This is an over-view of some of the common conditions which often accompany Systemic Lupus, but is by no means intended to be a complete listing of all such conditions. That would be near impossible to accomplish as SLE produces the greatest number and widest variety of symptoms found in any disease.
Fibromyalgia Syndrome, also called simply Fibromyalgia, FM, or FMS is a condition, but not a disease. FM afflicts some 6 million Americans, 90% of whom are women. About 20% of all lupus patients also have FM, and the two are sometimes confused. It has been estimated that at least 10% of patients diagnosed with Systemic Lupus actually have only Fibromyalgia. While FM can be extremely painful with debilitating fatigue, it is not life-threatening nor crippling, and does not damage organs.
There are 18 designated tender points in all four quadrants of the body (right side, left side, above the waist, below the waist), and a person must show pronouced tenderness in at least 11 of these 18 points to be diagnosed with FM. If a patient has tender points in less than the four quadrants, they have a regional myofascial syndrome. The cause of FM is unknown, but it is triggered by trauma, viral infection, an inflammatory disorder, or can happen as a reaction to physical or emotional stress.
The most common symptoms of Fibromyalgia are joint and muscle pain throughout the body, especially in the jaw, neck, and shoulders; painful muscle cramps or spasms; muscle weakness; sleep disturbances or nonrestorative sleep (waking up after 8 hours of sleep and not feeling resfreshed); functional bowel symptoms such as abdominal cramping, bloating, and swelling; numbness, tingling, and burning sensations in the limbs and extremities; profound fatigue; headaches; and cognitive dysfunctions, such as memory loss, difficulty consentrating, and anxiety. About 10% of FM patients have a positive ANA. Since these symptoms are also common to Systemic Lupus, many physicians make the mistake of taking the symptoms at face value, especially if a positive ANA is present, and diagnosing the patient with SLE without further laboratory findings to validate the diagnosis. While these symptoms in lupus patients are responsive to steroids and narcotic pain relievers, the same drugs cause these symptoms in Fibromyalgia to worsen. This is particularly a problem to patients who do actually have both, SLE and FM.
Fibromyalgia is best treated with NSAIDs (Non-Steroid Anti-Inflammatory Drugs) and muscle relaxants for pain; various types of medications which promote restful sleep; mild, non-strenous exercises, and deep-muscle massage therapy. FM is a chronic process which worsens and lessens, but most patients respond to treatments.
Sjogren's Syndrome, named after the man who discovered it, Henrik Sjogren, (pronounced show-gren) is usually thought of as the "dry-eye" syndrome. Those individuals whose mouth and eyes are exclusively affected, are said to have "Sicca Syndrome," a milder presentation of Sjogren's. However, Sjogren's can be much more inclusive than this. Mucous membranes throughout the body, such as eyes, ears, nose, mouth, salvitory glands, larynx, lungs, stomach, and vagina can all become extremely dry, along with the skin, hair, and nails. It can cause blurred vision, ringing in the ears, crops of mouth sores, constant thrist, and bouts of laryngitis. Sjogren's can be a secondary condition to other autoimmune diseases such as SLE, or it can exist by itself. Possibly as many as one-third of lupus patients have secondary Sjogren's Syndrome. It should be noted that most people do not experience all the above listed symptoms, but any combination of these.
Primary Sjogren's is, in itself, an autoimmune disease which can affect joints and damage organs. In severe cases, loss of vision can occur due to cornea damage, dry lungs can lead to pneumonia and lung disease, severe gastritis can result from dry stomach, pericarditis can result from inflammation in the sac surrounding the heart, and nerves may be damaged, particularly in the face. The liver, pancreas, spleen, kidneys, and lymph nodes may all be affected. Sjogren's Syndrome is the only autoimmue disease that has a potential for malignant transformation. Up to 5% of Sjogren's patients develop a blood disorder, particularly lymphoma. It is easily confused with SLE, as the signs and symptoms are shared by both conditions. Sjogren's patients often have a positive ANA and rheumatoid factor.
