However, three placebo-controlled studies, including the Exploratory Phase II/III SLE Evaluation of Rituximab [EXPLORER] trial and the Lupus Nephritis Assessment with Rituximab [LUNAR] trial, [124, 125] failed to show an overall significant response. Despite the negative results in these trials, rituximab continues to be used to treat patients with severe SLE disease that is refractory to standard therapy.

(1) SOC; (2) SOC plus methotrexate (MTX); (3) SOC plus leflunomide (LFN); (4) SOC plus belimumab; (5) SOC plus abatacept (ABT); (6) other options: azathioprine (AZA), mycophenolate mofetil (MMF), cyclosporine A (CsA) or rituximab (RTX) (online supplementary tables S2.1.1, S2.1.4, S2.1.6, S2.1.7, S2.2.11, S2.1.11, S2.1.12, S2.1.14, S2.1.15, S2.1.17, S2.2.1, S2.2.2, S2.2.4, S3.1.1, S3.1.3–S3.1.6, S3.2.1, S3.2.2, S12.2–S12.5, S12.8–S12.10).
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.
Since SLE patients can have a wide variety of symptoms and different combinations of organ involvement, no single test establishes the diagnosis of systemic lupus. To help doctors improve the accuracy of the diagnosis of SLE, 11 criteria were established by the American Rheumatism Association. These 11 criteria are closely related to the symptoms discussed above. Some people suspected of having SLE may never develop enough criteria for a definite diagnosis. Other people accumulate enough criteria only after months or years of observation. When a person has four or more of these criteria, the diagnosis of SLE is strongly suggested. Nevertheless, the diagnosis of SLE may be made in some settings in people with only a few of these classical criteria, and treatment may sometimes be instituted at this stage. Of these people with minimal criteria, some may later develop other criteria, but many never do.
In patients with systemic lupus erythematosus (SLE), the presence of antiphospholipid antibodies is common; depending on the assay, these antibodies have been reported in up to 30-50% of SLE patients. [137] Therefore, it is important to evaluate these patients for risk factors for thrombosis, such as use of estrogen-containing drugs, being a smoker, immobility, previous surgery, and the presence of severe infection or sepsis. [61] The European League Against Rheumatism (EULAR) has noted that low-dose aspirin in individuals with SLE and antiphospholipid antibodies is potentially useful for primary prevention of thrombosis and pregnancy loss. [61]
How an autoimmune disease affects you depends on what part of the body is targeted. If the disease affects the joints, as in rheumatoid arthritis, you might have joint pain, stiffness, and loss of function. If it affects the thyroid, as in Graves’ disease and thyroiditis, it might cause tiredness, weight gain, and muscle aches. If it attacks the skin, as it does in scleroderma/systemic sclerosis, vitiligo, and systemic lupus erythematosus (SLE), it can cause rashes, blisters, and color changes.
Rheumatologists may not discuss the topic of nutrition with their patients, which is “mainly due to the complex nature of the disease, and doctors often do not have time to discuss diet when there are so many other topics to cover,” Gibofsky explained. “Many rheumatologists will admit that diet is not their area of expertise and will instead refer their patient[s] to meet with a registered dietitian (RD) who can better help with these questions.”
In patients with systemic lupus erythematosus (SLE), the presence of antiphospholipid antibodies is common; depending on the assay, these antibodies have been reported in up to 30-50% of SLE patients. [137] Therefore, it is important to evaluate these patients for risk factors for thrombosis, such as use of estrogen-containing drugs, being a smoker, immobility, previous surgery, and the presence of severe infection or sepsis. [61] The European League Against Rheumatism (EULAR) has noted that low-dose aspirin in individuals with SLE and antiphospholipid antibodies is potentially useful for primary prevention of thrombosis and pregnancy loss. [61]
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 skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. Bone strength reflects the integration of two main features: bone density and bone quality. Bone density is expressed as grams of mineral per area or volume and in any given individual is determined by peak bone mass and amount of bone loss. Bone quality refers to architecture, turnover, damage accumulation (e.g., microfractures) and mineralization. A fracture occurs when a failure-inducing force (e.g., trauma) is applied to osteoporotic bone. Thus, osteoporosis is a significant risk factor for fracture, and a distinction between risk factors that affect bone metabolism and risk factors for fracture must be made.
In the absence of systemic lupus erythematosus, the most common reason for a positive ANA test is the presence of another connective tissue disease. Diseases that often are associated with a positive ANA test include Sjögren's syndrome (68 percent of affected patients), scleroderma (40 to 75 percent), rheumatoid arthritis (25 to 50 percent), and juvenile rheumatoid arthritis (16 percent).20 An ANA test also can be positive in patients with fibromyalgia. In patients with diseases other than systemic lupus erythematosus, ANA titers usually are lower, and the immunofluorescent pattern is different.20
Cognitive impairment is defined as any difficulty with normal thought functions or processes, such as thinking, learning, or remembering. Cognitive impairment can occur as a neurological symptom of lupus. However, cognitive impairment is a common occurrence that happens to everyone at some time, not just lupus patients, and it can affect one single thought process or many thought processes either temporarily or permanently.

