how is lupus diagnosed

1. What is systemic LUPUS erythematosus?

 

1.1 What is LUPUS

how is lupus diagnosed ? Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease that can affect different organs of the body, especially the skin, joints, blood, kidneys and central nervous system. "Chronic" means that it can go on for a long time. "Autoimmune" means a disorder in the immune system, instead of protecting the body from bacteria and viruses, it attacks the patient's own tissue.

The history of the name "systemic lupus erythematosus" is 20. Until the beginning of the century. "Systemic" means that it affects many organs of the body. "Lupus" derives from the Latin word "wolf" and refers to a characteristic, butterfly-like rash resembling the white markings on the face of the wolf. "Erythematosus", which means "red" in Greek, corresponds to the redness of the skin rash.

1.2 How common is it?

 

SLE is known all over the world. The disease is more common in African-Americans, originally Hispanic, Asian and Native American. In Europe, approximately 2,500 people were diagnosed with a SLE and 15% of all lupus patients were diagnosed before the age of 18. It is rare for SLE to start before the age of five, and it is not uncommon to start before puberty. If SLE is seen before the age of 18, physicians use different names such as pediatric SLE, juvenile SLE and childhood onset SLE. Women in the fertile age (15-45) are most frequently affected, and the proportion of women affected by the disease in this group of Ages is nine. The proportion of male children who have been infected before puberty is higher and one of the children of every five SLE patients is male.

 

1.3 What are the causes of the disease?

Antif SLE is an autoimmune disorder that is not contagious, the ability of the immune system to differentiate between a foreign substance and the person's own tissues and cells is lost. In addition to other substances, the immune system produces autoantibodies that mistakenly detect the person's normal cells as strangers and attacks the cells. This results in an autoimmune reaction that causes inflammation in some organs (joints, skin, kidneys, etc.). The meaning of inflammation is that the affected body parts become heated, fried, swollen, and sometimes delicate. As can be in SLE, if the symptoms of inflammation persist for a long time, damage to the tissues may occur and normal functions are disrupted. Therefore, treatment in SLE aims to reduce inflammation.

Along with random environmental factors, several hereditary risk factors are thought to be responsible for the abnormal immune response we have mentioned. In addition to hormonal irregularities and stress in puberty, it is known that SLE can be triggered by environmental factors such as sun exposure, viral infections and medications (e.g. isoniazide, Hydralazine, procainamide, anti-seizure drugs).

 

1.4 hereditary?

SLE can be familial. Children may be able to isolate some of the genetic factors that are yet unknown to their parents, which makes them prone to SLE development. This is more likely to be caught in the disease, although it does not necessarily mean that it is pre-specific to develop SLE. If two single eggs were diagnosed with SLE in one of the twins; The risk of SLE is not more than 50%. No genetic testing or prenatal diagnosis is available for SLE.

 

1.5 preventable?

SLE cannot be prevented, but the affected child should refrain from certain circumstances (e.g. sun exposure, some viral infections, stress, hormones and some medications) that trigger or induce the onset of the disease.

 1.6 contagious?

SLE is not contagious. I mean, it's not from one person to another.

 

 

1.7 What are the main symptoms?

 

The disease can start slowly with the emergence of new symptoms in weeks, months, and even years. Complaints that are not specific to this disease, such as fatigue and weakness in SLE children, are the most frequent onset relatives. Most children with SLE have intermittent or sustained fever, weight loss and loss of appetite.

In time, many children develop disease-specific complaints caused by the involvement of one or several organs. Skin and mucosal involvement is very common and can contain different skin rashes, light sensitivity (triggering exposure to sunlight) and ulcers in the nose or mouth. The typical ' butterfly ' rash around the nose and cheeks is seen in half of the affected children with one third. Sometimes increased hair loss (alopecia) may be noticeable. When exposed to cold, flushing, whitening and bruising can be seen in hands (Reynaud's phenomenon). Symptoms include joint swelling and stiffness, muscle pain, anemia, easy bruising, headache, seizures and chest pain. Most children with SLE have a degree of kidney involvement and this involvement is the main factor that determines the long-term outcome of the disease.

