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Autoimmune diseases arise from an inappropriate
immune response of the body against substances and
tissues normally present in the body. In other words, the
immune system mistakes some part of the body as a
pathogen and attacks its own cells. This may be
restricted to certain organs (e.g. kidney,lung,heart and
etc..) or involve a particular tissue in different places
.The treatment of autoimmune diseases is typically with
immunosuppression—medication which decreases the
Lupus is an autoimmune disease
What Is Lupus?
Lupus is a lifelong disorder of the immune system.
Immune cells attack the body's own healthy
tissues, leading to inflammation and tissue damage.
Symptoms may be limited to the skin, but more
often lupus also causes internal problems such as
joint pain. In severe cases, it can damage the
heart, kidneys, and other vital organs. Although
there's no cure, there are treatments that can
minimize the damage.
Joint and muscle pain is often the
first sign of lupus. This pain tends
to occur on both sides of the
body at the same time,
particularly in the joints of the
wrists, hands, fingers, and knees.
The joints may look inflamed and
feel warm to the touch. But unlike
rheumatoid arthritis, lupus
usually does not cause
permanent joint damage
A tell-tale sign of lupus is a
butterfly-shaped rash across the
cheeks and bridge of the nose.
Other common skin problems
include sensitivity to the sun with
flaky, red spots or a scaly, purple
rash on various parts of the body,
including the face, neck, and arms.
Some people also develop mouth
Lupus can cause the nails to crack
or fall off. They may be discolored
with blue or reddish spots at the
base. These spots are actually in
the nail bed, the result of inflamed
small blood vessels. Swelling may
also make the skin around the
base of the nail look red and puffy.
Fever and Fatigue
Most people with lupus experience
some degree of fatigue. In many cases,
it is severe enough to interfere with
exercise and other daily activities. Most
patients also run a low-grade fever
from time to time. This unexplained
fever may be the only warning sign in
Many people with lupus are unusually
sensitive to the sun and other forms of
ultraviolet light (such as tanning beds.)
A day at the beach may trigger a skin
rash in areas exposed to sunlight and
may worsen other lupus symptoms.
Certain medications can make people
with lupus even more sensitive to UV
The symptoms of lupus tend to
come and go, and this includes
hair loss. Patients may go
through periods where their
hair falls out in patches or
becomes thinner all across the
scalp. Once the flare-up is over,
new hair is likely to grow in
Some people with lupus develop a
condition called Raynaud's
phenomenon. Their fingers and toes
become painful, numb, and tingly in
response to cold temperatures or
emotional stress. This happens when
small blood vessels spasm and restrict
blood flow to the area. During an
attack, the fingers and toes may turn
white or blue. People can also have
Raynaud's without having lupus or any
serious health complications
When lupus begins, it can look a lot like rheumatoid
arthritis, which causes joint pain and swelling, or
fibromyalgia, which causes fatigue and pain. One aspect
that sets lupus apart is the combination of skin rashes with
joint pain and fatigue. There are also lab tests that can help
distinguish lupus from other diseases
Diagnosing lupus can be tricky. The disease
can mimic other conditions, and it often
takes a different course in different people.
Many people have it for years before
developing tell-tale symptoms. Although
there is no one test for lupus, certain
proteins usually show up in a patient's
blood. A blood test for antinuclear
antibodies (ANAs) can provide a critical
clue. Other lab tests may check cell
counts, kidney function, and clotting time.
A tissue biopsy of an involved organ such as
the skin or kidneys sometimes helps with
Who Gets Lupus?
Anyone can get lupus. But it affects women
10 times more often than men. Aside from
being female, your odds of getting the
disease are higher if you are:
•African-American, Latino, or Asian
•Between the ages of 20 and 40
•Related to someone with lupus
Types of Lupus
When people say "lupus," they usually mean
systemic lupus erythematosus (SLE), the most
common and serious type. But there are
other types. Cutaneous lupus erythematosus
– also called discoid lupus -- is limited to the
skin and doesn't cause the organ damage that
sometimes occurs with SLE. The most
common symptom is a circular rash. Drug-
induced systemic lupus causes temporary
lupus symptoms in people who take certain
Medical Treatments for Lupus
There are ways to control the symptoms of lupus. These
include corticosteroid creams for rashes and
nonsteroidal anti-inflammatory drugs (NSAIDs) for joint
pain and fever. Antimalarial medications can help fight
joint pain, ulcers, and rashes. Corticosteroids may also
be given as pills. In severe cases, they can be given
intravenously. People with severe lupus may benefit
from drugs that suppress the immune system.
