LUPUS ERYTHEMATOSUS

often referred to simply as lupus an autoimmune disorder that causes chronic inflammation in various parts of the body. Three main types of lupus are recognizeddiscoid, systemic, and drug-induced. Discoid lupus affects only the skin and does not usually involve internal organs. The term discoid refers to a rash of distinct reddened patches covered with grayish brown scales that may appear on the face, neck, and scalp. In about 10 percent of people with discoid lupus, the disease will evolve into the more severe systemic form of the disorder. Systemic lupus erythematosus is the most common form of the disease. It may affect virtually any organ or structure of the body, especially the skin, kidneys, joints, heart, gastrointestinal tract, brain, and serous membranes (membranous linings of organs, joints, and cavities of the body.) While systemic lupus can affect any area of the body, most people experience symptoms in only a few organs. The skin rash, if present, resembles that of discoid lupus. In general, no two people will have identical symptoms. The course of the disease is also variable and is marked by periods when the disease is active and by other periods when symptoms are not evident (remission). Drug-induced lupus can arise as a result of a reaction against certain prescribed medications. The signs and symptoms resemble those of systemic lupus. The most common drugs that cause such an autoimmune response are hydralazine, which is used to counteract high blood pressure, and procainamide, which is a medication for irregular heart rhythms. Only a very small number of people taking these drugs develop the disease, and the symptoms usually abate when use of the drug is stopped. Lupus results from a breakdown of the normal disease-fighting function of the immune system. Instead of producing antibodies that attack infectious organisms, the body produces antibodiescalled autoantibodiesthat react with components of the body's own tissues. This autoimmune reaction results in the formation of antigen-antibody complexes (also called immune complexes), which build up in tissues and cause inflammation and injury. The reason why these damaging autoantibodies develop is not entirely understood, but many factors seem to be involved. Environmental stimuli, such as infections, ultraviolet light, extreme stress, and certain drugs, are believed to contribute to the disease, and there also seems to be a genetic predisposition to lupus. Systemic lupus affects women much more often than menthe vast majority of cases arise in women between the ages of 12 and 40and hormones, particularly estrogen, may increase the likelihood of developing the disease. It is more common in blacks and some Asian populations. Identifying systemic lupus can be difficult because many symptoms of the disease are similar to those of other diseases and because symptoms are sometimes ambiguous and fleeting. In order to diagnose the disease, at least 4 of the following 11 criteria must be met: Rash over the cheeks (malar rash) Red raised patches (discoid rash) Photosensitivity Oral ulcers An inflammation of the joints that does not cause deformity An inflammation of membranes surrounding the lung or heart Renal disorder Neurologic disorder Hematologic disorder Immunologic disorder Antinuclear antibodies (those that bind to the nucleic acid and protein constituents of cell nuclei) Treatment of systemic lupus is directed toward relief of pain, controlling the inflammation, and limiting as far as possible damage to vital organs. A variety of medications are prescribed, depending on which organs are involved. Preventive measures include the avoidance of factors that seem to stimulate a recurrence of symptoms. Current methods of therapy are able to control the disease in most people and allow them to live a normal life span.