LUPUS

You form antibodies or lymphocytes that attack your tissues; you destroy yourselves.  LUPUS, a family of autoimmune conditions, ravages your body, especially systemic lupus erythematosus (SLE). Your immune system, which normally works to protect you from illness, mutates into a devouring, cannibalistic animal intent on destroying your body.  The potential for this destruction hides in your deoxyribonucleic acid (DNA). DNA contains the molecular basis of your heredity and is localized in your cell nuclei.

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LUPUS can attack any system of your body. When this occurs the doctor that you will become familiar with is a Rheumatologist.  This type of specially trained physician deals with acute diseases that are characterized by fever, inflammation and pain in and around the joints, and by inflammation of the membranes surrounding the heart and the heart valves.

Being diagnosed with LUPUS often sets you up to be diagnosed for other chronic diseases in the autoimmune spectrum; conditions such as rheumatoid arthritis, fibromyalgia, cataracts, glaucoma and interstitial lung disease (ILD).  An article in Arthritis Today (Jan/Feb 2016) states that the associated chronic conditions are collective called “Co-morbidity.” Often these medical conditions occur together, although the reason is unclear and it’s virtually impossible to know which comes first.

Since your immune system normally destroys viruses and other invading organisms that cause you illness, the same is true when this system’s potential for destruction is activated by a stressor.  However,  when this activation occurs, your immune system views your body as the invading organism and vigilantly destroys you. Since this activation sets off  chronic inflammation, your body is under attack – forever.  LUPUS is a slow, ever-invading, ever-destroying medical condition.  As I stated before, LUPUS can attack any system in your body.

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So, when you see your Rheumatologist you may be diagnosed with inflammation in multiple parts of your body.  Your joints could be stiff, swollen, hot and painful; your muscles may be achy; fluid may have accumulated around your heart; the functioning of your kidneys may not be working to produce clear urine or the urine may contain small particles of blood; thought processes may have become fussy or slow for you because the chronic inflammation of LUPUS has clouded the functions of your brain; your GI tract is out of sync and you are experiencing either diarrhea or constipation – all symptoms of LUPUS but only one medical condition on the autoimmune spectrum.  Your immune system’s mutation hypervigilance mobilizes and releases pro-inflammatory cytokines and tumor necrosis factor when it senses an invading entity.  This hypervigilance is activated by a stressor.  This stressor can be whatever each individual perceives as a stressor;  prolonged sleep deprivation, suffering from a cold or respiration infection, enduring intense psychological stress or being threatened by a physical danger.  Any or all of these situations can trigger a genetic potential for an autoimmune disease.

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The horizon looks better.  Recent research and current collective medical collaboration provides more treatment options.  Even though your body may be swollen, tired and painful, research shows that moderate exercise will improve your overall health and endurance level.  However, there are a few tips to keep in mind when you put your exercise plan into action.  When you turn your body, do so slowly.  Plan out your route so that you can decrease the number of turns and direction changes.  This will reduce your chance of “tripping over your own feet.”  As you turn, take multiple, small steps and lift your feet instead of pivoting.  Keep your feet under your hips – not too close together or too far apart, as either can cause your to lose your balance (Arthritis Today Mar/Ap. 2018). Also, take advantage of technology.  There are trackers and websites that can help.  You can monitor your symptoms, improve your health, stay on top of your medications, boost your overall fitness and thereby put your e-health to good use.

There are some basic truths about LUPUS that research has made more evident.  – You are a vital part of the health care team – pain medication may be helpful in your care plan – some people may experience medication side effects – pain can signal joint injury or overuse – some people with LUPUS can work by arranging flexible hours – medications won’t cure LUPUS – protecting your joints is vital- let your doctor know your medical history – ask questions of your medical provider.

Selma Gomez was diagnosed with LUPUS and recently underwent a kidney transplant in 2017; her friend Francia Raisa, donated a kidney.  This is just an example of the multiple medical advances in technology surrounding autoimmune conditions.  A few years ago this kind of event would not have been released to the news media.

