Tuesday, January 22, 2008

Diagnosing Lupus

Lupus is chronic, complex, and difficult to diagnose. No single lab test can tell if you have lupus. Many lupus symptoms imitate symptoms of other diseases and often come and go. Your primary care doctor or rheumatologist will use your medical history, a physical exam, and many routine as well as special tests to rule out other diseases.
Many physicians also use the American College of Rheumatology's "Eleven Criteria of Lupus" to aid in the diagnosis of lupus. The criteria include symptoms as well as specific laboratory findings that provide information about the functioning of a person's immune system. In most cases, the diagnosis of lupus is made when four or more of the criteria have occurred at some time.

The "Eleven Criteria"

  1. Malar rash: butterfly-shaped rash across cheeks and nose

  2. Discoid (skin) rash: raised red patches

  3. Photosensitivity: skin rash as result of unusual reaction to sunlight

  4. Mouth or nose ulcers: usually painless

  5. Nonerosive Arthritis (bones around joints do not get destroyed): in 2 or more joints with tenderness, swelling, or effusion

  6. Cardio-pulmonary involvement: inflammation of the lining around the heart (pericarditis) and/or lungs (pleuritis)

  7. Neurologic disorder: seizures and/or psychosis

  8. Renal (kidney) disorder: excessive protein in the urine, or cellular casts in the urine

  9. Hematologic (blood) disorder: hemolytic anemia, low white blood cell count, or low platelet count

  10. Immunologic disorder: antibodies to double stranded DNA, antibodies to Sm, or antibodies to cardiolipin

  11. Antinuclear antibodies (ANA): positive test in absence of drugs known to induce it

A Positive ANA Test: Should You Worry?

If you have positive antinuclear antibody (ANA) test, it does not automatically mean you have lupus. Your immune system is your body's natural defense against disease. A positive ANA blood test shows that your immune system is making an antibody (protein) that reacts with components of your body's cells. This is called autoimmunity and may or may not be harmful to your body.
While a positive ANA may be associated with an autoimmune illness like lupus, it does not mean you have the disease. Approximately 20% of the normal population will have a positive ANA test; positive tests are also seen in other conditions, such as thyroid disease, certain liver conditions, and other autoimmune diseases.
Before making a diagnosis, your doctor should be able to find objective physical or laboratory evidence of the condition, such as swelling of your joints, protein in your urine, fluid around your lungs or heart, or a positive skin biopsy.

If You Are Diagosed With Lupus

For many lupus patients, following their doctors' instructions very carefully is the first step in the right direction. While lupus can be disruptive to everyday life and even life-threatening, the good news is that, with the correct medication and a healthy lifestyle, many lupus patients can enjoy an improved quality of life.

Signs and Symptoms of Lupus

No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus experience episodes — called "flares" — of worsening signs and symptoms that eventually improve or even disappear completely for a time.
The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. But, in general, lupus signs and symptoms may include:

  • Fatigue
  • Fever
  • Weight loss or gain
  • Joint pain, stiffness and swelling
  • Butterfly-shaped rash (malar rash) on the face that covers the cheeks and bridge of the nose
  • Skin lesions that appear or worsen with sun exposure
  • Mouth sores
  • Finger and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon)
  • Shortness of breath
  • Chest pain
  • Dry eyes
  • Easy bruising
  • Anxiety
  • Depression
  • Memory loss

Lupus Causing Gene

Boston (eCanadaNow) - An international team of researchers has come out and stated that they have found a group of genes which cause lupus.Lupus is an autoimmune disorder which affects mainly young women.Dr. Noel Rose, director of the Johns Hopkins Center for Autoimmune Disease Research stated "It's an important moment in autoimmune disease research."There are many papers which make up the research, three of which appear in the journal Nature Medicine, while one is in the New England Journal of Medicine.Researchers have found many new genes such as ITGAM, KIAA1542, and others as confirmed to raise the risk of developing lupus, which affects 1.5 million people in the U.S. each year.Lupus is a disease which makes your body literally attack itself.The hope is that the discovery of these genes being involved could help researchers pinpoint the true causes of lupus to the point where they can make new treatments for it. It will provide a far better understanding of the disease.

Lupus Genes Discovered

International team of researchers finds fresh suspects for autoimmune disease
By Carolyn Colwell
Posted 1/21/08
MONDAY, Jan. 21 (HealthDay News) -- Researchers from around the world have pinpointed a batch of genes that can trigger lupus, a complex autoimmune disorder that has defied both a clear-cut diagnosis and a cure for decades.

