- Lupus Fog and Memory Problems
- Lupus and the Brain – LUPUS UK
- Diagnosing Systemic Lupus Erythematosus
- Diagnostic Criteria
- Three Types of Skin Rash
- Mouth Sores
- Joint Problems
- Reduced Levels of Blood Cells
- Organ Inflammation
- Nervous System Disorders
- Autoantibody Activity
- Urine Changes and Kidney Disease
- Autoantibody Tests
- Antinuclear Antibody Tests
- Anti-Double-Stranded DNA Antibody Tests
- Anti-SSA/Ro Antibody Tests
- Anti-Smith Antibody Tests
- Antiphospholipid Antibodies Tests
- Additional Blood Tests
- CT Scans
- MRI Scans
- 5 Strategies for Coping With Lupus-Associated Brain Fog
- Treatments may target lupus or symptoms
- 5 coping strategies
- Regaining control
Lupus Fog and Memory Problems
From the WebMD Archives
Lupus fog — the forgetfulness and fuzzy-headed feeling that can come with lupus (systemic lupus erythematosus, or SLE) – can be one of the most frustrating symptoms of the condition.
The term lupus fog means more than memory problems. It also refers to cognitive difficulties, such as trouble helping your child with homework, or writing a grocery list.
“It can really make your whole world fall apart,” says Janet Foley Orosz, PhD, a public policy expert in Ohio who has struggled with lupus fog for almost 20 years. She's now collaborating on a web site and vocational program designed to help others with the condition.
There's no cure for lupus, so there's no cure for lupus fog either. But there are ways to work around your problems with concentration and memory. Here's what you need to know.
Lupus fog is a general name for the cognitive impairments that often appear with lupus, including concentration and memory problems, confusion, and difficulty expressing yourself. These cognitive problems are often worse during flares.
The good news: Lupus fog doesn’t usually get progressively worse, dementia or Alzheimer's disease, says Lisa Fitzgerald, MD, a rheumatologist at the Lupus Center of Excellence at the Beth Israel Deaconess Medical Center in Boston. Instead, memory issues will probably wax and wane, just other lupus symptoms.
The exact cause of lupus fog is hard to pin down, experts say. In some cases, lupus can damage cells in the brain, leading directly to cognitive problems.
However, in most cases other factors play a role, including fatigue, stress, and depression. Lupus fog is sometimes worse in people who also have fibromyalgia.
Although it's possible that side effects from drugs such as NSAIDs or steroids could worsen lupus fog, experts say that switching medicines rarely resolves the problem.
While researchers study possible causes of lupus fog, Orosz focuses on coping strategies that help people deal with it.
“When you're a person dealing with lupus fog, you don't worry that much about what's causing it,” says Orosz. “What you care about is learning how to work around it.”
Here are some tips that may help you deal with lupus fog.
- Put it in writing. “It's really important to lighten the load on your working memory,” says Orosz. Instead of trying to keep stuff in your head — and failing — write it down. Write everything down — every household chore, every birthday, and every doctor's appointment. Take notes during conversations. You need to get in the habit of writing down even the stuff you’re positive you would never forget.
- Stay organized. Keep everything in a daily planner so you don't end up with your notes on random scraps of paper. Consult it many times a day. Come up with a schedule and manageable to-do list — or even just one specific goal — for every day. If you have a smart phone, get a good note-taking app that you can access on your phone and on your computer.
- Prioritize. “I divide tasks into two categories — things I must do and things that would be nice to do,” Orosz says. “Then I only do the must-dos.” She says an alternative way to organize is to rank to-do items by how much stress they're causing and to get rid of the stressful stuff first.
- Say it out loud. “Things seem to stick better in the short-term memory if you say them aloud,” says Robert Katz, MD, a rheumatologist and associate professor of medicine at Rush Medical College in Chicago. When you meet new people, use their name a few times in the conversation. After a chat or meeting at work, repeat the main points — it will help solidify your memory and let others fill in anything you missed.
- Time yourself. Orosz says that people with lupus fog should figure out when they're most efficient and schedule important tasks for then. Maybe it's a particular time of day or after a medication dose. Keeping track of time can help in other ways. “Allot a specific amount of time for a task and keep yourself to it with a timer,” she says.
