LUPUS

What Is Lupus?

Lupus is a long-lasting disease that comes in several forms and can 
produce inflammation in joints, muscles and other body parts.

Systemic lupus erythematosus (sis-TEM-ick LOO-pus er-i-THE-mah-TOE-sis), 
also called lupus (or SLE for short), is a rheumatic disease. Rheumatic 
diseases affect joints, muscles and other parts of the body.

Lupus is both inflammatory and chronic. Inflammation refers to a body 
reaction resulting in pain, heat, redness and swelling. Chronic means 
long-lasting, possibly for the rest of one's life. However, chronic does 
not necessarily mean that you will constantly experience symptoms. 
Nearly all people with lupus have changes in disease activity known as 
flares and remissions. A flare is a period of worsening inflammation. A 
remission is a period during which no signs or symptoms of lupus are 
present. On rare occasions a person may have a complete or long-lasting 
remission.

Several forms of lupus are listed in the following sections.

Systemic Lupus

Approximately 70 percent of the people who have lupus have systemic 
lupus. A systemic disease is one in which several different parts of the 
body may be affected. In systemic lupus, these include the skin, 
kidneys, nervous system, lungs, heart and/ or blood-forming organs. Of 
those people with systemic lupus, about half have the form that can 
damage the body's internal organs and half have the 
non-organ-threatening form.

Discoid Lupus

Approximately 15 percent of people with lupus have cutaneous 
(cue-TANE-ee-us) lupus, also called discoid (DIS-coyd) lupus This is a 
disease of the skin that's often chronic and can sometimes lead to 
scarring. It may be limited to the skin and not be associated with 
disease in any other body system.

Drug-Induced Lupus

Approximately 10 percent of people with lupus have drug-induced lupus 
This means that lupus occurs because of a reaction to one or more drugs. 
Symptoms often disappear when the person stops taking the drugs that 
caused the reaction.

Crossover, or Overlap, Syndromes

About five percent of people with systemic lupus have crossover 
syndromes. This means that they have features that overlap with another 
rheumatic disease, such as rheumatoid arthritis or myositis. Because 
these people have a combination of symptoms, their disease may not fit 
into traditional diagnosis categories.

What Causes Lupus?

Although doctors and scientists agree that lupus is an autoimmune 
disease that has some predictable characteristics, its cause remains a 
mystery.

The cause of lupus is unknown. Doctors and scientists agree that it is 
an autoimmune (aw-toe-im-MUNE) disease. The immune system is your body's 
natural defense against antigens, which are substances that your body 
regards as foreign. Bacteria and viruses are examples of antigens. The 
immune system fights off antigens by creating antibodies, which are 
special types of blood protein whose job it is to attack antigens and 
render them harmless.

Occasionally, the immune system does not function properly and loses the 
ability to distinguish between its own body cells and antigens. Instead 
of fighting antigens, the antibodies mistakenly fight the body's own 
cells. This is referred to as an autoimmune response (auto means self,
 and this is a response directed against the body's own cells).

In an autoimmune disease, antibodies that are directed against the 
body's own cells are called autoantibodies. Antinuclear antibodies are 
autoantibodies that react against the nucleus (core) of the body's own 
cells when these cell parts are mistaken for foreign substances.

The damage that occurs may take the form of inflammation and injury to 
body tissues and organs. Such damage may result in lupus symptoms.

Sometimes medications taken for other conditions, like high blood 
pressure, certain heart problems, seizures and psychiatric problems such 
as severe depression, may cause many of the symptoms and abnormal blood 
test results associated with lupus. Symptoms of such drug-induced lupus 
almost always go away when these medications are stopped. However, it 
may take several weeks to months for the symptoms and abnormal blood 
test results to disappear.

Can Lupus Be Inherited?

Lupus affects women about eight to 10 times as often as men. In most 
cases, symptoms first appear in women of childbearing age (18-45). 
However, lupus can occur in young children or in older people. It occurs 
more often in African-Americans than in Caucasians. Some data suggests 
that it also might occur more frequently in Asian and Hispanic 
populations than in Caucasians.

