*

* Our Research Program

* Lee C. Howley Sr. Prize for Arthritis Research
* In the Pipeline
email usprint this pageshare this pagerate this page
* Currently 0/5 Stars
* 1
* 2
* 3
* 4
* 5
Click to rate
Home > Research > Research Update > January/February 2009
Top 10 Arthritis Events of 2008
Each year the Arthritis Foundation highlights the top 10 most significant events
affecting the arthritis community. From achievements in public policy to new re
search findings, 2008 was a year marked by groundbreaking developments on both s
cientific and social fronts.
News that made the Arthritis Foundation’s Top 10 include reports on the ongoing se
verity of and risk for arthritis; the proof and promise of biologic medications
in treating several forms of arthritis; clues to better understanding arthritis
origins; and the growth of governmental support for programs designed to help p
eople with arthritis.
1. House Passes Landmark Arthritis Legislation
2. Early Aggressive Therapy Best for RA
3. Kinase Inhibitors Promising Treatment for RA
4. Arthritis Hampers Activity in Adults With Diabetes
5. Biologic Therapies Benefit Children With JA
6. Cardiovascular Risk High in Arthritis
7. State Arthritis Programs Enhanced
8. Immune System Ages Early in Arthritis
9. Gingivitis and RA Linked
10. Nearly Half of Americans Will Develop OA
Download the PDF of this issue.

1) HOUSE PASSES LANDMARK ARTHRITIS LEGISLATION

The U.S. House of Representatives passed the Arthritis Prevention, Control and C
ure Act (APCCA), the first comprehensive arthritis legislation in more than 30 y
ears. The legislation seeks to expand and strengthen research and public health
initiatives proven to combat the burden of arthritis and improve access to pedia
tric rheumatologists to address the country’s severe shortage of these critical he
alth professionals.
Although the bill never came to a vote in the Senate, the momentum behind the bi
ll is strong and optimism for congressional passage in 2009 is high.
The APCCA encompasses several initiatives that have the potential to greatly imp
rove the lives of people with arthritis. It’s written to:

Enhance public health activities related to arthritis. By fully implementing the

 Center for Disease Control and Prevention (CDC) National Arthritis Action Plan
(NAAP), several public health activities can be enacted.

Proposed endeavors include collecting prevalence/incidence data; conducting publ

ic health surveillance; identifying best practices for prevention, diagnosis, ma
nagement and care of arthritis; promoting community-based and patient self-manag
ement programs and activities; developing public information and education progr
ams; expanding physical activity programs; and informing the public about nutrit
ion education opportunities.

Expand and intensify research and public health activities related to juvenile a
rthritis. Grants and cooperative agreements will be made available to collect da
ta on the prevalence, incidence and outcomes associated with juvenile arthritis
at the CDC, including the development of a National Juvenile Arthritis Patient R
egistry.

Invest in tomorrow’s pediatric rheumatologists. To overcome the desperate shortage

of physicians who specialize in the treatment of children with arthritis and re
lated diseases, the Act provides for grants to institutions supporting pediatric
rheumatology and expands public-private partnerships to encourage pediatric rhe
umatology education and training. A loan repayment program would provide funds f
or professionals entering the field of pediatric rheumatology.
To receive updates on the Arthritis Foundation s advocacy efforts, visit www.art
hritis.org/advocacy and sign up to become an Arthritis Advocate.
Sources
2) EARLY, AGGRESSIVE THERAPY BEST FOR RA
Twenty years ago, doctors believed the best protocol for treating rheumatoid art
hritis (RA) was to start slow and build gradually until an adequate level of pai
n and inflammation control was reached. This way of thinking has changed over th
e years, and physicians now treat RA much more aggressively from the time of dia
gnosis. With the advent of new biologic medications, the treatment possibilities
for people with RA are many and their appropriate use is still being establishe
d.

Several key studies released data in 2008 provide physicians with more informati
on on which to base their treatment decisions. Two of note showed that tradition
al disease-modifying antirheumatic drugs (DMARDs) can be used with excellent eff
ect. Three others showed effective uses of adalimumab (Humira) in the treatment
of RA.

One study used traditional DMARDs, comparing a step-up approach to therapy (sulf
asalazine alone; then after 3 months, methotrexate was added; and when the maxim
um tolerated dosage of methotrexate was reached, hydroxychloroquine was added) a
gainst parallel triple therapy (giving the three drugs at the same time from the
beginning). The research team found that highly effective control of disease ac
tivity can be achieved using conventional DMARDs as part of an intensive disease
management strategy. In this study, step-up therapy was as effective as paralle
l triple therapy.
Another study found that people with RA who respond well to methotrexate therapy
– achieving a low disease activity score within four months – continue to have very
good clinical responses throughout the first year. An initial good response to
methotrexate defines a sub-population of people with early RA who can expect exc
ellent one-year clinical prognoses.

Now that the biologic adalimumab has been on the market for several years, long-
term study results are being released. Five-year results of the ongoing PREMIER
study were released at the American College of Rheumatology Annual Scientific Me
eting in October. This study compared the effectiveness of adalimumab in people
with early RA (less than 3 years’ duration) by comparing initial adalimumab plus m
ethotrexate therapy, adalimumab alone, or methotrexate alone for two years. Afte
r the first two years, participants were able to continue taking adlimumab eithe
r with methotrexate or not. After a total of five years, combination therapy led
to the best long-term inhibition of radiographic progression, best clinical rem
ission rates, and best reduction of inflammation as measured by C-reactive prote
in.

For more information on medications used to treat RA and other forms of arthriti
s, visit www.arthritistoday.org.
To order your free copy of the Arthritis Today Drug Guide or the Arthritis Found
ation’s DMARDs brochure, call 800-283-7800.
Sources

3) KINASE INHIBITORS PROMISING TREATMENT FOR RA

The treatment of rheumatoid arthritis (RA) has improved tremendously over the pa
st decade since the introduction of biologic agents. These agents, however, are
expensive to produce and must be administered via injection or intravenous infus
ion. In 2008, great strides have been made toward the development of a new type
of RA medication that can be taken by mouth. These drugs are called kinase inhib
itors and they interrupt the transfer of chemical signals involved in inflammati
on.

Spleen tyrosine kinase (Syk) is an important mediator of immune signaling in a v

ariety of cells, including mast cells, macrophages, neutrophils, and B cells. Re
sults of a clinical trial testing a Syk kinase inhibitor were released in Novemb
er in which researchers studied people with active RA who were already taking me
thotrexate. Participants received either the new drug at difference dosage amoun
ts or placebo. After 12 weeks of treatment, researchers found the two higher dos
ages tested were both effective; however, there were more adverse events with th
e highest dosage. The participants noted symptom relief in as little as one week
. There was also a significant decrease from baseline in biomarkers of disease a
ctivity. The research team concluded, “The rapid onset of effect, the improvement
in arthritis parameters and serum biomarkers show that inhibition of Syk kinase
is a viable new target for the treatment of rheumatoid arthritis.”

Jak-3 is a kinase involved in chemical signal transfer in B cells, T cells and n

atural killer cells – all of which are implicated in RA pathology. Early results o
f a clinical trial of a Jak-3 inhibitor were released in 2008. In this study, pe
ople with active RA who were receiving stable dosages of methotrexate but who di
d not get adequate relief from that drug were recruited. The participants receiv
ed one of six dose levels of an oral Jak-3 inhibitor or placebo. The research te
am determined that doses of the Jak-3 inhibitor at 3-mg twice daily and higher w
ere significantly more effective than placebo. Of participants in the 15-mg grou
p, and nearly 38 percent reached clinical remission, whereas only 9 percent in p
lacebo group got that result. Adverse events were dependent on the dosage taken.
The research team concluded that the oral Jak-3 inhibitor in combination with m
ethotrexate is efficacious, safe and well tolerated in patients with active rheu
matoid arthritis and is suitable for further evaluation in and expanded clinical
trial.
Sources
4) ARTHRITIS HAMPERS ACTIVITY IN ADULTS WITH DIABETES
An important study released by the Centers for Disease Control and Prevention (C
DC) in 2008 found more than half of adults with diagnosed diabetes also have art
hritis, a painful condition that can be a barrier to physical activity. Physical
activity is an important health strategy for managing both diabetes and arthrit
is, and lack of activity hinders successful management of these diseases.

The CDC analyzed data from the 2005 and 2007 Behavioral Risk Factor Surveillance
System (BRFSS), which is a state-based, telephone survey. The data found the pr
evalence of arthritis among adults with diabetes to be 52 percent, compared with
about 27 percent for all adults.

