1-موضوعات
عامة
2-أشعارى
3-مختارات شعرية و قصصية
4-مقالات أدبية
5-مقالات تاريخية و سياسية
6-شخصيات
7-إسلاميات
8-عروض الكتب
9-القسم الطبى
10-طب الأسنان
11-مدوناتى الخاصة
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Systemic lupus |
Also called: "lupus erythematosus
desseminatus" (LED) or "systemic lupus erythematosus".
Systemic lupus is different from discoid lupus. Discoid lupus is
mostly limited to the skin. It can occur by itself or in combination
with systemic lupus.
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What is
systemic lupus? |
Systemic lupus is a generalised
autoimmune disease.
In an autoimmune disease, the immune system (=defence)
partly targets itself, by producing autoantibodies that cause
inflammatory diseases.
Generalised means that the autoimmunity can attack
different organ systems and can cause generalised disease
manifestations
|
Who is
affected by lupus? |
Basically anyone at any age, but
mostly lupus strikes women of childbearing age (80 to 90%). The number
of lupus patients affected by lupus also differs according to race. In
the USA lupus is more common in Blacks than in Caucasians. Genetic
(hereditary) factors are sure enough believed to play a role in the
development of the disease.
|
Prevalence
of lupus |
Studies are scarce and results vary
widely, but it cannot be denied that the number of lupus patients is
increasing. Improved diagnostic measures and a better understanding of
the disease are two important factors in the increase of lupus
patients, but there is also an absolute rise in the incidence (=
number of new patients per year of a specific disease)
|
Cause
and heredity |
The cause remains unknown. Experts are
getting convinced of the fact that inflammations and damage are caused
by a reaction of autoantibodies with normal cellular components and
other elements. In this process both genetic as environmental factors
can play a role.
Several genetic factors are of importance, but they are unlikely to be
entirely passed on. This is the reason why lupus is not a hereditary
disease, although risks of developing lupus are bigger if a relative
in the first degree has been diagnosed with the disease.
Ultraviolet rays are an example of an environmental factor known to
trigger lupus. Although it has not been proved, viruses may also play
a role in the onset of lupus. Lupus, however, is not contagious at
all.
Hormones are involved as well: female hormones stimulate lupus, while
male hormones protect against it. This is one of the reasons to avoid
the use of the contraceptive pill.
|
Onset
and symptoms |
Possible symptoms and manifestations
of lupus are very diverse. The onset of the disease is never the same:
it may start off with any of the symptoms mentioned below, in a mild
or severe form. Because there are so many symptoms, we have to stick
to the following summary:
- 90 %
- fatigue, arthritis and joint pain
- 80 %
- fever
- 70 %
- hair loss, anaemia, swollen glands
- 60 %
- weight loss, poor appetite, butterfly-shaped rash
- 50 %
- inflammation of the pleura (pleuritis), inflammation of the
heart sac (pericarditis), inflammation of the membrane lining the
abdominal cavity (peritonitis), renal involvement, personality
changes, purpura
- 40 %
- photosensitivity, bacterial infections
- 30 %
- ulceration of the mucous membranes e.g. aphthous ulcers, pain in
the muscles or myositis (inflammation of the muscles),
gastrointestinal complaints, enlargement of the liver, high blood
pressure, pneumonia, myocarditis (inflammation of the heart muscle)
and endocarditis (involvement of the heart valves).
- 20 %
- Raynaud's phenomenon (turning white of the fingers), discoid
lupus (skin involvement in lupus with round disc-shaped scars),
inflammation of the eyes, Sjogren's Syndrome, severe renal
involvement, attacks of epilepsy, psychoses, inflammation of the
coronary arteries (supply of blood to the heart muscle)
- 10 %
- hives, oedema or formation of blisters on the skin, lupus
pneumonia, brain damage or damage to the spinal cord, migraine,
autoimmune destruction of red blood cells, low platelet count,
neuritis (inflammation of the nerves)
|
Diagnosis |
The diagnosis is based on complaints
and/or symptoms and/or involvement of internal organs and/or
abnormalities in laboratory test results. There is no single lupus
test that can confirm the disease. Beginning mild forms of lupus are
hard to diagnose, and sometimes diagnosis is only possible after
following the evolution of the symptoms. In case of a possible onset
of lupus, following up the early symptoms as well as informing the
patient are very important.
Because there is no decisive test for lupus and due to the changing
character of the disease, criteria have been defined to classify
lupus. Their main purpose, however, is scientific research as they can
only be used as a guideline to diagnose lupus. In some cases lupus can
be diagnosed before the patient meets these criteria.
|
Treatment |
Must be focused on the following:
| general degree of illness and complaints |
| internal organs involved |
| degree of involvement of these organs |
Medications range from absolutely nothing to high doses of
corticosteroids or immunosuppressive drugs.
