Epidemiology of the Lupus Disease and Its Diagnosis

Having the feeling of pain and/or swollen joints, unusual hair loss, extreme fatigue (Especially if you are college student), etc can be really uncomfortable for someone. Well, some people have to deal with those symptoms. These symptoms can be a sign of LUPUS; this disease is not biasing as it can attack woman and men. A person with unusual pain might complain about for the time being, however, those little pain can be the little cause of another person or a loved that suffer living with those problems. Lupus also is known as SLE (Systemic Lupus Erythematosus) is an autoimmune disease, where the body immune system starts attacking itself, but not just itself it also attacks healthy tissue that can cause several problems like joints inflammation, swelling, other things. Lupus history is interesting as it has three periods: Classical, Neoclassical, and Moder.

First in the classical period (1230-1856) although there is not much of research of it went in that time, Lupus was marked as a cutaneous disorder but then it was made/rename Lupus. The world Lupus it came from the Latin word “Wolf” the reason that it came from the word “wolf” it was due that in that time it looked like a facial lesion that was similar/reminiscent of a wolf’s bite. Since there was a lot of description feature of lupus, they were also a lot of dermatologists involved like Cazenave, Thomas Bateman, Moriz Kaposia, and many more were a part of the investigation about Lupus. Since it started to get more knowledge and also more patients with similar symptoms/scarf/lesion that was recognizable it was described discoid lupus in 1833 by Cazenave (also known as erythema centrifugal), even more, information started to appear and describe as the butterfly rash which was noted by Von Hebra in 1846. One of the first published illustrations of Lupus (Lupus erythematosus) was talking in Von Hebra’s text Atlas of Skin Diseases in 1856.

Then Lupus it came the Neoclassical era were the “actual story” of lupus began in 1872, when a guy named Kaposi describe Lupus systemic nature disorder, “...experience has shown that lupus erythematosus. .. may be attended by altogether more severe pathological changes and even dangerous constitutional symptoms may be intimately associated with the process in question and that death may result from conditions which must be considered to arise from the local malady.” With his explanation/investigation he proposed that there were two types of Lupus erythematosus: The discoid form and a Disseminated (systemic) form, Kaposi then talk about the symptoms that characterize this disease (but they are going to talk later in the symptom part.) As time pass systemic form of Lupus was established in 1904 by Osler in Baltimore and Jadassohn in Vienna.

And now as the Modern era Lupus, an investigation in the 1948 by Hargraves and colleagues observed that the cell in the bone marrow of a person with bad part of their body with Lupus the cell, “...is the result of...phagocytosis of free nuclear material with a resulting round vacuole containing this partially digested and lysed nuclear material...”. The discovery led in the present era about Lupus allowed to make it “easy” to diagnose a person with much milder form of the disease. In the 1950 two other markers were recognized as familiar with lupus, the biologic false-positive test for syphilis and the immunofluorescent test for antinuclear antibodies. “Fun fact” during that time if you were working in Baltimore it demonstrated the Lupus was developed 7 percent of 148 people with the false-positive test for syphilis and 30 percent had symptoms consistent with collagen disease.

An important fact about Lupus rather the MOST IMPORTANT is that is not contagious, not even with sexual contact, nor you can catch it, or give it to someone, nor touching it, in other you can’t get it by any interaction. Which why in it History makes it hard to know where it came from as nobody knows. However, there is research that dog also can have Lupus, but the same thing that I mention above about how is not contagious apply here also, you cannot get it from a dog, which again makes it hard to follow its tracks.

Nonetheless, this disease is not an epidemic or pandemic, rather Lupus is prevalent in women in ages 15 and 44, scientist believed that woman hormones are the reason or one of the causes of getting Lupus, and the reason that they speculate that is because there is the year that women are able to have babies. However is not as common to get it when you are 15 Lupus, the only exception if a woman who has Lupus gave birth which doesn’t mean that the baby will have Lupus it can cause the baby liver, skin, heart problem, but if the mother is healthy or has a healthy diet the baby and the pregnancy itself can be healthy. But it is important that this disease is not sexist it also attacks men, is not prevalent towards men but is more deadly/fatal/severe in men than it is women. So, Lupus can occur in all people regardless of gender, race, nationality or ethnicity. According to an article, “A Quick History of Lupus and Its Implications for You” Lupus demographically: In the United States anywhere between 20 and 150 per 100,000 women develop Lupus; Lupus being common in African American, yet it prevalence among African is surprisingly lower than African Americans.

