Talk:Lupus erythematosus

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Information from Lupus erythematosus appeared on Portal:Medicine in the Did you know section on May 30, 2006.
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Lupus is a bit mysterious, perhaps due to its scant presence in the population. Therefore, clear answers are hard to find. I have a question, how often do the effects become fatal for those with Lupus?

The part discussing porphyrias probably needs to be merged into the porphyrias article. It is discussed too deeply for an article on SLE.

Uh... this page requires a lot of attention (e.g. the fourteen diagnostic criteria), and epidemiology will be part of it when I finally lay my hands on this. As far as I know, there are few longitudinal studies that follow-up Lupus patients and their causes of death. Nevertheless, they suffer from accellerated atherosclerosis, especially when having positive antiphospholipid antibody, and they can develop a nastry nephritis (lupus nephritis). Furthermore, Lupus patients are at risk for infections when being treated with immunosuppressant drugs... Most will die of their Lupus rather than with it. JFW | T@lk 11:14, 22 Aug 2004 (UTC)

I am new to this website - recently diagnosed w/ lupus - can anyone recommend a good website/chat room for information? Thank you.

Contents

[edit] Anti-DNA?

Looking forward to your getting your hands on it, certainly! But in the meantime, I wonder if the whole reacting against DNA thing is quite true? (I'm not trying to imply it isn't, I don't know, that's why I'm asking). Lupus is characterised by antinuclear antibodies, but are they actually anti-DNA? I was just wondering if they might not be anti-another bit of the nucleus... histones or proteins specific to the nuclear envelope, for example? --Viki 23:24, 27 Aug 2004 (UTC)

I just found the answer in abzyme. I guess I should've looked there before. But I'm still keen to encourage wait-til-I-get-my-hands-on-it man to get his hands on it. Or I will (that's not a threat, by the way, I just want to see the article expanded). --Viki 23:29, 27 Aug 2004 (UTC)

There is both ANA and Anti-DNA that get measured. --Waterspyder 00:22, 12 October 2005 (UTC) just diagnosed -

[edit] Big rejig

Okay, done the threatened giant edit, but it could still probably do with something on the history of the disease and progression of clinical symptoms. Also, I'm just a student, so any real doctors/immunologists, go wild with the corrections!

--Viki 17:49, 20 Sep 2004 (UTC)

[edit] Update

I am altering some of the historical information since there are several different stories as to why it is called Lupus. I am also updating some of the drug information since quinines are still used in almost all Lupus patients (barring extreme side effects). Corticosteroids have some seriously negative effects and therefore many doctors are reluctant to prescribe them in the longterm due to these side effects, which include immunosuppression. --Waterspyder 00:23, 12 October 2005 (UTC)

Don't put too much in the intro, please. JFW | T@lk 03:12, 14 October 2005 (UTC)

What is acceptable for the intro then? I think that the statistics on number of people it affects is important. I think I would altogether like to see the part on the name removed since there are so many different interpretations and no one is really sure. Why are we favouring one over the other?

Additionally, the information on epidemiology was removed as was information on medication. Is there any particular reason for this? I read the instructions and I'm not sure what I'm doing wrong in this particular instance.

--Waterspyder 00:27, 16 October 2005 (UTC)

The number of people affected is not really useful. The proportion (e.g. 1 in 1000) is more to the point; ideally, incidence and prevalence ought to be menioned.
The favoured explanation is the one that has the most currency. JFW | T@lk 04:57, 16 October 2005 (UTC)
You also left a comment on my talk page. Let's discuss everything here. The intro is supposed to be telegram-style, and as long as things can be discussed briefly there is no reason why medication or epidemiology can't be alluded to. JFW | T@lk 06:48, 16 October 2005 (UTC)

I apologize that I am a little new at this, so I am getting used to the mechanisms of communication. I checked the page today and I presume it was you that made some alterations to it, and it definitely works a lot better in my mind. I fixed some punctuation, but that was it. The Causes under Pathophysiology is the only other section that needs major changing since there are presently thought to be three causes of Lupus. The first one is genetic, and is either the result of a spot mutation or it is hereditary and in the second case can be passed on to children. The second type is attributed to viral or bacterial infection. There is no documented proof, but many doctors suspect this is the case and suspect Staphylococcus and Streptococcus infections to be a chief culprit. The final type is Drug-induced Lupus. Currently the article indicates that medication exacerbates lupus symptoms, and while this is true, Drug-induced lupus is where medication actually causes a physiological mimicry of lupus that is treated in the same way as the first two forms, but usually once the medication is stopped, all symptoms of lupus also cease and many patients never again present with lupus. It's like fake lupus. Sunlight, stress and medication can all exarcerbate symptoms of all three. Finally, and I'm not sure where this should be mentioned, but under Diagnosis, there is a mention of an effect on electrolytes, but what is actually occurring is that there is an increase in the electrolyte sedimentation rate (ESR). Anyhow, that's pretty well it, I would be happy to fix the article in these remaining areas, but I guess I want to run it by you first? Thanks! --Waterspyder 15:18, 16 October 2005 (UTC)

