Lupus

All autoimmune problems inlcuding lupus have a common basis in an overactive immune system. It is caused by the B-cells,a type of white blood cells which mistakenly see the body’s own proteins as foreign and mount an immune response against them.

Lupus is the common name for Systematic Lupus Erythematosus (SLE) which means “wolf” in Latin. This disease was so named because its most common symptom, a red facial rash, resembles a wolfish snout.

The effects of SLE are more than skin-deep. They attack the skin, joints, central nervous system and the kidneys, heart and lungs. The body appears to be allergic to itself.

In the norm, antibodies will fight the antigen in our bodies. In SLE, the antibodies fight the tissue instead and damage it for example if it destroys the red blood cells it causes anemia.

There are 3 types of Lupus

  1. Non organ-threatening : (Discoid lupus)
    You will only experience aches, fatigue, fever and swollen glands or rashes.
     
  2. Organ-threatening : (SLE)
    This is the more serious form which involves the heart, lung and kidneys. It can be fatal if not treated.
  3. Drug-induced lupus 

SLE is more common than multiple sclerosis, cystic firbosis, cerebral palsy, sickle cell anemia and AIDS combined.

 

Discoid lupus (DLE)

This is sometimes referred to as "cutaneous lupus".  This affects the skin and not the organs. Therefore it is not life threatening. Symptoms are scaly red patches or lesions on the skin that shapes like a disc. It usually affects the face, neck and upper part of the chest. With proper care the lesions should clear up shortly. However the longer the lesion last, the greater risk of permanent scarring.

DLE can lead to hair loss and permanent bald patches.  It can also lead to SLE

 
Early Signs

Lupus can be difficult to diagnose especially in older people as the early signs look very much like a number of other illnesses. Children generally show more obvious symptoms and can therefore be diagnosed quickly.  

Note noone ever gets ALL the symptoms. Most will get a few of them. The most common symptoms include:
  • Joint pain and swelling ( seen in about 50% of cases)
  • Facial rashes ( in about 20% cases)
  • Malaise and fatigue (in about 70% cases)
  • Low grade fever
  • Loss of appetite (weight loss)
Other symptoms :
  • Chest : pleurisy-inflammation of the membranes lining the inside of the chest around the lungs. Pericarditis – inflammation of the sac surrounding the heart. These causes fluid to accumulate thereby affecting the function of the lungs and heart. Breathing and shortness of breath or a rapid heartbeat may result. Pain is common.

  • Muscular : weakness and aching pain

  • Blood : A low blood count (anemia) is common and can be a cause of fatigue. White blood cells may decrease (leukopenia or lymphopenia) so do platelets (responsible for blood clots) causing the blue and black marks. 

    Some will develop sticky blood or Hughes syndrome where the blood becomes more viscous and therefore more likely to clot. 

  • Circulatory : Spasms in the small blood vessels will restrict the flow to the extremities ie to your fingers, toes, ears or nose. This results in pain and bluish color change.

  • Digestive system : stomach pain, cramps, nausea, vomiting, diarrhea .  Could be caused by negative reaction to certain foods as lupus can make people highly allergic.

  • Kidneys : they become less efficient in filtering waste out of the blood. In an inflammatory reaction, when the antibody mixes with the antigen, it forms an immune complex. Normally this complex is eliminated from the body but in lupus some are trapped in certain parts of the body. Kidneys are damaged when they cannot filter out these immune complexes.

  • Neurological: may affect both the central and peripheral nervous system. Affecting the central nervous system would include seizures and phsychotic type behaviour. The other affects the nerves throughout the body hence impacting the five senses and movements, such that the hands, feet and parts of the face can become numb or oversensitive that they cannot be touched. It could be trembling hands or constant leg movement...in other words no control over your own movement.

Cross over symptoms from Hughes syndrome and Sjogrens' syndrome can also cause headaches, mouth ulcers and blood clots.

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Prevention of Lupus
 

This is a complicated proposition. The cause of lupus is still unknown.  The disease may be genetic which makes prevention harder to control. This genetic predisposition to lupus must still be triggered by environmental factors. 


Potential lupus triggers
  1. Alfalfa: These sprouts contain a high amount of the amino-acid L-canavanine which has been proved to cause or worsen inflammation in people with autoimmune diseases including lupus.

  2. Sun : The UVA and UVB radiation are known to aggravate lupus. You will develop rashes and fatigue. It may be initiating the disease process. So remember to apply sun block. Scientists know that UV rays from the sun increase immune system response, so this will be amplified in people suffering from lupus. since their immune system is already overactive.

  3. Avoid aromatic amines : These chemicals may have a role in causing or aggravating lupus. They can be found in hair coloring solution (para-phenylenediamine), tobacco smoke, food coloring and preservatives (tartrazines or yellow dye).

  4. Medication: Prescription drugs have been linked to lupus. If you take prescription drug and a rash, fever, or swollen joints result, call your doctor immediately.

  5. Stress : intense and prolonged stress has been seen as a cause of lupus flares.  This will include bereavement, job loss and major upheavels.

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Treatment
 

Since the actual cause is still unknown, it is the symptoms that are being treated.

About 90% of people with lupus need to take medication, mostly the anti-inflammatories, NSAIDs, including aspirin. Treatment is aimed at the symptoms and as each one experiences different symptoms, no one treatment will be the same.

