1. L UPUS Autoimmune Disorder

2. H ISTORY Classical Middle Ages 12 th century physician Rogerius Neoclassical Moric Kaposi Modern 1948 discovery of the LP cell

3. H ISTORY CONT. First Medications 1894 Quinine Salicylates Corticosteroids Too much or too little?

4. E VEN M ORE H ISTORY Origins Lupus is Latin for wolf ‘erythro’ is Greek for red 1. Rash resembles the pattern of fur on a wolfs face. 2. Rash creates lesions that resembled wolf bites or scratches 3. French women wearing masks 4. Repeated attacks like those of a predator.

5. N OTABLE P ATIENTS Ray WalstonRay Walston, character actor Tim RainesTim Raines, former major league baseball player, primarily with the Montreal Expos and Chicago White SoxMontreal ExposChicago White Sox Ferdinand MarcosFerdinand Marcos, former Philippine president, who died from complications of lupus in 1989 Michael JacksonMichael Jackson, pop superstar, was diagnosed with the disease in 1984 Flannery O'ConnorFlannery O'Connor, American fiction writer who died of the disease in 1964 Hugh GaitskellHugh Gaitskell, British politician J DillaJ Dilla (also known as Jay Dee, born James Dewitt Yancey), a hip-hop producer and beatmaker who died of the disease in 2006Jay Dee Elaine PaigeElaine Paige, British actress and singer SealSeal (born Seal Henry Olusegun Olumide Adelo Samuel), British artist/singer Charles KuraltCharles Kuralt, former anchor of CBS Sunday Morning CBS Sunday Morning Inday BaInday Ba (also known as N'Deaye Ba), a Swedish-born actress who died from complications of lupus at age 32 Caroline Dorough-Cochran, sister of Howie D. of the Backstreet Boys, who founded the Dorough Lupus Foundation in her memoryHowie D.Backstreet Boys Stephanie SmithStephanie Smith, artist who died of SLE complication in 1969 at the age of 22. The anti-smith (or anti-Sm) antigen was discovered in her, and is the basis of a SLE diagnostic test. Yonna, contestant on Ben Fogle's Extreme Dreams. Louisa May AlcottLouisa May Alcott, American author Sophie HowardSophie Howard, British glamour model Donald ByrneDonald Byrne, American chess player who died from complications of lupus in 1976chess Mercedes Scelba - ShorteMercedes Scelba - Shorte, America's Next Top Model season 2 runner up America's Next Top Model Mary Elizabeth McDonoughMary Elizabeth McDonough, American actress. Reportedly contracted it after undergoing silicone implantation in her breasts in 1984 Leslie Hunt, semifinalist on American Idol, 19th place American Idol

6. L UPUS IS … Autoimmune disorder Autoantibodies cause inflammation to various body parts as well as damaging organs and tissues Most common is antinuclear antibodies (ANA) and these antibodies attack a cells DNA Most Lupus carriers will test positive for ANA but so will sick people, other autoimmune disorders, and sometimes perfectly healthy people as well

7. T YPES OF L UPUS Systemic lupus erythematosus Any part of body Lupus in general normally refers to this Discoid lupus erythematosus Only the skin Rash on the face, neck and scalp

8. T YPES OF L UPUS Drug-induced lupus erythematosus Caused by prescription medications S/Sx go away once you stop taking the medication Neonatal lupus The mother is a carrier that normally isn't showing any signs of Lupus. The baby develops a rash on the face that normally disappears within 6 months to never come back.

