Laboratory tests for Lupus

Lupus is a difficult disease to diagnose because its symptoms can be vague. And unlike some other diseases, it cannot be diagnosed with a single lab test. 

Lupus is an autoimmune disorder that is about 10 times more common in women than in men. In lupus, the immune system, which normally protects against infections, produces an inappropriate immune response against its own tissues. This immune response can cause inflammation and damage to many areas of the body, including the skin, joints, blood vessels, and internal organs, specially kidneys, heart, lungs and the brain. Some women with lupus may have only vague, mild symptoms while others can experience various troubling symptoms that come and go over time. Women with lupus have a higher risk of other health conditions including heart disease, kidney disease and osteoporosis. There are several types of lupus; the most common is systemic lupus erythematosus (SLE), which affects many areas of the body. SLE is most frequently seen in people between the ages of 15 and 44, although children, including newborns, and older adults can also have lupus.

CAUSE OF LUPUS
The cause of lupus is not fully understood. It is thought to involve both an inherited component and a trigger that may be related to environmental factors, such as exposure to sunlight, and/or the use of certain medications and viral infections. Lupus may coexist with other autoimmune disorders, some forms of haemolytic anaemia, Hashimoto thyroiditis, and idiopathic thrombocytopenia purpura (ITP).

SIGNS AND SYMPTOMS
Diagnosis of lupus can be extremely challenging, especially because of its wide range of symptoms that can flare up and subside and change over time. A healthcare practitioner must rely on laboratory test results, clinical symptoms, and the person’s medical history for diagnosis. The signs and symptoms may vary from person to person, and by the type of the lupus. People with lupus may develop a rash, such as:
· A rash resembling a butterfly that appears across the nose and cheeks (malar rash)
· A red rash consisting of round or oval-shaped patches (discoid rash)
· A rash on areas of the skin that are exposed to sunlight (typically the face and extremities)

A rash is typically the only symptom in discoid and subacute cutaneous lupus. People with other types of lupus may have a combination of the following additional signs and symptoms:
· Muscle pain
· Arthritis-like pain in one or more joints (but no or little joint damage)
· Fever
· Persistent fatigue
· Swollen lymph nodes
· Sensitivity to sunlight
· Raynaud phenomenon
· Hair loss
· Anaemia
· Mouth ulcers

Inflammation and damage to organs and tissues, including the kidneys, lungs, heart, lining of the heart, central nervous system, and blood vessels
Symptoms of lupus may come and go over time and vary from person to person. They may worsen abruptly and die down. Flare-ups may be triggered by changes in someone’s health status, such as physical or emotional stressors, and during pregnancy and after child-birth in women.

LABORATORY TESTS FOR AUTOANTIBODIES
As the diagnosis of lupus is challenging, it is made by clinical evaluation of physical signs and symptoms in combination with tests that can help to confirm the condition or rule out other causes of the person’s signs and symptoms.
The following laboratory tests may be useful in the diagnosis of lupus:·
 Anti-nuclear antibody (ANA) – positive in almost all people with SLE, although it can also be positive with those with other autoimmune diseases as it indicates a stimulated immune system
· Anti-Sm antibody (Anti-Smith antibody) – usually seen only in those with SLE
· Anti-double stranded DNA (Anti-dsDNA) – high levels are characteristic of active SLE
· Anti-SSA and Anti-SSB – may also be positive
· Anti-RNP – may be positive
· Anti-chromatin antibodies – may be present in people with SLE who are positive for ANA but negative for anti-dsDNA
· Histone antibodies – for drug-induced lupus
· Antiphospholipid antibodies – such as lupus anticoagulant, anticardiolipin, anti-beta2 glycoprotein I

Other general tests that may be useful for evaluating someone with or suspected of having of having lupus:
· Urinalysis – may show blood, urinary casts, or protein in the urine, which can indicate kidney involvement
· Complete Blood Count (CBC) – may reveal anaemia and decreased numbers of white blood cells and platelets, which can occur with lupus
· Comprehensive Metabolic Panel (CMP) – indicates current status of the kidneys and liver as well as electrolyte and acid/base balance and levels of blood glucose and blood proteins
· Serum Protein Electrophoresis – gamma globulin protein levels are indicative of inflammatory diseases such as SLE
· C-reactive protein (CRP) – another marker of inflammation that may be elevated with lupus

