LUPUS: A Guide for Nurses
Lupus is a chronic condition which affects the patient's immune system. In lupus the immune system produces too many antibodies (or blood proteins). Instead of defending the body from infection, they attack the patient's own healthy tissue. This can directly or indirectly cause problems in almost any part of the body by inflaming and occasionally damaging the tissue. The antibodies are often directed against components of the nucleus such as DNA. These proteins may end up in the skin, causing rashes, or stick to the walls of blood vessels or deposit in the kidney, brain, lungs, heart, joints, or in fact in any connective tissue. In most cases, when the inflammation settles down the tissues or affected organs recover leaving no permanent damage.
The name Lupus is derived from the Latin for 'Wolf' because historically the pattern of the symptomatic pink facial rash was thought to resemble a wolf's mask or a wolf bite. It most commonly affects women in their child bearing years (one in a thousand women) although men and children (even new-born babies) can develop the disease. Lupus is now thought to be more common world-wide than leukaemia, multiple sclerosis, and many other well-known diseases.
The cause of lupus is still unknown although research has indicated a number of factors, including heredity, hormones and certain infections including viruses. It can be triggered by exposure to strong sun, stress, certain drugs or hormonal changes, for example after childbirth.
Active lupus is indicated by the presence of a variety of antibodies which react against some of the chemicals in the cell nuclei. The condition can normally be diagnosed by blood tests including the anti-nuclear antibody (ANA) and the DNA binding test. Blood tests can reveal anaemia, low platelets, which can lead to internal bleeding and purpura and a raised ESR (erythrocyte sedimentation rate indicating the degree of inflammation in connective tissue). In active lupus the ESR may rise to well over 100, the normal being under 15. Urine analysis is very important as proteinuria can indicate kidney involvement. Blood chemistry tests, GFR (glomerular filtration rate) or a renal biopsy can confirm this. Interestingly, other tests for acute phase inflammation such as C-reactive protein may remain normal providing helpful diagnostic data for the clinician. Also ENA tests and complement 3+4 proteins are checked. Cholesterol levels should be checked regularly as lupus can affect the production of cholesterol. Thyroid function can also be affected.
These are the different types of lupus, and lupus has the ability to mimic many other diseases and to vary from person to person. It is a chronic condition with no known cure and can be life-threatening. In most cases it is treatable by medication and patients can, after a flare, go on to live normal lives.
The most common symptoms are:
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