9. S IGNS AND S YMPTOMS Lupus come in two stages a Flare and a Remission Flare – where the symptoms present Painful or swollen joints or muscles Unexplained fever Red rashes most commonly on the face Chest pain when breathing in deeply Loss of hair Purple fingers or toes Sensitivity to the sun Edema in the legs Ulcers in the mouth Swollen glands Extreme fatigue Remission During this time the symptoms of Lupus are hidden

10. C AUSES OF L UPUS Environment vs. Genetics Environment Sunlight UV radiation damages the skin causing a flare Medications Chlorpromazine – antipsychotic HTN – hydralazine TB drug – isoniazid Heart med – procainamide Infection Epstein-Barr virus

11. C AUSES OF L UPUS CONT. Genetics Lupus seems to run in families but also appears in families with no history. Chromosome 6 More research is being done Inherited predisposition for Lupus

12. R ISK F ACTORS Sex 3x more likely in women Age 15 to 45 years old Race 3x more likely in African Americans More common in women of Hispanic, Asian, and Native American decent Sunlight Trigger a response in those that are susceptible Medications Overweight Smoking

13. D IAGNOSING L UPUS American College of Rheumatology Must meet 4 of these 11 criteria and you probably have Lupus Face rash, covers bridge of nose and spreads across the cheeks Scaly rash, which appears as raised scaly patches Sun related rash Mouth sores Joint pain and swelling in two or more joints Swelling of the lining of the heart and lungs Kidney disease Low blood counts Positive anti-nuclear antibody tests Other tests that indicate an autoimmune disease

14. M ORE D IAGNOSTIC S TUFF Lab Tests Complete blood count Erythrocyte sedimentation rate Kidney and liver assessment Urinalysis Antinuclear antibody test Chest x-ray Electrocardiogram Syphilis test A very long and drawn out process normally taking 1-3 years.

15. T REATMENT NSAIDs Ibuprofen (Advil) Aspirin Some NSAIDs have been know to cause severe stomach bleeding as well as increased rash of heart problems. Antimalarial drugs There isn't any know connection between Lupus and Malaria but the drugs used to treat Malaria work very well. Also shown to prevent flares. Side effects include vision problems and muscle weakness. Corticosteroids Counter the inflammation Side effects include weight gain, easy bruising, thinning bones, HTN, diabetes and increased risk of infection Take calcium and vitamin D to reduce osteoporosis

16. P REVENTION OF F LARES Rest Be sun smart Exercise Don’t smoke Diet Watch for warning signs of a flare Increased fatigue Pain Rash Fever Abdominal discomfort Headache Dizziness

17. P REGNANCY Can have severe flares during pregnancy Echocardiograms during the 16 th and 30 th week should be done to insure a healthy heart and surrounding vessels Higher rate of miscarriage and premature births Those with kidney problems have a high risk of developing preeclampsia Ideally a woman should be without signs and symptoms of lupus or taking medications for at least 6 months before pregnancy

18. R ESEARCH Stem cell transplants Building an entirely new immune system Dehydroepiandrosterone (DHEA) Hormone therapy Rituximab Decreases number of B cells in the body

19. F URTHER I NFORMATION Alliance for Lupus Reasearch www.lupusresearch.org American College of Rheumatology www.rheumatology.org National Institute of Arthritis and Musculoskeletal and Skin Disease www.niams.nih.gov

20. W ORKS C ITED `Bledsoe, Bryan, and Robert Porter. Paramedic Care Principles and Practice. 2nd ed. Upper Saddle River: Pearson Prentice Hall, 2005. McCance, Kathryn, and Sue Huether. Pathophysiology The Biologic Basis for Disease in Adults and Children. 5th ed. St. Louis: Elsevier Mosby, 2006. Venes (editor), Donald. "Lupus."Taber's Cyclopedic Medical Distionary. 20th ed. 2001. Beers (Editor), Mark H.. "Systemic Lupus Erythematosus."The Merck Manual of Diagnosis and Therapy. 18th ed. 2006. "Handout on Health: Systemic Lupus Erythematosus." National Insititute of Arthritis and Musculoskeletal and Skin Diseases. August 2003. NIAMS. 27 May 2008. "Lupus." Bones, Joints, and Muscles. October 2007. Mayo Clinic. 27 May 2008. "Systemic lupus erythematosus." Wikipedia, The Free Encyclopedia. 26 May 2008, 20:29 UTC. Wikimedia Foundation, Inc. 27 May 2008.http://en.wikipedia.org/w/index.php?title=Systemic_lupus_erythematosus&oldid=215123079>.