Assessment of Disease Activity:
Monitoring of SLE in clinical practice is based upon differentiating disease activity from organ damage accrual. A variety of disease activity indices have been formulated, including the SLEDAI (Systemic Lupus Erythematosus Disease Activity Index), SLAM (Systemic Lupus Activity Measure), BILAG (British Isles Lupus Assessment Group) (Ben-Menachem, 2011).
Assessing Chronic Damage of SLE:
In 1996, a damage index for SLE was developed by the SLICC and endorsed by the ACR; hence, it has become known as the SLICC/ACR Damage Index which complements other measures of lupus disease activity as an outcome measure (Gladman et al., 1996).
There is international consensus that it is the best instrument to measure organ
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B. Pharmacologic treatments:
1- Non steroidal anti-inflammatory drugs (NSAIDs):
NSAIDs are generally effective for musculoskeletal complaints, fever, headaches, and mild serositis (Schur and Wallace, 2012). NSAIDs may cause acute interstitial nephritis, acute tubular necrosis or membranous nephropathy so should be avoided in lupus nephritis. NSAIDS may be responsible for neuropsychiatric features like headache, dizziness, aseptic meningitis, etc. which need differentiation from neuropsychiatric involvement in SLE (Vasudevan and Ginzler, 2009).
2- Glucocorticoids:
Lympholytic (lysis of lymphocytes), inhibit mitosis of lymphocytes, reduce size and lymphoid content of the lymph node and spleen, inhibit the production of inflammatory mediators, including Platelet activator factor, leukotrienes, prostaglandins, histamine and bradykinin (Bertram, 2012).
In SLE, glucocorticoids remain the most important and most effective short-term therapy. Multiple studies have shown improvement in survival with glucocorticoid use (Lo and Tsokos, 2012).
High doses of 1 to 2 mg/kg/day of prednisone (or equivalent) or as intermittent intravenous "pulses" of methylprednisolone used alone or in combination with immunosuppressive agents are generally reserved for patients with significant organ involvement, particularly renal and CNS disease. Patients usually respond to 5 to 15 mg of prednisone daily until a steroid-sparing agent or
ANA: test for these autoantibodies (very general); DsDNA (+): Making antibodies to and attacking own DNA; Anti-Sm (+): these antibodies generally interfere with the cells metabolism and are responsible for the symptoms specifically seen with SLE. Here, they are specifically targeted at smooth muscle. CRP elevated: also indicates presence of inflammation, but is more specific towards disease activity; ESR elevated: indirectly indicates the activity of the disease and presence of inflammation; C3 and C4 (decreased): C3 and C4 usually attack the membranes of viruses and bacteria, but in the case of lupus, they attack the own body’s cells. When C3 and C4 suggest the disease is active
Management of SLE often depends on the severity of the disease. One treatment option are nonsteroidal anti-inflammatory drugs (NSAIDs), usually taken orally. There are over-the-counter NSAIDs such as ibuprofen, Advil, and aspirin. NSAIDs are used to treat swelling, pain and fever associated with lupus. They are also an inflammation suppressant. Different people respond better to one certain NSAIDs than another, sometimes a stronger NSAID is needed and available with a prescription. Jillian has already been taking ibuprofen, either a prescription NSAID would be needed or another treatment option. Immunosuppressants are also used as a treatment for SLE. Immunosuppressants, taken orally, are drugs that are used to suppress the immune system, which is helpful in more serious cases of lupus. Immunosuppressants work to suppress SLE symptoms “by interfering with the synthesis of DNA, the material in your cells that contain the blueprints for all of your genetic information” (Johns Hopkins Lupus Center). It is important for Jillian to get the right treatment for SLE, the symptoms are interfering with her daily life in a detrimental way. By managing her symptoms, Jillian will be able to live a normal
Joint pain is common in Lupus. Patients suffer from arthritis-like pain, swelling in the joints, redness and stiffness. These symptoms involve one or more joints.
In the journal, A Review of Systemic Lupus Erythematosus and Current Treatment Options, focus on the clinical presentation of systemic lupus erythematosus treatment options from pharmacological and
Szuda, Stephanie “Health: Life with Lupus.” The Times. 11 Jan 2008. 19 Nov 2010. <Mywebtimes.com>
Systemic lupus erythematosus (SLE) is a disease in which a person’s own immune system begins to recognize its own tissues and organs as foreign antigens which causes it to attack and injure those targeted structures (Perspectives 14). Discoid lupus erythematosus (DLE) causes coin-shaped lesions to appear on the skin and does not affect any other system other than the integumentary (Perspectives 23). As stated on the Mayo Clinic website the etiology of the disease is idiopathic, but it is believed that environmental factors and inherited genetic code may contribute to the formation of lupus. Lupus can also be triggered by sunlight, infections, and medications such as anti-seizure and hypertension prescriptions (Mayo Clinic). Iatrogenic cases of the disease often have their symptoms reduced or eradicated after stopping those medications (Mayo Clinic). Diagnosis of the disease is based upon criteria set in place by the American College of Rheumatology as lupus often affects the muscle and joints (Lupus.org). The list is comprised of eleven common signs and symptoms that have been observed by rheumatologists. They are: Malar or
Lupus is an autoimmune disease that attacks women between the ages of 15 and 40. It occurs less often in men than in women. The people affected by lupus vary depending on the country or region. In the US alone, the prevalence rate is highest among Asians of Hawaii, blacks of Caribbean origin, and Native Americans of the Sioux, Arapahoe, and Crow tribes. Lupus is a disease that affects the immune system. We can think of the immune system as an army within the body with hundreds of defenders (known as antibodies). They defend the body from attack by germs and viruses. In lupus, however, the immune system becomes overactive and creates antibodies that attack healthy tissues in the body, such as: the skin, kidneys, lungs, heart and brain.
