Lupus Autoimmune 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 OlusegunOlumideAdelo Samuel), British artist/singer • Charles Kuralt, former anchor of CBS Sunday Morning • IndayBa (also known as N'DeayeBa), 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>.