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 Lupus & EBV

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The Disease that cries Wolf           by Monika Guttman

Lupus-In which the bodies immune system attacks it's own cells-mimics many other illnesses, thwarting diagnosis. But once identified, new drugs and technologies have greatly improved the prognosis   

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Current thinking dictates that the diseases are turned on through a combination of genetic and environmental factors.

Jacob and others have identified six, possibly seven, genes that confer susceptibility to lupus. Once all the genes are noted, there could be a diagnostic test for lupus, he says. At the present time, Jacob is working with families where one member has lupus to determine the prevalence and number of the "lupus genes."

 One type of lupus, drug-induced lupus, occurs after the use of hydralazine (used to treat high blood pressure or hypertension) and procainamide (used to treat irregular heart rhythms).  Researchers are focusing on environmental triggers, such as infections, antibiotics, ultraviolet light, extreme stress, and certain drugs and chemicals.

Last December, researchers from the University of Oklahoma announced a study linking the Epstein-Barr virus and lupus. In a study of 117 patients with systemic lupus, the researchers found 99 percent previously had an Epstein-Barr virus infection.  The study provides a basis for further investigation.

  With Lupus, a number of systems are under attack, as in systemic lupus.

Autoimmune responses can lead to a number of different results: slow destruction of a specific type of cell or tissue, overstimulation of an organ or interference with its function. Most autoimmune diseases trigger inflammation-the reddening and swelling that normally indicates the body is fighting off an invader. In systemic lupus, the inflammation symptoms can appear in a number of places: in the joints, in the membranes that line different organs like the lungs and heart, on the skin and in the mouth, or even in the kidneys.

Many systemic lupus patients say there are subtle daily reminders that all is not perfect for them, even in periods of remission-they have days of extreme fatigue, for example, or pains that appear and disappear with no seeming cause.

A prolonged new symptom generally indicates a "flare up"-a period of active immune reaction triggered by some "event," such as stress, surgery, drugs or even exposure to sunlight.

A mild inflammation can be suppressed with omega-3, turmeric. Stop the immune reaction by corticosteroids (prednisone is the most often prescribed), anti-malarials (chloroquine or hydroxychloroquine) and cytotoxic,(  cyclophosphamide, azathioprine and methotrexate.) IVIG is the best drug to help all symptoms and the disease process.

For many, the serious side effects of the drugs or simply having to commit to long periods on medication can be difficult or demoralizing. Some lupus patients, already having a hard time reducing the stress and other factors that could trigger flare-ups, find the weight gain or acne from the steroids make it difficult to continue with their prescribed regimens.

But the goal of drug therapies, says Kitridou, is to "minimize damage during an active phase and add to the patient's quality of life. Lupus is not a 'life sentence,'" since most people go into extended periods of remission and, thanks to improved therapies, individuals with lupus are living normal life spans.

Patients and physicians have to engineer the remission." The earlier the symptom is recognized and treated, the better the outcome, she adds.

Kitridou is hopeful about new immuno-modulating drugs, like mycophenolate, , and there is a trial involving DHEA that "suggests this steroid may help in improving mild lupus."

While the investigation into these therapies continues, however, says Kitridou, "We can control lupus to a great extent. I'm hopeful there will eventually be a cure."

She adds: "In the meantime, research has made many inroads. Patients should know lupus can be managed."

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