All You Need To Know About Lupus

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.

What Is Lupus?

Lupus is a chronic autoimmune condition that can cause inflammation throughout your body. However, it tends to primarily be a localized condition, so it’s not always systemic.

An autoimmune disease is a condition in which your body’s own immune system is responsible for the inflammation and breakdown of its own cells.

Many people with lupus experience a mild version of it, but it can become severe without proper treatment. Currently, there’s no known cure for lupus, so treatment focuses on easing symptoms and reducing inflammation.

Lupus Types

Healthcare professionals usually categorize four lupus types.

1.  Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is the most common type of lupus. When you hear someone say that they have lupus, it’s likely they’re referring to SLE.

SLE gets its name from the fact that it typically affects several different organ systems of your body. Research shows that these include the:

• kidneys
• skin
• joints
• heart
• nervous system
• lungs

SLE can range from mild to severe. The condition causes symptoms that may get worse over time and then improve. According to the Lupus Foundation of America, the times when your symptoms get worse are called flares. The periods when they improve or go away are known as remissions.

2.  Cutaneous Lupus 

This type of lupus is generally limited to your skin. It may cause rashes and permanent lesions with scarring. A 2019 review identified several different types of cutaneous lupus, including:

• Acute Cutaneous Lupus. This type causes a characteristic “butterfly rash” to occur. This is a red rash that appears on the cheeks and nose.
• Subacute Cutaneous Lupus. This kind of cutaneous lupus causes a rash that’s red, raised, and scaly to form on the body. It’s often on areas that have been exposed to sunlight and typically doesn’t lead to scarring.
• Chronic Cutaneous Lupus. This type causes a purple or red rash. It can also cause skin discoloration, scarring, and hair loss. You may also see it called discoid lupus.

While acute cutaneous lupus is often associated with lupus in other parts of the body, subacute and chronic cutaneous lupus typically only occur on the skin.

3.  Neonatal Lupus 

This condition is extremely rare and affects infants whose birthing parents have certain autoimmune antibodies. These autoimmune antibodies are transmitted from parent to fetus across the placenta.

Not all parents who have these antibodies have symptoms of lupus. In fact, research shows that about 25 percent of mothers who give birth to a child with neonatal lupus don’t have lupus symptoms. However, it’s estimated that 50 percent of these mothers will show symptoms within 3 years.

Symptoms of this condition may include:

• a skin rash
• low blood cell count
• liver problems after birth

While some babies may have developmental issues in the heart, most have symptoms that will go away after several months.

If you have these antibodies, you’ll need to be followed very closely during pregnancy. Your care team will often include specialists, such as a rheumatologist and high risk obstetrician. An obstetrician is a doctor who specializes in fetal-maternal medicine.

4.  Drug-Induced Lupus 

The use of certain prescription medications can lead to drug-induced lupus (DIL). DIL may also be referred to as drug-induced lupus erythematosus (DILE).

Research shows that DIL can develop through the long-term use of certain prescribed medications. It typically occurs after just months of taking a drug.

Many drugs can cause you to develop DIL. Some examples include:

• antimicrobials, such as terbinafine (an antifungal) and pyrazinamide (a tuberculosis medication)
• anticonvulsant drugs, like phenytoin (Dilantin) and valproate
• arrhythmia drugs, such as quinidine and procainamide
• drugs for high blood pressure, like hydralazine
• biologics called anti-TNF-alpha agents, such as infliximab (Remicade) and etanercept (Enbrel)

While DIL mimics the symptoms of SLE, in most cases the condition doesn’t usually affect major organs. However, it can cause pericarditis and pleurisy. DIL usually goes away within weeks of stopping the medication that caused it to occur.

Is Lupus Curable?

Currently, there’s no cure for lupus. However, many different types of treatments can help you manage your symptoms.

According to a 2019 review, treatment for lupus focuses on several factors:

• treating lupus symptoms when you have them
• preventing lupus flares from occurring
• reducing the amount of damage that occurs to your joints and organs

Following a healthcare professional’s recommended treatment regimen is important in helping you to manage your symptoms and to live a fulfilling life.

Doctors and scientists continue their research to better understand lupus and develop new treatments for the condition.

Lupus Symptoms

The symptoms of lupus vary from one person to another. Some people have just a few symptoms, while others have many.

