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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Lupus Systemic Lupus Erythematosus

What is it?

Lupus, also known as systemic lupus erythematosus or SLE, is a persistent inflammation that may affect many organs throughout the body, including the skin and musculoskeletal, cardiovascular, renal, and neurological systems.Women are affected eight to 10 times more frequently than men. The precise cause of SLE is unknown. However, it is known that lupus is an autoimmune disorder: antibodies formed by the immune system attack some of the body's own cells. Inflammation typically occurs in the joints (arthritis), and inflammation of the skin may cause a characteristic butterfly rash on the face, as well as an increased sensitivity to the sun. Symptoms vary widely depending upon which organ systems are involved, and occur in a series of flare-ups or episodes separated by periods of normal or near-normal health. In severe cases SLE may lead to kidney or heart failure and can be fatal. However, SLE is often mild; many people never experience the most severe symptoms of the disease and, with treatment, are able to pursue a wide range of normal activities. An increased incidence of SLE is found among those of Asian or African descent and members of some Native American tribes. SLE usually develops between the ages of 15 and 35, although it may occur at any age. Currently, treatment is aimed at relieving the severity of episodes and limiting the progression of the disease.

What Causes It?

  • SLE is an autoimmune disorder, the exact underlying mechanisms of which remain unclear.
  • Hereditary factors and sex hormones appear to play a role.
  • Episodes may be triggered by ultraviolet radiation (as in sun exposure), infection, childbirth, abortion, or stress.
  • Many drugs, including hydralazine (an antihypertensive), procainamide (a drug used to treat heart rhythm disturbances), and chlorpromazine (a tranquilizer), and certain foods, such as alfalfa sprouts, may cause a temporary lupuslike illness in some people; the illness disappears when the medication or food is discontinued.
  • Some theories suggest that a virus may be responsible for the development of SLE.

Prevention

  • There is no known way to prevent SLE.

Diagnosis

  • Patient history and physical examination. Longterm observation may be necessary for definitive diagnosis, which requires the presence of at least four of the symptoms of SLE.
  • Blood tests for autoimmune antibodies, anemia, and decreased numbers of white blood cells and platelets.
  • Urine tests for excessive protein and red blood cells.
  • A kidney biopsy may be done. The doctor inserts a needle into the kidney through the back (under local anesthesia) to extract a small sample of tissue for microscopic examination.
  • Lumbar puncture (spinal tap).
  • CT (computed tomography) scans or MRI (magnetic resonance imaging).

How to Treat It

  • Treatment may be unnecessary for mild symptoms.
  • Take aspirin or other over-the-counter pain relievers to reduce fever and treat minor pain.
  • Apply warm compresses to relieve joint pain.
  • Get plenty of rest. People with SLE often need over 10 hours of sleep a night and may need more during episodes of active disease.
  • Oral corticosteroids such as prednisone may be prescribed to treat many of the major manifestations of lupus.
  • Immunosuppressive drugs, including high doses of corticosteroids as well as chemotherapeutic medications, may also be prescribed to control disease activity.
  • Hydroxychloroquine, an antimalarial drug, may be prescribed to relieve skin rash and the pain and swelling of arthritis.
  • Warfarin, an anticoagulant, may be prescribed to prevent blood clots and reduce the possibility of heart attack and stroke.
  • Your doctor may change your prescriptions for certain medications if they are suspected of causing drug-induced SLE.
  • Apply a sunscreen lotion containing PABA (paraaminobenzoic acid) with a sun protection factor (SPF) of 15 or higher. Avoid exposure to direct sunlight between 10 a.m. and 2 p.m. whenever possible.
  • Your doctor may recommend a low-salt diet. Calcium and vitamin D supplements may be advised for some patients.
  • Dialysis may be needed to treat kidney failure. This procedure performs the functions of the kidneys by removing waste products and excess fluid when the kidneys cannot (see Renal Failure, Chronic, for more information).
  • A kidney transplant is an alternative to dialysis in cases of kidney failure.

When to Call a Doctor

  • Make an appointment with a doctor if you develop symptoms of SLE.
  • Make an appointment with a doctor if, after being diagnosed with SLE, symptoms worsen or new symptoms develop.