Systemic lupus erythematosos

Lupus Lead to Dialysis.

Things about SLE Lupus; By Guy, (Karen Fiance/CareTaker)
What I researched on SLE;

Systemic Lupus Erythematosus (SLE)
Introduction: There is perhaps no rheumatic disease that invokes so much fear
and confusion among both patients and health care providers as SLE. Difficult to
diagnose, evaluate, and manage, SLE is an illness that may result in a wide variety of
complications, ranging from bothersome arthritis, rash, and fatigue to life-threatening
involvement of major organ systems such as the kidneys and brain.
SLE affects 1 in 2,000 individuals in Caucasian populations but is more common
in other ethnic groups, such as Afro-Americans and Asians. Women are affected 8-10
times more commonly than men, and the onset of symptoms is typically during active
child-bearing years, resulting in a substantial impact on quality of life. While survival
rates have steadily improved over the past several decades, 5% of patients with SLE die
within 5 years of being diagnosed, while nearly 10% die in the first 10 years from time of
While the cause of SLE is unknown, it is believed that a combination of genetic
factors and exposure to either infectious triggers or chemical agents is necessary to
initiate the disease. While first-degree relatives of SLE patients have an approximate 5%
chance of developing the same illness, an identical twin of an SLE patient has a nearly
50% chance.
We consider SLE to be an autoimmune disease. This means that the body’s
immune system, which is ordinarily designed to recognize and destroy everything that is
foreign to the body (such as infections) while leaving the various organs of the body
alone, inexplicably begins attacking different parts of the body and causing inflammation.
This results in the manifestations of SLE in the skin, joints, and potentially just about any
Features of SLE: While it is difficult to summarize the vast array of
complications seen in SLE, the most common features are arthritis, rash, and general
symptoms such as fatigue and intermittent fever. The arthritis is usually involving the
small joints of the hands and/or feet or occasionally the knees, ankles, or elbows. While
often troublesome, the arthritis of SLE does not typically cause joint destruction such as
what we can see in rheumatoid arthritis (RA). The rash is typically triggered by exposure
to sunlight and occurs most frequently in sun-exposed areas. Blistering or scarring may
Arthritis and Rheumatology Clinics of Kansas
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complicate skin lesions of SLE in severe cases. When deep layers of the skin are
involved, this may be called a discoid rash.
Other manifestations of SLE include inflammation around the lining of the heart
and lungs (pleuritis and pericarditis, respectively), lowering of blood cell counts (white
or red blood cells, platelets), mouth ulcers, an increased tendency to form blood clots,
inflammation of the kidneys (nephritis), and inflammation of the brain (cerebritis)
causing seizures or changes in mental functioning. Even after reviewing this list of
complications, it can be said that any part of the body is “fair game” for SLE. Of all of
the manifestations of SLE, nephritis seems to have the biggest impact in overall outcomes
and survival, particularly if the kidneys fail to function and dialysis is required.
Another important late complication of SLE is atherosclerosis (hardening of the
arteries). Just as in RA, patients with SLE have an increased risk of heart attacks and
strokes, which seems to be related to the effects of inflammation on the lining of the
blood vessels. Specifically, women in their 40’s with SLE have approximately 40 to 50
times the risk for heart disease as wo men of the same age in the general population. For
this reason, other risk factors for heart disease, such as smoking, high cholesterol levels,
high blood pressure, and diabetes should be addressed and minimized if possible.
Diagnosis: Even in the hands of experienced physicians, the diagnosis of SLE is
often very challenging. Most of the common symptoms patients with SLE exhibit may
mimic a number of other illnesses. Making the diagnosis is not as simple as performing a
blood test; it involves a comprehensive approach to each patient and incorporating
symptoms, physical findings, and laboratory abnormalities into the final analysis. For
this reason, it may require several visits to either confirm or rule out the diagnosis, but
this investment of time is critical to avoid either over-diagnosing or under-diagnosing
Laboratory findings are helpful in confirming the presence of SLE, but are not
sufficient to do so in the absence of typical symptoms or findings on physical
examination. The anti-nuclear antibody (ANA) is positive in about 99% of patients with
SLE, and depending on the presence or absence of other features, a negative test can rule
out SLE. A positive test, however, does not mean that one has “tested positive for
lupus.” Up to 10% of the general population may express a positive ANA, and by some
estimates just over 10% of individuals who show a positive ANA when a physician is
suspicious enough to order the test actually have SLE.
