Systemic Lupus Erythematosus

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Definition

Systemic lupus erythematosus (also called lupus or SLE) is a disease where a person's immune system attacks and injures the body's own organs and tissues. Almost every system of the body can be affected by SLE.

Description

The body's immune system is a network of cells and tissues responsible for clearing the body of invading foreign organisms, like bacteria, viruses, and fungi. Antibodies are special immune cells that recognize these foreign invaders, and begin a chain of events to destroy them. In an autoimmune disorder like SLE, a person's antibodies begin to recognize the body's own tissues as foreign. Cells and chemicals of the immune system damage the tissues of the body. The reaction that occurs in tissue is called inflammation. Inflammation includes swelling, redness, increased blood flow, and tissue destruction.

In SLE, some of the common antibodies that normally fight diseases are thought to be out of control. These include antinuclear antibodies and anti-DNA antibodies. Antinuclear antibodies are directed against the cell's central structure that contains genetic material (the nucleus). Anti-DNA antibodies are directed against the cell's genetic material. DNA is the chemical substance that makes up the chromosomes and genes.

SLE can occur in both males and females of all ages, but 90% of patients are women. The majority of these women are in their childbearing years. African Americans are more likely than Caucasians to develop SLE.

Occasionally, medications can cause a syndrome of symptoms very similar to SLE. This is called drug-induced lupus. Medications that may cause this syndrome include hydralazine (used for high blood pressure) and procainamide (used for abnormal heartbeats). Drug-induced lupus almost always disappears after the patient stops taking the medications that caused it.

— Rosalyn Carson-DeWitt, MD

Dictionary: lupus er·y·the·ma·to·sus  (ĕr'ə-thē'mə-tō'səs, -thĕm'ə-)

Any of several connective tissue disorders, especially systemic lupus erythematosus, that primarily affect women of childbearing age, have a variety of clinical forms, and are characterized by red scaly skin lesions.

[New Latin lupus erythēmatōsus : LUPUS + erythēmatōsus, erythematous.]

Definition

Lupus, also known as lupus erythematosus, is an autoimmune inflammatory disorder that occurs mostly in women.

Description

Lupus produces widely varying symptoms, although joint pain is reported by most patients and skin lesions are common. Lupus can cause short periods of symptoms alternating with healthy periods, or can progress into a life-threatening disorder affecting the heart, kidneys, and other organs.

Why the disease is termed lupus is unknown, but it has been known as a distinct disorder and called lupus by European physicians since at least the tenth century A.D. The term erythematosus was first attached to the disease in the 1850s, and it refers to the patchy congestion of skin capillaries with blood (erythema) that often accompanies the disease.

Demographics

Between one million and 1.5 million Americans have some form of lupus. The incidence among women is 10–15 times greater than among men, and it is two to three times more common among African Americans, Hispanics, Asians, and Native Americans than among whites. Lupus most often appears for the first time in women between the ages of 15 and 44. Twenty thousand people die of lupus-related causes in the United States annually.

Causes and symptoms

Lupus is an autoimmune disorder, a disease in which the body's immune system turns against the body itself. In a healthy person, the immune system defends against invading organisms but does not, in general, attack the body's own tissues. The cause of lupus is unknown. However, it is known that lupus has a genetic component, which means a predisposition to lupus can be inherited. Approximately 10% of lupus patients have one or more direct relatives with lupus. (Note that this means that 90% of lupus patients have no such relatives; however, it shows a genetic connection because 10% is a much higher figure for familial lupus than can be attributed to chance alone.) Lupus has been definitely linked to genes on chromosome 1 and less certainly to genes on chromosomes 4 and 6.

Given genetic susceptibility, the disease may either develop spontaneously or be triggered by some environmental factor. Environmental factors known to trigger lupus include infections (e.g., Epstein-Barr virus, which infects 99% of children with lupus, but only 70% of healthy children), antibiotics, ultraviolet light (the rays in sunlight or sunlamp-light that causes sunburn), stress, smoking, certain medications, and hormones (especially estrogen, the female sex hormone).

