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Systemic lupus erythematosus

Also listed as: Lupus

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis/Possible Complications
• Following Up
• Supporting Research

Systemic lupus erythematosus (SLE) is the most common form of lupus. Lupus is an autoimmune disorder in which the body harms its own healthy cells and tissues. This leads to inflammation and damage of body tissues in the joints, skin, kidneys, heart, lungs, blood vessels, or the brain. Lupus is also considered a rheumatic disorder because it can cause aches, pain, and stiffness in the joints, muscles, and bones.

Lupus usually first affects people between the ages of 15 - 45 years, but it can also occur in childhood or later in life. Patients experience periods of chronic disease and remission. The prevalence of the disease is not precisely known, ranging from an estimated 15 - 50 cases per 100,000 people.

Signs and Symptoms

Lupus is often accompanied by the following signs and symptoms.

• Extreme fatigue
• Painful or swollen joints (arthritis)
• Muscle pain and stiffness
• Unexplained fever
• Skin rashes, including a "butterfly" rash over the nose and cheeks
• Kidney problems
• Hair loss
• Nausea, vomiting, abdominal pain
• Headaches, migraine, seizures, stroke
• Depression, anxiety, confusion
• Photosensitivity (sensitivity to sunlight)

What Causes It?

The cause of lupus is unknown. Many researchers suspect it occurs following infection with an organism that looks similar to particular proteins in the body, which are later mistaken for the organism and wrongly targeted for attack.

Who's Most At Risk?

The following categories of people are at higher than average risk for lupus:

• Many more women than men have lupus.
• Lupus is more common in black women and women of Hispanic, Asian, and Native American descent than in white women.
• Lupus can run in families, but the risk that a child or a brother or sister of a patient also will have lupus is quite low.

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with lupus, you should see your health care provider. A team of specialists usually becomes involved in making a diagnosis and determining which treatment or combination of therapies will work best for you. Because lupus is so complex, reaching a diagnosis may gradually take time as new symptoms appear.

A diagnosis of lupus is based on a physical examination and the results of laboratory tests, including the following:

• Complete blood count.
• Erythrocyte sedimentation rate (ESR) — an elevated ESR indicates inflammation in the body
• Urinalysis.
• Blood chemistries.
• Complement test (a blood test that measures severity of infection).
• Antinuclear antibody test (ANA) — positive in most lupus patients.
• Other antibody tests.
• Syphilis test (may be falsely positive in people with lupus).
• Skin or kidney biopsy.

Imaging techniques may be used to evaluate central nervous system changes or problems and other symptoms associated with lupus.

Treatment Options

Prevention

While lupus itself cannot be prevented, there are ways to prevent flare-ups. These include the following:

• Avoiding sun exposure, high-dose birth control pills, penicillin, and sulfonamides (anti-bacterial agents)
• Exercising regularly
• Receiving flu and pneumococcal vaccines

Treatment Plan

There is no known cure for lupus. However, your team of health care professionals can develop a treatment plan to prevent flare-ups, to treat them when they do occur, and to minimize complications.

Drug Therapies

Your health care provider may prescribe the following medications:

• Corticosteroid hormones, to rapidly suppress inflammation. For patients who cannot take corticosteroids, a type of immunosuppressive drug called methotrexate may be used.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), to control pain, swelling, and fever.
• Antimalarials, to treat fatigue, joint pain, skin rashes, and inflammation of the lungs, and to prevent flare-ups from recurring.
• Immunosuppressives, which restrain the overactive immune system by blocking the production of some immune cells and curbing the action of others.
• Intravenous gamma globulin, a blood protein that increases immunity, helps fight infection, and controls acute bleeding.

Surgical and Other Procedures

Surgery is sometimes performed for lupus-related ailments.

Complementary and Alternative Therapies

A comprehensive treatment plan for lupus may include a range of complementary and alternative therapies.

Nutrition and Supplements

Nutritional tips for patients with lupus include the following.