Some studies suggest that certain people may inherit the tendency to get 
lupus. This conclusion stems from the fact that new cases of lupus may 
be more common in families in which one member already has the disease. 
However, there is no evidence that lupus is directly passed on from 
mother to daughter. Some scientists believe that perhaps a virus or 
other environmental substance may trigger the genetic tendency to 
develop lupus and bring on the symptoms of the disease.

What Happens in Lupus?

Lupus can cause a variety of different symptoms that can vary from 
person to person

There is no uniform pattern of symptoms when lupus is active. You may 
develop several of the symptoms mentioned in this section or just a few. 
Each person is different, and what is true about someone else's disease 
may not apply to you.

The following classification of 11 symptoms helps doctors tell the 
difference between people who have lupus and people who have other 
connective tissue disorders.

Eleven Main Symptoms

The 11 main symptoms of lupus include:

malar (MAY-lar) rash (a butterfly-shaped rash over the cheeks and across 
the bridge of the nose);

discoid rash (scaly, disk-shaped sores on the face, neck and/or chest);

photosensitivity (sensitivity to ultraviolet light);

oral ulcers (sores on the tongue, inside the mouth and/or in the nose);

arthritis (pain, stiffness and swelling in the joints);

serositis (SEE-row-SY-tis - inflammation of the lining around the heart, 
lungs and/or abdomen, causing pain when you move and/or breathe and 
often accompanied by shortness of breath);

kidney problems (can be mild with no early symptoms. Severe cases 
usually are associated with symptoms such as edema, which is a swelling 
of the legs that may occur if large amounts of protein leak from the 
kidneys into the urine. Other severe symptoms can include extreme 
fatigue, high blood pressure and loss of appetite.);

central nervous system problems (in a very small percentage of people, 
seizures or memory loss may develop, but they rarely persist);

blood problems (can include anemia - ah - NEE-me-ah - a condition in 
which you have fewer red blood cells, causing weakness and paleness or 
even shortness of breath; low white blood cell count; low platelet 
count; or an increased tendency to form blood clots, which is called the 
antiphospholipid or anti-cardiolipin syndrome);

problems with the immune system (which may increase the risk of 
infection);

antinuclear antibodies (autoantibodies that react against the nucleus 
(core) of the body's own cells when these cell parts are mistaken for 
antigens).

Other Symptoms

People with lupus may experience additional symptoms. Fever, weakness, 
fatigue or weight loss may be among the first signs of illness.

Sometimes the fingers, toes, nose and/or ears become unusually sensitive 
to cold and will turn blue when exposed to the cold. This color change 
is called Raynaud's (Ray-NODES) phenomenon.

Other common symptoms of the illness include muscle aches, swollen 
glands, lack of appetite, low-grade fever, hair loss and abdominal pain 
that may be accompanied by nausea, vomiting and diarrhea.

About 10 to 15 percent of people with lupus also have Sjogren's 
(SHOW-grens) syndrome. This is a chronic disorder that causes dry eyes 
and a dry mouth. In women it also can include dryness in the vagina.

Sometimes people with lupus experience depression or an inability to 
concentrate. Rapid changes in mood or unusual behavior may occur for any 
of the following reasons:

* The changes maybe due to inflammation from the disease itself.

* The changes may be a normal reaction to the changes in appearance and 
energy caused by the disease.

* The changes may be due to side effects of the medications used to 
treat the disease. You and your doctor should discuss your symptoms, 
especially when new ones develop or chronic ones worsen. Remember that 
lupus can take many forms. Although people with lupus can have many 
symptoms, most people only have a few problems that tend to occur in a 
repeated pattern. Many people with lupus do very well without having 
major problems.

How Is Lupus Diagnosed?

It sometimes is difficult to diagnose lupus, particularly in people with 
mild symptoms of the disease. This is because there is no single set of 
symptoms, pattern of disease or set of tests to diagnose all who have 
lupus

Your doctor will begin the diagnostic process by asking you many 
questions and doing a physical examination. Certain tests will be 
performed, such as a blood count to see if you have too few red cells, 
white cells or platelets (blood cells that help to control bleeding and 
clotting).