Lupus manifests as a continuum or spectrum of disorders. However, it is common to divide lupus cases into four categories or groups:

• Systemic lupus erythematosus. This is the most serious form of lupus and affects about 70% of all persons with lupus. It is termed systemic because, in this variety of lupus, the body's immune system attacks one or more essential body systems. Targets may include the brain, kidneys, heart, pancreas, or other organs.
• Discoid or cutaneous lupus erythematosus. This variety of lupus is less severe, in that it attacks the skin only. However, it can be disfiguring, often attacking the skin of the face. The term discoid is derived from the round (disc-shaped) lesions that appear on the skin. About 10–15% of lupus patients have cutaneous lupus.
• Drug-induced or drug-related lupus erythematosus. This term refers to lupus that develops after a patient has taken a medication. Medications that can trigger drug-induced lupus include procainamide or hydralazine. Many of the substances that can potentially trigger lupus fall into the class of aromatic amines, or hydrazines. For example, the aromatic amine paraphenylenediamine is present in certain hair dyes and has been associated with lupus or lupus-like syndrome. Tartrazine (a food coloring, FD&C yellow No. 5), which is present in thousands of foods and medications, has also been associated with lupus. Cocaine abuse can induce lupus and several other connective-tissue diseases, as can exposure to certain metals (e.g., mercury). Between 10,000 and 15,000 people are diagnosed with drug-induced lupus annually in the United States.
• Mixed connective tissue disease. Approximately 10% of patients with lupus also have symptoms of one or more additional connective-tissue diseases.

The symptoms of lupus are quite varied. In discoid lupus, red patches (erythema) appear symmetrically on the cheeks, possibly extending to the face, neck, scalp, and other parts of the body. No organ other than the skin is affected (or the disease is classified as systemic, rather than discoid). Systemic lupus may begin suddenly, signaled by fever, or develop slowly over months or years. Chronic fatigue is a common symptom. Symptoms related to impairment of any organ may occur. The lupus disease process in a given organ is named after that organ; for example, inflammation of the kidneys is termed lupus nephritis, and inflammation of the brain is termed lupus cerebritis. Kidney involvement may be fatal. Over 50% of all systemic lupus patients in the United States presently have some degree of lupus cerebritis; 25–75% have neuropsychiatric symptoms at some time in their illness. Symptoms of lupus cerebritis may include headaches, seizures, stroke, psychosis, dementia, peripheral neuropathy, cerebellar ataxia (failure of muscular coordination, usually on one side of the body), chorea (jerky, involuntary movements), and others. Duration of central nervous system involvement may be transient (as with a migraine headache) or long lasting (as with dementia). Stroke incidence is 3–20% in systemic lupus patients, and is highest in the first five years of the disease. Peripheral neuropathy (carpal tunnel syndrome, for example) occurs in more than 20% of systemic lupus patients and cranial nerve palsies occur in 10–15%.

Exposure to the ultraviolet rays in sunlight can trigger lupus or, in a person who already has the disease, cause it to flare up. Worsening flare-ups of the disease can be life threatening because they can include inflammation and failure of the kidneys. Also, declining memory and mental sharpness with long-term lupus is common.

Diagnosis

Lupus is notoriously difficult to diagnose. Many cases are not diagnosed until the patient has suffered irreversible kidney damage; for patients who do not have organ-threatening disease, diagnosis takes an average of two years of searching among physicians and conditions. The telltale erythematous skin lumps or rashes that give lupus erythematosus the latter half of its name eventually appear in 90% of systemic lupus patients and all discoid lupus patients, but may not appear early enough in the course of the disease to guarantee timely diagnosis. Additionally, no single lab test can confirm lupus, although certain antibody tests can help to distinguish lupus from other diseases.

