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diseaseconditions.peperonity.net

◆ SLE

●O------------O●

DEFINITION:
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Lupus is a condition of chronic inflammation caused by an autoimmune disease. Autoimmune diseases are illnesses that occur when the body's tissues are attacked by its own immune system. The immune system is a complex system within the body that is designed to fight infectious agents, for example, bacteria, and other foreign invaders. One of the mechanisms that the immune system uses to fight infections is the production of antibodies. Patients with lupus produce abnormal antibodies in their blood that target tissues within their own body rather than foreign infectious agents.
Both discoid and systemic lupus are more common in women than men (about eight times more common). The disease can affect all ages but most commonly begins from age 20 to 45 years. It is more frequent in African-Americans and people of Chinese and Japanese descent.

CAUSES:
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The precise reason for the abnormal autoimmunity that causes lupus is not known. Inherited genes, viruses, ultraviolet light, and drugs may all play some role. Genetic factors increase the tendency of developing autoimmune diseases, and autoimmune diseases such as lupus, rheumatoid arthritis, and immune thyroid disorders are more common among relatives of patients with lupus than the general population. Some scientists believe that the immune system in lupus is more easily stimulated by external factors like viruses or ultraviolet light. Sometimes, symptoms of lupus can be precipitated or aggravated by only a brief period of sun exposure.
Recent research provides direct evidence that a key enzyme's failure to dispose of dying cells contributes to SLE. The enzyme, DNase1, normally eliminates what is called "garbage DNA" and other cellular debris by chopping them into tiny fragments for easier disposal. The researchers turned off the DNase1 gene in mice. The mice appeared healthy at birth but after 6-8 months, the majority of mice without DNase1 showed signs of SLE. Thus, a genetic mutation that disrupts the body's cellular waste disposal may be involved in the beginning of SLE.


DRUG INDUSED LUPUS:
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Dozens of medications have been reported to trigger SLE; however, more than 90% of this "drug-induced lupus" occurs as a side effect of one of the following six drugs: hydralazine (used for high blood pressure), quinidine and procainamide (used for abnormal heart rhythm), phenytoin (used for epilepsy), isoniazide (used for tuberculosis), d-penicillamine (used for rheumatoid arthritis). These drugs are known to stimulate the immune system and cause SLE. Fortunately, drug-induced SLE is infrequent (accounting for less than 5% of SLE among all patients with SLE) and usually resolves when the medications are discontinued.


SYMPTOMS & SIGNS:
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In discoid lupus, only the skin is involved. The skin rash in discoid lupus often is found on the face and scalp. It usually is red and may have raised borders. Discoid lupus rashes are usually painless and do not itch, but scarring can cause permanent hair loss. Over time, 5 to 10% of patients with discoid lupus may develop SLE.

Patients with SLE can develop different combinations of symptoms and organ involvement. Common complaints and symptoms include fatigue, low-grade fever, loss of appetite, muscle aches, arthritis, ulcers of the mouth and nose, facial rash ("butterfly rash"), unusual sensitivity to sunlight (photosensitivity), inflammation of the lining that surrounds the lung (pleuritis) and the heart (pericarditis), and poor circulation to the fingers and toes with cold exposure (Raynaud's phenomenon).

More serious organ involvement with inflammation occurs in the brain, liver, and kidney. White blood cells and blood clotting factors also can be decreased in SLE, thereby increasing the risk of infection and bleeding.

Over half of the patients with SLE develop a characteristic red, flat facial rash over the bridge of their nose. Because of its shape, it is frequently referred to as the "butterfly rash" of SLE. The rash is painless and does not itch. The facial rash, along with inflammation in other organs, can be precipitated or worsened by exposure to sunlight, a condition called photosensitivity. This photosensitivity can be accompanied by worsening of inflammation throughout the body, called a "flare" of disease.
Most patients with SLE will develop arthritis during the course of their illness. Arthritis in SLE commonly involves swelling, pain, stiffness, and even deformity of the small joints of the hands, wrists, and feet. Sometimes, the arthritis of SLE can mimic that of rheumatoid arthritis (another autoimmune .


OTHER SYMPTOMS:
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Vasculitis
Pleuritis
Carditis
Kidney failure
Hair loss

DIAGNOSIS:
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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:
ulcers of the lining of the mouth, nose or throat
arthritis: 2 or more swollen, tender joints of the extremities

>Pleuritis/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 clumps of cellular elements called casts

>Brain irritation:
manifested by seizures (convulsions)

>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, falsely positive blood test for syphilis, anticardiolipin antibodies, lupus anticoagulant, or positive LE prep test

>Antinuclear antibody:
positive ANA antibody testing


OTHER INVESTIGATIONS:
---------------------

In addition, blood tests for individual types of autoantibodies exist that are more specific to persons with lupus, though not all persons with lupus test positive for these, and not all persons with these antibodies have lupus. These antibodies include anti-DNA, anti-Sm, anti-RNP, anti-Ro (SSA), and anti-La (SSB). These antibody tests may help in the diagnosis of lupus.


TREATMENT:
------------

(1).NSAIDs
>Ibuprofen
>Naproxen
>Misoprostol

(2).STEROIDS:
>Corticosteroids

(3). ANTI-MALARIAL:
>Hydroxychloroquine

(4).IMMUNOSUPPRESSIVE:
>Dapsone
>Methotrexate
>azathioprine


WHAT ELSE:
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Patients with SLE need more rest during periods of active disease. Researchers have reported that poor sleep quality was a significant factor in developing fatigue in patients with SLE. These reports emphasize the importance for patients and physicians to address sleep quality and the effect of underlying depression, lack of exercise, and self-care coping strategies on overall health. During these periods, carefully prescribed exercise is still important to maintain muscle tone and range of motion in the joints.


oO--------------Oo

Written BY:
Dr.Ijaz Aslam
COOL SITE Pvt.LtD




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