American Medical Association Family Medical Guide - American Medical Association [632]
Organs and tissues affected by systemic lupus Systemic lupus affects the skin as well as other organs and tissues throughout the body, causing inflammation in the lungs, heart, kidneys, joints, and nervous system.
Antimalarial drugs were originally developed to treat malaria, but doctors soon found that they were also effective in relieving the joint pain and inflammation of lupus. Antimalarial drugs work especially well to relieve the skin rash that characterizes discoid lupus (which affects only the skin).
Up to 60 percent of people with lupus are sensitive to sunlight. Exposure to sunlight can stimulate flare-ups or worsen lupus-induced skin rashes. It is very important for people with lupus to protect themselves from the sun by wearing clothing that blocks the sun’s rays such as long-sleeved shirts, long pants, and wide-brimmed hats. Applying sunscreen with a high sun protection factor (SPF 15 or above) half an hour before going outdoors will also help protect sensitive skin. Another way to minimize sun exposure is to avoid going out in the sun between 10:00 AM and 4:00 PM, when the sun’s rays are strongest.
Several experimental treatments aimed at improving the function of the immune system have proven successful in treating lupus. Stem cell transplants (see page 624) are being tried in people with severe lupus, with promising results. People with end-stage kidney failure require treatment with kidney dialysis (see page 818) or a kidney transplant (see page 820); a person with lupus can have a transplant only when the disease is inactive.
Scleroderma
Scleroderma (which means hard skin) is a chronic autoimmune disorder in which the immune system mistakenly produces antibodies (infection-fighting proteins) that attack connective tissue throughout the body. The disorder is characterized by an overproduction of the protein collagen in the body’s connective tissue, which results in thickening, hardening, and tightening of the skin, especially of the hands and face. There are two main types of scleroderma—localized (which affects only the skin and musculoskeletal system) and systemic (which causes a more widespread hardening of the skin and also affects internal organs, including the lungs, heart, kidneys, digestive tract, and blood vessels).
Scleroderma occurs much more frequently in women than in men, and its effects can range from mild to disabling to life-threatening. The cause of scleroderma is not known, and there is no known way to prevent it. Doctors think that genes play a role in the disorder, but it is not inherited. Environmental triggers or toxins, such as infection by a virus or exposure to organic solvents or adhesive materials, may also be factors. Some researchers theorize that, because the disorder affects women 7 to 12 times more often than men, female hormones such as estrogen may have an influence.
Symptoms
Symptoms of scleroderma usually appear between ages 20 and 40 and can vary, depending on the organs or tissues that are affected. In many people, the first symptoms of scleroderma occur when cold temperatures or stress trigger a condition called Raynaud’s phenomenon (see page 924), in which spasms of the small blood vessels in the fingers and toes impair blood flow, causing the fingers and toes to become pale, cold, numb, and painful. Although Raynaud’s phenomenon can be a symptom of scleroderma, not all people who have Raynaud’s develop scleroderma.
Other hallmark symptoms