A substance (generally a protein, polypeptide, or peptide) that stimulates the differentiation, division, development, and maintenance of cells and the tissues they make up. Growth factors are signaling molecules released by certain groups of cells, e.g., lymphocytes, to influence the activities of other cells. Growth factors can be divided into families, e.g., platelet-derived GFs, transforming GFs, and angiogenic GFs. They are released normally during fetal and embryonic development, wound healing, and tissue maturation. Massive releases of GFs are characteristic of some types of cancer cells. Artificial GFs, e.g., granulocyte colony-stimulating factor, are used in health care to restore depressed levels of cells to normal values, e.g., in patients who have received chemotherapy.

Vasculitis affecting medium and small arteries, particularly at the point of bifurcation and branching. Segmental inflammation and fibrinoid necrosis of blood vessels lead to ischemia of the areas normally supplied by these arteries. Signs and symptoms depend on the location of the affected vessels and organs, but patients usually present with symptoms of multisystem disease, including fever, malaise, weight loss, hypertension, renal failure, myalgia, peripheral neuritis, and gastrointestinal bleeding; these may occur episodically. Unlike most types of vasculitis, PAN does not affect glomerular capillaries although other renal vessels are involved. The disease is associated with hepatitis B and C.
The diagnosis of lupus is best made by an experienced clinician who fully understands the disease and other diseases with similar features that can mimic lupus. The diagnosis is made when a patient has several features of the disease (including symptoms, findings on examination and blood test abnormalities). The American College of Rheumatology has devised criteria to assist clinicians in making the correct diagnosis of lupus.
Levels of stress-related illnesses are on the rise, and stress, both emotional and physical, has been shown to trigger and intensify autoimmune disorders. Stress is your body’s response to a threat–a wound, injury, or infection. Acute stress revs up your immune system to help you deal with an immediate crisis, and then calms it back down once the threat is removed. On the other hand, chronic stress (the kind we face in this day and age) leads to long-term inflammation and actually suppresses your immune system. This can trigger or worsen autoimmune conditions, and can lead to the reactivation of latent viruses linked to lupus, perpetuating a vicious cycle.
The panel concluded that both options (GCs plus CYC and GCs plus RTX) were associated with large benefits and moderate harms in comparison to GCs plus placebo in patients with acute neurological manifestations. No studies comparing these two options were identified. In terms of SLE and severe neurological manifestations, clinical trials with GCs plus CYC focused on both general neurologic manifestations, and on seizures, psychosis, myelitis, peripheral neuropathy, brain stem disease and optic neuritis, specifically. No data were found regarding other neuropsychiatric manifestations. The panel significantly weighted the fact that the certainty of the evidence was better for CYC than RTX and that RTX was only evaluated in refractory patients.
In 2007, the European League Against Rheumatism (EULAR) released recommendations for the treatment of SLE. [61] In patients with SLE without major organ manifestations, glucocorticoids and antimalarial agents may be beneficial. [61] NSAIDs may be used for short periods in patients at low risk for complications from these drugs. Consider immunosuppressive agents (eg, azathioprine, mycophenolate mofetil, methotrexate) in refractory cases or when steroid doses cannot be reduced to levels for long-term use. [106]
Systemic lupus erythematosus (SLE) is a complex multisystemic autoimmune disease resulting, oftentimes, in irreversible damage, diminished quality of life and reduced life expectancy.1–3 Genetic and environmental factors play important roles in its pathogenesis.4–8 Disease manifestations and severity vary according to the patients’ racial/ethnic background and socioeconomic status (SES).1 9 10 Data from Grupo Latino Americano de Estudio del Lupus (GLADEL), Lupus in Minorities: Nature vs Nurture (LUMINA) and the Lupus Family Registry and Repository cohorts have demonstrated that Latin American and North American Mestizo patients (mixed Amerindian and European ancestry), African descendants and Native Americans develop lupus earlier11 12 although diagnostic delays may occur.1 They also experience more severe disease, have higher disease activity levels,1 accrue more organ damage2 and have higher mortality rates,1 succumbing mainly to disease activity and/or infections.1 3 13–15

