Essay Example on Lupus is a chronic autoimmune disease with widespread inflammatory effects








Lupus is a chronic autoimmune disease with widespread inflammatory effects including tissues throughout the body including the skin joints kidneys blood and heart The term lupus refers to several types of the disease most commonly Systemic lupus erythematosus SLE Discoid lupus erythematosus subacute cutaneous erythematosus neonatal lupus and drug induced lupus Marks Jasmer 2015 Mention of lupus herein will refer to SLE unless otherwise stated While there is no known cure the disease can be managed in several ways which along with the effects of the disease will be discussed herein While lupus can be difficult to diagnose seeing as the symptoms of lupus are many and affect tissues throughout the body they can be summarised effectively As per the findings of the American college of rheumatology the symptoms of SLE may be categorised into 11 groups malar rash discoid rash photosensitivity oral ulcers arthritis serositis renal disorder neurologic disorder haematologic disorder immunologic disorder and antinuclear antibody Tan et al 1982

This literature was updated later Hochberg 1997 to emphasise the importance of antiphospholipid antibodies and antiphospholipid syndrome as per the research of Harris et al 1983 Alarcon Segovia 1989 According to the American college of rheumatology guidelines if a patient exhibits four or more of the symptoms listed then SLE is considered to be present Gill et al 2003 In addition to a clinical diagnosis of lupus using some of the observable symptoms listed above laboratory tests can be done to aid in the diagnosis combining the sets of information to make a diagnosis Examples of such tests include a complete blood count CBC Erythrocyte sedimentation rate ESR and an antinuclear antibody ANA test The most common of these in diagnosing lupus being ANA tests an ANA test is done by adding cells with a fluorescent dye to those of a patient s antibodies from a blood sample such that they bind to one another The presence of the fluorescent dye as well as the pattern it forms is observed under a microscope to determine a positive result for the ANA test and can indicate HopkinsLupus 2018 Overall the use of ANA tests in diagnosing SLE can be beneficial but can give false positive results and does not test only for SLE and therefore should never be relied on solely for a diagnosis Solomon et al 2002 Whilst the exact causes of lupus development are not known it does seem clear that some individuals are genetically predisposed to develop it where it Is thought that as many as 48 different loci may have implications in the development of lupus Graham et al 2001

Conversely however there is mounting evidence that lupus transmission is not solely based on genetic factors pet dogs whose owners have SLE are at a significantly higher risk of developing SLE than those whose owners do not Chiou et al 2003 Although the mechanism by which this works is unclear evidence of environmental factors playing a part in the development of the disease is an important discovery with the potential to aid in treatment Being an autoimmune disease lupus causes an inflammatory response and can do so in a vast number of tissues throughout the body of particular concern however is the effect on the cardiovascular system This damage can come in many forms for example thrombosis pericarditis myocarditis among others with pericarditis being the most prevalent effect of SLE on the cardiovascular system occasionally being fatal Cervera et al 2003 Jacobson and Reza 2005 One such pathway through which this occurs is the dysfunction of myeloid circulating angiogenic cells CACs and endothelial progenitor cells EPCs in patients with SLE Both of these types of cells are responsible in part for the maintenance and repair of vascular endothelium Briasoulis et al 2010 Vasa et al 2001 Specifically the presence of lupus results in activation of the cytokine IL 18 which in turn causes the intima media to thicken blood vessels in general to stiffen and the level of EPCs in the blood to be decreased in addition to increasing the cholesterol uptake by 1 5 6x in smooth muscle Bruce 2005

This results in increased atheroma development and by extension coronary heart disease among other cardiovascular diseases leaving those with SLE at a 50x increased risk of cardiovascular disease in general Kahlenberg et al 2011 Despite there not being a cure a number of options exist for the treatment of lupus many of which are immunosuppressant and many anti inflammatory A common example of an immunosuppressant used is cyclophosphamide CYC which works by inhibition of lymphocytes in the blood and thereby decrease the production of anti DNA autoantibodies Sharabi et al 2007 However being an immunosuppressant CYC inevitably has side effects notably those being treated with CYC are significantly more prone to infections than average Martin et al 1997 While these side effects are often considered minimal against the beneficial effect of the drug they have prompted some to research other methods of delivering the drug such as significantly lower achieving similar results Houssiau et al 2002 Alternatively steroidal drugs can be used such as the widely used prednisolone which has been shown to be effective and without major side effects in the treatment of a number of manifestations of lupus These include both lupus nephritis and non renal lupus suggesting it has wide uses for the treatment of lupus throughout the body Isenberg et al 1982

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