What Can Cause Lupus & Flare Ups?

Doctors don’t know exactly what causes lupus. They think genetics, hormones, and your environment may be involved.

Your body’s immune system protects you from bacteria, viruses, and other foreign invaders that can make you sick. But if you have lupus, your immune system also mistakenly attacks and damages your body’s own tissues, too. Diseases that do this are called autoimmune diseases.

You could be born with a gene that makes you more likely to get lupus. Then you might be exposed to something in your environment, and that triggers the disease.

But even if both of these things come together, that still doesn’t mean you’ll get lupus. That’s why it’s so hard for doctors to figure out what causes it.

What researchers do know is there are certain things that make you more likely to get it, including your heredity, gender, race, and even previous illnesses.

Genetics and Lupus

Your genes are the sets of instructions that tell your body how to work. Changes to your genes can sometimes lead to disease.

Scientists haven’t found any single gene that causes lupus. Yet people with lupus are more likely to have changes to the genes that help their immune system recognize and respond to viruses and other germs.

Lupus also often runs in families. So if your parent, brother, or sister has lupus, you’re a bit more likely (just between 1% and 5%) to get it than someone who doesn’t have it in their family.

Certain ethnic groups share common genes that may make them more likely to get lupus. Your chances are higher of getting the disease if you are:

• African-American
• Asian
• Hispanic/Latino
• Native American
• Native Hawaiian
• Pacific Islander

Women and Lupus

Doctors think the hormone estrogen might play a part in lupus because 9 out of 10 people who have it are female. Men and women both make estrogen, but women make much more.

What’s the connection? Research shows that estrogen helps make women’s immune systems stronger than men’s, so the hormone could also trigger lupus or make it worse.

Some women with lupus also get symptom flare-ups around their period or during pregnancy when estrogen levels are higher. But this doesn’t prove that estrogen causes lupus.

Environmental Triggers

Most researchers believe that just having genes that make you more likely to get lupus isn’t enough. You also have to come in contact with something in the environment, such as a virus, to get the disease.

These triggers may include:

Sunlight. Ultraviolet, or UV, light from the sun damages your cells. That’s why you get sunburn. But in some people, the immune system attacks the sunburned, or damaged, cells.

And UV light not only seems to trigger lupus, it also appears to make symptoms worse. When people with lupus are exposed to UV rays, they tend to get joint pain and feel fatigued.

Infections. Usually when you get sick, your immune system fights off the virus and then stops. But in people with lupus, the immune system keeps attacking. Doctors don’t know why.

Viruses that have been linked to lupus include:

• Cytomegalovirus
• Epstein-Barr virus, which causes mononucleosis
• Herpes zoster virus, which causes shingles

Medications. Certain drugs can make your immune system overreact and cause what’s called drug-induced lupus. It usually doesn’t last long. Nearly 50 different drugs have been linked to lupus, including medicines to treat heart disease, thyroid disease, infections, and high blood pressure.

The drugs most likely to cause lupus are:

Toxins. Research shows that being around certain chemicals — including cigarette smoke, mercury, and silica — could be linked to lupus. But nobody has been able to prove a direct connection.

If you work in an industry where you’re exposed to mercury and silica, talk to your doctor. And it’s always a good idea to quit smoking.

Stress. Some people say that a stressful event happened right before their first lupus flare. Although doctors haven’t proven that stress is a direct cause of lupus, it’s known to trigger flare-ups in people who already have the disease.

Stressful events that can make symptoms worse include:

• A death in the family
• Divorce
• Extreme fatigue
• Injury
• Pregnancy/childbirth
• Surgery

Everyday stresses — things like traffic or conflicts at work or in a relationship — are less dramatic. But over time, if they build up, they can take a toll, too. So you’ll want to have a good way to handle those day-to-day challenges. Exercise is one way to burn off stress. So are spending time with friends, doing something you enjoy, and meditating or praying.

If you’re going through a hard time, or need more ideas to tame your stress, consider talking with a counselor. Even a few sessions can make a difference.

What You Can Do

Although we know the things that are linked to lupus, it’s important to remember that researchers have not been able to prove that they directly cause the disease.

Just because your brother or sister has lupus, or you’ve had herpes zoster virus, that doesn’t mean you’ll get lupus, too. If you’re concerned about your risk, or have already noticed symptoms, talk to your doctor.

Can lupus be caused by stress?

It now appears that a large subset of lupus patients’ disease is caused by mechanisms the immune system normally uses to combat viruses. The immune system produces virus-fighting hormones (called “cytokines”) such as interferon – which activates the production of antibodies and destructive inflammation intended to kill the infection. When this happens by error, and is directed at the self, tissue inflammation and damage occur.

Current treatments are limited to non-specific immune suppressant drugs “borrowed” from other diseases such as arthritis, and drugs used to stop an organ recipient’s body rejecting the donor organ. Although life-saving in many cases, these drugs have major side effects and don’t control all patients’ disease.

How is stress related to lupus?

As a rheumatologist I treat patients in hospital with musculoskeletal diseases and autoimmune conditions. A patient of mine suffering from lupus had, some time prior to diagnosis, been the victim of an assault, which caused post-traumatic stress disorder (PTSD).

This case posed to me, and more importantly to the patient, the question of whether stress could have led to the development of lupus. Until recently this question has been effectively unanswerable.

A new study looked at data reporting on the association of trauma and PTSD with the incidence of lupus. It found that PTSD was associated with a nearly threefold increase in risk of subsequently developing lupus.

A past history of trauma, regardless of carrying a PTSD diagnosis, was associated with a similar threefold increase in the risk of lupus.

These findings confirm a previous study of ex-service personnel, in which PTSD was both disturbingly prevalent and also a powerful risk factor for the development of autoimmune diseases, including lupus.

The association of stress and the immune system dates back to the 1930s, when pioneering endocrinologist Hans Selye found that there are distinct changes in the body in response to a threat. The term “stress” was also attributed to Selye, albeit coined much later.

Crucially, Selye also observed that stress results in disturbances in steroid hormone production. As we now know, the body’s naturally occurring steroids act through the same pathway as steroid drugs used to treat lupus. This provides a possible mechanism for the connection between stress and the control of immunity.

Intriguingly, some organ manifestations of lupus, such as severe skin or blood disease, are notoriously resistant to steroids, and recent laboratory studies suggest interferon activation in lupus may be responsible for this steroid resistance. Thus, stress, changes in steroid production, and failure to suppress interferons may represent a chain of events influencing the development of lupus.

So this new study means we’re a little less unsure about the causes of auto-immune diseases. And while sufferers can’t change past life events, knowing the causes brings us closer to understanding, and to better treatments.

Eric Morand is head of the School of Clinical Sciences at Monash Health.

This article was originally published on The Conversation. Read the original article.

Causes of Lupus : Johns Hopkins Lupus Center

What causes lupus?

Lupus is caused by a complex interplay of genes, hormones, and environmental factors. When patients first present signs of lupus, they are often asked whether they have a family member—a mother, aunt, sister, or other relative—with lupus or another autoimmune condition.  Researchers were first drawn to the link between genes and lupus because of the clustering of lupus in families and the increased prevalence of the disease among certain ethnic groups. For example, the risk for development of lupus in siblings of individuals with the disease is about 20 times higher than that of the general population. In addition, even healthy family members of people with lupus are more likely to test positive in several lupus-related medical tests, including ANAs and the false-positive test for syphilis. However, the presence of genes predisposing a person to lupus does not necessarily mean that the individual will develop the disease. While researchers are confident that lupus is caused by both genes and environmental triggers, they cannot determine which factor sets the disease in motion or how precisely these two elements interact. Research into both areas seeks to draw light upon this subject.

Genes Associated with Lupus

Our knowledge of the genes associated with lupus and other autoimmune diseases is growing, but certain genes have been identified that provide insight into an individual’s chance of developing lupus.

MHC Genes

MHC class II and III represent two families of genes known to be associated with lupus. Major histocompatability complex (MHC) genes help to shape your immune response by coding for proteins that function in response to invaders (antigens). The strength of the association of MHC II genes with lupus varies by ethnicity. MHC III genes code for components of the complement system, a group of proteins that interact to clear immune complexes and affect your body’s inflammatory response. Specifically, lupus involves defects of the genes for complement proteins C4 and C2.

Other Genes

Other genes have also been associated with the development of lupus. Among these are genes that code for variants of opsonins, molecules that make it easier for cells in your immune response to initiate certain steps. [Specifically, opsonins are involved in the facilitation of phagocytosis, the process in which cells called macrophages swallow antibodies carrying invading particles (antigens).] The specific opsonins involved are two proteins called mannose binding protein and C-reactive protein.

Genes that code for complement receptors and antibody receptors are also known to be associated with lupus. These receptors are responsible for detecting and binding to pathogens in the body. In addition, genes for cytokines, molecules that function as signaling molecules in your immune system, have also been implicated in the association with lupus. Specifically, researchers have focused on cytokines called tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10).

Genes that code for molecules called Fcγ-receptors that function to “catch” antibodies carrying antigens also have been linked to lupus nephritis (lupus affecting the kidneys). Specifically, researchers have targeted variants of this gene that cause these receptors to function poorly, causing inefficient clearance of immune system cells from the body.

Hormones and Environmental Factors

Women are 9 times more likely than men to develop lupus. This phenomenon can be explained by sex hormones and the resulting relative strengths of the female and male immune systems. The female body generates and uses larger quantities of estrogen, while the male body relies on hormones called androgens. Estrogen is known to be an “immunoenhancing” hormone, which means that women have stronger immune systems than men. For this reason, the incidence of autoimmune diseases is generally higher in women than in men. Such an observation make sense in light of the evolutionary need for women to survive to nurture their children.

In addition, certain environmental factors have been linked to the development of lupus. These environmental contributors are difficult to isolate, but researchers have established links between lupus and a variety of toxins, such as cigarette smoke, silica, and mercury. Infectious disease agents such as the Epstein-Barr Virus (EBV, which causes mononucleosis or “mono”), herpes zoster virus (the virus that causes shingles), and cytomegalovirus have also been implicated. Certain drugs can cause lupus-like syndrome and exposure to ultraviolet light and stress are known to aggravate lupus symptoms, but none of these factors have been identified as direct causes of the disease.

Sources

• Miller, Frederick W., and Glinda S. Cooper. “Environmental Aspects of Lupus.” Dubois’ Lupus Erythematosus. Ed. Daniel J. Wallace and Bevra Hannahs Hahn. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2007. 21-33.
• Salmon, Jane E., and Robert P. Kimberly. “Systemic Lupus Erythematosus.” Hospital for Special Surgery Manual of Rheumatology and Outpatient Orthopedic Disorders: Diagnosis and Therapy. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2006. 221-38.
• Tsao, Betty P. and Hui Wu. “The Genetics of Human Lupus.” Dubois’ Lupus Erythematosus. Ed. Daniel J. Wallace and Bevra Hannahs Hahn. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2007. 54-81.
• Wallace, Daniel J. The Lupus Book: A Guide for Patients and Their Families. 1st ed. New York: Oxford UP, 1995. 37-45.

