Lupus, SLE (Systemic
Lupus Erythematosus)

Any value less than 40 is considered a normal ANA level and called a negative test result.  Normal levels of ANA virtually rule out active SLE. [Med Clin North Am 81(1): pp.113-28, Jan. 1997]

Approximately 80% of patients with SLE have dermatological manifestations during the course of their illness.  The acute skin eruption manifests itself as a photosensitive rash which often has a butterfly appearance and involves the bridge of the nose and cheeks.  A feature of this rash is a sparing of the crease seen on the sides of the mouth when smiling.  Photosensitivity is less common in patients of color but occurs in 50% of all patients with SLE.

Prolonged or extreme fatigue is reported by 81% of lupus patients.

90% of patients with SLE experience fatigue.

Sun or light sensitivity (photosensitivity) is experienced by 30% of sufferers.

Mouth or nose ulcers have been reported by between 12% and 30% of lupus patients, depending on the study.  They most often occur in the mouth on the hard or soft palate but may also be found on the nasal septum.

Lupus patients have abnormalities in their immune systems that predispose them to develop infections.

A less common but more serious constitutional feature of SLE is persistent fever.

Fever of more than 100F (38C) is reported by 90% of lupus patients.

Muscle pains are a common symptom of SLE.  Less common is actual muscle inflammation which occurs occasionally during the course of SLE.

Inflammation of the nail fold (red, puffy skin around the nail) may indicate lupus or another connective tissue disorder.

Pain in the chest on deep breathing (pleurisy) is experienced by some 45% of lupus patients.

Sore throat or pain on taking a deep breath may occur with a flare of lupus.

Lupus patients often complain of prolonged morning stiffness or pain which may last 45 minutes or longer.

Most patients with SLE have musculoskeletal symptoms.  The typical clinical manifestations are arthralgia, reported by 95% of patients, and arthritis (swollen joints) by 90%.  The joints most commonly involved are the index finger, wrist and knees.  Lupus is rarely accompanied by actual joint erosion.

Lupus patients often complain of prolonged morning stiffness or pain which may last 45 minutes or longer.

Skin rashes are reported by 74% of lupus sufferers.

Approximately 10% of lupus patients have thyroid antibodies, and autoimmune thyroiditis occasionally coexists with SLE.

In the vasculitis caused by lupus, the antigens causing the immune complexes are often not known.  In some cases, the complexes contain DNA and anti-DNA antigens, or Ro (also called SS-A) and anti-Ro antigens.  Another antibody, ANCA (anti-neutrophil cytoplasm antibody), can cause vasculitis in some individuals.

Lupus patients are at an unusually high risk for contracting candida (yeast) infections.

Lupus patients are at an unusually high risk for contracting candida (yeast) infections.

Infections of the urinary tract are common in lupus patients.

Lupus patients are at an unusually high risk for contracting herpes zoster.

Lupus is suggested if thrombocytopenia (a low platelet count of under 100,000 platelets per cubic millimeter) is detected in the absence of drugs that are known to induce it.

Seizures have been found to complicate the course in between 15-25% of patients with lupus, depending on the study quoted.

Infections of the respiratory tract are common in lupus patients.

Alopecia occurs in 50% of patients.  Typically manifested as reversible hair thinning during periods of disease activity, it is demonstrated by the ease with which hair can be plucked from the scalp and the development of "lupus hairs" (i.e. short strands at the scalp line).  Following an acute attack of SLE, usually with fever, patients may experience much generalized hair loss.  This results from a period of arrested hair growth during the acute episode.

Interstitial cystitis patients have been found to be 30 times more likely to have systemic lupus erythematosus.

Some patients diagnosed SLE may in fact be suffering the results of gluten intolerance.  In these cases, removing gluten from the diet may completely cure the patient. [Annals of the Rheumatic Diseases (2004; 63: pp1501-3)]

Numerous studies have confirmed premature, accelerated atherosclerosis in SLE patients.  Although the exact cause is not known at this point, atherosclerotic heart disease is a common cause of morbidity and death amongst lupus patients.

Lupus patients are at an unusually high risk for contracting candida (yeast) infections.

Lupus patients are at an unusually high risk for contracting herpes zoster.

Lupus patients are at an unusually high risk for contracting candida (yeast) infections.

Seizures have been found to complicate the course in between 15-25% of patients with lupus, depending on the study quoted.

Muscle pains are a common symptom of SLE.  Less common is actual muscle inflammation which occurs occasionally during the course of SLE.

Lupus is one of the auto-immune diseases, caused by a hyperactive ("hypervigilant") immune system that attacks a person's own protein as if it were foreign matter.  One reason for this is poor adrenal function.  Adrenal steroids modulate (slow down) the immune system: when there is not enough of these steroids the immune system goes berserk.

Low blood levels of the hormone DHEA have been associated with more severe symptoms in people with SLE.  Preliminary trials have suggested that 50 to 200mg per day DHEA improved symptoms in people with SLE.  One double-blind trial of women with mild to moderate SLE found that 200mg of DHEA per day improved symptoms and allowed a greater decrease in prednisone use, but a similar trial in women with severe SLE found only insignificant benefits.