Antimalarials and nonsteroidal anti-inflammatory drugs are frequently
used. The basic principle to treat lupus is to react quickly with high
doses of corticosteroids and/or immunosuppressive drugs if necessary
and maintain the lowest dose possible during periods of low disease
activity.
|
Drug-induced lupus |
Some 50 prescription drugs can produce
symptoms of lupus, which normally disappear after the patient stops
taking the medication. This does not imply, however, that these drugs
are forbidden for lupus patients.
The most important ones are: Hydralasine (Neprosol), Procaïnamide
(Pronestyl), Isoniazide (Rimifon), Propylthiouracil (Strumazol),
d-Penicillamine (Kelatin)
The prescription drugs mentioned may have other brand names
|
Lupus en zwangerschap |
A lupus patient is allowed to become
pregnant if the disease is under control, with a low dose of
medication if necessary. The safest drug during pregnancy is a low
dose of corticosteroids. A lupus patient should not become pregnant
without a complete check-up, given the risk for mother and child. The
child may have neonatal lupus due to the presence of anti-Ro
antibodies and for the mother there is the risk of a severe flare.
During pregnancy a flare may occur. In this case, it needs to be
treated appropriately and the best way to do that is with
corticosteroids. If you have lupus, there is a greater risk of
miscarriage, often due to anti-cardiolipin antibodies (read further).
These antibodies cause the blood to clot more easily, so that small
blood vessels in the placenta can get clogged up. Low weight at birth
occurs more often in newborn babies of lupus patients.
|
Neonatal lupus |
This is a kind of skin lupus that
breaks out a few weeks after birth and disappears at the age of 6
months. It is caused by the transfer of anti-Ro antibodies through the
placenta to the foetus.
In more severe cases, the heart of the foetus may be affected at about
18 weeks and the foetus may die, or the baby may be born with a
congenital heart block (delayed contraction of the ventricle due to a
conduction disorder, resulting in a very slow heart rate).
The survival rate of these babies varies. The children themselves do
not have lupus.
|
Most important antibodies in lupus |
Anti-Sm antibodies |
About 15 % of lupus patients in Europe
have anti-Sm, compared to 30 % in the USA.
It is a disease marker: this means it is only found in patients with
lupus, and mostly in relatively serious cases. |
Anti-dsDNA antibodies
|
Seen in about 40 % of all lupus
patients. In more severe cases of lupus the percentage amounts to 80 %
during a flare. These antibodies are tightly linked with lupus and
lupus nephritis, though this is not 100 % the case. They occur
especially in lupus nephritis, in which they are also believed to play
an important role. |
Anti-Ro |
About 40 % of people with lupus have
anti-Ro. These antibodies are linked with congenital heart block and
neonatal lupus and are probably the cause of it. (read pregnancy) |
Anticardiolipin
antibodies |
Often facilitate blood clotting, which
may lead to a propensity for miscarriage and thromboses in young
patients. |
Antibodies against red
blood cells (positive Coombtest) |
kMay cause haemolysis, or the
destruction of red blood cells on an autoimmune basis. Severe
autoimmune haemolysis is very rare. |
A whole range of other
antibodies |
... of which the importance is not yet
clear.
|
Signs
and symptoms that need immediate medical examination: |
| fever attacks |
| sudden onset of extreme fatigue |
| general malaise |
| neurological complaints |
| extreme headache or unexplainable mood swings |
| acute or subacute skin rashes |
| unexplainable chest pains |
| unexplainable abdominal pains |
| new complaints due to arthritis |
| increasing shortness of breath |
| presence of protein in the urine |
| any form of infection |
|
Evolution and prognosis |
Systemic lupus progresses with ups and
downs. Periods of serious exacerbations may alternate with periods of
low disease activity, in which one may even discontinue taking
medication. The patient is then said to be in remission. After
menopause, lupus is likely to disappear spontaneously.
Life expectancy has increased greatly over the last 40 years and
statistically almost equals a normal life span with 93 % of all
patients surviving ten years after diagnosis. This improvement is due
to early diagnosis and better use of medication. Even lupus nephritis
can be reversed if treatment follows immediately and intensively.
The more severe forms of lupus that lead to death by affecting the
brain or kidneys have become rare. Exceptionally, however,
complications (mostly infections) or a neglected flare may be fatal.
Once "systemic lupus" is diagnosed, adapted drug treatment should be
able to stabilise the disease. Still, lupus is to be considered a
serious disorder.
Accurate compliance of medical advice together with regular medical
check ups are absolutely necessary to control the disease. Clear
information is in this case essential. Also contact with people from
our support group, the CIB-league, can be a step forward in the
process of learning how to cope with lupus.
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