- Stretch your memory. Playing word games and doing crossword puzzles can help sharpen your memory. “Many of the techniques that help older people who are getting forgetful will also benefit people with lupus fog,” Fitzgerald says. Keep your mind active and engaged.
- Keep good habits. If you have lupus, you need to take care of yourself. Reducing stress, taking naps, and getting enough sleep at night could help relieve lupus fog symptoms. “Regular exercise is important,” says Fitzgerald. “It does seem to make the brain sharper.”
When it comes to lupus fog, don't go it alone. Experts can help teach you ways to work around the cognitive symptoms.
Orosz suggests getting a referral to a neuropsychologist. Other types of experts who may help you cope with lupus fog include vocational counselors, cognitive therapists, and some occupational therapists.
Make sure these specialists have experience helping people cope with concentration and memory problems. They don't need to be experts in lupus specifically. Other conditions – such as MS and fibromyalgia — can cause similar types of concentration and memory problems. But the specialists do need to know how to help people with brain fog.
Pay attention to the costs. Insurers will hopefully cover a referral to a neuropsychologist, Orosz says, but coverage for cognitive therapy or occupational therapy might be more limited.
- Be honest with yourself. If your lupus fog symptoms are mild, you might not need to alter your routine much. If your lupus fog is severe — or long-lasting — you might need to consider big changes to your life and career.
That’s not easy. Just remember that trying to maintain a schedule that's become too demanding — and living in a state of panic and anxiety — will make you miserable. It will affect your family. It could very well worsen your lupus too.
“Having lupus fog will force you to change your expectations sometimes,” says Orosz. “It can be really hard to let go.” But making a big and necessary change will ly benefit you and your family in the long run.
- Be open with your family. Have an honest conversation with your loved ones about lupus fog. Make clear that lupus fog is not dangerous. It will probably come and go. They also need to understand that when things slip your mind — a child's soccer game or recital — it's a symptom, and not because you don't care.
Enlist your loved ones' help in supporting your memory. Ask them to use notes, texts, or email to remind you of things, instead of just telling you. You and your spouse may need to change how you divvy up responsibilities too.
- Consider talking to your employer. Lupus fog can be especially hard to manage at work, where concentration and memory problems might make you look lazy or unreliable. Some people with lupus decide to talk to their managers about the problem.Plan for the conversation. You need to know what you want to say and what you want to ask for. Some modest changes — modifying your hours or allowing for a little extra time on certain projects — may help. Before the talk, you may also want to talk to a counselor – such as an advocate from the Job Accommodation Network (JAN) — about your rights under the Americans with Disabilities Act.
Having lupus fog can be terribly discouraging. It can undermine your confidence and even your sense of self, Orosz says. It’s important to remember that it's not you. Lupus fog is just another lupus symptom — achy joints or facial rash.
Don't despair and don't settle for the symptoms. Talk to your doctor and see if you can get a referral to someone who specializes in treating lupus fog. The right treatments will help you feel better and more confident again.
Bonnie Lee Bermas, MD, director, Center for Lupus, Brigham and Women's Hospital, Boston.
Carey L. Busch, MA, assistant director of Disability Services, Office of Institutional Equity, Ohio University; cofounder of NavigateLupusFog.org.
Dawn Isherwood, RN, House Educator, Lupus Foundation of America.
Janet Foley Orosz, PhD, cofounder of NavigateLupusFog.org.
Lisa Fitzgerald, MD, rheumatologist, Lupus Center of Excellence at the Beth Israel Deaconess Medical Center, Boston.
Robert Katz, MD, associate professor of medicine, Rush Medical College, Chicago.
Hospital for Special Surgery.
Lupus Foundation of America.
© 2010 WebMD, LLC. All rights reserved.
Lupus is an autoimmune disease that damages all the organs in the body, including the brain. “Lupus brain fog” refers to cognitive problems, mood imbalances, and the fatigue people experience. It’s common but infrequently talked about. In this article, we bring up some possible symptoms and potential complementary strategies to discuss with your doctor.
What is “Lupus Fog”? Many people with lupus suffer from “brain fog,” mood disorders, and fatigue. The term “lupus fog” was coined to describe all these symptoms [ 1 ].Research suggests that about 10% to 80% of people diagnosed with lupus experience cognitive problems at some point.
