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Lupus

 

Lupus Introduction

Lupus is also known as systemic lupus erythematosus, or SLE. It is an autoimmune inflammatory disorder that affects many different systems within the body. Lupus can affect the joints, kidneys, skin, and even blood vessels. This chronic disease that has no known cause. Although, there is an autoimmune component to lupus, evident by the presence of autoantibodies in the blood. Some prescription medications can induce SLE. [1]

There are several different types of lupus, and each are characterized by the area of the body that is affected. Systemic lupus erythematosus, SLE, is the most common type of lupus and affects various areas of the body. Discoid lupus is a less common form that affects primarily the skin and is also referenced as cutaneous lupus erythematosus. SLE can have severe complications if untreated, including kidney failure and stroke. [2]

Lupus affects both men and women, though the prevalence in women is 8 times that in men. It is more common in blacks than any other race. Hispanics, Native Americans, and Asians are also more affected than Caucasians. SLE may have a genetic component, with roughly 5% of all diagnosed individuals having another family member with SLE. [3]

Lupus Symptoms

Lupus can have a quick onset or an insidious onset. Patients may complain of a high fever that precedes the onset. This fever may stimulate an acute reaction of SLE, or patients may present with ongoing fatigue that has slowly been worsening. The clinical ‘picture’ of SLE can vary greatly because of all the different body systems that can be affected. [4]



Lupus Symptoms:

  • The most common symptom (90%) that patients present with is arthralgia, or joint pain. The joint pain can be intermittent and long standing, or may be acute and debilitating. [5]
  • Lesions of the skin are the second most common symptom. Patients may present with a raised, red rash on the face, called a malar rash. Skin lesions are also common on the scalp, chest, and arms. These lesions can be flat, raised, blister like, crusts, or erosions. [6]

General symptoms that the patient may present with are headache, fatigue, fever, weight loss, and muscle soreness. Patients may also have enlarged lymph nodes upon examination. Certain individuals may suffer from numbness and tingling in parts of their body. Patients may also complain of diarrhea, nausea, or vomiting. Respiratory infections are also common as a result of SLE. [7]

In later stages of the disease complications in organs may be present. SLE can cause inflammation of the blood vessels, which can lead to brain damage, seizures, and psychosis. It can negatively affect the kidneys and lead to loss of protein in the urine. In rare cases, lupus may cause the destruction of one’s white and red blood cells. [8]

Lupus Statistics

  • It is estimated that 1.5 million Americans have some form of lupus. 90% of those affected are women.
  • 80% of individuals diagnosed with lupus are between the ages of 15-45.
  • 70% of the cases of lupus are SLE, and in 50% of these cases a major organ will be affected causing serious complications.
  • 10% of individuals diagnosed with lupus will have Discoid lupus. 5% of children born to parents with lupus will also develop the disease.
  • The survival rate for lupus after 5 years is 97% and after 10 years is 90%. Although once life-threatening, it is not common for individuals to die from lupus today. [9]

Lupus Treatment

Conventional lupus treatment is divided between mild SLE and severe SLE. Mild disease treatments are focused on controlling the symptoms. This can be carried out by using non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil, Aleve, or Tylenol. These class of drugs are used for the the treatment of arthralgia, common in lupus patients. Anti-malarial drugs, like hydroxychloroquine, are commonly prescribed for the treatment of skin lesions. Treatment of severe SLE is primarily focused on limiting damage to organs. In these cases, corticosteroid therapy (Prednisone) is used to suppress the immune reaction. Chemotherapeutic drugs (cyclophosphamide) may also be used for this purpose. [10]

Alternative treatment is focused on tonifying the body systems affected by lupus, and by concomitantly treating the symptoms. Treatment is geared towards providing the body with essential nutrients in adequate amounts to aid the natural healing mechanisms, and to reduce further damage caused by the disease.

Supplements helpful for Lupus (SLE)

Omega 3 fatty acids, EPA and DHA

Both EPA and DHA are the primary essential fatty acids found in fish oils. Because SLE it is an inflammatory disorder, fish oils have been studied for the treatment of this condition. Fish oils can effectively reduce the amount of pro-inflammatory molecules created by the body and provide an increase in the amount of anti-inflammatory molecules circulating throughout the body. Fish oil may also cause a reduction in platelet aggregation, which is a complication of severe SLE.

In a recent study on the effects of fish oil on disease severity and relapse, patients who supplemented their diet with EPA and DHA had positive results. Patients reported a mild effect on active inflammation and a possibility of preventing the relapse of this condition. The study concluded that fish oils may decrease the auto reactivity of white blood cells. Overall, individual survival rates were increased and the severity of disease was decreased. [11]

Another study found that fish oils actually induced clinical remission of the disease via modulation of oxidative stress in the body of patients with SLE.[12] In other studies concerning high dose fish oils, 100% of the participants reported and improvement in symptoms, with some even feeling treatment yielded ‘ideal’ results. [13]

Vitamin E

Vitamin E is indicated in patients with lupus due to its high anti-oxidant potential. It is also a critical nutrient in skin health, which is an organ largely affected by lupus. Vitamin E is deficient in patients with SLE. [14] Furthermore, conventional treatments with NSAIDs and corticosteroids cause an increase in oxidative stress upon the body. One study measured the effect of Vitamin E supplementation on oxidative stress markers in the blood of patients with SLE. Prior to treatment the patients had high levels of oxidative stress markers and low levels of anti-oxidants in the blood. Supplementation of vitamin E was shown to effectively reduce oxidative stressors, and increased anti-oxidant enzymes in the blood. [15]

Vitamin D

Vitamin D is a recommended therapy for patients who suffer from SLE. Vitamin D has an immunoregulatory role via white blood cell activity and cell signaling. Vitamin D levels in patients with SLE have been shown to be low. This characteristic may be due to treatments with pharmaceutical drugs, or the decreased sun exposure, which may result in a low conversion to the vitamin’s active form. [16, 17] Vitamin D supplementation is recommended for individuals with lupus who are taking corticosteroids, because of the risk of developing osteoporosis.[ 18]

DHEA

DHEA is a steroid hormone precursor naturally made in the adrenal glands. It is used as a treatment for lupus, do to its ability to modify and regulate hormone levels in the blood. SLE is thought to be affected by fluctuating estrogen and androgen levels. By decreasing inflammatory cell signaling molecules in the blood, DHEA may also provide for certain immunomodulatory effects.

