Lupus erythematosus

  • Basics

    Lupus is an autoimmune disorder that can affect many different parts of the body. Normally the immune system protects the body by fighting off bacteria, viruses, and other foreign invaders. However, if you have an autoimmune disease like lupus, the immune system starts attacking your own healthy tissue. This in turn, causes inflammation, which damages the tissues. Doctors do not completely understand why autoimmunity occurs, but they suspect that it involves some combination of genetics and triggering by environmental factors, such as viruses.

    There are three major types of lupus; the most common is systemic lupus erythematosus (SLE).

    • Systemic lupus erythematosus (SLE). Systemic lupus erythematosus (SLE) is the type of lupus with which most people are familiar. It is a systemic disorder, meaning that it can attack different parts of the body, including the joints (90%), skin (50%), kidney (50%), and nervous system (25%).
    • Discoid lupus erythematosus. Lupus that is limited to the skin is called discoid lupus erythematosus. About 5% to 10% of people with discoid lupus later develop SLE.
    • Drug-induced lupus. Drug-induced lupus is triggered by taking a medication. It usually goes away a few weeks or months after the patient stops taking the drug. Drug-induced lupus usually does not cause kidney or central nervous system problems like the other forms of lupus do.

    Nine times more women than men have lupus. While the disease usually strikes women during their childbearing years, men, children, and older adults also can develop lupus. As many as two million people in the US may have lupus, according to the Lupus Foundation of America.

    Systemic lupus erythematosis (SLE) is a chronic disorder punctuated by flares and remissions. The symptoms of lupus, such as fevers, swollen joints, and fatigue, can vary from day to day. Flares (exacerbations) are unpredictable in their character, frequency, and severity. Also, each person’s illness has its own personality and pattern of flares and characteristics. These flares alternate with periods of few or no symptoms (remissions). Some patients may be free of symptoms for a long period of time, even years. About 20% of patients may experience a remission, during which they do not require treatment. It is difficult to predict what course the disease will take, as manifestations range from mild to severe. If you suffer from lupus, you may experience reactions to light (photosensitivity), hair loss, or more severe troubles, such as problems with your kidney and heart.

    There is no cure for lupus, but with good medical care, most patients can live a long time. Drugs and lifestyle changes, such as avoidance of the sun, quitting smoking, abstaining from alcohol, and maintaining a balanced diet, help patients control the disease. The 10-year survival rate is 90%. Kidney problems related to lupus pose one of the greatest risks to health, and should be managed by a specialist.

  • Causes

    The cause of SLE is unknown. It is believed that several factors contribute to the appearance of lupus.

    • As autoimmune diseases tend to run in families, a genetic component most likely exists; however, experts believe that many more genes are involved.
    • The disease can be triggered by infections, stress, sunlight, or ultraviolet light.
    • Sex hormones may contribute.
    • Flares are sometimes associated with pregnancy, reproductive cycles, birth control pills, and hormone replacement therapy.
    • Different elements may trigger the disease in different people.

    Certain medications cause drug-induced lupus. Some drugs have been implicated in causing drug-induced lupus, such as:

    • Procainamide (Procan, Procanbid, Promine, Pronestyl) and Quinidine (Quinaglute, Cardioquin, Cin-Quin), used to control irregular heartbeats
    • Hydralazine (Apresoline, Apresazide, Unapres) and Methyldopa (Aldoclor, Aldoril, Aldomet), used to treat high blood pressure
    • Chlorpromazine (Thorazine), an anti-psychotic tranquilizer
    • Isoniazid (INH, Rifater, Rimactane), used to treat tuberculosis; and
    • Phenytoin (Dilantin), given to control seizures.

    There are other drugs that may trigger lupus in addition to these.

    Not all people who take these drugs develop SLE. Actually, fewer than 10% of patients on such medications will develop SLE, and then only after prolonged treatment.

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