The Impact, Causes, Symptoms, Treatment and Management of Systemic Lupus Erythematosus - Research Paper Example

10 April 2007 The Impact of Lupus Introduction Lupus or systemic lupus erythematosus (SLE) has been perceived as an extremely threatening disease in contemporary times, mainly because medical science has a lot to learn about it before it can be effectively diagnosed and managed. Its etiology is uncertain; diagnosis is complicated because of the confusing array of ambiguous symptoms that are not characteristic of the disease itself; it follows a fluctuating, unpredictable course with the symptoms either going into remission or becoming more severe with time; there is no known cure for the disease, although it can be controlled by effective management - these factors lead to an unfavorable prognosis for lupus, although in recent times, the outlook is more optimistic for those afflicted with lupus. That being said the disease has a tremendous physiological as well as psychological impact on the lives of those diagnosed with lupus. Lupus is a disease of the immune system, which constitutes the defense mechanism of the body. It plays a crucial role in protecting the body from the attack of hostile organisms like bacteria, viruses and the like. However, in individuals with lupus the immune system in addition to destroying foreign organisms that may harm the body, it attacks the normal cells and tissues as well. In the words of Petri, "Instead of fighting infection, the immune system attacks 'self/ the person's normal tissues" (qtd. in Meadows 29). A detailed study of the causes, symptoms, and treatment of lupus helps one understand the physiological impact of the disease, while an examination of families coping with the disease and particular symptoms coupled with treatment measures help us understand the psychological impact of the disease. Causes of Lupus Researchers have attempted to identify the causes of lupus in order to enable them to control it more successfully and to establish a successful cure; however their attempts have been unavailing thus far. It appears that multiple factors contribute to the development of lupus. Genetic, environmental and hormonal aberrations have been identified and there is evidence that these by themselves or by a process of combinations may be responsible for causing the disease. According to Wallace, "It begins when certain genes predisposing an individual to lupus interact with environmental stimuli. These interactions result in immunologic responses that make autoantibodies (antibodies to one's self) and form immune complexes (antigens combined with antibodies)" (35). He believes that this phenomenon explains some of the symptoms that indicate lupus. It is interesting to note that lupus is more prevalent in some races than in others. For instance Asians, Hispanics, and African - Americans are more susceptible to the disease than those belonging to other races like the Caucasians for instance. This finding implies that there is a chance that lupus may be genetically determined. Moreover, studies have shown that lupus is likely to run in families. If a parent has lupus, there is a five per cent chance that the children will contract it at some stage, further if an identical twin has lupus the other twin is more likely to develop it than a fraternal twin (Meadows 33). Research in this area has isolated certain genes that may cause lupus if there is some abnormality in their functioning. The human leukocyte antigen (HLA) genes, the receptors on the surface of T cells and other genes responsible for the proper functioning of the immune system are important in determining if one is liable to contract the disease or not. One theory suggests that lupus is caused by a defect in the functioning of the suppressor cells which serves to control the immune system and prevent it from getting overactive (Lahita & Phillips 25). In recent times, there has been some evidence pointing to irregularities in a process called apoptosis or cell death. The human body rids itself of damaged or useless cells by means of genetic selection, where the unnecessary cells are weeded out, to prevent the accumulation of this debris. If there is some error in the removal of these cells, and if the defective cells are allowed to live, it may result in the development of lupus. More research needs to be done, focusing on this area in order to ascertain the exact genes responsible for perpetuating this disease and to eventually find a cure. It is common knowledge that lupus is more prevalent among females. This tends to suggest that female hormones like estrogen are more closely associated with lupus and tend to determine the nature of the symptoms. The exact role of female hormones as a causal factor in lupus is uncertain but it is clear that that they affect the immune system in certain ways and hormonal malfunctioning may have an impact in the various manifestations of the disease. Environmental factors may are known to trigger symptoms in those already susceptible to the disease for various reasons. Prolonged exposure to sunlight and ultraviolet rays, birth control pills, radiation, pregnancy, stress or infections may bring about the sudden appearance of acute symptoms (Lahita & Phillips 46). There have also been reported cases of drug - induced lupus, where drugs like hydralazine, procainamide, sulphasalazine, minocycline, may aggravate symptoms or cause similar symptoms in otherwise healthy individuals (Hughes 100). Symptoms of Lupus Lupus is a complex illness that may concentrate its attack on any