Other antibody tests, such as anti-Smith, anti-RNP, anti-Ro/SSA, anti-La/SSB, or
anti-dsDNA are more specific, and when present are much more supportive of a
diagnosis of SLE. Of these antibodies, anti-dsDNA seems to be the best marker for
disease activity, particularly in those patients with nephritis. Proteins of the immune
system known as complement may be consumed with active inflammation in SLE
patients and also can be good markers for active disease. The findings of anti-cardiolipin
antibodies or a “lupus anticoagulant” are often present in those who demonstrate an
increased risk for blood clots.
Routine lab studies, such as blood counts, blood chemistries, and urine tests are
also useful in diagnosing SLE as well as screening for complications of the disease.
Patients with nephritis do not typically experience pain over the kidneys or other specific
symptoms other than fever or active disease in other locations, so urine tests are
particularly useful in picking up this complication at an early stage.
To assist doctors in making the diagnosis of SLE, criteria have been devised.
These criteria are not perfect and do not account for every feature that a given patient
may exhibit, but they at least serve as a useful guideline. The criteria include:

  1. Mouth or nasal ulcerations, observed by a doctor
  2. Rash present over the cheeks (malar or “butterfly” rash)
  3. Rash triggered or worsened by sun exposure (photosensitive rash)
  4. Discoid rash
  5. Arthritis of 2 or more different joints
  6. Inflammation of the lining of the heart or lungs (pericarditis or pleuritis)
  7. Nephritis
  8. Cerebritis
  9. Abnormalities of blood cells (low white blood cells, red blood cells, or
  10. Abnormal Anti-Nuclear Antibody (ANA)
  11. Other abnormal immunologic tests (Anti-Smith, Anti-dsDNA, Anti-
    Cardiolipin, Lupus Anticoagulant, or false + syphilis test)
    4 of 11 of these criteria are required for a diagnosis of SLE.
    Treatment: Because SLE is a disease that can behave very differently in any
    given patient, therapy must be individualized. The challenge lies in screening for and
    detecting complications of the disease and prescribing the appropriate medications to
    adequately suppress SLE activity while minimizing side effects. For serious disease
    manifestations that may be either damaging to various organs or life-threatening, the
    potential hazards of aggressive therapy are generally worth the risk. On the other hand,
    SLE that involves only skin and joints is usually most appropriately treated with safer
    long-term maintenance therapies (see Medications section).
    Antimalarial drugs such as hydroxychloroquine (HCQ, trade name Plaquenil) are the
    mainstay of therapy for mild SLE, or those patients who lack serious organ system
    involvement. Benefits are typically seen in 1-2 months for clearing of rashes but arthritis
    symptoms may require 3-6 months of therapy before maximum relief is seen. The effect
    of anti- malarial therapy on fatigue and other manifestations of SLE are variable. One
    study showed that patients on HCQ who were previously stable and discontinued their
    medication experienced worsening of disease activity compared to those who stayed on
    their medication. The only significant side effect of HCQ is a 1 in 1,000 risk of damage
    to the retina in the area where color vision is located, which is typically minimized when
    detected early by regular screening through an eye doctor.
    Sunscreens, avoidance of ultraviolet (UV) light, and protective clothing are
    recommended, particularly for those who have active skin manifestations of SLE. Any
    UV light, even many fluorescent lights, can trigger a disease flare. Therefore, avoidance
    of concentrated exposure to such light is advisable, and special screens or shields are
    available to limit UV exposure from fluorescent bulbs at one’s place of work.
    Sunscreens with SPF 15 or above usually provide protection from UV light as well and
    should be worn every day that significant light exposure is anticipated.
    Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to treat joint symptoms or
    pleuritis/pericarditis but may be best avoided in patients with nephritis due to the
    potential for these medications to reduce blood flow to the kidneys. Also, NSAIDs
    increase the risk of ulcer formation, particularly in patients taking corticosteroids (see
    below). In patients at risk for stomach complications, COX-2 selective NSAIDs may
    minimize this problem.
    Corticosteroids such as prednisone are widely utilized to treat many symptoms and
    complications of SLE. While effective in the majority of patients, steroids must be used
    wisely to avoid side effects, including weight gain, elevation of blood sugar, cataracts,
    increased susceptibility to infection, and thinning of the bones leading to increased
    fracture risk, among others. For this reason, it is important to resist the urge to
    automatically treat each and every symptom in an SLE patient with steroids. Keeping
    this in mind, low-dose prednisone (< 10 mg/day) may be used to treat joint symptoms,
    while high doses of steroids (oral or intravenous) are appropriate to rapidly treat serious
    disease manifestations while awaiting the effects of other medications that are typically
    started in this setting.
