Pregnancy with Lupus

       Since lupus primarily affects young women, pregnancy often becomes a crucial question. Years ago, all medical texts said that women with lupus could not have children, and if they became pregnant, they should have therapeutic abortions. We now know that these early conclusions were wrong. Currently, more than 50 percent of all lupus pregnancies are completely normal. Twenty-five percent of women with lupus deliver normal babies prematurely. Fetal loss, due to spontaneous abortion (miscarriage) or death of the baby, accounts for less than 20 percent. Not all of the problems of pregnancy with lupus have been solved, but pregnancies are possible, and normal children are the rule.

While it is certainly possible for women with lupus to have children, pregnancy may not be easy. It is important to note that although many lupus pregnancies will be completely normal, all lupus pregnancies should be considered "high risk." "High risk" is a term commonly used by obstetricians to indicate that solvable problems may occur and must be anticipated. A pregnancy in a woman with lupus should be managed by obstetricians who are thoroughly familiar with high risk pregnancies and who work closely with the woman's primary physician. Delivery should be planned at a hospital that has access to a unit specializing in the care of premature newborns. SLE mothers should not attempt home delivery, or be overly committed to "natural" childbirth, since treatable complications during delivery are frequent. However, under close observation, the risk to the mother’s health is lessened, and healthy babies can be born.

Will Pregnancy Flare My Lupus?

Although older medical texts suggest that SLE flares are common in pregnancy, recent studies indicate that flares are uncommon and are usually easily treated. In fact, some women with lupus will actually experience an improvement in disease symptoms during pregnancy. Most of the flares tend to be mild. The most common symptoms of these flares are arthritis, rashes, and fatigue. Approximately 33 percent of women with lupus will have a decrease in platelet count during pregnancy, and about 20 percent will have an increase in or new occurrence of protein in the urine. These abnormalities may be due to pregnancy rather than to lupus. These levels usually recover after delivery.

Women who conceive after five-six months of remission are less likely to experience a lupus flare than those who get pregnant while their lupus is active. The presence of lupus nephritis before conception also increases the chance of having complications during pregnancy.

It is important to distinguish the symptoms of a lupus flare from the normal body changes that occur during pregnancy. For example, because the ligaments that hold the joints together normally soften in pregnancy, fluid may accumulate in the joints (especially in the knees) and cause swelling. Although this condition suggests inflammation due to lupus, it may simply be the swelling that occurs during a normal pregnancy. Similarly, lupus rashes may appear to worsen during pregnancy, but this is usually due to increased blood flow to the skin that is common in pregnancy (the "blush" of a pregnant woman). Many women also experience new hair growth during pregnancy, followed by a dramatic loss of hair after delivery. Although hair loss is certainly a symptom of active SLE, this again is most likely a result of the changes that happen during a normal pregnancy.

See also:

Introduction to Lupus – Types of Lupus – Causes of Lupus – Symptoms

 

Symptoms of Lupus

Although lupus can affect any part of the body, most people experience symptoms in only a few organs. The most common symptoms of people with lupus are listed below. Occurrences of particular symptoms happening are listed as percentages.

• Achy joints / arthralgia (95 percent)
  
• Fever of more than 100 degrees F / 38 degrees C (90 percent)
  
• Arthritis / swollen joints (90 percent)
  
• Prolonged or extreme fatigue (81 percent)
  
• Skin Rashes (74 percent)
  
• Anemia (71 percent)
  
• Kidney Involvement (50 percent)
  
• Pain in the chest on deep breathing / pleurisy (45 percent)
  
• Butterfly-shaped rash across the cheeks and nose (42 percent)
  
• Sun or light sensitivity / photosensitivity (30 percent)
  
• Hair loss (27 percent)
  
• Abnormal blood clotting problems (20 percent)
  
• Raynaud's phenomenon / fingers turning white and/or blue in the cold (17 percent)
  
• Seizures (15 percent)
  
• Mouth or nose ulcers (12 percent)
  

If you have several of these symptoms, see your doctor right away.