The most common symptoms of renal involvement include high blood pressure, blood and protein in the urine, especially the swelling of the feet, legs and eyelids.

 

1.8 is the disease the same in every child?

The symptoms of SLE vary between individual cases, so each child's profile and symptom list is different. The symptoms described above may all be at the onset of the disease or at any time during the course of the illness. Taking medications prescribed by your physician who is interested in Lupusla will help to control the symptoms of SLE.

 

1.9 is the disease in children different from the disease in adults?

SLE shows itself in children and adolescents in similar ways with SLE in adults. But in children, SLE is heavier. It is so; At any time, children often show serious inflammation properties from SLE. Children with SLE also consist of more kidney and brain disease than adults.

           

 

 

2. Diagnosis and Treatment

 

2.1 How is it diagnosed?

The diagnosis of SLE is put into a combination of symptoms (such as pain), findings (such as Fever), blood and urine tests after other diseases are excluded. Not all findings and symptoms are present at the same time, which makes it difficult to diagnose SLE quickly. To facilitate distinguishing SLE from other diseases, the American Rheumatology College (ACR) has prepared a list of 11 substances that point to SLE by a diagnostic criteria.

These criteria correspond to some of the most common symptoms/abnormalities observed in SLE patients. In order to diagnose a definitive diagnosis, a patient must have at least 4 of these 11 criteria at any time from the beginning of the disease. On the other hand, an experienced physician can diagnose SLE even when there are fewer than 4 criteria. The criteria mentioned include:

' Butterfly ' rash

A red rash occurring on the cheeks and the bridge of the nose.

 

Sensitivity to light

Sensitivity to light is an extreme skin reaction to sunlight. It's not usually covered in clothes.

 

Discoid lupus

The percentage is a coin shaped, scaly and fluffy rash seen in the scalp, ears, chest and arms. These lesions may leave a mark as they heal. Discoid lesions are more common in blacks than other races.

 

Mucosal ulcers

Small wounds that arise in the mouth or nose. It is usually painless, but nasal ulcers can cause nosebleeds.

 

Arthritis

Arthritis affects the majority of children suffering from SLE. It causes swelling and pain of other joints in the legs with hand, wrist, elbow, knee or arm. Pain can be a roaming, so it passes from one joint to the other and can be seen in the same joints on both sides of the body. SLE arthritis does not usually cause permanent changes (deformity).

 

Plörit

Pleuritis is a layer of the surrounding lung, and pericarditis is the inflammation of the pericardium that surrounds the heart. Inflammation in these delicate tissues can cause fluid accumulation around the heart and lung. Plörit causes an increased type of chest pain when breathing.

 

Kidney involvement

It has almost all of the children with SLE and varies from very mild to severe. Initially, it usually does not provide symptoms and can only be identified by blood tests for urine analysis and kidney function. In children with significant kidney damage, the swelling can be seen in the urine, especially in the blood and in the legs and in the feet.

 

 

Central nervous system

The emergence of central nervous system involvement; There are neuropsychiatric statements such as headaches, seizures and attention gathering and remembering difficulties, mood changes, depression and psychosis (a serious mental condition where thinking and behaviour deteriorates).

 

Blood cell disorders

These disorders occur because autoantibodies attack blood cells. The destruction of red blood cells (which carry oxygen from lung to other parts of the body) is called hemolysis, and as a result, hemolytic anemia may develop. This destruction can be relatively slow and light, and may be very fast and can cause an urgent situation.

The decrease in white blood cells is called leukopenia and is usually not dangerous in SLE.

Thrombocytopenia is called a decrease in platelet count. In children with decreased platelet count, easy bruising in the skin and bleeding in various parts of the body such as the digestive tract, urinary tract, uterus and brain can be seen.

