The GRADE approach was followed in the process (http://www.gradeworkinggroup.org) answering the clinical questions voted most relevant by the panel. The description of the methodology followed to develop these guidelines has already been published.29 All authors listed in this manuscript have participated in planning, drafting, reviewing, final approval and are accountable for all aspects of the manuscript. No ethical approval was required by institutions. We present the final recommendations and their supporting information. Comments from three patients with SLE were also considered.
A. A healthy, young patient of mine once asked me what the chances were that she might one day develop a "terrible disease." When I asked her what she meant by "terrible disease," she surprised me: she didn't say a disease that could be fatal, but rather a disease that could attack every part of her body. By that definition, systemic lupus erythematosus (lupus for short) is, indeed, a terrible disease.
From the time we are kiddos, we are told that we should exercise and eat right in order to grow up big and strong, right? Well instead, we spent many-a-weeknight-dinners pushing around the peas and other veggies lying ominously on our plates, in the hopes that they will magically disappear, or hiding them under the mashed potatoes to make it look so. Then, making those stink faces at our parents, when we hear that we are having fish for dinner (unless, of course, its the breaded and fried unidentifiable kind.) As we grew, many of us -but not all of us- have had taste buds and/or common sense that grew and matured simultaneously with our bodies. We have since learned to like, perhaps even love our veggies and those little fishies we once abhorred. For others… not so much. Back to top
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.
If this disorder is suspected in people, brain scans are usually required for early detection. These scans can show localized areas of the brain where blood supply has not been adequate. The treatment plan for these people requires anticoagulation. Often, low-dose aspirin is prescribed for this purpose, although for cases involving thrombosis anticoagulants such as warfarin are used.
Rate of SLE varies between countries from 20 to 70 per 100,000. Women of childbearing age are affected about nine times more often than men. While it most commonly begins between the ages of 15 and 45, a wide range of ages can be affected. Those of African, Caribbean, and Chinese descent are at higher risk than white people. Rates of disease in the developing world are unclear. Lupus is Latin for "wolf": the disease was so-named in the 13th century as the rash was thought to appear like a wolf's bite.
As with all autoimmune conditions, lupus is a disease of the immune system. Your immune system has a very sophisticated mechanism for keeping you safe that it uses to identify the foreign substances that you come into contact with every day, such as allergens, toxins, infections, and even food. If your immune system deems anything dangerous, it will produce antibodies to ward off the harmful intruders.
A general, imprecise, colloquial, and somewhat old-fashioned term for acute and chronic conditions marked by inflammation, muscle soreness and stiffness, and pain in joints and associated structures. It includes inflammatory arthritis (infectious, rheumatoid, gouty), arthritis due to rheumatic fever or trauma, degenerative joint disease, neurogenic arthropathy, hydroarthrosis, myositis, bursitis, and fibromyalgia.
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."
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 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.
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 group of people who review, approve, and monitor the clinical study protocol. Their role is to protect the rights and welfare of human research subjects participating in a study. The group typically includes people with varying backgrounds, including a community member, to make sure that research activities conducted by an organization are completely and adequately reviewed. Also known as an institutional review board (IRB) or ethics committee.
As many as 70% of people with lupus have some skin symptoms. The three main categories of lesions are chronic cutaneous (discoid) lupus, subacute cutaneous lupus, and acute cutaneous lupus. People with discoid lupus may exhibit thick, red scaly patches on the skin. Similarly, subacute cutaneous lupus manifests as red, scaly patches of skin but with distinct edges. Acute cutaneous lupus manifests as a rash. Some have the classic malar rash (or butterfly rash) associated with the disease. This rash occurs in 30 to 60% of people with SLE.
Below you will find that list, accompanied by questions created by the LFA to help individuals determine whether they should contact a healthcare professional to discuss the potential for having lupus. The LFA suggests discussing the possibility with a doctor if you answer “yes” to more than three of the questions, from your present and past health history.
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.
Neuropsychiatric syndromes can result when SLE affects the central or peripheral nervous system. The American College of Rheumatology defines 19 neuropsychiatric syndromes in systemic lupus erythematosus. The diagnosis of neuropsychiatric syndromes concurrent with SLE (now termed as NPSLE), is one of the most difficult challenges in medicine, because it can involve so many different patterns of symptoms, some of which may be mistaken for signs of infectious disease or stroke.
Of note, problems faced by Latin American countries are shared by several developing nations. Therefore, it is expected that these guidelines will also be very useful for them. Furthermore, due to ever increasing globalisation and the increase of migratory movements of people from countries with more susceptible SLE groups in terms of frequency and disease severity both in terms of race/ethnicity (Mestizos, Asians, Africans) and low SES to countries with better life opportunities, we consider that these guidelines may be used by physicians anywhere in the world, even in developed countries, where such individuals may migrate to and seek care for their lupus.
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.
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.”
Corticosteroids. Prednisone and other types of corticosteroids can counter the inflammation of lupus. High doses of steroids such as methylprednisolone (A-Methapred, Medrol) are often used to control serious disease that involves the kidneys and brain. Side effects include weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and longer term therapy.
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.
Copyright © livehopelupus.org