Sjogren's is usually a benign process and is treated symptomatically. The problems associated with Sjogren's are highly responsive to medications and can usually be managed quite successfully.
Primary Raynaud's, which occurs independently from an autoimmune disorder, is called Raynaud's Disease. When it occurs as a secondary condition to an underlying disease, it is known as Raynaud's Phenomenon. However, the symptoms are identical in primary and secondary. Between 60 and 90% of those with Raynaud's are young women.
The condition is the result of small arteries, usually in the fingers and toes, going into spasms, causing the skin to become pale or a patchy red to blue. These spasms come on quickly and may last minutes to hours. Anything that stimulates the sympathetic nervous system, such as exposure to cold or intense emotion, can cause arterial spasms. Vascular migraine headaches are also associtated with Raynaud's.
Symptoms include the affected area turning a patchy red and white, usually in a spotted fashion. During an episode, the individual usually experiences numbness, tingling, pins & needles, and a burning sensation. When the espisode ends, the affected skin may be pinker than usual or bluish. If exposure to cold triggered the symptoms, rewarming the hands or feet restores normal color and sensation. Sores sometimes develop on the affected areas and in severe cases, can cause peeling of the skin.
There are specific drugs used to treat Raynaud's disease, as well as using preventative measures, such as protecting their trunk, arms, and legs from cold and by taking mild sedatives. In the case of Raynaud's Phenomenon, the symptoms improve with the treatment of the underlying disorder.
As you can see, the term CREST is an acronym. It is a syndrome made up of five different disorders presenting together. CREST Syndrome is a less severe form of an autoimmune disease called, Scleroderma. CREST is named for its symptoms:
Although this syndrome is usually less severe than Scleroderma, CREST can cause calcium bumps to form on boney areas or at the joints; severe acid reflux, heartburn, and difficulty swallowing; intestinal infections; and severe muscle and joint pain and weakness. It can also lead to high blood pressure, causing heart and respitory failure. CREST is treated symptomatically.
* C - Calcium deposits throughout the body;
* R - Raynaud's Phenomenon;
* E - Esophageal dysfunction;
* S - Sclerodactyly (skin damage on the fingers);
* T - Telangiectasia (spider veins).
[ Return to Organ Involvement ]
Systemic (meaning throughout various body systems) Vasculitis (meaning inflammation of blood vessels), is not a disease, but rather a disease process that occurs in a number of autoimmune, connective tissue diseases. Vasculitis can also occur without connective tissue involvement.
Lupus is the result of the body's immune system producing too many antibodies, and these turn against the body, attacking healthy cells and resulting in inflammation. This same process occurs in vasculitis. The auto-antibodies attack blood vessels, causing inflammation which damages the vessels and the tissues they supply. The blood vessels can become either leaky or clogged, and both conditions disrupt blood flow to nerves, organs, and other parts of the body. These affected areas can be damaged permanently. Symptoms may result directly from the damaged blood vessels or from the damaged tissues or nerves whose blood supply is restricted. Any vessels can be affected, and symptoms depend on whether small or medium veins or large arteries are affected. It has been suggested that a large number of Lupus symptoms result from vasculitis.
The most common cause of diabetes in SLE patients is cortisone therapy (Prednisone). Lupus itself can sometimes cause elevated triglycerides (fats caused by sugar) and steroids also increase blood sugars. The risk of developing diabetes depends on how much prednisone has been taken and for how long. Steriod-induced diabetes sometimes disappears after the prednisone is lowered or discontinued.
Scientists are not certain what role hormones play in Systemic Lupus, but there does seem to be an obvious corrolation. Thus, the menstrual cycle can be affected in some women with SLE. Those taking birth control pills (made up of the female hormone, estrogen), sometimes experience a decrease in disease activity, as do some women who have passed menopause. Lupus is much less common in men, yet males with lupus tend to experience more serious complications of the disease.