Diagnosis of systemic lupus is based on a list of 11 criteria listed by the American College of Rheumatology. If four or more of the 11 criteria are met, a patient is deemed to have systemic lupus. The criteria include discoid or macular rash (often in a classic facial butterfly pattern across the nose and cheeks), photosensitivity, ulcers in the mouth, kidney dysfunction, and the presence of various blood factors such as anti-DNA antibody or anti-nuclear antibody (antibody that targets cell nuclei).

Approximately 15% of diagnoses of lupus may be misdiagnoses of other disorders, including fibromyalgia, seronegative spondyloarthropathies such as ankylosing spondylitis or Reiter's syndrome, autoimmune thyroiditis, and multiple sclerosis.

Although diagnosis of lupus cerebritis is particularly difficult, even if a patient has lupus, this does not necessarily mean that the neurological symptoms are due to lupus. Imaging studies cannot necessarily distinguish lupus cerebritis, although magnetic resonance imaging (MRI) studies are considered helpful. Positron emission tomography (PET) imaging has a high sensitivity to changes in the brain resulting from lupus cerebritis.

Treatment team

As with other neurological diseases in which the spectrum of symptoms varies widely, the treatment team must be designed for each individual case of lupus. A dermatologist will be involved if skin lesions are present; a neurologist, if cognitive loss is a possibility; a nephrologist will monitor kidney function; and a rheumatologist is often involved because of the frequency of joint pain. Other specialists will be needed depending on what organ systems are affected.

Treatment

There is no known cure for lupus. However, there are numerous interventions designed to lessen the severity of the disease. These interventions can be classed as pharmacologic (drug-based) or nonpharmacologic.

Pharmacologic interventions (drug therapies)

Five categories of medication are used to treat systemic lupus patients: sunscreens and steroid lotions, nonsteroidal anti-inflammatory drugs (NSAIDs, e.g., acetaminophen or ibuprofen), corticosteroids (e.g., prednisone to suppress the autoimmune response and control inflammation), anti-malarial drugs, and cytotoxic agents (i.e., chemotherapy drugs that are used for cancer, such as methotrexate, azathioprine, and cyclophosphamide).

Cytotoxic agents are used in order to decrease steroid dosage. Anticoagulants (blood thinners) may also be prescribed. For patients with non-organ-threatening disease, the antimalarial drug hydroxychloroquine is often prescribed; prednisone is often prescribed in cases of organ-threatening disease. New lupus drugs are under investigation; with recent increases in knowledge about the genetic and molecular basis of autoimmune disorders, including lupus, pharmacological treatment breakthroughs are possible at any time.

Nonpharmacologic (non-drug) interventions

All persons with lupus should guard against exposure to the sun and use protective clothing, sunscreen, and common sense when going outdoors. Adequate exercise can protect against fatigue, obesity, osteoporosis (weakening of the bones), and hyperlipidemia (excessive fats in the blood plasma). In some cases, dietary restrictions may be helpful, including especially the avoidance of food allergens and foods that may trigger lupus symptoms (such as alfalfa seeds). Vitamins, minerals, and dietary fatty acids have been shown to moderate lupus symptoms in some cases. On the other hand, some dietary supplements such as melatonin and Echinacea can worsen symptoms of some autoimmune diseases.

For lupus cerebritis, therapy choices include all the above options for alleviating the disorder throughout the rest of the body. Drug therapy can also include psychotropic medications such as antipsychotics, antidepressants, and benzodiazepines to stabilize mood, if this is affected. Unfortunately, long-term use of corticosteroids, one of the mainstays of pharmacological lupus treatment, may itself cause psychiatric symptoms. Experimental investigation of pheresis of cerebrospinal fluid for treatment of lupus cerebritis (cerebrospinal fluid is withdrawn from, filtered, and returned to the patient) was begun in the early 1990s.

