Systemic Lupus Erythematosus

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that surfaces as inflammation and damage to various parts of the body and its tissues. Lupus can affect the joints, skin, heart, lungs, blood vessels, brain and kidneys. Systemic Lupus Erythematosus affects the blood vessels and connective tissues of the skin. Since the body turns against itself, the tissues become inflamed and swollen. Most often, SLE manifests itself with a butterfly-rash and pain in the joints. This disease is more pronounced among persons of Afro-Caribbean and Asian origin. Women are more likely to be afflicted by Systemic Lupus Erythematosus.

A patient suffering from Systemic Lupus Erythematosus experiences painful swelling in the joints, skin rashes, extreme fatigue, fever and infections due to weakened immune system. Scaly sores on the face (discoid rash) and butterfly-shaped rash on the bridge of the nose (malar rash) are also noticed. SLE also leads to serositis - inflammation in the linings of the hear, lungs and abdomen. There may be weight loss, vomiting and diarrhea. SLE can also cause swollen glands and sensitivity to cold. While symptoms of SLE are often noticed in the years of 15 - 45, it can even occur earlier or later.

This disease tends to appear in periodic flare-ups. Often diagnosis of systemic lupus erythematosus takes time. Blood tests are conducted for checking for the presence of antinuclear antibodies (ANA). Chest x-rays and urine analysis are done. Inflammation levels are checked with sedimentation rate (ESR) or C-reactive protein (CRP). While there is no cure for systemic lupus erythematosus, corticosteroids and anti-inflammatory drugs are prescribed to relieve pain and swelling. Immunosuppresants are also used in the treatment of SLE. Physiotherapy is used to give relief to the patient from pain in the joints.

Xerostomia

Xerostomia or Dry Mouth is a condition that can occur due to many reasons. It is often indicative of other health conditions. There is reduced saliva flow, not necessarily due to decreased salivary gland function. Other conditions that occur with xerostomia include constant sore throat, dry nasal passage, burning mouth or difficulty in swallowing. Symptoms of xerostomia include thick saliva, cracked lips and sores at the mouth corners. There might be red patches on the tongue and palate. The tongue appears dry with very few papillae - indentations. Xerostomia can lead to reduced oral pH and increased risk of plaque and dental caries, if left untreated. Other conditions that can develop include tongue ulcers, oral candidiasis, halitosis and sialadenitis.

Oral cavity examination to measure the flow rate of saliva is done to diagnose xerostomia. This is done through sialometry test. Sialography is an imaging test wherein the salivary glands are examined for stones and masses. The patients medications must be examined. Medications are the main cause for xerostomia. These include antihistamines, antidepressants, anti-Parkinson agents, diuretics and sedatives. Analgesics, decongestants and muscle relaxants also cause this. Another cause for xerostomia is Sjogren's syndrome. Other causes include sarcoidosis, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, diabetes mellitus, hypertension, cystic fibrosis, endocrine disorders and amyloidosis.

Palliative methods include use of water and glycerin and avoidance of alcohol-based mouth washes. Sip plenty of plain cool water. Eat more blended and moist foods. Include hard cheese in the diet. Suck on sugar-free gum. Artificial saliva and salivary stimulants might be suggested by the physician. Pilocarpine is the most prescribed medication for xerostomia.

Rheumatoid Factor Test

Rheumatoid factor test is used to measure the amount of rheumatoid factor in the blood. Rheumatoid factors are proteins produced by the body's immune system that can attack healthy tissue in the body. Antibodies are normal protein found in the blood, functioning within the immune system. Rheumatoid factor is an immunoglobulin i.e. antibody that can bind other antibodies. It may be present in 1-2% of the healthy population. In older people aged 65 and above, 20% have elevated level of rheumatoid factor.

Elevated levels of rheumatoid factor in the blood show up as autoimmune diseases, such as rheumatoid arthritis and Sjogren's syndrome. Many a time, rheumatoid factor may be detected in few healthy people and at times some people with autoimmune diseases have normal levels of rheumatoid factor. Patients with negative rheumatoid factor but suffering from the condition are classified as having seronegative rheumatoid arthritis. But largely, healthy people do not produce rheumatoid factor.

A sample of blood is drawn from the vein in the arm and sent to the laboratory for test. The RF test helps to diagnose rheumatoid arthritis and may also help the physician choose the line of treatment. A positive result, i.e. test result indicating the presence of rheumatoid factor in the blood may confirm rheumatoid arthritis in a person. About 80% of adults who have rheumatoid arthritis test high for rheumatoid factor.

This test helps differentiate between rheumatoid and inflammatory arthritis from other types of arthritis. High level of rheumatoid factor may also result from the presence of other autoimmune diseases in the body such as:

• Cancer
  
• Cirrhosis
  
• Scleroderma
  
• Sjogren's syndrome
  
• Chronic infections
  
• Mixed connective tissue disease
  
• Inflammatory lung disease like Sarcoidosis
• Systemic lupus erythematosus
  

When is the test ordered?

Rheumatoid factor test is ordered for persons suffering from the following symptoms:

• Stiffness in the joints
  
• Increased pain in the joints in the morning
  
• Bone loss
  
• Loss of cartilage
  
• Nodules under the skin
  
• Warmth and swelling in the joints.

Rheumatoid arthritis test principle

Rheumatoid factor can be identified in the laboratory by its ability to bind and form clumps with latex particles or red blood cells that have human immunoglobulin (IgG). If the patient being tested has rheumatoid factor, then it attaches to the IgG coating the latex particles causing lumps. This process is called agglutination. Agglutination is a positive reaction that indicates the presence of rheumatoid factor at a detectable level.

Rheumatoid Factor Results

The antibody titer is a test that measures the quantity of the blood that can be diluted before RF antibodies become indistinguishable. The following results will be considered as normal:
Less than 40 - 60 units/ml
Less than 1:80 (1 to 80) titer.

A low number (normal result) generally indicates that the person being tested does not have rheumatoid arthritis or Sjogren syndrome. However, a few people who have the condition may still have a normal or low rheumatoid factor (RF). Normal ranges may vary from laboratory to laboratory.

An abnormal result may mean the test is positive. Most patients with this result may have rheumatoid arthritis or Sjogren's syndrome. The higher the level, the more likely the condition is present. There are other tests that may be used to diagnose the condition.

• False positive results can occur when the fat content in the blood is high.
  
• Inaccurate results may show up when the blood specimen is handled improperly.
  
• A negative rheumatoid factor does not rule out the presence of rheumatoid arthritis.