Lupus
Systemic lupus erythematosus (SLE or lupus) is an autoimmune disease that causes your body’s immune system to attack its own cells and tissues. It causes episodes of inflammation to various parts of the body, as well as rashes, fatigue, pain and fever. Lupus can affect your joints, tendons, skin, blood vessels, kidneys, heart, lungs and brain. Severe lupus can cause harm to organs and other serious problems.
What causes lupus?
An immune system disorder. Your body protects itself with the immune system. The immune system makes proteins called antibodies. They protect against bacteria, viruses and cancer cells. In some people, the immune system makes antibodies that attack the body’s own cells. This leads to inflammation and tissue damage in the body.
In the United States, an estimated 1.5 million people live with lupus. About 16,000 new cases are diagnosed annually. Experts believe lupus may be caused by a mix of genes and other factors, such as exposure to the Epstein-Barr virus (EBV), which causes mononucleosis. Other environmental factors such as exposure to sunlight and physical factors such as stress or hormones (specifically the female hormone estrogen) can trigger lupus.
Lupus is not a contagious disease, meaning you cannot catch or spread it.
Drug-induced lupus. In some instances, drug-induced lupus is caused by a reaction to prescription medications. An estimated 10 percent of people with lupus have symptoms due to this kind of reaction. Around 80 drugs may cause the condition, including some blood pressure medications, anti-seizure drugs and antibiotics.
What are the symptoms of lupus?
There is no early symptom of lupus, and when symptoms do occur, they typically vary from person to person. Lupus signs can appear in many parts of the body, and may come and go.
Some common lupus symptoms include:
Many people with lupus also have a variety of symptoms that affect their skin and hair, which may include:
- Butterfly-shaped rash on the nose and cheeks of the face (malar rash).
- Hair loss.
- Pale, blue or red fingers triggered by cold, stress or illness (Raynaud phenomenon).
- Raised rash on the head, arms, chest or back.
- Rashes or lesions caused by sunlight.
- Nose or mouth sores, or mouth ulcers.
Symptoms of lupus can look like other health problems, such as arthritis or diabetes. Make sure to see your healthcare provider for a diagnosis and to get the proper treatment you need.
Who is at risk for lupus?
Anyone can develop lupus, but there are certain risk factors that may increase your likelihood of developing the disease. These include:
- Sex: Nine out of ten people diagnosed with lupus are female. The hormone estrogen is linked with lupus.
- Race/ethnicity: African Americans, Asian Americans, Hispanics and Native Americans are more likely to develop lupus.
- Age: People between ages of 15 and 44 years are most likely to develop lupus. Lupus in children occurs most often in those age 15 and older. However, around 20% of cases are diagnosed in people who are older than 50.
- Family history: People with a family member that has lupus or another autoimmune disease are likely to also have lupus.
What are the different types of lupus?
There are several kinds of lupus, including:
- Systemic lupus erythematosus (SLE), lupus that impacts the entire body. This is the most common kind of lupus.
- Discoid lupus erythematosus (DLE, cutaneous lupus erythematosus), a form of lupus that affects the skin, causing a red rash that doesn’t go away.
- Drug-induced lupus, a lupus-like disease caused by certain prescription medications.
- Neonatal lupus, a rare condition that affects infants of people who have lupus.
How is lupus diagnosed?
Lupus is a challenging disease to diagnose because many of the symptoms could be from other causes. The symptoms also develop slowly over time. Doctors do not have a simple “yes” or “no” test for the diagnosis of lupus, therefore you may need multiple tests to gather all information.
Initial steps to diagnosis
To diagnose lupus, your healthcare provider will ask about your medical history and your symptoms, and may perform a physical examination. Your healthcare provider may suspect you have lupus if you have 4 or more symptoms and no specific cause.
They may ask the following questions in your evaluation:
- What symptoms are you experiencing?
- How often do you experience said symptoms?
- When did you first begin to experience symptoms?
- Does anything make your symptoms feel better or worse?
- Are your symptoms constant, or do they come and go?
- Do you have any symptoms that get worse at certain times of the day?
- Do your symptoms interfere with your daily routine and livelihood?
- Do you have a family member with an autoimmune disease or lupus?