Inflammation of the heart muscle, usually in the U.S. as a consequence of infections (viruses, esp. coxsackie virus, and occasionally as a consequence of bacterial, protozoan or fungal infections); immunological-rheumatological conditions (e.g., systemic lupus erythematosus, ulcerative colitis, hypersensitivity reactions, or transplant rejection); exposure to chemicals or toxins (e.g., cocaine, doxorubicin, methamphetamine); nutritional or metabolic abnormalities (e.g., thiamine deficiency or hypophosphatemia); or radiation. Myocarditis also is occasionally found in pregnancy and with advanced age. The myocardium is infiltrated by leukocytyes, lymphocytes, and macrophages, leading to inflammation, necrosis of muscle cells, and fibrosis. Inflammatory damage to heart muscle fibers may resolve spontaneously or may cause progressive deterioration of the heart with pericarditis, arrhythmias, chronic dilated cardiomyopathy, and heart failure.


Decorin is a protein coded for by the DCN gene. This protein is a component of the extracellular matrix, which is the intricate lattice of proteins and other molecules that forms in the spaces between cells. Decorin is found in the extracellular matrix of a variety of connective tissues, including skin, tendon, bone, and cartilage. Connective tissues support the body’s joints and organs. Decorin is involved in the organization of proteins called collagens. Collagens strengthen and support connective tissues throughout the body. Collagens also play an important role in the cornea, which is the clear outer covering of the eye. Bundles of collagen called fibrils must be strictly organized for the cornea to be transparent. Decorin ensures that these collagen fibrils are uniformly sized and regularly spaced.
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.
A. Like Gomez, people with lupus often begin chemotherapy, which helps to suppress the immune system. Gomez has said that she is in remission, which means her disease is not causing her any symptoms. With luck, these remissions can last for years. But about 25% of people with lupus a year experience a "flare," in which symptoms recur. To keep the disease under control, people with lupus need to be treated for the rest of their lives. Most take a drug called hydroxychloroquine, which is also used to fight malaria. People also usually take an immune-suppressing drug, Gilkeson said.
Medical historians have theorized that people with porphyria (a disease that shares many symptoms with SLE) generated folklore stories of vampires and werewolves, due to the photosensitivity, scarring, hair growth, and porphyrin brownish-red stained teeth in severe recessive forms of porphyria (or combinations of the disorder, known as dual, homozygous, or compound heterozygous porphyrias).[121]
Joints that are red, warm, tender, and swollen may signal lupus. Aching and stiffness alone aren’t enough; the joints have to be affected by arthritis and these other "cardinal signs of inflammation," says Michael Belmont, MD, director of the lupus clinic at Bellevue Hospital and medical director at the New York University Hospital for Joint Diseases in New York City.
Gluten can also lead to what’s known as molecular mimicry. The gluten protein, gliadin, resembles many of your body’s own tissues, particularly thyroid tissue. If you have Celiac disease, gluten intolerance, or a leaky gut, your immune system releases gliadin antibodies every time you eat gluten. Because gliadin looks so similar to your own tissues, sometimes these antibodies mistakenly attack other organs and systems, from the skin to the thyroid to the brain. This case of mistaken identity often leads to full-blown autoimmune disease.
A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis.
Analgesics, or pain relievers, are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There are many different pain medicines, and each one has advantages and risks. Some types of pain respond better to certain medicines than others. Each person may also have a slightly different response to a pain reliever.
Inflammation associated with lupus can cause stiffness, swelling, pain, and warmth of the joints, most commonly in the fingers, hands, elbows, ankles, and toes. (8) Most people with lupus will experience joint inflammation at some point, says Caricchio. For many people, joint pain is one of the first symptoms of the disease that they’ll notice and report.

I just had a biopsy done, pictures taken yesterday. This doctor was very kind, but seem to know exactly what I have but is looking on how to best treat it. I had a Dr. Speigle (specialist) in Santa Barbara never having met him in my life, tell me 22 years ago, 6 months after having my daughter and never having met him this. He walked into exam room and his first words were “Boy you look depressed and you know what you have is fatal”. Went on to tell me how great his life is, wrote a book and on his way on a great trip with his wife to Big Sur. I left that appointment in tears on my way to the car, never told anyone not even my husband. I just thought what an unkind, unprofessional man. I work a very stressful job so I just knocked up the rashes to hives. Well, here I am and I do have most syptoms described for the skin type, however I have had numerous kidney stones and have felt lately like another one is trying to pass. I will have confirmation in a week, but am having 2nd spine surgery in August. This is what made me go in, was to make sure rashes won’t delay surgery as I can barely walk. I have always been active in sports, camping and on the go. I can’t say I am shocked maybe a bit relieved to have an explanation but this morning realty has hit. I believe in prayer and will keep all with this disease in my daily prayers. I don’t drink so at least I don’t have to worry about giving that up, but my husband is Italian cooks that way. Hmmmm………. Victoria from SB Prayers for all of you truly.