The prevalence of physical inactivity was significantly higher among adults with
both diabetes and arthritis (30 percent) compared with those with diabetes alon
e (21 percent), arthritis alone (17 percent) and among adults without arthritis
or diabetes (11 percent). A person with both arthritis and diabetes is 1.3 times
more likely to be physically inactive than a person with neither condition, eve
n after adjusting for age, sex and body mass index (BMI).

The study suggests adults with diabetes and arthritis have additional barriers t
o physical activity, such as concerns about pain, or aggravating and worsening a
rthritis condition, thereby limiting the ability to manage both conditions.
“Arthritis is a frequent comorbid condition for adults with diabetes,” said John H.
Klippel, M.D., president and CEO, Arthritis Foundation. “But for both diseases, ph
ysical activity is key to effective management. A lack of physical activity actu
ally results in undesirable consequences including increased pain, stiffness, in
flammation, physical limitation and potential disability.

The good news is that safe and effective self-management programs are available.
People living with arthritis and diabetes can benefit from participating in one
of the Arthritis Foundation’s exercise or self-management programs, such as the A
rthritis Foundation Aquatic Program, the Arthritis Foundation Exercise Program a
nd the Arthritis Foundation Self-Help Program,” said Dr. Klippel.

To learn about the Arthritis Foundation exercise and self-management programs av

ailable in your community, call 800-283-7800 or visit www.arthritis.org.
Sources

5) BIOLOGIC THERAPIES BENEFIT CHILDREN WITH JA

Up until 2008, the only biologic agent approved by the Food and Drug Administrat
ion for use in children with juvenile idiopathic arthritis (JIA; sometimes calle
d juvenile rheumatoid arthritis) was etanercept (Enbrel), which gained the OK fo
r use in children in 1999. But 2008 was a banner year for kids living with arthr
itis because two new biologic agents were approved for use in children.

On February 21, 2008, adalimumab (Humira) was approved by the FDA for reducing s
igns and symptoms of moderately to severely active polyarticular JIA in patients
four years of age and older. Then on April 8, 2008, abatacept (Orencia) was app
roved for use in patients six years and older.

Results of additional studies showing the safety and efficacy of biologic drugs
in children were released in 2008 as well. Two studies of particular relevance a
nd importance involved the two newly approved medications: adalimumab and abatac
ept. Both studies represent coordinated efforts by pediatric rheumatologists wor
ldwide and highlight the importance of professional cooperation when conducting
clinical trials in relatively rare diseases.

One study assessed the safety and efficacy of abatacept, a biologic drug that ac
ts on T cell activity, in children with active JIA who didn’t find relief from oth
er treatments. Of the participants who responded well to abatacept, half continu
ed to receive the biologic and half were unknowingly switched to placebo. The re
searchers then waited to see if the children would experience a disease flare. F
lares occurred in 53 percent of participants getting placebo and 20 percent of t
hose getting abatacept. On average, it took 6 months for those given placebo to
have a flare.

Another study was conducted to evaluate the efficacy and safety of adalimumab in
children with active JIA who had not responded adequately to treatment with non
steroidal anti-inflammatory drugs. The participants either had never been treate
d with methotrexate or had been treated but experienced adverse events or inadeq
uate response. All patients received adalimumab for 16 weeks and half also recei
ved methotrexate. After this portion of the study, half of the participants cont
inued to receive adalimumab, and half were unknowingly switched to a placebo. Th
e researchers then waited to see if the children would experience a disease flar
e, and how long it would take for that to occur.

After the initial phase of treatment, 94 percent of those children receiving bot
h adalimumab and methotrexate showed a significant improvement in disease signs
and symptoms. During the second phase of the study, disease flares occurred in 7
1 percent of those receiving just placebo, 65 percent of those receiving just me
thotrexate, 43 percent of those receiving just adalimumab, and 37 percent of tho
se receiving adalimumab plus methotrexate. Because disease flare was defined as
a relatively small degree of worsening, many patients met the criteria for a dis
ease flare while still showing substantial improvement compared with study entry
.

After the double-blind phase of the trial was complete, some participants contin
ued to receive adalimumab. Of those, after two years of treatment, 40 percent ha
d achieved 100 percent improvement in symptoms compared with when they first ent
ered the study.

For more information on juvenile arthritis, call 800-283-7800 to buy the Raising
a Child With Arthritis: A Parent’s Guide book or request a free copy of the Arthr
itis in Children brochure.
Sources

6) CARDIOVASCULAR RISK HIGH IN ARTHRITIS

Over recent years, evidence has shown that people with rheumatoid arthritis (RA)
are more likely to have cardiovascular disease (CVD) than the general population
, even after adjusting for traditional CVD risk factors, such as diabetes, high
cholesterol, smoking, high blood pressure and being overweight. An important stu
dy released in 2008 has now found that people with RA have as high or an even gr
eater risk of CVD than people with type 2 diabetes, a recognized risk factor.

In this study, the research team found the prevalence of CVD was 5 percent in in
dividuals without diabetes, 12.4 percent in people with type 2 diabetes, and 12.
9 percent in those with RA. After adjusting for age, sex and conventional cardio
vascular risk factors, the study found that a person with type 2 diabetes is twi
ce as likely to have CVD as a healthy individual, and the likelihood for a perso
n with RA to have CVD is 2.7 times that of a person without RA.

As we saw with Top 10 item number 4, diabetes and arthritis are involved in a fee
dback loop that leads to worsening of both diseases. If you add in heart disease
risk, the vicious cycle becomes even more serious. Arthritis pain prevents peop
le from getting the exercise they need, which can contribute to weight gain and
the development of type 2 diabetes. Both diabetes and rheumatoid arthritis incre
ase a person’s risk of CVD, as does obesity. Physical activity can break this cycl
e because it lessens your risk of disability due to arthritis, helps control wei
ght and reduces your risk of developing type 2 diabetes.

Another study released in 2008 looked at cardiac complications that occur after t
otal joint replacement. The researchers matched people who had had a joint replac
ement and suffered a cardiac complication with an equal number of people who had
had a joint replacement but no cardiac complication. Along with the typical fac
tors associated with a higher risk of cardiac complications (a history of irregu
lar heartbeat, coronary artery disease, heart attack, heart failure), the resear
ch team identified two new risk factors for cardiac complications following tota
l joint replacement: having two joints replaced at the same time, and having sur
gery on a joint that had already been replaced once.
These studies emphasize the importance for people with arthritis to be particula
rly diligent when it comes to caring for their heart and preventing cardiovascul
ar complications.
Sources

7) STATE ARTHRITIS PROGRAMS ENHANCED

The Centers for Disease Control and Prevention (CDC), guided by recommendations
in National Arthritis Action Plan: A Public Health Strategy, has been funding ar
thritis programs since 1999. In 2008, the state-based programs funded through th
e CDC entered into a new, enhanced phase.

In 2007, a panel of national experts reviewed the arthritis programs funded thro
ugh state health departments and made several important recommendations that led
to major changes in the program that took effect in 2008.

An important outcome was to strengthen programs by providing states with suffici

ent funds to extend effective, evidence-based interventions to reach more people
with arthritis. States will now use CDC funding to dramatically increase the av
ailability of interventions such as Arthritis Foundation exercise programs, stre
ngthen partnerships with Arthritis Foundation chapters and others, increase publ
ic awareness, and improve their ability to monitor the burden of arthritis and c
oordinate activities. The central aim is to improve the quality of life of peopl
e affected by arthritis.

As a result of increased investment in funded states, the CDC has funded 12 stat
es for the period of 2008-2011, with average funding levels of approximately $50
0,000. This funding level is now on par with other major chronic disease program
s.
With this enhanced program, states will increase awareness that something can be
done for arthritis and will help people strive toward a goal of a life free of
arthritis pain.

Goals of the CDC Arthritis Program

* Measure the burden of arthritis. Surveys are used to define the burden of
arthritis, monitor trends and assess how arthritis affects quality of life.
* Strengthen the science base. CDC conducts or supports research to define t
he impact of arthritis in the United States. It also supports research to both d
evelop and evaluate interventions to help people with arthritis improve their qu
ality of life.
* Increase awareness. Support two health communications campaigns which promo
te physical activity among people with arthritis: Physical Activity. The Arthrit
is Pain Reliever for English speaking audiences, and Buenos Días, Artritis for His
panic audiences.
* Build State Arthritis Programs. Support state health departments in effort
s to strengthen partnerships, increase public awareness, and expand the reach of
interventions that have been proven to improve the quality of life of people wi
th arthritis.
To learn more about the services the Arthritis Foundation offers near you, visit
www.arthritis.org and type in your zip code in the box provided.
Sources

8) IMMUNE SYSTEM AGES EARLY IN ARTHRITIS

Patients with autoimmune diseases such as rheumatoid arthritis (RA) have immune
system abnormalities that resemble characteristics of immune dysfunction typical
ly seen in the elderly. Studies released in 2008 reinforce and expand upon evide
nce previously released that people with autoimmune arthritis perhaps are biolog
ically older than their chronologic age would indicate.