Systemic lupus erythematosus, or simply lupus is a chronic autoimmune disease or immune system malfunction. A person's immune system normally protects the person from viruses, bacteria and other foreign materials. When a person has an autoimmune diseases like lupus, the immune system turns against itself and attacks itself.
Makover, M. & Zieve, D. (2011, February 14). Systemic Lupus Erythematosus. National Center for Biotechnology Information. Retrieved July
There are many different ways to treat Lupus. The most common treatment does not cure Lupus, but minimizes the symptoms and reduces inflammation. Support groups to help relieve anxiety and regular exercise can help treat the disease as well. There are a bunch of drugs that can be prescribed to help treat the specific symptoms. Most of these drugs are anti-inflammatory drugs. Some of them are as simple as over the counter painkillers like Tylenol, while others can be powerful steroids with anti-inflammatory agents in them. (The Lupus Foundation of America, The Lupus Page)
The aim of the pharmacology is pain management. The medications given are able to reduce the frequency and severity of the attacks seen with the disease. One of the medication is corticosteroids which is able to cut an attack time short. Corticosteroids, such as Prednisone, are a class of drug based of a component of the hypothalamic- pituitary-adrenal axis that control immune responses and reduce inflammation. The mechanism of action of the class is reducing the body’s autoimmune response and inhibits it from attacking its own tissues as it does in MS. The decrease in time and inflammation can result in decrease damage to the brain and spinal cord leading to a reduce progression of the disease. The steroids should only be used for a short period of time because long-term side effects. Some side effects include insomnia, headache, and suppression of immune system. The steroids sometime has to be given in combination therapy with antibiotics such as Sulfamethoxazole to fight possible infections. The chance of infections increases with the suppression of the immune system. Other drugs take care of symptoms such as muscle spasms, incontinence, and
Lupus is an autoimmune disease in an overly active state that attacks healthy, functioning tissue. This disease is not well known mainly for two reasons, firstly, it is not given enough hype in social media. Secondly, many people show symptoms during the early stages of lupus however, the victims do not recognize its severity until the disease has afflicted permanent damage. This is usually because some symptoms are similar to other less threatening ailments. Lupus affects many systems of the body which include the gastrointestinal system, the cardiopulmonary system, the musculoskeletal system, the renal system, and the integumentary system. This disease is formerly caused by genetic inheritance however, there are a great number of factors that trigger the immediate onset of lupus, as it is not necessarily prevalent on a person who has the genes from birth. Although there is no known cure for lupus, efficacious forms of treatment are possible.
The detection of autoantibodies against intracellular targets called antinuclear antibodies (ANA) is important in the diagnosis of systemic autoimmune rheumatic diseases (SARD) such as systemic lupus erythematosus (SLE), Sjögren's syndrome (SjS), mixed connective tissue diseases (MCTD), systemic sclerosis (SSc) and idiopathic inflammatory myopathies (IIM). Testing for ANA is therefore a logical first step in the differential evaluation of patients when systemic autoimmune etiology is suspected. Timely diagnosis of SARD is challenging due to the wide spectrum of overlapping symptoms. Furthermore, while the frequency of ANA is highest in patients with SARD, these antibodies are also found in
Most lupus patients are followed very closely by many different types of physicians and specialist due to the multisystem organ involvement. These doctors may include but are not limited to Rheumatologist who specializes in diseases of the joints; there are also Nephrologists the kidney doctor, the Optometrist doctor for the eyes, the Neurologist for the brain and central nervous system, the Cardiologist for the heart and the Primary Care Physician. All of these doctors work together to manage S.L.E. It literally takes a team to help the patient manage and cope with the changes someone with lupus will undergo throughout the entire disease process.
Lupus is a chronic inflammatory disease marked by its effect on various parts of the body, including the joints, skin, blood, and kidneys. It is a condition in which the body's immune system attacks its own cells and tissues, resulting in pain, inflammation, and often damage to organs. Lupus involves the immune system. The immune system makes antibodies that work to protect the body against foreign substances like viruses and bacteria. Such foreign bodies are called antigens. When a person has lupus, his or her body is unable to determine the difference between antigens and the individual's cells and body tissues. As such, the immune system creates antibodies against the individual's own tissues. These antibodies are called autoantibodies. Depending on the type of lupus, a wide range of symptoms may be experienced, from rashes, hair loss, and achy, swollen joints to fever, anemia, and abnormal blood clotting. Though the disease can affect many parts of the body, individuals usually experience symptoms in only a few organs. There is no known cure for lupus. However,