Additional information obtained from [1], [2], [3]. There is a ton more information that needs to be worked into the page and restructured, but I'm not up to the challenge right now. --Waterspyder 00:26, 17 October 2005 (UTC)

The three causes can be mentioned in an "etiology" section. Perhaps quoting a recent review is the best thing we can do. I'm not sure about the "spot mutations", as lupus is not known to be monogenic.
Drug-induced lupus should be mentioned in passing, but could well have its own article, as it is a distinct disease entity with distict serology (anti-histone antibodies) and a distinct cause (e.g. hydralazine, antithyroid medication).
We should avoid web references as sources; these are typically aggregations of articles in medical journals, and in that case the journal is the primary source. JFW | T@lk 02:21, 17 October 2005 (UTC)

You are correct, Lupus is the result of numerous genes, and is usually pretty dependent on parental contributions, but sometimes spot mutations do play a role according to some research (I would have to go hunting again). Basically it is not responsible for the entire cause of the disease ina person, but was thought to play a contributing role. Given I did read this 3 or 4 years ago, so it's also entirely possible that new research is debunking old research. I'm sure in 5 or 10 years reasearch on genetics will be much clearer in this field. I didn't add the web sources to the page itself for the very reason that while some of these are great FAQ articles, you can access them by going to places like lupus.org. I agree, Drug-induced lupus could easily have its own page, I just don't know quite as much about it. In the meantime, I think I am done for now on this page. Thank you for putting up with me. --Waterspyder 18:24, 17 October 2005 (UTC)


-Hi, don't know where to find or verify this, but I have heard/read that the term lupus is related to the belief that sufferers had lycanthropy- that is, people used to believe people with lupus were "werewolves". It has something to do with the skin rash and light sensitivity. Sorry I don't know more, but it might be something to look into...—The preceding unsigned comment was added by 68.35.4.7 (talk • contribs).

What I had actually read was that "Lupus" was used because the malar rashes sometimes looked like somoene who had been attacked by a wolf. I have also read another story which attributed "Lupus" to the French word "Loupe"; the mask that women wore on formal occasions and served to conceal the malar rash. --Waterspyder 14:04, 16 July 2006 (UTC)

The update I have read is still missing or mistakes three critical areas in the introduction alone.

Firstly, the introduction doesn't begin with the correct definition of lupus. It is an autoimmune rheumatological disease. This is why it falls under rheumatology and patients see a rheumatologist. I feel it is extremely important to add this to the into as well as further on in the article.

Secondly, the intro states that Plaquenil is the only antimalarial drug used to treat lupus. That's true; but the reason it is used is that it is a drug used to treat rheumatoid diseases, including rheumatoid arthritis (RA).

Thirdly, the intro and article do not clearly state that the parts of the body affected can indeed all be classified: it affects the connective tissues of the body. This includes literally everything except hair, nails, and bones (blood and skin are included, as are muscles, tendons, organs, etc.). It's much more clear to readers when it's spelled out this way, rather than trying to list all body parts that are affected by lupus and only giving a partial list--especially in the introduction. Believe me, I've tried when writing about lupus elsewhere!

I could edit the article, but am hesitant to until we discuss these corrections and suggestions, please.

--(author, The First Year: Lupus) --Editrx 23:22, 10 September 2006 (UTC)

[edit] Prognosis

I was confused by the statement "...fewer than five years. Advances in diagnosis and treatment have improved survival to the point where over 90% of patients now survive for more than ten years..."

Sounds like we used to die after 5 years, but now we die after 10 years or so!

