Lupus can be categorized into immunological diseases, a group called.autoimmune disease, with rheumatoid arthritis included(RA), scleroderma, Crohn's disease, psoriasis and takinglist of other diseases of equal or similar pathogenesis. Inthese diseases, the immune system, designed to defendbody against foreign invaders (bacteria, viruses and otherForeign agents), attacks the individual's own tissuesorganism, not recognizing them as more and treating theirthem as foreign, leading to serious and irreparable damagethereof, which often ends in a complete cancellationcertain vital organs, and early death of patient. Thisnew classification of these diseases, rather than before thelupus is a chronic multisystemic lumped into degenerativediseases of unknown cause, has changed the approach totheir treatment, where the emphasis is placed on the curbaberrant immune reaction, rather than interference inmedijatorstvo local inflammation and the degree of local damageattacked the organs as it once seemed. Although moderntreatment of this disease has led to its completecure, though it must be admitted that the greatly improvedquality of life of patients and patients suffering from
lupus andsimilar diseases can now lead an active and full of life, forUnlike the past when these patients after theythe symptoms appeared and the disease was diagnosed, the restlife spent mostly in hospitals, waiting for 'cancellationby a single system.
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Lupus is a multisystemic disease with many diversesymptoms, so the exact onset of the disease is difficult to determine, and thatand do not talk about what kind of confusion in settingcan make a diagnosis, so that the lupus is regularlythe differential-diagnostic list of every doctor. Iaddition to diversity in the symptomatology of this insidious disease,U.S. National Institute of Arthritis and Musculoskeletal andDeseases Skin (NIAMS) has issued a list of the most common symptomsthat occur in most patients and should servephysique as a landmark to the existence of forested Lupus-and ifhis patient was complaining of fatigue, extreme weakness andfatigue, painful and swollen joints (arthritis),unexplained fever and subfebrilnost (temperature about37 ◦ C), rash (particularly on the face, in the form of butterflies orother parts of the body in the form of erythema nodosum), andproblems with the kidneys. The disease is characterized byie during periods of fluctuating improvement and deteriorationdiseases.The question that arises in these chronic diseases isit, who is most often affected, and whycertain populations more inclined incidence of the diseasethan others? Lupus is still considered a woman's disease becausewomen dominating men sovereign in this statistic;disease is three times more frequent in African American descentthan those Caucasian race, then a lot is often discussed in the womenthe Spanish / Latin American and Asian descent, and, in womenNative American descent (North American Indians).Lupus often occurs in families, but the incidenceamong first relatives (siblings) are still small.There are several types of lupus:- Systemic lupus erythematosus (SLE) is the most common form ofdisease and when it says Lupus usually refers to SLE, and Iand I in my today's presentation will be focusing on thisform of the disease. The clinical picture may include a series of more orsmaller number of pronounced, symptoms of different intensity and diseasemay affect one or, more often, more organicsystems. Although the disease usually occurs in the agesbetween 15 and 45 years, the disease is sometimes encountered inchildren 'age, as well as in elderly people.- Discoid lupus erythematosus is a chronic skin in the formdiskoidnog a red rash on the face, scalp, or otherparts of the body. Discoid erythema on the face in the shape of a butterflyis so typical for lupus, that in the past, whendiagnostic methods for detection of the disease were significantlymore modest than the present, diagnosis, and only raisinginspection findings that this butterfly erythema. Thesediscoid eflorescence can eventually harden and becovered with scales, or even turn into scars. Changesmay also withdraw, and after a longer or shorter timereappear. A small percentage of people with discoid lupuslater develop SLE.- Subacute cutaneous lupus erythematosus is characterizedskin lesions of erythema nodosum in the shape of the partsbody exposed to sunlight. These lesions do not leavescars.