LUPUSAutoimmune Disorder
HISTORY
Classical Middle Ages 12th century physician Rogerius
Neoclassical Moric Kaposi
Modern 1948 discovery of the LP cell
HISTORY CONT.
First Medications 1894 Quinine Salicylates
Corticosteroids Too much or too little?
EVEN MORE HISTORY
Origins Lupus is Latin for wolf ‘erythro’ is Greek for red
1. Rash resembles the pattern of fur on a wolfs face.
2. Rash creates lesions that resembled wolf bites or scratches
3. French women wearing masks 4. Repeated attacks like those of
a predator.
NOTABLE PATIENTS Ray Walston, character actor
Tim Raines, former major league baseball player, primarily with the Montreal Expos and Chicago White Sox
Ferdinand Marcos, former Philippine president, who died from complications of lupus in 1989
Michael Jackson, pop superstar, was diagnosed with the disease in 1984
Flannery O'Connor, American fiction writer who died of the disease in 1964
Hugh Gaitskell, British politician
J Dilla (also known as Jay Dee, born James Dewitt Yancey), a hip-hop producer and beatmaker who died of the disease in 2006
Elaine Paige, British actress and singer
Seal (born Seal Henry Olusegun Olumide Adelo Samuel), British artist/singer
Charles Kuralt, former anchor of CBS Sunday Morning
Inday Ba (also known as N'Deaye Ba), a Swedish-born actress who died from complications of lupus at age 32
Caroline Dorough-Cochran, sister of Howie D. of the Backstreet Boys, who founded the Dorough Lupus Foundation in her memory
Stephanie Smith, artist who died of SLE complication in 1969 at the age of 22. The anti-smith (or anti-Sm) antigen was discovered in her, and is the basis of a SLE diagnostic test.
Yonna, contestant on Ben Fogle's Extreme Dreams.
Louisa May Alcott, American author
Sophie Howard, British glamour model
Donald Byrne, American chess player who died from complications of lupus in 1976
Mercedes Scelba - Shorte, America's Next Top Model season 2 runner up
Mary Elizabeth McDonough, American actress. Reportedly contracted it after undergoing silicone implantation in her breasts in 1984
Leslie Hunt, semifinalist on American Idol, 19th place
LUPUS IS…
Autoimmune disorder Autoantibodies cause inflammation to various
body parts as well as damaging organs and tissues
Most common is antinuclear antibodies (ANA) and these antibodies attack a cells DNA
Most Lupus carriers will test positive for ANA but so will sick people, other autoimmune disorders, and sometimes perfectly healthy people as well
TYPES OF LUPUS
Systemic lupus erythematosus Any part of body Lupus in general normally refers to this
Discoid lupus erythematosus Only the skin Rash on the face, neck and scalp
TYPES OF LUPUS Drug-induced lupus erythematosus
Caused by prescription medications S/Sx go away once you stop taking the medication
Neonatal lupus The mother is a carrier that normally isn't showing
any signs of Lupus. The baby develops a rash on the face that normally
disappears within 6 months to never come back.
SIGNS AND SYMPTOMS
Lupus come in two stages a Flare and a Remission Flare – where the symptoms present
Painful or swollen joints or muscles Unexplained fever Red rashes most commonly on the face Chest pain when breathing in deeply Loss of hair Purple fingers or toes Sensitivity to the sun Edema in the legs Ulcers in the mouth Swollen glands Extreme fatigue
Remission During this time the symptoms of Lupus are hidden
CAUSES OF LUPUS
Environment vs. Genetics Environment
Sunlight UV radiation damages the skin causing a flare
Medications Chlorpromazine – antipsychotic HTN – hydralazine TB drug – isoniazid Heart med – procainamide
Infection Epstein-Barr virus
CAUSES OF LUPUS CONT.