• Eliminate all suspected food allergens, including dairy, wheat (gluten), soy, chocolate, corn, preservatives and food additives. Avoid alfalfa sprouts and onions. Your health care provider may want to test you for food allergies.
• Eat more antioxidant-rich foods (such as green, leafy vegetables) and fruits (such as blueberries, pomegranates, and cherries).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise moderately at least 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

• Omega-3 fatty acids, such as flaxseed and fish oils, 1 - 2 capsules or 1 tablespoonful oil daily, to help decrease inflammation. Cold-water fish, such as salmon or halibut, are good sources.
• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant effects.
• N-acetyl cysteine, 200 mg daily, for antioxidant effects.
• Dehydroepiandrosterone (DHEA), start at 5 mg three times a day and work up to 100 mg per day for 7 - 12 months. If adverse effects develop, discontinue use and consult your health care provider.
• Calcium and vitamin D supplement, 1 - 2 tablets daily if taking corticosteroids.
• Methylsulfonylmethane (MSM), 3,000 mg twice a day, to help prevent joint and connective tissue breakdown.
• Melatonin, 2 - 5 mg before bed, for sleep and immune system regulation.

Herbs

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls per cup of water steeped for 10 - 15 minutes (roots need longer).

• Green tea ( Camelia sinensis ) standardized extract, 250 - 500 mg daily, for antioxidant effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Tripterygium wilfordii , 180 - 360 mg daily, a Chinese herb for immune system function. You may also prepare teas from the root of this herb.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for lupus based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Apis mellifica
• Arsenicum album
• Calcarea carbonica
• Causticum
• Rhus toxicodendron
• Ruta graveolens
• Thuja occidentalis

Acute dose is 3 - 5 pellets of 12X to 30C every 1 - 4 hours until symptoms are relieved.

Acupuncture

Acupuncture may help balance the immune system during remissions, and alleviate flare-ups. Acupuncture also may reduce pain and stiffness.

Prognosis/Possible Complications

The prognosis for lupus patients is mixed. Half of lupus patients who go into remission remain so for decades, but 90% of patients have complications. For women, symptoms tend to decrease after menopause. Ninety percent of patients have a survival rate of 10 years, and 63 - 75% have a survival rate of 20 years. Patients with certain complications from lupus tend to have a poor prognosis. The major cause of lupus-related death is infection.

Following Up

Patients need to be closely monitored during flare-ups to determine the appropriate course of treatment and induce remission.

Supporting Research

Bartram T. Encyclopedia of Herbal Medicine . Dorset, England: Grace Publishers; 1995:278. Bast A, Haenen GR. Lipoic acid: a multifunctional antioxidant. Biofactors . 2003;17(1-4):207-13.Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr . 2006;25(2):79-99. Carillo-Vico A, Reiter RJ, Lardone PJ, et al., The modulatory role of melatonin on immune responsiveness. Curr Opin Investig Drugs . 2006;7(5):423-31. Cecil R, ed. Cecil Textbook of Medicine . 20th ed. Philadelphia, Pa: W.B. Saunders; 1996. Dambro MR. Griffith's 5-Minute Clinical Consult . 1999 ed. Baltimore, Md: Lippincott Williams & Wilkins, Inc.; 1999. Dryden GW Jr, Deaciuc I, Arteel G, McClain CJ. Clinical implications of oxidative stress and antioxidant therapy. Curr Gastroenterol Rep . 2005;7(4):308-16. Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine . 14th ed. New York, NY: McGraw-Hill; 1998. Koopman WJ, ed. Arthritis and Allied Conditions . 13th ed. Baltimore, Md: Williams & Wilkins, Inc.; 1997. Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms . Albany, Calif: Hahnemann Clinic Publishing; 1993:39-44, 82-87, 272-276, 390-392. Ramgolam V, Ang SG, Lai YH, Loh CS, Yap, HK. Traditional Chinese medicines as immunosuppressive agents. Ann Acad Med Singapore . 2000;29(1):11-6. Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin . 2001;17(1):239-47. Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr . 2002;21(6):495-505. Tao X, Lipsky PE. The Chinese anti-inflammatory and immunosuppressive herbal remedy Tripterygium wilfordii Hook F. Rheum Dis Clin North Am . 2000;26(1):29-50, viii. Val Vollenhoven RD, Engleman, EG, McGuire JL. An open study of dehydroepiandrosterone in systemic lupus erythematosus. Arthritis Rheumatol. 1994;37:1305-1310. van Vollenhoven RF. Dehydroepiandrosterone for the treatment of systemic lupus erythematosus. Expert Opin Pharmacother . 2002;3(1):23-31. Werbach M. Nutritional Influences on Illness . New Canaan, Conn: Keats Publishing Inc;1987:292-296.

• Review Date: 8/4/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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