If your doctor thinks you may have lupus, a blood test called an ANA 
usually will be done. An ANA detects a group of autoantibodies found In 
the blood of almost all people with lupus These autoantibodies react 
with antigens in the nuclei of cells. Having these antibodies suggests 
that an autoimmune illness may be present, although some people test 
positive with little or no evidence of serious disease.

Other laboratory tests may be helpful in the diagnosis of certain 
related rheumatic diseases. The names of the following tests are 
abbreviations of some of the tests used to help confirm diagnoses:
anti-dsDNA; anti-Sm; anti-Ro/SS-A; and anti-RNP.

Complement tests (C3, C4, CH5O, CH1OO) measure the amount of complement 
proteins circulating in the blood. A low complement level suggests that 
an active inflammatory process is occurring because of the lupus These 
tests usually are used to diagnose or monitor people with active lupus, 
especially if their kidneys are affected.

Other blood tests may be done for diagnosis and as an aid in following 
disease activity Blood chemistry tests can help determine whether organs 
such as the kidneys and liver are functioning normally. A sedimentation 
rate (ESR) or C-reactive protein (CRP) also may be used to measure 
inflammation levels.

Because kidney problems often occur, you may have a urinalysis (you-rih- 
NAL-ah-sis),which is an examination of your urine. You may be asked to 
collect for analysis all the urine you pass in a 24- hour period. If 
kidney involvement is suspected, you may have a biopsy (BUY-op-see) 
performed, during which a small piece of tissue from one of your kidneys 
is removed and examined with special tests.

A chest X-ray may be taken to see whether your lungs or heart are 
involved. An electrocardiogram and echocardiogram also may help 
determine if there is any heart involvement.

In a few people with lupus, all the laboratory tests may be normal, 
despite other evidence of the disease. In other people, they may feel 
fine, but the results of laboratory tests may suggest significant lupus 
activity

Diagnosis of lupus depends on an analysis of your medical history, 
physical examination and the results of laboratory tests.

How Is Lupus Treated?

The treatment plan for lupus includes taking medications to reduce the 
inflammation or reduce the activity of the immune system, balancing rest 
with exercise and eating a proper diet.

Lupus is an unpredictable disease. Signs of the disease appear and 
disappear, sometimes for no apparent reason. Because lupus assumes so 
many different forms and can change, finding the right balance of 
treatment for you may take time. Once an effective treatment program has 
been started, continue it faithfully. If your symptoms change, let your 
doctor know so that you can work together to modify your program.

Medication

Medication is a necessary part of treatment for most people with lupus 
Until you and your doctor can identify your flare pattern, the type and 
amount of medications prescribed may frequently be changed.

Changing how much medicine you take or how often you take it is a 
decision to be made after talking with your doctor. Many medications 
have a four- to six-week time lag before you experience the greatest 
benefits. Therefore, changing your schedule on your own or not taking a 
drug your doctor has prescribed could have harmful effects. It also will 
make it more difficult for your doctor to evaluate what is happening in 
your disease and how effective the medication is in reducing 
inflammation or reducing the activity of the immune system. If you start 
taking a drug without medical advice, it could harm you, either by 
interacting with other medications prescribed for you or by causing side 
effects that might even mimic some of the symptoms of your lupus

Aspirin and Other Anti-inflammatory Drugs

Aspirin may be the only medication your doctor will prescribe. Aspirin 
is an anti-inflammatory drug, which makes it helpful in treating the 
symptoms of lupus, some of which are caused by inflammation. It may be 
necessary to take large doses of aspirin as directed at regular 
intervals for it to be effective.

However, some people are bothered by stomach problems when taking large 
doses of aspirin. One way to lessen this problem is to take the tablets 
with a meal and with plenty of liquids. You might try using enteric- 
(en-TERR-ik) coated aspirin tablets. These do not dissolve until they 
have passed through the stomach. Another hint is to take antacids about 
one-half hour after meals and at bedtime to help protect the lining of 
your stomach.

