INTRODUCTION
In the modern era there are a plethora of diseases, conditions and disorders that can affect individual’s health, well-being and quality of life for people all across the world. Whether it is from cancer to infections or from diabetes to HIV there is always the possibility of contracting or developing disease. However, not all diseases are contracted or developed due to an external influence, there are some that originate from the inside; such conditions are generally referred to as an autoimmune disease. This means that the problem involves an individual’s own immune system, perceives their own body as a threat and attacks itself; Lupus is one such autoimmune disease. More than 5 million people worldwide suffer with Lupus and 1.5 million of these people are living in the United States (Lupus Research Institute, 2016). Lupus, like all autoimmune diseases, continues to be research, studied and revisited. In order to address the topic and its understanding it is necessary to look at Lupus from its origins to its causes and from its symptoms to its preventions, just to name a few, in order to grasp the scope of the complex nature of Lupus. After reviewing available sources, it becomes clear that future and dedicated research in order to address Lupus better is both, worthwhile and essential.
HISTORY
Lupus is not the result of the modern age, while called by different names, signs, symptoms, it has been traced back as far back as the 13th century, when the physician Rogerius first began referring to the facial legions looked similar to bites left by wolves, and hence it became termed “lupus,” which is the Latin word for “wolf.” Other similar conditions had been identified as others researched lupus, from Thomas Bateman in Britain, in the 19th century Cazenave of France and Moriz Kapisi, also known as Moriz Kohn, of Australia. This research continued into the 20th and 21st century (Lupus Foundation of America, 2013). There are several different types of lupus that have been identified and studied. Lupus, specifically, is considered a chronic autoimmune inflammatory disease, which can affect many parts of the body in many different ways. It is often identified by the symptoms outbreaks or, more commonly referred to as, flare ups. There are several different types of lupus that have been identified and studied.
Neonatal Lupus: is rare and specifically effects newborns (Marks, 2015).
Discoid Lupus Erythematosus: this form of lupus causes skin rashes that do not heal or
go away (Marks, 2015).
Subacute Cutaneous Lupus Erythematosus: This form can cause skin sores on the parts of the body exposed to the sun (Marks, 2015).
Drug-Induced Lupus: Is a type of lupus that may only present when exposed to certain drugs and medications (Marks, 2015).
Systemic Lupus Erythematosus (SLE): This type of lupus is the most common and is the form of lupus that most are referring to when they are considering lupus. It will also be the type of lupus that the majority of this discussion will be on (Marks, 2015).
DISCUSSION
Systemic Lupus Erythematosus is one of, more than, 80 autoimmune diseases that scientists have identified in the modern era. Unlike traditional diseases and other types of lupus, Systemic lupus erythematosus can have a variant of different manifestations in sufferers and because in many cases the symptoms can come and go, it can be incredibly difficult to identify and diagnose (Katz, Alarcon and et. al 2007). In order to truly understand lupus better it is necessary to review those aspects individually.
Causes: While drug-induced lupus can be encouraged with medication as a causative act and subacute cutaneous lupus erythematosus can be triggered by exposure to the sun, in the case of systemic lupus erythematosus there is no specific root cause. In fact, determining its causes is highly important to ideally one day curing the condition, however, that point has not been reached as yet (Lupus Research Institute, 2016).
Signs & Symptoms: Again no two patients that may be suffering from lupus may present with the same signs and symptoms. That being said there are a number of signs that professionals would look to determine a case to be lupus. After all so many of the signs and symptoms are widespread that they could be indicative of any number of other serious and conditions that are even more common. These symptoms may include the following.
Chest Pain: This is generally present along with issues and painful breathing. Lupus can affect multiple systems of the body, including the lungs and heart. Many sufferers of lupus will find themselves seeing a cardiologist to maintain their heart health. Because the body is already weakened for the “self attacks” that is trademark of lupus, these individuals may not be able to recover as quickly or as productively as the average patient not suffering from lupus (Lupus Research Institute, 2016).
Unexplained Fever: Fever is the body’s way of preparing to fight foreign invaders and potential pathogens. The body temperature rises in order to produce what it needs to fight off such infections. In lupus patients they may run fevers when no outside infection is present, but as it prepares to attack its own body as an infection. This kind of fever without infection is an indicator of the presence of an autoimmune disease (Lupus Research Institute, 2016).
Sores: Sores found in the nose and mouths are often an indicator of lupus. Two thirds of lupus sufferers will ultimately develop the co-condition of cutaneous lupus erythematosus, which causes legions and sores that may not heal very quickly. Again, the areas most affected would be those parts of the body most often exposed to the sun, like arms, legs and face (Lupus Research Institute, 2016).
