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Post  Hummingbird on Wed Oct 21, 2009 12:43 pm

Lupus is a chronic inflammatory disease that occurs when your body's immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different body systems, including your joints, skin, kidneys, blood cells, heart and lungs.

Lupus occurs more frequently in women, though it isn't clear why. Four types of lupus exist — systemic lupus erythematosus, discoid lupus erythematosus, drug-induced lupus erythematosus and neonatal lupus. Of these, systemic lupus erythematosus is the most common and serious form of lupus.

The outlook for people with lupus was once grim, but diagnosis and treatment of lupus has improved considerably. With treatment, most people with lupus can lead active lives.

No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus have mild disease characterized by episodes — called flares — when signs and symptoms get worse for a while, then improve or even disappear completely for a time.

The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. But, in general, lupus signs and symptoms may include:

* Fatigue
* Fever
* Weight loss or gain
* Joint pain, stiffness and swelling
* Butterfly-shaped rash (malar rash) on the face that covers the cheeks and bridge of the nose
* Skin lesions that appear or worsen with sun exposure
* Mouth sores
* Hair loss (alopecia)
* Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon)
* Shortness of breath
* Chest pain
* Dry eyes
* Easy bruising
* Anxiety
* Depression
* Memory loss

When to see a doctor
If you develop an unexplained rash, ongoing fever, persistent aching or fatigue, see your doctor.

If you've already been diagnosed with lupus, meet with your doctor on a regular basis so that your condition and treatment can be monitored. Make an appointment with your doctor if new symptoms arise.

Lupus is an autoimmune disease, which means that instead of just attacking foreign substances, such as bacteria and viruses, your immune system also turns against healthy tissue. This leads to inflammation and damage to various parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels and brain.

Doctors don't know what causes autoimmune diseases, such as lupus. It's likely that lupus results from a combination of your genetics and your environment. Doctors believe that you may inherit a predisposition to lupus, but not lupus itself. Instead, people with an inherited predisposition for lupus may only develop the disease when they come into contact with something in the environment that can trigger lupus, such as a medication or a virus.

Types of lupus
Four types of lupus exist. Although similar, each type of lupus has a different prognosis and treatment.

* Systemic lupus erythematosus can affect nearly any part of your body. Body systems most commonly involved include the skin, joints, lungs, kidneys and blood. When people talk about lupus, they're usually referring to systemic lupus erythematosus.
* Discoid lupus erythematosus affects only the skin. People with discoid lupus, also called cutaneous lupus, experience a circular rash on the face, neck and scalp. A small number of people with discoid lupus may develop systemic lupus erythematosus, though it isn't possible to predict who will develop the more serious form of lupus.
* Drug-induced lupus erythematosus occurs after you take certain prescription medications. Not everyone who takes these medications develops lupus. Drug-induced lupus affects a wide variety of body systems. Signs and symptoms usually go away when you stop taking the medication that caused your lupus.
* Neonatal lupus is a rare form of lupus that affects newborn babies. A mother with certain antibodies that are linked to autoimmune diseases can pass them to the developing fetus — even if the mother has no signs or symptoms of an autoimmune disease. The antibodies can cause neonatal lupus. A baby with neonatal lupus may experience a rash in the weeks following birth. Neonatal lupus may last several months before disappearing. More-serious cases can cause a problem with the electrical system of the heart (congenital heart block).

While doctors don't know what causes lupus in many cases, they have identified factors that may increase your risk of the disease, including:

* Sex. Lupus is more common in women.
* Age. Although lupus affects people of all ages, including infants, children and older adults, it's most often diagnosed between the ages of 15 and 40.
* Race. Lupus is more common in blacks, Hispanics and Asians.
* Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people. Exactly why ultraviolet radiation has this effect isn't well understood, but scientists suspect that sunlight may cause skin cells to express certain proteins on their surface. Antibodies that are normally present in the body then latch onto these proteins, initiating an inflammatory response. Damaged skin cells also seem to die more frequently in people with lupus, leading to even more inflammation.
* Certain prescription medications. Drug-induced lupus results from the long-term use of certain prescription drugs. Although many medications can potentially trigger lupus, examples of drugs most clearly linked with the disease include the antipsychotic chlorpromazine; high blood pressure medications, such as hydralazine (Apresoline); the tuberculosis drug isoniazid and the heart medication procainamide (Pronestyl, Procanbid), among others. It usually takes several months or years of therapy with these drugs before symptoms appear, and even then, only a small percentage of people will ever develop lupus.
* Infection with Epstein-Barr virus. Almost everyone has been infected with a common human virus called Epstein-Barr virus. Epstein-Barr virus causes nonspecific signs and symptoms, such as fever and sore throat. Once the initial infection subsides, the virus remains dormant in the cells of your immune system unless something reactivates the virus. For reasons that aren't clear, recurrent Epstein-Barr infections seem to increase the risk of developing lupus.
* Exposure to chemicals. It's difficult to prove that chemicals can cause or increase the risk of a disease. But some studies have shown that people who work in jobs that involve exposure to mercury and silica may have an increased risk of lupus. Smoking cigarettes also may increase your risk of developing lupus.