Would it be better to expand this by adding something like: "longitudinal studies over a 10 year period show that more than 90% of patients do not die during the 10 year study, and, in general, the majority of people can hope to live a normal life-span" Ref: http://www.lupus.org/education/faq.html#4

Well, prognosis has improved with better treatment. The article says exactly that. If you have a reference for the study you cite, could you work that into this article? JFW | T@lk 23:46, 21 November 2005 (UTC)
The stat I was given when I was first diagnosed was 15% die within the first 10 years. My high school Biology teacher however told me that 90% of people die with Lupus, not from Lupus. I'm far more disturbed however by the difficulties associated with pregnancy. I should probably work on a section for Lupus and Pregnancy, there are some *serious* challenges (Lupus and Pregnancy from Lupus.org --Waterspyder 14:28, 16 July 2006 (UTC)
If you'd like, you can reference the chapter on lupus and pregnancy from the previous edition of my book (pp. 206-210), which I believe is online at Amazon and Google Print (The First Year: Lupus). No, I'm not trying to sell copies; it's going into a new edition anyway (which I have to get cracking on). But it may save you some time and provide pointers to primary resources you may not have read. Or, let me know if you'd like me to write up a section for the article here. --Editrx 23:30, 10 September 2006 (UTC)

[edit] nutrition

There's currently no references to other, natural, treatments. This is one book I have read, with lots of good references to back it up, but no doubt there's other too. [4]

[edit] Image needed

Anyone have a free photo of a lupus sufferer? —Keenan Pepper 05:34, 12 December 2005 (UTC)

try to find some free foto of Seal_(musician). he's got lupus. 84.129.157.24 (talk • contribs)

That is incorrect. Seal had lupus vulgaris (cutaneous tuberculosis). The malar rash of SLE does not cause scarrring. JFW | T@lk 19:08, 7 February 2006 (UTC)

Image up on the malar rash article. Salanth 12:15, 8 July 2006 (UTC)

JFW, the malar rash of SLE can cause scarring - see www.postgradmed.com/issues/2003/11_03/dallera.htm among others, which states: "The discoid lesions seen in SLE are raised, erythematous plaques with adherent scale and occur most commonly on the face, scalp, and neck. Over time, these lesions lead to changes in skin pigmentation and scarring."


I would note that "commonly" should be edited to "often." The malar rash is not seen in a majority of lupus patients, and never in ones who don't manifest discoid lupus -- which is another section altogether: the problem of lupus patients "not looking sick." I hesitate to edit the caption without a discussion of that, however. Maybe I'm just too shy about it. (--author, The First Year: Lupus) --Editrx 23:34, 10 September 2006 (UTC)

[edit] Seal

On the wikipedia Seal site it says that Seal had lupus - just lupus. And he doesnt seem to be dying (thank God) so what is the line about lupus being 'chronic'? (First line of the article)?

There are several versions of lupus. Drug-induced, cutaenous (skin-related) and systematic. Drug-induced usually occurs in cancer patients receiving treatments (I think). Seal has the skin related one, which may or may not develop into systematic. The last one is a chronic disease that takes an unpredictable variable course. Meaning a lupus flare could last anywhere from 6-months to 6 years then go into remission only to return within 6 months, 2 years or 5 years. Totally unpredictable. (sorry new to this wiki, perhaps I should RTFM) ~ rabbitinpumpkin (05/12/06)

Askmen.com has a blurb about Seal's scars being from discoid lupus. http://www.askmen.com/toys/interview_100/102_seal_interview.html Hm...looks like there's no separate article for discoid lupus - it just links back here to SLE. Salanth 12:22, 8 July 2006 (UTC)

[edit] the great imitator

I re-added the line "it is often mistaken for other illnesses because the symptoms come and go unpredictably" Sp that it reads... "SLE is known as "the great imitator". Its symptoms vary so widely it is often mistaken for other illnesses because the symptoms come and go unpredictably". As any of us that deal and have dealt with SLE (my daughter died from this dread disease a couple of years ago) I not only think it pertinent but an absolute to have remain in the article. As with SLE, we know this is one of the main reasons it is so hard to diagnose due to the symptoms coming and going. When doing any kind of research, knowing such information is not only valuable, but also nessary to understanding this illness and the range of possibilities that are often overlooked due to this very fact.--Mystar 15:24, 9 October 2006 (UTC)

Mystar: There are now both reasons for lupus being called the great imitator - there are references for both, so it makes sense that both are in the article. What is your reasoning for removing the reference to the multitude of symptoms? Now included are three references to why lupus is called the great imitator - it has many symptoms, it mimics other illnesses (because of the many symptoms) and the reference you included where it discusses the unpredictable coming-and-going of symptoms. WLU 20:34, 9 October 2006 (UTC)