Urinanalysis: The kidneys are organs that participate in the removal of waste from the body, specifically through urine. Signs that lupus may be causing damage to the kidneys is expected when the sufferer is urinating more often than usual, especially at night, the urine is foamy or contains blood. Very often urinalysis will reveal that a protein is spilling into the body because the kidneys are no longer processing waste correctly; this condition is called “proteinuria” (Lupus Research Institute, 2016).
Sensitivity to Sunlight: More than two thirds of lupus sufferers will experience this common symptom. This sensitivity can be from ultraviolet light, but for some, even fluorescent light can affect some sufferers. The light can cause lesions and sores, but can also exacerbate the conditions flare ups. This would increase the sufferer’s exhaustion and inflammation (Marks, 2015).
Joint Issues: The pain and inflammation in the joints, similar to what is experienced in arthritis, is common sign of lupus. The joints in the body can become so inflamed that it can make day-to-day activities very difficult. While many of the other symptoms and signs can vary greatly from patient to patient, the presence of inflammation and joints stiffness is one the most similar features. (Marks, 2015).
Discoloration of Digits: The finger tips or the toes are often highly affected by lupus. In many cases the tips of the digits will go very pale, almost white, and then turn to shades of blue and then, finally, red (Lupus Research Institute, 2016).
Purpura: Some people with lupus will experience this skin condition. It begins as a small purple or red discoloration, which is due to vessels leaking blood underneath the skin. The smallest purpura spots are called “petechiae” and the larger spots, called “eccymosis,” This is caused when there is insufficient blood platelet levels, other medical conditions the sufferer has and different medications taken (Marks, 2015).
Extreme Fatigue: Many lupus sufferers complain of chronic exhaustion that no amount of rest is improving. The body working so hard to attacks itself weakens the sufferer. On top of that the medications taken to control their lupus can also contribute to over-tiredness and the potential levels of depression that many lupus sufferers experience can also contribute to possible fatigue (Marks, 2015).
Rash: Sufferers may experience red or purple rashes, flaky, scaly skin all over the body, including neck, arms and faces, particularly on the bridge of nose and the cheeks. The “butterfly rash,” which is where the shape of the rash looks very much like a butterfly is highly indicative of lupus (Lupus Research Institute, 2016).
Mental Health Issues: Some sufferers may experience the effects of depression, may have difficulty with memory and trouble thinking, as in, for example, problem solving tasks. Depression is one of the major issues that can make it harder and harder to overcome symptoms and avoid outbreaks or flare ups. (Palagini, Mosca & et. al, 2013).
Hair Loss: One of the most common features of lupus is the loss of hair, specifically the hair on the head. This can be a very difficult symptom for many who suffer from it. Again, most lupus sufferers are women, losing one’s hair could be a topic of significant embarrassment and shame. All of which can add to other negative elements like greater depression (Palagini, Mosca & et. al, 2013).
Risks to Population: There are 16,000 new cases of lupus diagnosed every year. Fortunately it is not a condition that is contagious so it is not an exposure risk as other disease and conditions. The populations most at risk of a lupus diagnosis are women (Murphy & Isenberg, 2013). In fact, 90% of the cases of lupus diagnosed are women. The women between the ages of 15 to 44 are even more likely. Finally, women of color are three times as likely, as their Caucasian counterparts. However, men and children, even infants as mentioned previously, can develop lupus, but is simply far rarer. (Lupus Research Institute, 2016).
Diagnosis: Once again, without knowing the root cause and because the symptoms of lupus can be associated with many other diseases making the correct diagnosis is difficult. In fact, many cases of lupus are either under or mis-diagnosed. There are number of blood, urine and other tests needed in order to confirm the diagnoses and determine if the varying symptoms that the patient may be suffering can be properly addressed (Lupus Research Institute, 2016).
Treatment: Again, because the symptoms and signs of lupus can be so unique to each case, treating it can be rather difficult. Lupus can affect many different systems and organs in the body, meaning that the patient will likely visit many doctors that specialize in different parts of the body. Many cases of lupus are handled with rheumatologists as the primary caregiver, because they have expertise in treating disease that affects the bones, muscles and joints. If, however, the patient is also showing issues with their hearts or livers then others specialist will have to be coordinated in the treatment plan. In general there are a few treatments that are regularly relied upon to treat lupus.
Anti-inflammatory Drugs: These drugs are used to treat swelling and pain; they contain no steroids, including drugs like aspirin, ibuprofen and naproxen (Lupus Research Institute, 2016).
Antimalarial Drugs: These drugs were initially used to treat outbreaks of malaria in other parts of the world. However, these antimalarials interfere with the immune system, which could help a lupus patient to control certain lupus “flares.” Examples of antimalarials commonly used include quinicrine (Lupus Research Institute, 2016).
