Lupus is a chronic inflammation caused by an autoimmune diseases. In autoimmune diseases, the immune system turns against parts of the body it is designed to protect. Patients with lupus produce autoantibodies such as antinuclear antibody (ANA) against the body's healthy cells and tissues affecting many parts of the body such as Heart, Lungs, Skin, Joints, Kidneys and Nervous system.

There are several types of lupus :

* Discoid lupus affects the skin (a red, raised rash on the face, scalp, or elsewhere).

* Drug-induced lupus is a form of lupus caused by medications such as hydralazine (used for hypertension, procainamide (used for abnormal heart rhythm), phenytoin (for epilepsy), isoniazide (for T.B), d-penicillamine (for rheumatoid arthritis). These drugs stimulate the immune system and cause SLE. Symptoms disappear once the drugs are discontinued.

* Subacute cutaneous lupus erythematosus refers to skin lesions that appear on parts of the body exposed to sun but do not cause scarring.

Both discoid and systemic lupus are about eight times more common in women than men. The disease can affect all ages but most commonly has its onset between 15 and 40 years of age. SLE is more common in blacks and some Asian populations.

Some of the common symptoms are painful or swollen joints,muscle pain, Unusual loss of hair, Pale or purple fingers or toes from cold or stress (Raynaud's phenomenon), Mouth ulcers,unexplained fever, skin rashes, fatigue and kidney problems.In comparison to rheumatoid arthritis, Less than 10 percent of people with lupus arthritis will develop deformities of the hands called "Jaccoud-type deformities," which are reversible conditions.

Diagnosis of Lupus

Diagnosing lupus may take months or even years for doctors to diagnose this disease because no single test can determine whether a person has lupus. To help doctors improve the diagnosis of SLE, eleven criteria were established by the American Rheumatism Association. So diagnosis of SLE requires the presence of 4 of 11 criteria (see A through K below).

A. Malar rash (butterfly).

B. Discoid rash.

C. Photosensitivity (sensitive to sunlight)

D. Oral ulcers

E. Arthritis (two or more swollen, tender joints)

F. Serositis (pleuritis or pericarditis).

G. Renal disorder (proteinuria >0.5g/day,>3+ proteinuria)or cellular casts.

H. Haematological abnormalities (haemolytic anaemia, leucopenia, thrombocytopenia in the absence of offending drugs and on two occasions

I. Neurologic disorder (seizures or psychosis).

J. Immunological abnormality -(positive ANA, anti-DNA, anti-Smith antigen or false positive test for syphilis), abnormal IgG or IgM anticardiolipin antibodies, or positive lupus anticoagulant. or positive LE prep test

K. Positive antinuclear antibody (ANA)

Laboratory investigations

The ANA test is the most useful tests identify certain autoantibodies often present in the patients with lupus. Most people with lupus test positive for ANA. however; a positive ANA is neither required for a diagnosis of lupus nor sufficient in itself to make a diagnosis of lupus. It can occur in several conditions. Also it could be present in healthy people, infections and other autoimmune diseases. However, a positive test for anti-DNA and/or anti-Sm is more specific for SLE and is helpful in the diagnosis. Other antibodies include anti-Sm, anti-RNP, anti-Ro (SSA), and anti-La (SSB) could be found in SLE. Some tests are used less frequently such as anticardiolipin (or antiphospholipid) antibody which may indicate increased risk for blood clotting and miscarriage in pregnant women with lupus

Other laboratory tests are used to monitor the progress of the disease such blood count, urinalysis, blood chemistries, and the erythrocyte sedimentation rate (ESR) test can provide valuable information. People with lupus often have increased ESRs and low complement levels, especially during flares of the disease.

Treatment

Lupus arthritis is treated with non-steroidal anti-inflammatory drugs (NSAIDs).When NSAIDs are not adequate to control arthritis, antimalarial agents such as hydroxychloroquine (Plaquenil) are added.

 Corticosteroids are used when the joints remain swollen and painful despite other treatment.

 Immunosuppressive medications can be effective for inflammatory arthritis. However, in general, these agents are not used only for lupus arthritis. These drugs include:

- cyclophosphamide

- azathioprine

- methotrexate.

Other Therapies:

In some patients, methotrexate (Folex, Mexate, Rheumatrex), a disease-modifying antirheumatic drug, may be used to help control the disease. Working closely with the doctor helps ensure that treatments for lupus are as successful as possible. Because some treatments may cause harmful side effects, it is important to report any new symptoms to the doctor promptly. It is also important not to stop or change treatments without talking to the doctor first.

lupus can be effectively treated with drugs, and most people with the disease can be active, healthy lives. Lupus is characterized by periods of illness, called flares, and periods of wellness, or remission. Understanding how to prevent flares and how to treat them when they do occur helps people with lupus maintain better health.

A program of physical and occupational therapy is an important part of the treatment of lupus arthritis, such as:

range of motion exercises,

strengthening exercises,

joint protection strategies.

Alternative and Complementary Therapies:

Because of the nature and cost of the medications used to treat lupus and the potential for serious side effects, many patients seek other ways of treating the disease. Some alternative approaches people have tried include special diets, nutritional supplements, fish oils, ointments and creams, chiropractic treatment, and homeopathy. Although these methods may not be harmful in and of themselves, and may be associated with symptomatic or psychosocial benefit, no research to date shows that they affect the disease process or prevent organ damage. Some alternative or complementary approaches may help the patient cope or reduce some of the stress associated with living with a chronic illness. If the doctor feels the approach has value and will not be harmful, it can be incorporated into the patient's treatment plan. However, it is important not to neglect regular health care or treatment of serious symptoms. An open dialogue between the patient and physician about the relative values of complementary and alternative therapies allows the patient to make an informed choice about treatment options.