See also:
Introduction to Lupus
Types of Lupus
Causes of Lupus

Causes of Lupus

The cause(s) of lupus is currently unknown, but there are environmental and genetic factors involved. Some environmental factors which may trigger the disease include infections, antibiotics (especially those in the sulfa and penicillin groups), ultraviolet light, extreme stress, certain drugs, and hormones.

Scientists believe there is a genetic predisposition to the disease, as lupus is known to occur within families. However, there is no known gene or genes which are thought to cause the illness. There are recent discoveries of a gene on chromosome 1 which is associated with lupus in certain families. Previously, genes on chromosome 6 called "immune response genes" were also associated with the disease. Only 10 percent of lupus patients will have a close relative (parent or sibling) who already has or may develop lupus. Statistics show that only about five percent of the children born to individuals with lupus will develop the illness.

Lupus is often called a "woman's disease" despite the fact that many men are affected. Lupus can occur at any age, and in either sex, although it occurs 10-15 times more frequently among adult females than among adult males after puberty or after the emergence into sexual maturity. The symptoms of the disease are the same in men and women. People of African, American Indian, and Asian origin are thought to develop the disease more frequently than Caucasian women. The reasons for this ethnic selection are not clear.

Hormonal factors may explain why lupus occurs more frequently in females than in males. The increase of disease symptoms before menstrual periods and/or during pregnancy support the belief that hormones, particularly estrogen, may somewhat regulate the way the disease progresses. However, the exact reason for the greater prevalence of lupus in women, and the cyclic increase in symptoms, is unknown.

See also:
Lupus Introduction
Type of Lupus

Types of Lupus

There are four types of lupus: discoid, systemic, drug-induced and neonatal lupus.

Discoid (cutaneous) lupus is always limited to the skin. It is identified by a rash that may appear on the face, neck, and scalp. Discoid lupus is diagnosed by examining a biopsy of the rash. In discoid lupus the biopsy will show abnormalities that are not found in skin without the rash. Discoid lupus does not generally involve the body's internal organs. Therefore, the ANA test may be negative in patients with discoid lupus. However, in a large number of patients with discoid lupus, the ANA test is positive, but at a low level or "titer."

In approximately 10 percent of patients, discoid lupus can evolve into the systemic form of the disease, which can affect almost any organ or system of the body. This cannot be predicted or prevented. Treatment of discoid lupus will not prevent its progression to the systemic form. Individuals who progress to the systemic form probably had systemic lupus at the outset, with the discoid rash as their main symptom.

Systemic lupus is usually more severe than discoid lupus, and can affect almost any organ or organ system of the body. For some people, only the skin and joints will be involved. In others, the joints, lungs, kidneys, blood, or other organs and/or tissues may be affected. Generally, no two people with systemic lupus will have identical symptoms. Systemic lupus may include periods in which few, if any, symptoms are evident ("remission") and other times when the disease becomes more active ("flare"). Most often when people mention "lupus," they are referring to the systemic form of the disease.

Drug-induced lupus occurs after the use of certain prescribed drugs. The symptoms of drug-induced lupus are similar to those of systemic lupus. The drugs most commonly connected with drug-induced lupus are hydralazine (used to treat high blood pressure or hypertension) and procainamide (used to treat irregular heart rhythms). Drug induced lupus is more common in men who are given these drugs more often. However, not everyone who takes these drugs will develop drug-induced lupus. Only about 4 percent of the people who take these drugs will develop the antibodies suggestive of lupus. Of those 4 percent, only an extremely small number will develop overt drug-induced lupus. The symptoms usually fade when the medications are discontinued.

Neonatal lupus is a rare condition acquired from the passage of maternal autoantibodies, specifically anti-Ro/SSA or anti-La/SSB, which can affect the skin, heart and blood of the fetus and newborn. It is associated with a rash that appears within the first several weeks of life and may persist for about six months before disappearing. Congenital heart block is much less common than the skin rash. Neonatal lupus is not systemic lupus.

