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Lupus: Treatment, Symptoms, Diagnosis, Causes

by Gauri Kolhe

Lupus is an autoimmune disorder associated with the immune system and also known as disease of 1000 faces. Generally immune system is designed to fight from the microorganism, foreign particle or any other factor which is harmful to the body.

Immune system is your own body guard and protects you. But n case of autoimmune disease, immune system becomes hyperactive and attack back to the normal and healthy tissue of the body.

The basic lupus symptoms include inflammation, damage in the joints, swelling, blood, heart, kidneys and lungs. Lupus is not that easy to diagnose and it has many faces hence it is called as disease of 1000 faces due the variety in complication in different individual.

 Around 16000 new case of lupus has reported in United States every year.

According to the lupus foundation of America, around 1-5 million of the people may be living with the medical condition lupus.

Lupus particularly affects women in comparison to men and mostly between the ages of 15-44 years.

Lupus is not a contagious disease and also cannot be transmitting by sexual means or in any other way from person to person.

It could be possible in rare cases where lupus having women give birth to a child that can develop a form of lupus. This is known as neonatal lupus as it is associated with the neonates.

Types of lupus

There are some kind of lupus based on the site and stage. Some of the types are discussed below

Systemic lupus erythematosus (SLE) discoid, neonatal and drug induced lupus.

Systemic lupus erythematosus (SLE)

Systemic lupus erythematosus (SLE) is most common type of lupus. As the name indicates this is serious and systemic type of condition which has the impact on whole body or you can say throughout the body.

Lupus symptoms can be varies from mild to severe.

 SLE is the most serious lupus when it comes to the comparison of all kind of lupus because any organ or organ system can b affected with this while in case of others they are limited.

SLE affects the body organs by causing inflammation in joints, skin, lungs, heart, kidneys, and blood. In the starting, no symptoms can be seen but as it progress the disease become active and lupus symptoms starts to show.

Discoid lupus erythematosus

DLE is another kind of lupus which is associated with skin. It can also call as skin lupus. In this kind of lupus rashes on the skin are appears in the face, scalp neck and area.  

The affected areas may look thick and scale like structure and it may also leaves the scars behind. Surprising thing is that the rashes can also last from a couple of the days to years.

Although DLE does not affect organs other than skin, it has been reported that around 10 % of the patient of DLE will go to develop the SLE. However it is not confirm that the individual had SLE or they just show the sign on the skin.

Subacute cutaneous lupus erythematosus

This lupus refers the lesions on yes open parts of the skin that happens due to the exposure of the sunlight. This type of lesions does not cause any scar.

Drug induced lupus

Around 10 % of the people who have suffering from the SLE, some symptoms appears due to the reaction of prescribed drugs.

About 80 drugs are responsible to develop lupus symptoms including the drugs used to treat seizures, high blood pressure, and some thyroid medications like antibiotics, antifungal and oral contraceptives.  

Some of the drugs commonly associated with lupus symptoms are hydralazine (used in hypertension), procainamide (heart arrhythmia medication), isoniazid (antibiotic used to treat tuberculosis). Drug induced lupus symptoms disappear after stopping the use of the causative medication.

Neonatal lupus

As the name indicates this kind of lupus occurs in the neonates. Most of the babies are healthy born to the mother having SLE. The babies who have born to mothers, who already suffer from the lupus during pregnancy, sometimes show the lupus symptoms. This happens around 1 % of the women who have autoantibody relating lupus.

These women believed to may have another syndrome named Sjögren’s syndrome. This is another autoimmune disorder that appears often with the lupus. The main symptoms of the Sjögren’s syndrome are dry mouth and dry eye.  

At the time of birth neonates having lupus shows lupus symptoms as skin rash, liver problem, and blood counts. Almost 10 %of these kinds of babies have anemia.

Usually these lesions fade away after a few weeks of birth. In some cases the neonates have a congenital heart block. This condition is associated with the irregulation if a normal and rhythmic pumping action so they need pacemaker to regulate them. This could be life threatening disease.

This is really important for the women who have SLE or any other syndrome to consult the doctor and take proper care during pregnancy to prevent this kind of situation in the neonates.

Causes of lupus

Although it is known that lupus is an autoimmune disease but actual cause is not confirm yet here are some beliefs related to lupus discussed below.

When something is wrong with immune system:  Usually immune system fights from foreign particle and microorganism (virus, bacteria) to protect you from various diseases but if something goes wrong with this , immune system attack your healthy cells which turns into autoimmune disorder.

Antibodies which are made up of proteins are produce by the white blood cells, b lymphocytes. When a person suffers from the autoimmune medical condition like lupus, in this situation immune system cannot differentiate between the unwanted substances, antigen and healthy cells.

This results immune system attack direct antibodies against antigens as well as healthy cells. This attack of antibodies causes swelling, pain and tissue damage in the body.  

An antinuclear antibody (ANA) is the most common type of the antibodies that develop in people with lupus. The antinuclear antibody (ANA) reacts with the various components of the cells which leads having command on the centre of the cells.

