MINI MED SCHOOL: LUPUS
2 CLASS HOURS

Objectives: At the end of this class, you will be able to

1.    List the 4 types of lupus.

2.    Discuss the signs and symptoms of lupus.

3.    Relate how to care for the person with lupus.

Introduction
 
Lupus is a rare disease. It occurs when the body’s own immune system attacks the body, its tissues and its organs. The immune system protects the body from infection when it is normal. With lupus, this system attacks and hurts the body rather than helping it. Lupus can attack the blood, the heart, the lungs, the skin, and the joints. Women get it more than men. No one knows why but women are at a greater risk than men.
 
Types of Lupus
 
There are four types of lupus.  Each type is different. Each type has a different set of signs. These four types are:
 
·         systemic lupus (the most common form)
·         discoid lupus
·         drug-induced lupus
·         neonatal lupus.
 
The systemic type is the most common type. This type can attack the skin, joints, lungs, kidneys and blood. The discoidtype affects only the skin. A circle rash is seen on the neck, face or head. Some of these patients may also get the sytemic type. Some medications cause the drug-inducedtype of lupus for some people. Other people may take the same drugs and not get it. This type can affect a number of body parts but it usually goes away when the person stops taking the drug.
 

 
The neonatal form is rare. It affects some new born babies. These babies get it from the mother even when the mother may not even have it. The new baby may have a rash that goes away in a couple of months. Other new babies may end up with a heart problem because of it.
 

Causes

 
We do not really know why people get it. It seems that it may result from a combination of environment and genes. Many people think that you inherit a tendency to get lupus from your parents, but not the disease itself. It will only come out later in life when you contact something like a virus.
 
The Signs
 

 
Every case of this disease is different. No two patients will have the same signs. Some people have signs that come on very fast and without any signs. Other people get signs that develop slowly over time. Some people get very serious and severe signs. Others may get only very minor and mild signs. Most people have signs that go away over time and then come back later. Others have signs that do not go away. These signs are always there.
 
Some of the signs and symptoms of lupus are listed below.
 
·         Fatigue
·         Fever
·         Weight loss
·         Weight gain 
·         Joint pain and swelling
·         A butterfly-shaped rash on the face that covers the cheeks and the top of the nose
·         Skin changes that appear or get worse when the person is in the sun
·         Mouth sores
·         Hair loss
·         Blue or white fingers and toes when the person is cold or under stress
·         Shortness of breath
·         Anxiety
·         Chest pain
·         Dry eyes
·         Easy bruising
·         Anxiety
·         Depression
·         Memory loss

Risk Factors

Some people are more apt to get lupus than others. Some of the risk factors are:

·         Age. It is most often diagnosed in people beteen 15 and 40 years of age.
·         Sex. It is most common in women.
·         Race. It is most often seen among Asians, hispanics and African Americans
·         Sunlight. People that are in the sun a lot get it more than other people who do not spend a lot of time in the sun.
·         Some drugs. Some drugs lead to lupus. For example, some heart drugs, TB drugs, and antipsychotic drugs put the person at risk especially when they are taken for a long time.
·         Some infections. People who get infected with the Epstein-Barr virus are more at risk than other people who never got this infection. 
·         Some chemicals. Peoole that are exposed to chemicals, like mercury cigarettes and silica, are at greater risk than those who are not exposed to these things.
 
What Damage Does It Cause?
 

Lupus affects many parts of the body. The damage and the system affected are desribed below.
 
Kidneys. Kidney failure is one of the most common causes of death as a result of lupus. About ¾ of the people with lupus have this kind of damage within 2 years after they get this disease. As a result, they may have pain, itching, nausea, vomiting, leg swelling and weight gain. This problem is usually treated with drugs.
Brain. The person may be dizzy and confused. They may have headaches, seizures, changes in behavior, memory problems and trouble telling people what they need or think. 
Blood . Some people may have anemia, bleeding, bloodclotting problems and/or a serious problem with their veins. 

Lungs. Many may have trouble breathing because they have a problem with their lungs or a pneumonia.
Heart. Lupus can cause inflammation of all parts of the heart. This can lead to high blood pressure, heart attacks and hard arteries.
Infection. Some people will get infections easily. They occur because the person may be taking certain drugs that lower the person’s ability to fight off germs and some may get them because of the disease itself. These patients may get urine or lung infections, like pneumonia and food related infections. We must protect these people from all germs so that they do not get these serious things. Handwashing and infection control are very important.
Cancer. People with lupus often get cancer, like lung cancer, more than other people.
Bones. The bones may become weaker and weaker over time. This can lead to bone breaks or fractures. Again, we have to protect our patients from injury to their bones. These bones are not as strong as they should be. These bones may break very easily.
Pregnancy problems. Many people with lupus, who get pregnant, may lose the baby before it is born. Others may have their baby sooner than they should. These babies will be very, very tiny. They will need lots of care after they are born. Some of these tiny babies live. Others die because they were born too soon. The mother may also get very high blood pressure while they are carrying the baby before it is born. These mothers need good care from their doctor.
How Do People Find Out That They Have Lupus?

It is often very hard for the doctor to diagnose lupus. This is because the signs vary from person to person. They also vary over time. Some signs may come and others may go. Also, the signs are very often like those of other diseases and disorders like arthritis. So, it is hard find out what is wrong with the person.
 
Some doctors will decide that the person has it after the person has at least four of the following signs:

·         Face rash with a butterfly shape across the nose and the person’s cheeks
·         Raised, scaly patches on the person’s skin
·         A rash that appears after the person has been in the sun
·         Mouth sores that do not cause the person any pain
·         Pain and swelling of two or more bone joints
·         A swollen lining around the heart or the lungs
·         A kidney disorder
·         Seizures or a mental health disorder that can happen when lupus affects the nervous system
·         A low blood count (low red blood cells, white blood cells, etc.)
·         A positive autoimmune disease lab test
·         The results of other lab tests
How Is It Treated?

 

The treatment of this disease depends on the signs and symptoms that the person is having. Drugs and other treatments are often used. All drugs have side effects. For example, NSAIDs may lead to a bleed in the stomach or heart problems.

The person may get one or more of the following kinds of drugs:

·         NSIADs. Drugs like aspirin, Aleve and Advil.
·         Malaria drugs.
·         Steroids. Pills and skin creams are used.
·         Immune system drugs.  These are used to slow down this system when a person is having very serious problems
Other treatments can include natural things like:

• Fish oil
• Flax seed

How Can A Flare Up Be Prevented?
Since many people with lupus have periods of time when they feel fine and other periods of time when they will be ill. It is important to prevent flare ups so the person can feel fine most of the time or all of the time. People can prevent flare ups by doing some of these things. People with lupus should be told to do these things:

• Stay out of the sun and use sun screens
• Get rest so they will not be tired
• Get regular exercise for about at least ½ hour each day
• Eat a good, healthy diet
• Do not smoke

Helping the Person With Lupus
Many people with lupus get depressed. They may also have anxiety and low self esteem. We must be patient with the person and allow the person to talk about their sad thoughts. You must give the person support and caring. You should try to build up their self esteem. Praise them. Give them things that they can do. Praise them when they are able to do it.
Summary
Lupus is a serious disease that can be controlled and managed over a life time if the person can prevent flare ups and some of the serious effects, like kidney and heart problems.
The healthcare team plays an important role in helping the person to live as normal and as long a life as possible.
Copyright © 2010 Alene Burke
References
Mayo Clinic (2009). “Lupus”.http://www.mayoclinic.com/health/lupus/DS00115