See also:
http://timesharing4you.blogspot.com/2007/12/lupus-systemic-lupus-erythematosis.html

Lupus - Systemic Lupus Erythematosis

Lupus is an autoimmune disease that can affect various parts of the body, including the skin, joints, heart, lungs, blood, kidneys and brain. Normally the body's immune system makes proteins called antibodies, to protect the body against viruses, bacteria, and other foreign materials. These foreign materials are called antigens.

In an autoimmune disorder like lupus, the immune system cannot tell the difference between foreign substances and its own cells and tissues. The immune system then makes antibodies directed against itself. These antibodies -- called "auto-antibodies" (auto means 'self') -- cause inflammation, pain and damage in various parts of the body.

Inflammation is considered the primary feature of lupus. Inflammation, which in Latin means "set on fire," is characterized by pain, heat, redness, swelling and loss of function, either on the inside or on the outside of the body (or both).

For most people, lupus is a mild disease affecting only a few organs. For others, it may cause serious and even life-threatening problems. Although epidemiological data on lupus is limited, studies suggest that more than 16,000 Americans develop lupus each year.

The Lupus Foundation of America (LFA) estimates between 1.5 - 2 million Americans have a form of lupus, but the actual number may be higher. More than 90 percent of people with lupus are women. Symptoms and diagnosis occur most often when women are in their child-bearing years, between the ages of 15 and 45.

In the United States, lupus is more common in African Americans, Latinos, Asians, and Native Americans than in Caucasians.

SLE

What is lupus? What are the types of lupus?

Lupus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Autoimmune diseases are illnesses that occur when the body's tissues are attacked by its own immune system. The immune system is a complex system within the body that is designed to fight infectious agents, for example, bacteria, and other foreign invaders. One of the mechanisms that the immune system uses to fight infections is the production of antibodies. Patients with lupus produce abnormal antibodies in their blood that target tissues within their own body rather than foreign infectious agents. Because the antibodies and accompanying cells of inflammation can involve tissues anywhere in the body, lupus has the potential to affect a variety of areas of the body. Sometimes lupus can cause disease of the skin, heart, lungs, kidneys, joints, and/or nervous system. When only the skin is involved, the condition is called discoid lupus. When internal organs are involved, the condition is called systemic lupus erythematosus (SLE).
Both discoid and systemic lupus are more common in women than men (about eight times more common). The disease can affect all ages but most commonly begins from age 20 to 45 years. It is more frequent in African-Americans and people of Chinese and Japanese descent.

What causes lupus? Is it hereditary?

The precise reason for the abnormal autoimmunity that causes lupus is not known. Inherited genes, viruses, ultraviolet light, and drugs may all play some role. Genetic factors increase the tendency of developing autoimmune diseases, and autoimmune diseases such as lupus, rheumatoid arthritis, and immune thyroid disorders are more common among relatives of patients with lupus than the general population. Some scientists believe that the immune system in lupus is more easily stimulated by external factors like viruses or ultraviolet light. Sometimes, symptoms of lupus can be precipitated or aggravated by only a brief period of sun exposure.
It also is known that some women with SLE can experience worsening of their symptoms prior to their menstrual periods. This phenomenon, together with the female predominance of SLE, suggest that female hormones play an important role in the expression of SLE. This hormonal relationship is an active area of ongoing study by scientists.
More recently, research has demonstrated evidence that a key enzyme's failure to dispose of dying cells may contribute the development of SLE. The enzyme, DNase1, normally eliminates what is called "garbage DNA" and other cellular debris by chopping them into tiny fragments for easier disposal. The researchers turned off the DNase1 gene in mice. The mice appeared healthy at birth but after six to eight months, the majority of mice without DNase1 showed signs of SLE. Thus, a genetic mutation in a gene that could disrupt the body's cellular waste disposal may be involved in the initiation of SLE.

What is drug-induced lupus?

Dozens of medications have been reported to trigger SLE; however, more than 90% of this "drug-induced lupus" occurs as a side effect of one of the following six drugs: hydralazine (used for high blood pressure), quinidine and procainamide (used for abnormal heart rhythm), phenytoin (used for epilepsy), isoniazid Nydrazid, Laniazid), used for tuberculosis], d-penicillamine (used for rheumatoid arthritis). These drugs are known to stimulate the immune system and cause SLE. Fortunately, drug-induced SLE is infrequent (accounting for less than 5% of SLE among all patients with SLE) and usually resolves when the medications are discontinued.