There are several types of nonsteroidal anti-inflammatory drugs, or 
NSAIDs (EN-seds). NSAIDs are similar to aspirin. Examples include 
diclofenac, etodolac, flurbiprofen, ibuprofen, indomethacin, nabumetone 
and naproxen.

For some people, NSAIDs may be more effective or better tolerated than 
aspirin. They all have the potential for causing stomach irritation, 
bleeding from the stomach or intestines, ulcers or diarrhea. Your doctor 
may prescribe anti-ulcer medications to help you tolerate aspirin or 
other NSAIDs.

There are other problems associated with NSAIDs. They can thin the blood 
and extend bleeding time. If you are scheduled for surgery, you may need 
to temporarily stop taking NSAIDs. In addition, aspirin and most NSAIDs 
can damage the liver and/or decrease kidney function. However, the 
damage usually can be reversed when the medication is stopped or given 
in smaller doses.

Antimalarial Drugs

Some doctors prescribe drugs commonly used to treat malaria. The most 
commonly used antimalarial drug for lupus is hydroxychloroquine. 

There is no known relationship between lupus and malaria, but 
antimalarial drugs can interfere with the formation of antigens which, 
in turn, cause the body to form antibodies. This can reduce inflammation 
and the need to take inflammation-reducing corticosteroid drugs.

Antimalarial drugs are helpful in treating discoid lupus and some of the 
manifestations of systemic lupus, especially fever, joint pain and 
pleuritis (inflammation of the lining of the lungs, also known as 
pleurisy). These drugs can help prevent lupus rashes and systemic 
problems that can occur if you are sensitive to ultraviolet light. They 
also can help decrease fatigue.

The most common side effects from antimalarials are mild nausea, 
vomiting and diarrhea. On rare occasions, deposits from 
hydroxychloroquine may form in the transparent outer covering of the eye 
(cornea). You won't be able to tell the deposits are there, but you may 
notice a blurry ring around lights. If this happens, be sure to tell 
your doctor. The deposits won't harm your eye. They usually go away six 
to eight weeks after you stop taking the medicine.

In rare cases that usually follow prolonged or excessive use, 
hydroxychloroquine may injure the retina, nerves from the back of the 
eye that enable you to see. Early detection of this unusual occurrence 
can minimize its damage. Regular visits to an ophthaimic specialist who 
is familiar with this toxicity help to reduce the slight risk from this 
medication. Patients who experience visual change while taking 
hydroxychloroquine should discontinue this medication until the cause of 
the change can be determined.

Corticosteroids

Corticosteroids are similar to cortisol, hormone that occurs naturally 
in the body.

Caution!

Corticosteroids (CORE-tih-ko-STER-oydz) are widely used to treat lupus 
because of their overall effectiveness in reducing inflammation. They 
are related to cortisol, a hormone that occurs naturally in the body and 
controls many important body functions. You could not live without 
cortisol.

Doctors sometimes refer to corticosteroids as steroids. However, 
corticosteroids are not the same as anabolic steroid drugs that some 
athletes abuse.

It is common for doctors to prescribe large doses of corticosteroids 
when lupus is very active, especially if it affects the kidneys or 
nervous system. As symptoms and abnormal laboratory tests improve, the 
steroid dose usually is slowly tapered down over a period of time.

For some people, an alternate, or every-other-day, dose of steroids may 
be prescribed. This method of taking steroids may help to decrease some 
of the side effects of the drug. Similarly, if you have skin rashes, you 
may be given creams or ointments containing corticosteroids.

Sometimes pulse steroids may be prescribed if a person is very sick. 
This means that a very large dose of corticosteroid is given directly 
into the veins, usually every day for a three-day period. 

Common side effects of the cortisol-like drugs include weight gain, 
rounding of the face, easy bruising and slow healing. Large doses of 
corticosteroids may cause mood swings, from extreme nervousness and 
insomnia to depression.