NSAIDs (nonsteroidial anti-inflammatory drugs) inhibits the release of prostaglandin, a chemical that causes inflammation and pain (by sensitizing the nerve endings), that are found elsewhere as well as the stomach. 

Aspirin has long been used in treating lupus as it can lower fever, relieve headache, ease muscle aches and pains and reduce malaise but is found to be more toxic than NSAIDs.

However the side effects of taking NSAID is it can cause stomach, liver and kidney problems in some people.

This is because the NSAIDs (eg aspirin) blocks the production of Cyclooxygenase-1 (COX-1) enzyme which produces prostaglandin that also protects the stomach lining. As the protective mucus lining of the stomach is reduced, it causes stomach upset, ulceration, abdominal pain, heartburn and bleeding from the stomach and intestines. Some other drugs may be prescribed to prevent ulcers and bleeding.

They will also cause fluid retention, reduction in creatinine clearance and eventually renal failure.

Other side effects include hypertension and moderate to severe noncardiogenic pulmonary edema, sensitivity reaction, tinnitus, and hearing loss.

NSAIDs should be avoided during pregnancies as these appear in the breast milk.

A new generation prostaglandin-inhibiting NSAIDs called COX-2 (Cyclooxygenase-2) appears to be safer as it only blocks the prostaglandin at the site of inflammation and therefore does not affect the stomach. However, COX-2 raises the risk of heart attacks and are costly. The risk of kidney damage is also not eliminated as compared with the other NSAIDs used currently.

Find out more about NSAIDs and COX-2 from :
http://www.medicinenet.com/cox-2_inhibitors/article.htm

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Organ-threatened lupus
 

Stronger drugs are required for the organ-threatening form of lupus. These drugs also referred to as disease modifiers as they can change the course of the disease.

There are 3 general types used :
  • antimalarial : this is used to control lupus arthritis, skin rashes, mouth ulcers, fatigue and fever. though generally safe, chloroquine can cause permanent eye damage if taken in high dosages or over a long time. 

    Side effects include headache, irritability, dizziness, nausea, abdominal cramps and loss of appetite. Skin dryness, pigmentation and eruptions can also happen.

  • corticosteroids : although they are very effective in reducing inflammation, they will decrease immune response (by lowering the number of lymphocytes, white blood cells) and therefore more susceptible to infection. They are also prescribed to minimize damage to internal organs. They are available as creams, injections, or intravenous treatment.

    Side effects includes easy bruising and skin thinning, obesity, diabetes, high blood pressure, mood changes, ulcers and increased risk of infection. It may also include convulsions, headache, mood swings and congestive heart failure.

    Long tem usage may cause hypertension, glaucoma and osteoporosis. Also the adrenal glands which normally produce corticosteroids may stop producing them permanently, in which case you will need to take these drugs to stay alive.

  • Immunosuppressants : these are used in severe cases where the kidneys are affected. They are powerful and very toxic drugs but may slow the progress of the disease.

    They decrease or prevent immune response. They suppress the hyperactive immune response by targeting and damaging the autoantibody-producing cells.

    Side effects are dose dependent and are reversed once the medication is stopped or reduced.

    The use of immunosuppressants will increase susceptibility to infection , reduction in production of red blood cells, white blood cells and platelets, and may develop malignancies.

    Other side effects include pulmonary fibrosis, anemia, nausea and leucopenia

Besides medication, the following should be part of the programme to minimize flares:

  • Adjusting your lifestyle : avoid doing it if it makes you sick after eg rashes appear after exposure to sunbathing, then restrict your exposure to sunlight. Prioritize your activities.

  • Emotional reactions : control stress and negative thoughts. Pinpoint the source of the emotional problem.  Massage helps to relieve stress by relaxing muscles and imporve blood circulation.

  • Rest : have sufficient rest and don’t overdo activities
  • Keep a positive attitude, Put on a smile and get on with living

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Alternative treatment
 

At the moment no alternative treatment has been found or studied. But there are certain herbs that can help relieve the common symptoms of depression and mental and physical fatigue.

St John’s Wort has been used to treat lupus related depression without any side effects and gingko helped to counter malaise and mental fatigue.  These takes a few weeks for any results to be seen.  Can be used in conjunction with antidepressant.

There are no cures for lupus and any treatment hopes to relieve symptoms, prevent major organ deterioration and allow them to live a normal life. Lupus is an invisible disease. People with lupus may look healthy but in fact they could be feeling quite ill.

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Immune system concerns
 

As lupus affects the immune system, the body’s ability to fight and prevent infection will be reduced. This is compounded if taking corticosteroids and immunosuppressants. When the immune system is suppressed, you are more vulnerable to unusual organisms that usually don’t affect healthy people.

Extensive research has determined that many people with lupus have antiphospholipid antibodies which increase the risk of developing blood clots. There will be other dangerous complications as a result but only a small number will develop these complications.

 

 

NB: One of the most annoying thing about this condition is that it makes people with lupus looks well on the outside (glowing health in appearance-rosy cheek etc) but they can be really sick on the inside.  Hence it is usually impossible to spot someone with lupus just by looking at them. Until they have reach a serious stage of couse.

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