Lupus is an autoimmune disease. Your body’s immune system is like an army with hundreds of soldiers. The immune system’s job is to fight foreign substances in the body, like germs and viruses. But in autoimmune diseases, the immune system is out of control. It attacks healthy tissues, not germs. You can’t catch lupus from another person. It isn’t cancer, and it isn’t related to AIDS. The majority of lupus cases occur in women and Latinas had a poorer prognosis overall than Caucasian women, were more likely to have kidney involvement and damage, and showed a more rapid rate of kidney failure.
Lupus is a disease that can affect many parts of the body. Everyone reacts differently. One person with lupus may have swollen knees and fever. Another person may be tired all the time or have kidney trouble. Someone else may have rashes. Lupus can involve the joints, the skin, the kidneys, the lungs, the heart, and/ or the brain. If you have lupus, it may affect two or three parts of your body. Usually, one person doesn’t have all the possible symptoms.
There are three main types of lupus:
• Systemic lupus erythematosus (eh-RITH-eh-muh-TOE-sus) is the most common form. It’s sometimes called SLE, or just lupus. The word “systemic” means that the disease can involve many parts of the body such as the heart, lungs, kidneys, and brain. SLE symptoms can be mild or serious.
• Discoid lupus erythematosus mainly affects the skin. A red rash may appear, or the skin on the face, scalp, or elsewhere may change color.
• Drug-induced lupus is triggered by a few medicines. It’s like SLE, but symptoms are usually milder. Most of the time, the disease goes away when the medicine is stopped. More men develop drug-induced lupus because the drugs that cause it, hydralazine and procainamide, are used to treat heart conditions that are more common in men.
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Systemic lupus erythematosus
In studies of identical twins—who are born with the exact same genes—when one twin has lupus, the other twin has a 24-percent chance of developing it. This and other research suggests that genetics plays an important role, but it also shows that genes alone do not determine who gets lupus, and that other factors play a role. Some of the factors scientists are studying include sunlight, stress, hormones, cigarette smoke, certain drugs, and infectious agents such as viruses. Recent research has confirmed that one virus, Epstein-Barr virus (EBV), which causes mononucleosis, is a cause of lupus in genetically susceptible people.
Scientists believe there is no single gene that predisposes people to lupus. Rather, studies suggest that a number of different genes may be involved in determining a person’s likelihood of developing the disease, which tissues and organs are affected, and the severity of disease. Researchers have begun to make headway in identifying some of those genes, which could eventually lead to better ways to treat and perhaps even prevent lupus.
In lupus, the body’s immune system does not work as it should. A healthy immune system produces proteins called antibodies and specific cells called lymphocytes that help fight and destroy viruses, bacteria, and other foreign substances that invade the body. In lupus, the immune system produces antibodies against the body’s healthy cells and tissues. These antibodies, called autoantibodies, contribute to the inflammation of various parts of the body and can cause damage to organs and tissues. The most common type of autoantibody that develops in people with lupus is called an antinuclear antibody (ANA) because it reacts with parts of the cell’s nucleus (command center). Doctors and scientists do not yet understand all of the factors that cause inflammation and tissue damage in lupus, and researchers are actively exploring them.
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Lupus may be hard to diagnose. It’s often mistaken for other diseases. For this reason, lupus has been called the “great imitator.” The signs of lupus differ from person to person. Some people have just a few signs; others have more.
Common signs of lupus are:
• Red rash or color change on the face, often in the shape of a butterfly across the nose and cheeks
• Painful or swollen joints
• Unexplained fever
• Chest pain with deep breathing
• Swollen glands
• Extreme fatigue (feeling tired all the time)
• Unusual hair loss (mainly on the scalp)
• Pale or purple fingers or toes from cold or stress
• Sensitivity to the sun
• Low blood count
• Depression, trouble thinking, and/or memory problems.
Other signs are mouth sores, unexplained seizures (convulsions), “seeing things” (hallucinations), repeated miscarriages, and unexplained kidney problems.