With aging, the thymus gland shrinks and produces fewer and fewer new T cells – a
cell type intimately involved in the RA disease process. To compensate for this
reduction in new cells, existing T cells replicate and divide more frequently. E
very time a cell replicates, a buffering segment at the end of each DNA strand c
alled the telomere gets a bit shorter. Therefore, the biologic age of the immune
system can be estimated by the length of the T-cells’ telomeres.

One study released in 2008 dug deeper into this phenomenon to determine the root
of the premature aging. All immune cells ultimately come from bone marrow stem
cells. Because stem cells have the ability to repair their telomeres, they have
been considered to live forever; however, even in healthy individuals the stem c
ell reserve dwindles slowly as life progresses.

Researchers have now examined the biologic age and function of such bone marrow
stem cells in RA. In people with RA, bone marrow stem cells lose their telomeres
at a faster pace than in healthy individuals. Telomere sequences in 30-year-old
people with RA were already as short as those in the 60-year-old healthy contro
ls. This marked telomere shortening indicates the bone marrow cells were stresse
d in an attempt to keep up with high replication demands.

Thus, the researchers concluded that not only the immune cells but also the stem
cells from which they originate are aging before their time. Defective function
of bone marrow stem cells was independent of disease activity, suggesting bone
marrow failure as a potential factor in the development of RA.

With data accumulating that the immune system in adults with RA ages prematurely
, researchers released new data in 2008 showing similar premature aging in the i
mmune system cells of children with juvenile idiopathic arthritis (JIA).
The research team measured three indicators of immune cell aging. The scientists
found that children with JIA showed an accelerated loss of T cells with advanci
ng age. An accelerated decrease in the number of T cells in JIA patients may ref
lect loss of the ability of the thymus to produce new cells or the inability of
existing T cells to proliferate fast enough. Their findings indicate that the im
mune system of JIA patients is considerably older than their chronological age,
as is seen in RA patients.

These findings illustrate that premature aging of the immune system, and disturb
ed T cell numbers and functionality could be contributing to the immunologic abn
ormalities associated with autoimmunity and aging.
Sources

9) GINGIVITIS AND RA LINKED

Results of several studies released in 2008 have linked periodontal disease (als
o called gingivitis or gum disease) and rheumatoid arthritis (RA), revealing tha
t people with RA are much more likely to have gum disease than people without RA
.

One possible explanation for this co-occurrence is that pain and inflammation in
the hands makes brushing and flossing difficult, leading to poor oral hygiene.
However, the studies found that although oral hygiene was a factor, it did not f
ully explain the association between the two diseases. The results of these stud
ies suggest that other parameters – most likely factors related to chronic inflamm
ation – are responsible for the increased prevalence of gum disease in people with
RA.

One small study found that RA patients are nearly eight times more likely to hav
e periodontal disease compared to the control subjects. These findings accounted
for such demographic and lifestyle characteristics as age, sex, education and t
obacco use.

Other studies delved deeper into the association to look for disease and biochem
ical factors that could link the two conditions.

In a group of U.S. veterans with RA, scientists found that periodontal disease w
as more common and more severe in people with RA compared to people with osteoar
thritis (OA). The research team found no association between gum disease and RA
disease activity.

In research funded in part by grants from the Arthritis Foundation, another rese
arch team did find an association between periodontal disease symptoms and RA di
sease activity. This team, who reported findings in 2007 that periodontal diseas
e was frequent and severe in people with RA, evaluated oral health in a larger g
roup of people with RA. The overall prevalence of gum symptoms was 82 percent. A
nd after adjusting for confounding factors, RA disease activity was significantl
y associated with periodontal symptoms. This relationship was further amplified
with oral dryness, a common problem in RA patients.
Three research groups indicated that anti-cyclic citrullinated protein (anti-CCP
) antibodies may play a role in the overlap of these two diseases. Anti-CCP anti
bodies are specific for RA, and precede the onset of clinically detectable disea
se. Concentrations of these antibodies were higher in people with both RA and ev
idence of infection with the bacteria that causes gingivitis.
The finding of these various studies argue for greater attention to dental care
in people with rheumatoid arthritis.
Sources

10) NEARLY HALF OF AMERICANS WILL DEVELOP OA

A landmark government study released in 2008 suggests nearly one in two people (
45 percent) will develop painful knee osteoarthritis (OA) over their lifetime, w
ith the highest risk among those who are obese.

The study was conducted using data from the Johnston County Osteoarthritis Proje
ct, a long-term study of black and white women and men age 45 years or older liv
ing in rural North Carolina. It is one of the largest longitudinal studies to mo
nitor the onset and progression of knee and hip OA in this country.

Symptoms were determined through a question about each knee: “On MOST days do you
have pain, aching, or stiffness in your LEFT (or RIGHT) knee?” Radiographic knee O
A was determined by taking X-ray views of both knees, which were read by a radio
logist and scored using the Kellgren/Lawrence (K/L) scale. Symptomatic knee OA w
as defined as a K/L grade of ≥2 (at least mild radiographic OA) and symptoms in th
e same knee.

The study found that 60.5 percent of obese individuals – that is, those having a b
ody mass index (BMI) greater than 30 – will develop symptomatic knee OA over their
lifetime. The study also found that those with a prior knee injury were also at
high risk, with a probability of developing the disease over their lifetime of
57 percent.

“Weight loss can lead to a decreased risk of symptomatic knee OA, and the associat
ion between the modifiable risk factor, BMI, and lifetime risk of OA in this stu
dy further underscores the need for public health weight loss and management int
erventions that would contribute to a decreased lifetime risk of OA,” conclude the
study authors.

“While Americans are looking forward to longer life expectancies than ever before,
the reality is that they will also be facing many more years of pain and disabi
lity,” said John H. Klippel, M.D., president and CEO of the Arthritis Foundation. “O
besity in this country is at an all-time high, putting millions at risk for disa
bling arthritis. Coupled with sedentary lifestyles and an aging baby boomer popu
lation, we are facing a public health crisis if Americans and Congress don’t take
action.”
For more information on how you can make physical activity a part of your life,
visit www.letsmovetogether.org or call 800-283-7800 to order a copy of the Arthr
itis and Walking brochure or Arthritis Today Walking Guide.
Sources

How to Use Holistic Cures for Allergic Rhinitis

Contributor
By an eHow Contributing Writer
Article Rating: (1 Ratings)
* Email
* Facebook
* Twitter
* StumbleUpon
* Add to Favorites
* Print
* Share
I want to do this! What s This?
Allergic rhinitis, which is hay fever, occurs when a person breathes in somethin
g he or she is allergic to, and the inside of the person s nose becomes inflamed
or swollen. Some of the symptoms of allergic rhinitis are sneezing, a runny nos
e, a stuffy nose, and watery eyes.People can be allergic to a variety things. So
me have outdoor allergies and are allergic to grass, trees, and pollens. This is
often referred to as seasonal allergies. Other people are allergic to things in
side the house. These people could be allergic to dust mites, indoor mold, and h
ousehold pets.While taking antihistamines such as Claritin and Zyrtec can reliev
e symptoms, there are also some holistic cures and person can use.
Difficulty: Moderate
Instructions
Things You ll Need:
* Vitamins
* Herbs
* Garlic
* Honey
* Acupuncture practitioner
* Exercise
1.
Step 1
Take herbal or vitamin supplements. Vitamin C is a great vitamin to take t
o relieve symptoms to allergic reactions. A person can also take calcium, magnes
ium, and zinc. These vitamins can aid in helping the immune system to function.
Herbs that are good to use or feverfew, which is part of the sunflower family, a
nd Echinacea, which is effective against allergies.
2.
Step 2
Take apple cider vinegar. It is good for healing the body. The malic acid
in the apple cider vinegar gives the body energy to fight off disease. Apple cid
er vinegar can be taken at the first sign of an allergy symptom to stop the alle
rgic reaction from taking place. A person can mix apple cider vinegar with water
and drink the mixture with sips throughout the day or the person can drink the
mixture all at one time. Don t confuse apple cider vinegar with plain apple cide
r.
3.
Step 3
Get acupuncture. The small needles pressed into the body can increase ener
gy flow to organs and have a cleansing effect. The effect of acupuncture can be
immediate. It might be necessary to have consecutive acupuncture treatments unti
l the allergic reactions are permanently gone.
4.
Step 4
Get a massage. A massage can help clear mucus from a person s nose and thr
oat. Massage strokes should be made in the chest and throat area to relieve alle
rgic reactions. Massage oils, such as chamomile, can also be used to clear the a
ir of allergens.
5.
Step 5
Do yoga. It has been revealed that yoga reduces reactions to allergies. It
also drains mucus from a person s lungs and improves lung function and breathin
g. Actually, any type of daily exercise can improve lung function and breathing.