Clinical trials

As of mid-2004, approximately 25 lupus-related clinical trials were in progress, including investigations of monoclonal antibody therapy, the genetics of lupus, quality-of-life improvement, ultraviolet light therapy, stem-cell transplantation therapy, the mechanisms of kidney and brain damage, and many other aspects of lupus. Updated information on these trials can be found at the National Institutes of Health clinical trials website at for up-to-date information.

Prognosis

Prognosis for the individual patient depends on the severity of the disease process. Lupus can be fully compatible with a normal lifespan, or can result in fatal organ failure, depending upon the progression of the disorder in each individual.

Before corticosteroids became available, half of all patients with systemic lupus died within two years. Today, half of systemic lupus patients with organ-threatening complications survive for 20 years or longer. However, most systemic lupus patients eventually die from infections or from heart disease complicated by long-term use of corticosteroids.

There is some evidence that lupus may spontaneously resolve in part or whole, or resolve in response to treatment, in some lupus patients who have had the disease long term (i.e., 10 years or more).

Special concerns

Psychological counseling may be helpful, given that a diagnosis of lupus is life altering, and stress and frustration can enhance symptoms while searching for a diagnosis. Genetic counseling may be appropriate, as children of women with lupus have a 10% chance of developing lupus if female and 2% if male, while 20% of offspring overall will develop an autoimmune disorder of some type.

Resources

BOOKS

Phillips, Robert H., et al. Coping with Lupus: A Practical Guide to Alleviating the Challenges of Systemic Lupus Erythematosus, 3rd ed. New York: Avery Penguin Putnam, 2001.

Wallace, Daniel J. The Lupus Book: A Guide for Patients and Their Families. New York: Oxford Press, 2000.

PERIODICALS

Marshall, Eliot. "Lupus: Mysterious Disease Holds Its Secrets Tight." Science (April 26, 2002).

Nickens, Candice. "Treating Systemic Lupus Erythmatosus." Minority Health Today (July 1, 2000).

Rushing, Jill D. "Managing Organ-threatening Systemic Lupus Erythematosus." MedSurg Nursing (December 1, 2003).

"Systemic Lupus Erythematosus: Guidelines for Control." Consultant (February 1, 2000).

OTHER

"NINDS Neurological Sequelae Of Lupus Information Page." National Institute of Neurological Disorders and Stroke. April 24, 2004 (June 1, 2004). http://www.ninds.nih.gov/health_and_medical/disorders/lupus_doc.htm.

ORGANIZATIONS

Lupus Foundation of America. 2000 L Street, N.W., Suite 710, Washington, DC 20036. (202) 349-1155; Fax: (202) 349-1156. http://www.lupus.org/.

Larry Gilman

A chronic inflammatory disease of unknown etiology affecting skin, joints, kidneys, nervous system, serous membranes, and often other organs of the body. The classical facial “butterfly rash” facilitates diagnosis, although the rash need not be present. Other skin areas, particularly those exposed to the sun, may be involved by a scaly lesion that is referred to as discoid lupus erythematosus.

Definition

Systemic lupus erythematosus (also called lupus or SLE) is a disease in which a person's immune system attacks and injures the body's own organs and tissues. Almost every system of the body can be affected.

Description

The body's immune system is a network of cells and tissues responsible for clearing the body of invading organisms, like bacteria, viruses, and fungi. Antibodies are special immune cells that recognize these invaders, and begin a chain of events to destroy them. In an autoimmune disorder like SLE, a person's antibodies begin to identify the body's own tissues as foreign. Cells and chemicals of the immune system damage the tissues of the body. The reaction that occurs in tissue is called inflammation. Inflammation includes swelling, redness, increased blood flow, and tissue destruction.

In SLE, some of the common antibodies that normally fight diseases are thought to be out of control. These include antinuclear antibodies, which are directed against the cell structure that contains genetic material (the nucleus), and anti-DNA antibodies, which are directed against genetic material (DNA).

SLE can occur in both males and females of all ages, but 90% of patients are women. The majority of these women are in their childbearing years. African Americans are more likely than Caucasians to develop SLE.