part of the body - kidneys, central nervous system, skin, digestive system etc. The range of severity also varies. Severe forms of the disease are easier to identify than milder forms. Because of the disconcerting array of symptoms that may not exclusively suggest lupus, and its confusing nature physicians are more likely to make the diagnosis only when the disease is well advanced. However certain common symptoms have been identified and a few or many of these may occur. The disease is also likely to stay dormant for many years, before manifesting symptoms. Specific symptoms that are likely to indicate lupus include, persistent headaches often accompanied by fever, sore throat, muscular fatigue, joint aches, ulcers in the mouth, inflammation of the tissues covering organs like the heart or lungs, kidney - related problems, hair loss and extreme sensitivity of the skin (Hughes 9; Lahita & Philips 82). Patients may also show a history of miscarriages and migraine attacks. Lahita and Phillips describe Raynaud's phenomenon as a characteristic syndrome, where "the toes and the fingers turn red, white, and blue because spasms in their small arteries stop the blood flow" (81). Another reportedly common symptom is the malar rash, which spreads across the cheek in the shape of a butterfly. Hughes reports Sjogren's syndrome as a characteristic feature of lupus - in this condition tear secretion is affected, leaving the eye with scant protection from dust and other atmospheric pollutants and the patient experiences itchiness and scratchiness of the eyes (10). Stress, depression, moodiness, and psychosis have also been reported as likely psychological symptoms. Patients who report recurrent depression in their past, experience relief from this symptom, only after treatment for lupus commences (Hughes 10). Some symptoms are less likely to be associated with lupus as they are not unique to it, but they need to be studied as patients often report these symptoms, which can lead to diagnostic confusion. Overwhelming fatigue is a common complaint and it may be the result of physical problems like joint pain or inflammation or it may stem from psychological causes like stress or depression. Lupus patients also report skin problems like rashes and patches which may occur on account of continuous exposure to the sun or particular allergies that have become exacerbated because of their condition. Hair loss is an important diagnostic feature, as individuals afflicted with lupus experience sudden and extreme hair loss with hair coming out in bunches and sometimes leading to the formation of bald patches and scarring of the scalp. Muscular and joint pain is another reported symptom that may be mistaken for arthritis or rheumatism. Sometimes the pain can be debilitating in its severity and leads to a lot of physical as well as psychological suffering for the patient. As mentioned already, Lupus can affect the vital organs of the body. It can interfere with the normal functioning of the kidney and affects the disposal of wastes from the body, leading to its accumulation in the blood stream. This condition is called uremia, another condition called proteinuria results when protein is lost during urination (Lahita & Phillips 82). It causes inflammation of the lining of the heart and lungs leading to pleurisy and pericarditis respectively, which can be extremely painful (Hughes 10). The digestive and circulatory systems may also be affected, interfering with their regular functioning. The nervous system is also attacked and can help explain some of the psychological symptoms of the disease, particularly psychosis, which is a condition where one loses contact with reality and engages in destructive behavior. Treatment and Management of Lupus Since there is no cure for lupus, treatment focuses on containing or controlling the illness. The symptoms are treated using appropriate treatment measures and with time it is hoped that the ill effects will recede, possibly never to make an appearance again. As the symptoms are so varied, treatment programs are devised in keeping with the particular needs of the individual that is they are tailored to suit the patient. Doctors not only attempt to treat the distressing symptoms but focus on protecting the patient from harmful side effects as well. Treatment seeks to alleviate the physiological as well as psychological symptoms of lupus and therefore it incorporates medication, surgery, counseling programs, a dietary regime and carefully planned lifestyle changes into the treatment procedure, in order to lessen the impact of the disease. Medication has an important role to play in taking the edge of the severe symptoms and to gradually suppress it. Non - steroidal anti - inflammatory drugs (NSAIDS) such as Feldene, Naprosyn, Voltarol and others are used to reduce joint pain, fever and inflammation. Side - effects for NSAIDS include indigestion, ulcer formation, bleeding and irritation of the stomach and bowels and its continued use may also increase the risk of cardiac arrest and stroke (Hughes 36; Meadows 34). Corticosteroids or Steroids like prednisolone and cortisone have been put to good use in the effective management of severe symptoms related to vital organs. However despite their proven usefulness in treating life - threatening symptoms, the patient suffers from harmful side - effects such as bloating, acne, mood - swings, reduced concentration skills as well as increased risk of infection, cataracts, and diabetes (Meadows 34). Antimalarials like hydroxychloroquine, chloroquine and mepanine are