Lupus

People of all ages, races and sexes can get lupus, but 9 out of 10 adults with the disease are women between the ages of 15 and 45. African American women are at the highest risk.

The most common form of lupus is systemic lupus erythamatosus (SLE), an autoimmune, inflammatory condition in which the immune system malfunctions and attacks the body's own healthy tissues. Symptoms are wide-ranging, but often involve skin and joints. It may also affect organs, including lungs, kidneys and the brain.   

Other types of lupus include:

• Discoid lupus. This type causes a severe red rash that worsens in sunlight.
• Cutaneous lupus. This affects only the skin, and may vary in severityee.
• Drug-induced lupus. Certain medications can cause lupus symptoms that go away once the drug is stopped.
• Neonatal lupus. This type affects babies of women who have lupus. Skin symptoms usually go away within weeks to a few months after birth. It may cause heart problems.

Causes

The cause of lupus is not known. Researchers think that people with certain genes are triggered by an external factor, such as stress, a viral infection, medication or regular exposure to potentially toxic chemicals. Because lupus often strikes women during their childbearing years, hormones may play a role. 

Symptoms

Symptoms of lupus can come and go. Some people develop mild symptoms that slowly get worse. Others have severe and life-threatening symptoms that appear suddenly. The most common ones include

• Joint pain.
• Butterfly-shaped rash (on cheeks and nose). 
• Fatigue.
• Mouth sores (often painless).
• Headaches.
• Light sensitivity (sunlight and artificial light).
• Chest pain or trouble breathing. 

Health Effects

Additional conditions and symptoms that come with lupus include:

• Inflammation of the kidney, which occurs in up to 60% of adults with lupus (and two-thirds of children). It can cause high blood pressure, blood in the urine, frothy urine and swelling of the legs. 
• Raynaud’s disease, which causes fingers and/or toes turn white or blue when cold. 
• Sjogren’s, which causes dry eyes, mouth and vagina.
• Swelling in feet, hands or around eyes. 
• Hair loss that can be caused by lupus itself or medications used to treat it. 
• Blood problems including anemia (low red blood cell count), low platelet count, low white blood cell count and blood clots. 
• Memory problems or confusion.

Diagnostic Tests

Several tests can help diagnose lupus:

• A CBC checks the levels of red blood cells, white blood cells and platelets (blood cells that help to control bleeding and clotting). These tests check if organs, such as the kidneys and liver, are working properly.
• A biopsy is the removal of a small piece of tissue from the affected area. For lupus, the sample is taken from a rash or from the kidney when symptoms are active. This test looks for a group of proteins (called autoantibodies) found in the blood of people with lupus. While this test alone does not diagnose lupus, it can help confirm a diagnosis.
• If the ANA test is positive, the doctor may order other antibody tests. Antiphospholipid antibodies, including cardiolipin, are common in lupus. This blood test measures the level of complement proteins in the blood. People with lupus often have low levels of these proteins, which can indicate active lupus.
• Erythrocyte sedimentation rate (ESR or sed rate) and C-reactive protein (CRP) tests reveal inflammation levels. A high ESR or CRP combined with other signs of lupus can help make a diagnosis.
   

Treatments

There is no cure for lupus, but there are a number of treatments to help control the disease. Treatment involves managing systemic inflammation with medications and lifestyle changes. These medications treat inflammation, prevent lupus flares and ease symptoms:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Many people with lupus take NSAIDs to manage joint pain and swelling. Some NSAIDs (such as aspirin, naproxen and ibuprofen) are available over-the-counter and others require a prescription.  
• Corticosteroids. Corticosteroids are powerful anti-inflammatory drugs. These drugs are given at the lowest possible dose for the shortest length of time because of side effects. Corticosteroids come in pill form or may be given as an injection into the joint or muscle. 
• Disease-modifying antirheumatic drugs (DMARDs). DMARDs can modify the course of the disease, prevent progression and slow joint damage. DMARDs are often used with NSAIDs. Hydroxychloriquine commonly is prescribed for people with lupus. It can cause vision changes in some people, so regular exams are important. 
• Biologics. Belimumab (Benlysta) was approved in 2011 specifically for the treatment of lupus. It suppresses autoantibodies in people with lupus. In 2021, anifrolumab (Saphnelo), a monoclonal antibody, was also approved to treat SLE.

Other medications may be used to control conditions that are common in people with lupus.

• Corticotropin (Acthar gel or injection) is FDA-approved for lupus, but treatment guidelines do not include it.
• Water pills that help to prevent fluid buildup.
• Anti-hypertensive drugs to treat high blood pressure.
• Anticonvulsants to prevent or treat seizures.
• Antibiotics for infections.
• Bone-strengthening drugs for osteoporosis.

Self Care

• A balanced diet should include fruits, vegetables, whole grains, low-fat dairy, lean protein and healthy fats, such as extra-virgin olive oil and avocado. Look for foods high in omega-3s, which help reduce inflammation.
• When disease is active and joints are painful, swollen or stiff, it is important to rest to reduce inflammation and fatigue. When disease activity is low, regular exercise can ease pain and reduce stress. A balanced program includes low-impact aerobic activity, muscle strengthening and flexibility exercises.
• Ultraviolet (UV) radiation from the sun or fluorescent lights can cause a flare or skin rash. Always use SPF 30 or higher sunscreen and reapply every hour or after sweating, swimming or changing clothes. Avoid being outside at peak UV hours between 10 a.m. and 4 p.m. Wear protective clothing and hats and be especially vigilant when taking medications that increase photosensitivity.
• Fatigue is a common lupus symptom. It’s important to pace yourself to prevent extreme tiredness from taking over your day. Getting restful sleep will help to keep tiredness at bay.
• Develop strong positive relationships so you have emotional support for managing the ups and downs of a chronic disease. Use relaxation techniques, such as meditation, deep breathing or yoga to reduce stress. Stay connected to activities you enjoy to promote a positive mood. 
• Smoking harms the body and can worsen lupus symptoms. If it’s hard to quit on your own, get professional help.