 

Immunological disorders

These disorders correspond to the autoantibodies found in the blood and pointing to SLE:

A) presence of Anti-phospholipid antibodies (annex 1);

b) antibodies against their DNA (autoantibodies targeting the genetic structure within the cells). They are primarily seen in SLE. This test is often repeated because the amount of these antibodies that the person produces against his/her DNA increases while SLE is active and this test helps physicians measure the activity of the disease.

c) The Anti-Sm antibodies have been dedicated to the blood of a patient named Smith for the first time. These antibodies are almost specific to SLE and often help to verify the diagnosis.

 

Anti-Nuclear antibodies (ANA)

They are autoantibodies targeting nucleus cells called nucleus. It is found in the blood of almost all SLE patients. However, this test is not the proof of SLE alone, as the positive main test, as it is in other diseases and even mild degrees, while healthy children are 5-15 percent positive.

           

 

            2.2 What is the significance of tests?

Laboratory tests are helpful in deciding which internal organ involvement is in the diagnosis of SLE and if any. Regular blood and urine examinations are important in monitoring the activity and seriousness of the disease and determining how well the drugs are tolerated. In the placing of SLE, there are numerous laboratory tests that help assess which medications are prescribed and whether the medications being used are good for controlling SLE inflammation.

 

Routine clinical trials: it points to an active systemic disease where numerous organs are kept.

Both erythrocyte sedimentation rate (ESH, SE) and C-reactive protein (CRP) are increased in inflammation. In SLE, the CRP can be found normally while the ESH is increased. The increased CRP may be evidence of an additional infection.

Full blood count; Anemia can reveal the number of low platelets and white blood cells.

Serum protein electrophoresis can indicate the proliferation of gamma globulins (increased inflammation and autoantibody production).

Albumin: Low levels may mean kidney involvement.

The routine biochemistry panels can reveal kidney involvement (increase in serum blood urea nitrogen and creatinine, changes in electrolyte concentrations), liver function test abnormalities and muscle involvement, if any, increase in muscle enzymes.

Tests of liver function and muscle enzymes: if you have liver or muscle involvement, these enzymes will increase in levels.

Urine analysis is very important in the diagnosis of renal involvement in SLE and during the course of the disease. Urine analysis can show various findings of inflammation in the kidneys, such as red blood cells in urine or excessive amounts of protein. Occasionally, children with SLE may be asked to collect urine for 24 hours. In this way, early stage of kidney involvement may be detected.

Complement levels: Complement proteins are a part of the innate immune system. Some complement proteins (C3, C4) can be consumed in immune reactions and the low levels of these proteins are the signal of the presence of active disease, especially kidney disease.

There are many other tests nowadays to look at the effects of SLE on different parts of the body. If the kidneys are affected, the biopsy (taking a small piece of tissue) is frequently applied. Kidney biopsy provides valuable information about the type, degree and age of SLE lesions and is very useful in choosing the right treatment. A skin biopsy from a lesion can be beneficial in determining the nature of both skin vasculitis or discoid lupus, as well as a variety of skin rashes in a person with SLE. Other tests include lung film (X-rays of the heart and lungs), echocardiography (ECG), electrocardiogram for the Heart (ECHO), respiratory functions for the lungs, electroencephalography (EEG), magnetic resonance (MRI) and other brain scans. It's probably a variety of tissue biopsies.

 

2.3 Is it possible to cure/heal with full healing?

There is currently no disease-specific treatment that fully improves SLE. SLE therapy helps to control both the symptoms of SLE and to prevent complications including permanent damage to the organs and tissues caused by the disease. When the diagnosis of SLE is first diagnosed, the disease is usually very active. At this stage, you may need high doses of medications to control the disease and prevent organ damage. In many children, the fever of SLE is controlled by treatment, and the disease may enter the remission (the period in which the symptoms of the disease is lost) and the treatment should be minimal.

 

What are the 2.4 cures?