The Effects of Lupus and Lupus Medications on Mood

Introduction

Lupus can have a profound effect on one’s mood and outlook on life. Whether triggered by the physical symptoms of the condition itself, or as a result of side effects of medications commonly administered to lupus patients, the effects of lupus can have a marked psychological impact on those who live with it.

Lupus is a very complicated illness, and the various forms of the disease can affect people in different ways. Occasionally, this unpredictability leads to confusion, distrust, and stress.

Lupus is caused by an overactive immune system. Treatment is aimed at resetting the thermostat of the immune system so it’s not overreacting without causing major side effects; in short, the goal is to try to return the immune system to being normal. Occasionally, however, there will be unpredictable effects of a medication.

This presentation aims to explain the differences between the psychological effects of the condition and the medications used to treat it.

The Impact of SLE Symptoms

Lupus presents in so many different ways that it is known as “the great imitator. ” The broad range of symptoms can confuse both patients and their primary physicians, and so an initial diagnosis is often very difficult to make.

Further, even when the diagnosis is made, it isn’t possible to precisely anticipate the course of the illness. Delays in diagnosis and the unpredictability of symptoms tend to frustrate patients and can reduce their confidence in their medical teams.

An additional frustration relates to the fact that many of the symptoms of lupus are the sorts of aches, pains, and fatigue that are common among people who don’t have lupus. People with lupus are, therefore, faced with further uncertainty: Is their symptom related to lupus, or can it be chalked up to aging or a completely unconnected ailment?

This uncertainty can lead people with lupus to worry that every symptom is a sign of SLE and to have problems believing their medical team when they say not to be concerned. Such uncertainty can also lead to vague, chronic worry about health and can interfere with the ability to make plans for the future.

Stress

Is lupus caused by stress? The short answer is “no.”

While stress may appear to set off lupus flares, there hasn’t yet been evidence to indicate that stress, in itself, is enough to cause lupus or a lupus flare.

This clinical evidence is important in that some people might blame themselves for their lupus, believing that their stress might have caused the lupus. Such a rationalization is very human and understandable, but the reality is that our understanding of the cause of lupus is incomplete but that it does appear that lupus is not caused by psychological factors.

There is some biological evidence of links between stress and lupus flares. Such research focuses on B and T suppressor cells, cytokines, and various types of antibodies. It should be noted, however, that these research findings are interesting but have not yet been shown to have clinical, practical relevance.

While stress does not seem to be a primary cause for lupus, it is clear that lupus causes people stress through its physical effects, its related uncertainty, and the resulting worries about physical problems.

Direct Complications of SLE

Lupus can directly affect thinking, mood, and personality. When it has these effects, it is called neuropsychiatric lupus. Symptoms of neuropsychiatric lupus include:

• Cognitive dysfunction: Refers to a variety of related experiences, including forgetfulness, worry, mistrust, and a general difficulty in thinking. Some people with lupus describe feeling “fuzzy-headed” or being in a “lupus fog.” Often mild and reversible, cognitive dysfunction is commonly seen during lupus flares. These feelings are experienced by those without lupus as well, of course, and are perfect examples of the difficulty physicians face in diagnosing lupus.
• Depression and anxiety: May occur as direct effect of the lupus, as a psychological reaction to the illness, or as a reaction to medications used to treat lupus. Mood symptoms also occur commonly in people without lupus, and so it is generally difficult to be certain about what causes depression and anxiety in people with lupus.
• A personality change: This can refer to feelings of anger, irritability, and lability (the sensation of not feeling or acting like yourself). The unpredictability of these changes makes it hard for some people with lupus to connect with those around them. They may even wonder if their communication problems are the result of their friends and loved ones reacting poorly to their condition

Steroids

Steroids are often central to the treatment of lupus, but steroids such as prednisone can cause all of the symptoms of neuropsychiatric lupus. Because neuropsychiatric symptoms are common in SLE, terms have sprung up that are widely used but are also often inaccurate.

“Steroid psychosis” is a term that some use for the emotional effects of steroids. It should be emphasized, however, that steroids don’t commonly cause psychosis, but more often cause milder emotional changes, such as anxiety or depression. The term “lupus cerebritis” is used to specifically refer to the effects of lupus itself on the brain.

In trying to distinguish the cause of neuropsychiatric symptoms, it is useful to recall that lupus is more likely to be the cause than steroids when:

• It has been more than two weeks after an increase in prednisone
• The prednisone dose was less than 40 milligrams per day
• The emotional symptoms improve with additional steroids.

Biology of Neuropsychiatric Symptoms

Those with lupus may wonder how their condition can directly and biologically cause problems with thinking and mood.

Often, there is a direct neurological involvement in lupus related to the autoimmune system. There remains controversy about how lupus affects the brain. Antineuronal antibodies (antibodies against nerve tissue) have been demonstrated, but it is not yet clear whether it these antibodies cause direct damage to the nerves. We know that patients with lupus, on no steroids, can have  depression, delirium, confusion, mistrust, and even psychosis.

Anti-phospholipid antibodies are also present in some patients with lupus. Anti-phospholipid antibodies don’t seem to cause inflammation, but rather are involved with increased clotting risk, and can be associated with stroke and cognitive problems.

Many of these neuropsychiatric effects are reversible, and there is a much lower risk of developing these problems if a patient with lupus only has joint and skin involvement, if the patient is ANA-negative or if the illness is a the result of a medication, which can be withdrawn.

The Psychological Impact of SLE

People react to having lupus in different ways, and these reactions can change with time. Some of these reactions may include:

• Grief
• Depression
• Anxiety
• Regression and reduced independence (due to physical limitations, etc.)
• Isolation and social withdrawal (due to unpredictable moods, a prominent rash, etc.)
• Fears of worsening disease and disability
• Fears of cognitive problems, stroke, kidney failure, becoming a burden, etc.

It is important to note, however, that along with these “negative” reactions, those in the lupus community have rallied around each other to promote the positive effects of taking part in their shared experience. Feelings of pride, endurance, connection, appreciation, and maturity have also been commonly seen in people with lupus.

Ways to Improve the Negative Effects of SLE

After opening the topic up for discussion in the workshop, it became immediately clear that everyone in the room had a different way to cope with – and improve – their own relationship with lupus.

Advice from workshop members ranged from treating yourself (to additional sleep, to your favorite food item, to a vacation, or a book, or a movie, or TV, or a visit to a favorite place) to communicating with those who understand, or at least can empathize with – your struggle.

While it’s important to try to focus on the positive, it’s equally important to accept that certain days will be difficult and that merely trying to remain positive may not be enough. As one member put it, “you can live with it for years and years, and some times are better than others.”
 
“Be honest with yourself,” added another member. “Sometimes, it’s too much to ask to put on a front.”

“Sometimes I find myself spinning my own wheels, staying angry,” another member explained, “spending too much time on the Internet overdiagnosing myself, driving myself crazy. I had to tell myself not to obsess on the computer. Sit back. Get a different perspective.”

One way to get a new perspective is to reach out for help and accept that it’s okay to do so. Talk to those going through what you’re going through. Isolation can set in, and it’s important to realize that you’re not alone.

A major benefit of talking with others who share your experiences is to understand which tools they use in their “toolbox.” Each person has his or her own way of making their situation better, whether it’s a technique such as muscle relaxation, yoga, TV watching, or reading. You may have your own tools, but you may find that the tools other people are using can help you as well.

Learn more about the HSS SLE Workshop, a free support and education group held monthly for people with lupus and their families and friends.

Posted: 7/26/2007

Summary by Mike Elvin

Authors

John Barnhill, MD

Chief of Psychiatry, Hospital for Special Surgery
Professor of Clinical Psychiatry, Weill Cornell Medical College

Managing Your Emotional Health When You Have Lupus

Emotions can affect your quality of life for better or for worse, including with respect to your sense of identity and your relationship to others. In the words of one of our SLE Workshop members, “emotions are everything I feel, but also how well I handle what I feel. ” Often people tend to keep emotions bottled up inside as a way to compartmentalize or deal with things as they come. For people with lupus, flares can increase emotions that are already heightened. Without effective coping skills, it is challenging to manage these intense feelings. Developing strategies and tools for dealing with them can help you: avoid being flooded with emotions and thoughts, find particular ways to de-stress, and accept the feelings that may cause stress.

Sections of this article

What are emotions?

An emotion is a complex state of consciousness (or feeling). It triggers physical and psychological changes that influence a person’s thoughts and behaviors. At the same time, these thoughts, behaviors and physical changes can affect a person’s mood and feelings. An intense mental experience that causes sensations of pleasure or displeasure can be classified as an emotion. Emotions exist on a spectrum, and we all work with a full “color palette” of them: Like an artist, we “paint” our state of mind and body with all the colors available. ¹

Emotions include fear, sadness, anger, disgust, surprise and joy, as well as shame, guilt, pride, embarrassment, resentment, confusion, frustration, disappointment, happiness, jealousy and contentment. In other words, “emotion and its experience are not synonymous.”² This is because “the emotion itself is largely unconscious, causing people to behave in ways of which they are not aware. The feeling associated with the emotion is conscious, by definition, and is available to be experienced …”³ Sometimes, the way you are feeling may be related to deeper feelings (that is, the unconscious) unrelated to your chronic disease. This can complicate your understanding of where the emotion is coming from.

No emotion is better or worse than another. Some individuals express their emotions more deeply than others. Lupus has an impact on your emotions, and your emotions have an impact on your behavior. This can affect your ability to function in everyday life. The unpredictability of lupus flares, and the pain and fatigue can all have a compounding effect on your emotions. Additionally, medications you take to manage your lupus may have side effects that cause mood swings or emotions that are significantly different from those that you normally feel or want to express. Lifestyle choices can also affect your emotions: Your sleep patterns, schedule and environment can alter your feelings.

Stress

Coping with an illness, especially an unpredictable one without clear timelines, is stressful. You may have anxiety about the future, especially with regard to possible flares and remissions. Additionally, stress can, in turn, contribute to flares.

Types of stress

Acute stress occurs when we are faced with tasks that need completing on a timeline or when we are running late, having a minor illness, experiencing subway delays, or getting into an argument. Chronic stress, on the other hand, occurs over a period of time. Some examples include family pressures, financial concerns or long-term health issues.

A certain amount of stress is beneficial and helps protect your body from harm. The flight, fight or freeze response that is built into our biological response mechanisms are meant to be productive and allow our body to process stress. But experiencing these physical, emotional and mental responses over a long time can be overwhelming and undesired. When you are feeling stressed, your body releases the “stress hormones” cortisol, adrenaline and norepinephrine. Prolonged release of these hormones often has a negative impact on your physical and emotional health. Stress hormones have been linked to health problems with blood pressure, the immune system and many biological systems.