What are the symptoms and signs of lupus?

In discoid lupus, only the skin is typically involved. The skin rash

in discoid lupus often is found on the face and scalp. It usually is red and may have raised borders. Discoid lupus rashes are usually painless and do not itch, but scarring can cause permanent hairloss. Over time, 5%-10% of patients with discoid lupus may develop SLE.

Patients with SLE can develop different combinations of symptoms and organ involvement. Common complaints and symptoms include fatigue, low-grade fever

, loss of appetite, muscle aches,arthritis, ulcers of the mouth and nose, facial rash ("butterfly rash"), unusual sensitivity to sunlight (photosensitivity), inflammation of the lining that surrounds the lung (pleuritis) and the heart (pericarditis), and poor circulation to the fingers and toes with cold exposure (Raynaud's phenomenon).
More serious organ involvement with inflammation occurs in the brain, liver, and kidney. White blood cells and blood clotting factors also can be decreased in SLE, thereby increasing the risk of infection and bleeding.
Over half of the patients with SLE develop a characteristic red, flat facial rash over the bridge of their nose. Because of its shape, it is frequently referred to as the "butterfly rash" of SLE. The rash is painless and does not itch. The facial rash, along with inflammation in other organs, can be precipitated or worsened by exposure to sunlight, a condition called photosensitivity. This photosensitivity can be accompanied by worsening of inflammation throughout the body, called a "flare" of disease.
Most patients with SLE will develop arthritis during the course of their illness. Arthritis in SLE commonly involves swelling, pain, stiffness, and even deformity of the small joints of the hands, wrists, and feet. Sometimes, the arthritis of SLE can mimic that of rheumatoid arthritis (another autoimmune disease).

Inflammation of muscles can cause muscle pain and weakness.Inflammation of blood vessels, that supply oxygen to tissues, can cause isolated injury to a nerve, the skin, or an internal organ. The blood vessels are composed of arteries that pass oxygen-rich blood to the tissues of the body and veins which return oxygen-depleted blood from the tissues to the lungs. Vasculitis is characterized by inflammation with damage to the walls of various blood vessels. The damage blocks the circulation of blood through the vessels and can cause injury to the tissues that the vessels supply.
Inflammation of the lining of the lungs (pleuritis) and of the heart (pericarditis) can cause sharp chest pain. The chest pain is aggravated by coughing, deep breathing, and certain changes in body position. The heart muscle itself rarely can become inflamed (carditis). It has also been shown that young women with SLE have a significantly increased risk of heart attacks from coronary artery disease.
Kidney inflammation in SLE can cause leakage of protein into the urine, fluid retention,high blood pressure, and even kidney failure. With kidney failure, machines are needed to cleanse the blood of accumulated poisons in a process called dialysis.
Involvement of the brain can cause personality changes, thought disorders (psychosis), seizures, and even coma. Damage to nerves can cause numbness, tingling, and weakness of the involved body parts or extremities. Brain involvement is called cerebritis.
Many patients with SLE experience hair loss (alopecia). Often, this occurs simultaneously with an increase in the activity of their disease.
Some patients with SLE have Raynaud's phenomenon. In these patients, the blood supply to the fingers and toes becomes interrupted upon exposure to cold, causing blanching, bluish discoloration, and pain in the exposed fingers and toes.


How is lupus diagnosed?

Since patients with SLE can have a wide variety of symptoms and different combinations of organ involvement, no single test establishes the diagnosis of systemic lupus. To help doctors improve the accuracy of the diagnosis of SLE, eleven criteria were established by the American Rheumatism Association. These 11 criteria are closely related to the symptoms discussed above. Some patients suspected of having SLE may never develop enough criteria for a definite diagnosis. Other patients accumulate enough criteria only after months or years of observation. When a person has four or more of these criteria, the diagnosis of SLE is strongly suggested. Nevertheless, the diagnosis of SLE may be made in some settings in patients with only a few of these classical criteria. Of these patients, a number may later develop other criteria, but many never do.