There is no approved medication for treating children with SLE. The vast majority of SLE symptoms are caused by inflammation, and therefore the treatment aims to reduce inflammation. There are five pharmaceutical groups, almost universally used in treating children with SLE:

 

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Inflammation medications such as ibuprofen or Naproksen (NSAIDs) are used to control the pain of arthritis. They are usually prescribed for a very short period of time and are advised to reduce the dose when arthritis is corrected. In this drug family, there are many different medications, including aspirin. Today, aspirin is rarely used for the inflammation effect. However, in children with elevated antiphospholipid antibodies, aspirin is widely used to prevent unwanted blood clotting.

 

Malaria Remedies

Drugs used against malaria, such as hydroxychloroquine, are very useful in the treatment of skin rashes in the type of discoid or sub-acute SLE rash and to control the sensitivity of the sun. It may take a few months to demonstrate the beneficial effect of these medicines. When these medications are applied early, it reduces the exacerbation of the disease, facilitates the control of kidney disease and seems to protect the cardiovascular system and other organ systems from damage. Sitm with SLE

           

 

Malaria Remedies

Drugs used against malaria, such as hydroxychloroquine, are very useful in the treatment of skin rashes in the type of discoid or sub-acute SLE rash and to control the sensitivity of the sun. It may take a few months to demonstrate the beneficial effect of these medicines. When these medications are applied early, it reduces the exacerbation of the disease, facilitates the control of kidney disease and seems to protect the cardiovascular system and other organ systems from damage. There is no known relationship between SLE and malaria. Moreover, Hydroxychloroquin is an important condition in malaria individuals, helping to regulate the abnormalities of the immune system in SLE.

 

Corticosteroids

Corticosteroids such as prednisone or prednisolone are used to reduce inflammation and suppress the activity of the immune system and constitute the basic treatment of SLE. In children with mild disease, corticosteroids and malaria medications may be the only treatment necessary. When the disease is more severe, the immune system is used in conjunction with suppressor (immune-suppressive) medications when the kidneys or other internal organs experience involvement. In the initial disease, it cannot be controlled without the use of daily corticosteroids that usually take weeks or months, and most children need these medications for years. The initial dose of corticosteroids and the frequency of application depends on the severity of the disease and the affected organ systems. High doses of oral or intravenous corticosteroids are often used to treat severe hemolytic anemia, central nervous system disease and heavier types of renal involvement. After a few days of using corticosteroids, children experience a significant sense of kindness and increased energy. After the initial emergence of the disease is taken under control, corticosteroids are lowered to the lowest possible dose that can protect the child's good form. Because of the suppression of disease activity, frequent monitoring of certain clinical and laboratory measurements to ensure that corticosteroids must be gradually reduced.

Adolescents may be tired of the side effects, maybe they tend to feel better or worse, so they can occasionally stop taking corticosteroids, reduce or increase the dose they receive. It is important that children and parents understand how corticosteroids work, how dangerous it is to leave or replace the drug without medical supervision. Some corticosteroids (cortisone) are normally produced in the body. When the treatment begins, the body responds by stopping its production of cortisone and the adrenal glands that produce it will be lazy.

If corticosteroids are suddenly interrupted after a long period of time, the body may not start producing enough cortisone for a while. The result could be a life threatening cortisone deficiency (adrenal insufficiency). In addition, lowering the dose of corticosteroid very quickly may cause the disease to be decreased.

 

Non-biological, disease-modifying drugs (DMARDs)

These medicines include Azathiprin, Methotreksat, Myofenolate mofetil and Cyclophosfamid. It affects a different way than corticosteroid medications and it prints inflammation. These medications are used when corticosteroids do not control SLE alone, and doctors reduce the daily doses of corticosteroids in order to reduce side effects while keeping the properties of SLE under control It helps.

Myofenolate is given as mofetil and Azathiopprin pill as cyclophosphamide pill or intravenous. Cyclosphosphamide therapy is used in children with severe central nervous system involvement. Methotretsat is given by injecting it into a pill or under the skin.

