Lupus – Systemic Lupus Erythematosus ?>

Lupus – Systemic Lupus Erythematosus

Lupus – Systemic Lupus Erythematosus

Systemic lupus erythematosus, OR SLE, is an autoimmune disorder that affects many parts of the body. An autoimmune disorder is a condition in which the body creates antibodies against its own tissues.
What is going on in the body?

A person with SLE produces antibodies against many of his or her own tissues. This autoimmune reaction can damage many parts of the body. These include:
brain and nervous system
digestive system
eyes
heart
joints and muscles
kidney
lung
skin

What are the causes and risks of the disease?The exact cause of systemic lupus erythematosus is unknown. It is believed to be an autoimmune disorder. SLE tends to run in families.

New research findings suggest that autoimmune disorders may be triggered by a transfer of cells between the fetus and the mother during pregnancy. The study involved women with scleroderma, an autoimmune disorder involving the skin. These women have more fetal cells in their blood decades after a pregnancy than women who don’t have scleroderma. While further research is needed to substantiate these findings, the study does offer an explanation for the much higher incidence of autoimmune disorders in women than in men.

Certain medications have been known to cause systemic lupus erythematosus. These include procainamide, hydralazine, isoniazid, and chlorpromazine. Events that may trigger the disease include infection, stress, exposure to toxins, and sunlight.

Women account for 80% to 90% of cases of SLE. It is more common in black women than in white women. SLE is also more common in Asian, Hispanic, and Native American women.
Symptoms & Signs
What are the signs and symptoms of the disease?

Because SLE affects so many different parts of the body, the disease has many signs and symptoms. These are best listed by organ system.

Signs and symptoms that affect the whole body:
fatigue
fever
loss of appetite
nausea
weight loss

Signs and symptoms that affect the skin:
hives
loss of scalp hair
red “butterfly rash” on the face, which extends over the cheeks and bridge of the nose in the shape of a butterfly
red, raised rashes in areas exposed to the sun
sensitivity to the sun
ulcers of the mouth, nose, or vagina

Symptoms and signs that affect the muscles, bones, and joints:
arthritis
hand deformities
joint pain, especially in the hands, wrists, and knees
loss of the blood supply to bone, especially hips and shoulders
muscle pains and weakness
serious infection within a joint

Signs and symptoms of kidney involvement:
blood in the urine
decrease in kidney function or kidney failure
protein in the urine
white blood cells in the urine

Signs and symptoms affecting the nervous system:
bleeding in the brain, known as intracerebral hemorrhage
headaches, including migraines
loss of coordination
memory loss, problems with concentration
numbness, pain, or a feeling of “pins and needles” in the hands and feet
problems with the major nerves in the head and face
seizures
strokes

Signs and symptoms involving the blood:
anemia, which is a low red blood cell count
low blood platelet count
low white blood cell count
problems with both blood clotting and bleeding

Signs and symptoms involving the heart:
fluid collection in the sac around the heart, known as pericardial effusion
heart attack
heart valve problems
inflammation and infection in the heart
inflammation of the lining of the heart

Signs and symptoms involving the lungs:
cough, including coughing up blood
fluid in the lung
inflammation in the lung
inflammation of the lining of the lungs
shortness of breath

Signs and symptoms affecting the digestive system:
abdominal distress
diarrhea
enlargement of the liver
intestinal perforation due to inflammation of blood vessels
loss of appetite
nausea and vomiting
rectal bleeding caused by ulcerations

Symptoms and signs affecting the eye:
blindness
conjunctivitis, which is inflammation of the outer lining of the eye
damage to the retina, which may cause visual impairments
Diagnosis & Tests
How is the disease diagnosed?

A complete medical history and physical examination are important tools for diagnosing SLE. Blood tests also play an important role. A blood test called an ANA looks for antibodies that the person has produced against his or her own tissues.

Other tests used to diagnose SLE include the following:
CT scan
chest X-ray
electrocardiogram
kidney biopsy
MRI scan
spinal tap

Prevention & Expectations
What can be done to prevent the disease?

Most cases of systemic lupus erythematosus cannot be prevented. It may be helpful to avoid medications that cause SLE, but not everyone who takes these medications will develop the disease.
What are the long-term effects of the disease?

SLE is a long-term disease that flares up, then quiets down, then flares up again. Persons with SLE often have a significant decrease in the quality of daily life. Many complications of SLE put the person at risk. Many of the medications used to treat the disease also have significant side effects. SLE can be fatal, often as a result of kidney failure, infections, or heart attack.
What are the risks to others?

There is no evidence that SLE is a contagious disease that can be passed from one person to another. However, it does tend to run in families. Pregnant women with SLE have an increased risk of miscarriages, stillbirths, and premature infants.
Treatment & Monitoring
What are the treatments for the disease?

