Articular cartilage is the highly specialized connective tissue of diarthrodial joints. Its principal function is to provide a smooth, lubricated surface for articulation and to facilitate the transmission of loads with a low frictional coefficient. Articular cartilage is devoid of blood vessels, lymphatics, and nerves and is subject to a harsh biomechanical environment. Most important, articular cartilage has a limited capacity for intrinsic healing and repair. In this regard, the preservation and health of articular cartilage are paramount to joint health.
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The principal immunoglobulin in human serum. Because IgG moves across the placental barrier, it is important in producing immunity in the infant before birth. It is the major antibody for antitoxins, viruses, and bacteria. It also activates complement and serves as an opsonin. As gamma globulin, IgG may be given to provide temporary resistance to hepatitis or other disease.
In patients with SLE, the risk of developing cardiovascular disease (CVD) is at least twice that in the general population, and over half of patients have 3 or more CVD risk factors.3,4 “Following a heart-healthy diet that is rich in fruits, vegetables, whole grains, lean protein, and fatty fish and limiting saturated and trans fats can actually help reduce the risk of heart disease,” Gibofsky told Rheumatology Advisor.
Antinuclear Antibody Test (ANA):  A positive ANA test for the presence of these antibodies, which are produced by your immune system, indicates a stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA test do not have lupus.  If you have a positive ANA test, more specific antibody testing will most likely be advised.
There is no permanent cure for SLE. The goal of treatment is to relieve symptoms and protect organs by decreasing inflammation and/or the level of autoimmune activity in the body. The precise treatment is decided on an individual basis. Many people with mild symptoms may need no treatment or only intermittent courses of anti-inflammatory medications. Those with more serious illness involving damage to internal organ(s) may require high doses of corticosteroids in combination with other medications that suppress the body's immune system.

In general, cutaneous manifestations, musculoskeletal manifestations, and serositis represent milder disease, which may wax and wane with disease activity. These are often controlled with nonsteroidal anti-inflammatory drugs (NSAIDS) or low-potency immunosuppression medications beyond hydroxychloroquine and/or short courses of corticosteroids. More prolonged steroid use is generally reserved for patients with involvement of vital organs. For example, central nervous system involvement and diffuse proliferative renal disease must be recognized as more severe disease manifestations, and these are often treated with more aggressive immunosuppression. Evidence suggests a relative undertreatment of SLE patients with end-stage renal disease (ESRD), because the extent of lupus activity may be underestimated. [105]

Systemic lupus erythematosus (SLE) is a chronic inflammatory and autoimmune disease characterised by multiple organ involvement and a large number of complications. SLE management remains complicated owing to the biological heterogeneity between patients and the lack of safe and specific targeted therapies. There is evidence that dietary factors can contribute to the geoepidemiology of autoimmune diseases such as SLE. Thus, diet therapy could be a promising approach in SLE owing to both its potential prophylactic effects, without the side effects of classical pharmacology, and its contribution to reducing co-morbidities and improving quality of life in patients with SLE. However, the question arises as to whether nutrients could ameliorate or exacerbate SLE and how they could modulate inflammation and immune function at a molecular level. The present review summarises preclinical and clinical experiences to provide the reader with an update of the positive and negative aspects of macro- and micronutrients and other nutritional factors, including dietary phenols, on SLE, focusing on the mechanisms of action involved.
Lupus can affect men and women of any race or age. One in 2,000 people in the United States has lupus. People of African, Asian and Native American descent are more likely to develop lupus than are Caucasians. In addition, the disease develops in Emiratis at an earlier stage compared to Asians and expatriate Arabs working in UEA. Lupus studies also show racial preferences, being more prevalent among Arabs than Asians in the UAE region.