IMPORTANT THINGS TO CONSIDER
There are several things to keep in mind regarding lab tests for lupus:
· Lab tests usually cannot diagnose lupus. Signs and symptoms of the disease are also important.
· When a positive anti-nuclear antibody test (ANA) is accompanied by several other clues that doctors look for in diagnosing lupus, it is often a strong indication to consider lupus.
· It is common for positive lab tests to come and go over time. If this happens, it is less likely that one will receive a lupus diagnosis, though still possible.
· It is very common to get different results in different labs.
 
(The writer is Consultant Pathologistl)

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Autoimmune Disease 101

“There’s no sign of this trend slowing down; on the contrary, the prevalence of autoimmune diseases like type 1 diabetes, inflammatory bowel disease, and multiple sclerosis is increasing at an alarming pace. From 2001–2009 alone, the incidence of type 1 diabetes increased by 23 percent!”

To add concern to the growing number of individuals living with the condition, it appears that conventional treatment has little to offer in reducing the severity and discomfort that accompanies autoimmune disease. 

What is Autoimmune Disease?

The human body is designed with a specialized immune system composed of a complex network of special cells and organs.  These cells and organs are designed to defend the body from germs and other foreign invaders.  
At the core of your immune system is the ability to differentiate between “self” and “nonself”, or what is you versus what is foreign matter.  Autoimmune disorders, or disease, occurs when the body’s immune system begins to attack and destroy healthy body tissue by mistake.  

"Autoimmune diseases are born when your body is working hard to defend itself against something potentially dangerous, such as an allergen, a toxin, an infection, or even a food, and it fails to differentiate between the intruder and parts of your own body. Mistaking certain types of tissues for harmful substances, your body turns these antibodies against itself, wreaking havoc on your organs.”

Autoimmune disorders usually fall within one of two categories: systemic or local.  Here is the difference:

• Systemic autoimmune diseases are linked to the production of non-specific tissue autoantibodies, leading to a spectrum of damage which can affect a wide range of tissues, organs, and cells of the body.
• Localized autoimmune diseases, on the other hand, lead to organ-specific conditions, affecting a single organ or tissue.

It is important to note, however, that the boundary between systematic and non-systematic disorders can become a bit fuzzy as the disease runs its course.  In other words, as the effect and scope of localized autoimmune disorders takes hold of the body, it is not uncommon for the damage to extend beyond the initially targeted areas.

Immune System 101

To better understand how your body has the ability to “attack itself”, leading to the development of an autoimmune disease, it helps to know the basics about immunology.  Let’s briefly look at the various organs, the cells they produce, and the role these specialized cells play in protecting you from illness.
Immunology basics:

• Bone marrow – found within your bones, where immune cells are derived.
• Thymus –  A flat, pinkish-gray gland, found in the upper chest in front of the heart.  This is where your T-cells pass through and mature.
• Lymphatic system – A critical system for the elimination of toxic waste from your tissues.  This system is made up of lymph fluid, lymphatic vessels, bone marrow, lymph nodes, spleen and tonsils.
• T-cells –  These immune system cells function like “warriors” and mature in the thymus.  Once mature t-cells enable each individual T-cell to recognize only one of millions of antigens, at which time they migrate into your lymphatic system and circulate in the blood.
• B-cells – These immune cells are produced in and by your bone marrow and are responsible for the secretion of antibodies.

You’ll notice the term “t-cells” used multiple times in the above list, and as you may have already gathered T-cells are of great importance. These cells are taught to recognize invading cells, or non-self cells, from your own cells.  
Remember, a normal functioning immune system only attacks substances and infections that are thought of as foreign invaders, such as cancer cells.  When the immune system is “confused”, it begins to attack healthy cells found within the body.