Over time, LUPUS inflammation will cause damage in the joints and the muscles, tendons and ligaments that support them.  According to Philip J. Mease MD, Director of Rheumatology clinical research at The Swedish Medical Center and clinical professor of medicine at the University of Washington in Seattle, the goal in treating patients with LUPUS is to achieve either a state of remission or low disease activity.  Standard therapy usually begins with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to relieve joint symptoms. Methotrexate, alone or with other medication, can be a valuable option.  Methotrexate is referred to as a traditional disease-modifying antirheumatic drug (DMARD); it blocks several enzymes involved in the immune system.  The next step is usually to advance toward biologics.  Biologics block proteins or they target T-lymphocytes (T-cells) that play a key role in many inflammatory diseases.  Biologics are genetically engineered from a living organism, such as a virus, gene or protein,  Because they’re grown in labs, and not made from chemicals like many other drugs, they cost more to produce. And because they suppress the immune system, they can increase the risk of infections.  However, biologics may lose their effectiveness over time.  That’s why ongoing drug discovery is so important.  The overall goal of caring for LUPUS patients is controlling the disease activity, making people more comfortable and improving their daily functioning.

You play a vital part in the “exercise-medication” program.  Adhering to the mutually-agreeable upon medical plan devised by you and your medical provider will help to ensure that you modify some joint destruction and disability. Once you’re diagnosed with LUPUS it’s a journey of personal discovery between you and your doctor.

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Ghrelin

GHRELIN is an interesting hormone.  According to a recent article in WebMD (July/Aug 2018), this hormone is released from your stomach in large quantities when you lose weight.  So, while you’re trying to reduce your weight, you’re releasing a hormone to encourage yourself to eat more so that you’ll gain weight!  Not only that, the hormone ghrelin doesn’t level off after this roller-coaster ride.  After you have been successful in losing weight, your body does what ever it can to make you fat again.  That’s why researcher say that struggles with obesity and weight maintenance are a lifelong pursuit.  Looking at your relationship with GHRELIN is definitely an intimate experience. The reason why is because this same hormone is your “hunger” hormone.  It plays a pivotal role in helping you to maintain a healthy weight.  Looks like this is another situation where you get the opportunity to make healthy food choices.  Where have we heard that before?  I know – everywhere…

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 A Medscape article (11/4/2016) citing Dr. Kevin Hall from the National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, in Bethesda, Maryland, states “that metabolism slows when patients lose weight.”  He goes on to encourage medical providers to be aware that two processes are at work simultaneously: an increased appetite and a slowed metabolism.  This awareness may lead medical provider to develop new treatment guidelines for their patients.  Dr. Hall also goes on to highlight the fact that the few individuals who successfully maintain weight loss over the long term do so by heroic and vigilant efforts.

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A white paper by FAIR Health, a national nonprofit organization, reports that the number of children and adolescents diagnosed with type 2 diabetes has more than doubled in recent years and the increase appears to coincide with a rise in obesity rates and other obesity-related conditions (1/20/2017).  This report is based on actual health insurance claims for a privately insured population.  However, the CDC (Center for Disease Control) shows that there is a “fairly stable” obesity prevalence rate for children and adolescents. The difference between these reports is that the CDC survey is based on interviews and physical exams of a cross-sectional civilian population.  However, each study reports a correlation between age and obesity; that means as our children get older they are getting fatter.

Weighty matters continue to be of concern in the U.S.  In 25 states, laws now require that public schools monitor children’s body mass index (BMI) to identify overweight and obese students.  Fewer than half of the parents receiving their child’s health report card accepted the school’s assessment of their child’s weight (WebMD July/Aug 2018). This may indicate that many parents see excess weight as normal.  An article in WebMD Sept. 2018 issue indicates that more than 50% of babies born in the U.S. since 2000 could live to be at least 100 years of age.  However, this golden centenarian age will definitely be decreased by the increasing prevalence of childhood obesity.