Read more: How to Use Holistic Cures for Allergic Rhinitis | eHow.com http://www
.ehow.com/how_2363846_use-holistic-cures-allergic-rhinitis.html#ixzz0vUcPIl00

Allergic Rhinitis and Its Causes

Edit Article | Posted: Dec 12, 2006 | Comments: 0 | Views: 556 | Share
Ads by Google
Dust Mite Allergy Control Continuous Air Treatment Units Attacks Allergen Bacter
ia Viruses
www.inov8.com
Sinus Wars - Sinus Relief For Natural, Fast-Acting, Holistic & Long Lasting Reli
ef
www.sinuswars.com
Syndicate this Article
Copy to clipboard
<h1>Allergic Rhinitis and Its Causes</h1> <p><strong>By: <a href="http://www.art
iclesbase.com/authors/alexander-chong/2746" title="Alexander Chong s Articles">A
lexander Chong</a></strong><p> <!--articlecontent--> <p><strong>About the Author
</strong></p> <p><p>Alexander Chong<br /> Author of "How to cure your incurable
nasal allergy without using any synthetic drugs, herbs and expensive devices".<b
r /> <a href="http://www.cure-nasal-allergy.com">http://www.cure-nasal-allergy.c
om</a></p></p><p class="tracker">(ArticlesBase SC #81280)</p> <p>Article Source:
<a href="http://www.articlesbase.com/">http://www.articlesbase.com/</a> - <a hr
ef="http://www.articlesbase.com/health-articles/allergic-rhinitis-and-its-causes
-81280.html" title="Allergic Rhinitis and Its Causes">Allergic Rhinitis and Its
Causes</a></p>
Allergic rhinitis is an atopic disease, which is inherited from the parent. If b
oth your parents have allergic rhinitis or other respiratory diseases such as as
thma, tuberculosis, and emphysema, the probability that you have these kinds of
respiratory diseases is 50%. If one of your parents has respiratory diseases, th
e probability that you inherit their diseases is 25%. If both of your parents do
 not have any respiratory diseases, your chances to have respiratory diseases ar
e no more than 12.5%. Sometimes, what has happened during pregnancy can cause al
lergic rhinitis to the newly born baby. The immunological status of the mother d
uring pregnancy may cause the newly born baby has allergic rhinitis. Pregnant mo
thers who are smoking, drinking coffee and alcohol usually have poor immunologic
al status, which can also cause newly born infant has allergic rhinitis or other
respiratory diseases. This is because all these acts can cause high IgE antibod
y level in umbilical blood. Apart that, using bottle-feeding to feed milk to inf
ant, early introduction of several kinds of food and early exposure to certain a
llergens and pollutants can cause nasal allergy to the newly born infant.

Allergic rhinitis symptoms change with age. At the earlier stage, children are m
ostly sensitive to seasonal allergens. After they have grown older, they usually
become sensitive to perennial allergens. Therefore, after they have got over th
e symptom that is caused by seasonal allergens, they may still keep on the sympt
oms due to the perennial allergens. When the children grow older, they may have
higher risk to have bronchial hyperreactivity and asthma. 17 to 19% of them will
have asthma after grow up. To protect them from getting asthma, perennial immun
otherapy should be used at the early stage. Moreover, the risk of getting asthma
does not depend to age when the allergic rhinitis started, family history of at
opic disease, sex, severity of symptoms at the starting period and treatment.
Allergic rhinitis started when the atopic individual meets the antigens that are
able to stimulate the IgE response. So, what are substances that can act as all
ergens? Allergens usually are airborne particles, which have molecular weight ra
nging from 30 to 40,000 daltons and also with diameter ranging from 2 to 60 µm. Mo
st of them have diameter more than 15 µm, which can deposit onto the nasal, pharyn
geal and ocular surface. Chemically, these particles are proteins, which link to
some small unit of carbohydrate. Particles that have these kinds of characters
are pollen, acarids, animal dandruff and fungi.

Pollens that are released from grams, weeds and trees during breeding season usu
ally cause seasonal allergic rhinitis. Only light pollens that can be pollinated
by wind can exist in air and cause a high natural exposure to the allergic rhin
itis patient. The seriousness depends to the concentration of the pollens in the
atmosphere. Individual with allergic rhinitis who lives in suburban area will b
e seriously affected by these seasonal pollens compared to the one who lives in
city. Surrounding temperature also gives an impact to the pollens concentration
in air. Usually, in warmer environment, plants release more pollens compared to
cold environment. Most of the plants breed in late spring and summer that is the
warmest season. Windy weather will cause the pollens scatter around in air and
this will cause the most exposure to the allergic rhinitis patient. The better d
ay is rainy day. Rain water can wash all the pollens in air and bring them down
to the ground. Surrounding air becomes fresher and cleaner after raining.

The main culprit of the perennial nasal allergy is house-dust mites. The acarids
that are commonly found in the house dust are Dermatophagoides pteronyssimus an
d farinae, Euroglyphus maynei and Blomia tropicalis. Substances that are directl
y responsible to the nasal allergy from these dust mites are their body and meta
bolic products. Usually, mites grow rapidly in damp and warm climate. Therefore,
sensitization to acarids depends to where you are actually living. Nasal allerg
y for patients who live in tropical and equatorial regions have higher possibili
ty causes by acarids because these regions climate is promote mites growth. Hous
e-dust mites grow at maximized concentration when surrounding humidity level is
between 70 to 80 % and with the presence of high temperature. Nasal allergy symp
toms will develop when the level of dust mite concentration reaches 2 µg/g in air.
Conversely, in high mountains with dry and cold climate have lowest level of du
st mites because this climate prevents the mite growth. Animals also are the oth
er source of aeroallergens. These aeroallergens are present in the animal’s saliva
, feces, urine and dandruff. Therefore, nasal allergy can be caused by domestic
animals such as cat and dog and also wild rats and mice.

Air pollutants enhance the sensitization of the nasal allergy by the allergens.
Air pollutants can be divided to two groups that are outdoor pollutants, which a
re released from industrial works, automobile exhaust and domestic heating, and
indoor pollutants such as tobacco smoke, furnishings, wood and coal burning and
heater. Chemically, air pollutants consist of oxides of nitrogen, sulfur dioxide
, ozone, carbon monoxide and black smoke. How actually air pollutants enhance se
nsitization of nasal allergy is not completely clear. This may be due to air pol
lutants easily irritate the respiratory mucosa and make it prone to allergic sen
sitization. Air pollutants have negative impact to the nasal epithelium and cili
ary beat, which are responsible to the clearance of allergens. Furthermore, some
pollutants can enhance the releasing of the mediators that induce inflammation
such as histamine, prostaglandins and leukotriene C-4.
Apart from that, some pollutants also can stimulate synthesis of the IgE antibod
y directly. When allergen binds two IgE molecules together on the mast and basop
hil cells surface, primary chemical mediator; histamine, will be released and it
will cause nasal allergy. Therefore, we can affirm that allergens can easily en
ter into our blood stream through our nasal mucosal membrane if we have chronic
inflammation, not enough IgA antibody, impaired ciliary beat and also with air p
ollutants around us. IgA antibody is very important to our body because it preve
nts allergens from penetrating through our nasal mucosal layer. Monounsaturated
oleic acids, which can be found in cold-pressed extra virgin olive and coconut o
il, hazelnut or filbert oil (or the whole nuts), green and ripe olives, and almo
nds can increase IgA antibody in our body. Besides oleic acids, vitamin A also c
an increase IgA antibody, which can be found in cod liver oil, pumpkin, cooked c
arrots, sweet potatoes/yams, squash and other yellow or orange vegetable.
References:
Passàli D, Mosges R. Consensus Conference of Allergic Rhinitis in Childhood. Aller
gy 1999;54 (Suppl 55):5–27.
Linna O, Kokkonen J, Lukin M. A 10-year prognosis for childhood allergic rhiniti
s. Acta Paediatr 1992;81:100–2.
Braham SS, Barrows AA, Decotiis BA, Settipane GA, Corrao WM. Airway hyperresonsi
veness in allergic rhinitis. A risk factor for asthma. Chest 1987;01:671–4.
Pedvis S, Fox ZR, Bacal HL. Long-term follow-up of ragweed hay fever in children
. Ann Allergy 1962;20:
569–77.
Ausdenmoore RW. Allergeni aerei e fattori ambientali. In Lawlor GJJr, Fisher TJ
editors. Manuale di Immunolgia
e allergologia. Milano, Libreria Editrice Internazionale, 1990:50–62.
Taudorf E, Moseholm L. Pollen count, symptom and medicine score in birch pollino
sis. A mathematical approach. Int Arch Allergy Appl Immunol 1988;86:225–33.
Krishna MT, Mudway IM, Kelly FJ, Frew AJ, Holgate ST. Ozone, airways and allergi
c airways disease. Clin Exp Allergy 1995;25:1150–8.
Konlee, Mark. “A Consumer s Guide to Immune Restoration: The Search for Th1 .” Posi
tive Health News. Report No. 18. Spring 1999.
Read more: http://www.articlesbase.com/health-articles/allergic-rhinitis-and-its
-causes-81280.html#ixzz0vUcgYovk
Under Creative Commons License: Attribution

