Health Care and Lupus

One of the most difficult medical problems for any health care provider to diagnose is a disease called Lupus, primarily because it effects everyone differently. Over time, the malady can cause symptoms are similar to other health care problems, and people have varying degrees of symptomatic behavior.

According to the Mayo Clinic, diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders. No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis. Lupus is a chronic inflammatory disease that occurs when your body's immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs.

Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus. Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. While there's no cure for lupus, treatments can help control symptoms, according to the Mayo Clinic. Much more detailed info can be found at this site: http://www.mayoclinic.com/health/lupus/DS00115.

According to the Lupus Foundation of America, no gene or group of genes has been proven to cause lupus. Lupus does, however, appear in certain families, and when one of two identical twins has lupus, there is an increased chance that the other twin will also develop the disease. These findings, as well as others, strongly suggest that genes are involved in the development of lupus. Although lupus can develop in people with no family history of lupus, there are likely to be other autoimmune diseases in some family members. Certain ethnic groups (people of African, Asian, Hispanic/Latino, Native American, Native Hawaiian, or Pacific Island descent) have a greater risk of developing lupus, which may be related to genes they have in common. While a person’s genes may increase the chance that he or she will develop lupus, it takes some kind of environmental trigger to set off the illness or to bring on a flare. Examples include:

--ultraviolet rays from the sun.
--ultraviolet rays from fluorescent light bulbs.
--sulfa drugs, which make a person more sensitive to the sun, such as: Bactrim® and Septra® (trimethoprim-sulfamethoxazole); sulfisoxazole (Gantrisin®); tolbutamide (Orinase®); sulfasalazine (Azulfidine®); diuretics.
--sun-sensitizing tetracycline drugs such as minocycline (Minocin®).
--penicillin or other antibiotic drugs such as: amoxicillin (Amoxil®); ampicillin (Ampicillin Sodium ADD-Vantage®); cloxacillin (Cloxapen®).
--an infection.
--a cold or a viral illness.
--exhaustion.
--an injury.
--emotional stress, such as a divorce, illness, death in the family, or other life complications.
--anything that causes stress to the body, such as surgery, physical harm, pregnancy, or giving birth

Hormones are the body’s messengers and they regulate many of the body’s functions, according to their site Lupus.org. In particular, the sex hormone estrogen plays a role in lupus. Men and women both produce estrogen, but estrogen production is much greater in females. Many women have more lupus symptoms before menstrual periods and/or during pregnancy, when estrogen production is high. This may indicate that estrogen somehow regulates the severity of lupus. However, it does not mean that estrogen, or any other hormone for that matter, causes lupus.

Because lupus can affect so many different organs, a wide range of symptoms can occur. These symptoms may come and go, and different symptoms may appear at different times during the course of the disease. The most common symptoms of lupus, which are the same for females and males, are:

--extreme fatigue (tiredness).
--headaches.
--painful or swollen joints.
--fever.
--anemia (low numbers of red blood cells or hemoglobin, or low total blood volume).
--swelling (edema) in feet, legs, hands, and/or around eyes.
--pain in chest on deep breathing (pleurisy).
--butterfly-shaped rash across cheeks and nose.
--sun- or light-sensitivity (photosensitivity).
--hair loss.
--abnormal blood clotting.
--fingers turning white and/or blue when cold (Raynaud’s phenomenon).
--mouth or nose ulcers.

Many of these symptoms occur in other illnesses besides lupus. In fact, lupus is sometimes called "the great imitator" because its symptoms are often like the symptoms of rheumatoid arthritis, blood disorders, fibromyalgia, diabetes, thyroid problems, Lyme disease, and a number of heart, lung, muscle, and bone diseases. A significant additional amount of information about Lupus can be found at this site: http://www.lupus.org/newsite/index.html.

According to the Lupus Research Institute (LRI), although the broad term "lupus" usually refers to Systemic Lupus Erythematosus or S.L.E., this is only one type of lupus. Other types of lupus are:

1.) Cutaneous or “skin” lupus erythematosus. This form of lupus mainly affects the skin—not the rest of the body. Signs include a rash on the face, scalp, or elsewhere that may last for days or years, and can recur. Unlike systemic lupus, cutaneous lupus does not threaten the health of other organs and tissues in the body. And although it’s clearly a concern, it’s not that common for cutaneous lupus to turn into systemic lupus. A type of cutaneous lupus called “discoid” lupus involves potentially scarring sores with inflammation, typically on the face, scalp, and ears. These lesions can scar.