Inflammation caused by lupus can affect many areas of your body, including your:

* Kidneys. Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus. Up to three-quarters of people with lupus will develop kidney damage, usually during the first two years after diagnosis. However, with treatment, most people who develop lupus-related kidney problems can be effectively treated with medications. A blood test called serum creatinine level and urinalysis are used to monitor kidney function. Signs and symptoms of kidney problems may include generalized itching, chest pain, nausea, vomiting, leg swelling (edema) and weight gain.
* Central nervous system (CNS). If your central nervous system is affected by lupus, you may experience headaches, dizziness, behavior changes, hallucinations and even seizures. As many as 80 percent of people with lupus may experience cognitive dysfunction, such as confusion, memory problems and difficulty expressing their thoughts.
* Blood and blood vessels. Lupus may lead to blood problems, including anemia and increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels (vasculitis), a serious complication responsible for 7 percent of lupus-related deaths.
* Lungs. Having lupus increases your chances of developing an inflammation of the chest cavity lining (pleurisy) that can make breathing painful. You may also be more susceptible to a noninfectious form of pneumonia. Although a majority of people with lupus develop lung problems that can be detected by pulmonary tests, lung complications are rarely severe and often produce no symptoms.
* Heart. Lupus can cause inflammation of your heart muscle (myocarditis and endocarditis), your arteries (coronary vasculitis) or heart membrane (pericarditis). Having lupus also greatly increases your risk of cardiovascular disease and heart attacks. Nearly 40 percent of people with lupus develop prematurely hardened arteries (atherosclerosis), compared with 15 percent of their peers who don't have lupus. Controlling high blood pressure and high blood cholesterol, not smoking, and getting regular exercise are essential to help reduce the risk of heart disease.
* Infection. People with lupus are vulnerable to infection because both the disease and its treatments — corticosteroid and cytotoxic drugs, in particular — affect the immune system. And in a vicious cycle, infection can bring on a lupus flare, increasing the risk of infection even more. Infections that most commonly affect people with lupus include urinary tract infections; common respiratory infections, such as colds; yeast infections; salmonella; herpes and shingles. More-serious infections, such as pneumonia, account for about one-third of lupus-related deaths.
* Cancer. Having lupus appears to increase your risk of cancer — especially non-Hodgkin's lymphoma, which affects the lymphatic system, and lung cancer. Immunosuppressant drugs that are sometimes used to treat lupus also can increase the risk of cancer. However, other than a slightly increased risk of death from non-Hodgkin's lymphoma or lung cancer, people with lupus are less likely to die of cancer than is the general population.
* Bone tissue death (avascular necrosis). This occurs when the blood supply to a bone diminishes, often leading to tiny breaks in the bone and eventually to the bone's collapse. The hip joint is commonly affected, although avascular necrosis can occur in other bones as well. Avascular necrosis can be caused by lupus itself or by high doses of corticosteroids used to treat the disease. About 1 in 10 people with lupus develops symptoms of avascular necrosis.
* Pregnancy complications. Women with lupus have an increased risk of miscarriage. Some women with lupus experience a flare during pregnancy. Lupus increases the risk of high blood pressure during pregnancy (preeclampsia) and preterm birth. About 2 in 10 women with lupus develop preeclampsia, and about 1 in 4 will deliver healthy babies prematurely. In addition, about 1 in 4 women with lupus who becomes pregnant will experience a miscarriage. To reduce the risk of these complications, doctors advise waiting to get pregnant until your disease has been under control or in remission for one year.

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Post  Hummingbird on Wed Oct 21, 2009 1:00 pm

Oct. 20, 2009 (Philadelphia) -- Women who spray their homes and gardens with insecticides may be placing themselves at risk for rheumatoid arthritis and lupus, a study shows.