About 15% of women with SLE develop menorrhagia (excessive blood flow during menstrual periods) which may be due to clotting problems. Some lupus patients may also experience amenorrhea (lack of menstrual periods). Early menopause has also been noted in women with lupus. It has been estimated that the symptoms of menopause (mood swings, hot flashes, night sweats, irregular and/or unusual periods) actually begin some 3 - 5 years before the woman is pronounced as being in the process of menopause. Each of these conditions can be a direct result of Systemic Lupus, or a side effect of steroid therapy.
All lupus pregnancies should be considered high-risk and closely monitored, yet there is no reason for a lupus patient to avoid conception, unless she has moderate to severe organ involvement. However, for those whose organ involvement had been controlled prior to conception, an increase in organ disease occurs in only 10% who become pregnant. All women with lupus are at a higher risk of marriage, but especially those with the Lupus Anticoagulant Syndrome. In 40% of lupus patients, no change in disease activity occurs during pregnancy, disease exacerbation in seen in another 40%, and improvement of symptoms occurs in only 20%. Since the fetus produces additional cortisone, the withdraw of this increased hormone after childbirth can cause a flare in the mother's disease. Such exacerbation is usually mild in patients who have been treated prior to and during pregnancy, but can be quite severe in those who hadn't yet been diagnosed and treated.
Whether due to Lupus itself, certain lupus medications, or secondary conditions such as Sjogren's, Raynaud's, or Vasculitis, the eyes are often affected in a variety of ways.
Cataracts and Glaucoma are often seen in lupus patients, but the disease is not associated with either of these eye conditions. However, extended use of steroids, such as Prednisone, can cause Glaucoma and almost always produces cataracts. Since lupus patients are more suseptible to infections, Congunctivitis (more commonly known as "pink eye") commonly occurs, but is easily treated with antibiotic eye drops. Should you ever be given antibiotic eye drops which cause the affected eye to burn, itch, or worsen, discontinue use and contact your doctor immediately. These are indications of an allergic reaction to the particular solution, and there is more than one type of antibiotic drop available to treat eye infections.
Inflammation of the iris, known as Iritis, is a recurrent problem in about 2% of lupus patients. It has been observed in almost every autoimmine disease and can also exist by itself. It is usually managed successfully with steroid eye drops. The symptoms of iritis include hazy vision or floating black spots. Severe pain, redness in the white of the eye, and sensitivity to light are especially common.
Blood vessel disorders of the eye, called Retinal Vasculitis cause bleeding behind the eye, inadequate blood supply, and blood clots causing blockage to the vessels. These disorders lead to decreased vision and sometimes blindness. They also indicate that the person is at a high risk of other problems, such as stroke. This condition is usually a complication of the Lupus Anticoagulant Syndrome.
The decreased ability of the eyes to produce tears in persons with Sjogren's Syndrome prevents the cornea (outer covering of the eyeball) from being adequately lubricated. Left untreated, this excessive dryness results in the development of pits, leaving scarred areas on the cornea surface. This can be effectly treated with artificial tears.
Optic Neuritis, inflammation of the optic nerve, can also occur in SLE. The optic nerve is the primary nerve leading from the brain to the back of the eye, through which all sight responses are transmitted and received. This condition is not as common in lupus as it is in Multiple Sclerosis (MS). However, lupus mimicks the symptoms of many other diseases, including MS. Optic Neuritis can be painful or painless, depending on which section of the optic nerve is affected. It can cause blurred or cloudy vision or blindness, depending upon if the inflammation has actually damaged the nerve. Optic Neuritis is usually limited to one eye, but not always. The blindness can be temporary or permanent, and is treated with steroids.
| Back To Top |
| Lupus Facts 1 with graphics | Lupus Facts 1 without graphics |
Lupus Foundation of America
"Lupus Erythematosus"
"The Merk's Manual"
"The Lupus Book"
~ paraphrased and expounded upon by:
By: Ronald I. Carr, M.D., Ph.D.
and
By: Daniel J. Wallace, M.D.
Gayla L. Pledger
If you have any questions, comments, or would like to see something added to this page, please e-mail me at: