Lupus

Lupus is an autoimmune disease where the immune system mistakenly targets and attacks the body’s own tissues. While some people with this autoimmune disease experience only minor issues, others may face significant, lifelong challenges.

Who is Affected?

Demographics: Lupus is more common in people of African, Asian, or Native American descent, affecting them two to three times more than those of white descent.
Gender and Age: The majority of people with this autoimmune disease are women, and the disease typically develops between the ages of 15 and 44, though it can occur in older adults as well.

Causes of Lupus

The exact cause of this autoimmune disease is unknown, but it is believed to result from a combination of factors:

Genetics: Certain genes may increase the risk, especially among people of Hispanic, Native American, African, Asian, or Pacific Islander descent. However, having these genes alone isn’t enough to cause this autoimmune disease .
Hormones: Lupus is more common in women, especially during periods of high estrogen, such as pregnancy. However, hormone-related medications like birth control pills do not seem to increase the risk.
Environment: Possible environmental triggers include:
- Cigarette smoke
- Silica dust
- Mercury exposure
- Certain viruses (e.g., Epstein-Barr)
- Ultraviolet (UV) light
- Stress
Medications: Some drugs, such as hydralazine and procainamide, can cause lupus-like symptoms, which usually improve after discontinuation.
Other Risk Factors:
- Sex: About 90% of lupus patients are women.
- Age: Most commonly affects individuals aged 15 to 45.
- Family History: About 10% of people with lupus have a close relative with the disease.
- Race: More common among African American, Asian, Hispanic, and Native American women, with African American and Hispanic women experiencing more severe cases.

Lupus Symptoms: What to Look For

Lupus symptoms can differ greatly from person to person. Some individuals experience only a few mild symptoms, while others may face many severe ones. Here are common symptoms:

Achy Joints: Pain in the joints without visible swelling.
Fever: A temperature above 100°F.
Swollen Joints: Inflammation that can lead to joint pain and swelling.
Fatigue: Persistent or severe tiredness.
Skin Rash: Various types of rashes, including a butterfly-shaped rash across the cheeks and nose.
Swollen Ankles: Fluid buildup causing swelling in the ankles.
Chest Pain: Pain when taking deep breaths, known as pleurisy.
Malar Rash: A distinctive rash that appears like a butterfly over the cheeks and nose, often varying in color depending on skin type.
Hair Loss: Noticeable thinning or loss of hair.
Sun Sensitivity: Increased sensitivity to sunlight or other light sources.
Seizures: Episodes of abnormal brain activity.
Mouth or Nose Sores: Painful sores that can appear in the mouth or nose.
Raynaud’s Phenomenon: Fingers or toes turning pale or purple in response to cold or stress.

Early Symptoms

In the early stages, this autoimmune disease symptoms may not follow a clear pattern. Common early signs include:

Fever
Weakness
Weight loss
Fatigue
Joint pain

Lupus Rash

One of the most recognizable signs of this autoimmune disease is the butterfly-shaped rash on the face, which may worsen after sun exposure. Fluorescent lights can also trigger this rash.

Types of Lupus

Systemic Lupus Erythematosus (SLE)
- Impact: Affects both the skin and internal organs.
- Symptoms: Includes a distinctive butterfly-shaped rash across the nose and cheeks, which can scar if not treated. SLE may also cause skin issues elsewhere on the body.
- Internal Effects: Can inflame or damage connective tissues in the joints, muscles, and skin. It can also affect membranes around or within the lungs, heart, kidneys, and brain. SLE may lead to kidney disease and, although rare, can cause symptoms like confusion, depression, seizures, or strokes.
- Blood Vessel Effects: May lead to sores on the skin, particularly on fingers. Some patients develop Raynaud’s syndrome, where small blood vessels in the extremities contract in response to cold, causing temporary color changes and pain. Patients are advised to keep their hands warm in cold weather.
Lupus Nephritis
- Kidney inflammation due to SLE, potentially requiring dialysis or a kidney transplant.
Cutaneous Lupus
- Affects the skin with various forms:
  - Chronic: Long-term, can cause permanent scarring.
  - Subacute: Red, circular sores or scaly patches on arms, chest, or back.
  - Acute: A rash that appears with other lupus symptoms, usually short-lived and may cause skin discoloration.
Discoid Lupus
- Impact: Mainly affects the skin, particularly areas exposed to sunlight.
- Symptoms: Causes circular skin lesions that can leave scars once they heal.
- Internal Organs: Rarely affects internal organs.
Drug-Induced Lupus
- Caused by certain medications, such as proton pump inhibitors and calcium channel blockers. Symptoms usually improve after stopping the medication.
Neonatal Lupus
- Occurs in infants born to mothers with SLE.

