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... leven criteria are closely related to the symptoms discussed above. Some patients suspected of having systemic lupus may never develop enough criteria for a definite diagnosis. Other patients accumulate enough criteria only after months or years of observation. When a person has four or more of these criteria, the diagnosis of systemic lupus erythematosus is suggested. The eleven criteria used for diagnosing systemic lupus erythematosus are: malar (over the cheeks of the face) "butterfly" rash discoid skin rash: patchy redness that can cause scarring photosensitivity: skin rash in reaction to sunlight exposure mucus membrane ulcers: ulceration of the lining of the mouth, nose or throat arthritis: 2 or more swollen, tender joints of the extremities pleuritic / pericarditis : inflammation of the lining tissue around the heart or lungs, usually associated with chest pain with breathing kidney abnormalities: abnormal amounts of urine protein or cellular elements brain irritation: manifested by seizures (convulsions) and / or psychosis blood count abnormalities: low counts of white or red blood cells, or platelets immunologic disorder: abnormal immune tests include anti-DNA or anti-Sm (Smith) antibodies, or positive LE prep test antinuclear antibody: positive ANA antibody testing In addition to the eleven criteria, other tests can be helpful in evaluating patients with systemic lupus to determine the severity of organ involvement.
These include routine testing of the blood to detect inflammation (for example, a test called "sedimentation rate"), blood chemistry testing, direct analysis of internal body fluids, and tissue biopsies. Abnormalities in body fluids and tissue samples (kidney, skin, and nerve biopsies) can further support the diagnosis of systemic lupus erythematosus. The appropriate test procedures are selected for the patient individually by the doctor. There is no permanent cure for systemic lupus.
The goal of treatment is to relieve symptoms by decreasing inflammation and / or the level of autoimmune activity in the body. Many patients with mild symptoms may need no treatment or only intermittent courses of anti inflammatory medications. Those with more serious illness involving damage to internal organ (s) may require high doses of symptoms by decreasing inflammation and / or the level of autoimmune activity in the body. Patients with systemic lupus need more rest during periods of active disease. During these periods, carefully prescribed exercise is still important to maintain muscle tone and range of motion in the joints. Nonsteroidal anti inflammatory drugs (NSAIDs) are helpful in reducing inflammation and pain in muscles, joints, and other tissues.
Examples of NSAIDs include aspirin, ibuprofen (MOTRIN), naproxen (NAPROSYN), and sulindac (CLINORIL). Since the individual response to NSAIDs varies among patients, it is common for a doctor to try different NSAIDs to find the most effective one with the fewest side effects for the patient. The most common side effects are stomach upset, abdominal pain, ulcers, and even ulcer bleeding. NSAIDs are usually taken with food to reduce side effects. Sometimes, anti-ulcer medications, such as CYTOTEC, are given simultaneously.
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 involved. 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. Side effects of corticosteroids include weight gain thinning of the bones and skin, infection, diabetes, facial puffiness, cataracts, and death (necrosis) of large joints.
Hydroxychloroquine (PLAQUENIL) is an antimalarial medication found to be particularly effective for lupus patients with fatigue, skin, and joint diseases. Side effects include diarrhea, upset stomach, and eye pigment changes. Eye pigment changes are rare but require monitoring by an ophthalmologist (eye specialist) during treatment with PLAQUENIL. Medications that suppress immunity (immunosuppressive medications) are also called cytotoxic drugs. Immunosuppressive medications are used for treating severe cases of systemic lupus with damage to internal organ (s). Examples include methotrexate (RHEUMATREX), azathioprine (IMURAN), cyclophosphamide (CYTOXAN), chlorambucil (LEUKERAN), and cyclosporine (SANDIMMUNE).
All immunosuppressive medications can seriously depress blood cell counts and increase risks of infection and bleeding. RHEUMATREX can cause liver toxicity, while SANDIMMUNE can impair kidney function. In systemic lupus patients with serious brain and kidney disease, plasm apheresis is sometimes used to remove antibodies and other immune substances from the blood to suppress immunity. Some systemic lupus patients can develop seriously low platelet levels, thereby increasing the risk of excessive and spontaneous bleeding. Since the spleen is believed to be the major site of platelet destruction, surgical removal of the spleen is sometimes performed to improve platelet levels. Other treatments have included the use of male hormones.
Systemic lupus is undoubtedly a potentially serious illness with numerous organ system involvements. However, it is important to recognize that most patients with systemic lupus lead full, active, healthy lives. Periodic increases in disease activity (flares) can usually be managed by varying medications. Since ultraviolet light can precipitate and worsen flares, patients with systemic lupus should avoid sun exposure. Sunscreens and clothing covering the extremities can be helpful. Abruptly stopping medications, especially corticosteroids, can also cause flares and should be avoided.
Patients with systemic lupus are at increased risk of infections, especially if they are taking corticosteroids or immunosuppressive medications. Therefore, any unexpected fevers should be reported and evaluated. Patients with systemic lupus who become pregnant are considered "high risk. " Lupus patients who are pregnant require close observation during pregnancy and delivery. These patients can have an increased risk of miscarriages (spontaneous abortions) and can have flares of the disease activity during pregnancy. Presence of cardiolipin antibodies in the blood can identify patients at risk for miscarriages. Cardiolipin antibodies are associated with a tendency toward blood clotting.
Patients with systemic lupus who have cardiolipin antibodies may need blood thinning medications during pregnancy to prevent miscarriages. Lupus antibodies can be transferred from the mother to the fetus and result in lupus illness in the newborn ("neonatal lupus"). Neonatal lupus usually clears within six months of birth as the mother's antibodies are slowly metabolized by the baby. The role of the immune system in causing diseases is becoming better understood by scientific research. This knowledge will be applied to design safer and more effective treatment methods. Overall the outlook for patients with systemic lupus is improving each decade with the development of more accurate monitoring tests and treatments.
Individuals with systemic lupus can improve their prognosis by learning about the many aspects of the illness as well as closely monitoring their own health with their doctors. Rogan WJ: Occupational and environmental health. In Arnold C (ed. ): Advances in Disease Prevention Vol. 1, pp. 272 - 298, 1981 Bibliography:
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Research essay sample on Systemic Lupus Lupus Erythematosus
