Lupus Erythematosis 

upus erythematosis is relatively common in women. China has the highest incidence of this condition, which statistically occurs in 250 out of every 100,000 persons. Lupus erythematosis is an autoimmune disease whose pathogenic mechanism is still not very clear. It may be a malfunction of the immune system triggered by genetic susceptibility, environmental factors, and some circulatory factors. It typically appears as an imbalance in B and T lymphocytes, which may arise from increased T helper cell activity, reduced T lymphocyte inhibition effects, or because B lymphocytes are excessively activated. All of these may lead to the excessive production of antibodies. Multiclonal B lymphocytes are activated, and they stimulate the production of auto-immune antibodies against cell nuclei. 

      According to diagnosis criteria set by the American Rheumatism Association in 1982 and revised in 1997, lupus erythematosis must simultaneously or successively meet four of the diagnostic conditions listed below before it may be diagnosed as such: 

1.  Lasting red spots appear on the cheeks. They are flattened or protruding, and usually appear only on cheeks. 

2. Protruding circular areas of red rash are accompanied by flaking or  congestion of the hair follicles. Atrophied scars may appear around old foci of the rash. 

3. A red rash appears on the skin following exposure to light. 

4. Oral or nasopharyngeal ulcers appear, but are usually not painful. 

5. Arthritis attacks two or more peripheral joints, and appears as   redness, swelling, and accumulation of water. 

6. Pleurisy or pericarditis.

7. Kidney disease; urine protein consistently exceeds 0.5g per  day, or test paper yields a positive reaction of at least 3+, or   cellular sediment can be seen under the microscope. 

8. Neural disorders, epilepsy, or mental illness. 

9. Blood disease, hemolytic anemia, white blood cell count below  4,000 on more than two occasions, lymphocyte count below 1,500 on more than two occasions, or platelet count below 100,000 (per cubic millimeter). 

10. Immune disease, positive for anti-DNA antibodies, positive      for anti-Sm antibodies, or positive for anti-phospholipid antibodies (including anti-cardiolipin antibodies, lupus anticoagulant, or false positive serum syphilis test (STS)) persisting for at least six months. 

11.  Positive for anti-nuclear antibodies (ANAs). 

      While steroids are currently the standard, and the most important, type of drug for treating systemic lupus erythematosis, there are many problems that cannot be cured with steroids. For instance, because large doses of steroids may cause glomerular fibrosis in patients with kidney disease, steroids cannot be considered a panacea for lupus erythematosis. 

Reference: Cheng Chao-wen, Chen An, Chang Teh-ming, Li Wei-hua; 1999; A Discussion of the Pathologenic Mechanism Involving Th1 and Th2 Lymphocytes in Lupus Erythematosis and Genetic Therapy; Defense Medicine, 29: 449-452.