Moreover in the “LUPUS FOUNDATION OF NORTHERN CALIFORNIA” goes a little further on how it affects African American and other women of color, they mention that it affects women of color three times more likely than white women, furthermore is more common in Latino, Asian, and American Indian women. Also how in African American, Latino/a develop Lupus at a younger age and having more symptoms when being diagnosed. Even more, it talks about how an African American they tend to have more seizures and strokes, and in Latino/a trend to have more heart problems, as they mention in their website they don’t know as to why some people have more problem with Lupus then other people or group. Another article named, “Understanding the epidemiology and progression of systemic lupus erythematosus” talk about/gives little information the survivability rate of Lupus, which answered the question (not completely) of why minorities are the one suffering the most from this disease. According to them, the survival rate is less favorable with minorities which they speculate that is possibly related with socioeconomic status rather than to ethnicity and the social support show/given to be a protective factor in patients.

As mentioned before there is not an exact model of transmission, nor is infectiousness, and nor no one knows whom it got there, so it pretty hard to see how it got into a human. But what the researchers do know or believe/have an idea is how you can “get it”. As stated in the previous paragraph scientist believe that Lupus is developing due to inside and outside factors like hormones, genetics, and environment. Before starting on how Lupus is “get” must of information become from the Lupus Foundation of America.

So first let cover based on Hormones; hormones are the messengers of the body and help regulate the body’s function. Due to Lupus affects every 9 of every 10 women, scientist and researcher have look if there any relationship between estrogen and Lupus. Since Lupus affects both gender parties researcher look at the estrogen level of men and women which is much higher in women than men. But what does estrogen has to do with Lupus you may ask, is because there is pather that shows when there high amounts of estrogen, Lupus becomes more prevalent, which can be a little explanation of why is prevalent in women due to when they are pregnant or before menstrual periods they produce high amount of it. However, there are still some problems on this idea due to it has not been proven between estrogen, or any other hormone, and Lupus. Furthermore, women with Lupus taking estrogen in either birth control pills or as postmenopausal have shown no increase in significant on the disease, which leads to more research between the differences men and women on hormone level can answer the question or lead toward an idea of why women are more prevalent than men.

Now Genetically, an important fact about Lupus and genes is that no genes have been proven to cause Lupus, researcher, and scientist have found/identify that 50 genes are associated with Lupus. These genes are more seen in a patient with Lupus that those without Lupus, although these genes are not a hundred percent accurate they are to believe that they can the contribution to it. However gene aren’t fully the whole answered in this case as evidence in twins that are raised in the same environment and same features only one might develop Lupus while the other one doesn’t, but they are case when there are two identical twins that have Lupus, there can be an increasing chance that other twin will develop the Lupus “30% percent chance for identical twins; 5-10% percent chance for fraternal twins.” Moreover, Lupus doesn’t need to be a family history, yet they are another autoimmune disease in some families histories, and Lupus as not being discriminatory ethnic groups African American, Latina/o, Native American, Hawaiian, Pacific Island are greater risk developing Lupus.

Lastly environmental, since genetics, and hormones aren’t blooming scientist are moving towards to think Lupus can be an environmental agent, something that is chemical or encountered by walking or any acts that will trigger the disease, however there still not certain if actually, it is (Is just a hypothesis). But the biggest evidence that they have is ultraviolet light, “(UVA and UVB); infections (including the effects of the Epstein-Barr virus), and exposure to silica dust in agricultural or industrial settings.” The Lupus Foundation of America talk about other triggers of Lupus, “Ultraviolet rays from the sun and/or fluorescent light bulbs, Sulfa drugs which make a person more sensitive to the sun, Sun-sensitizing tetracycline drugs, Penicillin or other antibiotic drugs, Infection, colds or viral illnesses; Exhaustion, Emotional stress”. In the neoclassical period (1872- 1948) Kaposi was the one that describe the systemic nature of Lupus, and also furthermore he describe signs/symptoms that characterized Lupus, he mention as: “subcutaneous nodules, arthritis with synovial hypertrophy of both small and, large joints, lymphadenopathy, fever, weight loss, anemia, central nervous system involvement.” And in the classical period (1230-1856) it was known as butterfly rash. Now in the modern day more symptoms started to appear but also more awareness was also brought.

As it modern date Lupus has started to become harder to diagnose as it can easily mistaken from other diseases or been treat as a different disease, for this reason Lupus has gain it name as “Great Imitator”. An important about Lupus is that, it doesn’t have the same effect/symptom for every person, this mean that every person can/will experience something different while getting Lupus. Some common sign listed in the Lupus Foundation of American are: “Red rash or color change on the face, often in the shape of a butterfly across the nose and cheeks, Painful or swollen joints, Unexplained fever, Chest pain with deep breathing, Swollen glands, Extreme fatigue (feeling tired all the time), Unusual hair loss (mainly on the scalp), Pale or purple fingers or toes from cold or stress, Sensitivity to the sun, Low blood count and Depression, trouble thinking, and/or memory problems. Other signs are mouth sores, unexplained seizures (convulsions), “seeing things” (hallucinations), repeated miscarriages, and unexplained kidney problems.