also used to curtail some of the severe symptoms in lupus patients. High dosage has been known to affect the retina of the eyes and in extreme cases it may even lead to blindness (Hughes 38). The final group of drugs used in treating lupus is known as immunosuppressives. Imuran, Cytoxan, and Sandimmune are commonly used. As the term suggests these drugs suppress the immune system in order to limit its destruction of healthy tissues. However in doing so, the system is weakened and the body becomes susceptible to infection and there is an increased risk of contracting other life - threatening diseases such as cancer (Meadows 34). Therefore the biggest risk in using such powerful medication is that in some cases the side - effects are worse than the disease itself and adversely affect the physical as well as emotional well - being of the patient. In prescribing medication, doctors need to monitor the progress made by the patient and try to reverse the side - effects wherever possible. When a patient is diagnosed with lupus, there is a tremendous impact on their mental health and emotional state. The patient is likely to feel depressed, frightened, angry, stressed or anxious in turns and is given to bouts of panic and moments of denial. Counseling and medication are effective ways to help lupus patients improve their coping skills and to deal effectively with the situation by accepting it and devising strategies to help themselves regain their independence and former confidence and lead a relatively comfortable and fulfilling life. Counseling serves as a mental crutch that provides assistance to the patient till a positive outlook has been acquired and mental resolve has been strengthened. It must be remembered that the treatment procedures for lupus are very flexible and a number of methods can be added to enhance the well - being of the patient. Dietary measures, an exercise regime, spirituality, yoga, group therapy and other measures may be used to revitalize the body as well as the senses. Of course there is no evidence to suggest that any of these strategies work by themselves but when used in combination with prescribed treatment measures like medication, they may prove beneficial to the patient and help them recover and go into remission thereby fulfilling the goals of treatment. Families Coping with Lupus For patients suffering from lupus, familial support is an essential component of recovery as lupus has an impact on all aspects of life like social and sexual activity, the individual's career options, relationships with family, friends etc. Parents and loved ones can provide emotional as well as financial sustenance for the individual suffering from the debilitating effects of lupus. By being a stable presence in the life of the patient, family members can help the individual get through the hard times. It is not always easy for family members to deal with illness. According to Phillips, "Sometimes family members react more strongly and possibly even more irrationally than the person who's suffering with lupus" (296). The psychological manifestations of lupus like depression, psychosis and the like are likely to take their toll on the entire family. The patient's feelings of anger, fear and denial can communicate itself to the family and members need to draw on their resources to deal with their own feelings of fear and their limited ability to cope, while simultaneously dealing with the recalcitrant patient. Feelings of guilt may be experienced on account of their own good health in the face of the suffering of a loved one. Siblings may feel fear and anxiety as there is always the possibility of the disease being passed on to their offspring and they may harbor resentment towards the patient. Parents may feel responsible for causing the disease and are traumatized. The symptoms of the disease may repel and scare family members and they may feel stressed out and are unable or unwilling to deal with the problem. They may not have sufficient knowledge about lupus and their fear of the unknown coupled with their doubts for the future may prove to be a huge emotional burden. Well - adjusted families are likely to cope with the situation. If there is good communication and understanding among family members, odds are they will eventually find themselves on top of the situation. Otherwise counseling facilities and therapy need to be used by those in need of it, to help deal with the situation in a manner that is beneficial to all concerned. Conclusion Lupus has a profound impact on the individual both physiologically and psychologically. Patients diagnosed with lupus undergo a lot of suffering, but it is possible to help them by dealing with the symptoms and teaching them to go on with their lives. There is a long way to go before the threat of lupus can be curbed. In light of the dismal lack of knowledge pertaining to various aspects of lupus, it is imperative that more research be gathered to combat it effectively and to provide a brighter future for those afflicted with this dreaded disease. Works Cited Hughes, Graham. Lupus: The Facts. New York: Oxford University Press, 2000. Lahita, Robert, and Robert Phillips. Lupus Q & A: Everything you Need to Know. New York: Avery, 2004. Meadows, Michelle. "Battling Lupus". FDA Consumer Jul/Aug 2005: 28 - 34. Phillips, Robert. Coping with Lupus: A Practical Guide to Alleviating the Challenges of Systemic Lupus Erythematosus. New York: Avery, 2001. Wallace, Daniel. The Lupus Book: A Guide for Patients and their Families. New York: Oxford University Press, 2005. Read More