Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
By Mr. D.R.
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
So many people have had comments like, "I had no idea Susan was so sick."
That was because Susan did not want anybody to know.
Because lupus is such a crafty disease and flies under the general public's
radar, this is a good opportunity to clear things up.
Lupus is an autoimmune disease, not an infectious disease like HIV. People
with lupus have an overactive immune system. The body's defenses actually attack
healthy tissue. This has been happening to Susan for 30 years or more.
She was diagnosed around 1990, but she had symptoms way before then.
Originally, the disease would manifest itself as flu-like symptoms for about
three weeks out of every three months, with fatigue extending a month after
every flare-up.
In 2000, lupus attacked her central nervous system and involved her brain.
The original result of this new development was pain. From late in January 2000
until the day before she died, she was in pain. On the scale of 1 to 10, there
was no day that she didn't feel pain on an 8 to 10 level. (With 10 being
all-encompassing.)
Lupus attacked her lungs, causing shortness of breath, sleeping problems, and
more pain in the form of pleurisy. In addition to Hashimoto's thyroiditis(causing cold extremities) and Sjogren's syndrome(extremely dry eyes) and a few
more isms that I have forgotten, life was getting difficult.
Systemic lupus erythematosus (SLE) is an autoimmune
disease.
SLE is characterized by the production of unusual
antibodies in the blood.
SLE is eight times more common in women than
men.
The cause(s) of SLE
is (are) unknown, however,
heredity, viruses, ultraviolet light, and drugs all may play some
role.
Up to 10% of people with lupus isolated to
the skin will develop the systemic form of lupus (SLE).
Eleven criteria help doctors to
diagnose SLE.
Treatment of SLE is directed toward decreasing
inflammation and/or the level of autoimmune activity.
People with SLE can prevent "flares" of
disease by avoiding sun exposure and not abruptly discontinuing
medications and monitoring their condition with their doctor.
What is systemic lupus erythematosus? What are the types of lupus?
Lupus is an autoimmune disease characterized by acute and chronic
inflammation of various tissues of the body. Autoimmune diseases are illnesses
that occur when the body's tissues are attacked by its own immune system. The
immune system is a complex system within the body that is designed to fight
infectious agents, such as bacteria and other foreign microbes. One of the ways
that the immune system fights infections is by producing antibodies that bind to
the microbes. People with lupus produce abnormal antibodies in their blood
that target tissues within their own body rather than foreign infectious agents. These antibodies are referred to as autoantibodies.
Because the antibodies and accompanying cells of inflammation can affect tissues
anywhere in the body, lupus has the potential to affect a variety of areas.
Sometimes lupus can cause disease of the skin, heart, lungs, kidneys, joints,
and/or nervous system. When only the skin is involved, the condition is called
lupus dermatitis or cutaneous lupus erythematosus. A form of lupus dermatitis
that can be isolated to the skin, without internal disease, is called discoid
lupus. When internal organs are involved, the condition is referred to as
systemic lupus erythematosus (SLE).
Both discoid lupus and systemic lupus are more
common in women than men (about eight times more common). The disease can affect
all ages but most commonly begins from 20-45 years of age. Statistics
demonstrate that lupus is somewhat more frequent in African Americans and people
of Chinese and Japanese descent.
What causes systemic lupus erythematosus? Is lupus hereditary?
The precise reason for the abnormal autoimmunity that causes lupus is not
known. Inherited genes, viruses, ultraviolet light, and certain medications may
all play some role.
Genetic factors increase the tendency of developing autoimmune diseases, and
autoimmune diseases such as lupus, rheumatoid arthritis, and autoimmune thyroid
disorders are more common among relatives of people with lupus than the
general population. Some scientists believe that the immune system in lupus is
more easily stimulated by external factors like viruses or ultraviolet light.
Sometimes, symptoms of lupus can be precipitated or aggravated by only a brief
period of sun exposure.