The 11 criteria used for diagnosing systemic lupus erythematosus are

1. malar (over the cheeks of the face) "butterfly" rash
2. discoid skin rash: patchy redness that can cause scarring
3. photosensitivity: skin rash in reaction to sunlight exposure
4. mucus membrane ulcers: ulcers of the lining of the mouth, nose or throat
5. arthritis: two or more swollen, tender joints of the extremities
6. pleuritis/pericarditis: inflammation of the lining tissue around the heart or lungs,

usually associated with chest pain with breathing
7. kidney abnormalities: abnormal amounts of urine protein or clumps of cellular elements

called casts

8. brain irritation: manifested by seizures (convulsions) and/or psychosis
9. blood count abnormalities: low counts of white or red blood cells, or platelets
10. immunologic disorder: abnormal immune tests include anti-DNA or anti-Sm (Smith)

antibodies, falsely positive blood test for syphilis, anticardiolipin antibodies, lupus

anticoagulant, or positive LE prep test
11. antinuclear antibody: positive ANA antibody testing

In addition to the 11 criteria, other tests can be helpful in evaluating patients with SLE to determine the severity of organ involvement. These include routine testing of the blood to detect inflammation (for example, a test called the sedimentation rate), blood chemistry testing, direct analysis of internal body fluids, and tissue biopsies. Abnormalities in body fluids and tissue samples (kidney, skin, and nerve biopsies) can further support the diagnosis of SLE. The appropriate test procedures are selected for the patient individually by the doctor.

What is the treatment for systemic lupus?

There is no permanent cure for SLE. The goal of treatment is to relieve symptoms and protect organs by decreasing inflammation and/or the level of autoimmune activity in the body. Many patients with mild symptoms may need no treatment or only intermittent courses of antiinflammatory medications. Those with more serious illness involving damage to internal organ(s) may require high doses of corticosteroids in combination with other medications that suppress the body's immune system.
Patients with SLE need more rest during periods of active disease. Researchers have reported that poor sleep

quality was a significant factor in developing fatigue in patients with SLE. These reports emphasize the importance for patients and physicians to address sleep quality and the effect of underlying depression, lack of exercise, and self-care coping strategies on overall health. During these periods, carefully prescribed exercise is still important to maintain muscle tone and range of motion in the joints.
Nonsteroidal antiinflammatory drugs (NSAIDs) are helpful in reducing inflammation and pain in muscles, joints, and other tissues. Examples of NSAIDs include aspirin,ibuprofen (Motrin),naproxen(Naprosyn), and sulindac (Clinoril). Since the individual response to NSAIDs varies among patients, it is common for a doctor to try different NSAIDs to find the most effective one with the fewest side effects. The most common side effects are stomach upset, abdominal pain,ulcers, and even ulcer bleeding. NSAIDs are usually taken with food to reduce side effects. Sometimes, medications that prevent ulcers while taking NSAIDs, such as misoprostol (Cytotec), are given simultaneously.

Corticosteroids are more potent than NSAIDs in reducing inflammation and restoring function when the disease is active. Corticosteroids are particularly helpful when internal organs are involved. Corticosteroids can be given by mouth, injected directly into the joints and other tissues, or administered intravenously. Unfortunately, corticosteroids have serious side effects when given in high doses over prolonged periods, and the doctor will try to monitor the activity of the disease in order to use the lowest doses that are safe. Side effects of corticosteroids include weight gain, thinning of the bones and skin, infection,diabetes, facial puffiness,cataracts, and death (necrosis) of large joints.