In a study of patients with active SLE, supplementation with DHEA resulted in a significant improvement in symptoms. 16% of patients reported a decrease in flare-ups of the disease. Participants also benefited psychologically, reporting an improvement in their own feelings about the disease. [19] In another comparative study, DHEA supplementation, again, resulted in an overall improvement in symptoms. 7 out of 9 patients responded to treatment, as compared to only 50% in the placebo group. There was also a measured protective effect on the bone (increased bone mineral density), resulting in a decreased risk of osteopenia and osteoporosis due to corticosteroid use in patients with severe SLE. [20]

Vitamin A

Vitamin A is a potent anti-oxidant. It is a nutrient utilized by the body to maintain the health of skin and joints. Vitamin A also has immune stimulating properties. Vitamin A is often deficient in patients suffering from SLE. [21] A recent study measured the immune response in patients with lupus after administering high doses of Vitamin A. It was concluded that Vitamin A increases both antibody activity and anti-inflammatory cell signaling molecules. Supplementation resulted in a positive outcome. [10]

References

[1] Beers M and Berkow R. The Merck Manual 17th Ed. Systemic Lupus Erythematosus: 426-430.

[2] Beers M and Berkow R. The Merck Manual 17th Ed. Systemic Lupus Erythematosus: 426-430.

[3] Fitzpatrick, T et al. Color Atlas and Synopsis of Clinical Dermatology 3rd Ed. 1997 McGraw Hill New York; pp: 346-349.

[4] Beers M and Berkow R. The Merck Manual 17th Ed. Systemic Lupus Erythematosus: 426-430.

[5] Beers M and Berkow R. The Merck Manual 17th Ed. Systemic Lupus Erythematosus: 426-430.

[6] Fitzpatrick, T et al. Color Atlas and Synopsis of Clinical Dermatology 3rd Ed. 1997 McGraw Hill New York; pp: 346-349.

[7] Fitzpatrick, T et al. Color Atlas and Synopsis of Clinical Dermatology 3rd Ed. 1997 McGraw Hill New York; pp: 346-349.

[8] Beers M and Berkow R. The Merck Manual 17th Ed. Systemic Lupus Erythematosus: 426-430.

[9] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml November 2004.

[10] Beers M and Berkow R. The Merck Manual 17th Ed. Systemic Lupus Erythematosus: 426-430.

[11] Mendlovic S and Sthoeger ZM. n-3 fatty acids and the immune system in autoimmunity. Isr Med Assoc J. 2002 Jan; 4(1): 34-38.

[12] Mohan IK and Das UN. Oxidant stress, anti-oxidants, and essential fatty acids in systemic lupus erythematosus. Prostaglandins Leukot Essent Fatty Acids. 1997 Mar; 56(3): 193-198.

[13] Walton AJ et al. Dietary fish oil and the severity of symptoms in patients with systemic lupus erythematosus. Ann Rheum Dis. 1991 Jul; 50(7): 463-466.

[14] Bae SC, Kim SJ, Sung MK. Impaired anti-oxidant status and decreased intake of anti-oxidants in patients with systemic lupus erythematosus. Rheumatol Int. 2002 Nov; 22(6): 238-243.

[15] Serban MG, Balanescu E, and Nita V. Lipid peroxidase and erythrocyte redox system in systemic vasculitides treated with corticosteroids. Effect of vitamin E administration. Rom J Intern Med. 1994 Oct-Dec; 32(4): 283-289.

[16] Huisman AM et al. Vitamin D levels in women with systemic lupus erythematosus and fibromyalgia. J Rheumatol. 2001 Nov; 28(11): 2535-2539.

[17] Muller K et al. Vitamin D3 metabolism in patients with rheumatic disease: low serum levels of 25, hydroxyvitamin D3 in patients with systemic lupus erythematosus. Clin Rheumatol. 1995; 14: 397-400.

[18] Sen D and Keen RW. Osteoporosis in systemic lupus erythematosus: prevention and treatment. Lupus 2001; 10(3): 227-232.

[19] Chang DM, Lan JL, Lin HY, Luo SF. DHEA treatment of women with mild to moderate systemic lupus erythematosus-a multicenter randomized double blind placebo controlled trial. Arthritis Rheum. 2002 Nov; 46(11): 2924-2927.

[20] van Vollenhoven RF et al. A double blind placebo controlled clinical trial of DHEA in severe systemic lupus erythematosus. Lupus 1999; 8(3): 181-187.

[21] Bae SC, Kim SJ, Sung MK. Impaired anti-oxidant status and decreased intake of anti-oxidants in patients with systemic lupus erythematosus. Rheumatol Int. 2002 Nov; 22(6): 238-243.

[22] Vien CV et al. Effect of vitamin A treatment on the immune reactivity of patients with systemic lupus erythematosus. J Clin Lab Immunol. 1988; 26: 33-35.