Immunoglobulins are formed by light and heavy (depending on molecular weight) chains of polypeptides made up of about 100 amino acids. These chains determine the structure of antigen-binding sites and, therefore, the specificity of the antibody to one antigen. The five types of immunoglobulins (IgA, IgD, IgE, IgG, IgM) account for approximately 30% of all plasma proteins. Antibodies are one of the three classes of globulins (plasma proteins) in the blood that contribute to maintaining colloidal oncotic pressure.
Tingible body macrophages (TBMs) – large phagocytic cells in the germinal centers of secondary lymph nodes – express CD68 protein. These cells normally engulf B cells that have undergone apoptosis after somatic hypermutation. In some people with SLE, significantly fewer TBMs can be found, and these cells rarely contain material from apoptotic B cells. Also, uningested apoptotic nuclei can be found outside of TBMs. This material may present a threat to the tolerization of B cells and T cells. Dendritic cells in the germinal center may endocytose such antigenic material and present it to T cells, activating them. Also, apoptotic chromatin and nuclei may attach to the surfaces of follicular dendritic cells and make this material available for activating other B cells that may have randomly acquired self-specificity through somatic hypermutation. Necrosis, a pro-inflammatory form of cell death, is increased in T lymphocytes, due to mitochondrial dysfunction, oxidative stress, and depletion of ATP.
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.
You may need to see different kinds of doctors to treat the many symptoms of lupus. Once you’re diagnosed, your primary physician for lupus is usually a rheumatologist, who treats arthritis and other diseases that cause swelling in the joints. The rheumatologist may then send you to a clinical immunologist for treating immune system disorders; a nephrologist (kidney disease); a hematologist (blood disorders); a dermatologist (skin diseases); a neurologist (the nervous system); a cardiologist (heart and blood vessel problems), and an endocrinologist (glands and hormones).
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.
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.
Lupus affects people in many different ways, so there is not one diet which is guaranteed to work for everyone, but the Mediterranean diet (plenty of fruit and vegetables, grains, nuts and seeds, two portions of fish per week and small amounts of meat and dairy produce) is probably the simplest one to follow and is suitable for all the family as it is a pattern of healthy eating.
No single finding qualifies an individual as having SLE. Instead, the American College of Rheumatology (ACR) has devised certain classification criteria, and four or more of these criteria must be present for a classification of lupus. [The term “classification” is not synonymous with “diagnosis.” “Classification” means that reasonable certainty exists for the diagnosis of lupus for research purposes.] Although, these criteria are currently being updated, they are believed to be about 90% effective. The ACR criteria include malar rash; discoid rash; photosensitivity (development of a rash after sun exposure); oral or nasal ulcers; arthritis of multiple joints; serositis: (inflammation of the lining around the lungs or heart); kidney disease indicated by protein or casts in the urine; neurological disorders such as seizures and psychosis; and blood disorders such as hemolytic anemia, leukopenia, and lymphopenia. Other signs that are common but not included in the classification criteria are hair loss or breaking, especially around the forehead, and Raynaud’s Phenomenon, a two- or three-color change of the fingertips upon cold exposure.
Most people with lupus have symptoms in only a few organs. If you have not already been diagnosed, the following table may alert you to the possibility of lupus. If you have already been diagnosed, these symptoms may indicate increased activity of the disease, known as a "flare." You may also have periods of remission when few or no symptoms are present. For most people, lupus can be managed and will affect only a few organs. Others may face serious, sometimes life-threatening problems.
Granulocytes and monocytes, collectively called myeloid cells, are differentiated descendants from common progenitors derived from hematopoietic stem cells in the bone marrow. Commitment to either lineage of myeloid cells is controlled by distinct transcription factors followed by terminal differentiation in response to specific colony-stimulating factors and release into the circulation. Upon pathogen invasion, myeloid cells are rapidly recruited into local tissues via various chemokine receptors, where they are activated for phagocytosis as well as secretion of inflammatory cytokines, thereby playing major roles in innate immunity.
Disease that results when the immune system mistakenly attacks the body’s own tissues. Examples include multiple sclerosis, type 1 diabetes, rheumatoid arthritis, and systemic lupus erythematosus. Autoimmune diseases can affect almost any part of the body, including the heart, brain, nerves, muscles, skin, eyes, joints, lungs, kidneys, glands, the digestive tract, and blood vessels. The classic sign of an autoimmune disease is inflammation, which can cause redness, heat, pain, and swelling.