Other serious side effects include the development of fluid retention 
with swelling of the legs and high blood pressure, the triggering or 
worsening of diabetes, an increase in the risk of infection and, rarely, 
bleeding from the stomach. Use of corticosteroids over a long period of 
time may lead to cataracts; glaucoma; the death of bony tissue, called 
osteonecrosis (OS-te-o-ne-KRO-sis); and/or thinning of the bones called 
osteoporosis (OS-tee-o-por-O-sis). If you are taking corticosteroids, 
your doctor may recommend that you take calcium and vitamin D 
supplements to help prevent osteoporosis.

If you are taking these powerful drugs, be sure to inform any doctor or 
dentist before you have surgery or undergo any other type of stressful 
procedure. Your body may need more steroids at such times. It's also 
recommended that you wear special medical identification. This will 
alert others that you are taking corticosteroids in case you are unable 
to tell them.

Never change your dose of corticosteroids without first discussing it 
with your doctor, since stopping or changing the dose quickly can make 
you very ill.

Immunosuppressive Drugs

Treatment for lupus includes taking medication, balancing rest and 
activity and eating a proper diet.

Immunosuppressive (im-you-no-su-PRESS-iv) drugs are used to treat 
autoimmune diseases and reduce the activity of the immune system. They 
often are prescribed along with corticosteroids to treat people who have 
not responded to other types of drug therapy. They also may be used to 
help cut down the dose of corticosteroids or to prevent new flares of 
lupus activity

The most commonly used immunosuppressive drugs are azathioprine and 
cyclophosphamide. Chlorambucil, methotrexate, nitrogen mustard and 
cyclosporine, which also is given to people with kidney transplants, 
occasionally may be prescribed.

These drugs can have serious side effects. If you are taking an 
immunosuppressive drug, regular blood tests must be performed because 
the drug can interfere with the proper formation of blood cells. The 
development of an infection also is more likely when you are taking an 
immunosuppressive drug because it reduces the activity of the immune 
system. Therefore, it is important to notify your doctor if you develop 
a fever or any other new symptoms while taking immunosuppressive drugs.

Exercise

It is important to do proper exercises on a daily basis. This may be 
easier to do when lupus is not in an active stage and you are feeling 
better. However, even during a flare, doing gentle range -of- motion 
exercises is important to keep you from becoming stiff Exercise also can 
help you avoid muscle weakness. A physical therapist can work with your 
doctor to set up an exercise program that fits your schedule and 
physical condition. You can work together with your health professionals 
by designing a simple walking program for yourself. Even walking a few 
blocks helps. You can gradually increase the distance as you get 
stronger.

DEALING WITH FATIGUE

We all need to balance rest and activity. This balance is especially 
important for people with lupus Part of this balancing act includes 
pacing yourself during the day, as well as from day to day. Allow plenty 
of time to finish the things you start so you won't feel rushed. Don't 
try to do too much at one time. Be realistic. Planning ahead and pacing 
yourself also include doing the most difficult things when you're 
feeling your best. 

For more information about dealing with fatigue, contact your local 
Arthritis Foundation chapter and request a free copy of their brochure, 
Managing Your Fatigue.

Diet

Eating a balanced diet is an important part of your treatment plan. At 
times when your lupus is active and your appetite is poor, it may be 
helpful to take a daily multivitamin. It is important to remember, 
however, that excessive doses of vitamins can have serious side effects. 
You should be sure that your doctor is aware of any vitamin preparations 
you take.

At times you may be placed on a special diet because of problems caused 
by features of your lupus, such as kidney disease. A low-salt diet will 
help prevent the accumulation of edema fluid. You also may need to limit 
the amount of protein in your diet.

When it comes to alcohol consumption, moderation is advised. Alcohol can 
have a potentially harmful effect on the liver. If you decide to have an 
occasional drink, make sure you also eat something. In some instances, 
alcohol may be prohibited if you are taking certain drugs for your 
lupus, such as methotrexate.

Special Concerns

Sun and Artificial Light Exposure

Exposure to the sun and certain fluorescent lighting is known to make 
the skin rashes and/or other systemic problems associated with lupus 
worse in 40 to 60 percent of people with this disease. Approximately 
one-third of people with lupus are sun-sensitive (photosensitive). Sun 
exposure may cause generalized flares of lupus, resulting in fever, 
joint pain or even inflammation involving the heart, lungs, kidneys or 
nervous system. Of course, what is too much sun for one person may be 
fine for someone else. The degree of photosensitivity varies with 
disease activity.