A normal-range ANA titer in the context of organ system involvement that suggests systemic lupus erythematosus should prompt a work-up for alternative diagnoses. If no other cause is identified, the diagnosis of ANA-negative systemic lupus erythematosus and consultation with a rheumatologist should be considered. If patients with a normal ANA titer develop new clinical features that are consistent with systemic lupus erythematosus, ANA testing should be repeated.46 [Evidence level C, consensus/expert guidelines]

There are assertions that race affects the rate of SLE. However, a 2010 review of studies which correlate race and SLE identified several sources of systematic and methodological error, indicating that the connection between race and SLE may be spurious.[100] For example, studies show that social support is a modulating factor which buffers against SLE-related damage and maintains physiological functionality.[100] Studies have not been conducted to determine whether people of different racial backgrounds receive differing levels of social support.[100] If there is a difference, this could act as a confounding variable in studies correlating race and SLE. Another caveat to note when examining studies about SLE is that symptoms are often self-reported. This process introduces additional sources of methodological error. Studies have shown that self-reported data is affected by more than just the patients experience with the disease- social support, the level of helplessness, and abnormal illness-related behaviors also factor into a self-assessment. Additionally, other factors like the degree of social support that a person receives, socioeconomic status, health insurance, and access to care can contribute to an individual’s disease progression.[100][101] Racial differences in lupus progression have not been found in studies that control for the socioeconomic status [SES] of participants.[100][102] Studies that control for the SES of its participants have found that non-white people have more abrupt disease onset compared to white people and that their disease progresses more quickly. Non-white patients often report more hematological, serosal, neurological, and renal symptoms. However, the severity of symptoms and mortality are both similar in white and non-white patients. Studies that report different rates of disease progression in late-stage SLE are most likely reflecting differences in socioeconomic status and the corresponding access to care.[100] The people who receive medical care have often accrued less disease-related damage and are less likely to be below the poverty line.[102] Additional studies have found that education, marital status, occupation, and income create a social context which contributes to disease progression.[100]

This gene encodes a member of the interferon regulatory factor (IRF) family, a group of transcription factors with diverse roles, including virus-mediated activation of interferon, and modulation of cell growth, differentiation, apoptosis, and immune system activity. Members of the IRF family are characterized by a conserved N-terminal DNA-binding domain containing tryptophan (W) repeats. Alternative promoter use and alternative splicing result in multiple transcript variants, and a 30-nt indel polymorphism (SNP rs60344245) can result in loss of a 10-aa segment.
Although it is known that chronically low complement levels and functional asplenia may result in a low level of susceptibility to infection, it is not known to what degree. [128, 129] Overall, it is likely that the primary reason patients with SLE die of infections is immunosuppressive medications.Stress-dose steroid protocols should be used in patients who are receiving maintenance corticosteroids when they are admitted with infectious or perioperative stress.

Belimumab, a type of agent referred to as a B-lymphocyte stimulator (BLyS) protein inhibitor, was approved by the U.S. Food and Drug Administration (FDA) in March 2011 for patients with lupus who are receiving other standard therapies, including those listed above. Given by IV infusion, belimumab may reduce the number of abnormal B cells thought to be a problem in lupus.

Mixed connective tissue disease (MCTD) is a autoimmune disorder that causes overlapping features of three connective tissue disorders: lupus, scleroderma, and polymyositis. MCTD may also have features of rheumatoid arthritis. This condition is most often diagnosed in women in their 20’s and 30’s. Occasionally, children are affected. At this time the cause of this condition is unknown.

In healthy conditions, apoptotic lymphocytes are removed in germinal centers (GC) by specialized phagocytes, the tingible body macrophages (TBM), which is why no free apoptotic and potential autoantigenic material can be seen. In some people with SLE, accumulation of apoptotic debris can be observed in GC because of an ineffective clearance of apoptotic cells. In close proximity to TBM, follicular dendritic cells (FDC) are localised in GC, which attach antigen material to their surface and, in contrast to bone marrow-derived DC, neither take it up nor present it via MHC molecules.

Dermatomyositis (DM) and polymyositis (PM): While almost all people with lupus have a positive ANA test, only around 30 percent of people with DM and PM do. Many of the physical symptoms are different as well. For instance, people with DM and PM don't have the mouth ulcers, kidney inflammation, arthritis, and blood abnormalities that people with lupus do.