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Exams and Tests
There is no single test to diagnose lupus. It may take months or years for a doctor to diagnose lupus. Your doctor may use many tools to make a diagnosis:
• Medical history
• Complete exam
• Blood tests
• Skin biopsy (looking at skin samples under a microscope
• Kidney biopsy (looking at tissue from your kidney under a microscope).
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You may need special kinds of doctors to treat the many symptoms of lupus. Your health care team may include:
• A family doctor
• Rheumatologists—doctors who treat arthritis and other diseases that cause swelling in the joints
• Clinical immunologists—doctors who treat immune system disorders
• Nephrologists—doctors who treat kidney disease
• Hematologists—doctors who treat blood disorders
• Dermatologists—doctors who treat skin diseases
• Neurologists—doctors who treat problems with the nervous system
• Cardiologists—doctors who treat heart and blood vessel problems
• Endocrinologists—doctors who treat problems related to the glands and hormones
• Social workers.
Your doctor will develop a treatment plan to fit your needs. You and your doctor should review the plan often to be sure it is working. You should report new symptoms to your doctor right away so that treatment can be changed if needed.
The goals of the treatment plan are to:
• Prevent flares
• Treat flares when they occur
• Reduce organ damage and other problems.
Treatments may include drugs to:
• Reduce swelling and pain
• Prevent or reduce flares
• Help the immune system
• Reduce or prevent damage to joints
• Balance the hormones.
In addition to medications for lupus itself, sometimes other medications are needed for problems related to lupus such as high cholesterol, high blood pressure, or infection. Alternative treatments are those that are not part of standard treatment. No research shows that this kind of treatment works for people with lupus. You should talk to your doctor about alternative treatments.
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Inflammation caused by lupus can affect many areas of your body, including your:
• Kidneys. Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus. Signs and symptoms of kidney problems may include generalized itching, chest pain, nausea, vomiting and leg swelling (edema).
• Brain. If your brain is affected by lupus, you may experience headaches, dizziness, behavior changes, hallucinations, and even strokes or seizures. Many people with lupus experience memory problems and may have difficulty expressing their thoughts.
• Blood and blood vessels. Lupus may lead to blood problems, including anemia and increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels (vasculitis).
• Lungs. Having lupus increases your chances of developing an inflammation of the chest cavity lining (pleurisy), which can make breathing painful.
• Heart. Lupus can cause inflammation of your heart muscle, your arteries or heart membrane (pericarditis). The risk of cardiovascular disease and heart attacks increases greatly as well.
Having lupus also increases your risk of:
• Infection. People with lupus are more vulnerable to infection because both the disease and its treatments weaken the immune system. Infections that most commonly affect people with lupus include urinary tract infections, respiratory infections, yeast infections, salmonella, herpes and shingles.
• Cancer. Having lupus appears to increase your risk of cancer.
• Bone tissue death (avascular necrosis). This occurs when the blood supply to a bone diminishes, often leading to tiny breaks in the bone and eventually to the bone’s collapse. The hip joint is most commonly affected.
• Pregnancy complications. Women with lupus have an increased risk of miscarriage. Lupus increases the risk of high blood pressure during pregnancy (preeclampsia) and preterm birth. To reduce the risk of these complications, doctors recommend delaying pregnancy until your disease has been under control for at least 6 months.
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When to Contact a Medical Professional
When to call a doctor:
• You are suffering from chest pain or
• Shortness of breath.
• Trips to the bathroom are occurring less often, and you are urinating in smaller amounts than usual. Note any blood, as well.
• A fever over 100.5 without recent exposure to the cold or the flu
• Numbness or tingling in your hands or feet
• Muscle fatigue
• Swelling in your lower legs or feet
• An noticeable behavioral changes, like anxiety or depression
• Loss of appetite
• Loss of hair
• Skin rashes
• New mouth or nose sores
• Any worsening of previously known symptoms.
There is currently no way to prevent lupus. But people who smoke may be more likely to develop lupus. Avoiding smoking and perhaps other tobacco products may decrease your risk of developing lupus.
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