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
Most patients with systemic lupus erythematosus (unless they’re otherwise advised by their rheumatologist) should be taking an oral antimalarial drug — medications originally used to prevent a malaria infection, but that have been found to help with lupus symptoms, says Dr. Kramer. The antimalarial hydroxychloroquine helps prevent lupus flares, minimizes joint inflammation, and controls fever, fatigue, pleurisy (inflammation of the sac surrounding the lungs), and pericarditis (inflammation of the lining around the heart). The drug is also “the backbone of therapy” for most skin rashes associated with lupus, says Kramer. Mouth sores may also be alleviated with this drug. Chloroquine and quinacrine are other antimalarials drugs used to treat lupus. (3)
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)
The immune response is how your body recognizes and defends itself against bacteria, viruses, and substances that appear foreign and harmful.The immune system protects the body from possibly harmful substances by recognizing and responding to antigens. Antigens are substances (usually proteins) on the surface of cells, viruses, fungi, or bacteria. Nonliving substances such as toxins, chemicals, drugs, and foreign particles (such as a splinter) can also be antigens. The immune system recognizes and destroys substances that contain antigens. Your own body’s cells have proteins that are antigens. These include a group of antigens called HLA antigens. Your immune system learns to see these antigens as normal and usually does not react against them.
When choosing dairy products, remember to go either low-fat or fat-free. Some examples include 1% and skim milk, low fat and low sodium yogurt, and low fat cheese. Foods to avoid are 2% and whole milk, which contain a large amount of fat and cholesterol. If you do not or cannot consume milk, choose lactose-free milk, soy milk, and almond milk that are fortified with calcium and Vitamin D. Aim for three or more servings a day.
Foot pain may be caused by injuries (sprains, strains, bruises, and fractures), diseases (diabetes, Hansen disease, and gout), viruses, fungi, and bacteria (plantar warts and athlete's foot), or even ingrown toenails. Pain and tenderness may be accompanied by joint looseness, swelling, weakness, discoloration, and loss of function. Minor foot pain can usually be treated with rest, ice, compression, and elevation and OTC medications such as acetaminophen and ibuprofen. Severe pain should be treated by a medical professional.
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.
In SLE patients with serious brain (lupus cerebritis) or kidney disease (lupus nephritis), plasmapheresis is sometimes used to remove antibodies and other immune substances from the blood to suppress immunity. Plasmapheresis is a process of removing blood and passing the blood through a filtering machine, then returning the blood to the body with its antibodies removed. Rarely, people with SLE can develop seriously low platelet levels, thereby increasing the risk of excessive and spontaneous bleeding. Since the spleen is believed to be the major site of platelet destruction, surgical removal of the spleen is sometimes performed to improve platelet levels. Other treatments have included plasmapheresis and the use of male hormones.
B cells obtain help from T cells in the antibody response by acting as antigen-specific antigen presenting cells. A direct signal through binding of antigen to membrane Ig can enhance B cell antigen presentation and T-dependent B cell activation, but is not required for a productive interaction between a small resting B cell and a differentiated helper T cell.
Antinuclear antibody (ANA) testing and anti-extractable nuclear antigen (anti-ENA) form the mainstay of serologic testing for SLE. Several techniques are used to detect ANAs. Clinically the most widely used method is indirect immunofluorescence (IF). The pattern of fluorescence suggests the type of antibody present in the people's serum. Direct immunofluorescence can detect deposits of immunoglobulins and complement proteins in the people's skin. When skin not exposed to the sun is tested, a positive direct IF (the so-called lupus band test) is an evidence of systemic lupus erythematosus.
In the United States, systemic lupus erythematosus is reported to be more common in women, particularly black women, than in white men.14,16 One U.S. retrospective study16 of medical records found that the disease is diagnosed 23 times more often in black women than in white men. The prevalence of the disease is also higher in Hispanic and Asian Americans.16 In addition, a familial predisposition to systemic lupus erythematosus has been identified.17-19
The underlying trigger to develop these antibodies in lupus is unknown, although experts believe that a combination of genetic, environmental, and possibly hormonal factors are involved. The fact that lupus can run in families suggests that there is a genetic basis for its development, but so far no single “lupus gene” has been identified. Experts suspect that several different genes may be involved in determining an individual’s chance of developing the disease, as well as which tissues and organs are affected, and how severe the disease will be if it does occur. Other factors being investigated as contributing to the onset of lupus are overexposure to sunlight, stress, certain drugs, and viruses and other infectious agents.
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).
Acute cutaneous: This is the type of skin flare that occurs when your SLE is active. Lesions associated with acute cutaneous lupus appear as flattened areas of red skin on the face, reminiscent of a sunburn—the telltale butterfly rash. These lesions can appear on the arms, legs, and body, and are photosensitive. Though the lesions may discolor the skin, they don't scar. Lesions typically appear during a flare or after sun exposure.
The best diet to follow is one which contains a good balance of varied foods, and one which you feel you can stick to. There are many diets around, some are useful, others can be too extreme, or too complicated to follow when you have limited energy and particular needs. If you have lupus nephritis it is important that you follow the advice from your hospital dietician.
Everett adds that eating fish for protein is particularly good. Fish — especially salmon, tuna, and mackerel — contain omega-3 fatty acids, which are important because they help fight inflammation, she says. Omega-3s, which are also available as supplements, may decrease your risk for heart disease. This may be especially important for women with lupus because they have at least double the risk of heart disease compared with women who don't have lupus, according to a review of studies published in August 2013 in Seminars in Arthritis and Rheumatism. “Lupus is an independent risk factor for heart disease, so you should maintain a heart-healthy diet that helps fight inflammation and keeps you at a healthy weight," Everett says.
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.
Patients with SLE should be educated to avoid triggers for flare. Persons with SLE should avoid ultraviolet light and sun exposure to minimize worsening of symptoms from photosensitivity. Diet modification should be based on the disease activity. A balanced diet is important, but patients with SLE and hyperlipidemia, for example, should be placed on a low-fat diet. Many patients with SLE have low levels of vitamin D because of less sun exposure; therefore, these patients should take vitamin D supplements. Exercise is important in SLE patients to avoid rapid muscle loss, bone demineralization, and fatigue. Smoking should also be avoided.
To help doctors diagnose lupus, this list of 11 common criteria, or measures, was developed by the American College of Rheumatology (ACR). ACR is a professional association of rheumatologists. Rheumatologists are the doctors who specialize in treating diseases of the joints and muscles, like lupus. If you have at least four of the criteria on the list, either at the present time or at some time in the past, there is a strong chance that you have lupus.
For some patients whose kidneys or central nervous systems are affected by lupus, a type of drug called an immunosuppressive may be used. Immunosuppressives, such as cyclophosphamide and mycophenolate mofetil, restrain the overactive immune system by blocking the production of immune cells. These drugs may be given by mouth or by IV infusion. The risk for side effects increases with the length of treatment.
The following drugs are commonly used to treat the inflammation and symptoms of lupus. Since lupus manifests in different ways in different people, treatment regimens differ from patient to patient. In addition, one patient may experience several different treatment regimens during her/his lifetime. It is important that you understand the medications you are taking and the risks, benefits, and restrictions associated with them. Please remember to take your medications exactly as directed by your physician and to address any questions or concerns upon your next visit.
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