Systemic Lupus Erythematosus
   

Systemic Lupus Erythematosus
Also Listed As:  Lupus
 
Signs and Symptoms
What Causes It?
Who's Most At Risk?
What to Expect at Your Provider's Office
Treatment Options
Prevention
Treatment Plan
Drug Therapies
Surgical and Other Procedures
Complementary and Alternative Therapies
Prognosis/Possible Complications
Following Up
Supporting Research

Systemic lupus erythematosus (SLE) is the most common form of lupus. Lupus is an autoimmune disease—a disorder in which the body harms its own healthy cells and tissues. This leads to inflammation and damage of body tissues in the joints, skin, kidneys, heart, lungs, blood vessels, and/or the brain. Lupus is also considered a rheumatic disease because it can cause aches, pain, and stiffness in the joints, muscles, and bones.

Lupus usually first affects people between the ages of 15 and 45 years, but it can also occur in childhood or later in life. Patients experience periods of chronic disease and remission. The prevalence of the disease is not precisely known, ranging from an estimated 15 to 50 cases per 100,000 people.


Signs and Symptoms

Lupus is often accompanied by the following signs and symptoms.

  • Extreme fatigue
  • Painful or swollen joints (arthritis)
  • Muscle pain and stiffness
  • Unexplained fever
  • Skin rashes
  • Kidney problems
  • Hair loss
  • Nausea, vomiting, abdominal pain
  • Headaches, migraine, seizures, stroke
  • Depression, anxiety, confusion
  • Photosensitivity (sensitivity to sunlight)

What Causes It?

The cause of lupus is unknown. Researchers believe that there is probably no single cause but rather a combination of genetic, environmental, and possibly hormonal factors that work together.


Who's Most At Risk?

The following categories of people are at higher than average risk for lupus.

  • Many more women than men have lupus.
  • Lupus is more common in black women and women of Hispanic, Asian, and Native American descent than in white women.
  • Lupus can run in families, but the risk that a child or a brother or sister of a patient also will have lupus is quite low.

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with lupus, you should see your health care provider. A team of specialists usually becomes involved in making a diagnosis and determining which treatment or combination of therapies will work best for you. Because lupus is so complex, reaching a diagnosis may take time and occurs gradually as new symptoms appear.

A diagnosis of lupus is based on a physical examination and the results of laboratory tests, including the following.

  • Complete blood count
  • Erythrocyte sedimentation rate (ESR)—an elevated ESR indicates inflammation in the body
  • Urinalysis
  • Blood chemistries
  • Complement test (a blood test that measures severity of infection)
  • Antinuclear antibody test (ANA)—positive in most lupus patients; other antibody tests
  • Syphilis test (may be falsely positive in people with lupus)
  • Skin or kidney biopsy

Imaging techniques may be used to evaluate central nervous system changes or problems and other symptoms associated with lupus.


Treatment Options
Prevention

While lupus itself cannot be prevented, there are ways to prevent flare-ups. These include the following.

  • Avoiding sun exposure, high-dose birth control pills, penicillin, and sulfonamides (anti-bacterial agents)
  • Exercising regularly
  • Receiving flu and pneumococcal vaccines

Treatment Plan

There is no known cure for lupus. However, your team of health care professionals can develop a treatment plan to prevent flare-ups, to treat them when they do occur, and to minimize complications.


Drug Therapies

Your health care provider may prescribe the following medications.

  • Corticosteroid hormones, to rapidly suppress inflammation. For patients who cannot take corticosteroids, a type of immunosuppressive drug called methotrexate may be used.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), to control pain, swelling, and fever
  • Antimalarials, to treat fatigue, joint pain, skin rashes, and inflammation of the lungs, and to prevent flare-ups from recurring.
  • Immunosuppressives, which restrain the overactive immune system by blocking the production of some immune cells and curbing the action of others.
  • Intravenous gamma globulin, a blood protein that increases immunity, helps fight infection, and controls acute bleeding

Surgical and Other Procedures

Surgery is sometimes performed for lupus-related ailments.


Complementary and Alternative Therapies

A comprehensive treatment plan for lupus may include a range of complementary and alternative therapies.