Hydroxychloroquine (Plaquenil) is an antimalarial medication found to be particularly effective for SLE patients with fatigue, skin, and joint disease. Side effects include diarrhea, upset stomach, and eye pigment changes. Eye pigment changes are rare, but require monitoring by an ophthalmologist (eye specialist) during treatment with Plaquenil. Researchers have found that Plaquenil significantly decreased the frequency of abnormal blood clots in patients with systemic SLE. Moreover, the effect seemed independent of immune suppression, implying that Plaquenil can directly act to prevent the blood clots. This fascinating work highlights an important reason for patients and doctors to consider Plaquenil, especially for those SLE patients who are at some risk for blood clots in veins and arteries, such as those with phospholipid antibodies (cardiolipin antibodies, lupus anticoagulant, and false positive VDRL). This means not only that Plaquenil reduces the chance for reflares of SLE, but it can also be beneficial in 'thinning' the blood to prevent abnormal excessive blood clotting.
For resistant skin disease, other antimalarial drugs, such as chloroquine (Aralen) or quinacrine, are considered, and can be used in combination with hydroxychloroquine. Alternative medications for skin disease include dapsone and retinoic acid (Retin-A). Retin-A is often effective for an uncommon wart-like form of lupus skin disease. For more severe skin disease, immunosuppressive medications are considered as below.
Medications that suppress immunity (immunosuppressive medications) are also called cytotoxic drugs. Immunosuppressive medications are used for treating patients with more severe manifestations of SLE with damage to internal organ(s). Examples of immunosuppressive medications include methotrexate (Rheumatrex, Trexall), azathioprine (Imuran), cyclophosphamide (Cytoxan), chlorambucil (Leukeran), and cyclosporine (Sandimmune). All immunosuppressive medications can seriously depress blood cell counts and increase risks of infection and bleeding. Other side effects are peculiar for each drug. For examples, Rheumatrex can cause liver toxicity, while Sandimmune can impair kidney function.
In recent years,mycophenolate mofetil (Cellcept) has been used as an effective medication for lupus, particularly when it associated with kidney disease. Cellcept has been helpful in reversing active lupus kidney disease (lupus renal disease) and in maintaining remission after it is established. It's lower side effect profile has advantage over traditional immune suppression medications.
In SLE patients with serious brain or kidney disease, plasmapheresis is sometimes used to remove antibodies and other immune substances from the blood to suppress immunity. Some SLE patients can develop seriously low platelet levels, thereby increasing the risk of excessive and spontaneous bleeding. Since the spleen is believed to be the major site of platelet destruction, surgical removal of the spleen is sometimes performed to improve platelet levels. Other treatments have included plasmapheresis and the use of male hormones. Plasmapheresis has also been used to remove proteins (cryoglobulins) that can lead to vasculitis. Endstage kidney damage from SLE requires dialysis and/or a kidney tranplant.
Most recent research is indicating benefits of rituximab (Rituxan) in treating lupus. Rituximab is an intravenously infused antibody that suppresses a particular white blood cell, the B cell, by decreasing their number in the circulation. B cells have been found to play a central role in lupus activity, and when they are suppressed, the disease tends toward remission.
At the 2007 national Rheumatology meeting, there was a paper presented suggesting that low dose dietary supplementation with moega-3 fish oils could help patients with lupus by decreasing disease activity and possibly decreasing heart disease risk.

How can a lupus patient help prevent disease activity (flares)?

SLE is undoubtedly a potentially serious illness with involvement of numerous organ systems. However, it is important to recognize that most patients with SLE lead full, active, healthy lives. Periodic increases in disease activity (flares) can usually be managed by varying medications. Since ultraviolet light can precipitate and worsen flares, patients with systemic lupus should avoid sun exposure.Sunscreens

and clothing covering the extremities can be helpful. Abruptly stopping medications, especially corticosteroids, can also cause flares and should be avoided. Patients with SLE are at increased risk of infections, especially if they are taking corticosteroids or immunosuppressive medications. Therefore, any unexpected fever should be reported and evaluated.
The key to successful management of SLE is regular contact and communication with the doctor, allowing monitoring of symptoms, disease activities, and treatment side effects.

How can lupus affect pregnancy or the newborn?