It also is known that some women with SLE can
experience worsening of their symptoms prior to their menstrual periods. This
phenomenon, together with the female predominance of SLE, suggests that female
hormones play an important role in the expression of SLE. This hormonal
relationship is an active area of ongoing study by scientists.
Research has demonstrated evidence that a key enzyme's
failure to dispose of dying cells may contribute the development of SLE. The
enzyme, DNase1, normally eliminates what is called "garbage DNA" and other
cellular debris by chopping them into tiny fragments for easier disposal.
Researchers turned off the DNase1 gene in mice. The mice appeared healthy at
birth, but after six to eight months, the majority of mice without DNase1 showed
signs of SLE. Thus, a genetic mutation in a gene that could disrupt the body's
cellular waste disposal may be involved in the initiation of SLE.
Lupus - Symptoms at Onset of DiseaseQuestion: The symptoms of lupus can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Leukemia is a type of cancer of the blood cells in which the growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia).
Pink eye, also called conjunctivitis, is redness or irritation of the conjunctivae, the membranes on the inner part of the eyelids and the membranes covering the whites of the eyes. These membranes react to a wide range of bacteria, viruses, allergy-provoking agents, irritants, and toxic agents.
Breast cancer is the most common cancer in women and the second most common cause of cancer death in women in the U.S. Symptoms include a lump in the breast or underarm area, nipple pain, change in breast size or shape, an inverted nipple, nipple discharge, and breast skin changes. Treatment may involve chemotherapy, radiation therapy, biological therapy, hormone therapy, or surgery.
Sjögren's syndrome is an autoimmune disease involving the abnormal production of extra antibodies that attack the glands and connective tissue. Sjögren's syndrome with gland inflammation (resulting dry eyes and mouth, etc.) that is not associated with another connective tissue disease is referred to as primary Sjögren's syndrome. Sjögren's syndrome that is also associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma, is referred to as secondary Sjögren's syndrome. Though there is no cure for Sjögren's syndrome, the symptoms may be treated by using lubricating eye ointments, drinking plenty of water, humidifying the air, and using glycerin swabs. Medications are also available to treat dry eye and dry mouth.
Celiac disease is a result of an immune reaction to gluten, a protein found in wheat or related grains and present in many foods that we eat. Celiac disease causes impaired absorption and digestion of nutrients through the small intestine. Signs and symptoms of celiac disease include malabsorbption (diarrhea, foul smelling gas, bloating, and increased amounts of fat in the stool) and malnutrition (weight loss, edema, anemia, bruising easily, neuropathy, and infertility). Treatment for celiac disease is a gluten free diet, and at times if necessary, medications
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
There are many causes of scalp hair loss. This featured article covers the common ones such as patchy hair loss (alopecia areata, trichotillomania, and tinea capitis), telogen effluvium, and androgenetic alopecia (male-pattern baldness, female-pattern baldness).
A miscarriage is any pregnancy that ends spontaneously before the fetus can survive. Miscarriage usually occurs before the 13th week of pregnancy. The cause of a miscarriage cannot always be determined. The most common causes of a miscarriage in the first trimester are collagen vascular disease (lupus), hormonal problems, diabetes, chromosomal abnormalities, and congenital abnormalities of the uterus.
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions for example liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
Dry eyes are caused by an imbalance in the tear-flow system of the eye, but also can be caused by the drying out of the tear film. This can be due to dry air created by air conditioning, heat, or other environmental conditions. Treatment may involve self-care measures, medications, or rarely, surgery.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Raynaud's phenomenon is characterized by a pale-blue-red sequence of color changes of the digits, most commonly after exposure to cold. Occurring as a result of spasm of blood vessels, the cause is unknown. Symptoms of Raynaud's phenomenon depend on the severity, frequency, and duration of the blood vessel spasm. Treatments include protection of the digits, medications, and avoiding emotional stresses, smoking, cold temperature, and tools that vibrate the hands.
A heart murmur is the sound generated when blood flow within the heart is not smooth. Causes of heart murmurs can be functional, congenital, or caused heart valve conditions. Symptoms of a heart murmur may be none, or may include chest pain, shortness of breath, and arm, leg, and ankle swelling. Treatment of a heart murmur depends on the cause.