Steroidal Drugs: Steroids are part of a human beings hormonal make-up. Steroid drugs are synthetic substitute intended to act with the same purpose. Steroids, like Prednisone, the most common prescribed for lupus sufferers, are designed to lessen an immune response. That said if the lupus causes the body’s immune system to attack itself, then slowing it down can help to alleviate the symptoms of the lupus (Lupus Research Institute, 2016).
Cytoxic Chemotherapies: These are the same drug cocktails prescribed to many cancer patients because it works to stabilize an overactive immune system. Again by interfering with the immune system lupus sufferers can, ideally, avoid flare ups of symptoms (Lupus Research Institute, 2016).
Immunosuppressive medications: Immunosuppressant medications are ideally intended, like other treatments, to slow and control a lupus patient’s immune system to avoid inflammation. One of the most common immunosuppressive medications is azathioprine (Lupus Research Institute, 2016).
Belimumab: Belimumab is a B lymphocyte stimulator inhibitor, which has recently been approved for lupus patients, is shown to have the potential to arrest the negative behaviors of the immune system, but also, have the possibility to reverse the pathology and damage of the disease, but further studies are required. With the positive responses being found in this new therapy, it is paving the way for similar drugs that may in the future be instrumental in how lupus is treated (Tripathi & Chughco, 2015).
Complications & Contraindications: Because of the varying degree and types of symptoms means that patients will receive differing treatments, sometimes there can be complications and contraindications in lupus because negative reactions, including drug interactions, can actually make the situation worse for the sufferer. There is clinical proof that lupus sufferers have issues with liver dysfunction or show evidence of abnormal liver enzymes. Some of these liver-related complications include lupus hepatitis, autoimmune liver diseases, like primary biliary cirrhosis, autoimmune hepatitis, or primary sclerosing cholangitis. There are also reasons to watch for viral hepatitis, steatohepatitis, fatty liver and even drug induced damage to liver can occur (Shizuma, 2015). However, liver issues are only the beginning. Individuals with lupus may also face some serious complications. They may experience mental problems, like memory problems and behavioral changes, which for some can involve hallucinations. They may also experience kidney failure, vasculitis, high blood pressure, heart disease, stroke, seizures, anemia, lung conditions, including pleurisy and pneumonia, general infections, avascular necrosis, the death of bone tissue, and, finally, cancer. Lupus does not necessarily cause cancer but the patient’s compromised immune systems make them more susceptible (Marks, 2013).
Preventions: At present there is no direct prevention of lupus. In fact, again, science is still trying to determine the causes, so understanding how to prevent it is still a mystery. What lupus sufferers can prevent are the flare ups of their condition in some cases. Most professionals suggest that patients actively avoid the things that are likely triggers, whatever they may be in their case. Many of the common triggers include changes in weather, potent cleaning chemicals, infections, ultra-violet light and stressful thinking and situations (Squance, Reeves & Bridgman, 2012).
Rehabilitation: Rehabilitation in the case of lupus patients is a tricky concept. It is difficult to rehabilitate from something that has an unknown cause and cannot be cured. As mentioned previously, preventing flare up by avoiding potential triggers is a great way to overcome the symptoms (Squance, Reeves & Bridgman, 2012). There are many professionals that do suggest physical activity as therapeutic for patients who suffer severely from joint, bone and muscular inflammation and pain. Exercise in moderate to high intensity periods on a regular basis can lead to lessening of flare frequency and severity. It also seems to have a positive effect on the issues of fatigue, depression and physical function often suffered by lupus patients (Strömbeck & Jacobsson, 2007).
There are benefits to the future study and research into all of the facets of lupus. Again, with the still mysterious nature of lupus, despite its commonality, patients can be benefitted with many of the modern treatments. It is just a matter of what works best for one lupus patient may not work as well for another. A recent study may have identified a potential origin of lupus, it may lie in inflammation caused at the cellular level, when left over cells intended to attack disease, instead attacks the body instead; more dedicated study is required for this theory. (Goodman, 2011). That wide potential of symptoms, signs and reactions diagnosing, preventing or treating lupus can make finding beneficial results more easily said than done. However, there are new therapies being developed, treatments tested and progress being made in dedicated studies and laboratories all across the country and the globe (Shizuma, 2015).
CONCLUSION
Lupus is a very real disease that is affecting millions of people all across the globe. For a disease that has and continues to have such an extreme impact on the health of so many, science is now just beginning to understand what may be the causative factors and how best to treat symptoms. There is, again, no cure for lupus and as yet no prevention measures that can end development of the condition, but they have learned new and beneficial ways to prevent flare ups of the disease. Ultimately, there is still some distance to go before lupus is completely understood and ideally cured. In the meantime is about learning how better to recognize, diagnose and approach the care of lupus sufferers so that their quality of life is not so harshly impacted. Continuous research into this autoimmune disease is, both, necessary and worthwhile,
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