History

Systemic lupus erythematosus, also called lupus or SLE for short, belongs to the family of rheumatic diseases.

Rheumatic diseases affect joints, muscles and other parts of the body, and often involve abnormalities of the immune system. Lupus can affect not only joints and muscles but also skin, kidneys, nervous system, lungs, heart and the blood-forming organs.

Lupus is an autoimmune disease in which the tissues of the body are attacked by the overly active immune system and is treated by suppressing the immune system.

There are two common forms of lupus: discoid and systemic.

Discoid lupus is a disease of the skin which is often chronic and leads to scarring. It may be limited to the skin and not be associated with disease in any other body systems. In other cases, discoid lupus may be one of the features of the systemic form of lupus. This information focuses on the systemic form of the disease.

Lupus may be a mild disorder in some people, but for others it can lead to serious problems. Each person is different, and what is true about someone else's disease may not apply to you.

Lupus is a chronic, systemic, inflammatory disease. Chronic means it lasts a long time, probably for the rest of your life. However, nearly all people with lupus have fluctuations in disease activity known as flares and remissions. At times there may be no signs or symptoms of lupus at all (remissions). Some people have complete and long-lasting remissions. A systemic disease is one in which many different parts of the body may be affected. Inflammatory refers to a reaction of the body resulting in pain, heat, redness and swelling.

Although lupus is a chronic disease, this doesn't mean you can't live a full life. Chronic diseases can't be Treatmentd but they can be controlled through proper treatment.

Special concerns for people with lupus

People with lupus are more likely to develop infections. This is true partly because of the illness itself, and partly because of the side effects of medications, especially corticosteroids and immunosuppressive drugs. In some people with lupus, infections can trigger disease flares.

Exposure to the sun and fluorescent lighting is known to make the skin rashes associated with lupus worse in most people. Sun exposure may also cause generalized flares of lupus, resulting in fevers, joint pains, or even inflammation involving the heart, lungs, kidneys or nervous system. Of course, what is too much sun for one person may be fine for someone else. However, it's best to take simple precautions. These include regularly using a sunscreen lotion or sun block on your skin and avoiding outdoor activities during peak sunlight hours (usually 10 am to 4 pm). Sunscreens may be bought without a prescription, and are available in many different forms, some of which also include skin lubricants. Those with a sun protection factor of 15 or more are the best. Some chemicals in sunscreens may cause skin irritation or rashes, so it is important to try a different type of preparation if this occurs. During unavoidable times of sun exposure, it is important to wear a hat to shade you from direct sun and clothing to cover the arms, legs and chest.

Because of possible problems from sun exposure, you may wonder if it is safe to move to a warmer climate. As long as you protect yourself when you go out in the sun, your illness should not affect where you live.

How is lupus diagnosed?  

Because symptoms vary so widely from patient to patient, and because symptoms mimic the symptoms of many other diseases, diagnosis of systemic lupus erythematosus can be difficult.

• Diagnosis often occurs over time, as new symptoms gradually appear.
• Tools for diagnosis include:
• Patient's Medical History
• Complete Physical Examination
• Laboratory Tests
• [Note: A doctor can usually tell lupus apart from drug-induced lupus without the need for special tests.  The medication-related form generally does not produce hair loss, mouth sores, or rashes, nor is there involvement of the kidney or central nervous system.  Furthermore, drug-induced lupus differs from the expected side-effects of a drug, in that it is not manifest right away; it takes many months--or even years--for it to develop.)  If the supposition that the drug is responsible is correct, symptoms will go away once the patient has been taken off the medication.  

What would the tests for diagnosing lupus be?

Laboratory tests that maybe performed to help diagnose systemic lupus erythematosus are:

• Antibody Blood Tests, to look for particular auto antibodies (immune proteins that attack the patient's own cells and tissues) common in people with lupus.
• A major one is called” antinuclear antibody".   In its various forms, it is present in a number of autoimmune disorders.
• Antiphospholipid Antibodies, such as anticardiolipin
• Syphilis Test, which can give a false-positive result in patients with lupus
• Skin or Kidney Biopsy-A small sample of skin or kidney tissue is taken for microscopic examination.
• Complete Blood Count, to determine number of red blood cells, white blood cells, and platelets
• Erythrocyte Sedimentation Rate test (sed rate), to determine how quickly red blood cells fall to the bottom of a tube of blood. 
• High seed rate is a sign of inflammation in the body.
• Urinalysis: Abnormal urine test results can indicate kidney involvement in lupus.
• Complement Levels-Complement is a group of blood proteins involved in defending the body against infection.  Complement levels are often low in people with lupus.

What are the symptoms of lupus?

In discoid lupus, only the skin is involved. The skin rash in discoid lupus often is found on the face and scalp. It usually is red and may have raised borders. Discoid lupus rashes are usually painless and do not itch, but scarring can cause permanent hair loss. Over time, 5 to 10% of patients with discoid lupus may develop SLE.

Patients with SLE can develop different combinations of symptoms and organ involvement. Common complaints and symptoms include fatigue, low-grade fever, loss of appetite, muscle aches, arthritis, ulcers of the mouth and nose, facial rash ("butterfly rash"), unusual sensitivity to sunlight (photosensitivity), inflammation of the lining that surrounds the lung(pleuritis) and the heart (pericarditis), and poor circulation to the fingers and toes with cold exposure (Raynaud's phenomenon).

More serious organ involvement with inflammation occurs in the brain, liver, and kidney. White blood cells and blood clotting factors also can be decreased in SLE, thereby increasing the risk of infection and bleeding.

Over half of the patients with SLE develop a characteristic red, flat facial rash over the bridge of their nose. Because of its shape, it is frequently referred to as the " butterfly rash" of SLE. The rash is painless and does not itch. The facial rash, along with inflammation in other organs, can be precipitated or worsened by exposure to sunlight, a condition called photosensitivity. This photosensitivity can be accompanied by worsening of inflammation throughout the body, called a "flare" of disease.