been diagnosed, the doctor will develop a treatment plan based on the patient's age, sex, health, symptoms, and lifestyle. Treatment plans are tailored to the individual's needs and may change over time.

    In developing a treatment plan, the doctor has several goals: to prevent flares, to treat them when they do occur, and to minimize organ damage and complications. The doctor and patient should reevaluate the plan regularly to ensure it is as effective as possible.

    NSAIDs:
    For people with joint or chest pain or fever, drugs that decrease inflammation, called nonsteroidal anti-inflammatory drugs (NSAIDs), are often used. While some NSAIDs, such as ibuprofen and naproxen, are available over the counter, a doctor's prescription is necessary for others. NSAIDs may be used alone or in combination with other types of drugs to control pain, swelling, and fever. Even though some NSAIDs may be purchased without a prescription, it is important that they be taken under a doctor's direction. Common side effects of NSAIDs can include stomach upset, heartburn, diarrhea, and fluid retention. Some people with lupus also develop liver, kidney, or even neurological complications, making it especially important to stay in close contact with the doctor while taking these medications.

    Antimalarials:
    Antimalarials are another type of drug commonly used to treat lupus. These drugs were originally used to treat malaria, but doctors have found that they also are useful for lupus. A common antimalarial used to treat lupus is hydroxychloroquine (Plaquenil)*. It may be used alone or in combination with other drugs and generally is used to treat fatigue, joint pain, skin rashes, and inflammation of the lungs. Clinical studies have found that continuous treatment with antimalarials may prevent flares from recurring. Side effects of anti-malarials can include stomach upset and, extremely rarely, damage to the retina of the eye.

    * Brand names included in this publication are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

    Corticosteroids:
    The mainstay of lupus treatment involves the use of corticosteroid hormones, such as prednisone (Deltasone), hydrocortisone, methylprednisolone (Medrol), and dexamethasone (Decadron, Hexadrol). Corticosteroids are related to cortisol, which is a natural anti-inflammatory hormone. They work by rapidly suppressing inflammation.

    Corticosteroids can be given by mouth, in creams applied to the skin, or by injection. Because they are potent drugs, the doctor will seek the lowest dose with the greatest benefit. Short-term side effects of corticosteroids include swelling, increased appetite, and weight gain. These side effects generally stop when the drug is stopped.

    It is dangerous to stop taking corticosteroids suddenly, so it is very important that the doctor and patient work together in changing the corticosteroid dose. Sometimes doctors give very large amounts of corticosteroid by vein over a brief period of time (days) ("bolus" or "pulse" therapy). With this treatment, the typical side effects are less likely and slow withdrawal is unnecessary.

    Long-term side effects of corticosteroids can include stretch marks on the skin, weakened or damaged bones (osteoporosis and osteonecrosis), high blood pressure, damage to the arteries, high blood sugar (diabetes), infections, and cataracts. Typically, the higher the dose and the longer they are taken, the greater the risk and severity of side effects.

    Researchers are working to develop ways to limit or offset the use of corticosteroids. For example, corticosteroids may be used in combination with other, less potent drugs, or the doctor may try to slowly decrease the dose once the disease is under control. People with lupus who are using corticosteroids should talk to their doctors about taking supplemental calcium and vitamin D or other drugs to reduce the risk of osteoporosis (weakened, fragile bones).

    Immunosuppressives:
    For some patients whose kidneys or central nervous systems are affected by lupus, a type of drug called an immunosuppressive may be used. Immunosuppressives, such as cyclophosphamide (Cytoxan) and mycophenolate mofetil (CellCept), restrain the overactive immune system by blocking the production of immune cells.

    These drugs may be given by mouth or by infusion (dripping the drug into the vein through a small tube). Side effects may include nausea, vomiting, hair loss, bladder problems, decreased fertility, and increased risk of cancer and infection. The risk for side effects increases with the length of treatment. As with other treatments for lupus, there is a risk of relapse after the immunosuppressives have been stopped.

    Other Therapies:
    In some patients, methotrexate (Folex, Mexate, Rheumatrex), a disease-modifying antirheumatic drug, may be used to help control the disease. Working closely with the doctor helps ensure that treatments for lupus are as successful as possible. Because some treatments may cause harmful side effects, it is important to report any new symptoms to the doctor promptly. It is also important not to stop or change treatments without talking to the doctor first.

    Alternative and Complementary Therapies:
    Because of the nature and cost of the medications used to treat lupus and the potential for serious side effects, many patients seek other ways of treating the disease. Some alternative approaches people have tried include special diets, nutritional supplements, fish oils, ointments and creams, chiropractic treatment, and homeopathy.