Vasculitis is a general term for a group of uncommon diseases which feature inflammation of the blood vessels. Each form of vasculitis has its own characteristic pattern of symptoms. The diagnosis of vasculitis is definitively established after a biopsy of involved tissue demonstrates the pattern of blood vessel inflammation. Treatment is directed toward decreasing the inflammation of the arteries and improving the function of affected organs.
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate and exudate. The treatment of pleural effusion depends on the cause.
Optic neuritis is inflammation of the optic nerve, the structure that connects the eye to the brain. The precise cause of optic neuritis is unknown, but it is thought to be a type of autoimmune disorder. Optic neuritis most commonly develops due to an autoimmune disorder that may be triggered by a viral infection.
Connective tissue disease is when the body's connective tissues come under attack, possibly becoming injured by inflammation. Inherited connective tissue diseases include Marfan syndrome and Ehlers-Danlos syndrome. Systemic lupus erythematosus, rheumatoid arthritis, scleroderma, polymositis, and dermatomyositis are examples of connective tissue diseases that have no known cause.
Sunburn is caused by overexposure to UV radiation from the sun. UV rays can also damage the eyes. Repeated overexposure to UV rays also increases the risk for scarring, freckles, wrinkles, and dry skin. Symptoms of sunburn include painful, red, tender, and hot skin. The skin may blister, swell, and peel. Sun poisoning (severe sunburn) include nausea, fever, chills, rapid pulse, dizziness and more. Treatment for sunburn depends upon the severity. Sun protection and sunscreen for an individual's skin type is recommended to decrease the chance of sunburn.
Pericarditis is the inflammation of the pericardial sac that surrounds the heart. The causes of pericarditis include injury from heart attack, heart surgery, trauma; viral or fungal infection, HIV, tumors, mixed connective tissue disease, metabolic disease, medication reactions, or idiopathic. Treatment for pericarditis is generally medication, however, sometimes surgery is necessary.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Polymyositis is a disease of the muscle featuring inflammation of the muscle fibers. It results in weakness of the muscles which can be severe and when associated with skin rash, is referred to as dermatomyositis. Although the cause of this disease is unknown, diagnosis includes physical examination of muscle strength, blood tests for muscle enzymes, electrical tests of muscle and nerves, and conformation by a muscle biopsy. Treatment of Polymyositis and Dermatomyositis includes high doses of cortisone-related medications, immune suppression, and physical therapy.
Graves' disease is an autoimmune disease that affects the thyroid. Some of the symptoms of Graves' disease include hand tremors, rapid heartbeat, trouble sleeping, enlarged thyroid, thinning of the skin or fine brittle hair. Causes of Graves' disease are thought to be multifactorial such as genes, gender, stress, and infection. Treatment for Graves' disease is generally medication.
A corneal ulcer is an open sore on the cornea. Infection is a common cause of corneal ulcer. Symptoms and signs of corneal ulcer include redness, eye pain and discharge, blurred vision, photophobia, and a gray or white spot on the cornea. Treatment depends upon the cause of the corneal ulcer.
Iritis is an inflammatory condition of the colored portion (the iris which
surrounds the pupil) of the eye. It causes varying degrees of redness of the
eye, often with significant pain, sensitivity to light, tearing, and blurred
vision.
What causes iritis?
Often no reason is found. An infection of the eye or inflammation from trauma
may cause iritis. Iritis may also be a complication of many diseases such as
juvenile rheumatoid arthritis, ankylosing spondylitis, tuberculosis,
sarcoidosis, and collagen vascular diseases such as lupus. Iritis may occur with
herpes simplex of the eye and after eye surgery. Iritis related to juvenile
rheumatoid arthritis is especially dangerous and may not respond well to
treatment, leading to serious eye damage. In children with arthritis, pain from
iritis is often absent. Because of this, "simple" red eyes in these children
should not be ignored. Iritis is not contagious...