Initially the problem was that you removed (I'll assume an oversight on your part here) an extremely important fact regarding this disease. Secondly, you added an unnecessary link, making a repeat of the link I places and the information contained therein. We do not need duplicate information/references. Thirdly, you mis-referanced the additional link you placed. The section you edited was talking about SLE being mistakenly diagnosed due to the mimicking of symptoms it displays. Every Lupus sufferer is soon aware of these facts. People needing AWARENESS need to see and understand this fact. You miss-linked an article about Lupus among African-American Women, which had nothing to do with the section at hand. While I applaud your wanting to add this to the page, the place you inserted it to was not the correct setting. I reformatted the page to include this very pertinent fact. I suggest you please take time to read this section I reformatted very carefully. People count on information like this to assist them in their search for information and help. No matter what you think, I am acutely and intimately well versed in Lupus. Having done years worth of research and study. Please do not make this an edit war.--Mystar 04:03, 10 October 2006 (UTC)


The sentence I removed didn't make sense in the context. The sentence you replaced it with "SLE is known as "the great imitator", as it often mimics other illnesses because the symptoms come and go unpredictably" also didn't make sense in the context - illnesses are diagnosed through a coherent and specific set of symptoms. What makes it a great imitator is the variability of the symptoms, and also the variability across time supported by your reference. I added the link to support the statement of why it's called the great imitator. Your subsequent replacement reference included the sentence "SLE is known as "the great imitator", as it often mimics other illnesses and because they come and go unpredictably." which supports both points - it mimics other illnesses and its symptoms vary over time. Replacing the statement that it is misdiagnosed due to temporal changes alone is incorrect, it is both. Splitting the sentence "SLE is known as "the great imitator" because its symptoms vary so widely it is often mistaken for other illnesses> and because the symptoms come and go unpredictably" disconnects the idea of it being a great imitator from the reason why, which is why I kept it as a single sentence.

Your subsequent edits duplicated sections - you broke the introduction into sections on known treatment and diagnosis. Both these sections exist below. I reverted and applied the changes that you and others made to subsequent pages. Putting the reference from uuhsc.utah.edu/uuhsc didn't make sense, there is no need for a reference saying Lupus is the great imitator when the rest of the sentence and references discuss this. The references to people of colour and the brief article on lupus have the statements about why they are great imitators. Though the wrong diagnosis article does have statements about mimicing other illnesses the people of colour article contains the statement "With its numerous symptoms, lupus is often mistaken for other diseases, and has often been dubbed “the great imitator.” This article emphasizes the wide variety of symptoms, a reason why it is called "the great imitator".

Thirdly, you mis-referanced the additional link you placed. The section you edited was talking about SLE being mistakenly diagnosed due to the mimicking of symptoms it displays. Every Lupus sufferer is soon aware of these facts.

The article is for the population at large, not for the Lupus sufferer. The link I added justified one reason why it's the great imitator. I don't see how it is mis-referenced.

People needing AWARENESS need to see and understand this fact. You miss-linked an article about Lupus among African-American Women, which had nothing to do with the section at hand.

This isn't about awareness, it's about factual content. The article about lupus among AA women was relevant. As I stated above, it contains the sentence "With its numerous symptoms, lupus is often mistaken for other diseases, and has often been dubbed “the great imitator.", which seems to make it relevant. WLU 15:15, 10 October 2006 (UTC)


Mystar - I reverted because of the duplication of sections, the content is addressed above. WLU 16:17, 10 October 2006 (UTC)


  1. 1 it IS about awareness as well as Factual content, which I have correctly cited. With this type of Illness and the way it works, it is vital to include awareness. While the article is for the populace at large, it is also referenced in many Medical journals and is a very helpful resource tool and should include the pertinent info... As I have cited. You omitted the African-American link and mention, which is specific and needs to be cited as it is a unique aspect of this disease and as it attacks this people of color differently, having the nessary facts and citation is appropriate.

