Lupus

Lupus is a chronic inflammatory disease that occurs when your body's immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different body systems including the joints, skin, kidneys, blood cells, brain, heart, and lungs.

There are many kinds of lupus. The most common type, systemic lupus erythematosus, affects many parts of the body. Discoid lupus causes a rash that does not go away. Subacute cutaneous lupus causes sores after being out in the sun. Another type can be caused by medication. Neonatal lupus, which is rare, affects newborns.

Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other conditions. The most distinctive sign of lupus is a facial rash that resembles the wings of a butterfly unfolding across both cheeks.

Anyone can get lupus, but women are more likely to develop the disease than men. Lupus is also more common in African American, Hispanic, Asian, and Native American women than in other races. Lupus affects people of all ages, but it is most often diagnosed between the ages of 15 and 40 years old.

The exact cause of lupus is not known. Some people are likely born with a tendency toward developing lupus, which may be triggered by infections, certain drugs, or even sunlight. There is no cure for lupus, but treatments can help control symptoms.

The signs and symptoms of lupus differ from person to person, and the disease can range from mild to life threatening. Initial symptoms of lupus may begin with a fever, headaches, epilepsy, or psychoses. Other common symptoms of lupus include:

• joint and muscle pain or swelling
• fatigue
• low-grade fever
• skin rash, often on the face, which is called the “butterfly rash”
• fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon)
• shortness of breath
• dry eyes
• headaches, confusion, or memory loss
• chest pain
• unusual hair loss
• anemia
• sensitivity to sunlight

Lupus can affect many parts of your body and can lead to complications. Inflammation caused by lupus can affect the:

• 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 and central nervous system. If your brain is affected by lupus, you may experience headaches, dizziness, behavior changes, hallucinations, stroke, 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 an 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. You may also be more susceptible to pneumonia.
• heart. Lupus can cause inflammation of the heart muscle, arteries, or heart membrane (pericarditis). The risk of cardiovascular disease and heart attacks is also high if you have lupus.

Lupus occurs when your immune system attacks healthy tissue in your body. Lupus likely results from a combination of genetic and environmental factors. People with an inherited predisposition for lupus may develop the disease when something in the environment triggers lupus. Some potential triggers include sunlight, infections, and certain medications including ant-seizure medications, blood pressure medications, and antibiotics. The cause for lupus in most cases, however, is unknown.

Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. And, signs and symptoms of lupus may vary over time and overlap with those of many other disorders. No one test can diagnose lupus. A combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis.

Blood and urine tests used to diagnose lupus may include:

• complete blood count. This test measures the number of red blood cells, white blood cells, platelets, and hemoglobin (a protein in red blood cells). Results may indicate signs that commonly occur in lupus such as anemia, low white blood cell count, or low platelet count.
• erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus, or another inflammatory condition, cancer, or an infection.
• kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. These organs are often affected by lupus.
• urinalysis. Urine may reveal an increased protein level or red blood cells in the urine, which may occur if lupus has affected the kidneys.
• antinuclear antibody (ANA) test. The presence of ANAs in blood indicates a stimulated immune system. Most people with lupus have a positive ANA test, but most people with a positive ANA do not have lupus.

Your doctor may suggest imaging tests, such as X-rays, or an echocardiogram, if he or she suspects that lupus is affecting your lungs or heart, or a biopsy may be performed to evaluate organ damage related to lupus.

If you have lupus, take good care of your body. Simple measures can help prevent lupus flares and, if flares occur, you will cope better with the signs and symptoms you experience.

See your doctor regularly. Having regular checkups instead of only seeing your doctor when your symptoms worsen may help your doctor prevent flare-ups. This also provides an opportunity to address routine health concerns, such as stress, diet, and exercise that can be helpful in preventing lupus complications.

Get adequate rest. People with lupus often experience persistent fatigue that is different from normal tiredness and that is not necessarily relieved by rest. Therefore, it can be hard to judge when you need to slow down. Get plenty of sleep at night and take naps or breaks during the day as needed.

Be sun smart. Ultraviolet light can trigger a flare of lupus symptoms, so wear protective clothing such as a hat, long-sleeved shirt, and long pants and use sunscreens with a sun protection factor (SPF) of at least 55 every time you go outside.

Get regular exercise. Exercise can help you recover from a flare, reduce your risk of heart attack, help fight depression, and promote general well-being.

Do not smoke. Smoking increases your risk of cardiovascular disease and can worsen the effects of lupus on your heart and blood vessels.

Eat a healthy diet. A healthy diet emphasizes fruits, vegetables, and whole grains.

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 certain types of cancer.
• bone tissue death. 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 bone.
• 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 often recommend delaying pregnancy until your disease has been under control for at least six months.

There is no cure for lupus. Treatment for lupus depends on your signs and symptoms. Determining whether your signs and symptoms should be treated and what medications to use requires a careful discussion of the benefits and risks with your doctor. Most individuals with lupus can achieve remission or reduce their symptom levels with a combination of medication, rest, exercise, proper nutrition, and stress management. As your signs and symptoms flare and subside, you and your doctor may find that you need to change medications or dosages.

The medications most commonly used to control lupus include:

nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), may be used to treat pain, swelling, and fever associated with lupus.

antimalarial drugs. Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), also can help control lupus.

corticosteroids. Prednisone and other types of corticosteroids can control the inflammation related to lupus, but steroids can produce serious side effects after long-term use, including weight gain, easy bruising, weakening of bones (osteoporosis), high blood pressure, diabetes, and increased risk of infection.

immunosuppressants. Drugs that suppress the immune system may be helpful in serious cases of lupus. Examples include azathioprine (Imuran, Azasan), mycophenolate (CellCept), leflunomide (Arava) and methotrexate (Trexall). A newer medication, belimumab (Benlysta), also reduces lupus symptoms in some people.