Lupus

What is lupus?

Lupus is a chronic (long-lasting) type of autoimmune disease.Autoimmune diseases happen when your immune system attacks healthy cells and tissues by mistake. This attack causes inflammation. It can also damage many parts of the body, including the joints, skin, kidneys, heart, lungs, and brain.

There are several types of lupus:

• Systemic lupus erythematosus (SLE) is the most common type. It can be mild or severe and can affect many parts of the body.
• Cutaneous lupus affects the skin. It causes a rash or sores, usually after your skin is exposed to sunlight. The two major types of cutaneous lupus are discoid lupus and subacute cutaneous lupus.
• Drug-induced lupus is caused by a reaction to some medicines. The symptoms may start 3 to 6 months after starting the medicine. The symptoms usually go away when you stop taking the medicine.
• Neonatal lupus, which is rare, affects newborns. It is caused by certain antibodies that are passed from the pregnant parent to the baby.

The cause of lupus is unknown. Researchers are studying what might cause or trigger the disease, such as:

• Genetics
• Environmental factors, such as viral infections, sunlight, certain medicines, and smoking
• Problems with the immune system

Anyone can get lupus, but women get it much more often than men.

Lupus is more common in African Americans than in White people. It is also more common in people of American Indian and Asian descent. African American and Hispanic women are more likely to have severe forms of lupus.

Lupus can have many symptoms, and they differ from person to person. Some of the more common ones are:

• Arthritis, causing painful and swollen joints and morning stiffness
• Fever
• Fatigue or feeling tired often
• Red rashes, most often on the face (also called the "butterfly rash")
• Chest pain when taking a deep breath
• Hair loss
• Pale or purple fingers or toes, from cold and stress (Raynaud phenomenon)
• Sensitivity to the sun
• Swelling in legs or around eyes
• Mouth ulcers
• Swollen glands
• Headache and dizziness
• Confusion and memory problems

Symptoms may come and go. When you are having symptoms, it is called a flare. Flares can range from mild to severe. New symptoms may appear at any time.

Lupus causes inflammation throughout your body. This can cause problems in your organs, including:

• Kidney damage (lupus nephritis).
• Heart problems, including inflammation in the heart (myocarditis), heart valves, or lining of the heart muscle (pericarditis).
• Inflammation of blood vessels (vasculitis).
• Blood clots
• Inflammation of the tissue that surrounds the lungs (pleurisy). This can make it painful to breathe.

Some people with lupus may be more likely to develop other conditions, such as coronary artery disease (CAD) and atherosclerosis.

There is no specific test for lupus, and it's often mistaken for other diseases that cause similar symptoms. So it may take a while to get a diagnosis. To find out if you have lupus, your health care provider:

• Will ask about your symptoms, medical history, and family health history
• Will do a complete physical exam
• May order blood tests, such as ANA (antinuclear antibody), antibodies, complete blood count, and complement tests
• May order other tests, such as urine tests
• May do biopsies:
  • Skin biopsy (looking at skin samples under a microscope)
  • Kidney biopsy (looking at tissue from your kidney under a microscope)

There is no cure for lupus, but medicines and lifestyle changes can help control it.

People with lupus often need to see different providers. You will most likely have a primary care provider and a rheumatologist (a doctor who specializes in diseases of the joints and muscles). Which other specialists you will depend on how lupus affects your body. For example, if lupus is damaging your heart or blood vessels, you would see a cardiologist (a doctor who specializes in heart diseases).

Your primary care provider should coordinate care between all of your other providers and treat other problems as they come up. You and your primary care provider will develop a treatment plan to fit your needs. You will both review the plan often to make sure that it is working. You should report new symptoms to your provider right away so that your treatment plan can be changed, if needed.

The goals of a treatment plan are to:

• Prevent flares
• Treat flares when they occur
• Reduce organ damage and other problems
• Improve your quality of life

Treatments may include drugs to:

• Reduce fever, swelling, and pain
• Reduce inflammation in your body
• Prevent or reduce flares
• Reduce or prevent damage to joints
• Suppress (lower) the activity of your immune system

Besides taking medicines for lupus, you may need to take medicines for problems that are related to lupus such as high cholesterol, high blood pressure, or infection.

Alternative and complementary therapies are therapies that are not part of standard treatments. Some people try alternative and complementary therapies to improve their lupus symptoms. But research has not clearly shown whether these treatments may help or treat lupus. Talk to your provider before trying any new treatments.