    Methotrexate (MTX) may be used in SLE patient with more active arthritis that is
    resistant to HCQ and other therapies. Just as in patients with RA, MTX is given once
    weekly with folic acid daily to reduce side effects and generally begins taking effect in 1
    to 3 months. While often very effective in treating inflammatory arthritis, MTX must be
    routinely monitored to screen for side effects, such as infections, lowered blood counts,
    and elevated liver enzymes.
    Immunosuppressive drugs are typically reserved for serious manifestations of SLE, such
    as nephritis, cerebritis, or other involvement of major organ systems. Examples of such
    medications include cyclophosphamide (Cytoxan), azathioprine (Imuran), and
    cyclosporine (Neoral). These medications work by more powerfully suppressing the
    activity of the white blood cells causing inflammation and damage in SLE patients.
    Many physicians consider Cytoxan the treatment of choice for life-threatening SLE,
    particularly nephritis. This medication is often given in high doses intravenously
    (“pulses”) on a monthly basis and has been shown to reduce mortality and kidney failure
    in serious lupus nephritis.
    Novel agents used in the treatment of SLE include DHEA, mycophenolate mofetil
    (Cellcept), rituximab, and abatacept. DHEA is a hormone produced by the adrenal gland
    that may improve fatigue and/or mental functioning in SLE patients. Cellcept is rapidly
    gaining popularity for the treatment of nephritis, both as a maintenance therapy after
    initial treatment with Cytoxan, or in selected patients as an alternative to Cytoxan.
    Rituximab is an intravenous medication given in 4 once weekly infusions. While used to
    treat lymphoma and currently not approved for SLE by the FDA, rituximab has shown
    great promise in treating certain SLE manifestations in recent studies. Abatacept is an
    upcoming intravenous medication that blocks signals between cells in the immune
    system. It is anticipated that this medication as well as other “biologic response
    modifiers” will become useful options for treating SLE in coming years.
    Because SLE patients may be seen by multiple physicians, it is of utmost importance that
    all doctors are in communication with one another and that decisions to alter therapy be
    known by all involved. Ideally, clarifying which doctor is responsible for treating
    different components of the disease prevents confusion. By working with experienced
    physicians and making decisions between doctor and patient together, SLE management
    can be tailored for maximum benefit to patients suffering from this complicated and
    challenging illness

Lupus and The SUN!!!

The key to remaining healthy is to stay on top of LUPUS ,to be on the lookout for symptoms of a lupus flare.
Signs include red hands or fingernails, rashes on the face, body aches and fatigue. It’s important to be careful whenever
you’re outside in the sun,which means wearing plenty of sunscreen and avoiding peak hours. “Be reasonable. Don’t be the one who goes out into the sun first and comes back last.

: Who gets lupus?
A: Anyone can get lupus. But 9 out of 10 people who have lupus are women. African American women are three times more likely to get lupus than white women. Lupus is also more common in Hispanic/Latina, Asian, and Native American women.
African Americans and Hispanics/Latinos tend to get lupus at a younger age and have more symptoms, including kidney problems. Lupus also tends to be more severe in these ethnic groups. For example, African Americans with lupus have more problems with seizures and strokes. Hispanic/Latino patients have more heart problems. Scientists believe that genes play a role in how lupus affects these ethnic groups.
It is estimated that between 161,000 and 322,000 adults in the U.S. have SLE. Nine out of 10 people who have lupus are women. African American, Latina, Asian, and Native American women are at greater risk of getting lupus than white women.
Q: Why is lupus a concern for women?
A: Nine out of 10 people who have lupus are women. And lupus is most common in women of childbearing years. Having lupus increases your risk of developing other health problems that are common in women. It can also cause these diseases to occur earlier in life:
• Heart disease. When you have lupus you are at increased risk for the main type of heart disease, called coronary artery disease (CAD). This is partly because people with lupus have more CAD risk factors, which may include: high blood pressure (hypertension), high cholesterol levels, type 2 diabetes, and an inactive lifestyle due to fatigue, joint problems, and/or muscle pain. Heart disease is the number one killer of all women. But, women with lupus are 50 times more likely to have chest pain or a heart attack than other women of the same age.