If you are frequently having intense reactions to stressful events, it is useful to work on strategies to decrease your emotional response.

Let’s de-stress!

Conscious yawning exercise

You may recognize that when you are anxious you yawn more. Neuroscientist Andrew Newberg says yawning is a powerful tool. Conscious yawning increases the oxygen content in your body and can reduce stress, increase relaxation and promote alertness and cognitive awareness. Can’t yawn? Try faking it five or six times. You can do this both standing up or sitting down.

Another no-cost, portable de-stressing tool is 4-7-8 breathing, which is a form of the ancient yoga practice of “pranayama” or breath control.

4-7-8 breathing

1. Place your tongue on the roof of your mouth, behind your teeth and exhale.
2. Inhale for a count of four.
3. Hold your breath for a count of seven (set your own pace).
4. Exhale to a count of eight.
5. Inhale again
6. Repeat steps 1 to 5 three more times.

Depression

Depression is the most frequently reported mental health problem in people with lupus (between 10.8% to 39.6% of that population – Nery et al, 2008). Depression is a common and normal occurrence, as there are many events and challenges in navigating life’s journey that could lead to the onset of depression. Sadness and anxiety can lead to depression. There is an increased risk in the first two years of a chronic illness for the onset of depression. If you are experiencing little interest or pleasure in things you used to enjoy or are feeling down, depressed, or hopeless, it may be useful for you to find a professional to talk to regarding these feelings.

Experiencing a change in mood for over six weeks could also be an indicator of depression. Other symptoms of depression may include:

• Feeling restless, tired or rundown.
• Having trouble falling or staying asleep, or sleeping too much.
• Having difficulty concentrating.
• Experiencing abrupt dietary changes (having little appetite or overeating).

If you are presently having feelings of guilt, hopelessness, thoughts of hurting yourself, or suicidal thoughts, please talk to your rheumatologist, social worker, patient advocate, or nurse and ask for a referral to a mental health specialist. If you need immediate help, please call 911.

Anxiety

Anxiety often occurs along with depression. Nearly half of lupus patients experience an anxiety disorder (Nery et al, 2008). Most people recognize the normal, baseline level of everyday anxiety. If you experience a level of anxiety consistently above average, then you may want to seek alternative methods for managing your anxiety and those emotions surrounding it.

Anxiety can cause both physical and cognitive symptoms in one’s body, including:

• Sweaty hands.
• Shortness of breath.
• Digestive issues.
• Confusion, impaired memory or poor concentration.
• Heart palpitations or a racing heart.

The pain, fatigue, flares and unpredictability of lupus can influence anxiety. The erratic ups and downs in your health can make it difficult to make or keep plans or stick to a fixed schedule. Overwhelming feelings of dread can lead you to avoid doing certain things. For example, if you dread going to your doctor for your follow-up, you may continually cancel or miss appointments. These “avoidant behaviors” that are triggered by anxiety can prevent you from taking needed medications or getting medical treatment. Like emotions, anxiety disorders lie on a spectrum – from fairly mild to very anxious. Knowing how to properly predict instances where you might become anxious, and anticipating these moments with a plan may help combat feelings of anxiety.

What are your triggers?

When you think about instances that make you feel depressed, stressed or anxious, are they usually related to a specific obstacle or challenge? It is important to identify the triggers that you can control versus those that you cannot. Some triggers are related to your lupus (such as flares), but some are linked to behaviors or circumstances. For example, if a relative puts you down and makes you feel bad, it may make you feel depressed or stressed out. Lifestyle choices such as choosing the people you surround yourself with can help lessen triggers.

Getting the support you need

Support begins with self-compassion – treating yourself with the same kindness and care as you do with your and loved ones. Self-compassion seems to help with coping, resilience and enhancing one’s motivation. Research suggests that self-compassion is associated with lower stress, better well-being and adjustment to illness: Self-compassion seems to have a “buffering effect” against stress – to support one’s ability to navigate life’s challenges (Sirois, et al, 2014).

It can be frustrating and angering when the people in your life don’t understand what you are going through. Living with lupus has an impact on you and your relationships with others. It can also influence changes in your role in various areas of your life, as well as in your need for help from one day to the next. Sometimes these changes are not easy for others to understand. An important aspect to consider is how to communicate with others and how to ask for support. A few things to consider when thinking about how to gain support are:

• How can you best communicate your experience?
• How can you ask for the support you need?
• What are your barriers to getting the support you want?

Coping tools and strategies for emotional health

There are some basic actions you can take to help regulate your emotions and support emotional health and well-being:

• Be aware of your patterns of thinking, and the ways in which you may, for instance, tend to attack or criticize yourself.
• Get adequate rest and sleep.
• Carefully select what you eat and drink.
• Reduce stress through exercise, breath work, meditation, and/or various types of yoga.

There are also several strategies for emotional health:

• Aim to enhance self-efficacy (your belief in your ability to succeed and achieve goals).
• Work with a team of doctors and other providers from different physical and mental health specialties.
• Educate yourself about your lupus and how to manage it.
• Access support from family, friends, colleagues (new and old), community, spiritual guidance.
• Use coping tools such as activities that bring you joy or increase your creative expression. Listening to music, dancing, creating art and writing in a journal can also help.

Self-efficacy

Self-efficacy is the confidence to do things that help manage your condition and its symptoms. In the evolution of care, past medical models relied purely on medication and clinical interventions to help manage symptoms. Research has led to new medical treatments that build patients’ skills and confidence in “self-management.” In the 1980s, the Stanford Medical School developed self-management workshops for people with chronic conditions.

By actively working to improve your perceived self-efficacy, you can practice self-management behaviors, such as setting goals around things that you can do to help manage a symptom. This will encourage you to take action and self-manage, which in turn can result in better symptom management, leading to significant changes in your health status. Following this path, improving your self-efficacy can improve your exercise routines, communication skills and mental health management. It can also help you to relax and enhance your ability to find community resources to help deal with depression, anxiety, and stress. The Self-Management Resource Center offers many self-efficacy tools, and more on their evaluation tools page.

Some of us have external sources of control to help navigate life’s journey with lupus. These include medication, physical support like physical therapy, massages, exercise, and mobility aids like a cane or walker. However, we all have natural, internal sources of control to help regulate our emotions. Some examples of internal sources of control include mindfulness, physical exercises such as stretches and tai chi, opportunities for social support, and spiritual connections. It’s important to be aware that lupus has an impact on your emotions, moods, identity, relationships, ability to function and sense of self-efficacy. At the same time, gaining this awareness can help you set achievable goals in regard to coping with your disease and managing your emotional responses.

This presentation was held on 04/27/17. Learn more information about the SLE Workshop at HSS, a free support and education group held monthly for people with lupus, their families and friends.

Resources*

^* We hope that you find these resources helpful; they are provided for informational purposes only and are not intended to comprise a complete list. Links to sites are not meant as endorsements or recommendations by HSS or its faculty.

• Sirois, F. M., Kitner, R., & Hirsch, J. K. (2014, September 22). Self-Compassion, Affect, and Health-Promoting Behaviors. Health Psychology. Advance online publication. Retrieved from https://www. ncbi.nlm.nih.gov/pubmed/25243717.
• HSS Lupus Support Programs
• Lupus Research Alliance
• Center for Mindfulness – UMass Medical School
• National Center for Complementary and Integrative Health
• Andrew Newberg, MD
• UCLA Mindful Awareness Research Center
• Andrew Weil, MD

References

1. Cabanac, M. 2002. “What is emotion?” Behavioural Processes 60(2):69:83.
2. Barrett, 2006, Personality and Social Psychology Review.
3. Lambie & Marcel, 2002; Schooler, 2002-quoted in Barrett.

Updated: 10/30/2020

Summary by Sarah Kencel
Social Work Intern and Coordinator, SLE Workshop
Department of Social Work Programs

Authors

Joan Westreich, LCSW-R
Social Work Coordinator, Early Arthritis Initiative
Hospital for Special Surgery  

Self-efficacy section by Mayra Lemus
Social Work Intern and SLE Workshop Coordinator
Hospital for Special Surgery

Causes, Types, Symptoms, Treatments & Outcome

Overview

People with lupus may develop a rash across the face. This symptom of lupus is often described as looking like a butterfly.

What is lupus?

Systemic lupus erythematosus (SLE), commonly referred to simply as lupus, is a chronic autoimmune disease that can cause swelling (inflammation) and pain throughout your body. When you have an autoimmune disease, your body’s immune system fights itself. The immune system is supposed to fight possible threats to the body — infections, for example — but, in this case, it goes after healthy tissue.

If you have lupus, you might experience joint pain, skin sensitivities and rashes, and issues with internal organs (brain, lungs, kidneys and heart). Many of your symptoms might come and go in waves — often called flare-ups. At times, symptoms of lupus might be mild or not noticeable (meaning they’re in remission). Other times, you could experience severe symptoms of the condition that heavily impact your daily life.

What are the different types of lupus?

There are several different types of lupus. Systemic lupus erythematosus is the most common. Other types of lupus include:

• Cutaneous lupus erythematosus: This type of lupus affects the skin — cutaneous is a term meaning skin. Individuals with cutaneous lupus erythematosus may experience skin issues like a sensitivity to the sun and rashes. Hair loss can also be a symptom of this condition.
• Drug-induced lupus: These cases of lupus are caused by certain medications. People with drug-induced lupus may have many of the same symptoms of systemic lupus erythematosus, but it’s usually temporary. Often, this type of lupus goes away once you stop the medication that’s causing it.
• Neonatal lupus: A rare type of lupus, neonatal lupus is a condition found in infants at birth. Children born with neonatal lupus have antibodies that were passed to them from their mother — who either had lupus at the time of the pregnancy or may have the condition later in life. Not every baby born to a mother with lupus will have the disease.

Who is affected by lupus?

Anyone can have lupus. It can happen to women, men, children and even newborns. It’s much more commonly seen in women than men, with about 90% of diagnosed cases being women of reproductive age. Experts have a difficult time estimating how many people in the United States have lupus because it is difficult to diagnose. Lupus has a wide variety of symptoms that can also be signs of other medical conditions. Because of this, there may be people with lupus who go undiagnosed throughout their lives.

Lupus is also more prominent in certain ethnicities. African-American, Hispanic, Asian and Native American women are all more likely to develop the condition than Caucasian women.

Your risk of having lupus is also increased if you have a family member with lupus or another autoimmune disease.

Is lupus more common in women?

Lupus is much more common in women, with nine out of 10 cases happening in women. Often, women are diagnosed between the ages of 15 and 44 — during their reproductive years. Even though the cause of lupus is unknown, it’s thought that the hormone estrogen may play a part in the condition.