Target Organs and Tissues

The triggers for autoimmune disorders are rather variable, and may be brought on by the following conditions:

• Environmental exposure to chemical solvents 
• A drug response
• Contraction of a viral or bacterial infection
• Sunlight or radiation

Just as the triggers for an autoimmune reaction are varied, the debilitating effect vary as well depending on the target organs and tissues affected by disorders.  (1) With more than 80 types of autoimmune disorders, some common tissue types and bodily sites that the immune system can begin to attack include:

• blood vessels
• connective tissue
• endocrine glands (i.e. thyroid or pancreas)
• joints
• muscles
• red blood cells, and
• skin

Keep in mind it is possible to have multiple tissues and organs attacked by the immune system, resulting in the diagnosis and presence of more than one autoimmune condition at the same time. 

Signs and Symptoms of Autoimmune Disease

There is some amount of mystery and confusion behind certain autoimmune conditions, such as multiple sclerosis, rheumatoid arthritis and thyroiditis. Part of what contributes to the unknown lies in the fact that the biological basis, and some of the most common symptoms that accompany such debilitating illnesses, may not be linked to one specific infection.

“Despite its prevalence, the level of basic autoimmune research funding is below 3% of the National Institutes of Health (NIH) total budget, which may explain why we understand so little about the roots of these diseases. Indeed, AARDA reports that the whole arena of autoimmune research is in its infancy…We do know there are factors at the root of autoimmune diseases development, which include both genetic and environmental components.”

While the biological or genetic and environmental factors contributing to the development of an autoimmune disorder may not be well understood, there are some well documented signs and symptoms.
Experiencing any of the symptoms listed below may indicate the presence of an autoimmune disease; however, experiencing more than one of these symptoms could increase the likelihood of an autoimmune disorder:

• Joint pain or muscle pain, accompanied by weakness or tremors
• Unintentional weight loss or weight gain
• Insomnia
• Intolerance to heat or cold
• Rapid heartbeat
• Recurrent rashes or hives or sun-sensitivity 
• Brain fog, difficulty concentrating or focusing
• Abdominal pain, bloody stools, diarrhea
• White patches or ulcers in and around your mouth
• Dry eyes, mouth, or skin
• Numbness or tingling in hands or feet
• Multiple miscarriages or blood clots

Gender Differences

It is estimated that up to 1/3 of the risk factors for developing an autoimmune stem from heredity and genetics; however, gender plays a very large part in the development of autoimmune disease.
Interestingly enough, the female population accounts for about 75% of Americans afflicted by autoimmune conditions. On top of that, autoimmune disease constitutes some of the leading causes of death and disability in women, up to the age of 65.

Though the relationship between sex and the prevalence of autoimmune disease is not well understood, researchers have been able to document that women have higher levels of antibodies, mounting larger inflammatory responses than men when their immune systems are triggered.
As hormones fluctuate, autoimmune diseases responds in accordance to such shifts. When a women becomes pregnant, has her menstrual cycle, goes through menopause, or takes birth control, the severity of the condition may change.  Despite the large percentage of the female population at risk of developing an autoimmune disorder, autoimmunity is not often discussed as a potential health issue.

Commonly Diagnosed Diseases

Thyroid disease, lupus, multiple sclerosis, and rheumatoid arthritis top the list as some of the most commonly diagnoses autoimmune diseases in the United States.  Let’s take a closer look at these commonly diagnosed conditions so you have a better understanding of how autoimmune disorders can impact your health.
Thyroid Disease: Graves' diseases and Hashimoto's disease are the two types of autoimmune diseases that target the thyroid.  Graves’ disease leads to an overactive thyroid (hyperthyroidism), whereas Hashimoto’s disease causes an underactive thyroid (hypothyroidism).  Most individuals are diagnosed with thyroid disease between the age of 20 and 30 years old, and women have higher rates of thyroid disease compared to men.
 The thyroid gland is the main metabolic regulator of the body, thus any sort of gland dysfunction affects your metabolism. In the presence of Graves’ disease, as the thyroid gland is attacked by the body’s antibodies, inflammation and swelling result. This in turn leads to hyperthyroidism, or an overactive metabolic state, whereby the body  basically goes into overdrive.  As the metabolic rate increases, one may also experience an increase in heart rate and blood pressure.
Hashimoto’s thyroiditis is caused by antibodies reacting against proteins on the thyroid; however, this disease is characterized by a gradual destruction of the gland itself.  As the gland is destroyed, the body is no longer able to produce critical thyroid hormones required by the body, and metabolic rate will decrease, most often leading to unintentional weight gain.

