There is no single diagnostic test for systemic lupus. The test you will hear most about is called the antinuclear antibody (ANA) test. This is not a specific test for lupus, however. In fact, a variety of laboratory tests are used to detect physical changes or conditions in your body that can occur with lupus. Each test result adds more information to the picture your doctor is forming of your illness.
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.
A primary lymphoid organ located in the mediastinal cavity anterior to and above the heart, where it lies over the superior vena cava, aortic arch, and trachea. The thymus comprises two fused lobes, the right larger than the left. The lobes are partially divided into lobules, each of which has an outer cortex packed with immature and developing T lymphocytes (thymocytes) and an inner medulla containing a looser arrangement of mature T lymphocytes.
People with lupus are at great risk of contracting kidney disease. Kidney failure occurs in a minority of patients with lupus nephritis, despite advances in therapy. These patients must undergo dialysis. About one-third of patients who start dialysis during an acute lupus flare will be able to discontinue it within the first year. The remaining two-thirds, and those suffering gradual deterioration of kidney function over several years will require either continual dialysis for life or a kidney transplant.
The most serious health risks are cardiovascular disease, kidney disease and stroke. Specifically, people with lupus are at increased risk for atherosclerosis (hardening of the arteries). In some people, inflammation can occur in the heart itself (myocarditis and endocarditis) or the membrane that surrounds it. Endocarditis can damage heart valves, which can result in heart murmurs. When the disease affects the kidneys, patients generally require intensive drug treatment to prevent permanent damage. Lupus also may attack the brain or central nervous system, which can cause seizures or stroke.
The American College of Rheumatology (ACR) established eleven criteria in 1982, which were revised in 1997 as a classificatory instrument to operationalise the definition of SLE in clinical trials. They were not intended to be used to diagnose individuals and do not do well in that capacity. For the purpose of identifying people for clinical studies, a person has SLE if any 4 out of 11 symptoms are present simultaneously or serially on two separate occasions.
The medical doctors who treat lupus are rheumatologists who specialize in arthritis and other inflammatory disorders. However, depending on the individual, case treatment may involve a wide range of health professionals including clinical immunologists (doctors specializing in immune system disorders), nurses, psychologists, social workers, nephrologists (kidney disease specialists), hematologists (specialists in blood disorders), dermatologists, and neurologists.
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.
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.
Thinning hair is often one of the first symptoms of lupus. Hair loss is the result of inflammation of the skin and scalp. Some people with lupus lose hair by the clump. More often, hair thins out slowly. Some people also have thinning of the beard, eyebrows, eyelashes, and other body hair. Lupus can cause hair to feel brittle, break easily, and look a bit ragged, earning it the name “lupus hair.”
Osteoarthritis is the most common form of arthritis, affecting millions of people around the world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time. While osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips. Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can slow the progression of the disease, relieve pain and improve joint function.
Donna Jackson Nakazawa, researcher, writer, and author of The Autoimmune Epidemic, says "patients with lupus do better if they follow an 'anti-autoimmune diet,' which means consuming whole foods, rather than processed foods. This means lamb, chicken, or turkey; fish with low mercury content; hormone-free eggs; organic vegetables and fresh fruits; whole grains from gluten-free sources; nuts and seeds; and olive, sesame, and flaxseed oils. It also means avoiding highly processed foods, including preserved bread products, cereals and snacks, preserved meats, and other foods that are often full of chemicals, preservatives, and additives."
Drugs used to treat lupus include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, alone or combined with other drugs for pain, swelling, and fever. Drugs that work inside cells, including antimalarial drugs such as hydroxychloroquine (Plaquenil) are used for fatigue, joint pain, skin rashes, and inflammation of the lungs. Continuous treatment with antimalarials may prevent lupus flare up from recurring.
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.
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. For example, studies show that social support is a modulating factor which buffers against SLE-related damage and maintains physiological functionality. Studies have not been conducted to determine whether people of different racial backgrounds receive differing levels of social support. 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. Racial differences in lupus progression have not been found in studies that control for the socioeconomic status [SES] of participants. 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. The people who receive medical care have often accrued less disease-related damage and are less likely to be below the poverty line. Additional studies have found that education, marital status, occupation, and income create a social context which contributes to disease progression.