The article reads fins as I have edited it. The fact that you seem to think it confusing is not my problem. You have a disturbingly aggressive history of reverting edits that are not yours. Please stop edit warring. Separating the sections as I did actually makes the page read better and is easier to follow. Again I ask that you stop edit warring simply due to your distaste for me.--Mystar 16:27, 10 October 2006 (UTC)


I feel it's necessary to point out (I haven't edited the article, though it's bothered me a few times upon reading it) that lupus is not "the great imitator" per medical circles. Multiple sclerosis is "the great imitator." It would be far more accurate to state that lupus is "one of the great imitators." I've run into this misperception before in nonacademic works, but per medical journals, medical books, etc., labeling MS as "the great imitator" is endemic. As this may be a personal issue (per the last few notes I've seen, above), I have not edited "your" article here. If I can be of help, please just let me know; I'm doing the research right now to update the second edition of a book on lupus. --Editrx 18:41, 15 October 2006 (UTC)

I've got no problem with you changing it, a reference would be excellent. How about a sentence like "Along with multiple sclerosis/other diseases such as MS, lupus is a great imitator of other medical conditions"? I don't know enough about lupus to contribute much beyond the initial correction. WLU 21:09, 15 October 2006 (UTC)

[edit] porphyria?

What is the porphyria stuff doing in the middle of this? Cutaneous lupus needs its own section, I think. Subacute cutaneous lupus and discoid lupus should be delineated. --Caroldermoid (talk • contribs) 20:55, 19 November 2006 (UTC)

[edit] House

To clear up some confusion, I think part of the reason people (at least myself and one other person) keep putting House in is because the season 2 DVD has a special features segment that features every time Lupus is mentioned in the season (because it's a show about strange diagnoses, Lupus comes up a lot 'cause it's got such diverse symptoms). As far as I know it's never actually been a final diagnosis on the show, it just comes up a lot as a possibility. I'm quite willing to concede that it may not be noteworthy enough to include, but I'll throw in one of those invisible comments underneath the 'noteworthy people' section and hopefully head off any future contributors. WLU 23:36, 23 November 2006 (UTC)

Seconded it's inclusion. I have begun to see the phrase, "It's not lupus" pop up on websites, and I think that this is at least notable enough to get it included in the article. -Chris

I wasn't voting for the inclusion. To the contrary, I think it should be kept out, unless we can put in something more than "Lupus pops up a lot on House". The WP:MOS for medical articles does have a section called 'cultural references', which would include House and the famous patients, but it'd be nice to have something more than that; also, WP:AVTRIV. How would people feel about splitting trivia up into appropriate sections? House could go into symptoms for instance. Anyone know why George from Seinfeld keeps thinking he has lupus? That might be a useful tidbit for somewhere. WLU 20:33, 29 November 2006 (UTC)

In a recent episode of House this was said, highlighting the fact that Lupus is offered up so much in House and Seinfeld (by George). Perhaps a Trivia section?

Dr. Foreman: You hide drugs in a lupus textbook?
Dr. House: It's never lupus.

[edit] Recent changes

I made a buch of big changes today, here's a diff-by-diff list of rationales:

This is the first one. I'm just altering some simple wording because I think it flows better.

This one I replaced a sentence I removed in my previous edit in a different section. I'm not sure if it belongs in this section, or if it's true or not, but this way the information isn't lost.

This one I re-worked for flow, added the wikilink for collagen and changed the external link to a reference.

Here I'm just putting in the line about House in case anyone in the future thinks about putting the info back in.

(Diff) I didn't know what the Type III thing meant so I dug up a reference.

The sentence wasn't grammatical, added a 'disease' to make it so.

This one is obviously the biggest change. I'll go through section by section.

In the intro, I replaced "Joint (rheumetological)" with just joint, 'cause I didn't know why it was like that, and joints are just joints, there's no disambiguation for rheumatism. I added the brief line about treatment (steroids and suppresants), changed brain/nervous system to just NS#vertebrates as the NS page has links to CNS and PNS - if it attacks only one or the other, it'd be great if someone could clarify it. I also included the single line about the name. The line about the name could probably be taken out or re-worked, I'm not too sure about it.

I re-worked the order of the sections and consolidated a bunch of duplication. History seems to come first, though arguably diagnosis, symptoms or something else could go here. History seems to come first just 'cause it's history. I didn't change anything within that section. The SLE research section I rolled into the research section below.

Signs and symptoms I put next, followed by diagnostic criteria, then etiology. Signs and symptoms would seem to proceed diagnostic criteria, but I could also see diagnostics coming later because it would give definitive diagnostics, followed by the much more general or varied symptoms.

Etiology I put next - once diagnosed, the disease woudld progress, so it seemed logical. I moved the line about reseach and the human genome into the research section. I also re-formatted the description of the "wrong diagnosis" link. I left most of the rest of the section alone I believe.

