Category Archives: Healthy Life

Lung Disease In Systemic Lupus Erythematosus: Symptoms And Diagnosis Of Pleurisy In SLE

Although lung (pulmonary) problems are common in systemic lupus they are often not diagnosed until lung disease becomes advanced. Advanced lung disease and pleuropulmonary (affecting the lungs and respiration) problems can significantly contribute to mortality in SLE.

Symptoms and Manifestations

Lung disease (pleurisy) in systemic lupus causes a clinical spectrum of symptoms ranging from mild chest pain to fulminant and rapidly fatal pulmonary hemorrhage.

Inflammation of the pleural sac around the lung (pleurisy), with or withal pleural effusion (excess fluid in the chest cavity) is the most common manifestation in lupus. The pleura is a membrane covering the outside of the lung and the inside of the chest cavity.

Pleural cells produce a small amount of fluid that lubricates the space between the lung and the chest wall. As lupus activity causes the production of immune complexes (formed as antibodies and antigens combine), they complexes initiate an inflammatory response at the pleural membrane. The inflammatory response results in pleuritis.

Pleuritis can cause severe, often sharp, stabbing pain in one or more areas of the chest. Inhaling deeply, coughing, sneezing, or laughing can intensify the pain.

Other pulmonary manifestations frequently seen in SLE include pneumonitis, which refers to inflammation of the lung and pulmonary emboli, which refers to the presence of blood clots in the lung. Pneumonitis, which is usually caused by infectious agents, can cause fever, shortness of breath, chest pain, and cough.

Chronic interstitial lung disease in lupus may cause difficulty breathing during activity, chest pain with symptoms of pleurisy and a chronic dry cough.

Pulmonary embolism can cause chest pain and abnormal oxygen exchange resulting in shortness of breath.

Diagnosis

Imaging tests are primarily used to diagnose lung disease. Chest radiographs, ventilation-perfusion lung scans, gallium scans, and high-resolution CT scans are the tests most commonly used. If chest fluid is present, patients may also have a bronchoalveolar lavage in which fluid is aspirated from the chest cavity.

In addition, pulmonary function tests and arterial blood gas levels may be performed. However, it can be difficult to distinguish respiratory problems such as pneumonia from interstitial lung disease in patients with systemic lupus. A microbiology examination on sputum, a bronchoscopy or a lung biopsy may be performed when infectious pneumonitis is suspected.

You may read: St. John’s Wort (HypericumPerforatum): Can A Herbal Supplement Treat Major Depression Disorder?

In the past, pleural fluid was examined for the presence of anti-nuclear antibodies (ANA). Recent studies show that the ANA test is only positive in half of patients with lupus pleurisy. In addition, patients with other pulmonary diseases besides lupus can have a positive ANA.

Diagnostic criteria used in the past, including ANA tests and complement levels, made lupus pleurisy difficult to detect and difficult to manage. New studies suggest that an elevated white blood cell count, the presence of lupus erythematosus (LE) cells, and an elevated level of the enzyme lactic dehydrogenase (LDH) are more consistent findings.

Pulmonary embolism can be ruled out with negative results on a blood test known as the quantitative D-dimer test. However, a positive result can occur in other conditions and doesn’t necessarily mean that pulmonary emboli are present. Other tests used to diagnose pulmonary emboli include ventilation-perfusion (breathing and blood flow) scans of the lung.

St. John’s Wort (HypericumPerforatum): Can A Herbal Supplement Treat Major Depression Disorder?

St. John’s Wort is a yellow-flowered herb used to treat health conditions since the time of ancient Greece. The herb’s scientific name is Hypericumperforatum, and is sold in the United States as a dietary supplement. In Europe, St. John’s Wort is used to treat mild to moderate clinical depression.

St. John’s Wort Clinical Studies

While St. John’s Wort has a long history as a depression treatment, much of its reputation is based on historical use. Clinical trials suggest that while St. John’s Wort has some applications as a treatment for depression, it may not be well suited for all types of depression.

The National Center for Complementary and Alternative Medicine (NCCAM) funded one such study. The results of the NCCAM study were that placebos were as effective as St. John’s Wort for moderate to severe major depression disorder. The same study suggested that the antidepressant sertaline was also no more effective than placebo for depression treatment.

While such studies are discouraging, other research suggests that St. John’s Wort at least has potential as a treatment for mild depression. Further study is required to confirm or disprove this possibility.

How St. John’s Wort Treats Depression

It’s not entirely clear which compounds found in St. John’s Wort help people cope with depression. The two most likely active compounds are the chemicals hypericin and hyperforin, both of which are thought to affect neurotransmitters (compounds in the nervous system that act as chemical messengers). Low neurotransmitter levels appear to affect a person’s mood.

Types of St. John’s Wort

St. John’s Wort comes in three basic forms. Capsules or tablets of the herb are available, as are herbal teas made from St. John’s Wort. Liquid extracts are also available. St. John’s extracts are concentrated distillations of the plant chemical compounds.