It is important to take an active role in your treatment. It helps to learn more about lupus - being able to spot the warning signs of a flare can help you prevent the flare or make the symptoms less severe.

It is also important to find ways to cope with the stress of having lupus. Exercising and finding ways to relax may make it easier for you to cope. A good support system can also help.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Medicines

Medicines can treat diseases and improve your health. If you are like most people, you need to take medicine at some point in your life. You may need to take medicine every day, or you may only need to take medicine once in a while. Either way, you want to make sure that your medicines are safe, and that they will help you get better. In the United States, the Food and Drug Administration is in charge of ensuring that your prescription and over-the-counter medicines are safe and effective.

There are always risks to taking medicines. It is important to think about these risks before you take a medicine. Even safe medicines can cause unwanted side effects or interactions with food, alcohol, or other medicines you may be taking. Some medicines may not be safe during pregnancy. To reduce the risk of reactions and make sure that you get better, it is important for you to take your medicines correctly. You should also be careful when giving medicines to children, since they can be more vulnerable to the effects of medicines.

Myelodysplastic Syndromes

Your bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. It contains immature cells, called stem cells. The stem cells can develop into the red blood cells that carry oxygen through your body, the white blood cells that fight infections, and the platelets that help with blood clotting. If you have a myelodysplastic syndrome, the stem cells do not mature into healthy blood cells. Many of them die in the bone marrow. This means that you do not have enough healthy cells, which can lead to infection, anemia, or easy bleeding.

Myelodysplastic syndromes often do not cause early symptoms and are sometimes found during a routine blood test. If you have symptoms, they may include:

• Shortness of breath
• Weakness or feeling tired
• Skin that is paler than usual
• Easy bruising or bleeding
• Pinpoint spots under the skin caused by bleeding
• Fever or frequent infections

Myelodysplastic syndromes are rare. People at higher risk are over 60, have had chemotherapy or radiation therapy, or have been exposed to certain chemicals. Treatment options include transfusions, drug therapy, chemotherapy, and blood or bone marrow stem cell transplants.

NIH: National Cancer Institute

Pain Relievers

What are pain relievers?

Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There are many different pain medicines, and each has advantages and risks. Some types of pain respond better to certain medicines than others. Each person may also have a slightly different response to a pain reliever.

Over-the-counter (OTC) medicines are good for many types of pain. Two types of OTC pain medicines are usually recommended for mild to moderate pain.

• Acetaminophen (Tylenol) is used in many OTC and prescription medicines. It's often considered safer than other pain relievers. Unfortunately, it's common for people to take too much accidentally. Be careful not to take too much each day or use more than one medicine with acetaminophen. Check with your health care provider before taking medicines containing acetaminophen for more than ten days or five days for your child.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin). These pain relievers are often most effective if you have pain and inflammation (swelling), such as for arthritis or menstrual cramps. If you take more than the recommended amount, NSAIDs may cause nausea, stomach pain, or ulcers.

If OTC pain relievers don't relieve your pain, your provider may prescribe something stronger. Many NSAIDs are also available at higher prescription doses.

The most powerful pain relievers are opioids, sometimes called narcotics. They include strong prescription pain relievers such as oxycodone, hydrocodone, or morphine. Opioids are sometimes used to treat moderate to severe pain. Your provider may give you a prescription to reduce pain after you have had a major injury or surgery.

Opioids are very effective, but they can sometimes have serious side effects. There is also a risk of addiction. Because of the risks, you must use them only under your provider's supervision.

Pain relievers are just one part of a pain treatment plan. Environmental factors, stress, and beliefs about pain may affect the way you feel about pain and respond to treatment.

There are many things you can do to help ease pain. Treatment depends on the cause and type of pain. It's important to check with your provider before trying any of them. A few non-drug treatments for pain include:

• Acupuncture
• Hot or cold packs
• Massage therapy
• Physical therapy
• Relaxation techniques

Penis Disorders

Problems with the penis can cause pain and affect a man's sexual function and fertility. Penis disorders include:

• Erectile dysfunction - inability to get or keep an erection
• Priapism - a painful erection that does not go away
• Peyronie's disease - bending of the penis during an erection due to a hard lump called a plaque
• Balanitis - inflammation of the skin covering the head of the penis, most often in men and boys who have not been circumcised
• Penile cancer - a rare form of cancer, highly curable when caught early