Care for Lupus
Making some changes to your routine can also help
reduce lupus flare-ups:
•Cover up when you're in the sun.
•Improve your stress management skills.
Also be sure to get plenty of rest. Some people with
lupus need up to 12 hours of sleep a night.
Lupus and Kidney Problems
As lupus progresses, it can interfere with the
body's organs. Up to three out of four people
with lupus can develop kidney problems.
These problems may not cause symptoms,
though some people notice swelling in their
legs or ankles. Most patients only learn about
their kidney trouble when a urine test reveals
blood or abnormal protein levels.
Lupus and Heart Problems
The most common heart problem linked to lupus
is an inflammation of the sac around the heart.
This may cause severe pain in the left side of the
chest. People with lupus are also more likely to
develop plaques that narrow or clog the arteries.
This can lead to coronary artery disease. Other
complications include heart valve disease and
inflammation of the heart muscle. Call 911
immediately for chest pain, rather than trying
figure out the cause yourself
Lupus and Lung Problems
The tissue surrounding the lungs
becomes inflamed in about a third of
people with lupus. This may lead to
painful breathing, or chest pain, or it
may not cause any symptoms at all.
Sometimes lupus causes chest pain
that is not related to the lungs or the
heart. Instead, the pain comes from an
inflamed chest muscle or rib joint. Any
chest pain should be promptly
evaluated by a doctor
Lupus and Digestive Problems
Digestive problems are not common with lupus, but some people may experience
belly pain, nausea, vomiting, difficulty swallowing, or inflammation of the liver or
pancreas. This can be related to lupus itself or medications used to treat the
disease. Some people tend to lose weight during lupus flare-ups.
Lupus and Anemia
Lupus and the medications used to treat it can contribute to anemia
in some patients. This means the body has too few red blood cells,
because it is not making enough, or red blood cells are being
destroyed more quickly than they can be replaced. Symptoms
include fatigue and shortness of breath.
Lupus and the Nervous
Lupus can trigger a wide range
of problems with the nervous
system, most commonly
headaches. Mild memory
problems are a less common
complaint that may come and
go over time. Some people
with lupus have a greater risk
for a stroke, and in rare cases,
the disease can lead to
Lupus and Mental Health
Depression and anxiety are a risk for people with lupus. This
may be the result of the condition's affect on the nervous
system combined with the emotional strain of coping with a
chronic illness. Be sure to discuss any concerns about your
mood with your doctor or other health care provider. There are
highly effective treatments for depression and anxiety
Lupus and Pregnancy
Most women with lupus can get pregnant, though the condition increases the risk of
complications during pregnancy. Because lupus symptoms come and go, the best
time to get pregnant is when symptoms are at a minimum. Women who conceive
when symptoms are in remission are less likely to have complications. Make sure
your obstetrician knows you have lupus. Your medications may be modified and you
may undergo extra monitoring to ensure a successful pregnancy.
Most babies born to women with
lupus are entirely healthy. But in
rare cases, the newborn of a mom
with lupus may have neonatal
lupus. This condition can cause a
skin rash, anemia, or liver
problems. The symptoms usually
go away after a few months and
don't cause permanent damage.
However, some babies with
neonatal lupus can be born with a
serious heart problem.
Why Do People With Lupus Get Infections So Easily?
An individual with lupus is
more susceptible to infection
than most people for two
1. Lupus directly affects a person's
immune system and reduces his or her
ability to prevent and fight infection.
