Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

Systemic lupus erythematosus is also called SLE or simply lupus. It is a disease characterized by general symptoms of feeling bad, arthritis, and skin lesions, with gradual or rapid progression to serious manifestations, such as pneumonia, disabling arthritis, and kidney failure. Lupus is a member of the group of diseases called "collagen diseases," which include also rheumatoid arthritis, dermatomyositis, and others. Lupus often starts with a fever of unknown cause, which lasts for days, weeks or months. A rash, typically in the "butterfly area" of the face, may begin at that time. The disease is caused by an alteration in the chemical structure of collagen, a type of connective tissue fiber especially common in blood vessels, lungs, kidneys, skin, and the lining membranes of joints and body cavities. The organs where the connective tissue collagen fibers are most numerous will be most severely afflicted by the disease symptoms.

The disease runs an on-again-off-again course, lasting many years. It is chronic, often disabling, and labeled incurable. Cortisone is often used to relieve symptoms, but it does not in any way alter the progress of the disease. The long-term use of even low doses, such as 5 mg daily of prednisone, can lead to problems, such as moon face and buffalo hump, recurrent infections, osteoporosis, and cataracts.¹

The blood serum proteins may be abnormal. Lupus is more common in women in the childbearing age, and strikes all races and all geographic areas, no preferences having been noted. It is a fairly common disorder, and is increasing in frequency. The increase in frequency seems greater than can be accounted for on the basis of greater ability to make the diagnosis.

There are a number of causative factors that mark the onset of the disease, or that initiate a flare-up. Exposure to sunlight, which produces a severe skin reaction, may be followed by the development of widespread activity in the body. Various stresses such as surgery, pregnancy, abortion, and cancer are associated with initiating lupus.² The administration of a large variety of drugs, notably gold, sulfonamide, penicillin, or other anti-microbials may initiate the flare-up. When lupus is caused by certain drugs, the effect is sometimes reversible once the offending medication has been removed. A local infection or severe emotional or physical stress may be related to the flare-ups. Widespread use of drugs may be related to the increase in the incidence of lupus. The fact that the taking of drugs just prior to a flare-up is often a feature of the disease gives credence to the theory that lupus is caused by toxic agents.

There are several other theories as to the origin of lupus. One theory is that it is an autoimmune disease, that is, the body has become allergic to itself. It is true that some of the altered proteins in the blood act as antibodies to break down its own red blood cells, even to the point of causing anemia. The antinuclear antibody (ANA), an abnormal protein found in many collagen diseases, has been found in certain of the kidney lesions of lupus. Some feel, however, that the abnormal proteins develop mainly under conditions of low oxygen or some kind of circulatory ischemia, bringing us back to the idea of the influence of drugs on the body. Contraceptive pills can also cause the production of ANA.²

There seems to be a hereditary predisposition to the disease as immediate relatives of persons with lupus will show abnormal proteins in the blood and positive tests for rheumatoid factors more frequently than the general population. Many of these family members are without symptoms, but some relatives of lupus patients have certain manifestations including rheumatoid arthritis, rheumatic fever, skin eruptions from undetermined cause, or a neurological disorder.

Another theory is that lupus is caused by an infectious agent. There are some who have entertained the thought that a viral illness may be the cause of lupus. Measles virus has been implicated because certain sequences of nucleotide molecules in the genes of measles virus have been found in the genes of SLE patients, and not in the genes of persons not having SLE. Perhaps the virus triggers abnormal protein formation, which makes the body think its cells are foreign. Then the body attacks its own cells in an autoimmune reaction.³ Lupus has been seen to occur in families, the disease involving parents and children or a child and siblings. The disease has been recorded in identical twins. When the disease appears in the offspring of a pregnant woman having lupus, it does not usually conduct itself in such a way as to indicate an infectious disease, but rather it usually develops many years later. A chronic false positive test for syphilis may be present many years before a person develops frank lupus, hinting at a relationship with an infectious agent.

Dogs get systemic lupus erythematosus, as well as humans. There have been some authorities who have suggested a possible relationship between lupus in pets and lupus in humans. Nobody has yet shown any cross relationship between dog lupus and that of humans.⁴

In directing treatment to lupus, we aim at all three of the currently considered possible causes, a toxicity, an autoimmune or allergic type of reaction, and a viral infection. We begin our treatment with the use of charcoal. This excellent form of treatment can be used internally as well as externally. The internal dosage is 8 to 10 tablets (4 capsules) daily for a sufficient length of time to expect the toxic substance to be adsorbed. This may last a month or more. At the same time charcoal baths or charcoal whirlpool (a cup of charcoal to a whirlpool tank) or one-half cupful to a bathtub of hot water (103° to 104° F). If the disease is due to any of the three factors suspected, the charcoal is capable of assisting somewhat in taking up the causative agent.

A sweating bath is also used about five times per week, if the patient's condition will permit. The oral temperature is made to rise to 101 to 103°, so that a profuse sweating may occur. If the disease is due to a virus, the higher temperatures promote the phagocytic activity of the white blood cells, improve the defense mechanisms, and stimulate the immune system to normal function. If the disease is due to a toxin the treatment will assist in its removal through the process of sweating, phagocytosis, and increased urine production.

Massage is a good form of treatment, preferably using total body massage. The enhancement of immune function, encourages a return to normality in producing blood proteins.The diet should be chosen with the expectation that whatever the cause, the diet would be capable of assisting the body's own defense and elimination systems. A generally well balanced diet, chosen from a strictly vegetarian menu with an emphasis on fresh vegetables and fruits, is believed to be the best. Salt should be kept to the minimum. The elimination of all animal products would rid the body of one possible source of toxins and viruses, and would avoid one potential source of abnormal stimulation to the immune system. A diet containing no free fats and free sugars would allow the defense mechanisms of the body to operate untrammeled, since these food items are known to interfere with the proper functioning of the defense system. Good nutritional status is considered a factor in recovery from acute attacks.⁵ Some deficiency states, particularly a deficiency of manganese, have been indirectly implicated in lupus. This idea arose because of observations in chronic hydralazine (an older blood pressure medication) poisoning in animals. Lupus and the hydralazine syndrome in man may be related to manganese deficiency.

Dr. Joel Fuhrman, of New Jersey, has reported the novel treatment of fasting for lupus patients. He has fasted them, even some with fairly severe kidney disease, for up to 21 days, with excellent improvement. He cautions that this must be done only with strict medical supervision.⁶ This is a treatment that deserves more extensive trials.

Sunlight should be used, but in vanishing quantities at first, particularly in acute exacerbation. When the acute part of the disease has subsided, begin with very small doses of sunshine, perhaps five minutes. Before that, the patient is given five minutes in deep shade, daily progressing until five minutes can be tolerated in light shade, then advancing to a screened sun porch for as many hours daily as possible. We believe the very fact of being outdoors can be beneficial to many.

Of course, the good physical conditioning features of fresh air, sunshine, pure water, habit in regularity, abstemiousness, and trust in divine power are essential to the treatment of lupus.‍

Bibliography:‍

1. Journal of the American Medical Association, April 25, 1980, p. 1665.

2. Contemporary Obstetrics and Gynecology, July 1977.

3. Science News, September 6, 1975.

4. Arthritis and Rheumatism, May 1900, p. 564-568.

5. Journal of the American Medical Association, March 6, 1981, p. 834.

6. Fuhrman, Joel. Fasting and Eating for Health. St. Martin's Press, 175 Fifth Ave., New York, NY 10010, 1995.