American Medical Association Family Medical Guide - American Medical Association [631]
The best time for a woman with lupus to get pregnant is when she is between flare-ups of the disease. About 20 percent of pregnant women with lupus experience a sudden increase in blood pressure, protein in the urine, or both. This condition is called preeclampsia (see page 526), a serious condition that can be fatal for both mother and baby if delivery is not done immediately.
The major risk to a baby of a woman with lupus is prematurity. About 3 percent of premature babies have a disorder called neonatal lupus, characterized by a rash, blood count abnormalities, and, in rare cases, a heartbeat abnormality. These symptoms clear up on their own in 3 to 6 months, except for the heartbeat problem, which is permanent but not dangerous.
About one third of all people with lupus have kidney damage, and some people experience a progressive loss of kidney function and kidney failure. Lupus affects the central nervous system in many ways. For example, many people experience headaches, confusion, difficulty concentrating, and strokes when antibodies attack nerve cells or blood vessels. Inflammation in the blood vessels (vasculitis; see page 927) occurs when infection-fighting white blood cells mistakenly enter the walls of the blood vessels, reducing blood flow and damaging the tissue. Vasculitis can produce numerous symptoms in multiple parts of the body, including any part of the heart—the pericardium (the sac enclosing the heart), the endocardium (the lining of the inside of the heart), and the heart muscle itself. People who have lupus are at increased risk of infections, and some people with lupus have blood-clotting problems.
Diagnosis
Lupus can mimic other conditions, so it can be very difficult to diagnose. To make a diagnosis of lupus, the doctor must see evidence of abnormalities in many different organs and body systems, including the skin, joints, kidneys, blood, lungs, nervous system, and the membranes lining the heart and other organs. The doctor obtains this evidence through a thorough physical examination and the person’s description of his or her symptoms, including how and when they began. The doctor then looks for a relationship between the results of the physical examination and the person’s symptoms.
If you have a number of the characteristic symptoms of lupus, the doctor will order blood and urine tests, as well as a series of specialized tests that evaluate how well your immune system is working. No one test can positively determine if a person has lupus but, taken together, the battery of laboratory tests can point to a diagnosis. In general, the tests are designed to detect the presence of autoantibodies (proteins that mistakenly identify cells in the body as invading harmful organisms and attack them). The most common tests used to diagnose lupus include:
• Complete blood cell count
• Liver and kidney screenings
• Blood tests for specific autoantibodies
• Urinalysis to detect kidney problems
• Erythrocyte sedimentation rate to measure levels of inflammation
• Chest X-rays to assess lung damage
• ECG (electrocardiogram) to detect heart problems
The results of these tests will determine what further tests might be helpful.
Treatment
Treatment for lupus depends on the severity of the disease, but most treatment plans use a combination of medications, exercise, rest, a nutritious diet, and protection from the sun. The medications doctors prescribe for lupus are designed to relieve pain and inflammation and suppress the immune system