The Datamonitor reference I actually found on the web and put in as a reference. I also converted it from that long quote to a brief summary that captures the essence of change that could be occurring in treatment in the near future. I also put in the bit about the human genome. I think I also linked several orphan sentences into a paragraph.

Last on this diff, I changed it from "notes" to "footnotes", 'cause they are footnotes.

Here I put in some wikilinks and formatted weblinks into footnotes.

Here I altered the type II and III links and first two sentences to read better. I added info and a link about the LE cell test in the history section, added spaces in all of the signs and symptoms bullets (which I now realize is irrelevant) and put in the citation needed tag (later removed).

This one I just took out a sentence I made obsolete in my last edit.

Here I moved a section down to after the mnemonic, since SOAPBRAINMD seemed to apply only to the ACR symptoms.

Here I altered one of the references descriptions 'cause before it just said "American-American women", Lupus and African-American women seemed to make more sense given the actual reference. I also changed 'causes' to 'triggers' (just seemed to make more sense, but if the semantics don't match up then someone else can change it), genesis became creation, seems less biblical, and put in a wikilink.

Here I made the sentence a bit more grammatical (and mis-spelt though). I'll correct it and take out the 'appears' in the sentence on AAW.

Here I replaced the citation needed tag with the full references included in the references section, but embedded in the text itself.

Here I just fixed the formating I muffed up.

Here is another set of big changes. I read through the whole article and moved a bunch of stuff around in to more appropriate sections, and put in a reference.

I added kidneys to the intro since there seems to be significant involvement of the kidneys in lupus (it's mentioned several times in the text).

I added the section I took out of porphyria on medical historians and folklore/vampires/werewolves. I don't actually know how much lupus and porphyria overlap, so if anyone is more knowledgeable and they are welcome to edit those sections. I also re-worked the mention of the LE cell in history, but moved the reference and explanation of the LE test to a different section.

I moved the 'rarer manifestations' up, it seems to make sense there. I also removed the indent on other abnormalities in my next edit.

The LE test is now in the diagnosis section.

I re-worked a sentence in the diagnostic criteria section, the one about inclusion in clinical trials. Makes more sense to me now.

Epidemiology seems to make more sense to me right after diagnosis, though it might also make sense closer to the beginning.

In etiology, I put drug-induced SLE into its own category, and moved the non-SLE forms into its own bullet, adding a tag about the canine discoid lupus so people don't put in wikilinks unless someone creates a discoid entry for humans. Prognosis seems to make more sense in the etiology section, since etiology is how the disease progresses and prognosis is how long people can expect to live.

Porphyria appears to have a link to lupus, but looks like someone who knew a bunch of stuff about Porphyria just threw it in the lupus article. It needs to be worked over by someone who knows more about Porphyria and SLE than I do. I also integrated orphan sentences into a paragraph.

I put in the section on pathophysiology 'cause it seemed warranted, and introduces the apoptosis section a little better. I also tracked down an apoptosis references, as the "Apoptosis and autoimmunity" one doesn't seem to be published yet... I also fixed the orphans up into a proper paragraph.

Treatment I tried to clarify a bit.

Research I broke into research and a sub-heading of treatment research - the information seems to warrant separate sections.

The references I took out 'cause they're already in the body of the text.

A lot of the changes came from giving the entire article a read-through - this way seems to flow better, each section links more to the section before an after in my opinion, there's less duplication, better references for a bunch of entries, an it doesn't look quite so much like people have been coming in, adding a sentence or two, then leaving without bothering to integrate it into the rest of the article. Is there anyone who can work on the Porphyria/SLE section? I don't know enough to do so.

Thoughts? I think it flows better and the order makes sense, plus there is no duplication of sections and all the information is still there. WLU 02:09, 24 November 2006 (UTC)

Just made more changes, the biggest ones being trying to fit the article to the WP:MOS for medical articles - I moved stuff around, added sections (mostly classification) and tucked sections which didn't make sense into ones organized by the MOS. I also removed a whole bunch of the external links (which are supposed to be kept to a minimum according to the MOS), leaving in basically one for the US, UK and NZ, as well as Lupus international. I also removed a supprt group external link for the UK - just having one country's support group is too 'that-country-centric', but put in one from lupus.org (which is American) that has links to support groups in many different countries.

Mystar - your edit replaced autoimmunity with autoimmune in the wikilink section, which landed it on a re-direct. I changed it back so now it goes right to Autoimmunity, then went through the whole article and similarly corrected all the wikilinks so they go directly to the appropriate article rather than bouncing off of a re-directs.

