Lupus

Lupus is a chronic autoimmune disease that can cause inflammation and damage to various parts of the body. In autoimmune diseases, your immune system attacks healthy tissue. Inflammation caused by lupus can affect many parts of your body including joints, kidneys, skin, blood vessels, heart, lungs, and brain.

There are several types of lupus, the most common type being systemic lupus erythematosus (SLE), which affects multiple organs. Other types include cutaneous lupus, which primarily affects your skin, and drug-induced lupus, which is caused by certain medications.

Lupus has a variety of symptoms that can vary greatly in their severity and can come and go. Common symptoms of lupus include fatigue, joint pain and swelling, skin rashes (a trademark butterfly rash across your cheeks and nose), fever, hair loss, and photosensitivity. The disease can also affect organs such as the kidneys, heart, lungs, and brain.

The exact cause of lupus is unknown, but it is believed to result from a combination of genetic, environmental, and possibly hormonal factors. It is more common in women, particularly during their childbearing years, and is more common among certain ethnic groups, such as African Americans, Native Americans, Hispanics, and Asians.

Diagnosing lupus can be a challenge due to its various symptoms and because no blood test can confirm a diagnosis. Doctors usually rely on a combination of your medical history, clinical examination, and laboratory tests, including tests for specific antibodies in the blood.

While there is no cure for lupus, treatments are available that can help control symptoms. These include anti-inflammatory medications, immunosuppressants, and lifestyle changes to manage flare-ups and minimize their impact on your body.

There are 4 types of lupus, including:

• Systemic lupus erythematosus (SLE), which is the most common type of lupus.
• Cutaneous lupus or discoid lupus, which is a type of lupus that occurs as a red-raised rash that becomes scaly or changes color to a dark brown.
• Drug-induced lupus, which is a lupus-like disease caused by certain prescription medications.
• Neonatal lupus, a rare condition that affects infants of women who have lupus.

The exact cause of lupus is not fully understood, but it is thought to result from a combination of genetic, environmental, and hormonal factors. Some risk factors include:

• Genetic Factors: Having a family history of lupus or other autoimmune diseases can increase your risk. Specific genes have been associated with the disease, and these genes can affect your immune system's ability to function properly.

• Environmental Factors: Certain environmental triggers are believed to trigger lupus in certain people. These can include:

  • Ultraviolet (UV) light: Exposure to UV light from the sun or artificial sources can trigger flare-ups and skin lesions in some people.

  • Infections: Some viral and bacterial infections can cause or worsen lupus symptoms.

  • Certain medications: Drug-induced lupus occurs when you have symptoms similar to systemic lupus erythematosus that are caused by medications such as certain high blood pressure drugs, anti-seizure medications, and antibiotics. This form of lupus usually goes away after the medication is stopped.

  • Stress: Physical or emotional stress can also be a trigger for lupus symptoms.

  • Smoking: Smoking can increase your risk of developing lupus and can worsen its effects.

• Hormonal Factors: The fact that lupus is more common in women, especially during their reproductive years, suggests that hormones like estrogen may play a role in the development or worsening of the disease.

Lupus symptoms can vary widely and may develop suddenly or gradually. They can be mild or severe, temporary or permanent. You can experience episodes called flares, where symptoms worsen for a while before improving or even disappearing.

Some of the common symptoms of lupus can include:

• Fatigue: One of the most common symptoms, affecting the majority of those with lupus.
• Fever: Unexplained fever is often one of the early signs of lupus.
• Joint and Muscle Pain: Many people with lupus experience joint and muscle stiffness, pain, and swelling, particularly in the hands, wrists, and feet.
• Skin Rash: A distinctive butterfly-shaped rash across your cheeks and nose is one of the hallmark signs of lupus but is not present in all cases. Other skin problems may include a rash triggered by sunlight (photosensitivity), discoid rashes (round lesions), and other types of skin lesions such as mouth or nose ulcers.
• Kidney Problems: Lupus can affect your kidneys, a condition known as lupus nephritis, which can lead to serious complications if left untreated.
• Photosensitivity: Many people with lupus are sensitive to sunlight (and sometimes even to artificial ultraviolet light), which can trigger skin lesions or other symptoms.
• Gastrointestinal (GI) Problems: These can include nausea, vomiting, stomach pain, and liver issues.
• Neurological Symptoms: These can range from headaches and mild confusion to severe complications like seizures and strokes.
• Blood clots: This can be due to high levels of certain autoantibodies called antiphospholipid antibodies.
• Raynaud's Phenomenon: This condition causes your fingers and toes to turn white or blue and feel cold in response to stress or cold temperatures.
• Respiratory Problems: Lupus can cause inflammation of your lungs, leading to chest pain when you take a deep breath, and it also increases your risk of infections.
• Heart Issues: Lupus can affect your heart, leading to complications such as pericarditis (inflammation of the covering of the heart) and an increased risk of cardiovascular disease and heart attack.
• Blood Abnormalities: This includes anemia, thrombocytopenia (low counts of platelets), and leukopenia (low counts of white blood cells).