Lupus
Publication Date: April 2009
Handout on Health: Systemic Lupus Erythematosus
This booklet is for people who have systemic lupus erythematosus, commonly calle
d SLE or lupus, as well as for their families and friends and others who want to
better understand the disease. The booklet describes the disease and its sympto
ms and contains information about diagnosis and treatment, as well as current re
search efforts supported by the National Institute of Arthritis and Musculoskele
tal and Skin Diseases (NIAMS) and other components of the U.S. Department of Hea
lth and Human Services’ National Institutes of Health (NIH). It also discusses iss
ues such as health care, pregnancy, and quality of life for people with lupus. I
f you have further questions after reading this booklet, you may wish to discuss
them with your doctor.
* Defining Lupus
* Understanding What Causes Lupus
* Symptoms of Lupus
* Diagnosing Lupus
* Treating Lupus
* Lupus and Quality of Life
* Pregnancy and Contraception for Women With Lupus
* Current Research
* Hope for the Future
* For More Information
Information Boxes
* Common Symptoms of Lupus
* Diagnostic Tools for Lupus
* Warning Signs of a Flare
* Preventing a Flare
* Tips for Working With Your Doctor
Defining Lupus
Lupus is one of many disorders of the immune system known as autoimmune diseases
. In autoimmune diseases, the immune system turns against parts of the body it i
s designed to protect. This leads to inflammation and damage to various body tis
sues. Lupus can affect many parts of the body, including the joints, skin, kidne
ys, heart, lungs, blood vessels, and brain. Although people with the disease may
have many different symptoms, some of the most common ones include extreme fati
gue, painful or swollen joints (arthritis), unexplained fever, skin rashes, and
kidney problems.
At present, there is no cure for lupus. However, lupus can be effectively treate
d with drugs, and most people with the disease can lead active, healthy lives. L
upus is characterized by periods of illness, called flares, and periods of welln
ess, or remission. Understanding how to prevent flares and how to treat them whe
n they do occur helps people with lupus maintain better health. Intense research
is underway, and scientists funded by NIH are continuing to make great strides
in understanding the disease, which may ultimately lead to a cure.
Two of the major questions researchers are studying are who gets lupus and why.
We know that many more women than men have lupus. Lupus is two to three times mo
re common in African American women than in Caucasian women and is also more com
mon in women of Hispanic, Asian, and Native American descent. African American a
nd Hispanic women are also more likely to have active disease and serious organ
system involvement. In addition, lupus can run in families, but the risk that a
child or a brother or sister of a patient will also have lupus is still quite lo
w. It is difficult to estimate how many people in the United States have the dis
ease, because its symptoms vary widely and its onset is often hard to pinpoint.
There are several kinds of lupus:
* Systemic lupus erythematosus (SLE) is the form of the disease that most pe
ople are referring to when they say “lupus.” The word “systemic” means the disease can a
ffect many parts of the body. The symptoms of SLE may be mild or serious. Althou
gh SLE usually first affects people between the ages of 15 and 45 years, it can
occur in childhood or later in life as well. This booklet focuses on SLE.
* Discoid lupus erythematosus is a chronic skin disorder in which a red, rai
sed rash appears on the face, scalp, or elsewhere. The raised areas may become t
hick and scaly and may cause scarring. The rash may last for days or years and m
ay recur. A small percentage of people with discoid lupus have or develop SLE la
ter.
* Subacute cutaneous lupus erythematosus refers to skin lesions that appear
on parts of the body exposed to sun. The lesions do not cause scarring.
* Drug-induced lupus is a form of lupus caused by medications. Many differen
t drugs can cause drug-induced lupus. They include some antiseizure medications,
high blood pressure medications, antibiotics and antifungals, thyroid medicatio
ns, and oral contraceptive pills. Symptoms are similar to those of SLE (arthriti
s, rash, fever, and chest pain), and they typically go away completely when the
drug is stopped. The kidneys and brain are rarely involved.
* Neonatal lupus is a rare disease that can occur in newborn babies of women
with SLE, Sjögren’s syndrome, or no disease at all. Scientists suspect that neonata
l lupus is caused in part by autoantibodies in the mother’s blood called anti-Ro (
SSA) and anti-La (SSB). Autoantibodies (“auto” means self) are blood proteins that a
ct against the body’s own parts. At birth, the babies have a skin rash, liver prob
lems, and low blood counts. These symptoms gradually go away over several months
. In rare instances, babies with neonatal lupus may have congenital heart block,
a serious heart problem in which the formation of fibrous tissue in the baby’s he
art interferes with the electrical impulses that affect heart rhythm. Neonatal l
upus is rare, and most infants of mothers with SLE are entirely healthy. All wom
en who are pregnant and known to have anti-Ro (SSA) or anti-La (SSB) antibodies
should be monitored by echocardiograms (a test that monitors the heart and surro
unding blood vessels) during the 16th and 30th weeks of pregnancy. It is importa
nt for women with SLE or other related autoimmune disorders to be under a doctor’s
care during pregnancy. Doctors can now identify mothers at highest risk for com
plications, allowing for prompt treatment of the infant at or before birth. SLE
can also flare during pregnancy, and prompt treatment can keep the mother health
ier longer.
Understanding What Causes Lupus
Lupus is a complex disease, and its cause is unknown. Scientists are making prog
ress in understanding lupus, as described here and in the “Current Research” section
of this booklet.
In studies of identical twins—who are born with the exact same genes—when one twin h
as lupus, the other twin has a 24-percent chance of developing it. This and othe
r research suggests that genetics plays an important role, but it also shows tha
t genes alone do not determine who gets lupus, and that other factors play a rol
e. Some of the factors scientists are studying include sunlight, stress, hormone
s, cigarette smoke, certain drugs, and infectious agents such as viruses. Recent
research has confirmed that one virus, Epstein-Barr virus (EBV), which causes m
ononucleosis, is a cause of lupus in genetically susceptible people.
Scientists believe there is no single gene that predisposes people to lupus. Rat
her, studies suggest that a number of different genes may be involved in determi
ning a person’s likelihood of developing the disease, which tissues and organs are
affected, and the severity of disease. Researchers have begun to make headway i
n identifying some of those genes, which could eventually lead to better ways to
treat and perhaps even prevent lupus.
In lupus, the body’s immune system does not work as it should. A healthy immune sy
stem produces proteins called antibodies and specific cells called lymphocytes t
hat help fight and destroy viruses, bacteria, and other foreign substances that
invade the body. In lupus, the immune system produces antibodies against the bod
y’s healthy cells and tissues. These antibodies, called autoantibodies, contribute
to the inflammation of various parts of the body and can cause damage to organs
and tissues. The most common type of autoantibody that develops in people with
lupus is called an antinuclear antibody (ANA) because it reacts with parts of th
e cell’s nucleus (command center). Doctors and scientists do not yet understand al
l of the factors that cause inflammation and tissue damage in lupus, and researc
hers are actively exploring them.
Common Symptoms of Lupus
* Painful or swollen joints and muscle pain
* Unexplained fever
* Red rashes, most commonly on the face
* Chest pain upon deep breathing
* Unusual loss of hair
* Pale or purple fingers or toes from cold or stress (Raynaud s phenomenon)
* Sensitivity to the sun
* Swelling (edema) in legs or around eyes
* Mouth ulcers
* Swollen glands
* Extreme fatigue
Symptoms of Lupus
Each person with lupus has slightly different symptoms that can range from mild
to severe and may come and go over time. However, some of the most common sympto
ms of lupus include painful or swollen joints (arthritis), unexplained fever, an
d extreme fatigue. A characteristic red skin rash—the so-called butterfly or malar
rash—may appear across the nose and cheeks. Rashes may also occur on the face and
ears, upper arms, shoulders, chest, and hands and other areas exposed to the su
n. Because many people with lupus are sensitive to sunlight (called photosensiti
vity), skin rashes often first develop or worsen after sun exposure.
Other symptoms of lupus include chest pain, hair loss, anemia (a decrease in red
blood cells), mouth ulcers, and pale or purple fingers and toes from cold and s
tress. Some people also experience headaches, dizziness, depression, confusion,
or seizures. New symptoms may continue to appear years after the initial diagnos
is, and different symptoms can occur at different times. In some people with lup
us, only one system of the body, such as the skin or joints, is affected. Other
people experience symptoms in many parts of their body. Just how seriously a bod
y system is affected varies from person to person. The following systems in the
body also can be affected by lupus.
* Kidneys: Inflammation of the kidneys (nephritis) can impair their ability
to get rid of waste products and other toxins from the body effectively. There i
s usually no pain associated with kidney involvement, although some patients may
notice dark urine and swelling around their eyes, legs, ankles, or fingers. Mos
t often, the only indication of kidney disease is an abnormal urine or blood tes