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Since we have a lifelong relationship with GHRELIN, we may want to monitor our young children in the basic facts of good nutrition.  Sometimes children view pictures of thin, photo-shopped models portrayed in posed-positions representing unattainable body images inconsistent with life and believe that these photos are the standard of success.  Other children may be dealing with obesity issues and use food as a coping mechanism. Whether you’re an adult challenged with your own weight management lifestyle or you’re a parent dealing with childhood anorexia or obesity, you may want to sharpen your nutrition knowledge about the hormone GHRELIN.

Rheumatoid Arthritis (RA)

Rheumatoid Arthritis (RA), according to an article in WebMD (5/2018), isn’t our grandparents’ arthritis. This form of arthritis is based in our autoimmune system.

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 Inflammation is the driving force behind many major disorders and rheumatoid arthritis is only one of them.  In a publication by the Arthritis Foundation (Vol.10, Issue 2),  RA Today – The theory is that when a person is genetically predisposed to develop RA, and when the inflammation from that disease flares, the increased inflammation is equivalent to a single match igniting lots of other fires in our body.

Systemic inflammation usually begins when our immune system pumps out inflammatory proteins (cytokines) when not needed.  Normally, our body releases a type of cytokines called TNF (tissue-necrotic factor).  TNF is released when our body is hurt or we have an infection.  TNF acts as a “troop leader” that recruits other cytokines into action.  This recruitment leads to an inflammation cascade that helps to fight off serious infections.   However, when TNF is called out without reason, the inflammation becomes destructive.

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 The article in RA Today states that rheumatoid arthritis occurs when immune cells invade our joints and start churning out TNF.  This invasion not only destroys the joints but other parts of our bodies as well, such as connective tissue i.e. muscles, tendons and ligaments around the joints.  This may be why people who have rheumatoid arthritis are also diagnosed with fibromyalgia.  TNF is mainly produced in fat cells. Yes, fat cells.  Now we all have another reason to maintain a healthy weight and live a healthy lifestyle.

There’s discussion around the issue of what causes RA.  Newer studies point to disruptions in the microbes – bacteria, yeasts and fungi – that play critical roles in regulating the immune system.  Other researchers document a genetic component; that is if your parent or grandparent had RA you have a greater chance of being diagnosed with RA.  Still other studies point to stress being the main culprit targeting and disrupting the immune system. Whatever the cause, RA is variable because it’s autoimmune.  Meaning that symptoms can “come and go” and it can be diagnosed in both children and adults.  One thing is certain, RA can affect every organ of the body – eyes, mouth, skin, heart, kidneys, lungs, etc.  The most debilitating symptom is fatigue.  Up to 98% of people with RA report that they suffer from this “RA fatigue.”

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 Sleeping will not satisfy this fatigue although rest will help you stay healthier.  This type of fatigue can be relieved, in part, by medication because the medication brings down the inflammation.   If you’re diagnosed with RA there are some steps that you can take to foster better health for yourself.  The first is to maintain contact with good medical providers who are involved in your care.  This is a vital step.  Getting evidence-based, medically-accepted care early in your treatment process is important in managing your care.  Another wise step is to stop smoking or using tobacco products if you are currently doing so.  Also maintaining a healthy weight by eating a balanced diet and exercising to tolerance is helpful. Research shows that people with RA who are obese are more likely to develop type 2 diabetes.

New drugs are also on the horizon.  Disease-modifying antirheumatic drugs (DMARDs) are effective but must be used under the direction of a medical provider.  Some new biologics have been shown to be extremely effective in reducing inflammation, halting joint destruction and easing pain.  The number of patients undergoing joint replacements in the last two decades for RA has decreased dramatically.

Arthritis Today states in an article entitled “Chronic Pain & The Brain” (Sept/Oct 2018) that patients with RA show the same brain changes for heightened pain sensitivity as people diagnosed with fibromyalgia.  Both patients have the same “pro-pain” changes.  This change occurs in the central nervous system (CNS) – the brain and spinal cord – where pain signals are processed.  This accounts for the fact that many people with RA have pain even when their inflammation is well controlled with medication.

Dr. M. Elaine Husni, director of the Arthritis Center at Cleveland Clinic, says: The earlier you start treatment, the better the response.