Lupus Overview

Systemic Lupus Erythematosus (SLE) effects females 9 times more than it does males. Lupus is an autoimmune disease and like any autoimmune disease the immune system confuses the bodies own tissue with foreign particles. This causes the immune system to attack the bodies own organs. Any organ system can be affected.

There is no known cause of Lupus but genetics and lifestyle factors have been suggested to interact and lead to the progression of disease. Lifestyle factors that have been implicated include suffering from obesity, cigarette smoking, ultra violet light exposure and viral infections.

As the symptoms of Lupus are so diverse the condition is often confused with other illnesses. This can make obtaining a diagnosis difficult. Many patients report the most challenging symptom to be extreme fatigue.

Lupus Overview

Systemic Lupus Erythematosus (SLE)

Systemic Lupus Erythematosus (SLE) effects females 9 times more than it does males. Lupus is an autoimmune disease and like any autoimmune disease the immune system confuses the bodies own tissue with foreign particles. This causes the immune system to attack the bodies own organs. Any organ system can be affected.

There is no known cause of Lupus but genetics and lifestyle factors have been suggested to interact and lead to the progression of disease. Lifestyle factors that have been implicated include suffering from obesity, cigarette smoking, ultra violet light exposure and viral infections.

As the symptoms of Lupus are so diverse the condition is often confused with other illnesses. This can make obtaining a diagnosis difficult. Many patients report the most challenging symptom to be extreme fatigue.

Diagnosis

The American College of Rheumatology have developed an index to aid in the diagnosis of Lupus, whereby patients must meet 4 or more of the 11 criteria to be diagnosed, including:

  1. MALAR RASH – Fixed red rash over the cheeks

  2. DISCOID RASH – Red patches of skin associated with scaling and plugging of the hair follicles

  3. PHOTOSENSITIVITY – Rash after exposure to sunlight

  4. ORAL ULCERS – Small sores that occur in mucosal lining of mouth and nose

  5. SEROSITIS – Inflammation of the delicate tissues covering internal organs, and abdominal pain

  6. ARTHRITIS – Very common in Lupus, usually pain in the joints and tendons

  7. RENAL DISORDERS – Usually detected by routine blood and urine analysis

  8. NEUROLOGICAL DISORDERS – Seizures or psychosis, balance problems

  9. HAEMOTOLOGICAL DISORDER – Haemolytic Anaemia, Leukopenia, Thrombocytopenia

  10. IMMUNOLOGIC DISORDER – Tests anti-DNA, anti-SM antibodies, antiphospholipid antibodies

  11. ANTI-NUCLEAR ANTIBODY (ANA TEST) – When found in the blood and the patient is not taking drugs, it is known to cause a positive test for Lupus in most cases, but it is not necessarily conclusive

Treatment    

Lupus is an incurable condition but medications are available to help with the management of symptoms. Commonly used medication includes;

Non-steroidal ant inflammatory drugs (NSAIDs) – Aspirin, ibuprofen ect.

These are best used when muscle and joint pain is the main complaint. Equally aspirin may be prescribed as an anticoagulant (or alternatively warfarin).

Anti-Malarials – Chloroquine, Quinine ect.

Patients suffering from skin and joint problems may be prescribed anti-malarial medication. This has also been shown to help with fatigue. Hydroxychloroquine (Plaquenil) has the added benefit of providing protection from sun damage and reducing blood clotting.

Steroids – Prednisolone

Steroids are considered by many the most important treatment in the management of Lupus. They have strong anti-inflammatory effects. Patients will generally receive a large dosage when suffering from active disease, the dosage is then lowered or removed entirely as the symptoms subside.

Immunosuppressants – Methotrexate, Cyclophosphamide ect.

These are most commonly used when patients are suffering from kidney involvement. These are very effective and work by reducing the abnormal immune response to the body’s own tissues. Patients are monitored closely whilst undergoing immunosuppressant therapy.

Other drugs - Other drugs are less frequently used in Lupus and include intravenous immunoglobulin (often used when the platelets are low) and cyclosporin A, the drug widely used in transplantation medicine to suppress rejection. For very severe skin disease in patients where pregnancy is not a consideration, thalidomide has proved an extremely powerful medication.

Non-Lupus drugs –

As patients often suffer side effects of medications or as an indirect result of suffering from Lupus, various other treatments are available.

Patients are encouraged to use sun-protection creams (EVEN IN NORTHERN IRELAND!). Vitamin D and calcium is often prescribed alongside steroid treatment to prevent the development of osteoporosis. Depression is highly prevalent in patients with chronic illness, anti-depressive medications are available to aid with combating this.

Lifestyle management

The severity of Lupus varies between patient to patient, steps can be taken to manage the condition and the effect that an individual’s medication may have.

