Lupus Guide for the Perplexed: Eye Problems

Symptom:  Dry Eyes
 
Associated Terms: 
keratoconjunctivitis sicca;
Sjögren’s Syndrome; 
blepharitis; xerostomia;
There's No Crying In Lupus; 
No Tears for You!


Just like other organs, SLE can involve the eyes and the organs associated with the eye as well; the symptoms usually consist of dry, red, and irritated eyes without the associated fun of pot-smoking; dry mouth, without the associated fun of pot-smoking; and conjunctivitis, without the associated fun of... oh, never mind.  You get the point.  Your eyes are baked but the rest of you is not. 

The associated dryness, irritation and lack of tear production can, naturally, cause problems with your eyes.  For one, you might be really, really prone to conjunctivitis, better known as pinkeye.  (Pinkeye-- seriously?  There's nothing quite like your eyes reminding you what it was like being in kindergarten again, right?)  For those who have underlying diseases causing the problems, it can lead to other nasty things.  Like blindness, or damaged eyes. 

Yeah, sometimes it feels like that. 

The underlying causes are different for each person, but trust me it's probably somehow related.  One common manifestation is keratoconjunctivitis sicca, which basically means a "dry inflammation of the surface of the eye." Your eyes feel like they have sand in them.  The surface gets red and dry, and sometimes it just hurts to blink. 

Another common problem is blepharitis, which may sound all naughty and whatnot, but it just means that you have a problem with your eyelids getting irritated and swollen.  You know, like that guy up above.  Not a problem at all. 

And a really, really common problem is xerostomia, which just means cotton-mouth.  If your immune system is bothering your tear glands, there's a good shot it's bothering your other lubricating glands, too.  

This can often times be caused by a various array of irritations, but a really common one is a lack of proper eye lube.  You see, in your face is a little version of the Soup Nazi keeping you from getting your fair share of tears to keep your eyes healthy.  He smacks your fingers with his itty-bitty ladle and screams, no tears for you!  NO!   Some of us also have a Spit Nazi, so we get dry mouth along with it. 

Another possible problem is Sjögren’s syndrome, which is its own little autoimmune hell in a Dixie Cup.  Sometimes it occurs with other autoimmune diseases like lupus or rheumatoid arthritis, but Sjögren’s syndrome can also wreak havoc all by its little lonesome.  5 to 10 percent of lupus sufferers will have this disease, and getting close to half of Sjorgren's sufferers will have something else, too.  Some of the major problems with this disease are white blood cells gunking up and attacking the glands in your face.  Since it overlaps so much with other diseases like SLE, it can be hard to diagnose. 

The upside is that Sjögren’s is uncommon, and the other problems can be treated fairly easily with a few hygiene changes, such as using atrificial, preservative-free tears, eye ointments, cleaning your eyelids, and watching depressing chick-flicks.  (Okay, I made that last one up.)  The Sjögren’s Syndrome website has some great tips on all that if your interested.  

Lupus Guide for the Perplexed: Malar Rash

Malar Rash
Other names:  butterfly rash; lupus war paint

Like that proverbial squeaky wheel, it's always the visible symptoms that get the most attention.  Most symptoms of lupus, and the ones that really scare the hell out of us, are the ones that run silent and can't be diagnosed easily.  These symptoms-- numbness, depression, inflammation, pericarditis-- are the ninjas of lupus symptoms.

But then there are the attention whores of the autoimmune world.  The butterfly rash is the most obvious, because, just like Paris Hilton or Amy Winehouse, they're bitchy, flashy, and they request, nay, demand that they be in your face all the time. The rash can range from the "blushing"  look to bearing a familial resemblance to Seal (whose scarred cheeks are, in fact, a malar rash).  Sometimes your cheekbones and the bridge of your nose are just a little flushed, like your lupus slapped you across the face, and for other people it's a scarifying, face-munching wreck.  

 Yes, your disease really is this annoying. 

When somebody sees the malar rash, they automatically assume that lupus is involved, kind of like assuming Don King is around whenever there's a boxing scandal.  You know, like those commercials they've been running on TV recently: a woman looks in the mirror at her oh-so-obvious blush over the bridge of her nose and down her cheekbones, and the television asks in a hushed, pensive voice-over, "could I have lupus?"

Well, it's not so simple because, as it turns out, not everybody's autoimmune disease is an attention slut.  Only 45-65% of people ever develop the facial rash as an indication of SLE.  That leaves up to half of us without a blush on our cheeks and a visual cue for our distress.  On the other hand, just because you look like you've been stung in the face by a swarm of paper wasps doesn't mean you have lupus, either.  There are a whole host of inflammation disorders, infections and whatnot that can also give you a red nose and shiny cheeks-- dermatomyositis, a tinea or streptococcal infection of the skin, cellulitis, or plain old acne.  So, don't take out that life insurance policy just because you've gone patchy in all the right spots.  Nothing with SLE is ever that simple. 

