It is a chronic and complex disease that occurs when the body’s immune system attacks its own tissues and organs.
The inflammation that lupus causes can affect many systems such as the joints, skin, lungs, brain, kidneys, blood vessels, and heart, causing general inflammation affecting the tissues in the organs it affects.
The outlook for people with lupus was once bleak, but the diagnosis and treatment of lupus have improved considerably.
With treatment, most people with lupus can lead active lives. More than 90 percent of people with lupus are women.
Symptoms and diagnosis occur most often when women are of reproductive age, between the ages of 15 and 45.
The immune system is designed to identify foreign bodies (such as bacteria and viruses) and attack them to keep the body healthy.
However, in the case of lupus, the immune system mistakenly attacks healthy tissue, causing constant pain and inflammation.
Types of lupus
- Systemic lupus erythematosus: This is the most common and serious type that affects the kidneys, heart, skin, brain, and blood. Symptoms have high inter-individual differences in severity and exacerbation.
- Discoid lupus erythematosus: It is a chronic skin condition that appears reddened with round, scaly patches that tend to develop in areas exposed to the sun such as the face and hands. Sometimes injuries can develop in other areas of the body, including the neck and upper back.
- Drug-induced lupus: Some medications can cause symptoms similar to systemic lupus erythematosus, which then go away once the drugs are stopped. Medications that are known to cause lupus-like symptoms include medications used to treat high blood pressure and medications for heart abnormalities.
- Neonatal lupus: This is a rare form of temporary lupus that affects the fetus or newborn baby. It occurs when autoantibodies from a mother with systemic lupus erythematosus are passed to the baby before birth. Affecting the baby’s skin, heart and blood.
Lupus is an autoimmune disease, which means that instead of attacking foreign substances, such as bacteria and viruses, the immune system also turns against healthy tissue.
Doctors do not know what causes autoimmune diseases, such as lupus.
Lupus is believed to be the result of a combination of genetics and environment.
Doctors maintain that a predisposition to lupus can be inherited, but the disease is not inherited.
People with an inherited predisposition for lupus can only develop the disease when they come into contact with something in the environment that can trigger lupus, such as a medicine or a virus.
Some potential triggers include:
- Genetics: A family history of lupus can make you more susceptible to this disease.
- Infections: An infection can trigger lupus or cause a recurrence.
- Sunlight – Exposure to sunlight can trigger a response in susceptible people and cause skin damage.
- Hormones : both men and women produce estrogen, however, its production is much higher in women. Many women experience lupus symptoms before menstrual periods or during pregnancy when estrogen production is high.
- Medications: Certain medications, such as blood pressure medications, anticonvulsants, and antibiotics, can trigger lupus. These patients generally improve after stopping the medications.
Signs and symptoms
The signs of lupus are distributed throughout various parts of the body as the disease affects all internal tissues and organs of the body.
The signs of lupus in the early stages of the disease are nonspecific and can be caused by other conditions.
However, none of them should be overlooked and your doctor should be consulted as soon as they appear.
- Fatigue – Extreme or abnormal fatigue could be an early warning sign of lupus. Approximately 90% of patients diagnosed with lupus report fatigue as an initial symptom. Such is the degree of fatigue that doing regular activities can make you tired and weak. Getting enough sleep and a balanced diet does not seem to alleviate the fatigue associated with lupus. It can cause significant distress as it can interfere with social or professional life.
- Rash : Lupus rash appears most often on the face, while some patients may have lacy-like purplish patches on the lower extremities. The characteristic feature of the rash is that it resembles the shape of a butterfly. Also, the rash is further aggravated by exposure to sunlight.
- Joint pain : Pain especially affects the joints of the hands and feet. You may experience more severe pain in the morning. The pain often progresses gradually, causing noticeable swelling and difficulty with movements.
- Fever without a cause: Fever in lupus is indicative of inflammation or infection. It can happen randomly and your body temperature can return to the normal range even without any medication. Therefore, if you have a low-grade fever without an obvious cause or if it comes and goes frequently, you should see your doctor.
- Chest pain and trouble breathing: Although these are not specific signs of lupus, they should be closely examined if they persist or worsen. Lupus causes swelling of the lungs and blood vessels. Consequently, you may experience chest pain when breathing.
Lupus can also cause one or more of the following symptoms:
- High blood pressure
- Headache and stomach pain.
- Impaired thinking and memory problems.
- Hair loss.
- Memory problems.
- Mental depression
- Swelling in the ankle due to fluid build-up.
Although lupus is not a specific gender disorder, women ages 15 to 45 are more likely to have it compared to men in the same age group.
Also, the risk in African American women is three times higher than in Caucasian women.
The symptoms of lupus in women can coincide with other health conditions that can be very harmful to health.
Women are naturally at higher risk of developing lupus.
While the set of symptoms is similar in men and women, certain lupus symptoms in women need additional attention.
This is because women are inherently predisposed to certain health conditions that can be made worse by lupus.
Eventually, such a predisposition can lead to increased mortality and a deteriorated quality of life in them. These symptoms are:
- Heart disease : Heart disease is more common in women than in men. In addition, lupus multiplies the risk of heart disease. Therefore, lupus is considered a greater threat to women’s health.
- Bone loss: Women lose their bone mass more than men as they age. Lupus or its medications can further cause bone loss.
- Lupus, in the early stages, can cause a facial rash. In most cases, the rash affects your face, particularly the cheeks and nose. Exposure to sunlight or even artificial light can make the rash worse. It is seen in almost half of the patients who have lupus.