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U.S. Department of Health and Human Services, Office on Women’s Health

TDD: 1-888-220-5446
• Osteoporosis (OSS-tee-oh-puh-ROH-suhss). Women with lupus have more bone loss and breaks than other women. This is thought to happen because some medicines used to treat lupus cause bone loss. Bone loss also may occur as a direct result of the disease. Also, pain and fatigue can keep women with lupus from exercising. Keeping active is an important way to keep bones healthy and strong.
Q: What causes lupus?
A: The cause of lupus is not known. More than one factor is likely to play a role in getting lupus. Researchers are looking at these factors:
• Environment (Sunlight, stress, certain medications, and viruses might trigger symptoms in people who are prone to getting lupus.)
• Hormones (Lupus is more common in women during childbearing years.)
• Problems with the immune system
You can’t catch lupus from another person, and it isn’t related to AIDS.
Q: What are the symptoms of lupus?
A: The signs of lupus differ from person to person. Some people have just a few symptoms; others have more. Lupus symptoms also tend to come and go. Lupus is a disease of flares (the symptoms worsen and you feel ill) and remissions (the symptoms improve and you feel better).
Common signs of lupus are:
• joint pain and stiffness, with or without swelling
• muscle aches and pains
• fever with no known cause
• feeling very tired
• skin rashes
• anemia (uh-NEE-me-uh) (too few red blood cells)
• trouble thinking, memory problems, confusion
• kidney problems with no known cause
• chest pain when taking a deep breath
• butterfly-shaped rash across the nose and cheeks
• sun or light sensitivity
• hair loss
Less common symptoms include:
• blood clots
• purple or pale fingers or toes from cold or stress
• seizures
• sores in the mouth or nose (usually painless)
• severe headache
• dizzy spells
• “seeing things”, not able to judge reality
• feeling sad
• strokes
Q: What are flares?
A: The times when your symptoms worsen and you feel ill are called flares. Flares tend to come and go. You may
Fr equent l y As k ed Que s t ions
U.S. Department of Health and Human Services, Office on Women’s Health

TDD: 1-888-220-5446
have swelling and rashes one week and no symptoms at all the next. Even if you take medicine for lupus, you may find that some things trigger your symptoms to flare. You may find that your symptoms flare after you’ve been out in the sun or after a hard day at work. Common triggers include:
• overwork and not enough rest
• stress
• being out in the sun or close exposure to fluorescent or halogen light
• infection
• injury
• stopping your lupus medicines
• certain medications
See What can I do to control my lupus symptoms and prevent flares?
Q: How can a doctor tell if I have lupus?
A: Lupus can be hard to diagnose. It’s often mistaken for other diseases. Many people have lupus for awhile before they find out they have it. If you have symptoms, tell your doctor right away. No single test can tell if a person has lupus. But your doctor can find out if you have lupus in other ways, including:

  1. Medical history. Telling your doctor about your symptoms and other problems you have had can help him or her understand your situation. Keep track of your symptoms by writing them down. See the symptom checklist.
  2. Family history of lupus or other autoimmune diseases. Tell your doctor if lupus or other autoimmune diseases run in your family.
  3. Complete physical exam. Your doctor will look for rashes and other signs that something is wrong.
  4. Blood and urine tests. The antinuclear antibody (ANA) test can show if your immune system is more likely to produce the autoantibodies of lupus. Most people with lupus test positive for ANA. But, a positive ANA does not mean you have lupus. About 2 in 10 healthy people test positive for ANA. Positive tests also are seen in other conditions, such as thyroid disease, malaria, and other autoimmune diseases. That’s why your doctor will use many tools—and maybe other tests—to tell if you have lupus.
  5. Skin or kidney biopsy (BEYE-op-see). With a biopsy, doctors perform a minor surgery to remove a sample of tissue. The tissue is then looked at under a microscope. Skin and kidney tissue looked at in this way can show signs of an autoimmune disease.
    Together, this information can provide clues to your disease. It also can help your doctor rule out other diseases that can be confused with lupus.
    Q: How is lupus treated?