Systemic Lupus Erythematosus (SLE):  SLE (i.e. “lupus), is a chronic, autoimmune disorder that affects many organs and tissues, most often skin, blood, joints, kidneys, lungs, and the heart.  Antibodies produced in response to the disorder lead to the formation of immune cell complexes, which build up over time various tissues leading to pain, inflammation, or destruction of the areas of the body that are under attack.
For many, lupus is considered a mild condition and will only affect a few organs. For others, however, it can trigger serious and potentially life-threatening, conditions.  Lupus can occur at any age, and the disease is 10-15 times more common in women than men.
Studies have shown that some lupus patients have low levels of DHEA (i.e. dehydroepiandrosterone), and further studies are continuing to investigate the contribution of this hormone to the onset of the disease.

Multiples Sclerosis (MS): Multiple sclerosis is a chronic inflammatory autoimmune disease, that specifically targets the central nervous system, thus impacting normal function of the brain and spinal cord.
In MS, the body produces excess antibodies that go on to specifically attack the myelin, which is a protective sheath that covers nerves.  As a result of the attack, neurological, cognitive, and psychological problems set in.   One may experience weakness or paralysis of limbs, numbness, vision problems, speech difficulties, problems with walking or changes to motor skills, and sexual dysfunction.
MS is actually the most commonly diagnosed neurological disease in young adults and, most often detected in between  the age 20 and 40. MS, like many other conditions, is much more prevalent (almost twice as much) in women compared to men.

Rheumatoid Arthritis (RA):  Rheumatoid Arthritis is a widespread, disabling autoimmune disease, affecting the joints and muscles of the body.  The most  frequently impacted joints are those that are free-moving, including small joints of the hands, knees, ankles, hips, elbows, wrists and shoulders.
RA results after the body launches an autoimmune attack on the synovial membranes, the tissue that lines and cushions your joints.  In response to the attack, one may experience inflammation and pain. As the condition continues to progress, the pain and swelling increase, and over time this may result in destruction and deformity of the bones.
RA typically surfaces between the age of 25 and 50, though the symptoms may be mistaken as a normal part of aging.  The condition afflicts females two to four times more than males.  Unfortunately, RA is  rather progressive, despite treatment protcols.   Many times the objective of treatment is quite simply to control inflammation, prevent or slow joint damage, hopefully leading the condition into remission.

Traditional Autoimmune Treatments

To date, there is no cure for the majority of diagnosed autoimmune disorders, thus individuals are faced with a lifetime of debilitating symptoms, which may include loss of organ or tissue function, and extensive medical costs.
 The goal of treatment is most often targeted at the reduction chronic symptoms, decreasing the intensity of the immune system activity, and being able to maintain the immune system’s “normal” ability to fight foreign invaders.
Treatments vary widely and depend on the specific disease and the symptoms.
Take for example an individual living with Type I Diabetes, where the target is to replenish insulin levels, usually through injections or supplement the body with a hormone or vitamin that the body is lacking.  This is much different than the treatment of an autoimmune disorder that either directly or indirectly affects the blood or the circulatory system (i.e. autoimmune hemolytic anemia, lupus, or antiphospholipidal antibody syndrome.)  Treatment of these conditions may require blood transfusions.
In the case of an autoimmune disorder that affects the bones, joints, or muscle (i.e. multiple sclerosis or rheumatoid arthritis), treatment may be geared towards the maintenance of mobility or the incorporation of a medication to suppress pain and reduce inflammation.
It is also not uncommon for medicine to be prescribed as way to control or reduce the immune system’s response. Popular medications include corticosteroids and immunosuppressant drugs (i.e. azathioprine, chlorambucil, cyclophosphamide, cyclosporine, mycophenolate, and methotrexate). 