"It's an important moment in autoimmune disease research," noted Dr. Noel Rose, who is director of the Johns Hopkins Center for Autoimmune Disease Research. At least 1.5 million people in the United States suffer from lupus, a disease in which the body mistakenly begins to attack itself.
The papers, three of which appear in the Jan. 20 online issue of Nature Medicine and one of which is published in the Jan. 20 online issue of the New England Journal of Medicine, identify both novel and familiar genetic suspects for lupus. The findings lend support to the theory that a "consortium" of genes are responsible for the development of lupus, said Rose, who three decades ago became one of the first researchers to connect a specific gene with an autoimmune disease.
The researchers identified several new genetic players -- ITGAM, KIAA1542, PXK and rs10798269 among them -- that raise the risk of developing lupus, and they also confirmed other genetic regions already associated with the disease. Some of the genes that had been identified previously, such as PTPN22 and STAT 4, are associated with other autoimmune diseases such a rheumatoid arthritis and type 1 diabetes, the researchers noted.
"It is exactly the thing I was dreaming about so many years ago -- that there would be common genes that would be involved in many autoimmune diseases," Rose said. It's a case of the "bad luck hypothesis," which means "you inherited all of these genes that are perfectly normal regulatory genes, and you got just too many of them, and that will bias your response this way or that way" in terms of developing the disease, Rose explained.
The discovery that many genes are involved "means we may be one step closer to better therapies in the short run -- several years as opposed to 10 years. If we can figure out what these genes are responsible for and we can alter that, we may have a major impact on the disease," said Dr. Susan Manzi, co-director of the Lupus Center for Excellence at the University of Pittsburgh and a co-author on one of the studies.
"A better understanding of why you have this disease and what's gone wrong [creates] a potential to target better therapies," she added. A greater definition of which genes are implicated in symptoms of lupus involving the brain or kidneys, for example, would allow for more accurate screening and monitoring of people at risk for lupus, she explained.
"The holy grail is for you to have a set of genes that when they are together in the right combination incur an extremely high risk" so that people at risk can be identified and vaccinated to prevent the disease, Manzi added.
Some of the papers are the result of the recent availability of new microchip technology that allows genome-wide scans, according to Dr. Carl Langefeld, co-director of the International Consortium for Systemic Lupus Erythematosus Genetics (SLEGEN), which produced the discoveries reported in Nature Genetics.
Referring to some of the studies' overlap in results, Langefeld added, "The identification of the same genetic markers in different samples further strengthens our confidence in these findings."
A fifth study done by the Scripps Institute, which appeared in the Jan. 18 issue of Immunity, took an entirely different approach, focusing instead on a genetic mutation that reduces one's risk of developing lupus, Rose added.
Lupus can affect the skin, joints, lungs, blood and other organs, and lead to cardiovascular, kidney and arthritic problems, according to the Lupus Foundation of America. Women are much more likely to be struck by lupus than men, and black women are more vulnerable than white women to developing the disease.
The role that a family history of the disease plays has been known for some time, noted Dr. Robert Kimberly, principal investigator for SLEGEN. A sibling of a person with lupus has a 20 to 30 times greater likelihood of developing the condition.
Experts also say environmental factors might jumpstart the disease.
This latest research "represents an acceleration of discovery," Kimberly said. "It's not just encouraging. It has us all quite excited about what we might be able to accomplish."

What is Lupus?

Lupus is an autoimmune disease that can affect various parts of the body, including the skin, joints, heart, lungs, blood, kidneys and brain. Normally the body's immune system makes proteins called antibodies, to protect the body against viruses, bacteria, and other foreign materials. These foreign materials are called antigens.

In an autoimmune disorder like lupus, the immune system cannot tell the difference between foreign substances and its own cells and tissues. The immune system then makes antibodies directed against itself. These antibodies -- called "auto-antibodies" (auto means 'self') -- cause inflammation, pain and damage in various parts of the body.

Inflammation is considered the primary feature of lupus. Inflammation, which in Latin means "set on fire," is characterized by pain, heat, redness, swelling and loss of function, either on the inside or on the outside of the body (or both).

For most people, lupus is a mild disease affecting only a few organs. For others, it may cause serious and even life-threatening problems. Although epidemiological data on lupus is limited, studies suggest that more than 16,000 Americans develop lupus each year.