- Certain medications can also cause alupoidnih change and this type of lupus is calledDrug-induced lupus. Symptoms resemble those of SLE and usuallyinclude arthritis, rash, fever, chest pain, etc. TheseSymptoms usually disappear when you stop takingcertain medications. Systemic changes to this form of lupususually does not affect the brain and kidneys.- Chilblain lupus is characterized by changes in shapepurple-blue, sensitive nodules on the feet and toeswants, but sometimes on his knees, nose, and ears,that resemble smrzlinama, makes this form and named(Chilblain = frostbite). After several years of people withchilblain lupus can develop discoid shape changes andancestors in discoid lupus.- Neonatal lupus usually occurs in newborns of mothersSLE, Sjogren's syndrome, or sometimes the baby is completelyhealthy pregnant women. More research in this field tells thefavor of auto-antibodies in the mother's blood called anti-Ro (SSA) andanti-La (SSB) as a cause of lupus in the newborn. Onbirth babies have developed a rash, impaired liver functionand anemia. Through several months of these symptoms and withdrawdisorder gradually reconstructed. Exceptionally, babies with neonatalLupus can develop a serious disease with heart disorderrhythm. Although neonatal lupus rare disease, even whenwomen with SLE, is required for all anti-R0 and anti-Latiter-positive pregnant are more strict and ultrasound (U.S.)control, especially between 16 and 30 weeks of pregnancy. All womenat high risk of complications from lupus, as well as theirbabies, should be subjected to intensive perinatal andpostnatal anti-lupus treatment toforeclose serious complications such riskyPregnancy carries.The real cause of lupus is unknown. Today it is considered thatcombination of genetic factors, environmental influences andhormonal factors play a decisive role in the development of thiscomplex diseases. The fact that SLE occurs inindividual families does not justify forcing this hypothesis,especially when the individual knows that "lupus gene" has not yetalways isolated, but before it is intended this nominationdiseases of the priority list for future geneticengineering. The matter is further complicated by numerous genes that arebelieves could be responsible for the occurrence of disease anddetermining which organs will be affected by SLE. Because of this,most other scientific sources considered itself the genetic theoryunsustainable and includes the etiology of a number of other negenetskihfactors such as exposure to sunlight, stress dogotrajnom,certain drugs and infectious agents like viruses eg.Various forms of lupus can cause different types of symptoms,of which are mostly found as follows:-Muscle aches, and joint swelling and pain-Unexplained feverAlready mentioned, a rash on the face-Chest pain, especially when deep breath is certainlysign of lung disease-Unexplained hair lossAnd pale-blue okrajine, especially on the hands and fingersfeet during exposure to stress and cold (Raynaud'sphenomenon).-Sensitivity to the sunPeriorbital edema, and island legs-Ulcers in the mouthGland-island-Extreme general weakness and fatigueIn addition to skin changes, the following authorities may be affectedLupus:-Kidneys, nephritis in the first place, these changes in bloodurine as well as the island around the eyes and the legs only signs of lupus.Since the kidneys are vital organs, lupus at this stagerequire intensive treatment to prevent theirpermanent damage.-Some patients with lupus develop exudative inflammationpleura (pleurisy), which causes a burning pain when breathing.People with SLE and often develop pneumonia.-In some patients, SLE process of brain surgery or centralnervous system, which can cause headaches, dizziness,disturbance of memory, behavioral changes, problems with vision,epi-attacks, etc.- If you drew blood vessels inflammation (vasculitis) may causedisturbances in the flow of blood, from very mild, which do not requiretreatment of serious requiring promptintervention.- The changes in the blood very often come across as an anemiathe parameters of dominant, but very often, and leukopenia andthrombocytopeniju. Some patients are prone to thrombosis.