    Although these methods may not be harmful in and of themselves, and may be associated with symptomatic or psychosocial benefit, no research to date shows that they affect the disease process or prevent organ damage. Some alternative or complementary approaches may help the patient cope or reduce some of the stress associated with living with a chronic illness. If the doctor feels the approach has value and will not be harmful, it can be incorporated into the patient's treatment plan.

    However, it is important not to neglect regular health care or treatment of serious symptoms. An open dialogue between the patient and physician about the relative values of complementary and alternative therapies allows the patient to make an informed choice about treatment options.

    Lupus and Quality of Life
    Despite the symptoms of lupus and the potential side-effects of treatment, people with lupus can maintain a high quality of life overall. One key to managing lupus is to understand the disease and its impact. Learning to recognize the warning signs of a flare can help the patient take steps to ward it off or reduce its intensity. Many people with lupus experience increased fatigue, pain, a rash, fever, abdominal discomfort, headache, or dizziness just before a flare. Developing strategies to prevent flares can also be helpful, such as learning to recognize your warning signals and maintaining good communication with your doctor.
    It is also important for people with lupus to receive regular health care, instead of seeking help only when symptoms worsen. Results from a medical exam and laboratory work on a regular basis allows the doctor to note any changes and to identify and treat flares early. The treatment plan, which is tailored to the individual's specific needs and circumstances, can be adjusted accordingly. If new symptoms are identified early, treatments may be more effective. Other concerns also can be addressed at regular checkups. The doctor can provide guidance about such issues as the use of sunscreens, stress reduction, and the importance of structured exercise and rest, as well as birth control and family planning. Because people with lupus can be more susceptible to infections, the doctor may recommend yearly influenza vaccinations or pneumococcal vaccinations for some patients.
    Women with lupus should receive regular preventive health care, such as gynecological and breast examinations. Men with lupus should have the prostate-specific antigen (PSA) test. Both men and women need to have their blood pressure and cholesterol checked on a regular basis. If a person is taking corticosteroids or antimalarial medications, an eye exam should be done at least yearly to screen for and treat eye problems.
    Staying healthy requires extra effort and care for people with lupus, so it becomes especially important to develop strategies for maintaining wellness. Wellness involves close attention to the body, mind, and spirit. One of the primary goals of wellness for people with lupus is coping with the stress of having a chronic disorder. Effective stress management varies from person to person. Some approaches that may help include exercise, relaxation techniques such as meditation, and setting priorities for spending time and energy.

    Developing and maintaining a good support system is also important. A support system may include family, friends, medical professionals, community organizations, and support groups. Participating in a support group can provide emotional help, boost self-esteem and morale, and help develop or improve coping skills.

    Warning Signs of a Flare
    • Increased fatigue
    • Pain
    • Rash
    • Fever
    • Abdominal discomfort
    • Headache
    • Dizziness

    Preventing a Flare
    • Learn to recognize warning signals
    • Maintain good communication with your doctor
    Learning more about lupus may also help. Studies have shown that patients who are well-informed and participate actively in their own care experience less pain, make fewer visits to the doctor, build self-confidence, and remain more active.

    Tips for Working With Your Doctor

    • Seek a health care provider who is familiar with SLE and who will listen to and address your concerns.
    • Provide complete, accurate medical information.
    • Make a list of your questions and concerns in advance.
    • Be honest and share your point of view with the doctor.
    • Ask for clarification or further explanation if you need it.
    • Talk to other members of the health care team, such as nurses, therapists, or pharmacists.
    • Don't hesitate to discuss sensitive subjects (for example, birth control, intimacy) with your doctor.
    • Discuss any treatment changes with your doctor before making them.

    Pregnancy for Women with Lupus
    Although a lupus pregnancy is considered high risk, most women with lupus carry their babies safely to the end of their pregnancy. Women with lupus have a higher rate of miscarriage and premature births compared with the general population. In addition, women who have antiphospholipid antibodies are at a greater risk of miscarriage in the second trimester because of their increased risk of blood clotting in the placenta. Lupus patients with a history of kidney disease have a higher risk of preeclampsia (hypertension with a buildup of excess watery fluid in cells or tissues of the body). Pregnancy counseling and planning before pregnancy are important. Ideally, a woman should have no signs or symptoms of lupus and be taking no medications for at least 6 months before she becomes pregnant.