Although there is no cure for SLE, certain things can help prevent flare-ups. Persons with SLE should avoid intense sun exposure. Liberal use of sunscreens, long-sleeved shirts, and hats are helpful.

Since infections are common, persons with SLE should seek prompt evaluation of fevers. A yearly flu vaccine is recommended. If the spleen is removed, the person should receive the pneumococcal vaccine. Individuals should also receive antibiotics before any dental procedures.

A number of medications are used to treat SLE, including the following:
antimalarial medications, such as quinacrine and hydroxychloroquine. These are used to treat skin problems and arthritis.
corticosteroids, such as prednisone and methylprednisolone. These reduce the immune system response.
nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen and naproxen. These medications reduce fever and treat pain.
powerful cytotoxic medications, which kill cells. These are used to treat nephritis, a serious kidney problem.

Individuals with end-stage kidney disease may benefit from kidney dialysis or a kidney transplant.
What are the side effects of the treatments?

The medications used to treat lupus have significant side effects. Unfortunately, some of these side effects can mimic the symptoms of the disease itself.

NSAIDs can cause stomach irritation, allergic reaction, and decreased kidney function.

Antimalarial medications can cause rash, muscle weakness, and nerve problems.

Corticosteroids have a host of possible side effects. These include weight gain, high blood pressure, osteoporosis, and increased risk of infection.

The cytotoxic medications can cause problems with the bladder and with blood cell production.
What happens after treatment for the disease?

Systemic lupus erythematosus is a chronic disease that fluctuates over time. The best way to manage it is by active collaboration between the individual and his or her healthcare providers.
How is the disease monitored?

Periodic examinations allow the healthcare provider to monitor the activity of the disease and determine possible complications. A variety of blood tests help in the monitoring of the disease. Any new or worsening symptoms should be reported to the healthcare provider.

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Paranoia – Paranoid Personality Disorder
Overview, Causes, & Risk Factors
Symptoms & Signs
Diagnosis & Tests
Prevention & Expectations
Treatment & Monitoring
Attribution
Overview, Causes, & Risk Factors

A personality disorder is a mental disorder that causes a person to think and behave abnormally. This makes it hard for him or her to interact with other people and function normally in society. A person with paranoid personality disorder (PPD) mistrusts other people, even though he or she has no reason to do so.
What is going on in the body?

A person with PPD is suspicious and mistrustful of others. He or she is always “on guard”, and may be unable to form close relationships.
What are the causes and risks of the condition?

The exact cause of the condition is unknown. Genetics may be involved. Early childhood experiences, including physical or emotion trauma, may cause PPD.
Symptoms & Signs
What are the signs and symptoms of the condition?

A person with PPD:
unreasonably believes that others are harming, deceiving, or taking advantage of him or her
is unreasonably suspicious, angry, and very sensitive if he or she feel slighted or treated unfairly
has unjustified doubts about the commitment, loyalty, and trustworthiness of others
is afraid to confide in others
holds grudges and is unforgiving of others
looks for hidden meaning into remarks or events
feels attacked, even when others don’t see it
accepts criticism poorly

Diagnosis & Tests
How is the condition diagnosed?

A healthcare provider can diagnosis the disorder based on the way the person behaves, and if four or more of the symptoms listed above are present. Sometimes the provider also does psychological testing. It is important for to rule out any health problem that may have caused the paranoid behavior.
Prevention & Expectations
What can be done to prevent the condition?

There is no known way to prevent personality disorders. However, growing up in a nurturing environment is important toward developing a healthy personality.
What are the long-term effects of the condition?

A person with a personality disorder tends to have the same problems with relationships and work throughout his or her lifetime.
What are the risks to others?

This condition is not contagious. People with PPD often take legal action against others, and are unable to see their own roles in a conflict.
Treatment & Monitoring
What are the treatments for the condition?

Because a person with PPD has trouble trusting others, it is hard for a therapist to form a trusting relationship with him or her. Medications have been shown to be useful for reducing the anxiety and agitation often linked with PPD. Nonaddictive anti-anxiety medications have been effective. Low-dose antipsychotic medications have been used for brief periods for individuals with more severe symptoms. A person with PPD is usually wary of any medications.
What are the side effects of the treatments?

Side effects depend on the medication used to treat the disorder, but may include allergic reactions and drowsiness.
What happens after treatment for the condition?

People with PPD often do not follow the prescribed treatment plan. This resistance to treatment can make the PPD worse. In this case, the person may need to be hospitalized.
How is the condition monitored?

Personality disorders are chronic. Someone with PPD needs to be monitored on an ongoing basis. Some people are completely disabled by this condition and must be placed in a mental health facility or group home.

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