Other medicines. You may need other medicines to treat illnesses or diseases that are linked to your lupus — such as high blood pressure or osteoporosis. Many people with lupus are also at risk for blood clots, which can cause a stroke or heart attack. Your doctor may prescribe anticoagulants (“blood thinners”), such as warfarin or heparin, to prevent your blood from clotting too easily. You cannot take warfarin during pregnancy.
MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.

Microbial metabolomics constitutes an integrated component of systems biology. By studying the complete set of metabolites within a microorganism and monitoring the global outcome of interactions between its development processes and the environment, metabolomics can potentially provide a more accurate snap shot of the actual physiological state of the cell.
A. Lupus can vary from a moderately disabling disease to a life-threatening one. Because it can lead to cardiovascular disease, lupus can kill women in their 20s by causing heart attacks and strokes, Gilkeson said. People with lupus also can die at young ages due to infections that are related to the immune-suppressing drugs taken to control the disease. Although lupus doesn't make it harder to become pregnant, women with lupus are more likely to miscarry.
Sjogren’s syndrome is a disease that causes dryness in your mouth and eyes. It can also lead to dryness in other places that need moisture, such as your nose, throat and skin. Most people who get Sjogren’s syndrome are older than 40. Nine of 10 are women. Sjogren’s syndrome is sometimes linked to rheumatic problems such as rheumatoid arthritis. In Sjogren’s syndrome, your immune system attacks the glands that make tears and saliva. It may also affect your joints, lungs, kidneys, blood vessels, digestive organs and nerves. The main symptoms are:
Vasculitis, antiphospholipid antibodies, and renal failure are commonly found in patients with lupus; these conditions greatly increase the risk of developing pulmonary emboli. The diagnosis in a patient with shortness of breath, hemoptysis, and pleuritic chest pain is commonly made with ventilation-perfusion scans or computed tomography (CT) angiography. The CT angiogram demonstrates a filling defect in the left anterior segmental artery (arrow).
Useful medication for the disease was first found in 1894, when quinine was first reported as an effective therapy. Four years later, the use of salicylates in conjunction with quinine was noted to be of still greater benefit. This was the best available treatment until the middle of the twentieth century, when Hench discovered the efficacy of corticosteroids in the treatment of SLE.[121]
The clearance of early apoptotic cells is an important function in multicellular organisms. It leads to a progression of the apoptosis process and finally to secondary necrosis of the cells if this ability is disturbed. Necrotic cells release nuclear fragments as potential autoantigens, as well as internal danger signals, inducing maturation of dendritic cells (DCs), since they have lost their membranes' integrity. Increased appearance of apoptotic cells also stimulates inefficient clearance. That leads to maturation of DCs and also to the presentation of intracellular antigens of late apoptotic or secondary necrotic cells, via MHC molecules. Autoimmunity possibly results by the extended exposure to nuclear and intracellular autoantigens derived from late apoptotic and secondary necrotic cells. B and T cell tolerance for apoptotic cells is abrogated, and the lymphocytes get activated by these autoantigens; inflammation and the production of autoantibodies by plasma cells is initiated. A clearance deficiency in the skin for apoptotic cells has also been observed in people with cutaneous lupus erythematosus (CLE).[67]
Most autoimmune diseases affect one specific system. For example, Rheumatoid Arthritis involves the joints, and Multiple Sclerosis affects the brain and spinal cord. Lupus, on the other hand, affects more than one system simultaneously. No matter what organ or system is being attacked, all autoimmune diseases are similar in that they are an immune response caused by systemic inflammation that leads your body to attack itself.
The European League Against Rheumatism (EULAR) vaccination recommendations for rheumatic diseases, including lupus, advocate baseline assessment and delivery of nonlive vaccines during stable disease. [150] Particularly important is immunization against encapsulated organisms, such as meningococcal vaccine, pneumococcal vaccine, and routine Haemophilus influenzae childhood vaccination. Annual influenza vaccine is also encouraged.

