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Medical & Legal Information on Lupus Erythematosus: Causes & Treatment Options
• Lupus Erythematosus Overview
• Lupus Symptoms
• The Cause of Lupus
• Lupus Risk Factors
• Complications Associated with Lupus
• Diagnosing Lupus
• Treating Lupus
Lupus Erythematosus Overview
Systemic Lupus Erythematosus is a chronic (persistent) disease known to cause inflammation in the body. Commonly referred to as ‘lupus’, its severity can range from mild to severe. The autoimmune disease is classified as two main forms: discoid lupus that affects the skin, and systemic lupus erythematosus that involves the joints and skin and may also involve the heart, kidney, blood cells, skin, brain, joints and other organs as well. With early detection and treatment, individuals suffering from systemic lupus erythematosus can enjoy a normal quality of life.
Approximately 1.5 million men (10 percent) and women (90 percent) are diagnosed with lupus in the United States every year, usually between 15 and 44 years of age. Nearly 1 out of every 10 cases involve symptoms of more than just a single connective tissue disease. Often referred to as a mixed connective tissue disease or overlap syndrome, systemic lupus erythematosus typically mimics the signs and symptoms of other ailments.
Currently, no known cure is available for the disease which is often triggered by some prescription medication use, infection and sunlight. The most distinctive indicator of the presence of systemic lupus erythematosus is a butterfly wing-shaped facial rash on both cheeks. However, this external physical indicator does not always appear.
The chronic inflammatory disease has various symptoms that may appear suddenly or develop slowly over time. Some individuals experience mild and temporary symptoms while others tend to be more severe and permanent symptoms. Usually, the individual experiences flares or episodic periods where the indicators and symptoms become significantly worse for a specific period of time and then improve or completely disappear. The most common symptoms involved with systemic lupus erythematosus include:
- Fever and fatigue
- Dry eyes
- Chest pain
- Shortness of breath
- Skin lesions (photosensitivity) that can worsen with exposure to the sun
- Butterfly-shaped facial rash on the bridge of the nose and both cheeks
- Toes and fingers turning blue or white due to cold exposure or stressful events
- Joint swelling, stiffness, and pain
Individuals should consider seeking immediate medical attention if an unexplained rash develops or they experience fatigue, persistent aching or ongoing fever.
The Cause of Lupus
Lupus is an autoimmune disease where the immune system will attack the body’s healthy tissue believing it is an invader. Researchers believe that lupus is caused by a combination of environmental exposures and genetics. Science reveals that individuals with an inherited predisposition for the disease can trigger it by contact with an environmental source. Some believe that the condition can be triggered by:
- Sunlight – Exposure to sunlight and sun rays may trigger skin lesions or an internal response of the disease.
- Infection – Severe infections are thought to initiate Systemic Lupus Erythematosus or cause a relapse of a previous event.
- Drugs – Lupus is thought to be triggered by the use of some specific anti-seizure drugs, antibiotics, and medications used to treat blood pressure. The symptoms associated with lupus induced by drugs tend to disappear once the medication use has stopped.
Lupus Risk Factors
Specific risk factors increase the potential of developing systemic lupus erythematosus that includes:
- Gender – The disease is significantly more common in females compared to males.
- Age – Even though the disease can affect individuals of all ages, most cases of systemic lupus erythematosus are diagnosed in men and women between the age of 15 and 40.
- Race – Asians, African-Americans, and Hispanics have an increased potential of developing the disease compared to Caucasians and other races.
Complications Associated with Lupus
Systemic Lupus Erythematosus causes serious inflammation that may affect one or more areas of the body including:
- Heart – The disease can inflame the heart muscle, heart membrane (pericarditis) and arteries increasing the potential development of heart attacks and cardiovascular disease.
- Lungs – The disease can increase the potential development of inflammation of the lining of the chest cavity (pleurisy), causing painful breathing and a higher susceptibility to pneumonia.
- Blood Vessels and Blood – The disease can cause serious blood issues including anemia, blood clotting, and blood vessel inflammation (vasculitis).
- Brain and CNS (Central Nervous System) – The disease affects the brain causing headaches, behavioral changes, dizziness, seizures, strokes, and hallucinations. An individual suffering from lupus often experiences severe memory issues or has difficulty when expressing what is on their mind.
- Kidneys – The disease can result in serious damage to the kidneys including kidney failure. Specific indicators of the disease affecting the kidney include chest pain, generalized itching, edema (leg swelling), vomiting and nausea.
In addition to affecting specific body parts, other complications involved with systemic lupus erythematosus include:
- Infection – The condition and treatment can make individuals more vulnerable to acquiring infections that could include respiratory infections, urinary tract infections, salmonella, yeast infections, shingles, and herpes.
- Avascular Necrosis (blood tissue death) – The disease can diminish the bones blood supply and cause tiny breaks in the bone, causing it to collapse eventually. This condition tends to occur most commonly in the hip joint.
- Cancer – The disease has been shown to increase the potential of developing cancers.
- Complications during Pregnancy – Pregnant women have an increased potential risk of a miscarriage due to an increase potential risk of preeclampsia (high blood pressure during pregnancy) and pre-term births. Doctors often recommend that women delay their pregnancy until the lupus is better managed for a minimum of six months to avoid any complications.
There are significant challenges to diagnosing Lupus. This is because many of the symptoms vary greatly among individuals and some symptoms may overlap other disorders and conditions. Because of that, there is not a single test available to diagnose the disease. However, the doctor will conduct urine and blood tests as a part of a comprehensive physical examination that could eventually lead to the diagnosis.
Laboratory and imaging tests to diagnose lupus involve:
- Complete Blood Count
- Erythrocyte Sedimentation Rate Test
- Liver and kidney assessment
- ANA (anti-nuclear antibody) Test
- Chest x-ray
The doctor will recommend one or more treatments to manage the disease that is typically based on the type of lupus, the age of the patient, personal preferences, and available medications.
The drugs most commonly used to manage lupus involve:
- NSAIDs (nonsteroidal anti-inflammatory drugs) – Aleve, Advil, Motrin and other NSAIDs are proven effective at treating pain, fever, and swelling associated with the disease. However, these medications have significant side effects including kidney problems, stomach bleeding and an increased potential for heart problems.
- Antimalarial Medications – Plaquenil (hydroxychloroquine) and other medications used to treat malaria have been proven effective at controlling lupus. However, there are significant side effects including damage to the eye retina and stomach upset.
- Immunosuppressant Drugs – Drugs including azathioprine (Azasan, Imuran), methotrexate (Trexall), leflunomide (Arava), and mycophenolate (CellCept) have been shown to be helpful in managing serious cases involving lupus. However, the potential side effects of taking the medication include decreased fertility, liver damage, infections, and cancers.
Some doctors recommend the use of corticosteroids due to their anti-inflammatory properties. However, there are significant potential side effects including associated weight gain, high blood pressure, increased risk of infection, diabetes, easy bruising and osteoporosis (thinning bones).