2. Many of the drugs used to treat lupus
suppress the function of the immune
system and leave the body more prone to
Effects Of Medications Used In
The Treatment Of Lupus
Cortisone-like drugs (prednisone) and
cytotoxic drugs such as azathioprine
(Imuran) and cyclophosphamide (Cytoxan)
increase a person's susceptibility to
infections because they suppress both
normal and abnormal immune system
However, controlling lupus is usually more
important than the danger posed by a
possible infection due to the use of
The risk of infection parallels the dose and the
duration of treatment with steroids:
a. a daily dose of 20 mg. of prednisone is
enough to impose a significant risk of
b. taking steroids every other day ("alternate
day" treatment) decreases the risk and
incidence of infections
People with lupus have abnormalities in their
immune systems, so they are more likely to
develop infections. They are more susceptible to
infection even if they do not take corticosteroids.
Lupus experts such as Dr. Marian Ropes
sparingly used steroids in treating her patients in
the 1940s and 1950s. Yet, the data she published
showed that the majority of her patients
developed serious infections, even on low-dose
Types Of Infection In SLE
Infections in people with lupus
fall into two categories.
a. The first category includes infections with
organisms that can affect persons with lupus
and the general population:
- streptococcus (which causes strep throat)
- staphylococcus (which causes staph
b. The second category consists of "opportunistic"
infections, which are caused by organisms that
bring about disease only when the immune
system is weakened
Fortunately, only a few individuals will need aggressive
hospital treatment for infections. The most common
infections in people with lupus usually do not require
hospitalization. These common infections usually
the respiratory tract
the urinary tract
However, infections in people with lupus
tend to last longer and require a longer
course of treatment with antibiotics than
infections in people who do not have lupus.
In addition, people with lupus are at an
unusually high risk for contracting:
salmonella (a bacteria)herpes zoster (a virus)candida (yeast)
Fevers In Lupus
Anyone with lupus who experiences a fever should
be thoroughly evaluated, especially if they are also
taking aspirin, non-steroidal medications
(e.g., Advil, Naprosyn), or steroids, which lower
body temperature. Fevers in lupus may be due to:
a drug reaction
Laboratory testing for infection
White blood cell counts
this test can help a physician distinguish
an infection from a lupus flare
- a low white blood cell count usually
suggests active lupus (although certain
viruses can also give a low white count)
- a high white blood cell count suggests
Culture of throat, urine, blood or stool
Complete blood count (CBC)
Treatment and Prevention of Infection
The treatment of infections in a person with
lupus is basically the same as for anyone else;
even people taking high doses of
immunosuppressive medications for their lupus
may respond well to antibiotics.
However, the use of sulfa antibiotics to treat
infections in people with lupus should be
avoided whenever possible. Thirty percent of
people with lupus are allergic to sulfa antibiotics.
In addition, these types of antibiotics can: increase photosensitivity
increase skin rashes
lower white blood cell counts.
Living with Lupus
The fatigue and joint pain associated
with lupus can make it more difficult
to do your job or care for your
children. You may have to cut back
on activities or ask for help when
symptoms flare up. But most people
with lupus are able to continue with
their usual activities.
1. Utz PJ. Multiplexed assays for identification of biomarkers and
surrogate markers in systemic lupus erythematosus. Lupus 2004;
2. Liu CC, Manzi S, Danchenko N, Ahearn JM. New advances in
measurement of complement activation: lessons of systemic
lupus erythematosus. Curr Rheumatol Rep 2004; 6: 375-81.
3. Manzi S, Ahearn JM, Salmon J. New insights into complement:
a mediator of injury and marker of disease activity in systemic
lupus erythematosus. Lupus 2004; 13: 298-303
4. Buyon JP, Tamerius J, Belmont HM, Abramson SB. Assessment of
disease activity and impending flare in patients with systemic lupus
erythematous. Arthritis Rheum 1992; 35: 1028-37.