The Lupus Foundation of America (LFA) estimates between 1.5 - 2 million Americans have a form of lupus, but the actual number may be higher. More than 90 percent of people with lupus are women. Symptoms and diagnosis occur most often when women are in their child-bearing years, between the ages of 15 and 45.

In the United States, lupus is more common in African Americans, Latinos, Asians, and Native Americans than in Caucasians.

Bipolar disorder

Bipolar disorder is not a single disorder, but a category of mood disorders defined by the presence of one or more episodes of abnormally elevated mood, clinically referred to as mania. Individuals who experience manic episodes also commonly experience depressive episodes or symptoms, or mixed episodes which present with features of both mania and depression. These episodes are normally separated by periods of normal mood, but in some patients, depression and mania may rapidly alternate, known as rapid cycling. The disorder has been subdivided into bipolar I, bipolar II and cyclothymia based on the type and severity of mood episodes experienced.

Also called bipolar affective disorder until recently, the current name is of fairly recent origin and refers to the cycling between high and low episodes; it has replaced the older term manic-depressive illness coined by Emil Kraepelin (1856-1926) in the late nineteenth century.[1] The new term is designed to be neutral, to avoid the stigma in the non-mental health community that comes from conflating "manic" and "depression."

Onset of symptoms generally occurs in young adulthood. Diagnosis is based on the person's self-reported experiences, as well as observed behavior. Episodes of illness are associated with distress and disruption, and a relatively high risk of suicide.[2] Studies suggest that genetics, early environment, neurobiology, and psychological and social processes are important contributory factors. Psychiatric research is focused on the role of neurobiology, but a clear organic cause has not been found. Bipolar disorder is usually treated with medications and/or therapy or counseling. The mainstay of medication are a number of drugs termed 'mood stabilizers', in particular lithium and sodium valproate; these are a group of unrelated medications used to prevent relapses of further episodes. Antipsychotic medications, sometimes called neuroleptics, in particular olanzapine, are used in the treatment of manic episodes and in maintenance. The benefits of using antidepressants in depressive episodes is unclear. In serious cases where there is risk to self and others involuntary hospitalization may be necessary; these generally involve severe manic episodes with dangerous behaviour or depressive episodes with suicidal ideation. Hospital stays are less frequent and for shorter periods than they were in previous years.

Some studies have suggested a significant correlation between creativity and bipolar disorder. However, the relationship between the disorder and creativity is still very unclear.[3][4][5] One study indicated increased striving for, and sometimes attaining, goals and achievements.[6] While the disorder affects people differently, individuals with bipolar disorder tend to be much more outgoing and daring than individuals without bipolar disorder. The disorder is also found in a large number of people involved in the arts. It is an ongoing study as to why many creative geniuses had bipolar disorder.


schizophrenia /schizo·phre·nia/ (skit?so-fren´e-ah) (-fre´ne-ah) a mental disorder or group of disorders characterized by disturbances in the form and content of thought (e.g., delusions, hallucinations), in mood (e.g., inappropriate affect), in sense of self and relationship to the external world (e.g., loss of ego boundaries, withdrawal), and in behavior (e.g., bizarre or apparently purposeless behavior); it must cause marked decrease in functioning and be present for at least six months.schizophren´ic

catatonic schizophrenia a form characterized by psychomotor disturbance, which may be manifested by a marked decrease in reactivity to the environment and in spontaneous activity, by excited, uncontrollable, and apparently purposeless motor activity, by resistance to instructions or attempts to be moved, or by maintenance of a rigid posture or of fixed bizarre postures.
childhood schizophrenia former name for schizophrenia-like symptoms with onset before puberty, marked by autistic, withdrawn behavior, failure to develop an identity separate from the mother's, and gross developmental immaturity, now classified as pervasive developmental disorders.
disorganized schizophrenia , hebephrenic schizophrenia a form marked by disorganized and incoherent thought and speech, shallow, inappropriate, and silly affect, and regressive behavior without systematized delusions.
paranoid schizophrenia a form characterized by delusions, often with auditory hallucinations, with relative preservation of affect and cognitive functioning.
residual schizophrenia a condition manifested by individuals with symptoms of schizophrenia who, after a psychotic schizophrenic episode, are no longer psychotic.
undifferentiated schizophrenia a type characterized by the presence of prominent psychotic symptoms but not classifiable as catatonic, disorganized, or paranoid.

Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

schiz·o·phre·ni·a (skts-frn-, -frn-)
Any of a group of psychotic disorders usually characterized by withdrawal from reality, illogical patterns of thinking, delusions, and hallucinations, and accompanied in varying degrees by other emotional, behavioral, or intellectual disturbances. Schizophrenia is associated with dopamine imbalances in the brain and may have an underlying genetic cause.