2.) “Drug-induced lupus” is triggered by the use of certain medicines. It usually goes away once the triggering medicines are stopped. Symptoms of this form of lupus are often relatively mild.

Lupus is chronic and complex, and is often difficult to diagnose. According to the LRI, there is no single laboratory test that can determine if a person has lupus. To complicate matters, many symptoms of lupus are similar to those of other diseases, and can come and go over weeks and months. It can often take years for a diagnosis to be made. To diagnose lupus, a doctor should be able to find physical or laboratory evidence of the condition, such as swelling of joints, protein in the urine, fluid around the lungs or heart, or a skin biopsy (test of a sample) that shows evidence of the disease. The doctor also will look at a person’s medical history and special tests to rule out other diseases. More information can be found at their site: http://www.lupusresearchinstitute.org/lupus/lupus_diagnosis .
 
Lupus affects mainly the joints, kidneys and skin. It can range from mild to serious. Yet, there is much reason for hope. Improvements in treatment have greatly improved these patients' quality of life and increased their lifespan, according to the American College of Rheumatology. Here are a few fast facts:

--Lupus affects 10 times as many women as men.
--Treatment depends on the symptoms and their severity.
--Because it is a complex disease, lupus requires treatment by or consultation with a rheumatologist, a doctor who is an expert in treating diseases like lupus.
--People can live well with lupus if they actively work toward good health.

Health care providers may combine a few medications to control lupus and prevent tissue damage. Each treatment has risks and benefits, according to Rheumatology.org. Most immune-suppressing medications, for instance, may cause major side effects. Side effects of these drugs may include a raised risk of infections as well as nausea, vomiting, hair loss, diarrhea, high blood pressure and osteoporosis (weak bones). Rheumatologists may lower the dose of a drug or stop a medicine because of side effects or when the disease goes into remission. As a result, it is important to receive careful and frequent health exams and lab tests to track your symptoms and change your treatment as needed.
 
Even when it is not active, lupus may cause problems later. Some of these problems can be fatal. One of these problems is atherosclerosis (clogging of the arteries) that may develop in younger women or may be more severe than usual. This problem raises the risk of heart attacks, heart failure and strokes. Thus, it is vital that patients with lupus lower their other risk factors for heart disease, such as smoking, high blood pressure and high cholesterol. It is also important to have as active a lifestyle as possible.

Treatment of lupus has improved, and people with the disease are living longer. But, it is still a chronic disease that can limit activities. Quality of life can suffer because of symptoms like fatigue and joint pain. Furthermore, some people do not respond to some treatments. Also, you may not be able to predict when lupus will flare. Such problems can lead to depression, anger, loss of hope or loss of the will to keep fighting, according to Rheumatology.org. The best way to control lupus is to follow these tips:

1.) Form a support system. A good doctor-patient relationship and support from family and friends can help you cope with this chronic and often unpredictable illness.

2.) Get involved in your care. Take all medications as your doctor prescribed, and visit your doctor often. Learn as much as you can about lupus and your medications, and what kind of progress to expect.

3.) Stay active. Exercise helps keep joints flexible and may prevent heart disease and strokes. This does not mean overdoing it. Switch off doing light to moderate exercise with times of rest.

4.) Avoid excess sun exposure. Sunlight can cause a lupus rash to flare and may even trigger a serious flare of the disease itself. When outdoors on a sunny day, wear protective clothing (long sleeves, a big-brimmed hat) and use lots of sunscreen.

5.) Pregnancy. If you are a young woman with lupus and wish to have a baby, carefully plan your pregnancy. With your doctor's guidance, time your pregnancy for when your lupus activity is low. While pregnant, avoid medications that can harm your baby.

Lupus is treatable, but the conditions causing it are complex and hard to diagnose. If you suspect that you or someone in your family are suffering some recognizable symptoms, visit your primary care physician and ask for a referral to a rheumatologist who can help you figure out what's going on with your health. At least, they can guide you with options for testing and proper diagnosis. Plus, your overall health may be a risk for even greater complications if you don't follow their guidance, or if you continue to ignore your issues or delay getting help. Find a solution to your symptoms, and prevent any additional problems from developing over time.
 
Until next time.