 

Biological Dmard

Biological Dmard (commonly known as biologic) contains agents that block the production of autoantibodies or the effect of a particular molecule. One of these drugs is the rhythm used when the standard treatment fails to control the disease. Belimumab is a biological drug that targets antibody-producing types of B-cells in the blood, and is approved for treating adult SLE patients. The use of biology for SLE in children and adolescents is still experimental in general.

The research in the field of autoimmune diseases and especially SLE is very intense. Future purpose; Determination of the mechanisms specific to inflammation and autoimmunity and ensuring that the treatment is aimed at the target without having to suppress the entire immune system. Nowadays there are many ongoing clinical trials about SLE. These studies include research and testing of new therapies to improve our knowledge of the different aspects of childhood SLE. Ongoing active research ensures that the future is increasingly hopeful for children with SLE.

 

 

            2.5 What are the side effects of drug therapy?

Medications used to treat SLE are very useful in treating the findings and symptoms. As with all medications, they can cause a variety of side effects (see the Drug Treatment section for a detailed description of the side effects.)

 

L = 15 * T1 > NSAIDs can cause side effects such as discomfort in the stomach (should be taken after meals), easily bruising and rarely changes in kidney or liver function. Malaria meds can cause changes in the retina of the eye. Therefore, patients should be examined regularly by ophthalmologist.

 

Corticosteroids can cause many side effects in both short and long term. Corticosteroids increase the risk of side effects when required in high doses and when used for long periods of time. The main side effects include:

Physical seemingly changes (e.g. weight gain, swollen cheeks, increased body hair growth, changes in skin with purple streaks, acne and easy bruising). Weight gain can be controlled with low calorie diet and exercise.

In particular, the risk of infections such as tuberculosis (tuberculosis) and chickenpox increases. A child who is experiencing corticosteroid field and chickenpox should see a doctor as soon as possible. Quick protection against Suflower can be provided by pre-prepared antibodies (passive immunization).

Stomach problems such as dyspepsia (indigestion) or combustion. This problem may require ulcer treatment.

Suppression of growth

The less seen side effects include:

High blood pressure

Weakness in the muscles (children may have difficulty getting out of the chair or climbing the ladder).

Deterioration in glucose metabolism, especially if there is genetic predisposition to diabetes.

Mood swings, such as depression and emotion-condition fluctuations.

Eye problems such as eye lens blur (cataract) and glaucoma (eye pressure).

Bone melting (osteoporosis). This side effect, exercise, the defeat of calcium-rich foods, is reduced by the intake of extra calcium and vitamin. These preventive measures should be applied as soon as the high dose corticosteroids begin.

It is important to know that most of the corticosteroid side effects are recycled and the dose is reduced or eliminated when it is cut.

(biologically or non-biological) Dmard may have some serious side effects.

 

2.6 How long should the treatment last?

Treatment should persist as long as the disease persists. In most children with SLE, the general consensus is that corticosteroid medications can only be cut completely. Long-term low-dose maintenance corticosteroid therapy can minimize the exacerbation of the disease and keep the disease under control. This may be the best solution for most patients to avoid the risk of exacerbation. Such low-dose corticosteroids have very little and generally mild side effects.

 

2.7 What can be said about non-standard/complementary therapies?

There are numerous complementary and alternative treatments, which can be confusing for patients and their families. The dangers and benefits of testing these therapies should be carefully considered because their proven benefits are very scarce and may be troublesome in terms of burden and material burden to the child. If you would like to assess complementary and alternative therapies, please consult these options with the pediatric rheumatology specialist. Some treatments can interact with the standard medication treatments. The majority of doctors will not be opposed as long as you follow medical advice. It's important that you stop taking your prescription medication. It can be very dangerous to stop taking them while the disease is still active when medications are required to control the disease. Please consult with your child's physician about the problems with medication treatment.