The range is so large partly because different criteria are being used to define cognitive decline and low mood [ 2 , 3 , 4 , 5 , 6 ]. Lupus Systemic lupus ( systemic lupus erythematosus or SLE ) is a chronic autoimmune disease that often affects women more than men [ 7 ].In lupus, white blood cells incorrectly identify the body’s own tissues as a threat.
These cells become hyperactive and produce antibodies against healthy tissues. The tissues under attack — including the brain, skin, muscles, bones, and lungs — become inflamed and less functional [ 7 ].Symptoms of lupus vary from person to person and include fatigue, fever, and weight loss [ 7 , 8 , 9 , 10 , 11 , 12 ].
Research suggests that when lupus affects the central nervous system — the spinal cord and brain — people may begin to experience “lupus brain fog” and/or headaches , depression , anxiety , seizures, and strokes [ 7 ].Lupus fog is “brain fog” experienced by people with lupus. It’s thought to be a result of autoimmune inflammation.
“Brain Fog” “Brain fog” is a broader term used to describe a constellation of cognitive symptoms, the most common ones being [ 13 , 14 ]: Reduced mental clarity (“mental fogginess”) Slower thinking Inability to focus Reduced ability to multitask Long- and short-term memory loss People subjectively describe feeling forgetful, confused, and scattered — enveloped in what is felt as a “thick mental haze.” They feel their brain is slower and less agile than it should be. Thoughts become sluggish, blurred, and draining [ 15 ].According to one theory that has yet to be verified, “brain fog” might be caused by inflammation in the brain (as in lupus). Scientists hypothesize it might be triggered by [ 14 , 13 , 16 ]:It’s important to partner up with your doctor to uncover the underlying causes of your symptoms.People say “brain fog” is so frustrating because, for one, it is not a diagnosis. It’s a set of subjective symptoms. You may have “brain fog”, but it could be too “mild” or “unspecific” to be labeled as cognitive impairment . wise, “lupus fog” is not a diagnosis, though doctors accept its existence.While only people with lupus get “lupus fog,” anyone can experience “brain fog.” Inflammation is hypothesized to contribute to it, but the exact cause is unknown. Symptoms of “Lupus Fog” According to the research and clinical data, the main symptom of “lupus fog” is cognitive dysfunction : people may experience long- and short-term memory problems, have difficulty forming abstract thoughts, and feel their sense of judgment is off [ 1 , 17 ].Some people also feel they can’t understand and express speech ( aphasia ) or plan movements. Others find it difficult to recognize familiar objects ( agnosia ) and may also undergo personality changes [ 1 , 17 ].“Lupus fog” can take a large toll on day-to-day life. It may reduce productivity by 20-80% [ 1 ].Studies point out that it often arises alongside depression , fatigue , and anxiety early on — each of which can worsen “brain fog” [ 1 ].People with “lupus fog” may also experience a “ clouding of consciousness ” that intensifies at night. They often find it hard to focus and have reduced awareness of their physical environment. It can get frustrating, and people describe feeling they’re losing control, becoming agitated, or even aggressive [ 18 ].Additionally, about 5% of people diagnosed with systemic lupus will experience episodes of psychosis. These episodes can cause a loss of self-control, delusions, and hallucinations [ 1 , 17 ].The main symptoms of lupus fog evolve around difficulties remembering, thinking, focusing, understanding language, and recognizing familiar objects. Why Does “Lupus Brain Fog” Happen? Proposed Mechanisms
The exact cause of “lupus brain fog” is unknown. Scientists hypothesize it happens when the immune cells attack the brain and cause inflammation. Inflammation appears to slow down or stop brain cells from properly working [ 19 , 3 ].However, research is still in the early, experimental phases. Therefore, all the factors and biochemical processes outlined below are experimental and their contribution to disease development uncertain. The aim of this section is to outline research findings for informational purposes only. Potential mechanisms shown here are commonly associated with “lupus fog.” Work with your doctor or other health care professional for an accurate diagnosis.Also, have in mind that complex disorders lupus and its associated cognitive symptoms always involve multiple possible factors – including brain chemistry, environment, health status, and genetics – that may vary from one person to another. 1) Blood-Brain Barrier Breakdown Might Let Toxins In According to one unverified theory, one of the reasons “lupus brain fog” happens might be blood vessel disease. Scientists hypothesize that the barrier between the bloodstream and brain might start breaking down (i.e. “ leaky brain ”), allowing harmful substances to sneak in. Antibodies also purportedly enter the brain this way, potentially increasing inflammation, damaging brain cells, and triggering memory problems [ 20 , 21 ]. 2) Antibodies Against Brain Cells May Worsen Cognition Directly connected to blood-brain barrier damage, one analysis of 41 studies compared antibody levels in lupus patients with and without “brain fog.” Patients experiencing “lupus fog” had more antibodies targeting brain cells and their key components (i.e. ribosomes) [ […]
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Lupus and the Brain – LUPUS UK
This site is intended for healthcare professionals as a useful source of information on the diagnosis, treatment and support of patients with lupus and related connective tissue diseases.
