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By Dr. M. Walravens, rheumatologist, O.L. Vrouw-Clinic Aalst

Systemic lupus
Also called: "lupus erythematosus desseminatus" (LED) or "systemic lupus erythematosus".
Systemic lupus is different from discoid lupus. Discoid lupus is mostly limited to the skin. It can occur by itself or in combination with systemic lupus.
What is systemic lupus?

Systemic lupus is a generalized autoimmune disease.
In an autoimmune disease, the immune system (defense) partly targets itself, by producing autoantibodies that cause inflammatory diseases.
Generalised means that the autoimmunity can attack different organ systems and can means that the autoimmunity can attack different organ systems and can cause generalized disease manifestations

Who is affected by lupus?Basically anyone at any age, but mostly lupus strikes women of childbearing age (80 to 90%). The number of lupus patients affected by lupus also differs according to race. In the USA lupus is more common in Blacks than in Caucasians. Genetic (hereditary) factors are sure enough believed to play a role in the development of the disease.

Prevalence of lupus
Studies are scarce and results vary widely, but it cannot be denied that the number of lupus patients is increasing. Improved diagnostic measures and a better understanding of the disease are two important factors in the increase of lupus patients, but there is also an absolute rise in the incidence (= number of new patients per year of a specific disease)
Cause and heredity The cause is Autoimmune . Experts are getting convinced of the fact that inflammations and damage are caused by a reaction of autoantibodies with normal cellular components and other elements. In this process both genetic as environmental factors can play a role.
Several genetic factors are of importance, but they are unlikely to be entirely passed on. This is the reason why lupus is not a hereditary disease, although risks of developing lupus are bigger if a relative in the first degree has been diagnosed with the disease.
Ultraviolet rays are an example of an environmental factor known to trigger lupus. Although it has not been proved, viruses may also play a role in the onset of lupus. Lupus, however, is not contagious at all.
Hormones are involved as well: female hormones stimulate lupus, while male hormones protect against it. This is one of the reasons to avoid the use of the contraceptive pill.
Onset and symptoms Possible symptoms and manifestations of lupus are very diverse. The onset of the disease is never the same: it may start off with any of the symptoms mentioned below, in a mild or severe form. Because there are so many symptoms, we have to stick to the following summary:
90 %
fatigue, arthritis and joint pain
80 %
70 %
hair loss, anaemia, swollen glands
60 %
weight loss, poor appetite, butterfly-shaped rash
50 %
inflammation of the pleura (pleuritis), inflammation of the heart sac (pericarditis), inflammation of the membrane lining the abdominal cavity (peritonitis), renal involvement, personality changes, purpura
40 %
photosensitivity, bacterial infections
30 %
ulceration of the mucous membranes e.g. aphthous ulcers, pain in the muscles or myositis (inflammation of the muscles), gastrointestinal complaints, enlargement of the liver, high blood pressure, pneumonia, myocarditis (inflammation of the heart muscle) and endocarditis (involvement of the heart valves).
20 %
Raynaud's phenomenon (turning white of the fingers), discoid lupus (skin involvement in lupus with round disc-shaped scars), inflammation of the eyes, Sjogren's Syndrome, severe renal involvement, attacks of epilepsy, psychoses, inflammation of the coronary arteries (supply of blood to the heart muscle)
10 %
hives, oedema or formation of blisters on the skin, lupus pneumonia, brain damage or damage to the spinal cord, migraine, autoimmune destruction of red blood cells, low platelet count, neuritis (inflammation of the nerves)

The diagnosis is based on complaints and/or symptoms and/or involvement of internal organs and/or abnormalities in laboratory test results. There is no single lupus test that can confirm the disease. Beginning mild forms of lupus are hard to diagnose, and sometimes diagnosis is only possible after following the evolution of the symptoms. In case of a possible onset of lupus, following up the early symptoms as well as informing the patient are very important.
Because there is no decisive test for lupus and due to the changing character of the disease, criteria have been defined to classify lupus. Their main purpose, however, is scientific research as they can only be used as a guideline to diagnose lupus. In some cases lupus can be diagnosed before the patient meets these criteria.

4. Know your risk: at age 65--earlier for women who have health conditions or take medications that increase risk.


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