    A: There is no known cure for lupus, but there are treatments. Your treatment will depend on your symptoms and needs. The goals of treatment are to:
    • prevent flares
    • treat symptoms when they occur
    • reduce organ damage and other problems
    Fr equent l y As k ed Que s t ions
    U.S. Department of Health and Human Services, Office on Women’s Health
    TDD: 1-888-220-5446
    Your treatment might include using medicines to:
    • reduce swelling and pain
    • prevent or reduce flares
    • calm the immune system
    • reduce or prevent damage to the joints
    • reduce or prevent organ damage
    Drugs play an important role in treating lupus. Most likely, the drugs prescribed to you will change often during your treatment. Types of drugs commonly used to treat lupus include:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are used to reduce pain and swelling in joints and muscles. They can help with mild lupus—when pain isn’t too bad and vital organs are not affected. Aspirin, ibuprofen, and naproxen are some over-the-counter NSAIDs. You need a prescription
    Symptom Checklist
    Print out this table and use it to make notes to take to your doctor.
    Put a check mark beside the symptoms you have. Note when you have them.
    When did you first notice?
    How often?
    Recent dates?
    Example: rash
    face and chest
    2 years ago
    Once or twice a month
    9/17, 10/8, 10/23, 11/15
    Red rash or color change
    Painful or swollen joints
    Fever with no known cause
    Feeling very tired
    Trouble thinking, memory problems, confusion
    Chest pain with deep breathing
    Sensitivity to sun
    Unusual hair loss
    Pale or purple fingers or toes
    Sores in mouth or nose
    Adapted from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
    Fr equent l y As k ed Que s t ions
    U.S. Department of Health and Human Services, Office on Women’s Health
    TDD: 1-888-220-5446
    for stronger NSAIDs. NSAIDs can cause stomach upset, heartburn, drowsiness, headache, fluid retention, and other side effects. NSAIDs also can cause problems in your blood, liver, and kidneys if overused.
    Never take vitamins or herbal supplements without talking to your doctor first. They might not mix well with medicines you use to treat lupus.
    • Corticosteroids. Corticosteroids (KOR-tih-koh-STAIR-oyds) are hormones found in our bodies. Manmade versions are used to reduce swelling, tenderness, and pain in many parts of the body. In high doses, they can calm the immune system. Often, these drugs are called “steroids.” They are different than steroids used by some people who play sports or lift weights. Corticosteroids come as pills or liquids, creams to apply to the skin, and as a shot. Prednisone (PRED-nuh-sohn) is one drug commonly used to treat lupus. Lupus symptoms tend to respond very quickly to these powerful drugs. Once this has happened, your doctor will want to lower your dose slowly until you no longer need it. The longer a person uses corticosteroids, the harder it becomes to lower the dose. But stopping this medicine right away can harm your body. Make sure to use your medicine exactly as your doctor tells you to.
    Corticosteriods can have many side effects, so your doctor will give you the lowest dose possible. Short-term side effects can include: a round or puffy face, acne, heartburn, increased appetite, weight gain, and mood swings. These side effects typically stop when the drug is stopped. Long-term side effects can include: easy bruising, thinning skin and hair, weakened or damaged bones, high blood pressure, damage to the arteries, high blood sugar, infections, muscle weakness, and cataracts. Your doctor can prescribe medicines to take with corticosteroids to prevent some side effects, such as osteoporosis.
    • Antimalarial drugs. Medicines used to prevent or treat malaria are used to treat joint pain, skin rashes, and mouth sores. Two common antimalarials are hydroxychloroquine (heye-DROK-see-KLOR-uh-kween) (Plaquenil®) and chloroquine (KLOR-uh-kween) phosphate (Aralen® phosphate). Side effects of antimalarials can include stomach upset, nausea, vomiting, diarrhea, headache, dizziness, blurred vision, trouble sleeping, and itching.
    • Immunosuppressive agents/chemotherapy. These agents are used in severe cases of lupus, when major organs are not working well and other treatments do not work. These drugs suppress the immune system to limit the damage to the organ. Examples are azathioprine (az-uh-THEYE-uh-preen) (Imuran®) and cyclophosphamide (seye-kluh-FOSS-fuh-myd) (Cytoxan®). These drugs can cause serious side effects including nausea, vomiting, hair loss, bladder problems, decreased fertility, and increased risk of cancer and infection.
    Fr equent l y As k ed Que s t ions
    U.S. Department of Health and Human Services, Office on Women’s Health
    TDD: 1-888-220-5446
    You and your doctor should review your treatment plan often to be sure it is working. Tell your doctor about any side effects or if your medicines no longer help your symptoms. Tell your doctor if you have new symptoms. Never stop or change treatments without talking to your doctor first. Also, it is likely that you will need other drugs to treat conditions that are linked to your lupus—such as drugs to treat high blood pressure or osteoporosis.