Hormonal mechanisms could explain the increased incidence of SLE in females. The onset of SLE could be attributed to the elevated hydroxylation of estrogen and the abnormally decreased levels of androgens in females. In addition, differences in GnRH signalling have also shown to contribute to the onset of SLE. While females are more likely to relapse than males, the intensity of these relapses is the same for both sexes.
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.
A biopsy is a procedure that removes a small piece of living tissue from your body. The tissue is examined with a microscope for signs of damage or disease. Biopsies can be done on all parts of the body. A biopsy is the only test that can tell for sure if a suspicious area is cancer. But biopsies are performed for many other reasons too. There are different ways to do a biopsy. A needle biopsy removes tissue with a needle passed through your skin to the site of the problem. Other kinds of biopsies require surgery.
Mercury is toxic to our bodies and can be one piece of the puzzle for those with lupus and other chronic illnesses such as chronic fatigue syndrome, other autoimmune diseases, neurological disorders, and cancer. Mercury overload is far more common than many people think. We’re exposed to mercury in our air and water, the fish we eat, amalgam fillings, cosmetics, and vaccines. I recommend heavy metal testing for all of my patients with autoimmunity, using a pre- and post-DMPS urine challenge test. I also recommend that anyone with mercury amalgam fillings find a biological dentist and have them removed.
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.
Preventive measures are necessary to minimize the risks of steroid-induced osteoporosis and accelerated atherosclerotic disease.  The American College of Rheumatology (ACR) Guidelines for the prevention of glucocorticoid-induced osteoporosis suggest the use of traditional measures (eg, calcium, vitamin D) and the consideration of prophylactic bisphosphonate therapy.
Any of the plasma proteins whose concentration increases or decreases by at least 25% during inflammation. Acute-phase proteins include C-reactive protein, several complement and coagulation factors, transport proteins, amyloid, and antiprotease enzymes. They help mediate both positive and negative effects of acute and chronic inflammation, including chemotaxis, phagocytosis, protection against oxygen radicals, and tissue repair. In clinical medicine the erythrocyte sedimentation rate or serum C-reactive protein level sometimes is used as a marker of increased amounts of acute-phase proteins.
SLE can also flare during or after pregnancy. Whether flares of SLE are more frequent during pregnancy is controversial. The flares do not seem to be exceedingly more serious than those in nonpregnant patients, although pregnancy outcomes are generally more likely to be complicated. Increased rates of hypertension during pregnancy, premature delivery, unplanned cesarean delivery, postpartum hemorrhage, and maternal venous thromboembolism are all more frequent in women with SLE.
Scientists have suspected for years that infections from bacteria, viruses, and other toxins were likely to blame for the development of conditions like lupus. And while they have not been able to identify one single culprit, they have found strong correlations with a number of bacteria and viruses. For example, the Epstein-Barr virus (EBV) has been shown to trigger lupus in some individuals.4
Contraception and family planning are important considerations given the risks of disease flare with exogenous estrogens and pregnancy and with the teratogenic risks of some SLE drugs. Estrogen therapies have typically been avoided to prevent disease flares; progesterone-only contraception is more often considered.  However, studies have suggested that oral estrogen-containing contraceptives may not be associated with disease flares or thrombosis risk in patients with mild lupus without antiphospholipid antibodies. [52, 145]
And it’s important to point out that people who are initially diagnosed with systemic lupus (or SLE) can also get lupus rashes. One of the common rashes that occurs in people with systemic lupus is malar rash. It’s alternatively called a butterfly rash, and it spreads across the bridge of the nose and cheeks and is telltale sign of the disease because its appearance is so distinctive, Caricchio says. A malar rash can be flat or raised. While it usually isn’t painful, it can itch and burn. (3) And the rash can show up on other parts of the body, including the arms, legs, and torso.
Inflammation of the pleurae known as pleurisy can rarely give rise to shrinking lung syndrome. SLE can cause pleuritic pain and also give rise to shrinking lung syndrome, involving a reduced lung volume. Other associated lung conditions include pneumonitis, chronic diffuse interstitial lung disease, pulmonary hypertension, pulmonary emboli, and pulmonary hemorrhage.