    Some women may experience a mild to moderate flare during or after their pregnancy; others do not. Pregnant women with lupus, especially those taking corticosteroids, also are more likely to develop high blood pressure, diabetes, hyperglycemia (high blood sugar), and kidney complications, so regular care and good nutrition during pregnancy are essential. It is also advisable to have access to a neonatal (newborn) intensive care unit at the time of delivery in case the baby requires special medical attention.
    I have Lupus. So *^#@! what.

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    rob is offline Super Moderator Super ModeratorEmperor of the World
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    Outstanding work Oluwa. Thank you!

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    Oooo this is good...very good. I know lots will find this useful ('specially the 'newbies.') Make it a sticky, please? Rob? Saysusie? Admin? Who is in charge of the sticky department?

    Thanks you, Sweet Oluwa!

    Jody
    "If you trust Google more than you trust your doctor than maybe it's time to switch doctors."

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    Sticky.....Done!!

    Saysusie
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    Great job- Hey Oluwa, what about that show we discussed? Look at all of this info you have to share

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    Thank you..you're welcome...

    Love ya bunches,
    Oluwa
    I have Lupus. So *^#@! what.

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    Wow, that is great information.
    Thank you Oluwa! I am going to print this out for future reference.

    Robyn
    PS. Hope you have a wonderful, relaxing, peaceful vacation.
    Make sure you bundle up. It is getting chilly in the north. It is only 45 degrees here right now and I am about 400-500 miles south of the UP.
    Travel carefully!
    live, love and laugh often.

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    Default some info I found

    I was reading the post and noticed that they do talk about the lupus affecting the brain but I recently found that type of Lupus I have does just that and it has a name
    CFS Lupus or Cerebral Lupus
    Named for it affecting the central nervous system and the cerebellum My fine motor skills are moslty affected by this but here is some litteratur I found on it I hope it also helps.