Thoughts? WLU 16:58, 28 November 2006 (UTC)

Wow! Great job with the whole reorganization thing! Porphyria still needs to go, but I will work on that when I have time to figure out what else is on wiki on the topic. My next contribution will be to add material on lupus in animals. Caroldermoid (talk • contribs) 16:55, 28 November 2006 (UTC)
Thanks for the praise, it's always nice to be appreciated. Especially when I'm so humble. WLU

[edit] Antiphospholipid Antibody Syndrome

Is there a reason that this is not mentioned on this Wikipedia page considering 50% of the Lupus patients also have this in addition to Lupus?? See the Lupus Foundation page and APS Foundation of America, Inc page for more information. eyz 18:18, 29 November 2006 (UTC)

There's already a couple of mentions of AAS in the article (first in Hematological manifestations under the main heading of signs and symptoms, then again under diagnosis twice. WLU

Thanks...must have missed it. FYI, the accepted international abbreviation is APS. eyz 01:16, 4 December 2006 (UTC)

[edit] Breast implant rupture and lupus

I removed a little on breast implant rupture and lupus. There certainly has been much discussion on whether breast implant rupture is associated with connective tissue disease. But there was a NEJM review of the relevant meta-analyses (PMID 10717013) and several other papers that concluded that the association was poor. As such, I've left the bit about elevated antibody titres and breast implants, but removed the recommendations on MRIs and the like, as they are better suited for the breast implant article -- Samir धर्म 10:05, 2 December 2006 (UTC)

And the association of mesothelioma and asbestos are also poor, 10-15 years after exposure. Those are the types of studies we have, but nobody seems concerned about it. I give up, so whatever the "educated" medical doctors say. Jance 07:00, 4 December 2006 (UTC)

I appreciate your input, however I re-added some info on the subject. As this is an "informational" encyclopedic article, it is certainly pertinent to the person doing research to find this material. I think (from experience) that a person seeking not only info, but also recommendations from research is important. Not only important but in many cases life saving. Please try to understand that knowledge is the destination and the key. Omitting such knowledge is not helpful. Thanx Mystar 14:53, 2 December 2006 (UTC)

This is the text in question:
However there are no long-term studies (longer than 10 years) on women whose implants break. Because ruptures are usually "silent" (without symptoms), the US Food and Drug Administration (FDA) recommends that women follow-up after the first three years of implantation with Magnetic Resonance Imaging (MRI)s, and every two years thereafter. [1] In approving silicone implants, the FDA will require manufacturers to inform women that implants are not lifetime devices. [2]
In the context of the lack of association between breast implant rupture and lupus, I don't see how the above text is relevant to the subject of lupus -- Samir धर्म 16:27, 2 December 2006 (UTC)

I can appreciate your being an internist, however being that you are of a medical profession, surely you can see the importance of information while doing research. Though the disputed information is perhaps on the fringe it is nevertheless information that is relevant and certainly encyclopedic. If you wish to re-word, add to or correct the information, please do so. But to remove the whole paragraph is not appropriate when indeed there are references and uncertainties to this specific area of Breast implant. Simply because you in your learned state do not see the need for it, we who are much less educated in the medical profession perhaps need such information to help our lack of knowledge. By simply deleting such creditable information is not appropriate. Mystar 17:59, 2 December 2006 (UTC)

The information is correct and referenced, but not of relevance to the article on lupus. I've asked for comment at WP:CLINMED -- Samir धर्म 18:19, 2 December 2006 (UTC)

This paragraph has nothing common with Lupus. If you think that this kind of information would be needed in this article, then we should insert the paragraph nearly into every disease-related article. Even the first sentence of that part is not referenced ("Some researchers have found that women with silicone gel-filled breast implants have produced antibodies to their own collagen, but it is not known how often these antibodies occur in the general population and there are no data that show these antibodies cause connective tissue diseases such as lupus.") and these other sentences should be removed. Now, I remove it, please don't revert until we reach consensus here. Thank you for your appreciation. NCurse work 18:30, 2 December 2006 (UTC)