In lupus, autoantibodies keep circulating in the blood b but some of the autoantibodies permeate through the cell wall due to the permeable structure of cell wall. These antibodies attack the DNA present in the centre of nucleus of the cells. Just because of this lupus affects the specific organ so lupus symptoms appear.

Reason behind the wrong happening with the immune system:  There are several genetic factors that affects probably promote the development of SLE lupus.

Some of the genes are responsible for helping the functioning of the immune system. In case of the people with SLE, these genes stop working properly which may stop the function of immune system.

According to genetic home reference there is one possible theory relate to cell death which is a natural process happens in the body to renew the cells. Some of the researchers believe that due to some genetic factors, body does not able to get rid of the dead cell. These remaining dead cells may releases substances that cause the immune to malfunction.

Risk factors related lupus

Some of the health exerts believes the development of lupus appears in the response of numerous factors such as genetic, environmental, hormonal or sometimes combination of these.

Genetic factors

Genetic factors

Whenever it comes to any causes and risk factors of any disease the genetic factor is always on the top.

Researchers have not found any prove of any genetic specific factor that is related to causing lupus even though it is most common in many families. Some genetic factors may be the reasons are as follows:

Race: Race is the primary factor when it comes to the genetics. Lupus can be develop in any kind of background but it is fond that it is 2-3 c=times common in the people of color in comparison of white people like Hispanic, Asian and Native American women.

Family background:   A person having first or second degree relative had lupus will have the greater risk of developing the risk of lupus. Some of the scientists identified the certain genes which may lead the development of lupus but they do not having enough evidences that the genes are able to cause disease.

In several studies including identical twins it has been found that on twin may develop the lupus while another twin is perfectly fine, even when they grow up together and have the same environmental conditions.

In a study published in seminars in the arthritis and rheumatism in 2017 it has been reported that if one member of twin has lupus then there is a 25 % chance of developing the lupus in other twin. These identical twins have the same condition.

Lupus can also be developing in the people who do not have the family history of lupus. But there may be other autoimmune disease in the family history. For instance hemolytic anemia, idiopathic thrombocytopenia purpura, and thyroiditis are some other autoimmune disease.

Some of the studies proposed the changes in the X-chromosomes might affect the risk of developing lupus.

Hormones

Hormones are substances produced and secreted by the body in order to maintain the physiology of human body. Hormones are able to control and regulate the activity of certain cells or organs.

Hormonal activity could explain the following risk factors:

Sex: according to the U.S. National Institutes of Health females are nine times more prone to have lupus in comparison to males.

Age: age is another factor that works as risk factors in lupus. Lupus Symptoms often seen and can be diagnose in the age of 15-45 years, during the years of childbearing. According to Genetics Home Reference 20 percent of cases appear after the age of 50 years,

Researchers have found a possible link between estrogen and lupus as it has been seen that 9 out of 10 occurrences of lupus symptoms found in females. Although, both men and women produces estrogen women produce more in comparison to men.

In a study that was published in 2016, scientists observed that estrogen can affect immune activity and induce lupus antibodies in mice that are susceptible to lupus

There is no direct and enough evidence that can confirm the fact that estrogen causes lupus. But if there is any possible link between the lupus and estrogen then it could be regulate by the estrogen-based treatment. To offer the treatment, more research is needed.

Environment factors

Environmental factors affect our life in many aspects in regular life as well as diseases conditions. Environmental agents like chemicals or viruses seem to contribute in many diseases and may also be risk factor of developing lupus in genetically susceptible people.

Some Possible environmental triggers are as follows:

Sunlight exposure: sunlight exposure results in various gene expressions and also promotes DNA damage in many diseases like cancer and photo aging.  Some researchers suggest that sunlight exposure may be a trigger.

Smoking: higher tobacco exposure rise as a risk factor in the people who have lupus in recent decades.

Medication:  Reactions arises from the prescribed medication or long use of mediation may also contribute lupus and lupus symptoms can be seen in them.

Viral infections: viral infections may also triggers lupus symptoms in the people who are very prone to SLE.

Lupus Symptoms

Lupus symptoms includes following:

  • Swelling in the legs or around the eyes
  • fever
  • headaches
  • arthritis
  • Fatigue
  • Chest pain upon deep breathing
  • A loss of appetite and weight loss
  • Pain or swelling in joints and muscles
  • Swollen glands, or lymph nodes
  • Skin rashes, due to bleeding under the skin
  • Mouth ulcers
  • Sensitivity to the sun
  • Unusual hair loss
  • Pale or purple fingers or toes from cold or stress (raynaud’s phenomenon)Top of Form

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Diagnosis

Diagnosis

Various symptoms of lupus resemble the symptoms of other medical conditions so it is quite difficult to diagnose lupus easily.

The health experts will ask you some questions regarding to your problem, carry a physical examination and also study medical and family study. And thsy may request you to go for some blood tests and other laboratory based investigations. Some biomarkers and blood test helps to diagnose lupus.

Biomarkers

Generally Biomarkers could be a marker that indicates the biological process happening in body during disease condition. They could be found in the form of antibodies, proteins, genetic, and other factors that can directly show the processes happening in your body and what is the response of ypur body to the treatment to your doctor.