Unless you have skin involvement with your lupus, you may or may not ever find yourself daubed in lupus war paint.  I'm still rash-free on my face; I have problems with bruising instead.  That's my autoimmune disorder's plaintive, whiny, attention-whore cry for attention.  That malar rash may be the one sure-fire sign your doctor is looking for, so don't be fooled that you don't have lupus if you've never had a rash.  Instead, it could be that your SLE is much more sedate, and discreet, than having Paris Hilton splashed over your face like a magazine centerfold.

Lupus Guide for the Perplexed: Raynaud's Phenomenon

Raynaud's Phenomenon
 other names: Raynaud's disease; Zombie Fingers; Death Gives a Hand Job

If you've ever looked down at your hand and started cussing uncontrollably in a panicky, high-pitched voice, then you've probably had a bout of "zombie fingers," or as it's more commonly (and less amusingly) known, Raynaud's Phenomenon. The official name for this symptom makes it sound like some really cool sport of nature, like Northern Lights, ball lightning, or Adam Lambert.  It doesn't even begin to capture the weirdness of realizing that your fingers have decided to show you what you're going to look like when you're dead. 

In reality, Raynaud's Phenomenon only looks bizarre for the most part; you don't have leprosy, you're not turning into a flesh-eating zombie, and your fingers are really not going to drop off your hands like a bad episode of the Dick Van Dyke Show.  Just give them a couple minutes, or up to an hour, for the circulation to come back.  Only in very severe cases where it happens constantly (or doesn't go away) does Raynaud's phenomenon cause circulation or tissue health problems, so don't panic. 

Raynaud's Phenomenon occurs when the blood vessels in your fingers (or even your toes, ears and nose) constrict suddenly, limiting blood flow; the affected area will look dead and pasty at first, and then a lot of times become blue at the tips.  In most cases, it doesn't last very long, and for most people it isn't painful-- although some people get some pain and tingling because, you know, there's no blood down there. 

As to its causes, it seems like a lot of things can tell those blood vessels to clamp up-- things like cold, pressure on your fingers, or getting really stressed out.  The underlying causes can range from low thyroid to certain medications, sensitivity to drugs that affect circulation, to arthritis and injury.  In fact, it's apparently a workplace hazard of professional pianists.  Autoimmune diseases, obviously, are a possible cause too, because of the havoc they can wreak on connective tissues.

If you ever have Raynaud's phenomenon, it's obviously good to chat with your doctor about it.  For most people it's not a sign of the zombie Apocalypse.  Instead, the next time it happens, enjoy it!  Get yourself the Thriller soundtrack, a zombie suit, and go scare some little kids.

Lupus Guide for the Perplexed: ANA testing

I have a strange reaction to bad news.  I want to laugh at it, in the most savage, sarcastic and brutal way possible.  I know it's an odd response to tragedy, but for some reason it helps me keep things in perspective and keeps me from going insane.  So, with all this auto-immune disease stupidity I'm going through, I think I'll make fun of that, too. 

In the interest of giving people some basic information on what the SLE testing process is like, and in the interest of me not going insane, I've decided to kill two birds with one stone and do a series on lupus vocabulary.  The information is all culled from legit government and academic sources, although a little...  strange.  This is the first installment, and I hope you enjoy it!

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ANA (Anti-nuclear antibody): 

In layman's terms, this is a blood test to determine your body's level of misdirected hatred and self-loathing, and could just as well be termed your Immunological Emo Factor; it's just a way to see if your white blood cells have a Flock of Seagulls haircut or listen to Snow Patrol on their itty-bitty little iPods.

To be serious, an ANA is a serum-based screening method that's designed to check for signs of your immune system attacking normal cells instead of, you know, diseases and stuff.  A lab technician puts some of your serum in a petri dish with some cells to see what happens.  If everybody holds hands and sings protest songs, then it's negative.  If World War III in a microcosm breaks out, then it's positive.   The presence of antibodies that go after the nucleic matter in cells is an indication that something is rotten in the state of your autoimmune Denmark, telling your doctor that it's time to look further and see why everybody's so angsty all of a sudden. 

This test can have  a variety of different 'positive' readings that can be helpful to point your doctor to possible diagnoses, but it's not by any means going to tell you if you have SLE; a positive result on an ANA can indicate everything from other autoimmune diseases to cancer to absolutely nothing.  This is simply the version of your immunological "check engine" light going off.  If it's blinking, then maybe you've blown a head gasket.  It's much more likely that your gas cap is loose.

How important is a positive ANA to being diagnosed with lupus?  Sort of.  Depending on whom you ask, 95-97% of lupus sufferers will eventually have a positive ANA.  (And there's literature trying to figure out what's up with that other 5%.)  The ANA doesn't mean you have lupus, but it is the first line of attack doctors will use to determine whether or not to start worrying about it. 

So, if a doctor, like a good car mechanic, suspects lupus, this is often the first place they'll check because there is no reason to run more specific antibody tests until this one shows that there's a problem.  But, just because you get a negative result on your first ANA doesn't mean you won't pop positive later-- so it's important to have your ANA run several times, over several years, and make sure that all come back negative before you stick a stake in the heart of your autoimmune vampire.  He might still be lurking, with his Emo haircut and black lipstick, to show up and whine about how you don't appreciate him when you least expect it.