- For a number of patients with SLE inflammation of heart surgery, andmyocarditis or endocarditis is a leading and most dangerous signsystemic inflammatory process. It is not rare or pericarditis,they create violent pain in sredogrudju.Diagnosis of lupus is extremely difficult and delicate because of thesymptomatology is quite diverse and vague and testsnonspecific, and can take months and years until a doctor can notarranged in a mosaic of symptoms and signs necessary forthe correct diagnosis of this complex disease.As stated above, there is no single test thatcan safely assert the existence of lupus, andDiagnosis of this disease is based largely ondetail and precision taken in the history of the doctors andaccurate data and observations of the patient, with a conscientious anda comprehensive physical examination and a whole battery of tests andSearch the most important are the following:The most useful test is the one that reveals the existence ofauto-antibodies in the blood of the lupus patient, primarilyantinuclear antibody (ANA). This test reveals the existence ofantibodies that react to the components of the sail (nucleus) incells of the body's own tissues. In addition to the testuseful, though not sufficiently specific to be based on onlythis test with certainty to the diagnosis of Lupus,percent of the ANA test can be positive in otherautoimmune diseases, infections, and even in onenumber of completely healthy people. Besides this, there are testscertain types of antibodies that specifically occur inblood of patients with lupus, although here and do not suffer from lupusmust be positive, and that all test-positive at themust suffer from SLE. These antibodies include: anti-DNAanti-Sm, anti-RNP, anti-Ro (SSA) and anti-La (SSB). All of thesetests give only orientation to more easily reachdiagnosis, they are quite expensive and are not used routinely indiagnosis of SLE.In an effort to bring about accurate diagnosis, particularly incases where the clinical picture is unclear, the doctor cando skin or kidney biopsy, if these organscaptured Lupus inflammation.It is useful to sometimes do anticardiolipin / antiphospholipidantibody test. The presence of these antibodies indicates a highrisk of thrombosis, whereas in pregnancy indicates a highthe risk of miscarriage in women with lupus.Finally, we must once again emphasize that patients withsuspicion of SLE must be viewed in its entirety, takeaccurate history, do a detailed physical examination, anddo nonspecific blood and urine tests (urinalysisESR, FBC, biochemical blood tests), and only on the basis ofoverall finding that all the above-mentioned search setLupus diagnosis and begin treatment with odgovrarajucim.The treatment of Lupus as a multi-systemic illness, very oftenincorporate a great team of specialists, and treatment is aimed atseveral different fields, in order to achieve the full effect of thetreatment of this complicated situation and the way that thepossible consequences and minimize damage certain organsMIH Lupus inflammation. Coordination intreatment and if necessary involvement of other professionals intreatment should be povjerano a doctor, whetherspecialist in general practice or internal medicine, the sideline.Over time, as the disease goes through the stages and the patientundergoing different treatments, it is necessary to include thephysicians in different specialties in the treatment as eg.immunologists, hematologists, dermatologists, nephrologists, rheumatologists,neurologists, physiatrists, psychiatrists, and other relevantspecialists.As the main substrate of this autoimmune disease infectionindividual organs, primarily the skin, joints and kidneys,Therapy focused is directed towards the suppression of the aberrantimmunological reaction, then the inflammatory process as itseffects, and relief of symptoms of pain, fever andphysical disability, ill. As one of the stressmajor factors in the disruption of the immunological balance of the organismand a possible factor in the development of this answer to autoimmunogunknown internal or external cause, to changecognitivna way of life and psycho-therapy holds significantplace in the treatment of SLE.Because of the complexity of what one wears in immunological diseasesitself, today's approach to the treatment of Lupus include drugswith multisystem action and still insufficiently investigatedSide-effects and the same (treatment) conducted underpermanent scrutiny and precise control of dosage of thesechemicals, and monitoring of side effects caused by thisdrugs ingested infected. Because of allof the treating physician and his patient shouldmake up one team, with accurate reports and guidelinesin order to achieve maximum impact in the treatment ofdisease and minimize damage to vital organs in the body,which takes place over metabolism and excretionAnti-lupusnih therapeutics.There are several groups of drugs used in treatmentdifferent phases or forms of lupus:- NSADs (nonsteroidal anti-inflammatory drugs) are usedas a general anti-inflammatory therapeutics and analgesics (drugspain), usually in cases of lupus arthritis,chest pain or control fever, islands, etc. Althoughsome of these medicines can be bought without a prescription that is overthe counter as eg. Ibuprofen (Bruffen) or naproxen,their use should be controlled by doctors,because of their serious side effects on gastrointestinal,cardiovascularnom and neurological systems, and liver damageand kidney, the uncontrolled and prolonged use of thesedrugs can cause.