Other way to know the symptom of Lupus or to know if you have it, is if you have some of this algorithm, clinical characteristic and laboratory testing. This algorithm come from, “A Quick History of Lupus and Its Implications for You”, “Here are some clinical signs of lupus: Skin lesions, Alopecia (a type of hair loss), Oral ulcers, Synovitis (inflammation of the synovial membrane in joints), Neurological symptoms (seizures, psychosis and so forth) Here are some laboratory and diagnostic findings that can be used to diagnose lupus: Blood tests (low white blood cell counts, low platelet counts, and low red blood cell counts), Renal function tests, Renal biopsy, Urinalysis (looking for red blood cell casts), and Immunological tests (think testing for antibodies like ANA, antiphospholipid, Anti-Sm and anti-dsDNA)” However, that algorithm does always follow since from different patient who suffer from Lupus had different experience from another. Lupus has “short” story for it treatment and how people used to tent to deal with it. But something important to know our your daly important fact there in no cure found yet for Lupus which make it so dangerous, but that does mean it can be treatable no be reduce/control. Most information talk about treatment come from the Lupus foundation of America.

In 1894 a researcher Payne was the person who first ever reported usefulness of quinine in the treatment of Lupus, time passes (4 year) and the use of salicylates in conjunction with quinnie were also used and noticle to be beneficial. Later on in the 20th century, “Cortisone/corticosteroids were introduced for the treatment of lupus...by Hench. Presently, corticosteroids are the primary therapy for almost all individuals with lupus. Furthermore it the Lupus Foundation of American talks about the usage of Antimalarials w in the past for Lupus skin and joint development, which also used in the present day as a treatment which were to prevent occurrences of flares, accumulation of damage, and occurrences of early morality.

Now in today era Lupus is treat it more different way that are more adequate for the patient as again Lupus attack patient in different ways. The Lupus foundation touches in some way that Lupus has been treat, one of the way is Cytotoxic/immunosuppressive which is a drug for glomerulonephritis, systemic vasculitis, and other life threatening that Lupus attack. Moreover the Mayo Clinic talk about different way that Lupus is being trea it, but talk about how the different symptoms and sign that a person show and the type of medicine is recommended for them.

So let say you have any swelling, fever that is associated with lupus (reason I say associeted is due to how Lupus can trick patient rather doctor that is not actually Lupus) then some recommendation to treat it is Nonsteroidal anti-inflammatory drugs (NSAID), but if the swelling is stronger than a stronger dosage might need to be used. NSAID however it does cause some saide like stomach bleeding, kidney problems and increasing risk of heart problem. Anther medication use is Antimalarial drugs which are used to treat Malaria, but the they are also use in Lupus due to they decrease the risk of Lupus flares. But like many other diseases they have some side effects that include stomach upset, and unusual damage on the retina of the eye, which is prescribe an eye exam when you are taking the medication just to be safe because you never known. Furthermore there is Corticosteroids which help to counter inflammation of Lupus, doses on steroids as methylprednisolone are used to control diseases that have a connection on kidney and brain. As for this treatment side effect are weight gain, bruising, thinning of bones, diabetes, and rish conditions. Another medication is Immunosuppressants which is a drug the suppress the immune system which help on the cases on Lupus, some of the side effect that are listed are, increasing risk of infections, liver damage, fertility decreasement and risk of cancer. And there is Biologics a different medication that reduce symptoms in people, but it side effect are nausea, diarrhea and infections and some trigger of depression. Even Though there is a lot of treatment and different side effect is due to how Lupus affect different people in different way, so is important to known the sign that you are getting but also see a doctor.

When mention on it epidemiology Lupus doesn’t discriminate or it sexist it can attack any famous person as it can attack any minorities, so it important to know that you can be at risk like anybody else.Nonetheless, some of the important fact that I will repeat is that Lupus is not contagious, is not something that you can passed person to another person, or you can’t get it by any sexual interaction, nor touching it. Which makes this disease really difficult to control it. Moreover, I mention before that Lupus is prevalent in dog too, but dog aren’t the reason as why human have it due to again it cannot be pass or transmitted.

And to finalise most of information (and a huge thanks) was gotten by the Lupus Foundation of American is a voluntary health organization founded in the 1977. The purpose of this foundation is to solve the mystery of Lupus, but also giving support from those who suffer it, as it also trying to improve the quality the life of people who are being affected by Lupus through program of their research, support, advocacy, and education. So again most credit and knowledge about lupus has come from this great website who trying to give people with Lupus a better opportunity.