t. Because the kidneys are so important to overall health, lupus affecting the k
idneys generally requires intensive drug treatment to prevent permanent damage.
* Lungs: Some people with lupus develop pleuritis, an inflammation of the li
ning of the chest cavity that causes chest pain, particularly with breathing. Pa
tients with lupus also may get pneumonia.
* Central nervous system: In some patients, lupus affects the brain or centr
al nervous system. This can cause headaches, dizziness, depression, memory distu
rbances, vision problems, seizures, stroke, or changes in behavior.
* Blood vessels: Blood vessels may become inflamed (vasculitis), affecting t
he way blood circulates through the body. The inflammation may be mild and may n
ot require treatment or may be severe and require immediate attention. People wi
th lupus are also at increased risk for atherosclerosis (hardening of the arteri
es).
* Blood: People with lupus may develop anemia, leukopenia (a decreased numbe
r of white blood cells), or thrombocytopenia (a decrease in the number of platel
ets in the blood, which assist in clotting). People with lupus who have a type o
f autoantibody called antiphospholipid antibodies have an increased risk of bloo
d clots.
* Heart: In some people with lupus, inflammation can occur in the heart itse
lf (myocarditis and endocarditis) or the membrane that surrounds it (pericarditi
s), causing chest pains or other symptoms. Endocarditis can damage the heart val
ves, causing the valve surface to thicken and develop growths, which can cause h
eart murmurs. However, this usually doesn’t affect the valves’ function.
Diagnosing Lupus
Diagnosing lupus can be difficult. It may take months or even years for doctors
to piece together the symptoms to diagnose this complex disease accurately. Maki
ng a correct diagnosis of lupus requires knowledge and awareness on the part of
the doctor and good communication on the part of the patient. Giving the doctor
a complete, accurate medical history (for example, what health problems you have
had and for how long) is critical to the process of diagnosis. This information
, along with a physical examination and the results of laboratory tests, helps t
he doctor consider other diseases that may mimic lupus, or determine if you trul
y have the disease. Reaching a diagnosis may take time as new symptoms appear.
No single test can determine whether a person has lupus, but several laboratory
tests may help the doctor to confirm a diagnosis of lupus or rule out other caus
es for a person’s symptoms. The most useful tests identify certain autoantibodies
often present in the blood of people with lupus. For example, the antinuclear an
tibody (ANA) test is commonly used to look for autoantibodies that react against
components of the nucleus, or “command center,” of the body’s cells. Most people with
lupus test positive for ANA; however, there are a number of other causes of a p
ositive ANA besides lupus, including infections and other autoimmune diseases, a
nd occasionally it is found in healthy people. The ANA test simply provides anot
her clue for the doctor to consider in making a diagnosis. In addition, there ar
e blood tests for individual types of autoantibodies that are more specific to p
eople with lupus, although not all people with lupus test positive for these and
not all people with these antibodies have lupus. These antibodies include anti-
DNA, anti-Sm, anti-RNP, anti-Ro (SSA), and anti-La (SSB). The doctor may use the
se antibody tests to help make a diagnosis of lupus.
Some tests are used less frequently but may be helpful if the cause of a person’s
symptoms remains unclear. The doctor may order a biopsy of the skin or kidneys i
f those body systems are affected. Some doctors may order a test for anticardiol
ipin (or antiphospholipid) antibody. The presence of this antibody may indicate
increased risk for blood clotting and increased risk for miscarriage in pregnant
women with lupus. Again, all these tests merely serve as tools to give the doct
or clues and information in making a diagnosis. The doctor will look at the enti
re picture—medical history, symptoms, and test results—to determine if a person has
lupus.
Diagnostic Tools for Lupus
* Medical history
* Complete physical examination
* Laboratory tests:
o Complete blood count (CBC)
o Erythrocyte sedimentation rate (ESR)
o Urinalysis
o Blood chemistries
o Complement levels
o Antinuclear antibody test (ANA)
o Other autoantibody tests (anti-DNA, anti-Sm, anti-RNP, anti-Ro [SSA]
, anti La [SSB])
o Anticardiolipin antibody test
* Skin biopsy
* Kidney biopsy
Other laboratory tests are used to monitor the progress of the disease once it h
as been diagnosed. A complete blood count, urinalysis, blood chemistries, and th
e erythrocyte sedimentation rate test (a test to measure inflammation) can provi
de valuable information. Another common test measures the blood level of a group
of substances called complement, which help antibodies fight invaders. A low le
vel of complement could mean the substance is being used up because of an immune
response in the body, such as that which occurs during a flare of lupus.
X rays and other imaging tests can help doctors see the organs affected by SLE.
Treating Lupus
Diagnosing and treating lupus often require a team effort between the patient an
d several types of health care professionals. A person with lupus can go to his
or her family doctor or internist, or can visit a rheumatologist. A rheumatologi
st is a doctor who specializes in rheumatic diseases (arthritis and other inflam
matory disorders, often involving the immune system). Clinical immunologists (do
ctors specializing in immune system disorders) may also treat people with lupus.
As treatment progresses, other professionals often help. These may include nurs
es, psychologists, social workers, nephrologists (doctors who treat kidney disea
se), cardiologists (doctors specializing in the heart and blood vessels), hemato
logists (doctors specializing in blood disorders), enodocrinologists (doctors sp
ecializing in problems related to the glands and hormones), dermatologists (doct
ors who treat skin disease), and neurologists (doctors specializing in disorders
of the nervous system).
The range and effectiveness of treatments for lupus have increased dramatically
in recent decades, giving doctors more choices in how to manage the disease. It
is important for the patient to work closely with the doctor and take an active
role in managing the disease. Once lupus has been diagnosed, the doctor will dev
elop a treatment plan based on the patient’s age, sex, health, symptoms, and lifes
tyle. Treatment plans are tailored to the individual’s needs and may change over t
ime. In developing a treatment plan, the doctor has several goals: to prevent fl
ares, to treat them when they do occur, and to minimize organ damage and complic
ations. The doctor and patient should reevaluate the plan regularly to ensure it
is as effective as possible.
NSAIDs: For people with joint or chest pain or fever, drugs that decrease inflam
mation, called nonsteroidal anti-inflammatory drugs (NSAIDs), are often used. Al
though some NSAIDs, such as ibuprofen and naproxen, are available over the count
er, a doctor’s prescription is necessary for others. NSAIDs may be used alone or i
n combination with other types of drugs to control pain, swelling, and fever. Ev
en though some NSAIDs may be purchased without a prescription, it is important t
hat they be taken under a doctor’s direction. Common side effects of NSAIDs can in
clude stomach upset, heartburn, diarrhea, and fluid retention. Some people with
lupus also develop liver, kidney, or even neurological complications, making it
especially important to stay in close contact with the doctor while taking these
medications.
Antimalarials: Antimalarials are another type of drug commonly used to treat lup
us. These drugs were originally used to treat malaria, but doctors have found th
at they also are useful for lupus. A common antimalarial used to treat lupus is
hydroxychloroquine (Plaquenil1). It may be used alone or in combination with oth
er drugs and generally is used to treat fatigue, joint pain, skin rashes, and in
flammation of the lungs. Clinical studies have found that continuous treatment w
ith antimalarials may prevent flares from recurring. Side effects of antimalaria
ls can include stomach upset and, extremely rarely, damage to the retina of the
eye.
1Brand names included in this publication are provided as examples only, and the
ir inclusion does not mean that these products are endorsed by the National Inst
itutes of Health or any other Government agency. Also, if a particular brand nam
e is not mentioned, this does not mean or imply that the product is unsatisfacto
ry.
Corticosteroids: The mainstay of lupus treatment involves the use of corticoster
oid hormones, such as prednisone (Deltasone), hydrocortisone, methylprednisolone
(Medrol), and dexamethasone (Decadron, Hexadrol). Corticosteroids are related t
o cortisol, which is a natural anti-inflammatory hormone. They work by rapidly s
uppressing inflammation. Corticosteroids can be given by mouth, in creams applie
d to the skin, by injection or by intravenous (IV) infusion (dripping the drug i
nto the vein through a small tube). Because they are potent drugs, the doctor wi
ll seek the lowest dose with the greatest benefit. Short-term side effects of co
rticosteroids include swelling, increased appetite, and weight gain. These side
effects generally stop when the drug is stopped. It is dangerous to stop taking
corticosteroids suddenly, so it is very important that the doctor and patient wo
rk together in changing the corticosteroid dose. Sometimes doctors give very lar
ge amounts of corticosteroid by IV infusion over a brief period of time (days) (“b
olus” or “pulse” therapy). With this treatment, the typical side effects are less like
ly and slow withdrawal is unnecessary.
Long-term side effects of corticosteroids can include stretch marks on the skin,