    Q: Will I need to see a special doctor for my lupus?
    A: Depending on your symptoms and/or if your organs have been hurt by your lupus, you may need to see special kinds of doctors. Start by seeing your family doctor and a rheumatologist (ROOM-uh-TOL-uh-jist), a doctor who specializes in the diseases of joints and muscles such as lupus.
    Your rheumatologist may ask that you also see:
    • a clinical immunologist (im-yuh-NOL-uh-jist), a doctor who treats immune system disorders
    • a nephrologist (nuh-FROL-uh-jist), a doctor who treats kidney diseases
    • a hematologist (hee-muh-TOL-uh-jist), a doctor who treats blood disorders
    • a dermatologist (dur-muh-TOL-uh-jist), a doctor who treats skin problems and diseases
    • a neurologist (noo-ROL-uh-jist), a doctor who treats problems with the nervous system
    • a psychologist (seye-KOL-uh-jist)
    • an occupational (ok-yuh-PAY-shuh-nul) therapist
    • a social worker
    Q: What can I do to control my lupus symptoms and prevent flares?
    A: The best way to keep your lupus under control is by following your treatment plan and taking care of yourself. Take these steps:
    • Learn how to tell that a flare is coming.
    • See your doctors regularly.
    • Maintain life balance by setting realistic goals and priorities.
    • Limit the time you spend in the sun and in fluorescent and halogen light.
    • Maintain a healthy diet.
    • Develop coping skills to help limit stress.
    • Get enough sleep and rest.
    • Exercise moderately with your doctor’s okay and when you’re feeling up to it.
    • Develop a support system made up of people you trust and can go to for help.
    Despite your best efforts to follow your treatment plan and take good care of yourself, there will be times when your lupus symptoms are worse. Being able to spot the warning signs of a flare can help you prevent the flare or make it less severe. Before a flare your symptoms might get worse, or you might get new symptoms, such as:
    • feeling more tired
    • pain
    • rash
    Fr equent l y As k ed Que s t ions
    U.S. Department of Health and Human Services, Office on Women’s Health
    TDD: 1-888-220-5446
    • fever
    • stomach ache
    • severe headache
    Contact your doctor right away if you suspect a flare is coming.
    Q: Living with lupus can be hard. How can I cope?
    A: Dealing with a long-lasting disease like lupus can be hard on the emotions. Concerns about your health and the effects of your lupus on your work and family life can be stressful. Changes in the way you look and other physical effects of lupus and the medicines used to treat lupus can bring on body image issues and affect self-esteem. Your friends, family, and coworkers might not seem to understand how you feel. At times, you might feel sad or angry. Or, that you have no control over your life with lupus. But there are things you can do that will help you to cope and to keep a good outlook:
    • Pace yourself. People with lupus have limited energy and must manage it wisely. Most women with lupus feel much better when they get enough rest and avoid taking on too much at home and at work. To do this, pay attention to your body. Slow down or stop before you’re too tired. Learn to pace yourself. Spread out your work and other activities.
    • Reduce stress. Exercising with your doctor’s okay, finding ways to relax, and staying involved in social activities you enjoy will reduce stress and help you to cope.
    • Get support. Be open about your feelings and needs with family members and close friends. Consider support groups or counseling. They can help you to see that you are not alone. Group members teach one another how to enjoy life with lupus.
    • Talk to your doctor. The symptoms of lupus and some medications can bring on feelings of depression. Don’t be afraid to talk to your doctor about these feelings.
    • Learn about lupus. People who are well-informed and involved in their own care have less pain; make fewer visits to the doctor; feel better about themselves; and remain more active.
    Q: I have lupus. Is it safe for me to become pregnant?
    A: Women with lupus can safely become pregnant. If your disease is under control, pregnancy is unlikely to cause flares. But there are some important things you should know before you become pregnant:
    • Your disease should be under control or in remission for 12 months before you get pregnant. Getting pregnant when your lupus is active could result in miscarriage, stillbirth, or other serious problems. Planning ahead is critical if you have lupus.
    • Some women do develop flares during pregnancy. The flares happen most often in the first or second trimester or in the first few months after you have the baby. Most flares are mild and easily treated with proper medical care.
    • Preeclampsia (pree-ee-KLAMP-see-uh), or “toxemia”, is a serious condition that must be treated right