Does Raynaud's Syndrome ever go away

Lupus self-help



Information on the disease lupus erythematosus



Lupus erythematosus (LE) is an autoimmune disease that belongs to the inflammatory rheumatism and there to the "collagenoses". There are two main forms: skin lupus and systemic lupus erythematosus (SLE).



Are you sometimes inexplicably tired and exhausted?
Do you often have joint or limb pain?
Do you occasionally feel sick?
Do you have frequent hair loss?
Do you keep having headaches?
Do you sleep a lot and still not fit?
Do you sometimes have noticeably dry mouth and eyes? Do you have conjunctivitis?
Do you keep getting a high temperature or an inexplicable high fever?
Do you occasionally see a butterfly-shaped rash on your face or red spots on other parts of your body?
Are you sensitive to light and cannot tolerate the sun?
Have you been to many doctors and none of them could find an explanation for your complaints?

Even if you answered "yes" to only three or four of these questions, you may have a condition called "lupus erythematosus". Other complaints can also occur, for example heart, lung or kidney diseases, diarrhea, difficulty concentrating, seizures and mental disorders.

What is lupus

Lupus erythematosus (LE) is an autoimmune disease that belongs to inflammatory rheumatism and there to the "collagenoses". There are two main forms: skin lupus and systemic lupus erythematosus (SLE). Lupus does NOT belong to soft tissue rheumatism because it can also affect the joints and internal organs.

Skin lupus

In some of those affected, only the skin is involved. There are various sub-forms of skin lupus. The most common form is discoid LE, in which characteristic disc-shaped, reddish-scaly skin changes occur. In around five to ten percent of those affected, skin lupus can turn into systemic PE.

Systemic lupus erythematosus (SLE)

This is the most common form of LE. In addition to the skin and joints, other organ systems (internal organs) can also be affected. The typical reddening of the skin on the face (butterfly erythema) only occurs in less than half of those affected by SLE.

The following table provides an overview of the possible symptoms of systemic lupus erythematosus:

Symptoms of SLE

Frequency in percent

Joint pain 85
General complaints (e.g. tiredness, poor performance)84
Skin changes81
Kidney findings77
Inflammation of the joints63
Raynaud's syndrome (cold and
Whitening of fingers and toes)
58
Central nervous system discomfort54
Mucosal changes54
Gastrointestinal complaints47
pleurisy37
Lymph node disease32
Pericarditis29
Lung involvement17
Inflammation of the muscles  5
Myocarditis  4
Inflammation of the pancreas  4

(based on: Hettenkofer, Hans-Jürgen [ed.]: Rheumatologie. Stuttgart: Thieme Verlag, 1998, p. 91)


Factors that can trigger lupus erythematosus

Eighty percent of people with SLE are young women between the ages of 15 and 45. Lupus erythematosus has something to do with the female sex hormones (estrogens). Often times, lupus breaks out during or after pregnancy. Taking the "pill" (contraceptive containing estrogen) can promote the disease. Even if you notice noticeable cycle-dependent fluctuations in your symptoms, this could be a sign of this disease.
Sensitivity to the sun is also typical in lupus erythematosus. Sunlight can activate the disease. That's why she sometimes breaks out after sunbathing or a vacation in the south. As with other autoimmune diseases, physical and emotional stress has an unfavorable effect on the course of the disease. Incompatible foods and medication can increase disease activity.

The actual cause of the disease is still unknown today. As with other autoimmune diseases, it is assumed that there is a genetic predisposition that, in conjunction with external factors (triggers), leads to the disease.

A number of drugs can trigger a disease similar to SLE (drug-induced lupus erythematosus). The symptoms usually go away after you stop taking these drugs.

diagnosis

It often takes a long time to detect lupus erythematosus. This is because the complaints are very different for each person. The disease is different for each person affected. According to the criteria published by the American Rheumatologists Association in 2012, four out of seventeen characteristic findings must be present for a diagnosis of systemic lupus erythematosus to be likely (so-called SLICC criteria). A proven organ involvement is not required for the diagnosis of SLE. An early diagnosis of SLE is not possible with the SLICC criteria. Chronic, insidious forms of the course (see below) are more difficult to diagnose than acute, intermittent courses.
In addition, this disease is unknown to many doctors because it is relatively rare. Only about 30-40,000 people in Germany suffer from SLE. As a result, doctors often cannot recognize them. Many affected young women are therefore mistaken for simulators.

The specialist in the diagnosis and treatment of this disease is an internist who is also a rheumatologist. The disease can be recognized by certain blood values. To do this, antinuclear factors (ANA) and other autoantibodies such as the ds-DNA antibodies must be determined.
Often the diagnosis is initially "collagenosis" if no more precise diagnosis can be made based on the symptoms and (blood) findings. The treatment is the same. There are also various mixed forms between PE and other collagenoses such as Sjogren's syndrome, scleroderma and antiphospholipid syndrome.

course

In about two-thirds of those affected, the disease progresses in stages. Around half of those affected have little or no discomfort between attacks (remission). In the other half of those affected, the disease continues to be active between attacks (partial remission).
About a third of the sick has a chronically progressive course, which means that there are no relapses and the disease progresses slowly.

At present, no laboratory values ​​are known in medicine that can be used to reliably estimate the disease activity of the LE. Neither the blood sedimentation nor the level of antinuclear antibodies (ANA) clearly reflect the disease activity. The C-reactive protein (CRP) is only slightly increased in PE even in times of increased disease activity. An increase in ds-DNA antibodies and a decrease in complement appear most likely to indicate an increase in disease activity. In order to be able to assess the activity of the disease, a synopsis of the complaints and the clinical findings as well as the (laboratory) technical examination results is necessary, whereby the clinical findings are leading. Because there are no reliable indicators for the disease activity in lupus erythematosus and organ involvement in the early stages often cannot be diagnosed with certainty, the severity of the clinical picture is often underestimated by doctors.

treatment

The following tiered scheme applies to the treatment of lupus erythematosus:

Painkiller
Antimalarial drugs (e.g. chloroquine [Quensyl®])
Immunosuppressants (e.g. azathioprine, ciclosporin A, mycophenolate mofetil) or a biological, the monoclonal antibody belimumab
Cytostatics (e.g. methotrexate, cyclophosphamide [Endoxan®])
In parallel, cortisone is given at all levels (e.g. Lodotra®).


The list goes from lighter to heavier drugs. The purpose of these drugs is to reduce inflammation and excessive immune system activity. The drugs intervene at various points in the disease process, but a causal therapy that eliminates the cause of the disease does not yet exist.

The use of the medication depends primarily on the severity of the clinical picture. Antimalarials work particularly well against skin symptoms and joint problems in lupus erythematosus. Immunosuppressants and cytostatics are used for more severe disease processes. Those affected with progressive disease generally respond better to treatment with the drugs available today than those with chronic, insidious progression.

Medical research at the university clinics is currently concentrating on the development of new treatment methods for the most severe relapsing forms of SLE, which affect around five percent of all PE sufferers (high-dose endoxane therapy, autologous stem cell transplantation). For the majority of PE sufferers, no new drugs have been developed in the past few decades. This is because the development of new treatment methods is not worthwhile for the pharmaceutical industry because of the small number of patients.
The earlier treatment begins, the better the course of the disease can be influenced. If the disease is identified and treated soon after it breaks out, people with lupus can now have a normal life expectancy. However, the quality of life can be more or less restricted.