weakened or damaged bones (osteoporosis and osteonecrosis), high blood pressure
, damage to the arteries, high blood sugar (diabetes), infections, and cataracts
. Typically, the higher the dose and the longer they are taken, the greater the
risk and severity of side effects. Researchers are working to develop ways to li
mit or offset the use of corticosteroids. For example, corticosteroids may be us
ed in combination with other, less potent drugs, or the doctor may try to slowly
decrease the dose once the disease is under control. People with lupus who are
using corticosteroids should talk to their doctors about taking supplemental cal
cium and vitamin D or other drugs to reduce the risk of osteoporosis (weakened,
fragile bones).
Immunosuppressives: For some patients whose kidneys or central nervous systems a
re affected by lupus, a type of drug called an immunosuppressive may be used. Im
munosuppressives, such as cyclophosphamide (Cytoxan) and mycophenolate mofetil (
CellCept), restrain the overactive immune system by blocking the production of i
mmune cells. These drugs may be given by mouth or by IV infusion. Side effects m
ay include nausea, vomiting, hair loss, bladder problems, decreased fertility, a
nd increased risk of cancer and infection. The risk for side effects increases w
ith the length of treatment. As with other treatments for lupus, there is a risk
of relapse after the immunosuppressives have been stopped.
Other therapies: In some patients, methotrexate (Folex, Mexate, Rheumatrex), a d
isease-modifying antirheumatic drug, may be used to help control the disease. Ot
her treatments may include hormonal therapies such as dehydroepiandrosterone (DH
EA) and intravenous immunoglobulin (proteins derived from human blood), which ma
y be useful for controlling lupus when other treatments haven’t worked.
Working closely with the doctor helps ensure that treatments for lupus are as su
ccessful as possible. Because some treatments may cause harmful side effects, it
is important to report any new symptoms to the doctor promptly. It is also impo
rtant not to stop or change treatments without talking to the doctor first. In a
ddition to medications for lupus itself, in many cases it may be necessary to ta
ke additional medications to treat problems related to lupus such as high choles
terol, high blood pressure, or infection.
Alternative and complementary therapies: Because of the nature and cost of the m
edications used to treat lupus and the potential for serious side effects, many
patients seek other ways of treating the disease. Some alternative approaches pe
ople have tried include special diets, nutritional supplements, fish oils, ointm
ents and creams, chiropractic treatment, and homeopathy. Although these methods
may not be harmful in and of themselves and may be associated with symptomatic o
r psychosocial benefit, no research to date shows that they affect the disease p
rocess or prevent organ damage. Some alternative or complementary approaches may
help the patient cope or reduce some of the stress associated with living with
a chronic illness. If the doctor feels the approach has value and will not be ha
rmful, it can be incorporated into the patient’s treatment plan. However, it is im
portant not to neglect regular health care or treatment of serious symptoms. An
open dialogue between the patient and doctor about the relative values of comple
mentary and alternative therapies allows the patient to make an informed choice
about treatment options.
Lupus and Quality of Life
A diagnosis of lupus can have a significant impact on quality of life, including
the ability to work. Recent research on work loss associated with lupus, funded
in part by NIAMS, estimated that almost three-quarters of the study’s 982 partici
pants would stop working before the usual age of retirement, and that half of th
ose who had jobs when they were diagnosed (during their mid-thirties, on average
) would no longer be working by the age of 50. The researchers determined that d
emographics and work characteristics (the physical and psychological demands of
jobs and the degree of control over assignments and work environment) had the mo
st impact on work loss.
Despite the symptoms of lupus and the potential side effects of treatment, peopl
e with lupus can maintain a high quality of life overall. One key to managing lu
pus is to understand the disease and its impact. Learning to recognize the warni
ng signs of a flare can help the patient take steps to ward it off or reduce its
intensity. Many people with lupus experience increased fatigue, pain, a rash, f
ever, abdominal discomfort, headache, or dizziness just before a flare. Developi
ng strategies to prevent flares can also be helpful, such as learning to recogni
ze your warning signals and maintaining good communication with your doctor.
It is also important for people with lupus to receive regular health care, inste
ad of seeking help only when symptoms worsen. Results from a medical exam and la
boratory work on a regular basis allows the doctor to note any changes and to id
entify and treat flares early. The treatment plan, which is tailored to the indi
vidual’s specific needs and circumstances, can be adjusted accordingly. If new sym
ptoms are identified early, treatments may be more effective. Other concerns als
o can be addressed at regular checkups. The doctor can provide guidance about su
ch issues as the use of sunscreens, stress reduction, and the importance of stru
ctured exercise and rest, as well as birth control and family planning. Because
people with lupus can be more susceptible to infections, the doctor may recommen
d yearly influenza vaccinations or pneumococcal vaccinations for some patients.
Women with lupus should receive regular preventive health care, such as gynecolo
gical and breast examinations. Men with lupus should have the prostate-specific
antigen (PSA) test. Both men and women need to have their blood pressure and cho
lesterol checked on a regular basis. If a person is taking corticosteroids or an
timalarial medications, an eye exam should be done at least yearly to screen for
and treat eye problems.
People with lupus should also be aware of their increased risk of premature card
iovascular disease. This makes healthy lifestyle choices such as eating well, ex
ercising regularly, and not smoking particularly important for people with lupus
.
Warning Signs of a Flare
* Increased fatigue
* Pain
* Rash
* Fever
* Abdominal discomfort
* Headache
* Dizziness
Preventing a Flare
* Learn to recognize your warning signals.
* Maintain good communication with your doctor.
Staying healthy requires extra effort and care for people with lupus, so it beco
mes especially important to develop strategies for maintaining wellness. Wellnes
s involves close attention to the body, mind, and spirit. One of the primary goa
ls of wellness for people with lupus is coping with the stress of having a chron
ic disorder. Effective stress management varies from person to person. Some appr
oaches that may help include exercise, relaxation techniques such as meditation,
and setting priorities for spending time and energy.
Developing and maintaining a good support system is also important. A support sy
stem may include family, friends, medical professionals, community organizations
, and support groups. Participating in a support group can provide emotional hel
p, boost self-esteem and morale, and help develop or improve coping skills. (For
more information on support groups, see the “For More Information” section at the e
nd of this booklet.)
Tips for Working With Your Doctor
* Seek a health care provider who is familiar with SLE and who will listen t
o and address your concerns.
* Provide complete, accurate medical information.
* Make a list of your questions and concerns in advance.
* Be honest and share your point of view with the health care provider.
 * Ask for clarification or further explanation if you need it.
* Talk to other members of the health care team, such as nurses, therapists,
or pharmacists.
* Do not hesitate to discuss sensitive subjects (for example, birth control,
intimacy) with your doctor.
* Discuss any treatment changes with your doctor before making them.
Learning more about lupus may also help. Studies have shown that patients who ar
e well-informed and participate actively in their own care experience less pain,
make fewer visits to the doctor, build self-confidence, and remain more active.
Pregnancy and Contraception for Women With Lupus
Although pregnancy in women with lupus is considered high risk, most women with
lupus carry their babies safely to the end of their pregnancy. Women with lupus
in general have a higher rate of miscarriage and premature births compared with
the general population. In addition, women who have antiphospholipid antibodies
are at a greater risk of miscarriage in the second trimester because of their in
creased risk of blood clotting in the placenta. Lupus patients with a history of
kidney disease have a higher risk of preeclampsia (hypertension with a buildup
of excess watery fluid in cells or tissues of the body). Pregnancy counseling an
d planning before pregnancy are important. Ideally, a woman should have no signs
or symptoms of lupus and be taking no medications for at least 6 months before
she becomes pregnant.
Some women may experience a mild to moderate flare during or after their pregnan
cy; others do not. Pregnant women with lupus, especially those taking corticoste
roids, also are more likely to develop high blood pressure, diabetes, hyperglyce
mia (high blood sugar), and kidney complications, so regular care and good nutri
tion during pregnancy are essential. It is also advisable to have access to a ne
onatal (newborn) intensive care unit at the time of delivery in case the baby re
quires special medical attention.
For women with lupus who do not wish to become pregnant or who are taking drugs
that could be harmful to an unborn baby, reliable birth control is important. Pr
eviously, oral contraceptives (birth control pills) were not an option for women