In a study of more than 75,000 women, those who used insecticides six or more times a year had nearly two-and-a-half times the risk of developing the autoimmune diseases than women who adopted a live-and-let-live attitude toward bugs.

Similarly, the risk more than doubled if bug sprays were used in the home for 20 or more years.

Hiring a gardener or commercial company to apply insecticides also resulted in a doubling of risk, but only if they were used long-term, says Christine G. Parks, PhD, an epidemiologist with the National Institute of Environmental Health Sciences in Research Triangle Park, N.C.

"Our new results provide support for the idea that environmental factors may increase susceptibility or trigger the development of autoimmune diseases in some individuals," she says.

Although the study doesn't prove cause and effect, "we need to start thinking about what chemicals or other factors related to insecticide use could explain these findings," Parks tells WebMD.

The researchers used data from the Women's Health Initiative Observational Study of 76,861 postmenopausal, predominantly white women ages 50 to 79. Of the total, 178 of them had rheumatoid arthritis and 27 had lupus. An additional eight women had both disorders. As part of the study, the women were asked a number of questions relating to farming and insecticide use.

"Importantly, the relationships we observed were not explained by other factors that we considered, including farm history, age, race, ethnicity, socioeconomic factors such as education and occupation, smoking and other risk factors for disease," Parks says.

Interestingly, a history of working or living on a farm did not appear to increase risk of rheumatoid arthritis or lupus in the study, she adds. Previous studies have linked farming and agricultural pesticide exposure to the disorders.

The findings were presented at the annual meeting of the American College of Rheumatology.

Studies show that as many as three-fourths of U.S. households have reported using insecticides in the home or garden, and 20% of households have applied insecticides in the last month, according to Parks.

"Insecticide exposure in the home can be quite persistent because they don't break down in the home environment," Parks says.

"The findings are fairly compelling" because they show the greater and longer the exposure, the greater the risk, says Darcy Majka, MD, assistant professor of medicine at Northwestern University Feinberg School of Medicine.

"Now we have to go back to the bench. Which products pose a risk? Is skin exposure [to blame], or inhaling?" she says.

For now, Majka tells WebMD, "The important thing is to follow the directions [on the product] and take other measures to limit chemical exposure."

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Post  Hummingbird on Wed Oct 21, 2009 1:07 pm

Oct. 20, 2009 (Philadelphia) -- The first in a new class of experimental drugs that targets the disease process involved in lupus beat out standard treatment in a large clinical trial, researchers say.

If the findings hold up, the drug, Benlysta, could become the first new drug for lupus in five decades.

About 1.5 million Americans have lupus, a complex disease in which the immune system attacks a person's own tissues, wreaking havoc on the joints, skin and other organs. Benlysta dampens the abnormal immune signals, calming down the immune system.

The new study involved 865 patients on standard therapy, including steroids, for lupus. One-third were also given a high dose of Benlysta, one-third a low dose, and one-third received a placebo.

Sandra V. Navarra, MD, head of rheumatology at the University of Santo Tomas, Manila, Philippines, reported the findings at the 73rd Annual Scientific Meeting of the American College of Rheumatology.

After one year, 58% of patients on high-dose Benlysta experienced a significant improvement in symptom severity, compared with just 43% of those on placebo.

Patients taking Benlysta also had fewer disease flare-ups, fewer severe flare-ups, and a longer time between flare-ups. They also reported less fatigue and better quality of life.

Previously reported findings from the study showed that the drug is also more effective at reducing pain, hair loss, and skin rash than placebo.

Of particular note, doctors say, was that more patients taking Benlysta were able to reduce their steroid dose. "One of the most important goals of treatment is to get patients off steroids, which cause so many unforgivable side effects -- bloating, weight gain, acne, high blood pressure, and others," says Joan T. Merrill, MD, medical director of the Lupus Foundation of America.

The most common adverse events were headache, muscle pain, upper respiratory tract infections, urinary tract infection, and influenza, and were comparable between the three treatment groups. Serious infections were reported by about 6% of patients in all three groups.

Human Genome Sciences Inc. and GlaxoSmithKline, which are developing the drug, funded the study.

Results of another large trial pitting Benlysta against standard care are scheduled to be released next month. If the drug works as well as in this study, the companies plan to apply for FDA approval of the drug.

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