           

 

            2.8 What kind of regular checks are required?

Most of the situations that may arise in SLE, if detected early, can be prevented or easier to treat, it is often important to go to control. Children with SLE must be seen by a rheumatologist at least every three months. If necessary, the opinion of other experts can be consulted: Pediatric dermatologists (skin care), pediatric haematologists (blood disorders) or pediatric nephrologists (renal diseases). Social workers, psychologists, nutritionists and other professional health professionals are also involved in the care of SLE children.

Children with SLE should be regularly controlled by blood pressure measurement, urine analysis, full blood count, blood glucose analyses, coagulation tests, complement and autoantibody levels produced against their own DNA. During treatment with immunsuppressive agents, regular blood tests are mandatory to ensure that the blood cell levels produced by bone marrow are not too low.

 

2.9 How long is the disease?

As we mentioned above, there is no cure for SLE to heal with full healing. If medications are taken regularly and as prescribed by pediatric rheumatologist, SLE findings and symptoms can be minimized and even destroyed. In addition to other factors, infections, stress and sunlight may lead to worsening of SLE, as well as medications not being taken on a regular basis. This worsening is also known as the "Lupus atnet". It's usually very difficult to predict the course of the disease in advance.

 

2.10 How is the long-term departure (prognosis) of the disease?

The success of the disease under the use of Hydroxychloroquin, corticosteroids and dmard for an early and long period of time has ensured that SLE's results are greatly improved. Most patients with SLE that start in childhood maintain their lives well. Nevertheless, the disease can be severe and life-threatening and can remain active throughout adolescence and adulthood.

The prognosis of SLE in childhood depends on the severity of the internal organ involvement. Prominent kidney and central nervous system involvement requires aggressive treatment in children with considerable proportion. Unlike mild rash and arthritis, it can be easily controlled. However, it is relatively difficult to predict the prognosis of a child individually.

 

2.11 Is it possible to fully heal?

If it is diagnosed early and is treated appropriately in the early stages, this disease frequently sleeps and enters remission (all SLE findings and symptoms). But as we mentioned, it is a chronic disease that is difficult to predict SLE, and children diagnosed with SLE are normally kept in medical care by continuing medication. When the patient reaches adulthood, SLE should be followed by an expert who is interested in adult patients.


 

3. Daily life

 

3.1 How does the disease affect the daily life of the child and the family?

Children with SLE can maintain a fairly normal lifestyle after treatment. The exception is that it is exposed to UV light in extreme sunlight/nightclubs because it can trigger or aggravate SLE. The child with SLE should not stay on the beach all day, and should not be seated under the sun by the pool. Protection Factor (SPF) 40 and above solar creams are required to be used continuously. From the age of ten, it is important for children to take more responsibility for taking their medication and making choices about their personal care. Children and family must be aware of the symptoms of SLE so that they can distinguish a possible atnet. Some symptoms, such as chronic fatigue and reluctance, may be lasting for months after the end of the attack. It is important to perform regular exercise to maintain healthy weight, maintain bone health and condition.

 

3.2 How is school life affected?

Children with SLE can go to school outside of severe active illness periods and should go. If there is no central nervous system involvement, SLE does not usually affect the child's ability to learn and think. In the involvement of central nervous system, problems such as difficulty, headaches and mood changes can occur in the focus and remembering. In these cases, training plans must be regulated. In general, the child should be encouraged to participate in appropriate extracurricular activities as long as the disease is permitted. Teachers on the other hand should be aware of the diagnosis of the child's SLE; The convenience can be provided when there are problems associated with SLE, including joints and other bodily pains that may affect training.

           

 

3.3 Does affect sports?

Restrictions on general activity are often unnecessary and desirable. Regular exercise should be encouraged when the disease is in remission. Walking, swimming, cycling and other aerobic or outdoor activities are recommended. During outdoor activities, sun-protective suits, high-spectrum protection, sunscreen creams are advised to avoid exposure to sunlight during the sun's peak hours. Very tiring exercises should be avoided. Exercise should be restricted during the exacerbation of the disease.

