Lupus is an autoimmune disease, a type of self-allergy whereby the patient's immune system overproduces antibodies which then attack the person's own tissues. Lupus is neither infectious nor contagious, and its effect is inflammatory. Patients principally suffer extreme fatigue and joint and muscle pains. A variety of other symptoms are possible, as well as damage to vital organs if the illness has taken a strong hold. Nine out of ten people with lupus are female, and whilst it is usually triggered between the ages of 15 and 50, children can also have the illness. Some 50,000 people in the UK are thought to have lupus, many yet to be diagnosed, with the incidence of the disease being greater in Afro-Caribbean and Asian communities.
The causes of lupus are not fully understood, although heredity, puberty, hormonal activity and change, childbirth, viral infections, sunlight, the menopause, trauma or strong medication may play a part in triggering the illness. Lupus can affect people of all ages and both sexes. The predominance of the illness seen in females is due to the influence of hormonal factors.
Lupus can present in a complex number of ways, even to the extent of 'mimicking' other illnesses such as rheumatoid arthritis, multiple sclerosis (MS) and myalgic encephalomyelitis (ME). Lupus can be hard to diagnose and the condition can be overlooked, sometimes for years, unless the physician is alert to its possibility. Many patients differ in symptom patterns, which are taken into account with specific blood tests prior to diagnosis.
A skin problem does not necessarily occur in systemic lupus (SLE) but is always present in discoid lupus (DLE), where rashes occurring on the face, scalp or neck can be quite severe. Both types arise from a disorder of the immune system. DLE can develop into systemic lupus, but does not always do so. It is most unusual for the SLE patient to develop DLE. In summary:
SLE - acute, subacute or chronic skin rashes may occur, mainly on the arms and upper body, together with the possibility of a 'butterfly' rash on the cheeks.
DLE - disc-shaped lesions can occur on the face, neck or scalp.
Lupus is a weighty burden for the patient, being incurable and causing physical limitations and pain. Continuous resolve is needed by patients and their families to ensure that they are not 'dragged down' by lupus and are able to restore and maintain some quality to their lives.
Both SLE and DLE skin conditions respond to treatment, but may recur where the underlying illness flares from time to time. The reasons for flare-ups are not always well understood. There is, as yet, no cure. Careful monitoring of the illness together with a flexible treatment programme, enables the condition to be controlled in the majority of patients. Treatments may range from no medication at all in very mild lupus, through NSAIDs (non-steroidal anti-inflammatory drugs) and corticosteroids to immunosuppressives and even stronger medication, where the illness is more serious. As the patient's lupus becomes better managed, the physician will try to reduce the volumes and/or levels of medication, eventually to reach the lowest possible maintenance level. Patients can learn to reduce the impact of the illness by becoming better educated about the condition, by learning to 'pace' their daily routines, by taking regular rest and by reducing the incidence of stress, depression, anger and pain wherever possible. For many lupus patients, lifelong medication and care is needed, yet in a smaller percentage the illness has been known to recede, particularly after the menopause. Physicians now have much greater knowledge of this still-mysterious disease and have a wider range of drugs at their disposal, which have made for easier control of the individual's own ?reg;brand' of lupus.
Good information is also available to patients through lupus consultants, specialist nurses and support groups.
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