Diagnosing Lupus

Diagnosis involves a combination of physical exams and lab tests to identify key symptoms and rule out other conditions:

Physical Exam: Checking for malar rash, discoid rash, photosensitivity, and oral ulcers.
Blood and Urine Tests: To detect kidney issues, blood disorders, and unusual antibodies.

Antinuclear Antibody (ANA) Test

Purpose: Measures antibodies targeting cell nuclei. High levels suggest an autoimmune response, often associated with lupus.
Note: A positive ANA test alone is not sufficient for a lupus diagnosis. At least three other criteria are needed.

Treating Lupus

Treatment varies based on severity, affected organs, and overall health. Options include:

Biologics: Drugs like Belimumab and Rituximab help by targeting specific proteins or cells involved in this autoimmune disease.
Immunosuppressants: Medications such as Anifrolumab, Azathioprine, and Mycophenolate mofetil reduce immune system activity.
Corticosteroids: Useful for reducing inflammation and managing mild to severe symptoms.
NSAIDs: Over-the-counter options like ibuprofen and naproxen for pain and fever.
Antimalarial Drugs: Hydroxychloroquine helps control mild symptoms and prevent flares.
Chemotherapy Drugs: Cyclophosphamide and Methotrexate are used for severe cases.

Alternative Treatments

Vitamins and Supplements: Vitamins C and D, antioxidants, fish oil, and DHEA may offer some benefits.
Acupuncture: May help with pain and fatigue.
Mind-Body Therapy: Techniques like meditation and cognitive behavioral therapy can alleviate pain and mental health issues.

Living with Lupus

Managing daily life with this autoimmune disease involves:

Exercise: Low-impact activities like walking or swimming can maintain muscle health and improve mood.
Rest: Balance activity with adequate rest.
Healthy Diet: Focus on balanced nutrition, especially if you have lupus nephritis.
Avoid Alcohol and Smoking: Both can interact with medications and worsen symptoms.
Sun Protection: Limit sun exposure and use protective clothing and sunscreen.
Monitor Symptoms: Keep track of changes and triggers, and communicate openly with your healthcare provider.
Seek Support: Join support groups and ask for help when needed.

Living with Someone with Lupus

Supporting someone with this autoimmune disease involves:

Educate Yourself: Learn about the disease and treatments.
Provide Space: Allow them to manage their condition in their way.
Attend Appointments: Accompany them to doctor visits for support and to stay informed.
Encourage Self-Care: Support their adherence to treatment plans gently.
Open Communication: Discuss concerns and needs openly.

Takeaways

Lupus is a complex autoimmune disease with symptoms that can vary widely. Although there is no cure, treatments and lifestyle adjustments can help manage symptoms and improve quality of life. Regular medical care, a healthy lifestyle, and support systems are crucial for those living with this autoimmune disease.

Lupus FAQs

Is lupus cancer? No, lupus is an autoimmune disease, not cancer.
Is lupus deadly? Most people with this autoimmune disease do not die from it, but severe organ involvement can be life-threatening.
What is the life expectancy of a person with lupus? About 80%-90% of people with this autoimmune disease will live a normal lifespan.
What are common triggers of lupus? Overworking, excessive sun exposure, and infections can trigger lupus symptoms.
How does lupus feel? Active lupus often causes general illness, including fever, fatigue, and specific organ-related problems.
What happens if lupus goes untreated? Untreated lupus can lead to worsening symptoms, organ damage, and potentially life-threatening complications.

Sources

American College of Rheumatology
CDC
Cleveland Clinic
Lupus Foundation of America.
The Mayo Clinic,
The National Library of Medicine.