- Lupus is a systemic disorder, which means that it affects the internal organs of the body, some patients initially develop lupus that is restricted only to the skin. This condition is known as discoid lupus erythematosus. According to some studies, patients with discoid lupus eventually progress to systemic lupus.
- Some patients may also have spot marks on their legs, which is known as Livedo reticular. The spots appear like purple lace.
Diagnosis of lupus
Lupus presents itself in many different ways in the body, so diagnosis can be tricky.
The symptoms of lupus can mimic other health problems, so other conditions must be ruled out before making a final diagnosis.
In fact, this disease is known as “the great copycat” since its symptoms resemble many other diseases. Usually a general practitioner can diagnose lupus.
Depending on the severity of your condition, they may refer you to other specialists, such as a dermatologist, cardiologist, nephrologist, neurologist, gastroenterologist, pulmonologist, or perinatologist.
Diagnosis is based on clinical imaging tests, as well as laboratory and biopsy results.
To diagnose lupus, current symptoms will be looked for, such as pain, warmth, redness, swelling, and loss of function in a particular place on the body.
You should review the complete medical history and whether there is a family history of lupus.
There is no single diagnostic test for systemic lupus, however the test generally suggested by doctors for lupus is called an antinuclear antibody test.
This is not a specific test for lupus, but with this test, along with many other lab tests, a picture can be created that provides more information to the doctor and ultimately confirms whether it is lupus.
Other types of tests include:
- A kidney and liver evaluation.
- A chest X-ray.
- An echo cardiogram.
- A skin biopsy.
Blood and urine tests
- Complete blood count: This test measures the number of red blood cells, white blood cells, platelets, and the amount of hemoglobin in the blood. The results indicate if the patient has anemia which is a very common sign when there is lupus. A low white blood cell or platelet count may also occur in lupus.
- Erythrocyte sedimentation rate: This blood test establishes the sedimentation rate of red blood cells. This is not a specific result of any disease, but is elevated when the patient has an inflammatory condition, cancer, or any other infection.
- Kidney and liver evaluation: liver tests measure proteins, enzymes, and substances such as albumin, total protein, enzymes found in the liver (including alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase), bilirubin and prothrombin time.
- Antinuclear antibody test : This test is done to check if the patient has an immune disorder. If the test is positive, your doctor may recommend more specific antibody tests.
If the doctor suspects that lupus is affecting the lungs or heart, they may suggest:
- Chest X-ray: An X-ray image of the chest may reveal abnormal shadows that suggest fluid or inflammation in the lungs.
- Echo cardiogram: This test can check for heart problems.
Lupus can damage various organs, such as the skin, kidneys, brain, and other parts of the body in many different ways.
The treatment approach may vary, depending on the type of damage and the affected part.
The sample can be obtained with the help of a needle or through a small incision.
This process of collecting a tissue sample is known as a biopsy.
Lupus changes over time, and everyone responds to treatment differently. As such, caring for patients with lupus requires vigilance and attention to detail.
The goal of treatment is to limit inflammatory tissue damage, using a wide range of therapeutic options, from simple anti-inflammatory drugs to ‘immunomodulatory’ therapy that slows the immune response to ‘cytotoxic’ treatments that kill immune cells.
The stronger the medicine, the greater the risk, and a large part of lupus management involves determining the appropriate approach for the current state of the disease.
Although most people with lupus require special care and medication, a healthy lifestyle has a great impact on the course of the disease and should be the foundation on which medical intervention is built.
Since there is no cure, lupus treatment aims to reduce the severity of symptoms and preserve quality of life. It is possible to relieve symptoms and prevent flare-ups.
Lupus treatment is a collaborative effort by a team of healthcare professionals.
The treatment plan involves regular monitoring of symptoms and their response to particular medications.
Medications that make up the lupus treatment plan include:
- Pain medications: You can take over-the-counter pain relievers to relieve pain and reduce swelling. Also, your doctor may prescribe some stronger pain medications if over-the-counter pain relievers don’t provide the expected relief.
- Immunosuppressive drugs: These agents reduce immune function and can help treat severe cases. However, they make you more susceptible to infection and can also damage your liver. Therefore, precautions should be taken when taking any of them and following the doctor’s instructions.
- Anti-Malaria Medications – Anti-malarial agents are particularly effective in reducing joint pain, rashes, fatigue, and inflammation of the lungs. They modify the immune system, therefore making the symptoms more manageable.
- Steroid Medications: Steroids help reduce inflammation and also affect the immune system. Long-term steroid therapy has its own share of harmful side effects. You must learn about proper use.
Lupus is a long-lasting disease with flare-up periods. Understandably, treatment can take a long time.
You may also need to take more than one medicine to control symptoms and prevent flare-ups.
Therefore, you should take special care to reduce the incidence of adverse drug effects and possible drug interactions.
Alternative or complementary therapies can also be beneficial in treating lupus. However, these therapies are generally used in conjunction with conventional medications.
It is highly recommended to discuss these treatments with your doctor before beginning.
The most common complementary and alternative treatments for lupus include:
- Dehydroepiandrosterone: Supplements containing the hormone dehydroepiandrosterone have been shown to reduce the dose of steroids needed to stabilize symptoms in some people who have lupus.
- Fish oil: Supplements that contain fish oil are rich in omega-3 fatty acids and are often beneficial for individuals with lupus.
- Vitamin D: There is evidence that vitamin D may be beneficial for people with lupus.
Some of the main complications of lupus include:
- The risk of bleeding or blood clotting.
- Changes in behavior.
- Inflammation of the heart muscle and increased risk of cardiovascular diseases and heart attacks.