 

3.4 How should nutrition be?

There is no special nutrition that can fully improve SLE. Children with SLE should follow a healthy and balanced diet. If they take corticosteroids, they need to eat poor food from sugar, sugar and diabetes to avoid high blood pressure. They also need to use calcium and vitamin D supplements to help prevent osteoporosis. Any other vitamin supplements are scientifically proven to be beneficial to SLE.

 

3.5 Does the climate affect the course of the disease?

It is well known that exposure to sunlight can lead to the development of new skin lesions and cause disease activity in SLE. To avoid this problem, it is advisable to use the high-protective sunscreen in all parts of the body, as long as the child is out. Do not forget to apply the sunscreen at least 30 minutes before you go outside to penetrate and dry the skin. On a sunny day, sunscreen should be applied every three hours. Some sunscreen is water resistant, but it is recommended to re-apply after bathing and swimming. The UV rays can easily pass through the clouds, even on cloudy days, while on the outside, the sun-protective clothing such as a wide-edged hat and long sleeve garments should be worn. Some children experience problems after exposure to UV light from fluorescent lamps, halogen lamps or computer screens. UV-filtered screens are useful for children who have trouble using the monitor.

 

3.6 Children can be vaccinated?

A child with SLE increases the risk of infection and therefore prevention of infections with immunization is especially important. If possible, the child must comply with the regular vaccination calendar. However, there are some exceptions: no vaccine should be made to children with severe and active disease; The children receiving immune suppressive treatment, high doses of corticosteroids and biological agents should not be administered in general live virus vaccine (e.g. measles, mumps and rubella vaccine, oral polio vaccine and chickenpox vaccine). Family members who are immune suppressive treatment should not be given oral polio vaccine in the same household. Pneumococcal, meningococcal and annual flu vaccines are recommended in children with SLE who take high doses of corticosteroids and/or immune suppressive drugs. HPV vaccination is recommended for male and female adolescent patients with SLE.

It is observed that the protection of vaccines with SLE lasts shorter. Therefore, children with SLE may need to be vaccinated more often than their peers.

 

3.7 What can be said about sexual life, pregnancy and birth control?

Adolescents can maintain a healthy sexual life. However, some of the adolescents who are sexually active are treated with dmard, or those who are active in the disease should use safe methods of pregnancy prevention. The ideal pregnancy is always planned. Some blood pressure medications and dmard can damage the fetus's development. Most women with SLE can have a safe pregnancy and have healthy children. Ideal time for pregnancy; This is when the disease is particularly well-controlled for a long period of renal involvement. Women with SLE may have difficulty in continuing pregnancy due to disease activity or drug therapy. In addition, SLE is associated with higher risk in terms of a birth defect (appendix 2) known as newborn lupusu in low, premature birth and infant. Women with high antiphospholipid antibodies (annex 1) are considered to be at high risk for problematic pregnancy.

Pregnancy itself can aggravate the symptoms or trigger the SLE. For this reason, a female obstetrician who is experienced in terms of high-risk pregnancies and who works closely with Rheumatologist should do strict follow-up of all pregnant women with SLE.

The safest birth control forms for SLE patients are barrier methods (condoms or diaphragm) and sperit agents. Only systemic gestational inhibitors involving Projesteron and some types of intra-uterine instruments (RIA) are also accepted. Although new options have been released to minimize danger, birth control pills containing estrogen may increase the risk of exacerbation of disease in women with SLE.

           

 

 

4. Appendix 1. Anti-phospholipid Antibodies

 

Anti-phospholipid antibodies are autoantibodies to the body's own phospholipids (phospholipid, part of the cell membrane) or proteins that are connected to them. Three of the most well-known anti-phospholipid antibodies: anticardiolipin antibody, antibodies to β2 glycoprotein I and lupus anticoagulants. Anti-phospholipid antibodies can be seen in 50% of SLE children. But it can also be seen in some other autoimmune diseases, in various infections and in children with no known disease, albeit in a small proportion.