Keeping Your Immune System Healthy

Keeping the immune system healthy and functioning appropriately involves taking care of your health on many different levels.  Most books on the topics, as well as many health experts, promote the simple concept of “living well”.
Whole body wellness involves basic, common sense practices like following a healthy diet, getting enough rest or  sleep, exercising consistently, drinking alcohol only in moderation, and avoiding stress.
To take your wellness to the next level, there are some additional steps you can take to keep your immune system healthy such as:

• Avoiding all possible exposure to environmental toxins such as mercury, poisons and heavy metals.
• Avoidance of taking unnecessary drugs.
• Choosing your foods wisely with an understanding that your diet plays a large part in healthy functioning immune system.
• Regular sexual activity has been found to be beneficial through its contribution to a healthy hormone balance.

 Dietary Intervention
Now that you have a better understanding of autoimmune disease and how it can impact your health, you may be asking yourself, “Do I need to follow a Paleo gluten-free diet to help boost my immune system?  What about alternative supplements or more holistic treatments?”
If you are asking yourself these questions, join the club!  Of the estimated 23 million people in the United States suffering from autoimmune disease, most are asking themselves these same questions daily, hoping for a safe solution without medical and drug-related intervention.
If you suffer from an autoimmune condition, or you know of a loved one or friend who may be struggling with the condition, you may already be aware of the Autoimmune Paleo diet (AIP).  Many individuals are transitioning to a refined paleo eating plan in an effort to improve life-disrupting symptoms including pain and fatigue.
While medical experts have offered mixed feedback as to how effective the Paleo diet is in treating autoimmune disease, individuals who have a vested interest in following the dietary plan consistently support the AIP, claiming that it has improved their quality of life.
While the AIP may be initiated as a way to manage an autoimmune issue, chances are those suffering from autoimmune disease also have a poorly functioning digestive tract.  If the gut is not in good shape, byproducts of all of the things passing through the intestines are leaking through the gut barrier and into the blood stream, stimulating the immune system to respond with greater intensity.
The AIP is designed to help decrease inflammation and immune system stimulation at the same time.

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Symptoms in Lupus Are Worsened By Obesity

Patients that have systemic lupus erythematosus – SLE that were also obese had worse symptoms than the ones that had a normal range weight, according to a cross-sectional study.

Obesity is when a person has a fat mass index (FMI) if 13 or more. Researchers have compared patients that averaged a score of 14.8 with the ones that were not obese (had FMI 11.5).
Looking at the scores from the Center for Epidemiologic Studies Depression Scale, researchers reported  that the obese patients’ score was 19.8, while the non-obese group had only 13.1.

32% of 142 Women That Had Lupus Were Obese

In their study, the team included 142 women in the Lupus Outcomes Study, and 32% of them were obese.

The researchers used a system called dual-energy x-ray absorptiometry to correctly asses fat mass. 

The FMI was calculated by dividing it by the patient’s height.

The average age in the study participants was 48. The number of obese women was more increased in black women, or in women that were less educated, or in women at or below the level of poverty. 

Most of the obese women had diabetes and a high level of C-reactive protein.

In the Survey, obese patients score worse symptoms of pain (38.7) compared to the non-obese patients (44.2). The same goes in cases of fatigue, with similar results.

What Did the Researchers Recommend?

The researchers said: “We now understand that adipose tissue is an active endocrine tissue that secretes proinflammatory cytokines and adipokines (including leptin, adiponectin, and resistin) into systemic circulation.”

Katz and the team in the research now know that excess adiposity in patients that have lupus can increase the symptoms, as shown in the reports mentioned above:

“This finding has important clinical implications, as the symptoms assessed in our study are known to have profound effects on quality of life and remain an area of unmet need for the majority with the disease.”

There is a way to reduce the risks of conditions that can become fatal. The author said in a press release, that lupus patients have to change their lifestyle to lower the excess adiposity. This way, they can also reduce symptoms of lupus.

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.                                                                                                                                                                                                        PS- THOSE INTERESTED IN RECIPES ARE FREE TO  VIEW MY BLOG-                                                                                           https://gseasyrecipes.blogspot.com/  

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