Genetics Lupus seems to run in families but also appears
in families with no history. Chromosome 6 More research is being done Inherited predisposition for Lupus
RISK FACTORS
Sex 3x more likely in women
Age 15 to 45 years old
Race 3x more likely in African Americans More common in women of Hispanic, Asian, and
Native American decent Sunlight
Trigger a response in those that are susceptible Medications Overweight Smoking
DIAGNOSING LUPUS
American College of Rheumatology Must meet 4 of these 11 criteria and you
probably have Lupus Face rash, covers bridge of nose and spreads across
the cheeks Scaly rash, which appears as raised scaly patches Sun related rash Mouth sores Joint pain and swelling in two or more joints Swelling of the lining of the heart and lungs Kidney disease Low blood counts Positive anti-nuclear antibody tests Other tests that indicate an autoimmune disease
MORE DIAGNOSTIC STUFF
Lab Tests Complete blood count Erythrocyte sedimentation rate Kidney and liver assessment Urinalysis Antinuclear antibody test Chest x-ray Electrocardiogram Syphilis test
A very long and drawn out process normally taking 1-3 years.
TREATMENT NSAIDs
Ibuprofen (Advil) Aspirin Some NSAIDs have been know to cause severe stomach
bleeding as well as increased rash of heart problems. Antimalarial drugs
There isn't any know connection between Lupus and Malaria but the drugs used to treat Malaria work very well.
Also shown to prevent flares. Side effects include vision problems and muscle weakness.
Corticosteroids Counter the inflammation Side effects include weight gain, easy bruising, thinning
bones, HTN, diabetes and increased risk of infection Take calcium and vitamin D to reduce osteoporosis
PREVENTION OF FLARES
Rest Be sun smart Exercise Don’t smoke Diet Watch for warning signs of a flare
Increased fatigue Pain Rash Fever Abdominal discomfort Headache Dizziness
PREGNANCY
Can have severe flares during pregnancy Echocardiograms during the 16th and 30th
week should be done to insure a healthy heart and surrounding vessels
Higher rate of miscarriage and premature births
Those with kidney problems have a high risk of developing preeclampsia
Ideally a woman should be without signs and symptoms of lupus or taking medications for at least 6 months before pregnancy
RESEARCH
Stem cell transplants Building an entirely new immune system
Dehydroepiandrosterone (DHEA) Hormone therapy
Rituximab Decreases number of B cells in the body
FURTHER INFORMATION
Alliance for Lupus Reasearch www.lupusresearch.org
American College of Rheumatology www.rheumatology.org
National Institute of Arthritis and Musculoskeletal and Skin Disease www.niams.nih.gov
WORKS CITED `Bledsoe, Bryan, and Robert Porter. Paramedic Care Principles and Practice. 2nd ed. Upper
Saddle River: Pearson Prentice Hall, 2005.
McCance, Kathryn, and Sue Huether. Pathophysiology The Biologic Basis for Disease in Adults and Children. 5th ed. St. Louis: Elsevier Mosby, 2006.
Venes (editor), Donald. "Lupus."Taber's Cyclopedic Medical Distionary. 20th ed. 2001.
Beers (Editor), Mark H.. "Systemic Lupus Erythematosus."The Merck Manual of Diagnosis and Therapy. 18th ed. 2006.
"Handout on Health: Systemic Lupus Erythematosus." National Insititute of Arthritis and Musculoskeletal and Skin Diseases. August 2003. NIAMS. 27 May 2008 <http://www.niams.nih.gov/Health_Info/Lupus/default.asp>.
"Lupus." Bones, Joints, and Muscles. October 2007. Mayo Clinic. 27 May 2008 <http://www.mayoclinic.com/health/lupus/DS00115>.
"Systemic lupus erythematosus." Wikipedia, The Free Encyclopedia. 26 May 2008, 20:29 UTC. Wikimedia Foundation, Inc. 27 May 2008 <http://en.wikipedia.org/w/index.php?title=Systemic_lupus_erythematosus&oldid=215123079>.