What does lupus do to the body?

Lupus can impact many different parts of your body. It can cause aches and pains, as well as serious complications to your major organs. Because lupus is an autoimmune disease, it causes your body to attack itself. This can lead to organ damage over time.

Parts of the body that can be impacted by lupus can include the skin, blood, joints, kidneys, brain, heart and lungs.

• Skin: Skin problems are a common feature of lupus. Some people with lupus have a red rash over their cheeks and the bridge of their nose. Because the location of this rash is the same as the common markings of a wolf, the name “lupus” (wolf in Latin) was given to this disease many years ago. Other skin problems that may happen include large red, circular rashes (plaques), which may scar (called discoid lupus). Skin rashes are usually made worse by sunlight. Hair loss and mouth sores are also common.
• Blood: Blood involvement can happen with or without other symptoms. Individuals with lupus may have dangerous reductions in the number of red blood cells, white blood cells or platelets (cells that help clot the blood). Sometimes, changes in blood counts may contribute to symptoms of fatigue (low red blood cell count, anemia), serious infections (low white blood cell count), or easy bruising (low platelet count). However, many people do not have symptoms that indicate blood abnormalities, so it’s important to have periodic blood tests in order to detect any problems. Blood clots are seen with increased frequency in lupus. Clots often happen in the legs (a vein clot, called deep venous thrombosis), lungs (a lung clot, called pulmonary embolus), or brain (stroke). Blood clots that develop in lupus patients may be associated with the production of antiphospholipid antibodies. These antibodies are abnormal proteins that may increase the tendency of the blood to clot.
• Joints: Arthritis is very common in people who have lupus. There may be pain, with or without swelling. Stiffness and pain may be especially uncomfortable in the morning. Arthritis may be a problem for only a few days to weeks or may be a permanent feature of the disease. Fortunately, arthritis is usually not crippling.
• Kidneys: Kidney involvement in people with lupus is potentially life threatening and may occur in up to half of lupus patients. Kidney problems may become apparent when lupus patients feel ill with arthritis, have a rash, fever and weight loss. Less often, kidney disease may happen when there are no other symptoms of lupus. Kidney disease itself usually doesn’t produce symptoms until it’s in the advanced stages. It is important that kidney disease be diagnosed early and treated appropriately. The earliest signs of kidney disease are apparent from a urine test called urinalysis.
• Brain: Fortunately, brain involvement is a rare problem in people with lupus. When present, it may cause confusion, depression, seizures and, rarely, strokes.
• Heart and lungs: Heart and lung involvement is often caused by inflammation of the covering of the heart (pericardium) and lungs (pleura). When these structures become inflamed, you may develop chest pain, irregular heartbeat and build up of fluid around the lungs (pleuritis or pleurisy) and heart (pericarditis).

Symptoms and Causes

What causes lupus?

The cause of lupus is currently unknown. Researchers are still working to learn more about the reason lupus happens. Even though the exact cause isn’t known, there are factors that may play into the condition. Possible factors that could cause lupus can include:

• Hormonal changes: Women are more likely to experience lupus than men and this could be partly due to hormones like estrogen. Lupus is often seen in women during their reproductive years (ages 15 to 44) when estrogen levels are higher.
• Environmental factors: Different aspects of your environment can also increase your risk of having lupus. Factors like the amount of sunlight you’re exposed to, medications you take, viruses you might have been exposed to, or even stress, can all be possible causes of lupus. A history of smoking can also be a possible cause of lupus.
• Your family history: There may be a genetic factor to lupus. If you have family members who have lupus, your risk of the disease is increased.

What are the symptoms of lupus?

There are a wide variety of symptoms you might experience if you have lupus. Not everyone with lupus will have the same set of symptoms. Also, many of these symptoms overlap with what you could experience with other medical conditions. This is one of the difficulties in diagnosing someone with lupus.

The symptoms of lupus can be slow to develop. You may notice new symptoms over time. The severity of your symptoms can also change over time. Sometimes symptoms may barely be present (in remission), while other times they could flare up. A flare-up is when a symptom is suddenly more severe than before.

Symptoms of lupus can include:

What are the symptoms of lupus in women?

A majority of the people diagnosed with lupus are women. Women tend to experience the general symptoms of lupus, but they can also have complications that impact various parts of the body. These complications can include kidney problems (more commonly seen in African-American and Hispanic women than other groups), osteoporosis and heart disease.

What is the lupus rash?

A skin rash is one common symptom of lupus. Rashes from lupus are often from prolonged sun exposure, and usually last days to weeks. You can have a rash on your face, hands or wrists. When you have a rash on your face, it typically extends across the bridge of your nose and onto each of your cheeks. This is often referred to as a “butterfly rash” because of the shape across your face.

Skin rashes can be uncomfortable and itchy. These rashes can sometimes fade after a short period of time. However, some rashes and sores on your skin can be permanent.

Why does lupus cause hair loss?

One of the complications of lupus can be damage to your skin and hair loss. People with lupus can develop scarring on their skin and scalp from rashes. This can cause your hair to thin and fall out. You could also experience hair loss as a side effect of some medications that treat lupus — hair loss can be a side effect of steroids. If your hair is thinning or falling out, talk to your healthcare provider. Sometimes, changing your medications can help with this issue. Your provider might also recommend using gentle shampoos (baby shampoo).

Why does lupus cause weight gain or weight loss?

Many people with lupus may experience weight loss. This can be caused by the medications that are used to treat lupus or from the discomfort of the disease itself. On the flip side, some people may gain weight if they find that they are inactive due to joint pain. It’s important to maintain a healthy diet when you have lupus. Talk to your healthcare provider — and possibly a nutritionist (a food specialist) — to determine the best diet for you.

Diagnosis and Tests

How is lupus diagnosed?

The diagnosis process can be long and difficult for lupus. The symptoms that you might experience with lupus can overlap with those of other conditions — for example, diabetes and arthritis. Symptoms of lupus may also take time to develop, adding to the challenge of diagnosing the disease.

Your healthcare provider will typically start with a family history to see if lupus runs in your family. Then, your provider will want to discuss any symptoms you’ve experienced. After talking to you about your symptoms, your provider will typically do some lab tests. These tests are looking for things like low blood cell counts, anemia and other abnormalities.

The provider may also do an antinuclear antibody (ANA) test. This test looks for antibodies — proteins in your body that defend against disease — that could be a sign you have an autoimmune disease. People who have systemic lupus erythematosus usually test positive for ANAs.

Does a positive antinuclear antibody (ANA) test mean I have lupus?

Testing positive for antinuclear antibodies alone does not mean you have lupus. The ANA test is positive in most people with lupus, but it’s also positive in many people who do not have lupus. Because of this, a positive ANA alone isn’t enough to diagnosis you with lupus. Your provider will typically look for at least three other clinical features (including symptoms and family history) before making a diagnosis of lupus.

Management and Treatment

How is lupus treated?

The way your provider treats lupus can depend on several factors, including:

• The symptoms and complications you are experiencing.
• The severity of your case.
• Your age.
• The type of medications you may be taking.
• Your general health.
• Your medical history.

Lupus is a life-long (chronic) condition that will needed to be managed regularly. The goal with treatment is to get your symptoms into remission (not active) and limit the amount of damage the disease does to your organs. Unfortunately, lupus is unpredictable and the way the condition impacts you can shift and change over time. You will need to regularly visit your healthcare provider and adapt your care plan to match your symptoms.

Some people with mild features of lupus might require limited treatment. These individuals may have symptoms that are monitored and watched to make sure they do not get worse, but they aren’t currently in need of treatment. Others may need an aggressive treatment plan. These individuals tend to have more serious complications (like heart, lung or kidney complications). Your healthcare provider will discuss the best treatment options with you based on your symptoms, complications and medical history.

What are common lupus medications?

Medications that can be used to treat lupus include:

• Steroids (corticosteroids, including prednisone): Steroid creams can be directly applied to rashes. The use of creams is usually safe and effective, especially for mild rashes. The use of steroid creams or pills in low doses can be effective for mild or moderate features of lupus. Steroids can also be used in higher doses when internal organs are threatened. Unfortunately, high doses are also most likely to produce side effects.
• Hydroxychloroquine (Plaquenil®): This medication is commonly used to help keep mild lupus-related problems, such as skin and joint disease, under control. It’s also used to treat fatigue and mouth sores.
• Azathioprine (Imuran®): A medication originally used to prevent rejection of transplanted organs, this is commonly used to treat the more serious features of lupus.
• Methotrexate (Rheumatrex®): This medication is another chemotherapy drug that’s used to suppress the immune system. Its use is becoming increasingly popular for skin disease, arthritis and other non-life threatening forms of disease that have not responded to medications such as hydroxychloroquine or low doses of prednisone.
• Cyclophosphamide (Cytoxan®) and mycophenolate mofetil (CellCept®): These medications are chemotherapy drugs that have very powerful effects on reducing the activity of the immune system. They are used to treat more severe forms of lupus, especially lupus that affects the kidneys.
• Belimumab (Benlysta®): This medication is a monoclonal antibody that reduces the activity of white blood cells (lymphocytes) that make autoantibodies. Autoantibodies are important as they cause tissue damage. Belimumab is used to treat lupus that does not involve the kidneys and has not responded to other types of treatments.
• Rituximab (Rituxan®): This medication is also a monoclonal antibody that reduces the activity of white blood cells (lymphocytes) that make autoantibodies. It’s sometimes used to treat lupus that has not responded to other types of treatments.

Outlook / Prognosis

Can lupus be cured?

There’s currently no cure for lupus. Treatment of lupus is focused on controlling your symptoms and limiting the amount of the damage the disease does to your body. The condition can be managed to minimize the impact lupus has on your life, but it will never go away.

Can you die from lupus?

In most cases, death wouldn’t be caused directly by lupus, but by the symptoms and damage to organs. Issues like kidney damage, cardiovascular disease and infections can cause serious harm and be life-threatening.

Is lupus contagious?

Lupus is not contagious and cannot be passed from one person to another by touch, sneeze or cough.

Living With

Can I get pregnant if I have lupus?

Women with lupus can get pregnant. However, there is a risk of poor pregnancy outcomes (miscarriage) in people with lupus. If you’re considering a future pregnancy, start talking to your healthcare provider several months in advance during a preconception appointment. Your provider may need to adjust your lupus medications to ensure that they’re safe for pregnancy.

If I have lupus, will I pass it on to my children?

There can be a genetic factor to lupus. Your risk of having lupus increases if you have other family members with the condition. A mother with lupus can pass it on to her child. However, this doesn’t always happen, nor does it happen often. Some women with lupus deliver a baby with the condition, while others do not. If you have a family history of lupus or have lupus yourself and are thinking about getting pregnant, talk to your healthcare provider.

