อาการ สาเหตุ การตรวจวินิจฉัย และการรักษาโรคลูปัส (Lupus) หรือโรคแพ้ภูมิตัวเอง (SLE)

Lupus or SLE

Lupus or SLE is an autoimmune disease in which your immune system attacks your own tissues and organs. Lupus-related inflammation can impact many body systems

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Lupus or SLE

Lupus or SLE is an autoimmune disease in which your immune system attacks your own tissues and organs. Lupus-related inflammation can impact many body systems, including the joints, skin, kidneys, blood cells, brain, heart, and lungs.

Lupus can be difficult to diagnose since its symptoms frequently resemble those of other diseases. The most distinguishing feature of lupus is a facial rash that resembles butterfly wings extending over both cheeks, occurring in many but not all individuals with lupus.

Some people are genetically predisposed to develop lupus. While there is no cure for lupus, therapies can help reduce symptoms.

Symptoms of Lupus or SLE

Lupus symptoms differ from person to person. Some have few symptoms, while others have several.

Lupus may damage any organ in the body. Typical symptoms include:

  • Fatigue
  • Fever
  • Joint Pain
  • Stiffness
  • Swelling in the leg
  • Butterfly-shaped rash on the face
  • Rash from sun allergy
  • Breathing difficulties
  • Dry eyes
  • Disorientation and cognitive impairment


Causes

Lupus is an autoimmune illness in which your immune system attacks healthy tissue in your body. Lupus most likely originates from a combination of hereditary and environmental factors.

People with a hereditary predisposition to lupus may get the condition if exposed to something in the environment that might cause lupus. In most cases, the etiology of lupus is unknown. Among probable triggers are:

  • Sunlight. Sun exposure may cause lupus skin lesions or an internal reaction in prone individuals.
  • Infections. Infections can trigger lupus or induce clinical relapse in some cases.
  • Medications. Certain blood pressure medications, anti-seizure medications, and antibiotics may trigger lupus.


Risk Factors

  • Gender: Lupus affects women more than men
  • Age: Incidence is highest between the age of 15 to 45
  • Race: Lupus affects more African Americans, Hispanics, and Asians than others


Complications

  • Kidneys- Kidney failure is the cause of death in most Lupus patients
  • Brain- Headaches, dizziness, eyesight issues, and even strokes and seizures
  • Blood Vessels – Blood clotting and reduced red blood cells are common.
  • Lungs- Lupus increases the risk of having inflammation in the lung capacity
  • Heart- Lupus can induce inflammation of the heart muscle, arteries, and membranes.
  • Infections- Lupus patients are more susceptible to getting other viral infections due to weakened immunity
  • Bone tissue decomposition. Occurs when the blood flow to the bone decrease, typically resulting in tiny fractures and the inevitable collapse of the bone.


Diagnosis

Lupus is difficult to diagnose since physical findings and symptoms vary widely among individuals. Lupus symptoms overlap with many other diseases and can change over time.

It cannot be diagnosed with a single test. The doctor makes the lupus diagnosis by combining results from blood and urine tests with physical findings and symptoms.

Laboratory examinations

Blood and urine testing may include the following:

  • Complete blood count (CBC) - This test analyzes red blood cells, white blood cells, platelets, and hemoglobin -- an oxygen-transporting molecule in red blood cells.
  • Erythrocyte Sedimentation Rate (ESR) or C-Reactive Protein (CRP) - These tests quantify inflammation in the body by measuring how quickly red blood cells sink to the bottom of a tube or the amount of specific protein in the blood, respectively. Higher-than-normal values suggest a systemic inflammatory condition like lupus.
  • Liver Function Test (LFT) and Renal Function Test (RFT) - Blood testing can determine how effectively your kidneys and liver work. Lupus can affect these organs.
  • Urinalysis - Laboratory testing on a urine sample may reveal elevated urinary proteins or red blood cells.
  • Autoimmune laboratory tests, such as Antinuclear Antibodies (ANA), Extractable Nuclear Antigen (ENA) panel, Complement Component 3 (C3), and Complement Component 4 (C4).

    Imaging tests

    • Chest radiograph. A chest scan may reveal irregular shadows indicating fluid or inflammation in the lungs.
    • This test utilizes sound waves to generate real-time images of your beating heart. It can detect abnormalities with your heart's valves and other components.

    Biopsy

    Lupus can damage the kidney in many ways, and treatments might vary based on the type of damage. Needle or open kidney biopsy via a small incision to acquire the tissue sample, and occasionally, obtaining a skin biopsy sample help to confirm the diagnosis.

    Treatment

    The treatment for lupus depends on the patient's symptoms.

    As your signs and symptoms of lupus flare up and subside, you and your doctor may find it necessary to adjust your medications or doses. Drugs most often used to treat lupus include:

    • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium, and ibuprofen, may be efficacious in treating lupus-related pain, inflammation, and fever. Stronger NSAIDs are available with a doctor's prescription.
    • Antimalarial drugs, hydroxychloroquine affecting the immune system, reduce the incidence of lupus flares.
    • Corticosteroids such as prednisone and other corticosteroids help alleviate the inflammation caused by lupus. High doses of corticosteroids, such as methylprednisolone, are frequently used to treat severe kidney and brain diseases.
    • Immunosuppressants can be beneficial for certain patients. Examples include azathioprine, mycophenolate, methotrexate, cyclosporine, and leflunomide.
    • Biologics decrease lupus symptoms in some individuals.


    Lifestyle & Home Remedies

    Certain behavior adjustments can help prevent lupus recurrence. If they occur, you should:

    • See your physician regularly. Regular follow-ups instead of sporadic visits when symptoms worsen help your doctor better prevent flares. It can be valuable for addressing fundamental health problems, such as stress, nutrition, and exercise, which can be beneficial for reducing lupus complications.
    • Avoid the sun. Wear protective clothing, including a cap, long-sleeved shirt, and long pants, because UV radiation can produce a flare.
    • Get regular exercise. Exercise can help maintain strong bones, lower the chance of a heart attack, make you feel relaxed, and improve sleep quality.
    • Don't smoke. Smoking can exacerbate the effects of lupus on the heart and blood vessels, increasing the risk of cardiovascular disease. 
    • Consume a balanced diet. The emphasis of a healthy diet is on regular consumption of fruits, vegetables, and whole grains.

    Since lupus symptoms mirror so many other conditions, you need patience while awaiting a diagnosis. Before diagnosing lupus, your physician must rule out several other diseases. Moreover, you may have to visit various specialists to confirm the diagnosis and formulate a treatment plan.

    Article by

    Published: 12 Jan 2023

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