Along with nutritional deficiencies, steroid medications can cause significant weight gain and increased cholesterol, blood glucose, and triglycerides, further underscoring the need for patients with SLE who are taking these agents to follow a healthy diet to counter the effects.6 There are also specific things that individuals with SLE should avoid, including alfalfa sprouts and garlic, which can stimulate an already overactive immune system.7
The Scientific Advisory Board is comprised of leading lupus experts. Following the first stage of the peer review process, the Scientific Advisory Board conducts a second level of detailed analysis of the projects that are submitted to our organization. The goal is to make a determination about which of these excellent projects should actually be recommended to our board of directors for funding.
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.
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]
Although guidelines for SLE treatment do exist and there is scarce evidence to support specific therapies for Latin American patients with lupus,16–21 this regional effort has considered the impact of racial/ethnic background1 10 22–28 and SES3 9 on lupus outcomes and treatment response.25 26 Other medication variables such as cost and availability were also taken into account since they affect adherence and are relevant in decision-making.27 28 GLADEL and the Pan-American League of Associations of Rheumatology have joined efforts to produce these guidelines,29 which are presented by organ systems, although manifestations usually occur in more than one. Nevertheless, treatment is usually tailored to the more severe manifestation(s), which usually benefits the less severe.
A healing lupus diet can help improve gut health in those with lupus by preventing allergies, reducing deficiencies and slowing down free radical damage. In fact, due to how autoimmune disorders develop, a low-processed lupus diet high in antioxidants is usually key for managing any autoimmune-related symptoms, including those due to arthritis, thyroid disorders, etc., which often overlap with lupus symptoms.
What are the causes and types of arthritis? Arthritis is a term that describes around 200 conditions that cause pain in the joints and the tissues surrounding the joints. The most common form of arthritis is osteoarthritis. Other related conditions include gout and fibromyalgia. The article looks at the types, causes, and treatments, including natural remedies. Read now
A common neurological disorder people with SLE have is headache, although the existence of a specific lupus headache and the optimal approach to headache in SLE cases remains controversial. Other common neuropsychiatric manifestations of SLE include cognitive dysfunction, mood disorder, cerebrovascular disease, seizures, polyneuropathy, anxiety disorder, psychosis, depression, and in some extreme cases, personality disorders. Steroid psychosis can also occur as a result of treating the disease. It can rarely present with intracranial hypertension syndrome, characterized by an elevated intracranial pressure, papilledema, and headache with occasional abducens nerve paresis, absence of a space-occupying lesion or ventricular enlargement, and normal cerebrospinal fluid chemical and hematological constituents.
According to the Lupus Foundation of America, approximately 1.5 million people in the U.S. have lupus. People of African, Asian, and Native American descent are more likely to develop lupus than are Caucasians. Although it can occur in both men and women, 90% of people diagnosed with the disease are women. Women of childbearing age (14 to 45 years old) are most often affected and as many as 1 in 250 people may develop lupus.
No overarching diet exists for people with lupus. However, lupus is a systemic disease, so maintaining good nutritional habits will help your body remain as healthy as possible. Generally, doctors recommend a diet composed of about 50% carbohydrates, 15% protein, and 30% fat. However, since people with lupus often experience symptoms like weight loss or gain, inflammation, osteoporosis, kidney disease, high blood pressure, and atherosclerosis, certain specific nutritional concerns may also need to be taken into consideration. If you need help managing your weight or making healthy food choices, please speak with your doctor. S/he can give you more specific information and refer you to a registered dietitian if needed.
The variety of symptoms that lupus can bring on can make it tough to spot. Another reason the disease can be difficult to identify is that some of its most common symptoms — such as fatigue, headaches, joint pain, swelling, and fever — occur in a lot of other illnesses, too. Lupus can imitate rheumatoid arthritis, blood disorders, fibromyalgia, diabetes, thyroid problems, and more, according to the Lupus Foundation of America. (1)
This diet is not intended for weight loss (although that can be a side effect). The anti-inflammatory diet is intended to provide steady energy, plenty of vitamins and minerals, and the essential fatty acids needed to maintain optimum health. You could look at this more like an eating plan for life as opposed to a diet per se. It is based on the general concept that eating to avoid inflammation promotes better health and can ward off diseases. According to Dr. Andrew Weil, the Harvard trained natural and preventative medicine physician (as seen on Oprah, and the Dr. Oz show,) there is clear evidence to support that inflammation can be very damaging to the body and he therefore openly supports the Anti-Inflammatory Diet. “We all know inflammation on the surface of the body as local redness, heat, swelling and pain. It is the cornerstone of the body’s healing response, bringing more nourishment and more immune activity to a site of injury or infection. But when inflammation persists or serves no purpose, it damages the body and causes illness. Stress, lack of exercise, genetic predisposition, and exposure to toxins (like secondhand tobacco smoke) can all contribute to such chronic inflammation, but dietary choices play a big role as well.” Both he and Barry Sears, MD, the author of the well-known Zone Diet both agree that this diet can have significant positive results on many diseases. Here are the basics of the anti-inflammatory diet (all versions vary, but this is the general proposal for all:
If your doctor suspects you have lupus, he or she will focus on your RBC and WBC counts. Low RBC counts are frequently seen in autoimmune diseases like lupus. However, low RBC counts can also indicate blood loss, bone marrow failure, kidney disease, hemolysis (RBC destruction), leukemia, malnutrition, and more. Low WBC counts can point toward lupus as well as bone marrow failure and liver and spleen disease.
