Because the antibodies and accompanying cells of inflammation can affect tissues anywhere in the body, lupus has the potential to affect a variety of areas. Sometimes lupus can cause disease of the skin, heart, lungs, kidneys, joints, and/or nervous system. When only the skin is involved by rash, the condition is called lupus dermatitis or cutaneous lupus erythematosus. A form of lupus dermatitis that can be isolated to the skin, without internal disease, is called discoid lupus erythematosus. When internal organs are involved, the condition is referred to as systemic lupus erythematosus (SLE).
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.
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.
Antibodies produced by a single clone of cells; A type of protein made in the laboratory that can bind to substances in the body, including cancer cells. There are many kinds of monoclonal antibodies. A monoclonal antibody is made so that it binds to only one substance. Monoclonal antibodies are being used to treat some types of cancer. They can be used alone or to carry drugs, toxins, or radioactive substances directly to cancer cells.
Acute Cutaneous Lupus results in flat red patches on the cheeks and nose called a malar or butterfly rash that looks quite like sunburn. These patches may also appear on the arms, legs, trunk and any other area that is commonly exposed to the sun. Patients with Acute Cutaneous Lupus can also manifest oral ulcers, hives and temporary hair loss. Acute Cutaneous Lupus is more common in people living with SLE.
“I have had severe lupus for over twenty years and find that diet doesn’t really change any symptoms. I eat meat, fish, dairy, gluten and sugar too…all in moderation. I eat lots of fruit and veg and avoid processed foods. The only thing I avoid is alcohol. I guess everyone is different but a well-balanced, healthy diet with exercise (when I’m up to it) is my formula.”
The panel recommends SOC (GCs and antimalarials (AM)) in addition to an IS (CYC in high or low doses, MMF or TAC) over GCs alone, for induction in patients with SLE-related kidney disease (strong recommendation based on moderate certainty of the evidence). Although more African-American descendants and Hispanic patients responded to MMF than CYC (25), limited access to MMF and TAC in several Latin American countries, due primarily to cost issues, makes CYC the best alternative for induction (high or low dose) in these regions (table 2).
No diet-based treatment of SLE has been proven effective. Patients with SLE should be reminded that activity may need to be modified as tolerated. Specifically, stress and physical illness may precipitate SLE flares. Additionally, persons with SLE should wear sunscreen and protective clothing or avoid sun exposure to limit photosensitive rash or disease flares.
There have been several diet studies using omega-3 fatty acids in people who have lupus. A 2012 study looked at the eating habits of 114 SLE patients. They found that those who had a diet low in omega-3 fatty acids had worse lupus disease activity as well as higher levels of cholesterol and atherosclerosis (which can cause heart attacks and strokes). Therefore, it is important for people who have lupus to supplement their diet with foods rich in omega-3 fatty acids, olive oil, or supplements containing these oils. Not only may this possibly improve lupus disease activity, but it may also improve cholesterol levels, which could help to decrease the risk of getting heart attacks, strokes and blood clots.
Once remission is achieved, start maintenance therapy with azathioprine or mycophenolate mofetil (ie, use less potent agents relative to long-term cyclophosphamide). The ALMS maintenance trial also found that mycophenolate mofetil was superior to azathioprine in the maintenance of the renal response to treatment and in the prevention of relapse in patients with lupus nephritis.  In the MAINTAIN trial, there was a trend toward fewer renal flares in patients receiving mycophenolate mofetil than in those receiving azathioprine  ; however, these results did not reach statistical significance.
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 rheumatologic illness marked by fevers, malaise, weight loss, muscle pain, stiffness (esp. of the shoulders and pelvis), and morning stiffness. It occurs primarily, but not exclusively, in white people over 60. The cause of PMR is unknown. Although there is no single diagnostic test for PMR, patients typically have a markedly elevated erythrocyte sedimentation rate (>50 mm/hr) and no evidence of another disease (such as infection, cancer, rheumatoid arthritis, or lupus). Patients obtain rapid and durable relief from corticosteroids but usually require a course of treatment lasting 6 to 18 months. Pathologically, and sometimes clinically, PMR is related to giant cell arteritis. Mild cases may sometimes respond to nonsteroidal anti-inflammatory drugs.
Another new B-cell-suppressing treatment is belimumab (Benlysta). Belimumab blocks the stimulation of the B cells (a B-lymphocyte stimulator or BLyS-specific inhibitor) and is approved for the treatment of adults with active autoantibody-positive systemic lupus erythematosus who are receiving standard therapy. It is important to note that the efficacy of belimumab has not been evaluated in patients with severe active lupus nephritis or severe active central nervous system lupus. Belimumab has not been studied in combination with other biologic therapies or intravenous cyclophosphamide.
Avoiding sunlight in SLE is critical, since sunlight is known to exacerbate skin manifestations of the disease. Avoiding activities which induce fatigue is also important, since those with SLE fatigue easily and it can debilitating. These two problems can lead to people becoming housebound for long periods of time. Drugs unrelated to SLE should be prescribed only when known not to exacerbate the disease. Occupational exposure to silica, pesticides, and mercury can also worsen the disease.
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.
In addition to the oral antimalarial hydroxychloroquine, doctors may prescribe topical steroids for lupus rash. Steroids or antimalarials may also be injected directly into rash lesions. (8) Topical creams containing tacrolimus or pimecrolimus that modulate the skin’s immune response may help manage lupus rash. Oral thalidomide, which affects the immune response, may be prescribed if other therapies don’t work. Doctors may also recommend that people with lupus rash avoid the sun and other ultraviolet light sources and wear sunscreen.
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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