- Antimalarial drugs are medicines that were originally used intreatment and prevention-ie, prophylaxis and malaria, but theprove effective in the treatment of lupus. Taken asmonotherapy or in combination with other drugs,can be effective in the treatment of general weakness, painjoints, skin rashes, and suppressing inflammation in lupuslungs. Clinical studies have shown that anti-Malarić,of which is the most commonly used hydroxychloroquine(Plaquenil), the most effective in suppressing episodesexacerbation of disease and the maintenance of stable conditionsdisease over a long period of time. Unfortunately, longer use ofThese drugs also cause a number of side effects and adverseAction oraganizmu affected, of which the mostdamage to liver, bone marrow and rarely retina of the eye. Forit was during the use of these drugs are often necessarycontrol the concentration of drug in the blood, especially whenchange the dose, and control blood (FBT) and liver tests(LFT).- The central place in the treatment of SLE is still occupyingcorticosteroid, primarily prednisone (Deltasone eg.)hydrocortisone, methylprednisolone (Medrol) and dexamethasone(Decadron, Hexadrol). On the multiple adverse effectsgroups of drugs, primarily hypertenzije development (highblood pressure), diabetes (diabetes mellitus), damagecardiovascular and gastrointestinal systems,Osteoporosis, a disorder seksulnih functions, etc. toCushing syndrome with drugs as a final resultprolonged use of steroids, there were already plenty of talk inmy earlier speeches. However, the use of these hormones inSLE therapies because of their powerful anti-inflammatory(Inflammatory) actions, but it seems indispensabledecades. Aware of noxious, these drugs producethe long-term use, doctors very often resort toparenteral treatment of short courses of corticosteroidlasting only a few days so. bolus or pulsetherapy, when the side-efects rarer and it is not necessary to graduallyremoval from the steroids.- The third important group of drugs in the treatment of SLE areImmunosuppresanti, whose most important task is to curbautoimmune response that is inadequate, disturbed responsesimmune system, especially in cases of lupusnephritis or central nervous system damage caused bySLE included. Since immunosuppressant in the treatment of SLE are the most commoncyclophosphamide (Cytoxan) and Mycophenolate mofetil(CellCept), and others, whose main task isstop dividing cells of the immune system. Someof these drugs are also used as a cytostatictherapy (suppression of separation) of malignant cells in variouscombinations chemotherapije cancer or intransplantation surgery after transplantation of individualorgans (kidney, heart, lungs, liver, etc.). Taking thesedrugs were facing with a number of side effects, some of which are atLife-threatening and require strict control of dose,and the vital organs during the entire course of therapy. OfRoad side effects are nausea and vomiting (nausea and vomiting),hair loss, problems with urination, loss or reductionfertility, increased risk of cancer, a tendency thatinfections.- In patients with arthritis please join us as a dominant(Chilblain lupus), very good results were achieveduse of anti-rheumatic, as eg. methotrexate (Folex,Mexate, Rheumatrex), which is very well controlled rheumaticinflammation.- For all of these harmful effects of certain drugs, andSLE high cost of treatment, many patients resort toalternative treatments, which include specialchild, a variety of vitamin preparations and other Nutritionsaplemente, fish oils, ointments and creams,Chiropractic treatments, and a variety of homeopathic methodstreatment. While this therapy causes much less harmfulside effects and apparently provides much greater benefit in terms ofreducing symptoms and general psycho-socialwelfare of the patient, however, clinical trials of thistreatments are not shown absolutely no impactalternative medicine in the course of the disease. As has been proventhat stress plays a significant role in the regulation of immunity,assumed to be dysfunctional immune response thatencountered in SLE is one of the major factors inetiology and pathogenesis of this disease, and therefore intensecognitivna psychoterapija and in people exposed to permanentstress, and a balanced and healthy life-style, occupiescentral to anticipating and mitigatingthis disease.