It's best to take simple precautions. One precaution is to avoid outdoor 
activities during peak sunlight hours (usually 10 a.m.-4 p.m.). Another 
precaution is to regularly use a sunscreen lotion or sunblock on your 
skin. Sunscreens can be bought without a prescription and are available 
in many forms, some of which also include skin lubricants. Those with a 
sun protection factor of 15 or more are the best. Because some chemicals 
in sunscreens may cause skin irritation or rashes, it may be necessary 
to try a different brand. Checking the ingredients on sunscreen labels 
can help avoid problems. Oxybenzone blocks ultraviolet A (UVA) light, 
and chemical-free formulas block UVA light, UVB light and infrared rays 
(IR).

During unavoidable times of sun exposure, it is important to wear a hat 
to shade you from direct sun and clothing to cover your arms, legs and 
chest.

Because of possible problems from sun exposure, you may wonder if it is 
safe to move to a warmer climate. As long as you protect yourself when 
you are out in the sun, where you live should not affect your illness.

The sun is not the only light source that can cause problems. Sometimes 
artificial sources of ultraviolet light, such as photocopying machines, 
slide projector lights, halogen lamps or TV studio lights, can aggravate 
lupus It's a good idea to avoid these sources as much as possible. White 
fluorescent light can, on rare occasions, cause problems. Installing 
plastic shields over fluorescent lights can help block ultraviolet 
leakage. Using a sunscreen and wearing protective clothing is suggested. 
Women may find that wearing opaque makeup is helpful.

Pregnancy and Contraception

Pregnancy may present special problems for women with lupus During 
pregnancy or several weeks to months after delivery, women may 
experience lupus symptoms for the first time, or the symptoms they 
already have can worsen.

Fertility, or the ability to conceive, maybe decreased during periods of 
disease flares. This may be the result of hormonal changes caused by 
lupus or from side effects of medications used to treat lupus.

Women with lupus also have an increased chance of having a miscarriage 
either early or late in their pregnancy Certain abnormal antibodies 
present in the blood of some women with lupus (anti-phospholipid or 
anti-cardiolipin antibodies) may increase the chance of having a 
miscarriage. Therefore it is important that you discuss any plans to 
become pregnant with your doctor and that you visit your doctor 
regularly during your pregnancy Blood tests should be done to detect the 
presence of the abnormal antibodies and to measure other signs of lupus 
activity With these precautions, many women with lupus can have normal 
pregnancies.

Occasionally newborn babies of mothers with lupus have a mild illness 
caused by transfer of the mother's autoantibodies through the placenta 
to the baby This illness may include a rash, anemia, low platelet or low 
white blood cell counts or an enlarged liver. These features go away 
generally by six months after birth. On very rare occasions, babies may 
have a permanent problem called congenital heart block, which causes a 
slow heart-beat. This may require treatment with a pacemaker.

If, on the other hand, your doctor advises against pregnancy, or if you 
do not wish to have children, it's important to continue practicing 
birth control measures. Even though fertility may be decreased during 
periods of disease flares, it's still possible to become pregnant. An 
unplanned pregnancy during a period of active disease could negatively 
affect your health and/or expose the growing fetus to medications you 
have taken to treat your lupus The safest method of contraception for 
women with lupus is the diaphragm used with contraceptive jelly However, 
some women with lupus are able to use birth control pills safely. 
Special care is advised regarding the use of intrauterine devices (IUDs) 
because of the risk of infection.

Kidney Dialysis and Transplantation

Sometimes, even with the use of corticosteroids and immunosuppressive 
drugs, kidney failure occurs. Fortunately, dialysis (die-AL-ah-sis) is 
available to cleanse waste products from the blood. One form of dialysis 
is hemodialysis (HE-mo-die-AL-ah-sis), in which catheters are placed in 
an artery and vein and the blood is run through a cleansing machine.