Follow-up testing
You may have laboratory tests to help confirm the diagnosis, notably to look for changes in your body such as inflammation. Your provider may order certain blood tests, such as:
- Antibody blood tests. These tests are done to look for certain kinds of antibodies in your blood to find out if your immune system is attacking healthy tissue. The main test for lupus is the antinuclear antibodies (ANA) test. Most people with lupus will have a positive ANA test result.
- Complete blood count (CBC). This test checks for low red blood cell counts, white blood cell count, platelets which help your blood clot, and the protein hemoglobin. Results may indicate you have anemia, which commonly occurs in lupus
- Complement test. This test is done to measure the level of complement, a group of proteins in the blood that help destroy foreign substances. Low levels of complement in the blood are often linked with lupus and show signs of inflammation.
- Erythrocyte sedimentation rate (ESR or sed rate). This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood’s proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
- C-reactive protein (CRP). This protein shows up when inflammation is found in the body. ESR and CRP show similar amounts of inflammation. But in some cases, one will be high when the other is not. This test may be repeated to check your response to medicine.
You may also have other tests done, such as:
- Urine tests. These look for blood or protein in the urine to assess your kidney function.
- Biopsies. A biopsy is when tiny pieces of tissue are taken from the body to be checked under a microscope. To look for signs of lupus, biopsies of the skin and kidneys may be done to look for inflammation or damage to these organs.
- Echocardiogram. Using sound waves to produce real-time images of your beating heart, an echocardiogram can check for problems with your valves and heart muscles.
- X-rays. This test uses a small amount of radiation to create images of organs, bones and other tissues. These images may reveal abnormal shadows that suggest fluid or inflammation in your lungs.
How is lupus treated?
If your health care provider confirms you have lupus, they will work with you and a special doctor called a rheumatologist (a doctor who specializes in the diseases of joints and muscles) to create a treatment plan to alleviate your symptoms. Although there is no cure for lupus, a proper treatment plan will help you stay on top of your health, manage symptoms and have a better quality of life.
The main goal for your treatment options will include the following:
- Controlling your symptoms to minimize fatigue, inflammation and joint pain.
- Preventing your immune system from attacking your body.
- Protecting you from organ damage or organ failure.
Because lupus can cause an array of symptoms, there are many different kinds of medicines that can treat it. Your doctor may recommend the following as a part of your treatment plan:
- Anticoagulants to prevent the risk of blood clots.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce inflammation, pain and fever.
- Antimalarials to protect your skin from rashes and UV light and reduce lupus flare-ups.
- Biologics to help your immune system work correctly.
- Immunosuppressants to help keep your immune system from attacking your body.
- Steroids to help with inflammation.
As with any medication, side effects can occur. Always speak to your doctor to know what changes to watch for, if your medications may interact with one another, what the appropriate dosage is and how to combat any serious side effects.
It is also important to inform your provider if you are pregnant or breastfeeding to know which treatments are safe for both you and your baby.
Can lupus cause any complications?
Yes, if left untreated, lupus can affect many areas of the body and increase your risk of developing serious problems. Since lupus is an autoimmune disease, it causes your body to attack itself. If you have lupus, you are at higher risk of developing the following complications:
- Cancer. Having lupus can cause a slight increase to your risk of getting cancer.
- Infections. Since lupus is an autoimmune disease, you may be more vulnerable to infection due to both the disease and certain treatments that weaken the immune system.
- Arthritis: Lupus can cause joint pain, stiffness and swelling. It can also lead to arthritis which can be severe and disabling.
- Pregnancy complications. If you are pregnant and diagnosed with lupus, you are at higher risk of miscarriage or preterm birth. This is due to the risk of high blood pressure during pregnancy with lupus. Doctors often recommend delaying pregnancy until your disease has been under control for at least six months to prevent such complications.
Certain internal organs are also adversely affected by inflammation caused by lupus. These include:
- Brain and central nervous system. Lupus can cause behavior changes, dizziness, memory problems, strokes or seizures, and vision problems when it affects the brain.
- Blood and blood vessels. Lupus can reduce your number of healthy red blood cells (anemia) and increase your risk of bleeding or blood clotting. It also causes blood vessel inflammation.