These antibodies increase the tendency of clotting in blood vessels and these autoantibodies are thrombosis of arteries and/or toparveins, excessive drop of platelets (thrombocytopenia), migraine, headache, epilepsy, skin-variegated and morumsu color (livedo reticular) were found to be associated with many diseases. One of the common areas of coagulation is the brain, which can cause a stroke. Other places where clots are common are the veins and kidneys in the legs. Anti-phospholipid syndrome is the name given to the disease when thrombosis occurs with anti phospholipid antibody positivity.

Anti-phospholipid antibodies are especially important in pregnant women because they interfere with the function of the placenta. Blood clots developing in the veins of the placenta can cause (involuntary) miscarriage, inadequate development of the fetus, preeclampsia (high blood pressure during pregnancy) and dead birth. Some women carrying Anti-phospholipid antibodies may also have difficulty conceiving.

In most children with positive Anti-phospholipid antibody test, there is no thrombosis. Nowadays, research on the best preventive treatment for these children is ongoing. For now, children with positive and underlying autoimmune diseases with anti-phospholipid antibodies are usually given low doses of aspirin. The effect of aspirin on platelets decreases adhesion and hence the ability of blood clotting. Ideal approach for adolescents with Anti-phospholipid antibodies; It involves avoiding risk factors such as cigarettes and birth control pills.

When diagnosed with Anti-phospholipid syndrome, primary treatment (after thrombosis in children); The thinning of the blood. Thinning is usually achieved with a tablet-shaped drug called Varfarin, which is anticoagulant (anti-coagulation). This medication is taken every day, and regular blood tests are required to ensure that the varfarin is adequately thinning the blood. The heparin and oral aspirin injected under the skin can also be used. The duration of anticoagulation therapy depends largely on the severity of the disease and the type of coagulation.

Women who carry Anti-phospholipid antibodies and recurrent miscarriage may also be treated, but because of the potential to cause an anomaly in the fetus, Varfarin is not used in the treatment. Aspirin and Hepar are utilized to treat pregnant women with Anti-phospholipid antibodies. During pregnancy, heparin should be given with injection under the skin every day. With careful supervision by the use of these medications and women's birth specialists, about 80% of women are successful in pregnancy.

 

5. Appendix 2. Newborn Lupusu

 

Newborn Lupusu is a rare disease that occurs with the passage of the placenta of some autoantibodies in the fetus and newborn in the mother. Specific autoantibodies associated with neonatal lupusu are known as anti-Ro and anti-La. Although these autoantibodies are found in approximately one-third of patients with SLE, many mothers with this antibody do not have newborn lupuslu babies. On the other hand, newborn lupusu can also be seen in infants of non-SLE mothers.

The newborn lupusu differs from SLE. In most cases, the symptoms of neonatal lupus disappear spontaneously in 3-6 months, without leaving an effect on the heron. The most common symptom; A few days or weeks after the birth, especially the skin rashes that start when exposed to the sun. The rash caused by neonatal lupus is temporary and usually recovers without scarring. The second common symptom; The blood count is abnormal, which usually does not watch heavily and tends to heal in weeks without requiring treatment.

Very rarely known as congenital heart block, a special type of heart rate anomaly occurs. In the congenital heart block, the baby's pulse is unusually slow. This abnormality is permanent and often diagnosed, the 15th of pregnancy. and 25. may be used in fetal cardiac ultrasound. In some cases, it is possible to treat this disease in the unborn infant. Many children born with congenital heart block must be fitted with a pacemaker after birth. If your mother has a child born with a congenital heart block, the risk of having another child with the same problem is around 10-15%.

Children with newborn lupus grow and develop in a normal way. The risk of developing SLE during their subsequent lives is very low.

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