The Overview of the Most Common Immune-Related Diseases

There are many conditions that are faced by the population across the lifespan. At times, it may be difficult to cope with being diagnosed with a condition in the early stages, especially the conditions that are diagnosed at an early age between 18-25. It is extremely important to be aware of some of the common conditions and their manifestations to obtain a better understanding of them. Systemic Lupus Erythmatosus (SLE) is an inflammatory condition where the body’s own immune system attacks the organs of the body. In some cases, this can become quite severe if not treated early and appropriately. Another condition commonly diagnosed at a young age is Crohn’s disease. This is another chronic inflammatory condition of the gastrointestinal system where lesions are present along the digestive tract and causes intermittent cramping abdominal pain and diarrhea. Multiple sclerosis is a chronic demyelinating condition which affects mainly females between 20-25 years of age and continues throughout the lifespan.

Multiple Sclerosis (MS) is an autoimmune disease which demyelinates the nervous system and therefore damages the insulating nerve cells of the brain and spinal cord. There is no reason for the incidence of MS however there are environmental and hereditary factors which may be responsible. It occurs predominantly in 20-50 year old females but can occur in males as well. In the clinical environment, a patient with MS would typically present with the following symptoms: muscle weakness, weak reflexes, muscle spasms, double vision or blindness, incoordination, difficulty moving and imbalance (Koriem, 2016). There are four types of MS and the classification is important for treatment. The types are relapse-remitting, primary progressive, secondary progressive and progressive relapsing. Unfortunately, treatment options are very limited for MS and there is no cure. However, the treatments provided attempt to improve the neuronal function and limit the progression of the disease.

Crohn’s disease (CD) is an idiopathic chronic inflammatory bowel disease with stages of activity and remission. The main characteristic of Crohn’s is that there are lesions that affect the entire gastrointestinal tract. It occurs predominantly between the ages of 15-35 and affects men and women equally. The presentation of CD varies depending on the location and severity of the disease pattern. In the clinical environment, it is likely that a patient would typically present with abdominal pain usually located in the right iliac fossa and may complain of chronic diarrhea (Ballester Ferré, 2018). It is also common to be presented with systemic symptoms including malaise, fever or weight loss. The main aim for treatment is to achieve clinical and endoscopic remission. Treatment of CD includes glucocorticoids, immunomodulatory and surgery.

Lupus is an autoimmune disease that affects organ systems predominantly in females aged 15-40. The most common form is systemic lupus erythematosus (SLE) and is mainly characterized by the body attacking healthy tissue rather than foreign bodies. This process can occur in many organs of the body but mainly takes place in skin, muscles, joints, kidneys, heart and lungs (Lahita, Tsokos, Buyon & Koike, 2011). In the clinical environment, patients with SLE may present with some of the following symptoms: joint and muscle pain, skin rashes, hair loss, fatigue, ulcers, chest pain, seizures and poor kidney function. Lupus has no cure; however, medications are provided to manage the condition and if diagnosed in the early stages this can prevent progression.

Currently, there is no known cause or cure for Lupus but experts believe it may be due to genetics, hormonal and environmental factors. Lupus can flare up in unpredictable patterns over the course of a year which can make existing symptoms more severe or cause the patient to develop new symptoms. Due to the unpredictability of the condition, the short term and long term goals of treatment must be taken into consideration to achieve the most desirable outcome. Doctors aim to decrease disease activity while taking into considering the short term and long term side effects of the medications they are prescribing their patients.

The most common general clinical presentation of SLE is fatigue as well as fever and weight loss. Musculoskeletal manifestations include morning stiffness as well as mild joint swelling. From a skin point of view, patients may develop a malar or butterfly rash. The discoid rashes are the most severe. Patients may also present with pulmonary features such as chest pain on inspiration usually in the form of pleurisy. It is possible that lupus activity can cause this. Cardiac manifestations must also be investigated as SLE may also cause premature coronary artery disease or pericarditis. Oral ulceration is the most common gastrointestinal feature as well as abdominal pain, nausea, vomiting and diarrhoea. At times, renal disease may also develop due to SLE and so it is important to regularly measure renal function as well as monitoring urine for proteinuria. Failing this, patients are at risk of chronic renal damage and may require dialysis or transplant. Patients suffering from SLE may also present with neurological symptoms such as headaches, seizures or aseptic meningitis. According to (Smith & Gordon, 2010), a patient must have four or more of the eleven criteria in order to be diagnosed with SLE. Patients can also be diagnosed through laboratory features such as a full blood count where leucopoenia is detected. “Anaemia and thrombocytopenia may also be present” (Smith & Gordon, 2010). Autoantibodies are also associated with SLE, such as antinuclear antibody. “Anti double-stranded DNA antibodies occur in around 60% of lupus patients” (Smith & Gordon, 2010). Patients who have a rising anti-dsDNA antibody and decreasing complement levels should be carefully monitored as this may indicate a flare up of Lupus and therefore increased treatment may be necessary.