Moderate use of alcohol is usually not a problem for people with lupus, but alcohol can lower the effectiveness of some medications, cause new health problems, and/or can make existing problems worse. For example, non-steroidal anti-inflammatory drugs -- such as aspirin, ibuprofen (Motrin®), naproxen (Naprosyn®), and celecoxib (Celebrex®) -- can cause ulcers and bleeding in the stomach and intestines at any time during treatment; the chance of developing an ulcer or internal bleeding increases with alcohol use. Also, anticoagulant medicines such as warfarin (Coumadin®) and the chemotherapy drug, methotrexate, may not be as effective if you are drinking alcohol.


According to Goldman Foung, “A diet rich in vegetables gives me energy and keeps me feeling strong and healthy." She typically eats meals filled with dark leafy greens and other colorful vegetables, eats lots of whole grains, and limits her consumption of meat and processed foods. “I also try to drink fresh-pressed beet juice as often as possible,” she adds. “It’s a great way to sneak in some of those body-boosting ingredients.”
Sometimes, changes in blood counts (low red cell count, or anemia), may cause fatigue, serious infections (low white cell count), or easy bruising or bleeding (low platelet count). Many patients do not have symptoms from low blood counts, however, so it is important for people with lupus to have periodic blood tests in order to detect any problems.
Raynaud’s phenomenon is a condition in which the small blood vessels in the fingers and toes spasm, limiting circulation, says Dr. Kaplan. People with Raynaud’s are extremely sensitive to cold temperatures and, in those conditions, will often notice a loss of circulation and loss of color in their digits much more quickly than people without the condition. Raynaud’s affects about a third of people with lupus and can cause color loss in the fingers and toes, which first turn blue, followed by red. (9)

For people with joint or chest pain or fever, drugs that decrease inflammation, called nonsteroidal anti-inflammatory drugs (NSAIDs), are often used. Although some NSAIDs, such as ibuprofen and naproxen, are available over the counter, a doctor’s prescription is necessary for others. NSAIDs may be used alone or in combination with other types of drugs to control pain, swelling, and fever. Even though some NSAIDs may be purchased without a prescription, it is important that they be taken under a doctor’s direction.


Systemic lupus erythematosus (SLE), also known simply as lupus, is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body.[1] Symptoms vary between people and may be mild to severe.[1] Common symptoms include painful and swollen joints, fever, chest pain, hair loss, mouth ulcers, swollen lymph nodes, feeling tired, and a red rash which is most commonly on the face.[1] Often there are periods of illness, called flares, and periods of remission during which there are few symptoms.[1]

Because lupus can produce a variety of symptoms in different individuals, it may take some time for a physician to actually make the diagnosis. Often a doctor will say that lupus might be present, but that the current symptoms are insufficient to signify a firm diagnosis. In this event, s/he will likely monitor the patient’s symptoms, signs, and lab tests closely over time and have him/her return for regular visits.
SLE may cause pericarditis—inflammation of the outer lining surrounding the heart, myocarditis—inflammation of the heart muscle, or endocarditis—inflammation of the inner lining of the heart. The endocarditis of SLE is non-infectious, and is also called (Libman–Sacks endocarditis). It involves either the mitral valve or the tricuspid valve. Atherosclerosis also occurs more often and advances more rapidly than in the general population.[23][24]
Unfortunately, significant side effects are associated with cyclophosphamide-based regimens, which are the only ones with proven long-term efficacy. An alternative consideration is mycophenolate mofetil, which may be as effective as pulse cyclophosphamide but with less severe adverse effects. In refractory cases (lack of treatment response by 6 months), consider intensifying therapy with mycophenolate mofetil. [61]
Anti-dsDNA test:This is the protein directed against the double-stranded DNA, the material making up the genetic code.  This test is very specific for lupus, and can be used to determine a lupus diagnosis. One in every two people with lupus has a positive anti-dsDNA test.  The presence of this anti-dsDNA can indicate a higher risk of lupus nephritis, kidney inflammation that can occur with lupus. This test can confirm the need to closely monitor the kidneys.  Only half the people with lupus have a positive test, so a positive or negative test does not mean you have lupus.
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.
The panel concluded that long-term IS agents during maintenance therapy prolong stable renal function, reduce proteinuria, extend renal survival and minimise the toxicity of GCs. AZA, CYC, MMF and CsA seem to be equivalent regarding efficacy but MMF and AZA have a better safety profile, particularly regarding gonadal toxicity and blood pressure control. We found very low certainty of the evidence for TAC as maintenance therapy, with studies mostly restricted to Asian populations.