5. Spronk PE, Limburg PC, Kallenberg CG. Serological markers of
disease activity in systemic lupus erythematosus. Lupus 1995; 4: 86-
6. Sullivan KE, Wisnieski JJ, Winkelstein JA, Louie J, Sachs E, Choi
R, et al. Serum complement determinations in patients withquiescent
systemic lupus erythematous. J Rheumatol 1996; 23:
7. Prrcel JM, Ordi J, Castro-Salamo A, Vilardell M, Rodrigo MJ,
Gene T, et al. The value of complement activation products in
the assessment of systemic lupus erythematosus flares. Clin
Immunol Immunopathol 1995; 74: 283-8.
8. Milis L, Timmermans V, Morris CA, Pussell BA, Charlesworth
JA. The value of complement measurements in the assessment
of lupus activity. Aust N Z J Med 1992; 22: 338-44.
9. Röther E, Lang B, Coldewey R, Hartung K, Peter HH.
Complement split product C3d as an indicator of disease activity
in systemic lupus erythematosus. Clin Rheumatol 1993; 120: 31-
10. Chiu YY, Nisihara RM, Würzner R, Kirschfink M, de Messias-
Reason IJ. SC5b-9 is the most sensitive marker in assessing
disease activity in Brazilian SLE patients. J Investig Allergol Clin
Immunol 1998; 8: 239-44.
11. Manzi S, Rairie JE, Carpenter AB, Kelly RH, Jagarlapudi SP,
Sereika SM, et al. Sensitivity and specificity of plasma and urine
complement split products as indicators of lupus disease activity.
Arthritis Rheum 1996; 39: 1178-88.
12. Jamal S, Jolles S. The role of complement testing in dermatology.
Clin Exp Dermatol 2005; 30: 321-6.
13. Illei GG, Tackey E, Lapteva L, Lipsky PE. Biomarkers in systemic
lupus erythematosus: II. Markers of disease activity. Arthritis Rheum
2004; 50: 2048-65.
14. Liu CC, Manzi S, Ahearn JM. Biomarkers for systemic lupus
erythematosus: a review and perspective. Curr Opin Rheumatol
2005; 17: 543-9.
15. Bresnihan B. Outcome and survival in systemic lupus erythmatosus. Ann Rheum Dis.
16. Ballou SP, Khan MA, Kushner I. Clinical features of systemic lupus erythmatosus:
Differences related to race and
age of onset. Arthritis Rheum. 1982;25:55-60.
17. Lahita RG. Sex and age in systemic lupus erythmatosus. In: Lahita RG (ed) systemic
lupus erythmatosus. New York:
Wiley Press; 1986:523-529.
18. Campos LM, Kiss MH, D Amice EA, Silva CA. Antiphospholipid antibodies and
antiphospholipid syndrome in 57
children and adolescents with systemic lupus erythematosus. Lupus. 2003;12:820-826.
19. Wang LC, Yang YH, LU MY, Chiang BL. Retrospective analysis of mortality and morbidity of
lupus erythematosus in the past two decades. J microbial Immumol Infect. 2003;36:203-208.
20. Larson DL. Systemic lupus erthematosus. Boston: litthe brown Press; 1961.
21. Dubois EL. Lupus erythematosus. 2nd ed. Los Angeles: University of South California Press;
22. Wallace DJ, Dubois EL. Dubois, lupus erythematosus. Philadelphia: Lea and Fibiger Press;
23. Talal N, Pillarisetty R, Papoian R. Experimental lupus: A disorder of immunologic regulation.
Adv Neph Rol.
24. Roubinian JR, Papoian R, Talal N. Androgenic hormones modulate autoantibody responses
and improve survival in
murine lupus. Y Clin Invest. 1977;59:1066-1070.
25. Papoian R, pillarisetty R, talal N. Immunological of spontaneous antibodies to DNA and RNA:
II Sequential switch
from IgM to IgG in NZB/NZWa f, MICE. Immunology. 1977;32:75-79.
26. Yocam MW, Grossman J, water house C, Abraham GN, May AG, Condemi JJ. Monozygotic
twins discordant for
systemic lupus erythematosus. Arthritis Rheum. 1975;18:193-199.
27. Stern R, Fishman J, Brusman H, Kunkel HG. Systemic lupus erythematosus associated with
Arthritis Rheum. 1977;20:18-22.