by Lynnette Southwood

Created on: January 16, 2007   Last Updated: April 18, 2007

Lupus and Infections: Flare or Infection?

The threat of infection for people with lupus is very real and very dangerous. Lupus patients have abnormalities in their immune systems that predispose them to develop infections. It is harder to fight infections partly because the drugs that are normally prescribed, Cytotoxic (Imuran, Cytoxan) and corticosteroids (Prednisone) suppress both normal and abnormal immune functions. Interestingly enough, research shows that lupus patients are still susceptible to infections whether or not they are on these medications just by the sheer nature of the disease. Lupus reduces the ability to ward off and fight infections because cellular mechanisms are responsible for defective microbial killing.

Sometimes infections can cause auto-antibodies to be produced and this may be a causes of Lupus. When the immune system goes wrong, antibodies can be formed that bind to parts of the body (an auto-antibody). The antibodies circulate in the blood, but sometimes cell walls let these antibodies in. These can then attack the DNA in the cell's nucleus. That's why some organs are attacked during a flare while others aren't.

To further complicate things, lupus flares and infections mimic each other. Both conditions show signs of fever, chills, pain, lack of energy and motivation. The only way to know for sure is to get a blood test that will measure your white blood count. Some physicians find a C-reactive protein (CRP) blood test to be helpful in differentiating active lupus from infection, but this is controversial.

The treatment of infections in lupus patients is basically the same as for other patients. Even those taking high doses of immunosuppressive medications for their lupus may respond well to antibiotics. The use of sulfa and penicillin drugs in the treatment of infections should be avoided whenever possible, because they can increase photosensitivity and they may aggravate the condition. Bacterial infections have a tendency to adapt genetically and resist antibiotics over time. You should urge your doctor to use caution when using antibiotics for fear of the drugs becoming less effective. Some bacteria build a tolerance to antibiotics, making it difficult to treat diseases such as meningitis and lyme disease. To prevent possible infections, patients at high risk of infection often benefit from taking antibiotics before dental treatment or surgical procedures. This is especially important if you have had joint replacements, as there

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