The male hormone DHEA (dehydroepiandrosterone), produced in the adrenals, seems to help and may reduce the need for prednisone. Although DHEA is available over-the-counter, don’t take it without medical supervision. It presents an increased risk of heart attack and breast and prostate cancer so it is vital that a physician monitor anyone taking it for lupus. Furthermore, over-the-counter brands of DHEA may not be as reliable as prescription forms.
Corticosteroids and immune suppressants: Patients with serious or life-threatening problems such as kidney inflammation, lung or heart involvement, and central nervous system symptoms need more “aggressive” (stronger) treatment. This may include high-dose corticosteroids such as prednisone (Deltasone and others) and drugs that suppress the immune system. Immune suppressants include azathioprine (Imuran), cyclophosphamide (Cytoxan), and cyclosporine (Neoral, Sandimmune). Recently mycophenolate mofetil has been used to treat severe kidney disease in lupus – referred to as lupus nephritis.
For people with joint or chest pain or fever, drugs that decrease inflammation, called nonsteroidal anti-inflammatory drugs (NSAIDs), are often used. Although some NSAIDs, such as ibuprofen and naproxen, are available over the counter, a doctor’s prescription is necessary for others. NSAIDs may be used alone or in combination with other types of drugs to control pain, swelling, and fever. Even though some NSAIDs may be purchased without a prescription, it is important that they be taken under a doctor’s direction.

The history of SLE can be divided into three periods: classical, neoclassical, and modern. In each period, research and documentation advanced the understanding and diagnosis of SLE, leading to its classification as an autoimmune disease in 1851, and to the various diagnostic options and treatments now available to people with SLE. The advances made by medical science in the diagnosis and treatment of SLE have dramatically improved the life expectancy of a person diagnosed with SLE.[105]


