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>.