Anemia as a result of chronic inflammation is a characteristic but not especially common feature of active SLE.

Raynaud's phenomenon has been observed in 17-30% of patients with SLE, depending on the study.

The miscarriage rate in SLE patients is much higher than that of the general population.  Although most women who suffer recurrent miscarriages do not have clinical signs of SLE, many exhibit autoimmune phenomena which is similar to that seen in SLE patients.

Active lupus and an infection may share many symptoms.  Further, infection can induce a lupus flare or be difficult to distinguish from a lupus flare.  A low white blood cell count is suggestive of active lupus (although certain viruses can also give a low white count) while a high count suggests infection.

Vascular or migraine headaches occur in 10% of lupus patients.

There is a possible defect in the metabolism of essential fatty acids (EFAs) in systemic lupus erythematosus (SLE).  In order to verify this possibility, doctors in one study measured the plasma levels of various EFAs and their metabolites in SLE.  These results showed that amongst SLE patients the concentrations of Omega-6 and Omega-3 oils or metabolites were low.  Even small doses of fish oils (which contain EPA and DHA) have been shown to help.

Diverse kidney problems can arise from the deposition of circulating immune complexes in the kidneys.  Lupus, being an auto-immune disease, causes the immune system to attack the body's own tissues.  The commonly affected organs/tissues are skin, joints, nervous system and kidneys.

Alopecia occurs in 50% of patients.  Typically manifested as reversible hair thinning during periods of disease activity, it is demonstrated by the ease with which hair can be plucked from the scalp and the development of "lupus hairs" (i.e. short strands at the scalp line).  Following an acute attack of SLE, usually with fever, patients may experience much generalized hair loss.  This results from a period of arrested hair growth during the acute episode.

Systemic Lupus Erythematosus (SLE) is an autoimmune disease sometimes misdiagnosed as retinitis pigmentosa. [Am J Ophthalmol, 1996 Dec, 122:6, pp.903-5 Abstract]

Lyme arthritis is often mistaken clinically for systemic lupus erythematosus.

Through his clinical experiences with thymic supplementation, Dr. Burgstiner said he observed 12 cases of systemic lupus go into remission.  Some of the patients were using as many as 22 different drugs and are now diagnosed as asymptomatic.

Amongst patients with lupus nephritis who were unresponsive to prednisone and other immunosuppressive drugs, combined administration of prednisone and TP (polyglycoside extract of Tripterygium wilfordii Hook F) resulted in reduction or even complete disappearance of protein in the urine in 40-50% of cases.  Many side-effects, however, have been reported. [Chin Med J (Taipei) 1996; 57: S35]

Animal-based proteins (beef and milk) seem to be the prime offenders in aggravating the symptoms of Lupus.  However, certain plant-based proteins appear also to be.  These include soy beans, corn, spinach and carrots. [Scandinavian Journal of Gastroenterology 1982;17: pp.417-24]

Alfalfa sprouts and legumes, to a lesser extent, should also be avoided as the constituent L-canavanine causes SLE-like diseases in primates. [Acta Medica Scandinavica 1984;216: pp. 67-274]  Peas and lima beans are alright to eat in this regard.

Lupus flare-ups have also been reported after the ingestion of large amounts of foods containing psoralens (celery, celery salt, parsnips and figs).

A one-month trial period of avoiding dairy products and foods containing gluten/gliadin should indicate whether there is going to be any change in symptoms or lab values in individual patients.  If there are improvements then these foods will need to be avoided on a permanent basis.

If there is kidney involvement, bromelain can be added as a cleansing agent.  Flax oil or fish oil along with bromelain between meals is a good natural anti-inflammatory combination.

Stomach acid levels are generally lower in patients with autoimmune diseases.  Inadequate digestion can add to the immune system malfunction.

Hair dyes contain high levels of hydrazines and other similar chemicals that are absorbed through the scalp, thus increasing the risk of contracting Lupus. [Am J Med 1983;75: pp.365-70]  Hydrazines are also present in mushrooms, some food dyes, tobacco smoke and some cooked foods, especially meats.

There is an acceleration of the testosterone-to-estradiol conversion by an increase in aromatase activity in healthy SLE patients when compared to controls.  According to [Lupus 1992;1(3): pp.191-5], "among SLE patients the aromatase activity varied inversely with the disease activity.  Patients with SLE had decreased androgen and increased estrogen levels.  Aromatase activity in SLE patients had significant direct correlation with estrogen levels.  These data suggest that abnormal regulation of aromatase activity may partially explain the abnormalities of estrogen synthesis in SLE." These patients are relatively testosterone deficient.  Aromatase blockers such as DIM and Chrysin should be considered in such cases.

DHEA is almost always low in patients with autoimmune conditions such as SLE.

"MSM has been shown to be clinically helpful in lupus and may be beneficial in other autoimmune disorders as well." [Stanley W. Jacob, M.D.]

Flax seed oil and/or fish oil have been shown to reduce the severity of the disease in animal studies.  One tablespoon flax seed oil bid is recommended.

Vitamin B6 at a dosage of 500mg tid causes some patients to feel better.  Side effects such as pain, numbness and weakness in the limbs are a possibility at this dose.  If found to be beneficial, supplementation may need to be long term or permanent.