Blood clots are seen with increased frequency in lupus. Clots often occur 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.
If your doctor suspects you have lupus based on your symptoms, a series of blood tests will be done in order to confirm the diagnosis. The most important blood screening test is ANA. If ANA is negative, you don’t have lupus. However, if ANA is positive, you might have lupus and will need more specific tests. These blood tests include antibodies to anti-dsDNA and anti-Sm, which are specific to the diagnosis of lupus.
Kidney inflammation in SLE (lupus nephritis) can cause leakage of protein into the urine, fluid retention, high blood pressure, and even kidney failure. This can lead to further fatigue and swelling (edema) of the legs and feet. With kidney failure, machines are needed to cleanse the blood of accumulated waste products in a process called dialysis.
Inflammation of the kidneys caused by an autoimmune disease called systemic lupus erythematosus. The condition can cause hematuria and proteinuria, and it may progress to end-stage renal disease. The most severe form of lupus nephritis, called diffuse proliferative nephritis, can cause scars to form in the kidneys. Scars are permanent, and kidney function often declines as more scars form. Early diagnosis and treatment may help prevent long-lasting damage.
Changes in ESR over time can help guide a healthcare professional toward a possible diagnosis. Moderately elevated ESR occurs with inflammation, but also with anemia, infection, pregnancy, and old age. A very high ESR usually has an obvious cause, such as a marked increase in globulins that can be due to a severe infection. A rising ESR can mean an increase in inflammation or a poor response to a therapy. A decreasing ESR can mean a good response, though keep in mind that a low ESR can be indicative of diseases such as polycythemia, extreme leukocytosis, and protein abnormalities.
Any of a group of autoantibodies that react against normal components of the cell nucleus. They are present in several immunologic diseases, including systemic lupus erythematosus, progressive systemic sclerosis, Sjögren syndrome, scleroderma, polymyositis, and dermatomyositis, and in some patients taking hydralazine, procainamide, or isoniazid. In addition, ANA is present in some normal people. Tests for ANAs are used in the diagnosis and management of autoimmune diseases.
Below you will find that list, accompanied by questions created by the LFA to help individuals determine whether they should contact a healthcare professional to discuss the potential for having lupus. The LFA suggests discussing the possibility with a doctor if you answer “yes” to more than three of the questions, from your present and past health history.
In 2009, an American College of Rheumatology (ACR) Task Force generated a quality indicator set. [107] In 2012, the ACR published “ Guidelines for the Screening, Diagnosis, Treatment and Monitoring of Lupus Nephritis in Adults,” as well as an evidence report for lupus nephritis. These and other guidelines are available at the ACR's Clinical Practice Guidelines Web site.

Genome-wide association studies (GWAS) revealed regions of linkage that were found on most chromosomes.[52] These studies are useful in identifying the genes that may be responsible for complex diseases such as SLE. Candidate gene loci implicated with SLE include multiple alleles from the HLA region, Fc-gamma receptor, and complement component system.[50] However, association does not prove that a specific form of a gene is responsible for the disease, as there may be other polymorphisms in the region that have a greater association effect.[50] However, because the biological role of most genes are not completely understood, it can be difficult to attribute phenotypic traits to certain genetic polymorphisms. Since SLE is associated with so many genetic regions, it is likely an oligogenic trait, meaning that there are several genes that control susceptibility to the disease.[50] Further complicating our understanding is the association of certain linkages with various ethnic groups.[50]


The ACR recommends ANA testing in patients who have two or more unexplained signs or symptoms listed in Table 2.2,20,21 [Reference2—Evidence level C, consensus/expert guidelines] Because of the high rate of false positive ANA titers, testing for systemic lupus erythematosus with an ANA titer or other autoantibody test is not indicated in patients with isolated myalgias or arthralgias in the absence of these specific clinical signs.45 Under most circumstances, a persistently negative ANA titer (less than 1:40) can be assumed to rule out systemic lupus erythematosus.41


