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System lupus erythematosus
System lupus erythematosus — the general autoimmune disease affecting vessels and connecting fabric. If at an organism normality the immune system of the person produces antibodies which have to attack the alien organisms getting to an organism, then at a system lupus in a human body a large number of antibodies to organism cells, and also to their components is formed. As a result, immunocomplex inflammatory process which development leads to defeat of a number of systems and bodies is shown. At development of a lupus heart, skin, kidneys, lungs, joints, and also a nervous system is affected.
At defeat only of integuments the diskoidny lupus is diagnosed. The skin lupus erythematosus is expressed by strong indications which are accurately visible even on a photo. If the disease affects internals of people, then in this case diagnosis demonstrates that at the person the system lupus erythematosus is shown. According to data of medical statistics, symptoms of a lupus erythematosus of both types (both system, and diskoidny forms) are about eight times more often noted at women. At the same time the illness a lupus erythematosus can be shown both at children, and at adults, but nevertheless most often the illness affects people at working-age — between 20 and 45 years.
Still accurately the reasons which cause this disease are not defined. Doctors are inclined to versions that a certain value in this case has a hereditary factor, impact on a human body of viruses, some medicines, and also ultraviolet radiation. Many patients with this illness in the past suffered from allergic reactions to food or medicines. If the person has relatives who were ill a lupus erythematosus, then the probability of an illness sharply increases. Being interested whether the lupus is infectious, it is necessary to consider that it is impossible to catch an illness, but it is inherited on recessive type, that is through several generations. Therefore treatment of a lupus has to be carried out taking into account influence of all specified factors.
Tens of drugs can provoke development of a lupus, however the illness is shown approximately in 90% of cases after treatment gidralaziny, quinine and procaineamide, Phenytoinum, an isoniazid, d-penitsillinaminom. But after the termination of reception of such means the disease passes independently.
The course of a disease at women considerably worsens in days monthly, besides the lupus can be shown owing to pregnancy, childbirth. Therefore, specialists define influence of female sex hormones on emergence of a lupus.
The tubercular lupus is a kind of display of a tuberculosis cutis, its manifestation is provoked by a tuberculosis mycobacterium.
If at the patient the diskoidny lupus develops, then initially on skin there is rash of red color which does not cause in the person of an itch and pain. Seldom diskoidny lupus, at which takes place, the isolated defeat of integuments passes into a system lupus at which internals of the person are already surprised.
The symptoms which are shown at a system lupus erythematosus can have various combinations. Muscles, joints can hurt it, in a mouth ulcers develop. Also rash on a face (on a nose and cheeks) which has the form of a butterfly is characteristic of a system lupus. Skin becomes especially sensitive to influence of light. Under the influence of cold the blood stream in fingers of extremities (Reynaud's syndrome) is broken.
Rash on a face is shown approximately at a half of patients with a lupus. Characteristic rash in the form of a butterfly can become aggravated if it is influenced by a direct sunlight.
Most of patients in development of hard currency note arthritis symptoms. In this case at arthritis pain, hypostases, feeling of constraint in joints of feet and brushes, their deformation is shown. Sometimes joints at a lupus are surprised as and at a pseudorheumatism.
Also the vasculitis (inflammatory process of blood vessels) can be shown that leads to disturbance of blood supply of fabrics and bodies. Sometimes the pericardis (a heart cover inflammation) and pleurisy (an inflammation of a cover of lungs) develops. At the same time the patient notes emergence in a breast of severe pain which becomes more expressed when the person changes position of a body or inhales deeply. Sometimes at hard currency muscles and valves of heart are surprised.
Development of a disease can affect over time kidneys which damage at hard currency is called lupoid nephrite. Increase of pressure, emergence of protein in urine is characteristic of this state. As a result, the renal failure at which to the person the dialysis or a renal transplantation is vital can develop. Kidneys are surprised approximately at a half of patients with a system lupus erythematosus. At damage of a digestive tract the dispepsichesky phenomena are observed, in more exceptional cases of the patient periodic attacks of an abdominal pain disturb.
In pathological processes at a lupus it can be involved and the brain (tserebrit) that leads to psychoses, change of the personality, display of spasms, and in hard cases – to a coma. After involvement of a peripheral nervous system functions of some nerves are lost that leads to an anesthesia and to weakness of certain groups of muscles. Peripheral lymph nodes at most of patients are a little increased and painful at a palpation.
Alopecia (hair loss) — also characteristic phenomenon when progressing hard currency. Besides, fragility of nails, display of decubituses is noted.
Most often the patient states also the general complaints, noting small displays of fever, the general weakness, appetite loss. Fever shows resistance to influence of streptocides and antibiotics, however sensitivity to glucocorticoids is noted.
Considering features of a clinical course of a disease, three options of an illness are allocated: acute, subacute and chronic forms.
At acute hard currency continuous recurrent disease is noted. Numerous symptoms are shown early and actively, resistance to therapy is noted. The patient dies for two years after an onset of the illness. Most often the subacute hard currency when symptoms accrue rather slowly meets, but at the same time they progress. The person with this form of a disease lives longer, than at acute hard currency.
The chronic form is a high-quality option of an illness which can proceed many years. At the same time by means of periodic therapy it is possible to achieve long remissions. Most often at this form skin, and also joints is surprised.
Depending on activity of process three different degrees are allocated. At the minimum activity of pathological process at the patient insignificant reduction of weight, normal body temperature is noted, on integuments there is a diskoidny defeat, the joint syndrome, chronic nephrite, a polyneuritis is noted.
At average activity body temperature does not exceed 38 degrees, body weight is moderately lost, on skin there is an exudative erythema, also the pericardis dry, subacute polyarthritis, a chronic pneumonitis is noted, diffusion gomerulonefrit, entsefalonevrit.