Diagnosing lupus can be challenging because its symptoms can mimic many other diseases. There is no single test that can definitively diagnose lupus, so your healthcare provider will use a combination of tests to determine if you have this autoimmune disorder. These can include:

• Medical History: Your healthcare provider will look at your complete medical history, looking for patterns of symptoms that are common in lupus. This includes the type of symptoms, how long you have been experiencing them, a family history of lupus or other autoimmune diseases, and a look at your other organs to identify symptoms across different parts of the body.

• Physical Examination: A thorough physical exam will help identify any physical signs of lupus, such as rashes, joint swelling, and other symptoms of the disease.

• Laboratory Tests: Several lab tests are useful in diagnosing lupus:

  • Antinuclear Antibody (ANA) Test: A positive ANA test can show an autoimmune disease and is commonly seen in lupus patients. However, a positive ANA alone is not definitive for lupus since other conditions can also cause a positive result.

  • Anti-dsDNA and Anti-Smith (Sm) Antibodies: These are more specific for lupus and are rarely found in other diseases.

  • Complete Blood Count (CBC): This can reveal low platelet counts, low red blood cell counts, and low white blood cell levels, which are common in lupus.

  • Urinalysis: Protein or red blood cells in the urine may suggest kidney disease, which is a concern in people with lupus.

• Imaging Tests: Imaging studies such as chest X-rays, echocardiograms, or kidney ultrasounds may be performed to check for organ involvement, especially if there are symptoms in these areas.

• Biopsy: In certain cases, a biopsy of the kidney or skin may be necessary to confirm lupus, particularly if these organs are affected. A biopsy can provide definitive evidence of autoimmune activity and damage.

Because lupus symptoms can vary and you may not experience all of them, the diagnosis of this disease can take time. It often requires ongoing evaluation and repeated testing to confirm a diagnosis.

The treatment of lupus will be based on your symptoms and how severe the disease is. There is no cure for lupus, but effective management can help control your symptoms and minimize organ damage. Some treatment options can include:

• Medications:

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are used to treat pain and swelling. Common examples include Advil (ibuprofen) and Naprosyn (naproxen).

  • Antimalarial Drugs: Drugs like Plaquenil (hydroxychloroquine) are commonly prescribed for skin and joint problems and can also help reduce flare-ups.

  • Corticosteroids: These potent anti-inflammatory drugs, such as prednisone, can control severe symptoms quickly but come with significant side effects, especially with long-term use.

  • Immunosuppressants: For patients with symptoms affecting the kidneys or other organs, drugs that suppress the immune system may be necessary. Examples include Imuran (azathioprine), Cellcept (mycophenolate mofetil), Arava (leflunamide), and Rheumatrex (methotrexate).

  • Biologics: Newer therapies, such as Benlysta (belimumab), are designed to target specific parts of the immune system involved in lupus. Benlysta is specifically approved for treating lupus.

  • Other Medications: You may need other medications to treat specific lupus symptoms or other health conditions it is causing such as osteoporosis, anemia, or high blood pressure.

• Lifestyle Changes:

  • Sun Protection: Since UV light can trigger or worsen symptoms, protecting your skin from the sun and using sunscreen is important.

  • Diet and Exercise: Eating a balanced diet and regularly exercising can help manage symptoms, reduce your risk of heart disease, and maintain your overall health.

  • Smoking Cessation: Smoking can worsen lupus symptoms and increase your risk of cardiovascular disease, so quitting smoking is strongly recommended.

  • Calcium and Vitamin D Supplements: This is some research that suggests you may benefit from these supplements if you have lupus. Talk to your healthcare provider to see if supplemental vitamin D and calcium may be right for you.

• Regular Monitoring and Support:

  • Regular Check-Ups: Frequent monitoring by your healthcare provider is important to adjust your treatment plan if needed and to monitor for side effects of medications.

Treatment plans will vary depending on your specific symptoms and the severity of your disease. Regular follow-ups with a healthcare team specializing in autoimmune diseases, such as rheumatologists, nephrologists, and dermatologists, can help to effectively manage lupus.

Sources:

• Lupus. American College of Rheumatology. Accessed Apr. 18, 2024.

• Overview of Systemic Lupus Erythematosus (Lupus). National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH). Accessed Apr. 18, 2024.

• What is Lupus? Lupus Foundation of America. Accessed Apr. 18, 2024.
• Systemic Lupus Erythematosus (SLE). Centers for Disease Control and Prevention. Accessed Apr. 18, 2024.
• What is Lupus? Autoimmune Association. Accessed Apr. 18, 2024.