Areas of lifestyle that can be managed include;

Stress management
Fatigue management
Dietary choices

Stress management

The daily stresses that everyone encounters are made more difficult when suffering from an illness, it is important to manage stress to stop it becoming overbearing. Methods of stress management include;

Obtaining enough sleep – Stress and sleep depravity go hand in hand. A lack of sleep can lead to agitation and feelings of anxiety whilst stress can interrupt sleep. It is important to create a relaxed environment to improve the quality of sleep a person gets. Helpful tips include removing reminders of the source of stress from your bedroom. Stopping any mentally demanding tasks 2 hours before your intended sleep time. Some people find a warm bath relaxing and soothing before bedtime whilst this refreshes others and makes them feel awake, similarly some people benefit from reading an engrossing book before bedtime whilst this stimulates others.

Talk to someone –  Friends, family and even a professional are often best placed to give advice because they aren’t being effected by the stress that the circumstances are causing. The old adage that “a problem shared is a problem halved” is true when considering stressful situations.

Make time for fun activities – The stresses and strains of life often force people to prioritise others needs over their own. It is important to make time for activities that you enjoy and activities that stimulate you. Examples of these include quiz’s, visiting museums, exploring new landscapes, learning new skills and visiting interesting places. Try involving your family in these and possibly adding an activity that involves exercise.

Exercise – Physical activity doesn’t have to mean spending hours in the gym red faced and exhausted, taking the dog for a walk or using the stairs instead of the elevator counts as physical activity. It’s easy to look at this as a chore because physical activity is often strenuous but it can actually be a great way to socialise. Many walking and running clubs exist for amateurs. For those more athletic there are sports teams that always welcome new members.

See below for nutritional tips on how to reduce stress

Fatigue management

Symptoms of fatigue range between severe to mild. One method of increasing a patient’s stamina is to exercise, this initially is a difficult hurdle to overcome as the lethargy caused by Lupus can deter a patient from exercising. It is important to get the balance between exercise and rest right. Exercises such as swimming and cycling places minimal impact on joints and are therefore are recommended. The patient may need to get creative depending on their limitations, it is recommended to seek the advice of a medical professional before undertaking a new exercise regime.

See below for nutritional tips on how to reduce fatigue

Nutrition advice

Dietary advice for Lupus patients is similar to that given to the general population, although the consequences of not adhering to these recommendations may be more important for a Lupus patient given their increased susceptibility to certain conditions.

Avoid caffeine - It may be tempting to combat fatigue by over-indulging in caffeine containing drinks (coffee, energy drinks ect.) but this is a temporary fix that may have unwanted side effects such as irritability, anxiety, sleep disorders and reduced appetite.

Reduce alcohol intake – Similar to caffeine, alcohol is a stimulant and therefore can increase anxiety. The recommendations for alcohol intake for Lupus patients is the same for the general population 2-3 units a day for females, 3-4 units per day for males.

A glass of wine typically contains 2.3 units as does a pint of beer.

People that regularly take non-steroidal anti-inflammatory drugs (NSAIDs) should abstain from alcohol as these drugs taken along with alcohol can increase the risk of stomach irritation.

Reduce sodium intake – A prolonged high intake of sodium can increase blood pressure. Which increases the risk of heart conditions and can also place strain on the kidneys.

Maintain a healthy weight – It is clear from scientific research that being overweight impacts negatively on the health of Lupus patients. Achieving a healthy weight can be accomplished by completing regular physical activity and having a balanced diet. Recipe ideas are available online.

Improve joint symptoms – Some promising research has indicated a role for “tThe Mediterranean diet” in improving joint pain in sufferers of rheumatoid arthritis. This diet includes the daily consumption of poultry and fish whilst limiting the portions of red meat to once weekly. The basis of the diet includes plenty of vegetables, fruit, olive oil, wholegrain cereals, legumes, nuts and seeds.

Improve skin health – Lupus patients are at an increased risk of suffering from damaged skin. Nutrients that aid in skin health include; vitamin A, vitamin C, riboflavin, niacin, pyridoxine, vitamin E, zinc and selenium. Obtaining enough of these nutrients in the diet is easily achieved by having a varied diet.

Dietary considerations for patients taking corticosteroids – Steroids may increase appetite and therefore it is important to limit the consumption of high calorie foods (fast food, cakes, chocolate & ice cream). Steroids can also increase the retention of fluid and therefore patients should limit their salt intake as this will increase thirst and further contribute towards retention. Steroids can have a negative impact on bones, patients should have a diet rich in calcium and vitamin D to counteract this.

The Lupus support group meets 4 times per year at the Whiteabbey Methodist Church Halls. For details of meetings see the upcoming events page.

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