- Heart. Lupus can cause inflammation of your heart muscle, your arteries or heart membrane, increasing your risk for heart attack and cardiovascular disease.
- Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus.
- Having lupus increases your chances of developing an inflammation of the chest cavity lining, which can make breathing painful. Lupus can also cause bleeding in the lungs and pneumonia.
See your doctor immediately if you develop an unexplained rash, ongoing fever, persistent aching or fatigue, or any of the above complications.
What is the outlook for someone with lupus?
Lupus is a challenging disease that affects every facet of your daily life. You may struggle to cope with your diagnosis, the constant pain, or even feel alone throughout treatment. It is important to know there are a variety of resources to help you adjust to treatment and get back to living your life.
Take steps to help prevent flare-ups
There are certain measures that can be taken to help you prevent lupus flares and, should they occur, better cope with the signs and symptoms you experience. Practicing the following can help you manage life with lupus:
- Ask your doctor if you need vitamin D and calcium supplements. Some evidence suggests that vitamin D supplements can benefit people with lupus. A calcium supplement can help you meet the daily recommended dietary allowance to help keep your bones healthy.
- Be sun smart. Wear protective clothing (such as a hat, long-sleeved shirt and pants) as well as sunscreen (SPF 55 minimum) every time you go outside to prevent flare-ups caused by sun exposure.
- Don’t smoke. Smoking increases your risk of cardiovascular disease and can worsen the effects of lupus on your heart and blood vessels. If you do smoke, sign up for smoking cessation training to stop.
- Eat a healthy diet. Eat a healthy diet rich in fruits, vegetables and whole grains.
- Exercise regularly. Exercise can help keep your bones strong, reduce your risk of heart attack and promote general well-being.
See your doctor regularly. Have regular check ups to prevent flares and address routine health concerns, such as stress, diet and exercise that can be helpful in preventing lupus complications.
FAQs about lupus
Is lupus more common in men or women?
While anyone can have lupus, it’s much more commonly seen in women, who make up about 90% of all diagnosed cases.
What is the lupus rash?
The lupus rash (also known as the butterfly rash), is a rash that appears on the cheeks and bridge of the nose in the shape of a butterfly. The rash is usually flat or slightly raised and can be red, purple or pink in color. It can be triggered or made worse by exposure to sunlight. It’s a common symptom of lupus, but not all people with lupus develop the rash.
Does lupus cause hair loss?
Yes, lupus can cause hair loss. It is one of the most common symptoms of lupus, affecting approximately 45% of people with the condition. Hair loss in lupus is typically characterized by thinning, but it can also lead to patches of hair loss, as well as loss in your eyebrows or eyelashes.
Does lupus cause weight loss?
Lupus can sometimes cause weight loss, although it is not a common symptom of the disease. Weight loss in lupus patients may be due to a variety of factors, such as loss of appetite, gastrointestinal issues or side effects of medications. If you are experiencing unexplained weight loss, it is essential to consult with your healthcare provider to determine the underlying cause.
Is there a cure for lupus?
There is no cure for lupus. Treatments for lupus focus on managing the symptoms and minimizing the damage lupus can cause on your body.
Is lupus contagious?
No, lupus is not contagious. It is an autoimmune disease, which means that it arises from the body’s immune system attacking its own healthy tissues. Unlike infectious diseases, lupus cannot be transmitted from person to person through contact or exposure.
Can I get pregnant if I have lupus?
Yes, women with lupus can get pregnant. However, there is a higher risk of miscarriage in women with lupus. If you plan to become pregnant and have lupus, it is important to talk with your healthcare provider first in case your lupus medications need to be modified to ensure safety during pregnancy.
How can I prevent lupus flare-ups?
Flare-ups of lupus symptoms may be minimized by avoiding extended sun exposure, doing low-impact exercises and keeping your body in motion, and by maintaining healthy diet and sleep habits.
References
MedlinePlus: National Library of Medicine. Lupus (https://medlineplus.gov/lupus.html)
Center for Disease Control and Prevention (CDC). Systemic Lupus Erythematosus (SLE) (https://www.cdc.gov/lupus/facts/detailed.html)
The Lupus Foundation of America. Lupus symptoms (https://www.lupus.org/resources/common-symptoms-of-lupus)