therapy treatment Lupus erythematosus

Lupus erythematosus

 is a category for a collection of diseases with similar underlying problems with immunity (autoimmune disease).Symptoms of these diseases can affect many different body systems, including joints, skin, kidneys, blood cells, heart, and lungs. Four main types of lupus exist — systemic lupus erythematosus, discoid lupus erythematosus, drug-induced lupus erythematosus, and neonatal lupus erythematosus. Of these, systemic lupus erythematosus is the most common and serious form of lupus.

Photosensitivity's relationship to and influence on the systemic manifestations of lupus remain to be defined. Mechanisms for photosensitivity might include: modulation of autoantibody location, cytotoxic effects, apoptosis induction with autoantigens in apoptotic blebs, upregulation of adhesion molecules and cytokines, induction of nitric oxide synthase expression and ultraviolet-generated antigenic DNA. Tumor necrosis factor alpha also seems to play a role in the development of photosensitivity.

Types

Lupus erythematosus may manifest as a systemic disease or in purely cutaneous forms. Types of lupus erythematous can be categorized into the following types:

•  
• Acute cutaneous lupus erythematosus
• Subacute cutaneous lupus erythematosus
• Chronic cutaneous lupus erythematosusComplement deficiency syndromes
  • Discoid lupus erythematosus
    • Childhood discoid lupus erythematosus
    • Generalized discoid lupus erythematosus
    • Localized discoid lupus erythematosus
  • Chilblain lupus erythematosus (Hutchinson)
  • Lupus erythematosus-lichen planus overlap syndrome
  • Lupus erythematosus panniculitis (Lupus erythematosus profundus)
  • Tumid lupus erythematosus
  • Verrucous lupus erythematosus (Hypertrophic lupus erythematosus)
• Drug-induced lupus erythematosus
• Neonatal lupus erythematosus
• Systemic lupus erythematosu

Signs and Symptoms of Lupus

Lupus is characterized by variable symptoms -- in other words, it's not the same for everyone. Lupus symptoms can range from mild to severe and the symptoms can go away as well as recur. Painful or swollen joints (arthritis), unexplained fever, and fatigue are among the most common symptoms. A characteristic red skin rash, known as the butterfly or malar rash, may appear across the nose and cheeks. Rashes may also occur on the face and ears, upper arms, shoulders, chest, and hands. Many people with lupus are photosensitive (sensitive to sunlight) so rashes often appear on areas of the skin exposed to skin and worsen after exposure.

In-Depth From A.D.A.M.Complications

COMPLICATIONS OF THE BLOOD

Systemic lupus erythematosus (SLE) can cause systemic complications throughout the body 

Almost 85% of patients with SLE experience problems associated with abnormalities in the blood.

Anemia. About half of patients with SLE are anemic. Causes include:

• Iron deficiencies resulting from excessive menstruation
• Iron deficiencies from gastro-intestinal bleeding caused by some of the treatments
• A specific anemia called hemolytic anemia, which destroys red blood cells
• Anemia of chronic disease

Hemolytic anemia can occur with very high levels of the anticardiolipin antibody. It can be chronic or develop suddenly and be severely (acute).

Antiphospholipid Syndrome. Between 34 - 42% of patients with SLE have antiphospholipid syndrome (APS). This is a specific set of conditions related to the presence of autoantibodies called lupus anticoagulant and anticardiolipin. These autoantibodies react against fatty molecules called phospholipids, and so are called antiphospholipids. Their actions have complex effects that include causing narrowing and abnormalities of blood vessels.

• Patients who have APS have a very incidence of blood clots, which most often occur in the deep veins in the legs. Blood clotting, in turn, puts patients at higher risk for stroke and pulmonary embolism (clots in the lungs).

This picture shows a red and swollen thigh and leg caused by a blood clot (thrombus) in the deep veins in the groin (iliofemoral veins). Such a clot prevents normal return of blood from the leg to the heart.

• The effects on blood vessels have also been associated with confusion, headaches, and seizures. Leg ulcers can also develop.
• Patients with APS who become pregnant have a high incidence of pregnancy loss, especially in the late term.

Not all patients with APS carry both of the autoantibodies, and they can also wax and wane and so have varying effects. APS also occurswithout lupus in about half of patients with the syndrome.

Thrombocytopenia. In thrombocytopenia, antibodies attack and destroy blood platelets. In such cases, blood clotting is impaired, which causes bruising and bleeding from the skin, nose, gums, or intestines. (This condition can also occur in APS, but it is not considered to be one of the standard features of the syndrome.)

Neutropenia. Neutropenia is a drop in the number of white blood cells. Patients with SLE often neutropenia, but the condition is usually harmless unless the reductions are so severe that they leave the patient vulnerable to infections.

Acute Lupus Hemophagocyte Syndrome. A rare blood complication of SLE that occurs primarily in Asians is called acute lupus hemophagocytic syndrome. It is generally of short duration and characterized by fever and a sudden drop in blood cells and platelets.

Lymphomas. Patients with SLE and other autoimmune disorders have a greater risk for developing lymph system cancers such as Hodgkin’s disease and non-Hodgkin’s lymphoma (NHL).

HEART AND CIRCULATION COMPLICATIONS

Heart disease is a primary cause of death in lupus patients. The immune response in SLE can cause chronic inflammation and other damaging effects that can cause significant injury to the arteries and tissues associated with the circulation and the heart. In addition, SLE treatments (particularly corticosteroids) affect cholesterol, weight, and other factors that can also affect the heart.

Patients with SLE, have a higher risk for developing the following conditions, which put them at risk for heart attack or stroke:

• Atherosclerosis, or plaque buildup in the arteries
• Increased stiffness in the arteries
• Unhealthy cholesterol and lipid (fatty molecules) levels
• High blood pressure, most likely because of kidney injury and corticosteroid treatments
• Heart failure
• Pericarditis, an inflammation of the tissue surrounding the heart
• Myocarditis, an inflammation of the heart muscle itself (rare)

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