Drug-induced lupus erythematosus (DIL) Some drugs can cause lupus, resulting in symptoms such as rash, arthritis, hair loss, and fever. “Once medications are discontinued, the symptoms go away,” says Roberto Caricchio, MD, the interim section chief of rheumatology at Temple University Hospital in Philadelphia and the director of the Temple Lupus Clinic at the Lewis Katz School of Medicine.
This axial, T2-weighted brain magnetic resonance image (MRI) demonstrates an area of ischemia in the right periventricular white matter of a 41-year-old woman with long-standing systemic lupus erythematosus (SLE). She presented with headache and subtle cognitive impairments but no motor deficits. Faintly increased signal intensity was also seen on T1-weighted images, with a trace of enhancement following gadolinium that is too subtle to show on reproduced images. Distribution of the abnormality is consistent with occlusion of deep penetrating branches, such as may result from local vasculopathy, with no clinical or laboratory evidence of lupus anticoagulant or anticardiolipin antibody. Cardiac embolus from covert Libman-Sacks endocarditis remains less likely due to distribution.
***Please note that this article is written for informational purposes only and should not be a substitute for professional medical advice or treatment. Do not delay seeking or disregard medical advice based on information here. Always seek the advice of your local family physician or other qualified health professional before starting any new treatment or making any changes to existing treatment. It is also advisable to consult a medical professional before making any changes to diet or starting alternative remedies, which may interact with other medications.***
Limitations of the test: Although almost all people with lupus have the antibody, a positive result doesn't necessarily indicate lupus. Positive results are often seen with some other diseases and in a smaller percentage of people without lupus or other autoimmune disorders. So a positive ANA by itself is not enough for a lupus diagnosis. Doctors must consider the result of this test along with other criteria.
Raw veggies promote an alkaline environment in the body which can help keep inflammation levels lower. They also supply antioxidants, prebiotics, dietary fiber, and many essential vitamins and minerals. Whether eaten raw or cooked, some of the best choices include leafy greens, garlic, onions, asparagus, artichoke, bell peppers, beets, mushrooms and avocado. These help supply nutrients like the vitamin C, selenium, magnesium and potassium you need. Aim for variety and a minimum of four to five servings per day.
Regulatory T cells (Tregs) are a population of CD4+ T cells with a unique role in the immune response. Tregs are crucial in suppressing aberrant pathological immune responses in autoimmune diseases, transplantation, and graft-vs-host disease after allogeneic hematopoietic stem cell transplantation. Tregs are activated through the specific T-cell receptor, but their effector function is nonspecific and they regulate the local inflammatory response through cell-to-cell contact and cytokine secretion. Tregs secrete interleukin (IL)-9 (IL-9), IL-10, and transforming growth factor-beta 1 (TGF-beta 1), which aid in the mediation of immunosuppressive activity.
The ACR recommends ANA testing in patients who have two or more unexplained signs or symptoms listed in Table 2.2,20,21 [Reference2—Evidence level C, consensus/expert guidelines] Because of the high rate of false positive ANA titers, testing for systemic lupus erythematosus with an ANA titer or other autoantibody test is not indicated in patients with isolated myalgias or arthralgias in the absence of these specific clinical signs.45 Under most circumstances, a persistently negative ANA titer (less than 1:40) can be assumed to rule out systemic lupus erythematosus.41
Dermatomyositis. Acute onset of confluent macular erythema in a periorbital and malar distribution (involving the cheeks and extending over the nasal bridge), with extension to the chin in a female with juvenile dermatomyositis. Note the perioral sparing. In some patients, there may be more extensive involvement of the face, including the perioral region, forehead, lateral face, and ears. In contrast to SLE , in dermatomyositis with malar erythema, the nasolabial folds are often not spared.
Blood and urine tests. The antinuclear antibody (ANA) test can show if your immune system is more likely to make the autoantibodies of lupus. Most people with lupus test positive for ANA. But, a positive ANA does not always mean you have lupus. If you test positive for ANA, your doctor will likely order more tests for antibodies that are specific to systemic lupus erythematosus (SLE).
Chronic diseases are noncommunicable illnesses that are prolonged in duration, do not resolve spontaneously, and are rarely cured completely. Although chronic diseases are more common among older adults, they affect people of all ages and are now recognized as a leading health concern of the nation. Growing evidence indicates that a comprehensive approach to prevention can save tremendous costs and needless suffering.
Other tests for lupus depend on the symptoms patients are experiencing, says Kaplan. For example, chest X-rays and echocardiograms may be necessary to investigate fluid around the lungs and the heart. If doctors suspect nephritis is present, the patient may need a kidney biopsy. Early diagnosis and treatment can help to avoid complications, he adds.
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.
Corticosteroids. Corticosteroids, such as prednisone, can be helpful in reducing inflammation. Sometimes steroids are used for a few weeks until other slower medications can become effective. Because of their many side effects, the lowest possible dose should be used for the shortest length of time. Usually a corticosteroid is given by mouth as a pill or liquid. However, some forms can be given as an injection into the joint or muscle, or as an IV into a vein. It is important to slowly stop (taper off) steroids instead of stopping them suddenly.

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