If there is enough concern on the subject to do a meta-analysis on it, then I'd say it warrants inclusion (the current sentence seems about right), maybe change the 'connective tissue diseases' to lupus itself since it is an article about lupus and not CTD. I'd say that if science can't find a link, it's not really encyclopaedic, it's just hearsay. I'd definitely put in a reference to the meta-analysis though, and can anyone find a credible reference discussing possible/theoretical links between SBI and lupus, just to reference "some researchers have found"? That'd allow people to look up further evidence on their own if they wanted to. However, not knowing enough about the causes of lupus, if we put in every single possible or considered cause of lupus, I'm guessing it'd make the environment sub-heading way too long. Just my opinion. WLU 22:15, 2 December 2006 (UTC)

Sure there's been meta-analyses on CTD and silicone breast implants, and yes that should be mentioned. But FDA suggestions on silicone implant ruptures and MRIs are outside the realm of lupus and are tangential to this article -- Samir धर्म 15:20, 3 December 2006 (UTC)
The new "labeling" required by FDA for silicone gel breast implants (as of Nov 2006) specifies that safety and effectiveness has not been established for lupus and other autoimmune diseases ( see http://www.fda.gov/cdrh/pdf2/P020056d.pdf on page 11). (By the way, the old labeling is almost identical on this issue, and this label is identical for all silicone implant manufacturers). The reason it is not established is that women with autoimmune diseases were intentionally excluded from the studies because there were concerns about safety.

I agree that this point is too peripheral for the lupus article, but probably belongs in the breast implant article. Drzuckerman 21:35, 3 December 2006 (UTC)

I just did a bit of research on google, very simple but should be comprehensive (lupus erythematosus silicone breast implant), and everything I turned up said that there was not enough evidence to rule out a link, but none said anything about a specific relationship between lupus alone and SBI - the only ones that showed up a maybe were anecdotal. Given that it is much harder to prove there is not a link than it is to prove that there is, it looks like scientific consensus is basically 'could be, but we doubt it'. I'd think that some references for what is there now (i.e. some researchers have found, also links between other environmental triggers), and one reference for for lupus not being consistently linked to it (or CTD in general) is sufficient, in case people are tuning into the article because they have SBI and are worried about lupus. Maybe a line about how it's not definitive that there's not a link, but it's looking pretty much like a no. The breast implant article itself has a long summary of negative findings as well. So my vote is:

  • very brief mention of possible connection, but no strong evidence for it (basically what's there).
  • definitely no info re: MRI and follow-ups, that's for breast implants, not here.

WLU 22:40, 3 December 2006 (UTC)

[edit] Treatment

I find this new information highly suspect and unfounded. It should be removed. With out proper citation it is conjecture. Also past treatment notations are warrented. I'll allow it to stay for now to give WLU some time to not only back up his claim, but to also add a proper treatment information history Mystar 23:19, 2 December 2006 (UTC)

What new information are you refering to? I was just about to say that we should remove the citation needed tag. I just put in a minor introductory sentence to the section - there is no cure, only treatment of symptoms, unless the article is wrong. The use of NSAIDS, DMARDs, anti-malarials and steroids are all for the treatment of symptoms, and nothing I have seen on lupus is a cure. Accordingly, the treatment of lupus is restricted to treatment of the symptoms, like allergies or a genetic condition. I really don't see what new information I put into the article, as the sentence I added is just a summary of the information below it on treatment to act as a brief introduction to the section no treatment. Unless you have some new type of treatment to add to the article, I don't think there's much that can be added. WLU 13:50, 3 December 2006 (UTC) Also, as I have repeatedly stated, I am a male, thanks Ron.
I'm going to jump in here. Much of the information on treatment has been up for a while. I made some additions due to a pet peeve of mine that despite Lupus' reputation as a "Disease of 1000 faces" it's handled as if it is a uniform ailment. Most of my information comes from Rheumatologists and University Biology professors, and I will attest to the following facts. 1) SLE does not presently have a cure (except drug-induced by removing the drug responsible for the reaction); 2) All current approved therapies are palliative or suppressive in their nature. No treatments currently advertise to be cures; 3) No current drug therapies are universal to all patients. Each treatment is tailored spcifically to each patient based on sex, ethnicity, history, severity of illness, and dual diagnosis ailments (Raynauds, Fibromyaligia, Rheumatoid Arthritis, Sjogren's).
I personally know NSAIDS, Cox-2 inhibitors, immunosuppressives, anti-malarials, corticosteroids are commonly used to treat the symptoms of Lupus. I don't know what a DMARD is all about, but that's not to say they aren't also used. When I added things in, I did cite my reference, and there is other information there. At present, I do not see anything off base with the medication area, except that it is incomplete, and could use a little editing for style. --Waterspyder 21:05, 4 December 2006 (UTC)
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