with lupus because doctors feared the hormones in the pill would cause a flare
of the disease. However, a large NIH-supported study called Safety of Estrogens
in Lupus Erythematosus National Assessment (SELENA) found that severe flares wer
e no more common among women with lupus taking oral contraceptives than those ta
king a placebo (inactive pill). As a result of this study, published in 2005, do
ctors are increasingly prescribing oral contraceptives to women with inactive or
stable disease.
Current Research
Lupus is the focus of intense research as scientists try to determine what cause
s the disease and how it can best be treated. Some of the questions they are wor
king to answer include: Why are women more likely than men to have the disease?
Why are there more cases of lupus in some racial and ethnic groups, and why are
cases in these groups often more severe? What goes wrong in the immune system an
d why? How can we correct the way the immune system functions once something goe
s wrong? What treatment approaches will work best to lessen lupus symptoms? How
do we cure lupus?
To help answer these questions, scientists are developing new and better ways to
study the disease. They are doing laboratory studies that compare various aspec
ts of the immune systems of people with lupus with those of other people both wi
th and without lupus. They also use mice with disorders resembling lupus to bett
er understand the abnormalities of the immune system that occur in lupus and to
identify possible new therapies.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS
), a component of the U.S. Department of Health and Human Services’ National Insti
tutes of Health (NIH), has a major focus on lupus research in its on-campus prog
ram in Bethesda, Maryland. By evaluating patients with lupus and their relatives
, researchers at NIH are learning more about how lupus develops and changes over
time.
NIAMS also funds many lupus researchers across the United States. To help scient
ists gain new knowledge, NIAMS also has established a Specialized Center of Rese
arch at the University of Virginia School of Medicine in Charlottesville devoted
specifically to lupus research. In addition, NIAMS is funding a Lupus Registry
and Repository that gathers medical information, as well as blood and tissue sam
ples from patients and their relatives. This gives researchers across the countr
y access to information and materials they can use to help identify genes that d
etermine susceptibility to the disease.
Another NIAMS-funded registry is collecting information and blood samples from c
hildren affected by neonatal lupus and their mothers. Information from the regis
try forms the basis of family counseling and tracks important data such as recur
rence rates in subsequent pregnancies. The hope is that the registry will facili
tate improved methods of diagnosis, as well as prevention and treatment for this
rare condition.
In 2003, NIH established the Lupus Federal Working Group (LFWG), a collaboration
among the NIH Institutes, other Federal agencies, voluntary and professional or
ganizations, and industries with an interest in lupus. The Working Group is led
by NIAMS and includes representatives from all relevant U.S. Department of Healt
h and Human Services (HHS) agencies and other Federal departments having an inte
rest in lupus.
Here are some recent major advances in different areas of lupus research:
Genetics
Identifying genes that play a role in the development of lupus or lupus severity
is an active area of research.
NIAMS intramural and extramural investigators have established that a variant in
a gene called STAT4, which is associated with lupus susceptibility, is more spe
cifically associated with disease characterized by severe symptoms such as disor
ders of the kidney. This finding may allow doctors to determine which patients a
re at risk of more severe disease and may lead to the development of new treatme
nt for patients at greatest risk of complications.
Scientists have also found a gene that may confer susceptibility to lupus. They
have shown that having an alternative form of the gene Ly108 may impair the body’s
ability to keep self-destructive B cells in check. This gene is part of a gene
family (SLAM) that has been linked to lupus-like disease in mice.
Biomarkers
Biomarkers are another significant area of lupus research. Biomarkers are define
d as molecules that reflect a specific biological or pathological process, conse
quence of a process, or a response to a therapeutic intervention. Simply put, th
ey can let the doctor know what is happening in the body—or predict what is going
to happen—based on something reliably measurable in tissues, cells, or fluids. NIA
MS-supported researchers have identified anti-double-stranded DNA antibodies and
complement C3a—both of which can be found in blood tests—as biomarkers for flares,
meaning they can predict that a flare will occur. They also showed that moderate
doses of prednisone can prevent flares in people having these biomarkers.
In separate research, NIAMS-supported investigators identified a list of protein
s in the urine of people with renal disease caused by lupus. These biomarkers ca
n be used to indicate the type and severity of renal disease in these patients,
as well as the extent of damage to the kidney. Such biomarkers could form the ba
sis of clinical tests to help doctors establish an effective treatment plan for
these patients without putting them through repeated kidney biopsies. Further st
udies are needed to determine whether urine protein analysis could replace the u
se of biopsies to assess kidney damage in lupus.
The Disease Process
One recent NIAMS-supported study found that the disease process of lupus—including
the development of certain autoantibodies and some symptoms of the disease—begin
before the disease is diagnosed. Because lupus is different in different people
and is characterized by autoimmunity in various systems of the body, the initial
presentation can be unpredictable. Many symptoms wax and wane over time, often
delaying diagnosis and the start of therapy.
Seeking to identify patterns among early clinical events in lupus, as well as to
assess whether the presence of lupus-associated autoantibodies precedes clinica
l manifestations, investigators looked back at the charts of 130 lupus patients,
analyzing 633 serum samples taken at different times and noting when the criter
ia for a lupus diagnosis were fulfilled. To be classified as having lupus, a per
son needs to meet at least 4 of 11 criteria. They found that in 80 percent of th
e patients, at least one clinical criterion for SLE appeared before SLE was diag
nosed. Eighty-four percent developed antinuclear antibodies (ANAs). Discoid rash
es and seizures were the earliest observed symptoms, with a mean onset of 1.74 y
ears and 1.70 years prior to diagnosis, respectively. Oral ulcers tended to appe
ar only after diagnosis, making this a less useful diagnostic tool. Among SLE pa
tients with renal disease, anti-double-stranded DNA antibodies appeared before o
r at the same time as American College of Rheumatology (ACR)-defined renal disor
der in the majority of patients who had both the autoantibodies and the renal di
sorder.
Researchers are also making strides in understanding how the disease process aff
ects different organs. One NIAMS investigator reported that a subset of antibodi
es to DNA can be found in the blood and the brain of lupus patients with cogniti
ve problems. These anti-DNA antibodies bind to specific receptors (NMDA [N-methy
l-d-aspartate] receptors) on nerve cells in the brain. In the culture dish, bind
ing of these anti-DNA antibodies to nerve cells results in the death of the cell
s. In subsequent studies involving mice, the researchers found that these antibo
dies affect the nervous system only when the blood-brain barrier was broken, all
owing the antibodies access to the brain. Where the blood-brain barrier was brok
en, antibodies bound to the neurons in a specific area of the brain that helps r
egulate emotion and memory. Tests for cell death in that area of the brain were
positive. Behavioral tests on the mice also revealed impaired cognitive function
and memory. Perhaps more important was the finding that the nerve cell binding
and its damage could be prevented with a drug that inhibits the NMDA receptor. R
esearchers say the findings suggest that such drugs may eventually be a useful t
herapy for people with lupus.
Treatment
Understandably, identifying and developing better treatments for lupus—and ensurin
g that patients receive the best treatments—are among the primary goals of lupus r
esearch. A 2005 study of 17 adults with lupus that was clinically active despite
treatment, found that just one injection of the cancer drug rituximab (Rituxan)
eased symptoms for up to a year or more. Several participants were able to redu
ce or completely stop their regular lupus medications. Rituximab works by loweri
ng the number of B cells—white blood cells that produce antibodies—in the body. It i
s approved by the U.S. Food and Drug Administration (FDA) for a type of cancer c
alled lymphoma, as well as for rheumatoid arthritis. Further research is needed
to better understand its effectiveness and safety and to better determine its ro
le in lupus treatment.
Other research is examining barriers that keep certain populations from complyin
g with their prescribed medical treatment, which could contribute to worse disea
se outcomes, including disability and death in those populations. One NIAMS-supp
orted study of economically disadvantaged and ethnically diverse people with rhe
umatoid arthritis or lupus identified fear of side effects, including long-term
damage, as a major reason people failed to take prescribed medications for their
disease. Other factors identified included belief that medicines are not workin
g, problems with health system such as navigating Medicaid requirements and a la
ck of continuity with the same doctor, and medication cost.