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almost every other organ, the brain can be involved in lupus. When the brain is inflamed, it has only limited ways of reacting. Disturbances of areas that it controls, such as very severe headaches, speech, movement, the eye, seizures or hallucinations can be seen in different patients attending for review, and these can range from the more mild, such as brain fog and memory challenges, to veryserious and dramatic, such as psychosis. It is very important to remember lupus patients can suffer from ordinary tension headaches and migraine just as anyone can. Depression and other emotional changes can develop but are often a reaction to being ill, rather than being directly caused by autoantibodies. In general terms there are two main types of brain involvement in lupus: that of generalised lupus, and that of clotting problems associated with antiphospholipid syndrome. It is vital to distinguish between these two forms of brain disease; the former requires immunosuppressive treatment, the latter anticoagulants.
Some level of neurological abnormalities present fairly commonly in patients with lupus. It is recognised that the figure is probably far higher if one includes the more ‘subtle’ forms of brain disease such as mood disturbances and agoraphobia. Some of the main brain manifestations are listed below:
General headaches are a very common feature with lupus but are rarely due to the lupus condition itself. They may be generalised and can be migraineous with flashing lights and vomiting. While they can improve when the lupus is adequately treated, in some patients the headaches prove a resistant problem to conventional lupus treatment. Lupus patients can also of course experience symptoms unrelated to their disease such as headache and migraine, which occur at a similar level as occurs in the general population. However, we always assume there could be a link until things are carefully investigated if the headaches are persistent and limiting activities. This reassurance of nonconnection between lupus and the most common ordinary headaches and migraines can be invaluable to the concerned patient.
Occasionally lupus starts in a very dramatic way with a seizure or fit – especially in teenagers, and especially where there is a high fever. In some patients the seizures are prolonged and in others they occur in isolation. In the vast majority of patients with lupus, once the disease is brought under control there is no further risk of seizures.This is an important feature of the disease, should not be overlooked, and is understandably worrying to the patient. For most people it is difficult to know when memory loss is part of normal ageing, due to poor sleep or when it is abnormal. In some hospitals, formal psychometric analysis can be conducted to see if there has been serious change in memory. This is particularly important in those patients with the antiphospholipid syndrome when memory loss may be the first and major feature of very small blood clots affecting the brain. In these patients there may be dramatic improvement when treatment is started with anticoagulants. For those who have been investigated and without red-flag signs, without a clear root cause, improving sleep and sleep patterns, increasing exercise gently sometimes with physio guidance, and improving general mood can bring significant improvement.Sometimes, and by getting to know your patients over time, a patient’s approach to decisions and life events can be an indicator that their SLE is more active, when observed alongside objective SLE blood tests. Depressive moods, unusual decisions, and lack of enjoyment in previous activities can all be pointers to brain changes. But these must be interpreted with objective bloods tests, such as decreasing complement (C3 &/or C4), and rising double-stranded DNA (dsDNA) to be attributable to lupus. Alongside family members, nurses in contact with patients in regular appointments and between their appointments can be the first to notice changes, so do raise these observations with appropriate colleagues when pertinent.Occasionally patients can present with a movement disorder or tremor but this is uncommon. One is chorea (St. Vitus dance) and in these patients the disease is often wrongly diagnosed as rheumatic fever.This is a rare manifestation of lupus, presenting with weakness and loss of sensation, usually in both legs and without back pain or sciatica. It may be associated with antiphospholipid syndrome, and as with any significant symptom it needs careful management, especially as this can be a life-changing condition. Disturbance of bladder and/or bowel function is not common, but when present as well indicates severe disease and is a medical emergency requiring urgent admission that day for investigation to establish the cause and the best treatment.