What can I do to prevent lupus flare-ups?

While lupus itself can’t be prevented, you can make changes to your daily life to help avoid flare-ups of your symptoms. A few things to try can include:

• Avoiding sun exposure: For many with lupus, sun exposure can be an issue. Try avoiding going outside during peak hours when the sun is out, wearing protective clothing (long sleeves and a brimmed hat) and wearing sunscreen.
• Staying in motion: Joint pain can make you want to sit down and rest, but doing low-impact exercises can actually help.
• Maintaining healthy habits: A few habits to keep in mind include making healthy choices when it comes to your food, getting plenty of sleep and cutting back on the stress in your life. There is also a strong link between lupus and heart disease. Make sure you are working with your healthcare team to reduce your risk of heart issues.

A note from Cleveland Clinic

If you are experiencing the symptoms of lupus, reach out to your healthcare provider. Lupus can take a long time to diagnose because of the wide range of symptoms and the way symptoms slowly build over time. Getting diagnosed is the first step to managing the condition and improving your quality of life.

The effects of daily stress and stressful life events on the clinical symptomatology of patients with lupus erythematosus

Objective:

The purpose of this study was to verify whether stress worsens the clinical symptomatology perceived by patients with lupus erythematosus. Toward this end, we considered two types of stressors-daily stress and high-intensity stressful life events.

Methods:

In 46 patients with systemic lupus erythematosus and 12 patients with chronic lupus discoid, we studied the stress they experienced daily for 6 months and their disease symptoms. During this period, we also analyzed the levels of C3 and C4 complements and anti-DNAn antibodies. The systemic lupus erythematosus activity (assessed by the Systemic Lupus Activity Measures) and cumulative organ damage (assessed by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) were also analyzed.

Results:

We did not find that high-intensity stressful life events produced a worsening of the symptomatology of the disease. However, using a time-series analysis (Box-Jenkins), we found that a high percentage of lupus patients (74.1%) perceived a worsening in their clinical symptomatology due to the effects of daily stress. Of this 74.1%, 53.4% worsened the same day they suffered the perceived daily stress, and the remaining 20.7% experienced an increase in symptoms both the same day and the following day. Subsequent Mann-Whitney analyses showed that the patients who worsened for 2 days because of the effects of stress had greater lupus activity, as evaluated by their levels of C3, C4, and anti-DNAn.

Conclusion:

Daily stress, and not stressful life events, worsened the clinical symptomatology perceived by lupus erythematosus patients. This increase extended at times to 2 days, and was associated with greater lupic activity.

Systemic lupus erythematosus (SLE) – treatment, symptoms, causes, diagnosis

Lupus is an autoimmune disease, which means that the body’s natural defense system (immune system) is the target of attack to start choosing not foreign agents (viruses and bacteria), but its own tissues. This triggers an inflammatory response that manifests itself as swelling, pain, and tissue damage throughout the body. In severe SLE, the kidneys, heart, lungs, nervous system, and hematopoietic system can be damaged.And although in some patients with systemic lupus erythematosus symptoms can be very mild, it must be understood that the disease is chronic (throughout life) and, over time, the symptoms can become very serious. But in most cases, it is possible to control the course of the disease and prevent complications and damage to organs and systems. This became possible thanks to drug treatment, exercise therapy and control by the attending physician. In addition to systemic lupus erythematosus (the most common), there are other types of lupus: lupus erythematosus, drug-induced lupus, neonatal lupus and subacute cutaneous lupus.

The prognosis for people with systemic lupus erythematosus has improved significantly since adequate treatment was available. Currently, almost 70% of patients have a chance to live 20 or more years after the initial diagnosis of the disease. The course of the disease is individual and it is difficult to predict the periods of exacerbations. SLE usually develops slowly and sometimes a person does not notice symptoms for a long time.

Periods of exacerbation are sometimes called flare-ups or relapses.The periods following exacerbations are called periods of remission. In some cases, there is a rapid development of SLE. Relapses and remissions occur sometimes spontaneously, suddenly. And therefore, it is not possible to predict a relapse, severity, duration of exacerbation. In addition, new symptoms may appear with a relapse.

Children can also have lupus, although as a rule the disease develops in adolescence or in an older group. SLE in childhood is more severe than in adults and damage to organs and systems (kidney and heart) is common.Perhaps this is due to the difference in metabolic rate and the degree of completeness of tissue differentiation. Some patients are forced to lead a less active lifestyle than healthy people due to the presence of rapid fatigue, joint pain. In addition, the ability to aerobic physical activity (walking or swimming), which is necessary for better oxygenation of the blood. Some patients have the following complications of SLE:

• Problems with pregnancy
• Kidney problems
• Heart problems
• Respiratory problems
• Hematopoietic systems
• Nervous system
• Mental disorders.

Most people with systemic lupus erythematosus maintain their normal daily physical activity. But it is often necessary to adjust the level of physical activity due to fatigue, joint pain or other symptoms, up to a complete cessation of vigorous activity.

Normal or near-normal life expectancy can be predicted for most patients with SLE, depending on the presence of damage to vital organs (such as the kidneys) and the degree of impairment of their functions.SLE usually does not cause joint damage or deformation, as with rheumatoid arthritis or other autoimmune diseases. Medications used to treat moderate to severe SLE have a host of side effects, and often with prolonged use of these drugs it is difficult to understand what caused the symptoms – the disease itself or the side effects of the drugs. In the recent past, the pathogenesis of SLE was not understood and patients often died in at a younger age, especially when complications appeared in the internal organs.Now, when pathogenetic treatment appeared, the prognostic life expectancy has increased significantly. About 90% of patients live 5 or more years after diagnosis, and almost 70% 20 years or more.

Reasons

Systemic lupus erythematosus (SLE) is an autoimmune disease, that is, the immune system reacts aggressively to its own tissues, perceiving them as foreign. SLE is neither infectious nor contagious, and it has not yet been possible to figure out why the immune system affects its own tissues.In part, a genetic determinism of the failure of the immune system is assumed. But most scientists agree on the influence of a combination of factors that provoke an autoimmune reaction.

Excessive exposure to ultraviolet radiation (usually sunlight) triggers a process or aggravation.

It is believed that estrogens also affect the likelihood of lupus due to the fact that women have more SLE. And although hormone levels are highest during pregnancy, a large proportion of women get sick after the age of 45, when estrogen levels are at their lowest.

Smoking increases the risk of SLE and worsens the prognosis for existing disease.

Some medications are considered to be SLE triggers.

Some infections are considered to be SLE triggers. In some patients with cytomegalovirus, hepatitis C, parvovirus, systemic lupus erythematosus developed after a while. In children, this infection is considered to be the Epstein-Barr virus.

Intoxication with various chemicals (eg trichlorethylene).

Risk Factors:

• female
• race (more susceptible to representatives of the Negroid race)
• age from 15 to 45 years old
• Presence of relatives with SLE
• taking drugs that provoke the appearance of SLE.

Symptoms

Patients with SLE may have symptoms such as fatigue, skin rashes, or joint pain. If the disease is difficult, then there are problems with the kidneys, lungs, heart, blood or in the nervous system.

The severity of symptoms depends on the affected organ and the degree of its damage.

Fatigue: Fatigue is common in all patients with systemic lupus erythematosus.Even with a mild course of SLE, patients are significantly less able to perform normal physical activities. Fatigue is a classic symptom of SLE, as is a rash on the face (in the form of a butterfly).

Joint and muscle pain: Most patients have periods of joint pain (arthritis). In approximately 70% of patients, joint and muscle pain were the first symptoms of the disease. This can be manifested by swelling, hyperemia of the joints and stiffness in the morning hours.As a rule, with SLE, arthritis occurs on both sides and mainly in the small joints (hands, wrist, ankles), sometimes in the knees.

Skin manifestations: In most cases, patients present with skin eruptions. The nature of the rash is often the key in the diagnosis of SLE. In addition to rashes on the face, on the cheeks and the bridge of the nose (in the form of a butterfly), there may be red spots on the neck, on the head, on the lips, arms, and on the chest. The rash tends to flake off.

Light Sensitivity: Exposure to ultraviolet radiation from sun or tanning beds worsens skin manifestations and may cause facial flushing.Light sensitivity is greater in patients with fair skin.

Nervous system disorders: Some patients have nervous system disorders – usually this is manifested by headaches. It is not entirely clear whether headaches are a direct symptom of SLE or are associated with chronic stress and fatigue. However, memory or concentration impairments are not common in SLE.

Cardiac disorders: Patients with SLE may have inflammation of the bursa (pericarditis), which can cause acute pain in the left side of the chest, radiating to the neck and shoulder of the arm.

Lung Disorders: Patients with SLE may have inflammation of the pulmonary sac around the lungs (pleurisy), which can cause coughing and chest pain when breathing.

Mental Disorders: Patients with SLE may have disorders such as anxiety and depression. These disorders can be caused by lupus, the medications used to treat it, or associated with the chronic stress that accompanies the disease.

Fever (febrile condition): Most patients have subfebrile condition for a long time and this is often the first symptom of the disease.

Changes in body weight: Most active patients lose weight.

Hair loss: With SLE, significant hair loss is possible as skin rashes develop on the scalp.

Enlargement of lymph nodes: Often, with the development of rashes on the face, an increase in lymph nodes occurs.

Raynaud’s Syndrome: Raynaud’s syndrome sometimes occurs in patients with SLE and occurs as a result of narrowing of the capillaries in the fingers and toes.This is manifested by paleness or blue discoloration of the fingers (this is due to poor circulation) and they are cold to the touch.

Swelling in the arms and legs: Due to possible kidney damage, patients may have swelling in the arms and legs due to impaired excretion of fluid from the body by the damaged kidneys.

Anemia: Anemia is a decrease in the hemoglobin content in erythrocytes. In addition, in patients with SLE, the hematopoietic lineage is suppressed and the number of erythrocytes decreases.

Diagnostics

Sometimes the diagnosis of systemic lupus erythematosus is difficult and can take from several weeks to a year. SLE manifests itself in different ways in people and sometimes it takes a certain time until symptoms characteristic of the disease appear. The doctor needs a medical history, physical examination and identification of certain criteria for the disease to diagnose the disease. Criteria are required for differential diagnosis with other diseases. In the presence of 4 out of 11 criteria, we can talk about the presence of SLE.These signs can appear at the same time or one after the other over time.