The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

schizophrenia (skit´sfrē´nē),
n (dementia praecox), a functional psychosis (split personality) characterized by emotional distortion, withdrawal from reality, and disturbances of thought processes. It includes such disorders as hebephrenia, catatonia, and paranoia.

Morgellons Disease Not Delusional

Psychiatric News June 1, 2007
Volume 42, Number 11, page 24
© 2007 American Psychiatric Association

I am pleased to see that in the December 15, 2006, issue, Psychiatric News drew attention to Morgellons disease and that the excellent article gave sound advice on communicating with delusional parasitosis patients. However, I would like to add comments about the distinction between Morgellons disease and delusional parasitosis.

I've evaluated and treated Morgellons patients, spoken with researchers and other clinicians who work with these patients, read the limited literature on the subject, and reviewed a database of 3,000 Morgellons patients. The Morgellons patients I have seen had surprisingly similar symptoms, with an abrupt onset, often following a toxic exposure. Before the onset of their illness, these patients' mental status appeared to be quite representative of the general population, and some (including physicians) were high-functioning professionals. The condition appears more common in nurses, teachers, and in family members in the same household, which suggests a contagious component.

After the onset of the illness, these patients report surprisingly similar symptoms. They have a combination of bizarre dermatological sy mptoms, cognit ive impairments, mood disturbances, and sometimes paranoia and suicide attempts in later stages of the illness.

Their symptoms are not compatible with schizophrenia, bipolar illness, substance abuse, or other recognized causes of delusions. When patients complain of fibers protruding from their skin, examination with a low-power digital microscope can visualize and photograph the presence or absence of these fibers. In addition, many Morgellons patients test positive for Lyme disease. The mental symptoms seen in Morgellons are similar to those of other chronic general medical illnesses with psychiatric manifestations, since the mental symptoms fluctuate in a pattern similar to that of the general medical symptoms; and this suggests that the mental symptoms are probably associated with immune and/or toxic effects upon the brain.

When these patients are treated with modest courses of antibiotics, their dermatological and psychiatric symptoms often show significant improvement. Without a thorough assessment, Morgellons patients are commonly given a diagnosis of delusional parasitosis, resulting in a delay in proper treatment. Whatever Morgellons is, it is something very different and unique and should be considered as a condition needing further study and possibly listed in the next edition of the DSM.

In summary, Morgellons disease and delusional parasitosis are two distinct clinical entities. Morgellons does not appear to be an imaginary or delusional illness and merits the research effort that we see with any other emerging and serious illness.

What is Delusional Parasitosis?

Delusional Parasitosis is a mistaken belief that one is being infested by parasites such as mites, lice, fleas, spiders, worms, bacteria, or other organisms. (If of interest, please read from the sufferer's view.) This site has been created in an attempt to centralize accurate information on this misunderstood and increasingly common syndrome.
Delusional parasitosis or Ekbom's Syndrome is a rare disorder in which sufferers hold a delusional belief they are infested with parasites. A related symptom involving a tactile hallucination of insects, snakes, or other vermin crawling over the skin is known as formication. The origin of this word is from the Latin formica, "ant".
It is not to be confused with Wittmaack-Ekbom or restless legs syndrome. Unfortunately, this is also referred to in short as "Ekbom's Syndrome" leaving the audience having to infer the particular meaning from the context. It is named after a Swedish neurologist, Karl Axel Ekbom, who published seminal accounts of the disease in 1937 and 1938.
The sufferer typically reports parasites to exist under the skin, around or inside body openings, in the stomach or bowels and may include a belief that the parasites infest the sufferer's home, surroundings or clothing.
A person holding such a belief may approach doctors or dermatologists asking for treatment for the supposed infestation, and will often bring small particles, dust, skin flakes and other material for the doctor to inspect. Since the material may be carried in an envelope or matchbox, this presentation is known as the "matchbox sign."
Stimulant drug abuse (particularly amphetamine and cocaine) can lead to delusional parasitosis. For example, excessive cocaine use can lead to an effect nicknamed "cocaine bugs" where the affected person believes he has, or feels parasites crawling under his skin. These conditions are also associated with high fevers and extreme alcohol withdrawal, often associated with visual hallucinations of insects.
People suffering from these conditions may scratch themselves to the extent of serious skin damage and bleeding, especially if they are delirious or intoxicated.