In addition to the usual blood tests to assess lupus disease activity, other tests of brain and spinal cord function may be required. The most important of these is an MRI scan which helps to distinguish clots from other causes of neurological involvement. An EEG (electroencephalography, an electrical test of brain activity) is required for suspected seizures. Where there are severe brain problems or real diagnostic difficulties a lumbar puncture may be required to exclude a secondary infection in the brain and spinal fluid or subarachnoid haemorrhage.
If the brain disease is thought to be due to APS then anticoagulants are used, though when these are started depends on the presentation. If the disease is thought to be part of a generalised lupus flare then an increase in steroids for a short period is generally used (e.g. to maximum of 60mg orally daily, or an intravenous pulse treatment). Doses are reduced as quickly as safely possible depending on severity of symptoms and potential long term damage. For severe cerebral lupus the addition of an immunosuppressive such as cyclophosphamide is extremely helpful and can reduce the severity and the duration of the brain disease.
Apart from those patients who have suffered multiple strokes where there may be irreversible brain disease, the prognosis of brain involvement in lupus is excellent. Even in those patients who present with a very extreme form of brain disease such as schizophrenia or seizure, total recovery can occur with treatment and a return to normal lifestyle predicted.
Diagnosing Systemic Lupus Erythematosus
Systemic lupus erythematosus, commonly known as lupus, is a chronic autoimmune disease.
This means that the immune system, which attacks viruses and bacteria, instead attacks healthy tissue, causing inflammation throughout the body and, sometimes, damaging tissue.
Lupus can affect the blood vessels, brain, joints, kidneys, heart, lungs, nervous system, or skin. Another type of lupus, cutaneous (discoid) lupus, affects only the skin.
Symptoms of lupus can range from mild to serious, depending on the organs affected. Lupus involves periodic flare-ups, in which symptoms intensify, and remission, in which symptoms lessen or disappear.
The most common symptoms include fatigue, painful and swollen joints, skin rashes—most notably, a butterfly-shaped rash across the face—unexplained fever, and mouth or nose ulcers.
More severe lupus can cause pleuritis, an inflammation of the lining of the lungs; kidney disease; neurological conditions—those affecting the brain and spinal cord—such as weakness or memory loss; and pericarditis, an inflammation of the sac that covers the heart.
Experts don’t know what causes lupus. But a family history of the disease increases risk, and hormones or chemicals may also play a role. In people with a family history of lupus, exposure to sunlight can trigger symptoms. Lupus affects 10 times more women than men and more African Americans. It is most common in women between the ages of 15 and 40.
Systemic lupus erythematosus is a lifelong condition. Your NYU Langone rheumatologist, a doctor specializing in conditions such as arthritis and lupus that cause pain and swelling in joints and other tissues, can help you successfully manage the symptoms for the long term.
Systemic lupus erythematosus can be difficult to diagnose: no single blood or imaging test can definitively identify it, and its symptoms can be vague, progress slowly, change, or mimic other conditions, such as rheumatoid arthritis. As a result, it’s important to consult a rheumatologist.
After conducting a physical exam and taking your medical history, your doctor orders tests your symptoms. If you have at least four of the following signs and symptoms with no other known causes, even if they appear just once or come and go, you may be diagnosed with lupus.
Three Types of Skin Rash
Each of the three following kinds of rash constitutes one criterion for diagnosing lupus: a butterfly-shaped (malar) rash across the bridge of the nose and onto the cheeks; a red or purple scaly rash on both arms, the fingers of both hands, the neck, the torso, or the legs; a rash resulting from photosensitivity—that is, exposure to sunlight.
Ulcers may appear on the roof of the mouth or inside the nose and are typically painless.
Stiff, swollen, or painful joints in the arms and legs may also be hot to the touch.
