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By Root 10178 0

anti-inflammatory drugs were traditionally the mainstays of rheumatoid arthritis treatment in the early stages, and more powerful drugs were reserved for later, more severe stages. This approach has now been reversed, in the belief that stronger drugs taken early might prevent or limit additional joint damage. Drugs currently used to treat rheumatoid arthritis include hydroxy-chloroquine, sulfasalazine, and methotrexate. These drugs are powerful enough to interrupt the process that produces inflammation by blocking the interactions between immune system cells. A promising new class of genetically engineered drugs called tumor-necrosis factor (TNF) inhibitors are proving effective in both limiting inflammation and slowing the destruction of cartilage and bone, with few side effects.

Surgery can be helpful in the management of rheumatoid arthritis for relieving pain and improving joint function. Three types of surgery are available: joint replacement surgery (see page 999), reconstruction of affected tendons (most often in the hands), and synovectomy, in which the inflamed tissue of the synovium is completely removed.

Systemic Lupus Erythematosus

Systemic lupus erythematosus (usually referred to simply as lupus) is a chronic autoimmune disease that affects the skin, joints, muscles, and many other organs in the body. Lupus develops primarily in women during their childbearing years but can also affect men. In people with lupus, the immune system attacks multiple body systems, causing inflammation that damages organs and tissues.

There are three main types of lupus—systemic lupus, discoid lupus, and drug-induced systemic lupus. Systemic lupus, the most common type, produces inflammation in multiple body systems. Discoid lupus erythematosus (see page 1072) produces only a skin rash characterized by crusty skin patches on the face, neck, or chest that may scar. Drug-induced systemic lupus can be triggered by a wide variety of drugs, including beta blockers (see page 562) used for treating heart disease and high blood pressure. The drug-induced type of lupus disappears completely when the person stops taking the drug.

Systemic lupus affects women about 10 times as often as men and usually develops between ages 18 and 45. Blacks and Hispanics have an increased risk of developing the disorder. Lupus occurs more often in first-degree relatives (children, siblings, or parents) of affected people than in the general population, indicating that genes play a role. In other cases, the cause is unknown. Drug-induced lupus affects men more often than women because more men use the drugs that trigger the condition. Like all autoimmune disorders, lupus is not contagious.

Earlier diagnosis and better management of the disease have greatly improved the outlook for affected people in recent years. In the 1960s, only 40 percent of people diagnosed with systemic lupus were expected to live more than 3 years. Today, 80 to 90 percent of people with lupus live longer than 10 years after diagnosis, and many have a normal life expectancy.

Symptoms

The symptoms of systemic lupus vary greatly from person to person, and the course of the disease is unpredictable. The disorder’s severity varies from mild cases (which require minimal treatment) to severe cases (in which potentially fatal damage occurs to organs such as the lungs, heart, kidneys, and brain). Lupus is characterized by periodic flare-ups of symptoms followed by improvement that can last for weeks, months, or years.

Early symptoms of lupus are usually vague and easily confused with other disorders. But the following symptoms usually appear over the lifetime of a person who has the disease:

• Fever over 100°F

• Painful, red, swollen joints

• A butterfly-shaped facial rash

• Coin-shaped skin rashes on areas exposed to the sun

• Anemia

• Pleurisy (inflammation of the pleura—the two membranes that line the lungs)

• Sensitivity to sunlight

• Hair loss

• Mouth or nose ulcers

• Seizures

Lupus and Pregnancy

Because lupus primarily affects women of childbearing