They can indicate the condition of the person even when there is no symptom that’s why they are very useful.

As the name says disease of 1000 face, lupus affects different individual in different way so it difficult to find a reliable biomarker.

Moreover, a combination of blood tests and other investigations can helpful to a doctor to confirm a diagnosis of lupus.

Blood tests

Blood tests are reliable to diagnose any disease and they can show whether certain biomarkers are present or not. Some blood tests are as following that is helpful to diagnose lupus.

Antinuclear antibody

Antinuclear antibody found in the people with lupus symptoms and ANA controls the centre of cell and disrupt the function of immune system. This will work as biomarker.

It has been seen that around 95 percent of people with lupus will have a positive result in the test carried out for ANA.  However, in some cases people found positive in the test but they don’t have lupus.

Anti-dsDNA antibody

This test is used to diagnose lupus. Less than 1 % of healthy individual have this antibody. Basically the anti-double-stranded DNA antibody (anti-dsDNA) is a specific type of ANA antibody that appears in around 30 %of the people who suffers from lupus.

In case of positive test result, this says that person has the serious form of lupus like kidney lupus or lupus nephritis.

Anti-DNA antibody test

 70 percent of people can diagnose with lupus by testing an antibody called as the anti-DNA antibody. The result of the test is more likely to be positive during a flare-up.

Anti-phospholipid antibodies

Antiphospholipid antibodies (APLs) are another type of antibody that are made up of proteins and work against phospholipids. About 50 % of the people having lupus found positive in the test for APLs. PALs also present in the people who don’t have lupus.

Presence of APLs develops the higher risk of the stroke, blood clots and pulmonary hypertension. This could be risky in pregnancy.

Anti-Smith antibody

The anti smith antibody occurs around 20 percent of people with lupus. SM is a kind of ribonucleoprotein that is present in the nucleus of a cell. This antibody is present in less than 1 % of the population with lupus. This is absent in case of lupus nephritis.

Anti-U1RNP antibody

This antibody present only less than 1 % in healthy individual other wise 25 % of the people with lupus can be diagnosed with this test. This antibody may be appears in the people who have a medical condition associated with deformity of the hand due to arthritis also called as jaccourd’s arthropathy and raynaud’s syndrome.

Anti-Ro/SSA and anti-La/SSB antibodies

Anti-Ro/SSA and anti-La/SSB antibodies occur Between 30 and 40 percent of people suffering lupus.

These antibodies are present in a little amount in around 15  percent of healthy individual as they can associated with other rheumatic conditions, such as rheumatoid arthritis.

If a mother bears anti-Ro and anti-La antibodies, there is a high possibility that a baby born to her will have neonatal lupus.

So a person with lupus who wishes to become pregnant should have gone through this tests.

Anti-histone antibodies

Anti-Histone antibodies are the protein that associated with the synthesis of DNA. Usually these antibodies occur in case of drug induced lupus and people with SLE may also have them.

Serum (blood) complement test

a serum complement test associated with the measurement of the levels of proteins that the body consumes at the time of inflammation. The low levels of complement level indicate that inflammation is present in the body and SLE is also in the active from.

Urine tests

Urine tests

Urine tests are other tests helps to diagnose numerous medical condition. They can help in the diagnosis of the effects of lupus on the kidneys.

The wellness of the kidneys can see with the presence of protein, red blood cells, white blood cells and cellular casts.

Tissue biopsies

Biopsies of the tissue are sophisticated and reliable method of diagnosis. In case of lupus doctor may also request to biopsies with the tissues of skin or kidneys, to check for any damage or inflammation.

Imaging tests

Imagine tests such as magnetic resonance imaging, X-rays and other imaging tests can help to diagnose areas of the organs affected by lupus.

Treatment and home remedies for lupus

Due to the various complications and confusion with lupus symptoms to others, currently there is no cure for lupus, but somehow people can manage lupus symptoms with changes in lifestyle and medication.

The aim of the Treatment is to manage flare and reduce the risk of organ damage.

In case of lupus the medication helps to reduce pain and swelling, regulate the activity of the immune system, balance hormones, reduce or prevent joint and organ damage, manage blood pressure, reduce the risk of infection, control cholesterol.

The exact treatment varied from person to person as they have different physiology and different lupus symptoms. But if lupus leaves untreated, the flares may lead to the life threatening consequences.

Alternative and home therapies to manage lupus

  • Despite the medication, some other alternatives can also helps to manage the lupus symptom by reducing risk of flare or reduce and relief in the pain.
  • Lupus symptoms can be soothe by applying heat and cold
  • Lupus can be mange by participating in relaxation or meditation activities, including yoga and tai chi
  • Doing regular exercise when possible is another method to manage and reduce lupus symptoms.
  • If possible try to avoid exposure to the sun
  • Avoiding the stress, as far as possible can also be a help to manage lupus symptoms

Some people use also use the supplement thunder-god vine. However, it could be poisonous according to National Center for Complementary and Integrative Health (NCCIH). So if you are thinking to use it , first go to your doctor and ask him.   

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