Lupus

Lupus is a chronic inflammatory disease that can affect various parts of the body, particularly the skin, joints, blood, and kidneys. The immune system normally makes proteins called antibodies to protect the body against bacteria, viruses, and other threatening invaders. These invaders are called antigens and the body responds to them by making antibodies that "attack" them. In an autoimmune disorder such as lupus, the immune system loses its ability to tell the difference between antigens and its own cells and tissues. As a result, it produces antibodies known as auto-antibodies, which produce immune complexes. These immune complexes build up in the tissues, causing inflammation, injury to tissues, and pain.

The most common form of lupus is systemic lupus erythematosus (SLE). This form of lupus can cause inflammation in the skin, muscles, joints, heart, lungs, kidneys, blood vessels and the nervous system. Joint and muscle pains are very common symptoms of systemic lupus erythematosus (SLE). In fact, 90 percent of people with lupus will experience joint and/or muscle pain at some time during the course of their illness.

When people mention lupus, they are usually referring to systemic lupus erythematosus (SLE). Another form of lupus, discoid lupus, affects only the skin. Discoid lupus produces a rash on the head, neck and scalp. Close to 10 percent of discoid lupus cases progress to systemic lupus erythematosus (SLE).

HOW COMMON IS LUPUS?

Lupus affects approximately one in 2,000 North Americans. Systemic lupus erythematosus (SLE) is approximately 8 to 10 times more common in women than in men. While lupus can affect men, women and children of any age, it most often occurs in women of childbearing age.

WHAT ARE THE WARNING SIGNS OF LUPUS?

Symptoms of lupus vary from person to person. In some people lupus disease will be mild with periods of activity or inflammation (flare-ups) and inactivity (remissions). Other people will experience lupus symptoms continuously, and the disease will worsen over time. Here are the most common lupus symptoms:

• Pain in the muscles and joints of the hands, arms, shoulders, feet, knees, hips or jaw. The pain may move from area to area and may cause swelling, heat or redness in the skin.
• Fever and loss of appetite.
• Low energy and fatigue.
• Skin rashes. A "butterfly rash" across the cheeks and bridge of the nose often signals lupus. A mild form of lupus called discoid lupus causes a red, scaly rash on the face, scalp, ears, arms or chest.
• Small, usually painless sores in the moist lining of the mouth or nose called mucosal ulcers.
• Sensitivity to sunlight.
• Changes in the colour of the fingers when they are cold.
• Sudden and unexplained weight loss or weight gain.
• Increase in the number and severity of headaches.
• Increase in loss of hair over the whole scalp.
• Chest pain when lying down or taking deep breaths
• Ongoing high blood pressure
• Swelling of the feet and legs

HOW DOES LUPUS PROGRESS?

Since lupus causes a wide variety of symptoms, and few people will experience exactly the same set of lupus symptoms, it may be difficult to diagnose. There is no single symptom, sign or test that will give a diagnosis of lupus. Your doctor will reach a diagnosis after thorough examination of the symptoms and test results. Early detection can lead to more effective lupus treatment.

If you have been diagnosed with lupus disease, it is important to understand that lupus is not, generally, a fatal disease. (This is a common misconception.) The prognosis for lupus is much better today than ever before. While medical science has not yet developed a cure for lupus, if you have the non-organ threatening variety of the disease, observing your doctor's treatment plan will enable you to enjoy a normal lifespan.

Although some people with lupus have severe recurrent attacks necessitating hospitalization, many lupus patients never have to be hospitalized. The progress made in treatment and diagnosis of lupus during the last decade has been greater than that made over the past 100 years.

If you have been diagnosed with lupus, the goal of your treatment plan will be to bring the lupus symptoms under control. Each person's pattern of lupus flare-ups tends to be unique but, with experience, a person with lupus should be able to detect the early warning signs.

Click here for lupus risk factors and wellness tips.

UNDERSTANDING LUPUS MEDICATIONS

If you have been diagnosed with lupus, your doctor or other healthcare practitioner will review the best course of lupus treatment. This will likely include medication. Here are the most commonly used medications for lupus, and how they work.

MEDICATIONS THAT CONTROL LUPUS SYMPTOMS

These include non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics (pain relievers). They help you to feel better by reducing the amount of discomfort that you experience but they do not inhibit the disease process itself. These formulations typically take a few days to a few weeks to control pain effectively.

• NSAIDs
  Pronounced "ensayds," these drugs help reduce pain and swelling in the joints while decreasing stiffness. When a low dose is taken, NSAIDs control pain, but higher doses are required to reduce inflammation. The problem with NSAIDs is their side effects. Taking more than one NSAID at a time increases the possibility of heartburn and severe side effects such as ulcers and bleeding. NSAIDs inhibit the blood's ability to clot properly and may therefore interact with blood-thinning medications such as coumadin. Kidney disease has also been reported as a side effect.
  