Occasionally, such medications as hydralazine and procainamide can cause symptoms very similar to SLE. This condition is called drug-induced lupus. Drug-induced lupus usually disappears after the patient stops taking the particular medication.

Causes & Symptoms

The cause of SLE is unknown. Because the vast majority of patients are women, some research is being done to determine what (if any) link the disease has to female hormones. Susceptibility to SLE is known to have a genetic basis, although more than one gene is believed to be involved in disease development. As of 2002, notable progress has been made in narrowing the location of these genes. Because SLE patients may suddenly have worse symptoms (called a flare) after exposure to sunlight, such foods as alfalfa sprouts, and certain medications, environmental factors may also be at work.

The severity of symptoms varies over time, with periods of mild or no symptoms followed by a flare. During a flare, symptoms increase in severity and new organ systems may become affected.

Many SLE patients have fevers, fatigue, muscle pain, weakness, decreased appetite, and weight loss. The spleen and lymph nodes are often swollen and enlarged. Recurrent infections, particularly those caused by bacteria, are common in patients with SLE. The development of other symptoms in SLE varies depending on the organs affected.

• Joints. Joint pain and problems, including arthritis, are very common. About 90% of all SLE patients have these types of problems.
• Skin. A number of skin rashes may occur, including a red butterfly-shaped rash that spreads across the face. The "wings" of the butterfly appear across the cheekbones, and the "body" appears across the bridge of the nose. A discoid, or coin-shaped, rash causes red scaly bumps on the cheeks, nose, scalp, ears, chest, back, and the tops of the arms and legs. The roof of the mouth may develop sore, irritated pits (ulcers). Hair loss is common. SLE patients tend to be very easily sunburned (photosensitive).
• Lungs. Inflammation of the tissues that cover the lungs and line the chest cavity causes pleuritis, with fluid accumulating in the lungs. The patient frequently experiences coughing and shortness of breath.
• Heart and circulatory system. Inflammation of the tissue surrounding the heart causes pericarditis; inflammation of the heart itself causes myocarditis. These heart problems may result in abnormal heartbeat (arrhythmias), difficulty pumping the blood strongly enough (heart failure), or even sudden death. Blood clots often form in the blood vessels and may lead to complications.

• Nervous system. Headaches, seizures, changes in personality, and confused thinking (psychosis) may occur. The molecular mechanism responsible for brain dysfunction in lupus was identified in 2001.
• Kidneys. The kidneys may suffer significant destruction, with serious life-threatening effects. They may become unable to adequately filter the blood, leading to kidney failure.
• Gastrointestinal system. Patients may experience nausea, vomiting, diarrhea, and abdominal pain. The lining of the abdomen may become inflamed (peritonitis).
• Eyes. The eyes may become red, sore, and dry. Inflammation of one of the nerves responsible for vision may cause vision problems, and blindness can result from inflammation of the blood vessels (vasculitis) that serve the retina.

Diagnosis

Diagnosis of SLE can be somewhat difficult. There are no definitive tests for diagnosing SLE. Many of the symptoms and laboratory test results of SLE patients are similar to those of patients with other diseases, including rheumatoid arthritis, multiple sclerosis, and various nervous system and blood disorders.

Laboratory tests that are helpful in diagnosing SLE include several tests for a variety of antibodies commonly elevated in SLE patients (including antinuclear antibodies, anti-DNA antibodies, etc.). A blood test called the lupus erythematosus cell preparation (or LE prep) test is also performed. The LE prep is positive in 70–80% of all patients with SLE. SLE patients tend to have low numbers of red blood cells (anemia) and low numbers of certain types of white blood cells. The erythrocyte sedimentation rate (ESR), a measure of inflammation in the body, tends to be quite elevated. Samples of tissue (biopsies) from affected skin and kidneys show characteristics of the disease.