An intravenous pyelogram (IVP) is a special x-ray examination of the kidneys, bladder, and ureters (the tubes that carry urine from the kidneys to the bladder). An intravenous pyelogram is performed by injecting contrast material into a vein in the arm. A series of x-rays are taken at timed intervals as the contrast material goes through the kidneys, the ureters, and the bladder. The procedure helps to evaluate the condition of those organs.

The Food and Drug Administration is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation’s food supply, cosmetics, and products that emit radiation. FDA also has responsibility for regulating the manufacturing, marketing, and distribution of tobacco products to protect the public health and to reduce tobacco use by minors.
Your kidneys are two bean-shaped organs, each about the size of your fists. They are located near the middle of your back, just below the rib cage. Inside each kidney about a million tiny structures called nephrons filter blood. They remove waste products and extra water, which become urine. The urine flows through tubes called ureters to your bladder, which stores the urine until you go to the bathroom. Most kidney diseases attack the nephrons. This damage may leave kidneys unable to remove wastes. Causes can include genetic problems, injuries, or medicines.

The word Paleo means ancient or older. The Paleo diet, as its name states, is a diet based around focusing on foods that have been eaten by humans for thousands of years during their evolution. Foods that existed before the introduction of agriculture. These foods are fresh and free of any added preservatives, mainly consisting of vegetables and meats. Paleo advocates claim that this way of eating can improve all aspects of your health, including your weight, reduction of disease activity and prevention of some chronic diseases like heart disease and type 2 diabetes. The Paleo diet provides that we should be eating what heals and supports our immune system. This diet includes diet the following diet recommendations as shown in the above graphic:
Steroids decrease inflammation and may be used to treat many inflammatory conditions and diseases, such as systemic vasculitis, rheumatoid arthritis, lupus, and Sjögren's syndrome. Steroids are injected, rather than administered orally, to deliver a high dose of medication to a specific area. Side effects of steroid injections include infection, tendon rupture, skin discoloration, allergic reaction, and weakening of bone, ligaments, and tendons.

“It’s always difficult for children and parents to live with the idea that lupus is chronic,” says Pascual. That means the child has many more years worth of living with the condition than if he or she were diagnosed later in life. And because this disease is lifelong and may involve complications such as nephritis, doctors need to manage it aggressively.
Why the test is used: Abnormalities in blood cell counts, including white blood cells and red blood cells, may occur in people with lupus. This may be related to the lupus, lupus treatments, or infection. For example, leukopenia, a decrease in the number of white blood cells, is found in about 50% of people with lupus. Thrombocytopenia, or a low platelet count, occurs in about 50% of people with lupus, as well. Doctors can use this test to monitor these potentially serious problems.
In this presentation, Ms. Everett covers the relationship of diet and nutritional considerations and lupus, osteoporosis, medication side effects, and vitamins and supplements. This is the first of a two-part presentation. In Part II, Ms. Everett will focus more specifically on nutrition and the importance of heart health and kidney health for people with lupus. Before beginning the presentation, Ms. Everett highlighted that nutrition has become an important area of research in regard to lupus.
When Griffiths et al compared the corticosteroid-sparing effect of cyclosporine with azathioprine in patients with severe SLE, they concluded that azathioprine may be considered first-line therapy, whereas cyclosporine requires close monitoring of blood pressure and serum creatinine. However, the investigators noted that in patients who are unable to tolerate azathioprine, cyclosporine may be considered. [136]
If you have lupus you may have noticed that certain foods tend to lead to lupus flares. A lupus flare is a period when the symptoms of lupus become more active. Kathleen LaPlant, of Cape Cod, Mass., was diagnosed with systemic lupus several years ago. "I have learned to be careful with foods that seem to trigger lupus symptoms. The biggest trigger for me has been fried foods. I have had to eliminate these from my diet," says LaPlant. It is hard to predict which foods may trigger a lupus flare, but you can start by paying close attention to your diet. If a particular type of food repeatedly causes problems, try taking it out of your diet and see if it makes a difference.
Two working teams on logistics and methodological issues constituted by experienced Latin American rheumatologists and experts in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guideline system developed a framework for these guidelines. Nine organ/system sections were prepared with the main findings. Special emphasis was placed on reviewing local problems and regional publications.
Most people who have SLE have low levels of vitamin D and should take a vitamin D supplement regularly. Vitamin D is essential for proper function of the immune system and several studies have shown that people who have more severe lupus tend to have lower levels of vitamin D compared to those who have milder disease.  It is advised to talk with your consultant or GP about your vitamin D levels as you may already be prescribed calcium supplements which may contain vitamin D. Some dietary sources of vitamin D can be found HERE. It is important to bear in mind that most vitamin D is usually synthesised from sunlight on the skin, but with lupus you should be protecting yourself from exposure to UV.
Many drugs have been known to cause this form of the disease, but several are considered primary culprits. They are mainly anti-inflammatories, anticonvulsants, or drugs used to treat chronic conditions such as heart disease, thyroid disease, hypertension (high blood pressure), and neuropsychiatric disorders. The three drugs mostly to blame for drug-induced lupus are:

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Please Note: The material on this site is provided for informational purposes only and is not medical advice. Always consult your physician before beginning any diet or exercise program.

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