Whether choosing teas, capsules or St. John’s extract, bear in mind that herbal and dietary supplements – in the U.S. at least – are not as well regulated as medications. The range of quality and purity from one herbal supplement to the next can vary widely, and it’s wise to bear this in mind when purchasing St. John’s Wort or any other natural remedies for depression.

St. John’s Wort, Side Effects and Serotonin Syndrome

St. John’s Wort is usually safe to use, but can cause unwanted side effects. The most common side effects associated with St. John’s Wort include:

  • anxiety
  • diarrhea
  • dizziness
  • dry mouth
  • fatigue
  • headaches
  • insomnia
  • irritability
  • photosensitivity (sensitivity to sunlight)
  • restlessness
  • skin rash
  • stomach problems
  • tingling sensations
  • vivid dreams.

St. John’s Wort can also interfere with the effectiveness of certain medications. People should avoid St. John’s Wort if they are prescribed any of the following:

  • anticancer medication
  • anticoagulants (blood thinners)
  • antidepressants
  • birth control pills
  • cyclosporine
  • digoxin
  • medications used to treat HIV.

Pregnancy and nursing women should avoid St. John’s Wort, as should anyone trying to conceive children. As the herb affects anticoagulants, people scheduled to have surgery should avoid taking St. John’s Wort for at least two weeks before surgery.

Using St. John’s Wort in combination with certain antidepressants can result in a potentially fatal condition known as serotonin syndrome. Before taking any dietary supplement with prescription medication, be sure to talk to a health care professional about possible interactions.

Other Depression Herbs

In addition to St. John’s Wort, a number of other natural remedies for depression exist, including kava kava and ginkgo biloba. Clinical studies into the efficiency of these natural treatments for depression are limited.

Read More: Report Encourages Widespread Use Of ASA: Benefits For Men, Women Of Certain Ages.

It cannot be overstated: before choosing natural remedies for depression check their safety with a mental health professional and be sure the dietary supplement does not interact with any prescribed or over the counter medications.

Report Encourages Widespread Use Of ASA: Benefits For Men, Women Of Certain Ages

The new recommendations are in a report from the US Preventive Services Task Force.

  • Women age 55 to 79 years old should take ASA to prevent strokes, providing the benefit outweighs the risk of ASA.
  • Men age 45 to 79 years old should take ASA to prevent heart attacks, providing the benefit outweighs the risk of ASA.

These new recommendation are stronger than the 2002 ones from the same group. Along with these new recommendations, the experts present ways to estimate personal benefit and risk. The report is available on the AHRQ website.

How to Calculate Stroke Benefit

The benefit is reduction in stroke risk. Tables are provided to estimate how women may benefit from taking ASA (Report Figure 4). For example, among 65 year old women with a 5% 10-year stroke risk, eight strokes per 1000 women will be prevented by taking ASA.

To Determine Stroke Risk

You can determine your personal stroke risk using the an interactive calculator at the Western Stroke Organization (for the web address, look under “Clinical Considerations, Women). For example, a 65 year old woman with systolic blood pressure of 160 has a 5.2% risk of stroke over 10 years (‘systolic’ is the first set of numbers in a blood pressure reading). If she also is a smoker, the risk jumps to 8.8%.

For a man of the same age, same systolic blood pressure, and a smoker, the ten year stroke risk is almost 14%.

To Determine Heart Attack Risk and Benefit

You can determine your personal heart attack risk using the provided link to an interactive calculator at the Medical College of Wisconsin.

Benefit–heart attacks prevented–is provided in Figure 2 of the report. For example, a 65 year old non-smoking man with no special risks, LDL cholesterol 99, HDL cholesterol 45, has a 10% risk of a heart attack in the next ten years. Taking ASA by 1000 men in this risk profile will prevent 32 heart attacks in ten years.

ASA Risks

Whether or not to take ASA depends on the downside–the risks of taking ASA–as well as the benefits. ASA use increases the risk of serious bleeding from the stomach and elsewhere in the gastrointestinal (GI) tract. The risk is increased in people who have bled once. Previous bleeding from the GI tract is associated with at least double the risk of bleeding from ASA.

The risk is increased four times over in people who concurrently take NSAIDS (Motrin, Aleve, Naprosyn, others). Uncontrolled hypertension increases bleeding risks. Taking warfarin (coumadin, others) is generally considered a contraindication to ASA (ASA should not be used with warfarin).

  • Men have twice the risk of bleeding than women.
  • Enteric coating on ASA has not been shown to reduce the risk of bleeding.
  • There are special safety considerations for older people.

Other Benefits of ASA

Not included in the Task Force’s considerations are other potential benefits from ASA. It may reduce the risk of dangerous colon polyps; however, a recent study indicated it does not reduce the risk of death from colon cancer. (Journal of the National Cancer Institute 2009 (Feb 18); 101:256)

What to Do

The panel encourages shared decision making. Individuals should discuss their potential personal benefits and risks from ASA with their physician.

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