Criteria specific for systemic lupus erythematosus:

• Butterfly-shaped rash on cheeks
• Rash on the face, arms, neck, lower back (disc-shaped)
• Skin rash that appears after exposure to sunlight or ultraviolet radiation (photosensitivity).
• Presence of painless sores in the mouth or nasal cavity.
• Swelling, pain, stiffness of two or more joints (arthritis).
• Inflammation of the mucous membranes surrounding the lungs (pleurisy) or heart (pericarditis).
• Abnormalities in urinalysis in the form of an increase in protein, erythrocytes or renal cells (casts) in the urine.
• Nervous system disorders such as seizure or psychosis for no apparent reason.
• Blood disorders such as a decrease in the number of red blood cells, platelets or leukocytes.
• Laboratory tests showing high autoimmune activity.
• Presence of antibodies to the cell nucleus

If there is clinical evidence of SLE and an anti-nuclear antibody test is positive, no further testing is usually required. But in some cases, if necessary, an additional examination may be prescribed .:

• blood tests for other antibodies
• dna analysis
• thorough urinalysis
• blood test for thromboplastin.

Potential organ damage detection:

A urinalysis for cell protein can help detect kidney damage.

Kidney biopsy. This test can help identify inflammation of the kidney tissue and provide appropriate treatment. But as a rule, this method is rarely prescribed for SLE.

CT (computed tomography) and MRI (magnetic resonance imaging) are prescribed to visualize organs that are secondarily affected by SLE.

Treatment

The main task of treatment is to prevent exacerbations, during which there is an increase in symptoms such as fatigue, joint pain, skin rashes.For this, it is necessary to systematically visit a doctor, and not only when an exacerbation occurs. During a relapse, the task of treatment is to relieve symptoms as quickly as possible and minimize possible damage to internal organs.

Treatment for moderate lupus erythematosus includes:

Avoid exposure to sunlight. If you have to stay in the sun, then you need to protect exposed areas of the body with clothing, and lubricate your face with a special sunscreen.

Application of a cream with corticosteroids for rashes.

Use of NSAIDs to relieve pain in joints and muscles and febrile condition.

The use of antimalarial drugs for skin rashes, as well as to reduce fatigue and joint pain.

The use of corticosteroids in small doses (if NSAIDs are not effective)

For more severe SLE, treatment may include:

Higher dose corticosteroids (tablets or injections).

Medicines that suppress the immune system (immunosuppressants).

But it must be borne in mind that long-term use of steroids can increase the risk of heart attack or stroke and, therefore, it is necessary to control risk factors such as high blood pressure and high cholesterol. In addition, a healthy lifestyle is of great importance: a normal balanced diet, avoiding tobacco use, regular physical activity. The main task of long-term treatment of SLE is the prevention of damage to vital organs (blood vessels, kidneys, bone tissue, brain).

Systemic lupus erythematosus: Diagnosis and treatment

Systemic lupus erythematosus (SLE) is a disease in which, due to a malfunction of the immune system, inflammatory reactions develop in various organs and tissues.

The disease proceeds with periods of exacerbation and remission, the occurrence of which is difficult to predict. In the end, systemic lupus erythematosus leads to the formation of a failure of one or another organ, or several organs.

In SLE, the body’s immune system does not work as it should.A healthy immune system produces antibodies, which are specific proteins – proteins that help fight and destroy viruses, bacteria, and other foreign substances that invade the body. In lupus, the immune system produces antibodies (proteins) against healthy cells and tissues in your body. These antibodies, called autoantibodies (auto means “own”), cause inflammation in various parts of the body, causing them to swell, redness, fever, and pain.

Women suffer from systemic lupus erythematosus 10 times more often than men. The disease is most common between the ages of 15-25. Most often, the disease manifests itself during puberty, during pregnancy and in the postpartum period.

Reasons

Systemic lupus erythematosus is a complex disease with no known cause. It is likely that this is not one cause, but rather a combination of several factors, including genetic, environmental and possibly hormonal, the combination of which can cause the disease.The exact cause of the disease may differ from person to person; stress, colds, and hormonal changes in the body that take place during puberty, pregnancy, after abortion, and during menopause can be a provoking factor.

Researchers believe that genetics play an important role in the development of the disease, however, a specific “lupus gene” has not yet been identified.

The fact that lupus can occur in families indicates that the development of the disease has a genetic basis.But genes alone cannot explain the onset of lupus. Other factors also have to play a role. Among those that continue to be studied intensively: solar radiation, stress, certain drugs and infectious agents such as viruses.

Symptoms

General symptoms of SLE:

• Soreness and swelling of joints, muscle pain
• Unexplained fever
• Chronic fatigue syndrome
• Rash on the skin of the face red or discoloration of the skin
• Chest pain during deep breathing
• Increased hair loss
• Whitening or blue discoloration of the skin of fingers or toes in cold or stress (Raynaud’s syndrome)
• Increased sensitivity to the sun
• Swelling (edema) of the legs and / or around the eyes
• Increase in lemphatic nodes

Other symptoms of lupus include chest pain, hair loss, sensitivity to the sun, anemia (a decrease in red blood cells), and pallor or purplishness of the skin of the fingers or toes from cold and stress.Some people also experience headaches, dizziness, depression, or seizures. New symptoms may continue to appear years after the diagnosis is made, and different signs of the disease may appear at different times.

In some patients with SLE, only one system of the body is involved, for example, the skin or joints, or the organs of hematopoiesis. In other patients, manifestations of the disease can affect many organs and the disease is multi-organ in nature.The severity of damage to body systems is different in different patients. More commonly, joints or muscles are affected, causing arthritis or muscle pain called myalgia.

Diagnostics

Diagnostics of SLE is strictly individual and it is impossible to verify this disease by the presence of any one symptom. Sometimes it can take years to get an accurate diagnosis.

If symptoms are similar, tests are used to detect specific autoantibodies often present in people with lupus.Many patients test positive for antinuclear antibodies, however, certain medications, infections, and other illnesses can also test positive.

Your doctor may order a biopsy of the skin or kidneys if they are affected. Usually, when a diagnosis is made, a test for syphilis is prescribed – a Wasserman reaction, since some lupus antibodies in the blood can cause a false positive reaction to syphilis.

Other laboratory tests are used to monitor the course of a disease from the time of diagnosis.A complete blood count, urinalysis, biochemical blood test, and erythrocyte sedimentation rate (ESR) can provide valuable information. ESR is an indicator of inflammation in the body. She diagnoses how quickly red blood cells fall to the bottom of the non-clotting tube. However, an increase in ESR is not an important indicator for SLE, and in combination with other indicators, it can prevent some complications in SLE.

Treatment

It is impossible to achieve a complete cure for this disease, but timely therapy can improve the patient’s quality of life.

Which doctor treats systemic lupus erythematosus?

A rheumatologist treats SLE.

In uncomplicated forms of lupus erythematosus, nonsteroidal anti-inflammatory drugs are prescribed to eliminate pain in the muscles and joints. It is mandatory to take glucocorticosteroids, while the doses of drugs are selected in such a way as to minimize side effects to protect the internal organs from damage.

Immunosuppressive therapy using stem cells has been proven to be effective.

Patients with lupus erythematosus should avoid direct sunlight, wear clothing that covers the entire body, and apply cream with a high protective filter against ultraviolet radiation on open areas. Corticosteroid ointments are applied to the affected areas of the skin, since the use of non-hormonal drugs has no effect. Treatment must be carried out intermittently so that hormone-related dermatitis does not develop.

A healthy lifestyle, cessation of alcohol and smoking, adequate physical activity, balanced nutrition and psychological comfort allow patients with lupus erythematosus to control their condition and prevent disability.

90,000 13 Lupus symptoms that are dangerous to ignore

What is lupus

Lupus ^{is a systemic autoimmune disease. In other words, a disease in which your immunity goes crazy and begins to attack your own organs and tissues. Many body systems are affected, including joints, skin, blood cells, brain, heart, lungs, kidneys, and other vital organs.}

This disease is a genius in disguise: its symptoms coincide with those of hundreds of other ailments.If mistaken and mistaken for something else, lupus can kill quickly enough.

Lupus is ^{among the 20 common causes of death among women aged 5–64 years.}

On the other hand, if you recognize lupus in time, you can learn to live with it. And even for a long time.

Where does lupus come from

Science has not yet figured out this question. There are only assumptions. Perhaps we are talking about a certain genetic defect in immunity, which sharply exacerbates when the body encounters an infection, even a common ARVI.

In addition to infections, triggers for lupus are often:

• Long exposure to the sun, ultraviolet burns of the skin.
• Taking certain medications. These include some medicines for high blood pressure, anticonvulsants, and antibiotics.
• Strong emotional experiences.

Try to avoid these factors whenever possible.

Why lupus is dangerous

When the immune system attacks an organ, an inflammatory process occurs in it.A side effect of this is swelling and pain. But the painful sensations are just flowers. Berries are much more unpleasant. This is how different organs suffer if they are affected by lupus:

• Kidneys. Disease can seriously damage them. Renal failure is perhaps the main cause of death in people diagnosed with lupus.
• Brain and Central Nervous System. If the brain is affected by lupus, the person may experience unexplained bouts of dizziness and headache.His behavior changes, visual impairments occur, convulsions and even strokes may occur. Many people with this form of lupus have problems remembering and expressing their thoughts.
• Blood and blood vessels. Lupus can alter blood clotting, leading to anemia and increased bleeding. Sometimes, against the background of the disease, inflammation of the blood vessels (vasculitis) occurs.
• Light. Lupus increases the risk of developing inflammation of the lining of the chest cavity (pleurisy).This can make breathing difficult. It is also possible bleeding in the lungs and frequent pneumonia.
• Heart. Lupus can cause inflammation of the heart muscle, arteries, or heart membrane (pericarditis). The risk of cardiovascular disease and heart attacks also increases significantly.

As is clear from the list, it is not so much lupus that kills as the complications it causes. Therefore, it is extremely important to detect in time that the body has begun to attack itself, and not to let the process go too far.

What are the symptoms of lupus

The signs depend on which body system is affected by the autoimmune process. Therefore, they are often fundamentally different. However, some general points can still be highlighted. This is what lupus ^{does in most cases.}

• Unmotivated fatigue. Sometimes strong. You don’t feel rested even after a good night’s sleep or vacation.
• Headaches.
• Memory degradation.
• Joint stiffness and pain.
• Chronic anemia. Different types: low red blood cell count, hemoglobin, or total blood volume.
• Fever. The temperature reaches 37.7 ° C and above, although there are no prerequisites for this, for example, a cold, at first glance.
• Increased swelling. Most often, swelling occurs on the legs (particularly feet), arms, or under the eyes.
• Fingers that turn white or blue under stress or exposure to cold.
• Shortness of breath, shortness of breath, sometimes chest pain.
• Hair loss.
• Dry eyes.
• Light sensitivity. A person almost instantly burns (gets skin irritation) when exposed to the sun.
• A butterfly-shaped rash that appears on the cheeks and bridge of the nose and becomes more noticeable after exposure to sunlight. Also, rashes can appear on other parts of the body.

The last symptom is the most obvious sign of lupus.Others may be associated with dozens of other medical conditions. But if you observe any of them, and even more so several at once, be sure to consult a therapist.