Another form of dialysis is continuous ambulatory peritoneal dialysis 
(CAPD), a cleansing procedure in which fluid is instilled into and 
drained out of the abdominal cavity A person can perform this procedure 
at home.

When kidney failure is permanent, a kidney transplant may be performed. 
This procedure often can allow a person with lupus to return to a normal 
lifestyle, even though medication generally is required to prevent 
rejection of the new kidney.

Infections

People with lupus are more likely to develop infections. This is true 
because the immune system may not be working properly or because of the 
side effects of medications, especially corticosteroids and 
immunosuppressive drugs. In some people with lupus, infections can 
trigger disease flares. If you have a fever, which is a sign of possible 
infection, consult your doctor.

Dryness

Women with lupus who have gone through menopause or who also have 
Sjogren's syndrome may experience vaginal dryness. Estrogen creams can 
help restore moisture. If you have lupus and experience this dryness, be 
sure to consult your rheumatologist before using any lubricating 
products.

Coping Tips

There's no question that there are social and emotional problems that 
come with having a chronic disease. Talking about your fears, anger and 
depression usually helps. At times it may be hard to confide in your 
family, friends or doctor. Joining a support group and talking about 
problems and frustrations with others who have lupus may be just what 
you need to improve your spirits, and it can help you find solutions to 
your problems, too. It is important to remember, though, that you may 
never experience some of the problems that others with lupus have had.

Reading about lupus is another way to learn more about how it affects 
your body and how other people have dealt with it.

There may be times, though, when attending support groups or reading 
about lupus may not be enough to overcome a sense of being overwhelmed. 
At such times counseling from a person trained in helping people with 
chronic diseases such as lupus may be helpful. Your doctor or local 
chapter of the Arthritis Foundation can give you suggestions about 
agencies and mental health professionals such as social workers and 
psychologists who may be able to offer their support. Patient education 
programs such as the SLE Self-Help Course may be offered by local 
chapters of the Arthritis Foundation.

For more Information

Contact your local Arthritis Foundation chapter for a complete list of 
brochures about arthritis. Most chapters will send you a single brochure 
free of charge. Their services also may help you.

Brochures

* Arthritis and Employment: You Can Get the Job You Want - A discussion 
of the various stages of a job search; an explanation of how to make 
disability laws work for you; and suggestions for discussing arthritis 
with employers.

* Arthritis Answers - An overview of the more common types of arthritis, 
including treatments.

* Arthritis on the Job: You Can Work with It - A guide to your legal 
rights in the workplace; suggestions for gaining support from your 
employer and co-workers; and tips on how to make your work easier.

* Aspirin and Other NSAIDs - An overview of this specific group of 
medications used to treat the pain and inflammation associated with 
arthritis.

* Corticosteroid Medications - An overview of this specific group of 
medications used to decrease inflammation and suppress the activity of 
the immune system.

* Exercise and Your Arthritis - Information on how exercise can benefit 
people with arthritis.

* The Family - Effects of arthritis on family life and ways to cope.

* Hydroxychloroquine - An overview of when hydroxychloroquine may be 
used, how it works and possible side effects.

* Living and Loving -Tips for solving problems when arthritis interferes 
with sexuality.

* Managing Your Activities - Suggestions on how to perform daily 
activities in ways that are less stressful to your body.

* Managing Your Fatigue - Basic information about arthritis-related 
fatigue and tips on how to manage it.

* Managing Your Health Care - Tips on how to establish and strengthen
communication with your doctor.

* Managing Your Pain - A discussion of how arthritis causes pain, how 
you react to pain and how you can help manage your pain.

* Managing Your Stress - Tips for reducing the stress associated with 
arthritis.

* Methotrexate- An overview of when methotrexate may be used, possible 
side effects and tips for taking it.

* Surgery - A description of the different types of joint surgery, plus 
questions to ask your doctor prior to surgery.

* Travel Tips - Tips for easier land, sea and air travel.

* Unproven Remedies - Tips on how to identify unproven remedies plus 
information on safe and effective ways to control the pain and loss of 
motion associated with arthritis.