    Cerebral lupus (CL) is a common cause of morbidity and mortality in patients with SLE. The brain CTs of 27 consecutive adult patients with SLE and various neurological presentations were reviewed. The median age and duration of neurological symptoms at the time of the brain CT were 30 years (range = 14-51 years) and six days (range = 1 day-22 years), respectively. Eleven patients (41%) had normal CTs. The abnormalities in the remaining patients could be divided into six categories: (a) cerebral atrophy alone (two patients); (b) calcification alone (three patients); (c) infarct(s) alone (five patients); (d) cerebral atrophy and calcification (three patients); (e) cerebral atrophy and infarct(s) (one patient) and (f) cerebral atrophy, calcification and infarct(s) (two patients). Altogether eight patients (30%) (age range = 17-47 years) had intracerebral calcification : the globus pallidus was involved in all, putamen in two, head of the caudate nucleus in one, thalamus in one, centrum semiovale in two and cerebellum in three patients. Two patients had extensive calcifications of most of the basal ganglia, centrum semiovale and cerebellum. There was no relationship between the presence/degree of calcification and age of patients/duration or type of neurological presentation. The pathogenesis of cerebral calcification in CL is unknown. Cerebral lupus must now be included in the differential diagnosis of intracerebral calcification
    Systemic lupus erythematosus
    A chronic autoimmune disease characterized by inflammation in the brain.
    Chronic autoimmune disease which produces symptoms varying from mild to life-threatening. Characteristically affects young women but all ages can be affected. Most distinct immunological abnormality is the presence of autoantibodies. Anti-nuclear antibodies to native double-stranded DNA are diagnostic. Course of the disease is characterised by periods of remission and relapse.
    Epidemiology
    prevalence 4-280 cases/100 000. Highest in Afro-Caribbeans, followed by Asians
    male:female = 1:13
    disease onset 16-55 years
    blacks have a worse prognosis
    Clinical features
    Constitutional symptoms (very common): fatigue, fever, weight loss
    Joints: athritis and arthralgia in 95%. Usually non-deforming
    Skin: involved in 80%.
    butterfly rash
    photosensitivity
    painful mucous membrane lesions
    alopecia
    Raynaud's phenomenon
    purpura
    urticaria
    micro-infarcts of fingertips and toes
    Renal:
    about 50% develop urinary or functional renal abnormalities but virtually all patients have histological abnormalities
    proteinuria is most common abnormality, usually presenting within the first 5 years of diagnosis
    renal biopsy useful in differentiating lupus nephritis from other causes of renal abnormalities such as infection but more importantly it determines precise histology and therefore likely response to therapy. Generally performed on all patients with haematuria/proteinuria or a fall in creatinine clearance
    Pulmonary:
    pleuritic chest pain extremely common. May be due to a serositis in which case may be accompanied by a pleural rub or an effusion. Pulmonary embolus and infarction need to be excluded in view of the increased risk in patients with SLE
    pneumonia
    acute lupus pneumonitis
    uncommon
    no specific clinical characteristics distinguish it from pneumonia and it is essential to rule out infection
    clinical features include fever, dyspnoea and hypoxia
    CXR: alveolar infiltrates - usually basal
    biopsy may be helpful in distinguishing it from pneumonia
    pulmonary haemorrhage
    rare overall but not uncommon in those patients requiring ICU admission
    clinical features: dyspnoea, severe hypoxia, sudden drop in haemoglobin, haemoptysis (not invariable)
    treatment: pulsed methylprednisolone, pulsed cyclophosphamide and plasma exchange
    pulmonary hypertension
    17-40% of unselected patients with SLE
    more common in patients with Raynauds
    not responsive to corticosteroids except in the rare patients in whom it is due to an arteritis
    Cardiovascular:
    innocent systolic murmurs and mild pericarditis are frequent
    diastolic murmurs are indicative of Libman-Sachs endocarditis:
    due to an accumulation of inflammatory material and thrombus
    embolic risk
    increased risk of coronary disease
    hypertension; often causes deterioration in renal function
    Haematological
    normochromic, normocytic anaemia common (anaemia of chronic disorders)
    haemolytic anaemia in 25%
    leucopaenia common with a reduction in both granulocytes and lymphocytes
    thrombocytopaenia common; usually due to anti-platelet antibodies. Spleen is major site of destruction
    lymphadenopathy occurs especially during exacerbations
    Neuropsychiatric:
    spectrum of disease varies from purely functional to completely organic (differential includes steroid psychosis)
    seizures occur in 15%. Metabolic abnormalities and other secondary causes need to be excluded but often no specific abnormality is found
    peripheral neuropathy in around 10%
    aseptic meningitis (differential includes NSAID-induced aseptic meningitis)
    CVAs and transverse myelitis occur secondary to vasculitis or thromboembolism
    transverse myelitis may respond to combination of pulsed methylprednisolone and pulsed cyclophosphamide
    diagnosis of cerebral lupus is difficult because there may be little correlation to disease activity elsewhere
    Diagnosis
    Think of SLE in patients (especially young females) with any of the following:
    photosensitivity
    arthralgia or rash
    Raynaud's or mouth ulcers
    pleurisy
    proteinuria
    haematological abnormalities (especially low white cell count or thrombocytopaenia)
    abortion (recurrent, midtrimester)
    any neurological abnormality (including seizures)
    fatigue or depression
    Investigations
    Initial screening
    FBC and differential
    ESR/CRP. Obviously there are few patients in ICU in whom the ESR will be normal but the combination of a high ESR with a low CRP is highly suggestive of SLE. NB In the presence of co-existing infection CRP will also be raised
    anti-nuclear antibodies: screening test of choice. Positive in virtually all cases of SLE
    If ANA positive:
    double stranded DNA: although specific not positive in all patients with SLE
    anti-Ro, anti-La, anti-RNP or anti-Sm are less specific
    tests for anti-phospholipid syndrome
    complement (C3, C4)
    +/- renal biopsy
    Screen for infection as this often precipitates or accompanies disease flares
    Treatment
    supportive
    specific:
    corticosteroids: mainstay of therapy
    cyclophosphamide: used for life-threatening conditions (vasculitis, renal disease, severe thrombocytopaenia, disease-induced leucopaenia and anaemia). Trend towards pulse therapy as this allows effective use of Mesna to prevent haemorrhagic cystitis
    azathioprine: generally used for maintenance regimes to allow a reduction in steroid dose
    therapy of renal disease is a specialist area with a variety of immunosuppressive regimes under investigation
    IV gamma globulin effective short term therapy for thrombocytopaenia

    © Charles Gomersall December 1999
    Department of Medicine, National University of Malaysia
    Life is a Journey not a guided tour

  10. #9
    rob is offline Super Moderator Super ModeratorEmperor of the World
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    Excellent info Gurkinbabies. If you are anything like me, typing can be painful at times, so extra thanks to you for posting all of that.

    Rob

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    Thank you again to everyone for all the info i was at my rheume this week and i told him about all the info i am getting and he was suprised at the questions i had for him . Right now my red blood and white blood are going down to critical levels and ssome other blood components. I just had 16 tubes of blood done and hemocult testing and urinalysis done and am awaiting the results i will keep looking at this site. What is a sticky? Bonita

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