Patients with SLE who become pregent

are considered "high risk." Women with SLE who are pregnant require close observation during pregnancy and delivery. This includes fetal monitoring by the obstetrician during later pregnancy. These women can have an increased risk of miscarriages (spontaneous abortions) and can have flares of SLE during pregnancy. The presence of phospholipid antibodies, such as cardiolipin antibodies or lupus anticoagulant, in the blood can identify patients at risk for miscarriages. Cardiolipin antibodies are associated with a tendency toward blood clotting. Patients with SLE who have cardiolipin antibodies or lupus anticoagulant may need blood thinning medications (aspirin with or without heparin) during pregnancy to prevent miscarriages. Other reported treatments include the use of intravenous gamma globulin for selected patients with histories of premature miscarriage and those with low blood-clotting elements (platelets) during pregnancy. Pregnant women who have had a previous blood clotting event may benefit by continuation of blood thinning throughout and after pregnancy for up to six to 12 weeks, at which time the risk of clotting associated with pregnancy seems to diminish. Plaquenil has now been found to be safe for use to treat SLE during pregnancy.
Lupus antibodies can be transferred from the mother to the fetus and result in lupus illness in the newborn ("neonatal lupus"). This includes the development of low red cell (anemia) and/or white blood cell and platelet counts, and skin rash. Problems can also develop in the electrical system of the baby's heart (congenital heart block). Occasionally, a pacemaker for the baby's heart is needed in this setting. Neonatal lupus and congenital heart block are more common in newborns of mothers with SLE who carry antibodies referred to as anti-Ro (or SS-A) and anti-La (or SS-B). (It is wise for the newborn baby's doctor to be made aware if the mother is known to carry these antibodies. Risk of heart block is 2%, risk of neonatal lupus is 5%.) Neonatal lupus usually clears after six months of age as the mother's antibodies are slowly metabolized by the baby.

What does the future hold for patients with lupus?

Overall, the outlook for patients with systemic lupus is improving each decade with the development of more accurate monitoring tests and treatments.
The role of the immune system in causing diseases is becoming better understood through research. This knowledge will be applied to design safer and more effective treatment methods. For example, completely revising the immune system of patients with extremely aggressive treatments that virtually temporarily wipe out the immune system is being evaluated. Current studies involve immune eradication with or without replacement of cells that can re-establish the immune system (stem cell transplantation

).
It should be noted that patients with SLE are at a somewhat increased risk for developing cancer. The cancer risk is most dramatic for blood cancers, such as leukemia and lymphoma, but is also increased for breast cancer . This risk probably relates, in part, to the altered immune system that is characteristic of SLE.
Women with SLE appear to be at increased risk for heart disease (coronary artery disease) according to recent reports. Women with SLE should be evaluated to minimize risk factors for heart disease, such as elevated blood cholesterol,quitting smoking, high blood pressure, and obesity .
DHEA (dehydroepiandrosterone) has been helpful in reducing fatigue, improving thinking difficulties, and improving quality of life in patients with SLE. Recent research indicates that DHEA has been shown to improve or stabilize signs and symptoms of SLE. DHEA is commonly available in health food stores, pharmacies, and many groceries.
Landmark research has shown clearly that oral contraceptives do not increase the rate of flares of systemic lupus erythematosus. This important finding is opposite to what has been thought for years. Now we can reassure women with lupus that if they take birth control pills, they are not increasing their risk for lupus flares. NOTE: Birth control pills or any estrogen medications still should be avoided by women who are at increased risk of blood clotting, such as lupus women who have phospholipid antibodies (including cardiolipin antibody or lupus anticoagulant).
Individuals with SLE can improve their prognosis by learning about the many aspects of the illness as well as closely monitoring their own health with their doctors

Systemic Lupus Erythematosus At A Glance :

1.Systemic lupus erythematosus (SLE) is an autoimmune disease.
2.SLE is characterized by the production of unusual antibodies in the blood.
3.SLE is eight times more common in women than men.
4.The cause(s) of SLE is (are) unknown, however, heredity, viruses, ultraviolet light, and

drugs all may play some role.
5.Up to 10% of patients with SLE isolated to the skin will develop the systemic form of lupus

(SLE).
6.Eleven criteria help doctors to diagnose SLE.
7.Treatment of SLE is directed toward decreasing inflammation and/or the level of

autoimmune activity.
8.Patients with SLE can prevent "flares" of disease by avoiding sun exposure and not

abruptly discontinuing medications.