How to define lupus

The doctor will examine and, if necessary, suggest ^{to do the following tests:}

• Complete blood count. Helps to establish the number of red blood cells, white blood cells and platelets, as well as the level of hemoglobin. The results may indicate that you have anemia – one of the common signs of systemic illness.Low white blood cell or platelet counts are also sometimes seen with lupus.
• Erythrocyte sedimentation rate analysis. This specific test allows you to establish how quickly red blood cells settle to the bottom of the tube within an hour. If the speed exceeds the norm, this may indicate the presence of a systemic disease.
• Biochemical blood test. It can help you assess the health of your kidneys and liver, which are common with lupus.
• Urinalysis. If protein or blood is found in it, this indicates kidney damage.
• Anti-nuclear antibody test. If it is positive, then the immune system is on the alert. This suggests the potential presence of an autoimmune disease.
• Chest X-ray. It will help determine the condition of the lungs.
• Echocardiogram. Its purpose is to clarify the state of the heart.
• Biopsy. For example, skin – it is relevant if lupus affects the skin. Also, depending on symptoms, a kidney or liver biopsy may be required.

Unfortunately, no test can definitively diagnose lupus.The doctor can only suggest a diagnosis based on the totality of the patient’s complaints, the results of the physical examination and analyzes. Therefore, it is extremely important to find a truly competent physician or be examined by several specialists.

How to treat lupus

There is no way to cure lupus yet. Treatment is mostly symptomatic. Understanding what laws the disease develops, the doctor will suggest a therapy that will be most effective in a particular case. In addition, constant observation will help prevent negative scenarios.

The most commonly used drugs are:

• OTC pain relievers. For example, based on ibuprofen. They help relieve pain, swelling, and fever associated with lupus. Occasionally, you may need stronger pain relievers, which are prescribed by your doctor.
• Anti-malaria drugs. These medications affect the immune system and reduce the risk of flare-ups of lupus. They have side effects (up to damage to the retina), so antimalarial drugs can only be taken as prescribed by a physician.
• Corticosteroids. Helps relieve inflammation. Often used to combat diseases affecting the kidneys and brain. They also have a serious side effect.
• Immunosuppressants. These medications suppress the overactive immune system.

Read also 👩‍⚕️🤧🚑

Lupus erythematosus – types, symptoms, treatment – Dobrobut clinic

Lupus erythematosus – what is this disease.Causes, symptoms, treatment

Lupus erythematosus is one of the most complex diseases, characterized by an attack by the body’s immune system on its own cells. Diagnosis of lupus disease, as a rule, is not difficult, the difficulty lies in the fact that the pathology affects the skin, joints, and kidneys.

Causes of development

The exact causes of the disease have not yet been identified. But doctors suggest that a hereditary factor plays a large role in this.History knows many examples when lupus affected all members of one family. But this does not mean that the pathology is contagious and dangerous to others – no infectious or viral etiology has been identified.

Official medicine identifies two causes of lupus in women – hormonal disorders and prolonged stress. These two factors can appear during pregnancy and after childbirth, during menopause, against the background of frequent abortions and miscarriage. There is an opinion that lupus is a disease of women, because, according to statistics, it is more often diagnosed in the fair sex at the age of 20-50 years.

Symptoms of lupus

There are two forms of the disease:

• discoid lupus – a chronic pathology that affects only the skin;
• systemic – most of the internal organs become inflamed.

If the first form of pathology manifests itself only on the skin, then the systemic one has a negative effect on the general state of health – the patient becomes weak, suddenly loses weight, apathy appears towards the world around him and his own problems.Systemic lupus symptoms:

• red, butterfly-shaped rashes appear on the face, back of the hands and neck;
• small ulcers form in the oral cavity;
• swelling and stiffness of movements is noted in the joints.

As the disease progresses, there are problems with urination (kidney damage), seizures for no apparent reason (damage to the central nervous system) and other disorders of the body.The signs of lupus in children will be identical.

The disease in question always proceeds in a chronic form with periods of exacerbation and remission. As the progression progresses, all internal organs and systems will be involved in the pathological process, a person may completely lose hair, teeth, and scales appear on the skin.

Diagnosis of lupus erythematosus is a complex measure. The patient donates blood for tests, sometimes a biopsy of the skin and kidneys is required. Specific treatment is prescribed only after receiving the results of the examination, and until then symptomatic therapy is carried out.

General principles of therapy

It is impossible to cure lupus, but patients receive supportive therapy, which prolongs a person’s life and makes it as complete as possible. Treatment of systemic lupus erythematosus involves an individual selection of drugs. Most often, doctors make a choice in favor of:

• cytostatic immunosuppressants;
• glucocorticosteroids;

90,011 non-steroidal anti-inflammatory drugs;

• biological agents.

Periodically, the patient undergoes detoxification of an extracorporeal type, constantly – symptomatic treatment. If the patient’s condition worsens and the process of progression of the pathology cannot be stopped, a decision is made to transplant stem cells.

Prevention of lupus erythematosus

There are a number of provoking factors that can lead to a failure in the immune system and cause the development of lupus erythematosus. These include saunas, baths, solariums, direct sunlight.Therefore, preventive measures are reduced to the following:

• avoid prolonged exposure to the sun;
• do not sunbathe in the solarium;
• do not allow strong overheating in the bath or sauna;
• Monitor your diet and avoid hyperallergenic foods.

If there is a patient with lupus erythematosus in the family, then you need to seek help from doctors. Control by physicians will help to timely identify the pathological process that has begun and protect internal organs and systems from rapid destruction.

Doctors believe that playing sports, avoiding alcoholic beverages, proper allocation of time for rest and wakefulness will help reduce the negative impact of autoimmune processes.

On the pages of our website https://www.dobrobut.com/ you will find out what kind of disease is lupus erythematosus and which doctor to seek help from.

Fear fakes, listen to specialists – Rossiyskaya Gazeta

The pandemic draws attention to fundamentally new clinical and fundamental problems of human diseases.The columnist “RG” talks about this with the chief freelance specialist-rheumatologist of the Ministry of Health of the Russian Federation, Academician of the Russian Academy of Sciences Yevgeny Nasonov.

Evgeniy Lvovich! Rheumatological diseases torment people, regardless of age, season, and place of residence. Is the ill-fated virus exacerbating the situation with the treatment of these diseases?

Evgeny Nasonov : Now we can talk about new problems presented by the pandemic, which have yet to be formulated. However, something else is already obvious: the unique experience accumulated in rheumatology in the study of the causes, mechanisms of development and treatment of rheumatic diseases can be of no small importance for deciphering the nature of severe, potentially fatal complications of coronavirus disease.And, perhaps, it will help improve their therapy.

Experts are now increasingly talking about new indications for the use of known drugs.

Evgeny Nasonov : “How much we know. How little we understand.” I am quoting the great Albert Einstein. Indeed, there are significant prerequisites for the use of some drugs widely used in rheumatology for the prevention and treatment of complications of coronavirus disease for new indications.

What about the prospects for infection of patients with rheumatic diseases?

Evgeny Nasonov: Infection with coronavirus (like other viruses) can exacerbate the disease. And severe pathology of the immune system and concomitant diseases, in turn, aggravate the course of coronavirus infection. It must be borne in mind that some clinical symptoms (fever, fatigue, pain in muscles and joints, headache) and laboratory abnormalities (a decrease in the number of lymphocytes and platelets, an increase in the level of blood proteins reflecting inflammation, a blood clotting disorder) observed in the onset of rheumatic diseases or with their exacerbation are characteristic of the “prodromal” and early period of coronavirus infection.This makes it difficult to diagnose both rheumatic diseases themselves and infections. This can lead to inappropriate drug prescriptions, which worsen the prognosis in patients with these diseases.

There are significant prerequisites for the use of some drugs widely used in rheumatology for new indications. Both for the prevention and for the treatment of complications of coronavirus disease. We are talking about antimalarial drugs, possibly with antiviral effect, and inhibitors of some inflammatory mediators (cytokines) that can suppress inflammation, which is associated with severe complications of coronavirus infection – damage to the lungs and other vital organs.

For example, now everyone is hearing about the antimalarial drug hydroxychloroquine (Plaquenil).

Evgeny Nasonov : This is a synthetic derivative of quinine, which has been used in medicine for more than seventy years. Initially for the treatment of malaria, and then a wide range of inflammatory rheumatic diseases. As a curiosity, everyone is discussing US President Donald Trump’s March emotional Twitter recommendation to take hydroxychloroquine (as well as the antibiotic azithromycin) to treat COVID-19.From my point of view, he was unjustifiably attacked by the media, accusing him of the death of three people who began to take chloroquine (a more toxic analogue of hydroxychloroquine) in an incomprehensible dose.

Of course, treatment of any disease is unacceptable without a doctor’s recommendation, even if the president advises it. At the same time, although the effectiveness of hydroxychloroquine, as, indeed, of almost all specific antiviral drugs, has not been proven in special controlled studies, its use in certain situations seems to be quite justified.

Which one?

Evgeny Nasonov: First, there are very serious theoretical grounds for the favorable antiviral, as well as anti-inflammatory and many other positive (for example, reducing the risk of thrombus formation) effects of antimalarial drugs. Including those that are most directly related to the mechanisms of inflammation in COVID-19. Secondly, in rheumatology, over the past forty years, a large positive experience has been accumulated in the use of hydroxychloroquine for the treatment of inflammatory rheumatic diseases.For example, such a severe autoimmune pathology as systemic lupus erythematosus. Hydroxychloroquine is actually the only drug (I do not count steroid hormones), which is indicated for all patients with lupus, practically for life. The drug protects their organs from severe inflammation-related damage. These recommendations would not be possible if the drug was very toxic to the body.

Any medicine can cause unwanted effects …

Evgeniy Nasonov: In this regard, hydroxychloroquine is no exception.These include nausea, stool disorders, muscle weakness, and heart rhythm disturbances. It should be taken with caution when treated with antiarrhythmics. And also retinopathy – the deposition of the drug in the retina, which is especially dangerous. Fortunately, these undesirable effects occur mainly with prolonged use – more than 10 years, high doses of hydroxychloroquine, and in patients with severe kidney disease. And for the prevention of coronavirus infection, a short course is recommended, at the beginning 400 mg (2 tablets) 2 times a day, and then 200 mg (1 tablet) 2 times a day for just four days.

But nothing has been proven yet!

Evgeny Nasonov: Not proven. But given the lack of serious alternatives, it seems to me as a rheumatologist that the potential benefits of hydroxychloroquine treatment outweigh the risks associated with the potential for adverse effects. Unfortunately, the use of hydroxychloroquine for the prevention of coronavirus infection in our country has a “downside of the coin”. Already now, from the regions, I, as the chief rheumatologist of the Ministry of Health of Russia, receive alarming information about the absence of hydroxychloroquine in the pharmacy network and in hospitals.This means that practically many of our patients with rheumatic diseases, primarily with such a serious illness as systemic lupus erythematosus, are forced to interrupt treatment. And this is fraught with the most tragic consequences. It seems to me that the problem of coronavirus infection, no matter how difficult it is, should not lead to a “failure” of drug provision (of course, this is not only about hydroxychloroquine) for patients with rheumatic diseases. Moreover, these patients are more at risk of contracting coronavirus than healthy people.