Reduced Levels of Blood Cells
A blood test may find lower-than-usual numbers of red blood cells, which carry oxygen to organs and tissues; platelets, which aid in blood clotting; or white blood cells, which fight infection.
An inflammation in the lining of the lungs, called pleurisy, or in the sac surrounding the heart, called pericarditis, can cause chest pain and may signify lupus. Sometimes, systemic lupus erythematosus can lead to lupus nephritis, which is a serious inflammation of the kidneys.
Nervous System Disorders
When lupus affects the nervous system, a person may experience seizures or psychosis, including hallucinations or delusions—that is, thoughts that don’t match up to reality.
Antibodies normally fight infections. But in lupus, antibodies become autoantibodies and mistakenly attack the body’s healthy tissues, recruiting other cells and proteins to help, causing inflammation.
Urine Changes and Kidney Disease
Urine abnormalities, such as high levels of protein in the urine, can indicate that lupus has affected the kidneys. Some people develop lupus nephritis, an inflammation of the kidneys that can cause them to leak protein and blood cells into urine. Left untreated, this can lead to kidney failure.
Symptoms of kidney disease also often include swelling of the ankles, feet, legs, and, less commonly, the face or hands, as well as puffy eyes upon waking.
Dark-colored and foamy urine, high blood pressure, and weight gain may also appear.
After speaking with you about your symptoms, including those you may have had in the past or that come and go, your NYU Langone rheumatologist orders a series of diagnostic tests.
Normally, antibodies in the blood repel invading viruses and bacteria. Autoantibodies mistakenly target a person’s own healthy tissues. Your doctor may perform a series of blood tests to check for autoantibodies in the blood, which are common with lupus.
Antinuclear Antibody Tests
An antinuclear antibody (ANA) blood test measures the presence of antibodies that are directed against the body’s cells, a sign of systemic lupus erythematosus. ANA is present in nearly everyone with active lupus.
It’s important to know that because some healthy people can also have a positive ANA, a positive result doesn’t necessarily mean that you have lupus. Positive results on the ANA test may indicate other autoimmune disorders, such as certain kinds of thyroid disease and rheumatoid arthritis. Doctors may consider other criteria to help diagnose or rule out lupus.
If you test positive for ANA, your NYU Langone rheumatologist may order tests for anti-double-stranded DNA, anti-SSA/RO, and anti-Smith antibodies to get more detailed information.
Anti-Double-Stranded DNA Antibody Tests
People with lupus often have an antibody in the blood called anti-double-stranded DNA, also known as anti-dsDNA. This antibody targets double-stranded DNA, the material that makes up the body’s genetic code. As lupus becomes more active, the level of anti-dsDNA autoantibodies can rise, indicating a greater risk of lupus nephritis, which can lead to kidney failure.
Anti-SSA/Ro Antibody Tests
Doctors may order an anti-SSA/Ro antibody test to look for Sjogren’s syndrome, an autoimmune disease that causes severe dryness in the eyes and mouth.
Some of its symptoms, such as joint pain and skin rashes, mimic those of lupus, and people with lupus can have Sjogren’s syndrome at the same time.
Because this antibody can also be associated with rashes caused by exposure to sunlight, people who test positive should take extra caution when outdoors by wearing hats and sunscreen.
Rarely, these antibodies can lead to complications during pregnancy, and so pregnant women who have tested positive for this antibody require extra monitoring.
Anti-Smith Antibody Tests
The anti-Smith antibody, also known as the anti-Sm antibody, targets the body’s own proteins and is found almost exclusively in people with lupus. Though not all people with lupus have this antibody, those who do usually receive a diagnosis of lupus.
Antiphospholipid Antibodies Tests
Antibodies associated with increased risk of forming blood clots are commonly found in people with lupus. These antibodies are also found in people with antiphospholipid syndrome, an autoimmune disease associated with excessive blood clotting.
Additional Blood Tests
Your NYU Langone doctor may recommend other blood tests to check for inflammation. These may include an erythrocyte sedimentation rate (ESR) test or a C-reactive protein (CRP) test. Results showing increases in either of these tests can indicate inflammation or infection in the body, but the tests don’t identify its location.
Blood tests that measure the activity of the complement system, a network of proteins that work together to eliminate foreign invaders, may also be performed. Decreased levels of C3 and C4 complements can indicate active lupus. The doctor draws blood from your arm and sends it to a laboratory for results, which take up to a week to be completed.