Fatigue is different from drowsiness. Drowsiness is feeling the need to sleep. Fatigue is a lack of energy and motivation. Drowsiness and apathy (a feeling of not caring about what happens) can be symptoms that go along with fatigue. Fatigue can be a normal and important response to physical activity, emotional stress, boredom, or lack of sleep. Fatigue is a common symptom, and it is usually not due to a serious disease. But it can be a sign of a more serious mental or physical condition. When fatigue is not relieved by enough sleep, good nutrition, or a low-stress environment, it should be evaluated by your doctor.
Environment Researchers suspect environmental factors may increase the risk of developing lupus. For example, exposure to sun can cause a lupus rash and some systemic lupus activity, says Stacy Ardoin, MD, a rheumatologist at the Ohio State University Wexner Medical Center in Columbus. Other environmental factors that may contribute to lupus can include some drugs, viral infections, exhaustion, stress, and anything that can cause physical stress to the body (such as surgery, physical harm, injury, pregnancy, or giving birth).
Repair. It’s essential to provide the nutrients necessary to help the gut repair itself. My most comprehensive weapon against leaky gut is Leaky Gut Revive™ powder, which contains powerful gut-repairing ingredients l-glutamine, aloe, deglycyrrhizinated licorice, arabinogalactan, slippery elm and marshmallow root. With these ingredients, Leaky Gut Revive™ nourishes and soothes your gut cells, restores your gut’s natural mucosal lining, and maximizes gut-mending fatty acid production. Another one of my favorite supplements is collagen, which is rich in amino acids that quite literally, “seal the leaks” or perforations in your gut by repairing damaged cells and building new tissue.
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.
Since a large percentage of people with SLE have varying amounts of chronic pain, stronger prescription analgesics (painkillers) may be used if over-the-counter drugs (mainly nonsteroidal anti-inflammatory drugs) do not provide effective relief. Potent NSAIDs such as indomethacin and diclofenac are relatively contraindicated for people with SLE because they increase the risk of kidney failure and heart failure.
This screening test is used to detect substances or cellular material in the urine associated with metabolic and kidney disorders. It's a routine test, and doctors utilize it to detect abnormalities that often appear before patients suspect a problem. For those with acute or chronic conditions, regular urinalysis can help monitor organ function, status, and response to treatment. A higher number of red blood cells or a higher protein level in your urine may indicate that lupus has affected your kidneys.
Gene regulation is the process of turning genes on and off. During early development, cells begin to take on specific functions. Gene regulation ensures that the appropriate genes are expressed at the proper times. Gene regulation can also help an organism respond to its environment. Gene regulation is accomplished by a variety of mechanisms including chemically modifying genes and using regulatory proteins to turn genes on or off.
Anyone can have lupus. More than 90 percent of people living with lupus are women between the ages of 15 and 45. African-American, Hispanic, Asian and Native American women are at greater risk of developing lupus than white women. In particular, African-American women are three times more likely to get lupus than white women. Men, who make up 10 percent of lupus patients, often develop the disease before puberty and after the age of 50.
Aggrecan is a type of protein known as a proteoglycan, which means it has several sugar molecules attached to it. It is the most abundant proteoglycan in cartilage, a tough, flexible tissue that makes up much of the skeleton during early development. Most cartilage is later converted to bone (a process called ossification), except for the cartilage that continues to cover and protect the ends of bones and is present in the nose, airways, and external ears. Aggrecan attaches to the other components of cartilage, organizing the network of molecules that gives cartilage its strength. These interactions occur at a specific region of the aggrecan protein called the C-type lectin domain (CLD). Because of the attached sugars, aggrecan attracts water molecules and gives cartilage its gel-like structure. This feature enables the cartilage to resist compression, protecting bones and joints. Although its role is unclear, aggrecan affects bone development.
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.