Another problem that is directly related to rheumatology. I mean the treatment of arterial hypertension (it is observed in almost two-thirds of patients with rheumatic diseases) with ACE inhibitors and angiotensin AT II receptor blockers (sartans). I will not go into details. I will say that there was an assumption that these drugs can contribute to the infection of the patient’s body. I just want to draw your attention to the fact that “amateurish” discussion of these and many other complex medical problems may lead to an unjustified change in the treatment tactics by the patient himself, who is afraid of “catching the coronavirus.”A kind of “self-isolation from treatment.” Its consequence is the development of severe complications of the underlying disease.

Moreover, psychological factors hold a special place in the art of healing …

Evgeny Nasonov : Anxiety and depression associated with chronic stress worsen the course and reduce the effectiveness of therapy for any disease. It is no coincidence that the problem of interaction between a doctor and a patient, social support of patients at the state level, occupies an important place not only in professional recommendations addressed to patients with rheumatic diseases, but also in recommendations regarding the management of patients with coronavirus infections.

Anxiety and depression associated with chronic stress worsen the course and reduce the effectiveness of therapy for any disease

The All-Russian public organization “Association of Rheumatologists of Russia” (APP) has developed guidelines for the management of patients with rheumatic diseases in the context of a coronavirus pandemic. After all, I repeat, patients with the majority of rheumatic diseases are at a very high risk of getting it. For them, a “self-isolation” regime can be vital.Therefore, if during an epidemic there is a need for consultation with a rheumatologist, it is necessary to find out whether it is extremely necessary or can be postponed to a more favorable time. Consultation is possible by phone or using virtual technologies. A hotline has been organized at the Nasonova Institute of Rheumatology to consult patients. Questions can also be asked through the APP website. Hospitalization in a hospital is possible only for urgent indications. In this case, patients must undergo a special examination for the presence of coronavirus infection.In any case, I advise, please do not stop the treatment on your own without the consent of a rheumatologist. It is advisable, if not done earlier, to get vaccinated against influenza virus and pneumococcal infection.

Why is systemic lupus erythematosus dangerous if left untreated?

Systemic lupus erythematosus is an autoimmune disease that develops due to an attack by the immune system of the tissues and organs of the body. In this disorder, extensive inflammation affects various parts of the body – including joints, skin, kidneys, blood cells, brain, heart, and lungs.

Because the symptoms of lupus very often mimic those of other diseases, it is not always easy to diagnose it. Some people were born with a predisposition to this disorder. In this case, its outbreak can be provoked by environmental factors such as infections, taking certain medications, and even sunlight. Most often, young girls aged 15-44 are faced with this autoimmune disease.

According to experts from the world famous Mayo Clinic, each case is not 100% similar to the other.Symptoms can come on suddenly or develop gradually, they can be mild to very severe, and they can be short-lived or long-lasting. In most patients, systemic lupus erythematosus manifests itself rather mildly. People have episodes of exacerbation, then relief, when the symptoms completely go away for a while.

The most distinctive symptom of lupus is a rash on both cheeks that resembles a butterfly with its wings spread out. This symptom worries many, but not all patients.

In general, the symptoms of the disease appear depending on which organ or system of the body is affected by autoimmune inflammation. The most common signs of lupus are:

• Fatigue,
• Fever,
• Pain, swelling and decreased joint mobility,
• Butterfly-like rashes on the cheeks and bridge of the nose, or rashes elsewhere on the body,
• Skin lesions that appear or worsened by sun exposure (photosensitivity),
• Pale or blue fingers and toes due to cold or stress (Raynaud’s phenomenon),
• Dyspnea,
• Chest pain,
• Dry eyes,
• Headaches, confusion and memory loss.

A person should definitely see a doctor if they have an unexplained rash, prolonged fever, persistent pain or fatigue.

Where does systemic lupus erythematosus come from?

Most likely, this disease develops due to a combination of genetic predisposition and exposure to environmental factors. According to scientists, lupus develops after contact with some irritant, which causes an attack of the disease.However, in most cases, it is not possible to establish the exact cause of the development of this disorder. Major potential triggers include:

1. Sun exposure. It can damage the skin or cause inflammation of internal organs and systems in susceptible people.
2. Infection. The presence of an infection in the body can cause the first outbreak of lupus erythematosus. After re-penetration of the infection, the disease will remind of itself.
3. Taking medications. Drugs that can cause this disease include blood pressure medications, anticonvulsants, and antibiotics.It is usually sufficient to stop taking these drugs if possible to relieve the condition. In this case, doctors prescribe alternative medicines.

Complications of lupus

Inflammation can affect many parts of the body and lead to the following consequences:

• Serious kidney damage and kidney failure. The latter is the leading cause of death in people with lupus.
• Damage to the brain and other parts of the central nervous system.In this case, patients are worried about headaches, dizziness, changes in behavior, memory lapses, difficulty expressing thoughts, vision problems, seizures, and even a stroke.
• Increased risk of bleeding or excessive blood clotting, anemia, vasculitis (vascular inflammation).
• Inflammation of the membrane in the chest cavity (pleurisy), bleeding in the chest cavity, pneumonia.
• Inflammation of the heart muscle, arteries, or heart membrane (pericarditis). It also increases the risk of developing cardiovascular disease and heart attack.
• Increases susceptibility to infection, as both the disease itself and the drugs to control it weaken the immune system.
• Insignificant risk of developing cancer.
• Bone death (avascular necrosis). In this case, the blood supply to the bone mass decreases, which leads to tiny breaks in the bones.
• Complications during pregnancy, up to premature birth and miscarriage. To reduce risks, doctors often recommend postponing planning for a baby until the disease is under control for at least 6 months.

Treatment Systemic Red Lupus

The choice of medication and general treatment strategy depends on the symptoms. As exacerbations appear and symptoms disappear, the doctor and patient will change the drugs or their dosage. Unfortunately, this autoimmune disease cannot be cured – it is chronic. All you can do is keep it under control. To do this, the following drugs are prescribed:

• Non-steroidal anti-inflammatory drugs (NSAIDs) – naproxen and ibuprofen.These medicines are prescribed to relieve pain, swelling, and fever if associated with lupus. More potent drugs are prescribed only by prescription.
• Antimalarial drugs. They are usually prescribed to treat malaria, but they are also used to reduce the frequency of lupus attacks.
• Corticosteroids. Prednisone and other drugs can fight inflammation. If the disease is very severe and has spread to the kidneys or brain, then the patient may be prescribed high doses of steroid drugs such as methylprednisone.
• Immunosuppressants. These drugs suppress the activity of the immune system and can be prescribed for severe forms of the disease. Examples of such drugs are azathioprine, mycophenolate mofetil, and methotrexate.
• Other drugs, such as belimumab given intravenously.
• Combination of different drugs.

How to make life easier for patients with systemic lupus erythematosus?

The main task of the patient is to prevent an exacerbation of the disease, or at least reduce the frequency of symptoms.For this it is recommended:

• Visit a doctor regularly. You should not wait until the aggravation “comes”. Better from time to time to be examined and tested.
• Watch out for the stinging sun. Because UV rays can trigger an onset of lupus symptoms, you need to protect yourself from them. It is recommended to wear a hat, long sleeve T-shirts and long pants. You can also use sunscreen.
• Move regularly. Exercise makes our bones stronger, reduces the risk of heart attack, and simply improves our quality of life.
• Give up bad habits, especially smoking. Smoking can worsen the effects of lupus on the heart and blood vessels.
• Eat healthily and as varied as possible – include all major food groups with a focus on fruits, vegetables, cereals, fish and lean meats. It also doesn’t hurt to visit a dietitian at least occasionally to help you make up your diet. In some cases, doctors develop a specific anti-inflammatory diet that helps control inflammation in the body.

Complementary and Alternative Treatments for Lupus

There is some evidence that taking vitamin D supplements helps people who suffer from this condition. Also, to maintain bone health, some patients are advised to take calcium at a dosage of 1200-1500 mg. In addition, omega-3 fatty acids may help some patients.

Acupuncture is used to relieve muscle pain associated with lupus erythematosus.

Now you know how dangerous this disease is. If you experience similar symptoms, you need to see a doctor as soon as possible. Be healthy!

Sources:

1. Lupus, Mayo Clinic,
2. Lupus Detailed Fact Sheet, Centers for Disease Control and Prevention,
3. Lupus, American College of Rheumatology.

Lupus – Signs and Symptoms

Unknown What Causes Lupus / Gazeta.ru

Lupus is an autoimmune disease, which means that your body’s natural defense systems begin to attack your body.It is not known what causes lupus, but it has been suggested that viral infections, certain medications, and sunlight could be the possible causes.

Lupus is often caused by hormonal changes such as puberty, childbirth and menopause.

What is lupus?

Lupus is a chronic condition that causes a variety of symptoms, including rashes and joint pain.

The condition, also known as systemic lupus erythematosus, is very difficult to diagnose because the symptoms are similar to those of other conditions.You will be diagnosed with blood tests, x-rays and scans and will be checked regularly to see if you have them.

Lupus cannot be cured, but there are ways to relieve symptoms.

Lupus symptoms

Lupus symptoms range from mild to severe, but the main symptoms are:

• joint and muscle pain
• extreme fatigue that does not go away no matter how much rest
• rashes – often over the nose and cheeks
• headaches
• mouth ulcers
• fever
• hair loss
• sensitivity to light (causes rashes on uncovered skin)

Symptoms of mild lupus are joint and skin problems and fatigue.

Mild cases of lupus involve inflammation of other parts of the skin and body, such as the lungs, heart, and kidneys.

Patients with worse symptoms may experience inflammation that seriously damages the heart, lungs, brain, or kidneys.

Lupus is life-threatening if you have severe lupus. However, symptoms tend to come and go, and lupus gets worse from time to time.

What causes lupus is not known for certain, but it has been suggested that stress, overwork, and excessive sun exposure can cause flare-ups.

Other triggers include emotional stress, infections, trauma, and drug changes.

However, in some cases the symptoms persist and the symptoms remain constant.

How to cure lupus

You cannot cure lupus, but medications will be prescribed to control your symptoms and the development of the disease.

It is important to use a high factor sunscreen every day to avoid further inflammation.

Fortunately, if you have lupus, you can get a prescription sunscreen.

In particularly sunny weather, a sun hat should be worn.

If you feel tired, you should learn to control yourself throughout the day.