The clinical presentations of SLE are affected with age. Majority of the time the severity of symptoms may increase with age due to the fact that as you age you must deal with not only your current symptoms, but also the damage that your disease activity has caused in the past. Another reason there may be complications is because of the side effects related to allopathic treatments that the patient has been on for an extended period of time such as kidney dysfunction. Fatigue can also be progressive with age. Lupus creates a lot of damage as you age such as destruction of joints and causes chronic pain. This may mean physical surgery due to eroded cartilage etc. there is also a risk of osteoporosis with lupus due to the medications which accelerate bone loss such as glucocortoids. This may mean that the patient is more likely to experience fractures.

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Allopathic treatment of SLE is dependent on the activity and severity of the disease, it therefore needs to be individualised to each patient. The main form of medicinal treatment is glucocorticoids, nonsteroidal anti-inflammatory drugs, antimalarial’s and immunosuppressant’s with the aim to reach either remission or achieve minimal disease activity at minimum dosage of these drugs (Mejia-Vilet, Tejeda-Maldonado & Correa-Rotter, 2018). The clinical reasoning as well as side effects of these medications in the treatment of lupus will be discussed in further detail.

Although there is currently no cure for Lupus, Chiropractic care can be extremely beneficial in treating uncomfortable and painful joints and muscles in those who suffer from the condition. SLE is responsible for the inflammation that occurs in the tissues and causes damage to the joints and organs. Inflammation can be subsided with Chiropractic treatment. Proper alignment of the spine may help with the aches and pains associated with Lupus and also aid in preventing the musculoskeletal symptoms of SLE from worsening. Some patients who suffer from SLE may be sensitive to touch and Chiropractors have a variety of treating tools to accommodate for those patients. These include modalities such as light trigger therapy, stretching to restore flexibility and improve range of motion, low impulse electric stimulation, cold laser treatments, ultrasound and nutrition measures to reduce inflammation.

A study conducted by Merrell and Shulman found that there is a 51% survival rate 4 years post diagnosis. The prognosis has Improved remarkably to a 90% 10 year survival rate since that study was conducted. Antimalarial therapy for patients with systemic lupus erythematosus (SLE) is associated with improved survival and reduced disease activity, as well as cardioprotective and anticancer effects. Life expectancy is not an easy calculation as it differs from person to person due to the individualised symptoms and complications a patient may face. However, due to the successful progression of treatments, Lupus is no longer considered fatal. Some people experience extreme flare ups and these are the people who are likely to have further complications such as organ damage and infections, which may decrease their life expectancy. Research has proven that people diagnosed with Lupus have been living with the disease for up to 40 years. As research progresses, scientists hope to identify people who have a risk of lupus through genetic studies. This will allow doctors to begin preventing known complications much earlier and further improve the life expectancy. Researchers also hope to find the molecular pathways that cause lupus so that they can target them for new therapies.

The toxicity of the drugs prescribed to lupus patients must be monitored. Some patients do not respond to standard treatment and at times require a higher unacceptable dose of medications to achieve remission.

Glucocorticoids are potent anti-inflammatory and immunosuppressant agents, these bind to intracellular glucocorticoid receptors (nuclear receptors) to alter gene transcription. Glucocorticoids are the main form of treatment for SLE with short-term side effects of weight gain, peripheral oedema, glaucoma, high blood pressure and also psychological effects such as confusion and memory and behaviour changes. The long term side effects of glucocorticoids include cataracts, increased risk of infections, osteoporosis, slower wound healing and supressed adrenal gland hormone production (Smith & Gordon, 2010).

Antimalarial’s such as hydroxychloroquine are used to improve the discoid lesions associated with SLE. such as chloroquine have short term side effects such as nausea, vomiting, headache, dizziness and abdominal pain. The rarer side effects include anxiety, depression, restlessness and hallucinations. The efficacy of antimalarial’s are not widely studied however there is no evidence that higher doses are more effective than low doses. They cause inhibition of B cell-activating factor which aids in the treatment of skin lupus (Smith & Gordon, 2010). Patients with impaired renal function, caution with dosing of antimalarial agents is recommended and careful monitoring for adverse events should be undertaken (Lee, Silverman & Bargman, 2011).

Immunosuppressant’s such as Mycophenolic acid (MMF) is used as induction therapy to stop the damage and recover the function loss caused by disease activity of lupus. This therapy promotes the maintenance of remission and prevents relapse. Patients may encounter side effects from using immunosuppressant’s such as fever, chills, lower back pain, trouble or painful urinating and fatigue or weakness.