Autoantibodies directed against various nuclear antigens including DAutoantibodies directed against various nuclear antigens including DNA, RNA, histones, acidic nuclear proteins, or complexes of these molecular elements. Antinuclear antibodies are found in systemic autoimmune diseases including systemic lupus erythematosus, Sjogren’s syndrome, scleroderma, polymyositis, and mixed connective tissue disease. Autoantibodies directed against various nuclear antigens including DNA, RNA, histones, acidic nuclear proteins, or complexes of these molecular elements. Antinuclear antibodies are found in systemic autoimmune diseases including systemic lupus erythematosus, Sjogren’s syndrome, scleroderma, polymyositis, and mixed connective tissue disease.
Once a lupus diagnosis has been confirmed by your physician, you will have many questions. Here is a quick list of questions to help you get started in getting the necessary information in order to have a better understanding of your specific symptoms and move forward towards the most successful course of treatment and/or management of the disease. It may also be helpful to have an advocate along with you like a friend or loved one to help you remember important details:
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.
Corticosteroids are more potent than NSAIDs in reducing inflammation and restoring function when the disease is active. Corticosteroids are particularly helpful when internal organs are affected. Corticosteroids can be given by mouth, injected directly into the joints and other tissues, or administered intravenously. Unfortunately, corticosteroids have serious side effects when given in high doses over prolonged periods, and the doctor will try to monitor the activity of the disease in order to use the lowest doses that are safe. Side effects of corticosteroids include weight gain, thinning of the bones and skin, infection, diabetes, facial puffiness, cataracts, and death (necrosis) of the tissues in large joints.
Describes a clinical trial in which two or more groups of participants receive different interventions. For example, a two-arm parallel design involves two groups of participants. One group receives drug A, and the other group receives drug B. So during the trial, participants in one group receive drug A “in parallel” to participants in the other group receiving drug B.
Micrograph of a section of human skin prepared for direct immunofluorescence using an anti-IgG antibody. The skin is from a person with systemic lupus erythematosus and shows IgG deposits at two different places. The first is a bandlike deposit along the epidermal basement membrane ("lupus band test" is positive); the second is within the nuclei of the epidermal cells (antinuclear antibodies are present).
Proteinuria (also called albuminuria or urine albumin) is a condition in which urine contains an abnormal amount of protein. Albumin is the main protein in the blood. Proteins are the building blocks for all body parts, including muscles, bones, hair, and nails. Proteins in the blood also perform a number of important functions. They protect the body from infection, help blood clot, and keep the right amount of fluid circulating throughout the body.
Avoid calcium supplements, however, which Johns Hopkins researchers have found to potentially increase the risk of heart damage and arterial plaque buildup. “Due to the risk of accelerated atherosclerosis in lupus, we no longer recommend calcium supplementation and encourage a diet rich in calcium instead,” noted George Stojan, MD, a rheumatologist and assistant professor of medicine at Johns Hopkins.
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
Aseptic meningitis is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord known as the meninges. Unlike other forms of meningitis, aseptic meningitis is not caused by infection and cannot be spread person-to-person. Instead it can be caused by lupus, cancers, certain drugs, head injury, and brain surgery, among others. Meningitis is characterized by a sudden onset of fever, headache, and stiff neck. It is often accompanied by other symptoms, such as nausea, vomiting, photophobia (sensitivity to light), and altered mental status (confusion).
Landmark research has shown clearly that oral contraceptives do not increase the rate of flares of systemic lupus erythematosus. This important finding is opposite to what has been thought for years. Now we can reassure women with lupus that if they take birth-control pills, they are not increasing their risk for lupus flares. Note: Birth-control pills or any estrogen medications are still be avoided by women who are at increased risk of blood clotting, such as women with lupus who have phospholipid antibodies (including cardiolipin antibody and lupus anticoagulant).
Lupus is a serious disease that can affect anyone. It is most often diagnosed in young women, between the ages of 15 and 44. While the cause is not known, lupus is an autoimmune disease – in which your immune system attacks healthy cells by mistake – that can potentially damage many parts of the body. There is no known cure for lupus, though effective treatments are available.
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.
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