Nutrition

Nutritional tips for patients with lupus include the following.

  • Eliminate all suspected allergens, including dairy, wheat (gluten), soy, chocolate, eggs, corn, and preservatives; avoid alfalfa sprouts. Your provider may want to test for food sensitivities.
  • A modified fast of five to seven days at two-week intervals may be helpful, especially during flare-ups. A modified fast can consist of eating fruits, vegetables, and fish or vegetable protein.
  • Avoid coffee, alcohol, and smoking.
  • Minimize red meat and saturated fats to decrease inflammation.

Potentially beneficial nutrient supplements include the following.

  • Omega-3 fatty acids such as flaxseed and fish oils decrease inflammation.
  • Beta-carotene (50 mg three times a day), although some controversy exists about the use of vitamin A. Check with your health care provider before using.
  • Vitamin B12 (1,000 mcg via injection once or twice a week) to heal lesions.
  • Vitamin E (800 IU per day)
  • Hydrochloric acid to decrease symptoms.
  • DHEA (start at 5 mg three times a day and work up to 100 mg per day) to reduce symptoms in mild to moderate lupus, with incremental benefits over three to twelve months. Note: Tryptophan should be avoided in patients with SLE-type lupus.
  • Melatonin (20 mg before bed) has been shown to be helpful in many autoimmune diseases. Take a lower dose if drowsiness occurs.
  • Methylsulfonylmethane (MSM) (3,000 mg twice a day) helps prevent joint and connective tissue breakdown.
  • Iron can increase inflammation. Avoid it unless you are anemic (have low red blood cells).

Herbs

Mix dandelion (Taraxacum officinale), yellowdock (Rumex crispus), echinacea (Echinacea purpurea), and garlic (Allium sativum) equal parts in a tea, 1 cup three times daily. Herbs may be useful for treating lupus, as well as secondary symptoms, such as depression and insomnia.


Homeopathy

An experienced homeopath can prescribe a regimen for treating lupus that is designed especially for you. Some of the most common acute remedies are listed below.

  • Arsenicum album for restless exhaustion
  • Calcarea carbonica for overworked, overwhelmed people with poor stamina and low back pain
  • Nux vomica for irritability with constipation and sharp, cramp-like pains
  • Tuberculinum for repeated chest infections and joint pain with swollen glands

Acute dose is three to five pellets of 12X to 30C every one to four hours until symptoms are relieved.


Acupuncture

Acupuncture may help balance immune response during remissions, and alleviate flare-ups.


Prognosis/Possible Complications

The prognosis for lupus patients is mixed. Half of lupus patients who go into remission remain so for decades, but 90 percent of patients have complications. For women, symptoms tend to decrease after menopause. Ninety percent of patients have a survival rate of 10 years, and 63 to 75 percent have a survival rate of 20 years. Patients with certain complications from lupus tend to have a poor prognosis. The major cause of lupus-related death is infection.


Following Up

Patients need to be closely monitored during flare-ups to determine the appropriate course of treatment and induce remission.


Supporting Research

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:278.

Cecil R, ed. Cecil Textbook of Medicine. 20th ed. Philadelphia, Pa: W.B. Saunders; 1996.

Dambro MR. Griffith's 5-Minute Clinical Consult. 1999 ed. Baltimore, Md: Lippincott Williams & Wilkins, Inc.; 1999.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

Koopman WJ, ed. Arthritis and Allied Conditions. 13th ed. Baltimore, Md: Williams & Wilkins, Inc.; 1997.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:39-44, 82-87, 272-276, 390-392.

Val Vollenhoven RD, Engleman, EG, McGuire JL. An open study of dehydroepiandrosterone in systemic lupus erythematosus. Arthritis Rheumatol. 1994;37:1305-1310.

Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing Inc;1987:292-296.


Review Date: March 2000
Reviewed By: Participants in the review process include: Shiva Barton, ND, Wellspace, Cambridge, MA; Peter Hinderberger, MD, PhD, Ruscombe Mansion Community Health Center, Baltimore, MD; Lonnie Lee, MD, Internal Medicine, Silver Springs, MD.

Copyright © 2004 A.D.A.M., Inc

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

 
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