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SOURCE: National Institutes of Health, U.S.Department of Health and Human Services: Link to NIH

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Lupus means wolf.
Erythematosus means redness.

In 1851, doctors coined this name for the disease because they thought the facial rash that frequently accompanies lupus looked like the bite of a wolf.

There are four categories of lupus: systemic lupus erythematosus, cutaneous lupus, drug-induced systemic lupus erythematosus, and neonatal lupus (see Pregnancy in Chapter Four). Lupus: A Patient Care Guide for Nurses and Other Health Professionals is concerned primarily with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE, or lupus) is a chronic, inflammatory, multisystem disorder of the immune system. In SLE, the body develops antibodies that react against the persons own normal tissue. These antibodies are markers for SLE, and are one indicator of many immune system abnormalities that lead to clinical manifestations.

The course is unpredictable and individualized; no two patients are alike.

Lupus is not contagious, infectious, or malignant. It usually develops in young women of childbearing years, but many men and children also develop lupus.

SLE also appears in the firstdegree relatives of people with lupus more often than it does in the general population, which indicates a hereditary component. However, most cases of SLE occur sporadically, indicating that both genetic and environmental factors play a role in the development of the disease.

Lupus varies greatly in severity, from mild cases requiring minimal intervention to those in which significant and potentially fatal damage occurs to vital organs such as the lungs, heart, kidneys, and brain. For some patients, the disease can be characterized by flares of activity interspersed with periods of improvement or remission.

A flare, or exacerbation, is increased activity of the disease process with an increase in physical manifestations and/or abnormal laboratory test values.

Periods of improvement may last weeks, months, or even years. Other patients have continuous, or chronic, activity.

Although remissions are unusual, some patients never develop severe manifestations, and the outlook is improving for patients who do develop them.

Cutaneous lupus, which affects primarily the skin, is common among patients with lupus erythematosus.

The most prevalent and severe form of cutaneous lupus is called chronic cutaneous lupus.

It is commonly known as discoid lupus, but it has other forms as well (see Dermatologic Manifestations in Chapter 4).

Drugs Implicated as Activators of Drug-Induced Lupus

Drugs with proven association Drugs with possible association
  • Beta blockers (e.g., acebutolol, atenolol, labetalol, metoprotolol, oxprenolol, pindolol, practolol, and propranolol)
  • Captopril
  • Carbamazine
  • Cimetidine
  • Diphenylhydantoin (phenytoin)
  • Ethosuximide
  • Methimazole
  • Penicillamine
  • Phenazine
  • Quinidine

Drug-induced lupus erythematosus develops after the use of certain drugs or biologics and has symptoms similar to those of SLE.

The characteristics of this syndrome are pleuropericardial inflammation, pleuritic chest pain, pericarditis, fever, rash, and arthritis. Serologic changes can occur.

The clinical and serologic signs usually subside gradually after the offending drug is discontinued. A wide variety of drugs is implicated in this form of lupus (see box, above).

More recently, the newer TNF (tumor necrosis factor) inhibitors used to treat rheumatoid arthritis, Crohns disease, and ankylosing spondylitis have been associated with the development of lupus symptoms.

As with lupus triggered by other drugs, the symptoms resolve when the agent is stopped.

Source: National Institutes of Health, U.S.Dept of Health and Human Services

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