At the maximum activity of hard currency body temperature can exceed a mark 38, the person strongly loses flesh, face skin is surprised in the form of "butterfly", polyarthritis, a pulmonary vasculitis, a nephrotic syndrome is noted, entsefalomiyeloradikulonevrit.
At a system lupus erythematosus there are lupoid crises which consist in the highest activity of manifestation of lupoid process. Crises are characteristic of any disease, at their manifestation laboratory indicators considerably change, all-trophic disturbances, activation of symptoms are swept aside.
This kind of a lupus is one of tuberculosis cutis forms. Its activator — a tuberculosis mycobacterium. At this disease integuments of the person generally are surprised. Sometimes defeat extends to skin of an upper lip, mucous a mouth.
Initially the patient has a specific tubercular hillock, reddish or yellow-red, having in the diameter of 1-3 mm. Such hillocks are located on the affected skin groups, and after their destruction there are ulcers with edematous edges. Later defeat affects a mucous membrane of a mouth, the bone tissue in interdental partitions collapses. As a result, teeth are loosened and drop out. Lips at the patient swell, becomes covered by bloody and purulent crusts, on them cracks appear. There are dense regional lymph nodes. Often the centers of a lupus can be complicated by accession of consecutive infection. Approximately in 10% of cases lupoid ulcers ozlokachestvlyatsya.
In the course of diagnosis the diaskopiya is used and research is conducted by a probe.
For treatment medicamentous drugs, and also high doses of D2 vitamin are used. Sometimes X-irradiation, phototherapy practices. Removal of tuberculous focuses is in certain cases reasonable in the operational way.
Considering the fact that at patients with a lupus very wide range of symptoms is observed, special criteria which are used in the course of diagnosis are developed. In the presence of four and more symptoms from eleven listed it is possible to speak about the probable diagnosis "lupus erythematosus".
The following symptoms are estimated: rash on face skin in the form of "butterfly"; diskoidny rash (red sites of skin where hems can appear later); a high photosensitivity (rash after stay on the sun); ulcers on mucous a nose, a mouth, a throat; damage of kidneys; arthritis; pleurisy/pericardis; damage of a brain; change of laboratory indicators (decrease in quantity of leukocytes of erythrocytes, thrombocytes in blood, existence of specific antibodies, false positive reaction to syphilis).
Also results of biochemical analyses, biopsies of fabrics undertake in attention.
Unfortunately, full treatment of a lupus is impossible. Therefore therapy is selected so that to reduce manifestations of symptoms, to suspend inflammatory, and also autoimmune processes.
By means of non-steroidal anti-inflammatory drugs it is possible to reduce inflammatory process, and also to reduce pain. However drugs from this group at long reception can cause irritation mucous a stomach, and, as a result, gastritis and an ulcer. Besides, it reduce coagulability of blood.
More expressed antiinflammatory effect drugs - corticosteroids have. However their long use in high doses also provokes serious side reactions. At the patient diabetes, osteoporosis, obesity can develop, there are cataracts, the necrosis of large joints, the increased arterial pressure is noted.
High performance of influence at sick hard currencies with defeat of integuments and weakness drug Hydroxychloroquinum (Plaquenil) possesses.
Complex treatment also includes drugs which suppress activity of immune system of the person. Such means are effective at a severe form of an illness when the expressed damage of internals develops. But reception of these means conducts to anemia, a susceptibility to infections, and also to bleeding. Some of such drugs harmful influence a liver, kidneys. Therefore means immunosuppressors can be used only under careful control of the rheumatologist.
In general treatment of hard currency has to pursue several aims. First of all, it is important to suspend the autoimmune conflict in an organism, to recover normal function of adrenal glands. Besides, it is necessary to carry out impact on the think-tank for the purpose of an equilibration of a sympathetic and parasympathetic nervous system.
Treatment of a disease is carried out by courses: on average it is required of six months of continuous therapy. Its duration depends on the activity of an illness, its duration, weight, from quantity involved in pathological process of bodies and fabrics.
If at the patient the nephrotic syndrome develops, then treatment will be longer, and recovery – more difficult. The result of treatment depends also on that how the patient is ready to implement all recommendations of the doctor and to assist it in treatment.
The hard currency is a heavy illness which results in disability and even to death of the person. But nevertheless the people who are ill a lupus erythematosus can conduct normal life, especially during remissions. Sick hard currencies have to avoid those factors which can negatively influence disease, aggravating it. They cannot be on the sun a long time, it is worth wearing clothes with long sleeves in the flying and to apply sun-protection creams.
It is necessary to take all medicine which was appointed by the doctor and not to allow sharp cancellation of corticosteroids as similar actions can conduct to a serious exacerbation of an illness. Patients whose treatment is conducted with use of the corticosteroids or means suppressing immunity are more susceptible to an infection. Therefore, he has to report about increase of temperature to the doctor at once. Besides, the specialist has to conduct continuous supervision of the patient and know about all changes in his state.
Pregnant women with a system lupus erythematosus enter category of an extra risk. Throughout the period of incubation of the child not only the gynecologist, but also the rheumatologist has to watch the woman. Such women have a high risk of abortion, tendency to fibrinferments. Often pregnant with hard currency appoint aspirin for the purpose of blood fluidifying, and also immunoglobulin.
Antibodies of a lupus can be transferred from mother to the newborn, as a result, the so-called "lupus of newborns" is shown. At the baby rash on skin is shown, in blood the level of erythrocytes, leukocytes, thrombocytes decreases. The child can sometimes have a heart block. As a rule, to six-months age of the kid the lupus of newborns recovers as maternal antibodies collapse.