Doctors use urinalysis to look for high levels of protein or red blood cells in the urine, which can indicate kidney damage. Your doctor may ask you to collect urine for 24 hours in supplied containers.
Your doctor may recommend a kidney biopsy if he or she suspects kidney damage because of your symptoms or the results of a urinalysis. In this procedure, a small piece of tissue is removed for analysis.
First, your doctor numbs the skin on your back near the kidneys with a local anesthetic. Then, using ultrasound for guidance, the doctor injects a needle into one kidney to draw out a tissue sample.
You can return home the same day and resume normal activity the next day.
Your doctor may refer you to a dermatologist for a skin biopsy, the analysis of a small sample of skin. He or she may perform a “lupus band test,” which checks for lupus-related antibodies.
The doctor injects an area of the skin with a local anesthetic, then uses a punch, an instrument with a sharp circular edge, to remove a core of skin for testing.
In some situations, a stitch may be used to close the wound.
Your NYU Langone rheumatologist may order CT scans of your heart, joints, kidneys, or lungs to check for the causes of your symptoms. A CT scan uses X-rays to create detailed, three-dimensional images of organs. Before the test, you may drink a liquid contrast dye that makes certain organs more easily visible. It leaves your body hours later in the urine or stool.
An echocardiogram is an ultrasound test that uses sound waves to create images of the heart. It allows the doctor to evaluate how well your heart is functioning.
In MRI a magnetic field and radio waves are used to create computerized, three-dimensional images of organs that lupus may be affecting. Your doctor may order an MRI if it appears that lupus has affected the central nervous system, which includes the brain and the spinal cord, and is causing confusion or “brain fog,” depression, seizures, or psychosis.
5 Strategies for Coping With Lupus-Associated Brain Fog
By: Howard Smith, MD
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Monday morning finds many of us feeling foggy, but 20 percent to 50 percent of people with lupus have a unique feeling of mental fogginess, including:
This set of symptoms, often called brain fog or lupus fog, is important to identify if you or a loved one has lupus. Knowing what to expect and having coping mechanisms in place can help with these issues.
What causes confusion? Patients with lupus can be confused because of cognitive defects, short- or long-term memory problems, psychosis, severe depression or anxiety, dementia, an infection or fever or sometimes even because of medications.
If brain fog occurs, it usually happens within the first year or two after diagnosis.
Treatments may target lupus or symptoms
Treatments for brain fog are available, but it might take some time for you and your doctor to find one that will work for you. Not all treatments work the same way on each patient with lupus.
A physician will try to identify what could be causing the confusion. Depending upon the patient, we’ll try various medications, including those aimed at treating the underlying lupus itself and those that target an associated problem, such as depression, anxiety or psychosis.
Steroids are commonly used to treat lupus, but they can sometimes worsen confusion or cause mood changes, so patients need to be monitored closely while taking them.
5 coping strategies
Medications are just one part of the puzzle when it comes to treating lupus and brain fog. It’s important to look at your overall health by working to:
- Foster a good emotional environment. A warm, supportive environment and being surrounded by positive people at home and at work are important to help lupus patients manage symptoms.
- Partner up with your doctor. The No. 1 goal is to get the disease under control. Having a good rapport with all your physicians and a supportive environment at home, taking your medications, and following your doctors’ instructions will help with that.
- Take care of your body. People with lupus should eat a healthy diet and exercise regularly. Avoid alcohol, tobacco and illegal substances.
- Challenge your mind. Give yourself cognitive challenges. Do whatever you can to keep your physical and mental health at its peak.
- Consider therapy. Cognitive-behavioral therapy (CBT) can be helpful in teaching people to cope with their illness and its symptoms.
Counselors can play a big role in helping manage brain fog. The goal of counseling is to help patients identify any anxiety or depression that could contribute to feelings of confusion and to strategize about how patients can regain control.
One strategy to consider is list-making, which is helpful in easing anxiety for many patients.
CBT won’t cure memory problems, but might make them easier to deal with.
In general, make sure your doctor knows about any mental or emotional issues you’re having, so the two of you can work out a treatment plan that clears the fog.