The American Rheumatism Association developed a list of symptoms used to diagnose SLE. Research supports the idea that people who have at least four of the 11 criteria (not necessarily simultaneously) are extremely likely to have SLE. The criteria are:

• butterfly rash
• discoid rash
• photosensitivity
• mouth ulcers
• arthritis
• inflammation of the lining of the lungs or the lining around the heart
• kidney damage, as noted by the presence of protein or other abnormal substances called casts in the urine
• seizures or psychosis
• the presence of certain types of anemia and low counts of particular white blood cells
• the presence of certain immune cells, anti-DNA antibodies, or a falsely positive test for syphilis
• the presence of antinuclear antibodies

Treatment

Although there is no cure for SLE, a number of alternative treatments may help reduce symptoms.

• Acupuncture can relieve pain in joints and muscles.
• Chinese herbals are chosen based on treatment principles and the patients specific symptoms. A simple decoction for the treatment of SLE joint and kidney problems is Lei Gong Teng (Caulis tripterygii), Ji Xue Teng (Caulis spatholobi), and Gan Cao (Radix glycyrrhizae). Chinese patent medicines for SLE include Qin Jiao Wan (Gentiana Macrophylla Pill) and Kun Ming Shan Hai Tang Pian (Tripterygii Tablet).
• DHEA (dehydroepiandrosterone) treatment, in a small study, led to disease improvement and reduction in the use of corticosteroids.
• Diet. The SLE patient should drink plenty of water and eat a well balanced diet of whole, unprocessed foods that are low in fat and high in fiber. Mackerel, sardines, and salmon contain the beneficial fatty acid omega-3. Caffeine, sugar, alcohol, red meats, and alfalfa sprouts should be avoided. Because food allergies can be associated with SLE, an elimination/change in diet can help identify the offending foods (often wheat, dairy products, and/or soy).
• Enzyme therapy treats SLE with 10X U.S.P. of digestive enzymes, protease, lipase, amylase, and cellulase to improve digestion of foods, based on the theory that a leaky gut causes SLE.
• Exercise can reduce fatigue, reduce muscle weakness, speed weight loss, and increase energy, stamina, and confidence.
• Herbals remedies include capsaicin (Capsicum species) cream, pau d'arco (Tabebuia species), pine (Pinus species) extract, wheat grass (Triticum aestivum), Bupleurum falcatum, licorice (Glycyrrhiza glabra), wild Mexican yam (Dioscorea villosa), stinging nettle (Urtica dioica), flaxseed (Linus usitatissimum) oil, turmeric (Curcuma species), and borage (Borago officinalis) oil.
• Massage can relieve pain and reduce stress.
• Probiotic treatment using Lactobacillus species to restore a healthy balance of bacteria in the intestines.
• Stress management techniques, such as guided imagery, meditation, hypnotherapy, and yoga, can reduce stress that exacerbates SLE.
• Supplements commonly recommended for SLE patients include vitamins B, C, and E, beta-carotene, bioflavonoids, selenium, zinc, magnesium, a complete trace mineral supplement, glutamine, gammaoryzanol, 1-butyrate, fructooligosaccharides (FOS), and omega-3 fatty acids (fish oil). Vitamin A is believed to help improve discoid skin rashes.
• Support groups for SLE patients can provide emotional and social help.

Allopathic Treatment

Treatment depends on the organ systems affected and the severity of the disease. Patients with a mild form of SLE can be treated with nonsteroidal anti-inflammatory drugs, or NSAIDs, like ibuprofen (Motrin, Advil) and aspirin. More severely ill patients with potentially life-threatening complications (including kidney disease, pericarditis, or nervous system complications) will require treatment with more potent drugs, including steroid medications and possibly other drugs that decrease the activity of the immune system (immunosuppressant drugs).

Kidney failure may require the blood to be filtered by a machine (dialysis) or even a kidney transplantation.

Expected Results

The prognosis for patients with SLE varies, depending on the organ systems most affected and the severity of inflammation. Some patients have long periods of remission with mild or no symptoms. About 90–95% of patients are still living after two years with the disease, 82–90% after five years, 71–80% after 10 years, and 63–75% after 20 years. The most likely causes of death during the first 10 years include infections and kidney failure. During years 11–20 of the disease, the development of abnormal blood clots is the most common cause of death.