Due to the variety of symptoms and organ system involvement with SLE, its severity in an individual must be assessed in order to successfully treat SLE. Mild or remittent disease may, sometimes, be safely left untreated. If required, nonsteroidal anti-inflammatory drugs and antimalarials may be used. Medications such as prednisone, mycophenolic acid and tacrolimus have been used in the past.
ANA screening yields positive results in many connective tissue disorders and other autoimmune diseases, and may occur in normal individuals. Subtypes of antinuclear antibodies include anti-Smith and anti-double stranded DNA (dsDNA) antibodies (which are linked to SLE) and anti-histone antibodies (which are linked to drug-induced lupus). Anti-dsDNA antibodies are highly specific for SLE; they are present in 70% of cases, whereas they appear in only 0.5% of people without SLE.[10] The anti-dsDNA antibody titers also tend to reflect disease activity, although not in all cases.[10] Other ANA that may occur in people with SLE are anti-U1 RNP (which also appears in systemic sclerosis and mixed connective tissue disease), SS-A (or anti-Ro) and SS-B (or anti-La; both of which are more common in Sjögren's syndrome). SS-A and SS-B confer a specific risk for heart conduction block in neonatal lupus.[71]
Certain foods, including garlic and alfalfa sprouts, should be avoided by people with lupus. [For a more complete list of items to be avoided, please see the article “Things to Avoided” in the Lupus 101 section.] Recently controversy has also arisen over whether aspartame induces lupus. However, scientists have concluded that there is no evidence to suggest that aspartame causes lupus.
Medications that suppress immunity (immunosuppressive medications) are also called cytotoxic drugs. They are sometimes referred to as chemotherapy because they are also used to treat cancer, generally in much higher doses than those used to treat lupus. Immunosuppressive medications are used for treating people with more severe manifestations of SLE, such as damage to internal organ(s). Examples of immunosuppressive medications include azathioprine (Imuran), cyclophosphamide (Cytoxan), chlorambucil (Leukeran), cyclosporine (Sandimmune), and the disease-modifying drug methotrexate (Rheumatrex, Trexall). All immunosuppressive medications can seriously depress blood-cell counts and increase risks of infection and bleeding. Immunosuppressive medications may not be taken during pregnancy or conceptionbecause of risk to the fetus. Other side effects are specific for each drug. For examples, methotrexate can cause liver toxicity, while cyclosporine can impair kidney function.
I recommend that everyone remove gluten from their diets because it’s simply an inflammatory food, and this is particularly critical for anyone with an autoimmune condition. I also highly recommend that anyone with an autoimmune condition remove all grains and legumes from your diet as well. These foods contain proteins known as lectins, which act as a natural pesticide for crops and can wreak havoc on the lining of your gut. My cookbook, The Autoimmune Solution Cookbook, contains over 150 specially designed recipes to help make following an autoimmune-friendly protocol easy and delicious!
Libman-Sacks endocarditis is the most characteristic cardiac manifestation of lupus. It is characterized by clusters of verrucae on the ventricular surface of the mitral valve. These lesions consist of accumulation of immune complexes, platelets, and mononuclear cells. This can lead to heart failure, valvular dysfunction, emboli, and secondary infective endocarditis. Diagnosis is best made via echocardiography, which may reveal the characteristic valvular masses (arrows). IVS = interventricular septum; LA = left atrium; LV = left ventricle.
Whether you’re dealing with lupus, rheumatoid arthritis, Hashimoto’s or one of the hundreds of other autoimmune conditions out there, you have the power to beat your symptoms, regain your energy, and feel like yourself again. By following these steps to uncover the root cause of your illness, you CAN reverse your disease and live a life full of optimal health!
A healthy diet is important in general, but perhaps even more so for the roughly 1 million Americans and 3 million people worldwide who suffer from systemic lupus erythematosus (SLE).1 Because of the multifaceted challenges presented by the disease, consuming adequate amounts of the right nutrients — and limiting others — can help relieve symptoms and improve outcomes.
To minimize complications in pregnancy, SLE ideally should be well controlled for at least 4-6 months before conception. Obstetricians who handle high-risk pregnancies should optimally offer pregnancy planning consultation and monitor all pregnancies in patients with SLE. Suggestions for treatment of SLE during pregnancy are also included in the European League Against Rheumatism (EULAR) recommendations. High-dose aspirin and NSAIDs should be avoided in later pregnancy.
Your primary care doctor should coordinate care between your different health care providers and treat other problems as they come up. Your doctor will develop a treatment plan to fit your needs. You and your doctor should review the plan often to be sure it is working. You should report new symptoms to your doctor right away so that your treatment plan can be changed if needed.
Other medicines. You may need other medicines to treat illnesses or diseases that are linked to your lupus — such as high blood pressure or osteoporosis. Many people with lupus are also at risk for blood clots, which can cause a stroke or heart attack. Your doctor may prescribe anticoagulants (“blood thinners”), such as warfarin or heparin, to prevent your blood from clotting too easily. You cannot take warfarin during pregnancy.
After one more attempt at getting something useful to work with to help myself, I realized I was on my own dealing with lupus. In an internal fit of rage toward her cold, aloof attitude I decided right then and there that I would heal my lupus, (with the added bonus to never endure the presence of that 'specialist' again). I did. I don't have lupus anymore.
A diet high in folic acid, such as found in leafy green vegetables, fruits, and fortified breads and cereals, or a folic acid supplement is important if you are taking methotrexate (Rheumatrex). For nausea caused by medications, eat small frequent meals and foods that are easy to digest. Try dry cereals, breads, and crackers. Also avoid greasy, spicy, and acidic foods.