  Most NSAIDs require a prescription, including naproxen (Naprosyn®), nabumetone (Relafen®), indomethacin (Indocid®), diclofenac (Voltaren®), piroxicam (Feldene®) and sulindac (Clinoril®). Other NSAIDs are available over-the-counter; these include ASA (Aspirin®, Anacin® and others), and ibuprofen (Motrin IB®, Advil® and others.)
   
• COX-2 Inhibitors
  This sub-class of NSAID has recently been introduced to the North American marketplace. The most frequently prescribed Cox-2 inhibitors are celecoxib (Celebrex®), rofecoxib (Vioxx®), valdecoxib (Bextra®) and meloxicam (Mobicox®). Unlike standard NSAIDs, Cox-2 inhibitors do not inhibit proper blood clotting. Recent evidence, however, strongly suggests that Cox-2 inhibitors have the same degree of negative side effects as standard NSAIDs - including contributing to kidney failure - and may increase the risk of heart attack and other cardiovascular problems.
  
  *Important News Release September 2004
  Vioxx®, the cox-2 inhibitor made by Merck, has been pulled from the market because of severe lethal side effects due to heart attack and stroke.
   
• ACETAMINOPHEN
  Acetaminophen (Tylenol®, Panadol®, Exdol®, and others) is often prescribed to relieve mild to moderate joint pain. Acetaminophen is not an anti-inflammatory drug and may therefore usually be safely combined with an anti-inflammatory medication to relieve pain. (Please consult your doctor or other health care practitioner regarding medications that are appropriate for you.)
  
  While acetaminophen can bring relief for joint pain, it does not help the underlying cause of the condition. Overdosing can cause liver damage. (If you are taking acetaminophen on a regular basis to control pain, you should make sure that other over-the-counter medications such as cold and flu remedies do not contain enough acetaminophen to constitute an overdose.)
   
• CORTICOSTEROIDS
  Cortisone is a steroid that is naturally produced by the body. It reduces swelling and inflammation and can help regulate the immune system. Corticosteroids are man-made drugs that closely resemble cortisone but have a much more powerful effect on inflammation. The most common form of corticosteroid is called prednisone. Oral prednisone is usually considered when the symptoms of systemic lupus erythematosus (SLE) are not being controlled by other treatments, and there is concern about an imminent flare-up, or when the disease is severe and perhaps life threatening. Prednisone use needs to be carefully monitored because of its many side effects, and the drug must never be stopped abruptly.
  
  Side effects from long term use of corticosteroids may include cataracts, high blood pressure, sleep problems, muscle loss, bruising, thinning of the bones (osteoporosis and osteopenia), weight gain, immune suppression and increased susceptibility to infections. The goal with these drugs is to find the lowest effective dose that will avoid as many of the side effects as possible.
   
• ANTI-MALARIALS
  Anti-malarial medications help to manage the fatigue, skin rashes and joint pain associated with lupus. Chloroquine (Aralen®) and hydroxychloroquine (Plaquenil®) are examples of antimalarial medications. They may take several months to take effect.
  The most common side effect of anti-malarial medications is stomach upset. A more serious, although rare, side effect is loss of vision. This may occur if anti-malarials are taken in high doses over a long period of time. If you are prescribed an anti-malarial, you will probably be required to have an eye examination before starting the medication, and have regular follow-up eye examinations.
   
• CYTOTOXIC DRUGS
  Cytotoxic drugs are often prescribed to control inflammation by suppressing the immune system. For this reason, they are also known as immunosuppressive drugs. You may be prescribed these if your symptoms are difficult to control with prednisone alone or if you are experiencing side effects from prednisone. Cyclophosphamide (Cytoxan®), cyclophosphamide (Procytox®) and azathioprine (Imuran®) are commonly prescribed cytotoxic drugs.
  
  Serious side effects include decreased blood cell counts, increased risk of infection and a risk of developing certain types of cancer. If you have lupus and you are taking cytotoxic drugs, you should have regular blood tests and be monitored closely by your doctor or other health practitioner.

SUBSTANCES THAT IMPROVE QUALITY OF LIFE

• Nutricol®
  Nutricol®, available as Recovery® in many pharmacies and health retailers, is a food-based non-drug supplement produced to improve quality of life*.
  
  Nutricol® (Recovery®) may be safely combined with lupus drugs. Recovery® is designed to improve circulation and healing and to minimize damage, inflammation and spasm. It does not produce unpleasant side effects. Since Recovery® works to modify and improve your body's own responses, it may take up to three to five weeks for you to experience relief.
  
  Click here to see what health professionals are saying about results from Recovery® with Nutricol®.