Lupus

Overview

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

Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus.

Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. While there's no cure for lupus, treatments can help control symptoms.

Symptoms

No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus have mild disease characterized by episodes — called flares — when signs and symptoms get worse for a while, then improve or even disappear completely for a time.

The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. The most common signs and symptoms include:

• Fatigue
• Fever
• Joint pain, stiffness and swelling
• Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body
• Skin lesions that appear or worsen with sun exposure
• Fingers and toes that turn white or blue when exposed to cold or during stressful periods
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches, confusion and memory loss

Causes

As an autoimmune disease, lupus occurs when your immune system attacks healthy tissue in your body. It's likely that lupus results from a combination of your genetics and your environment.

It appears that people with an inherited predisposition for lupus may develop the disease when they come into contact with something in the environment that can trigger lupus. The cause of lupus in most cases, however, is unknown. Some potential triggers include:

• Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people.
• Infections. Having an infection can initiate lupus or cause a relapse in some people.
• Medications. Lupus can be triggered by certain types of blood pressure medications, anti-seizure medications and antibiotics. People who have drug-induced lupus usually get better when they stop taking the medication. Rarely, symptoms may persist even after the drug is stopped.

Risk factors

Factors that may increase your risk of lupus include:

• Your sex. Lupus is more common in women.
• Age. Although lupus affects people of all ages, it's most often diagnosed between the ages of 15 and 45.
• Race. Lupus is more common in African Americans, Hispanics and Asian Americans.

Complications

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.
• Brain and central nervous system. If your brain is affected by lupus, you may experience headaches, dizziness, behavior changes, vision problems, 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 a reduced number of healthy red blood cells (anemia) and an increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels.
• Lungs. Having lupus increases your chances of developing an inflammation of the chest cavity lining, which can make breathing painful. Bleeding into lungs and pneumonia also are possible.
• Heart. Lupus can cause inflammation of your heart muscle, your arteries or heart membrane. The risk of cardiovascular disease and heart attacks increases greatly as well.

Other types of complications

Having lupus also increases your risk of:

• Infection. People with lupus are more vulnerable to infection because both the disease and its treatments can weaken the immune system.
• Cancer. Having lupus appears to increase your risk of cancer; however, the risk is small.
• Bone tissue death. This occurs when the blood supply to a bone declines, often leading to tiny breaks in the bone and eventually to the bone's collapse.
• Pregnancy complications. Women with lupus have an increased risk of miscarriage. Lupus increases the risk of high blood pressure during pregnancy 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.

Treatment consists of immunosuppressants

While there's no cure for lupus, current treatments focus on improving quality of life through controlling symptoms and minimising flare-ups. This begins with lifestyle modifications, including sun protection and diet. Further disease management includes medication such as anti-inflammatories and steroids.

Rash

Skin rashes are a common symptom of lupus that many people experience.

Rash typically occurs after sun exposure.

it often presents as a butterfly-shaped rash on the cheeks and bridge of the nose.

Skin rashes may also appear as patches or ring-shaped lesions on the:

• arms
• legs
• upper back
• chest
• neck
• scalp
• face
• shoulders

These rashes may be raised, smooth, or scaly and can be painful or itchy in some cases. The rashes usually also appear red or purple and may be more noticeable in people with darker skin tones

Lupus diagnosis

Doctors don’t use a single blood test or imaging study to diagnose lupus. Instead, they consider a person’s signs and symptoms and rule out other potential conditions that could be causing them.

Research has shown that some antibodies are highly specific to lupus, including double-stranded DNA (ds-DNA) and the Smith (Sm) antibody. The Sm antibody is also associated with SLE-related renal disease (nephritis).

Your doctor will first request your medical history and perform a physical examination. They’ll ask about your symptoms, including how long you’ve had them, and if you have a family history of lupus or other autoimmune diseases.

• Blood tests. These could include a complete blood count. Doctors use this test to determine the number and type of red blood cells, white blood cells, and platelets in the blood. Other tests they may order include an erythrocyte sedimentation rate, C-reactive protein test, and antinuclear antibody test, which can indicate heightened immune system activity.
• Urine tests. Using urinalysis can determine if there’s an elevated level of blood or protein in your urine. This can indicate that lupus may be affecting your kidneys.
• Imaging tests. Chest X-rays and echocardiograms are two imaging studies that may indicate inflammation or fluid buildup in or around your heart and lungs.
• Tissue biopsy. Your doctor can take a biopsy — or sample of cells — from an area of lupus-like rash. This may help determine if cells typical of a person with lupus are present. If kidney damage is present, a kidney biopsy may be necessary to help determine an appropriate treatment.

Pregnancy and lupus

Women with lupus can safely get pregnant and most will have normal pregnancies and healthy babies. However, all women with lupus who get pregnant are considered to have a "high risk pregnancy." This means that problems during pregnancy may be more likely for women with lupus. It doesn't mean there will definitely be problems.

Lupus and women

Lupus is a chronic, autoimmune disease that affects more women than men. If you have lupus, your risk is higher for other health problems that are common in women, such as heart disease and osteoporosis.