It also is known that some women with systemic lupus erythematosus can experience worsening of their symptoms prior to their menstrual periods. This phenomenon, together with the female predominance of systemic lupus erythematosus, suggests that female hormones play an important role in the expression of SLE. This hormonal relationship is an active area of ongoing study by scientists.
Individual test results can also vary from one visit to another, which can be very confusing.  A doctor will take into consideration a combination of factors as well as the test results when diagnosing lupus, and because of this, we encourage you inquire about the ANA and DNA testing, which doctors are often reluctant to give.  These two tests together can create a clearer picture of whether the diagnosis could be lupus.  Again, we must remind you that just because you test negative today, it does not mean that you won’t test positive tomorrow.
Why the test is used: Anti-Ro is found in anywhere from 24% to 60% of lupus patients. It's also found in 70% of people with another autoimmune disorder called Sjögren's syndrome. Anti-La is found in 35% of people with Sjögren's syndrome. For this reason, their presence may be useful in diagnosing one of these disorders. Both antibodies are associated with neonatal lupus, a rare but potentially serious problem in newborns. In pregnant women, a positive Anti-Ro(SSA) or Anti-La(SSB) warns doctors of the need to monitor the unborn baby.
A one-celled organism without a true nucleus or cell organelles, belonging to the kingdom Procaryotae (Monera). The cytoplasm is surrounded by a rigid cell wall composed of carbohydrates and other chemicals that provide the basis for the Gram stain. Some bacteria produce a polysaccharide or polypeptide capsule, which inhibits phagocytosis by white blood cells. Bacteria synthesize DNA, RNA, and proteins, and they can reproduce independently but may need a host to provide food and a favorable environment. Millions of nonpathogenic bacteria live on human skin and mucous membranes; these are called normal flora. Bacteria that cause disease are called pathogens.
Other medicines. You may need other medicines to treat illnesses or diseases that are linked to your lupus — such as high blood pressure or osteoporosis. Many people with lupus are also at risk for blood clots, which can cause a stroke or heart attack. Your doctor may prescribe anticoagulants (“blood thinners”), such as warfarin or heparin, to prevent your blood from clotting too easily. You cannot take warfarin during pregnancy.

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