For pregnant SLE patients, about 30% of the pregnancies end in miscarriage and about 25% of all babies are born prematurely. Most babies born to mothers with SLE are normal. Rarely, babies develop a condition called neonatal lupus, which is characterized by a skin rash, liver or blood problems, and a serious heart condition.

Prevention

There are no known ways to avoid developing SLE. However, it is possible for a patient who has been diagnosed with SLE to prevent flares of the disease. Recommendations to prevent flares include decreasing sun exposure, getting sufficient sleep, eating a healthy diet, decreasing stress, and exercising regularly.

Resources

Books

Aaseng, Nathan. Autoimmune Diseases. New York: F. Watts, 1995.

Hahn, Bevra Hannahs. "Systemic Lupus Erythematosus." In Harrison's Principles of Internal Medicine. 15th ed., edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 2001.

Long, James W. The Essential Guide to Chronic Illness. New York: HarperPerennial, 1997.

Ravel, Richard. "Systemic Lupus Erythematosus (SLE)." In Clinical Laboratory Medicine: Clinical Application of Laboratory Data. St. Louis: Mosby, 1995.

Wallace, Daniel J. The Lupus Book. New York: Oxford University Press, 1995.

Ying, Zhou Zhong, and Jin Hui De. "Lupus Erythematosus." In Clinical Manual of Chinese Herbal Medicine and Acupuncture. New York: Churchill Livingston, 1997.

Periodicals

Graham, R. R., W. A. Ortmann, P. M. Gaffney, et al. "Localization of the Human SLE Susceptibility Genes Within the HLA Using a Recombinant Ancestral Haplotype Approach. American Journal of Human Genetics 69 (October 2001): 507.

"Lupus Brain Damage Pathway Identified Through Molecular Mechanism." Immunotherapy Weekly (December 12, 2001): 7.

Mann, Judy. "The Harsh Realities of Lupus." The Washington Post 120 (October 8, 1997): C12.

Noel, V., O. Lortholary, P. Casassus, et al. "Risk Factors and Prognostic Influence of Infection in a Single Cohort of 87 Adults with Systemic Lupus Erythematosus." Annals of the Rheumatic Diseases 60 (December 2001): 1141–1144.

Umansky, Diane. "Living with Lupus." American Health for Women 16 (June 1997): 92+.

Yap, Hui-Kim, Siau-Gek Ang, Yee-Hing Lai, Vinod Ramgolam, and Stanley C. Jordan. "Improvement in Lupus Nephritis Following Treatment with a Chinese Herbal Preparation." Archives of Pediatric and Adolescent Medicine 153 (August 1999): 850–852.

Organizations

American College of Rheumatology. 1800 Century Place, Suite 250, Atlanta, GA 30345. (404) 633-3777. acr@rheumatology.org. .

Lupus Foundation of America, Inc. 1300 Piccard Dr., Suite 200, Rockville, MD 20850. (800) 558-0121. .

Other

Balch, T. Stephen. "Living Well with Lupus." January 1, 2001 [cited October 2002]. .

Hoffman, David L. "The Use of Herbs in the Treatment of Systemic Lupus Erythematosus." HealthWorld Online. [cited October 2002]. .

[Article by: Belinda Rowland; Rebecca J. Frey, PhD]

For more information on lupus erythematosus, visit Britannica.com.

An autoimmune disease that tends to strike women more frequently than men. The disease attacks the body's connective tissues.

[L.] wolf, pike.

• l. band — the deposit of immunoglobulin or complement, or both, at the basement membrane zone that can be demonstrated by direct immunofluorescence testing in lupus erythematosus.
• l. panniculitis, l. profundus — circumscribed, subcutaneous nodules of panniculitis associated with lupus erythematosus.