It can be very scary to receive a lupus diagnosis, have your life disrupted and cause you to become uncertain about the future. The good news is that strides are continually being made in the discovery of better diagnostic tools and more effective medications. With the combination of correct treatment, medication, and living a healthy lifestyle, many people with lupus can look forward to a leading a long and productive life.
The most commonly sought medical attention is for joint pain, with the small joints of the hand and wrist usually affected, although all joints are at risk. More than 90 percent of those affected will experience joint or muscle pain at some time during the course of their illness. Unlike rheumatoid arthritis, lupus arthritis is less disabling and usually does not cause severe destruction of the joints. Fewer than ten percent of people with lupus arthritis will develop deformities of the hands and feet. People with SLE are at particular risk of developing osteoarticular tuberculosis.
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:
While SLE can occur in both males and females, it is found far more often in women, and the symptoms associated with each sex are different. Females tend to have a greater number of relapses, a low white blood cell count, more arthritis, Raynaud's phenomenon, and psychiatric symptoms. Males tend to have more seizures, kidney disease, serositis (inflammation of tissues lining the lungs and heart), skin problems, and peripheral neuropathy.
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.
Next, a doctor will usually prescribe a corticosteroid such as prednisone, which has a variety of unpleasant and dangerous side effects. Long term prednisone therapy can cause muscle wasting and osteoporosis, and those side effects require additional monitoring and medication. If the steroids stop controlling the symptoms, then a host of other serious medications are prescribed that either modulate or suppress the immune system as a whole. Plaquenil and belimumab (Benlysta) are some of the drugs used, and they have very harsh side effects including hair loss, muscle atrophy, blood disorders and increased susceptibility to infections.
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.
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.
One food for people with lupus to avoid is alfalfa. Alfalfa tablets have been associated with reports of a lupus-like syndrome or lupus flares. The lupus-like effects may include muscle pain, fatigue, abnormal blood test results, changes in how the immune system functions, and kidney problems. These reactions may be due to the amino acid L-canavanine (found in alfalfa seeds and sprouts, but not in leaves), which can activate the immune system and increase inflammation.
All of the energy and material transformations that occur within living cells. It includes material changes undergone by substances during all periods of life (growth, maturity, and senescence) and energy changes (transformations of chemical energy of foodstuffs to mechanical energy or heat). Metabolism involves the two fundamental processes of anabolism and catabolism.
Other drugs used to treat lupus include the antimalarial drug hydroxychloroquine, which modulates the immune system, and belimumab, a targeted drug that is a biologic (meaning it’s made from natural sources). Some chemotherapy drugs and anti-rejection drugs may be used, too, to treat patients with lupus nephritis or other organ problems, says Caricchio.
Systemic lupus erythematosus is a multisystem inflammatory disease that is often difficult to diagnose. Before the diagnosis can be established, four of 11 clinical and laboratory criteria must be met. Antinuclear antibody titer is the primary laboratory test used to diagnose systemic lupus erythematosus. Because of the low prevalence of the disease in primary care populations, the antinuclear antibody titer has a low predictive value in patients without typical clinical symptoms. Therefore, as specified by the American College of Rheumatology, this titer should be obtained only in patients with unexplained involvement of two or more organ systems. Pa tients with an antinuclear antibody titer of 1:40 and characteristic multiorgan system involvement can be diagnosed with systemic lupus erythematosus without additional testing; however, patients with an antibody titer of 1:40 who fail to meet full clinical criteria should undergo additional testing, including tests for antibody to doublestranded DNA antigen and antibody to Sm nuclear antigen. While an antinuclear antibody titer of less than 1:40 usually rules out systemic lupus erythematosus, patients with persistent, characteristic multisystem involvement may be evaluated for possible antinuclear antibody–negative disease.
The mechanism by which foreign antigens are taken into antigen-presenting cells (APCs) and broken up. Part of the antigen is then displayed (presented) on the surface of the APC next to a histocompatibility or self-antigen, activating T lymphocytes and cell-mediated immunity. T lymphocytes are unable to recognize or respond to most antigens without APC assistance.
The doctor who caused you distress and probably confusion about your situation sounds bipolar. He probably experienced the episode when walking through the door. The basic human instinct is fight or flight when entering a new environment and he seems to have been confused by it. Also maybe he had a patient or personal experience that affected him deeply, this has nothing to do with you or your situation. My wife went through the same unnecessary experience more than once.
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Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), may be used to treat pain, swelling and fever associated with lupus. Stronger NSAIDs are available by prescription. Side effects of NSAIDs include stomach bleeding, kidney problems and an increased risk of heart problems.
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