Lupus can affect any part of your body. Common symptoms include:

• Achy joints (arthralgia)
• Fever higher than 100 F
• Swollen joints (arthritis)
• Constant or severe fatigue
• Skin rash
• Ankle swelling
• Pain in your chest when breathing deeply (pleurisy)
• A butterfly-shaped rash across your cheeks and nose (malar rash)
• Hair loss
• Sensitivity to the sun or other lights
• Seizures
• Mouth or nose sores
• Pale or purple fingers or toes when you’re cold or stressed (Raynaud's phenomenon)

Symptoms can vary, depending on the individual. They may:

• be permanent
• disappear suddenly
• flare up occasionally

Lupus 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:

1. Genetics. According to the Lupus Foundation of America, more than 50 genes associated with lupus have been identified. Additionally, having a family history of lupus may put a person at slightly higher risk for experiencing the condition.

2. Sunlight.  Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people.

3. Infections. Having an infection can initiate lupus or cause a relapse in some people.

4. 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.

5. Hormones. A 2019 review suggests that atypical hormone levels, such as increased estrogen levels, could contribute to lupus.

6. Environment. It can be hard to figure out exactly which things around you act as causes of lupus. But there are some factors that scientists have strong suspicions about. These include:

• Cigarette smoke
• Silica, a common mineral from the earth's crust found in sand, stone, concrete, and mortar
• Mercury
• Viruses including Epstein-Barr, herpes zoster, and cytomegalovirus
• UV light
• Stress  

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.
• Family History. Having a family history of lupus means that you’re at a greater risk of developing the condition.

Remember that having risk factors for lupus doesn’t mean you’ll get lupus. It just means that you’re at increased risk compared to those who don’t have risk factors.

Complications

Inflammation caused by lupus can affect many areas of your body, including your:

1. Kidneys. Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus.
2. 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.
3. 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.
4. 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.
5. 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.

Lupus Diagnosis

Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may change over time and overlap with those of many other disorders.

No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis.

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.

According to a 2019 review, in addition to requesting a detailed medical history and doing a physical examination, your doctor may perform the following tests to diagnose lupus:

1. 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.
2. 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.
3. 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.
4. 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

Treatment 

Treatment for lupus depends on your signs and symptoms. Determining whether you should be treated and what medications to use requires a careful discussion of the benefits and risks with your doctor.

As your signs and symptoms flare and subside, you and your doctor may find that you'll 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. Stronger NSAIDs are available by prescription. Side effects of NSAIDs may include stomach bleeding, kidney problems and an increased risk of heart problems.
• Antimalarial Drugs. Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), affect the immune system and can help decrease the risk of lupus flares. Side effects can include stomach upset and, very rarely, damage to the retina of the eye. Regular eye exams are recommended when taking these medications.
• Corticosteroids. Prednisone and other types of corticosteroids can counter the inflammation of lupus. High doses of steroids such as methylprednisolone (Medrol) are often used to control serious disease that involves the kidneys and brain. Side effects include weight gain, easy bruising, thinning bones, high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and longer term therapy.
• Immunosuppressants. Drugs that suppress the immune system may be helpful in serious cases of lupus. Examples include azathioprine (Imuran, Azasan), mycophenolate (Cellcept), methotrexate (Trexall, Xatmep, others), cyclosporine (Sandimmune, Neoral, Gengraf) and leflunomide (Arava). Potential side effects may include an increased risk of infection, liver damage, decreased fertility and an increased risk of cancer.
• Biologics. A different type of medication, belimumab (Benlysta) administered intravenously, also reduces lupus symptoms in some people. Side effects include nausea, diarrhea and infections. Rarely, worsening of depression can occur.
• Rituximab (Rituxan, Truxima) may be beneficial for some people in whom other medications haven't helped. Side effects include allergic reaction to the intravenous infusion and infections.

It’s important to monitor how your medications affect your symptoms. If your medication has side effects or doesn’t work to treat your symptoms anymore, let your doctor know.

Lupus Alternative Treatments

Some people use complementary or alternative treatments to ease lupus symptoms. But there’s no proof that any of them treat or cure the disease. Some herbal supplements can even interact with prescription drugs or make your symptoms worse. Talk to your doctor before starting any treatments.

Research has found some benefits with certain treatments, including:

• Vitamins and supplements. Vitamins C and D and antioxidants may help with symptoms and boost your overall health. The omega-3 fatty acids in fish oil also might be useful.
• Dehydroepiandrosterone (DHEA). This hormone may lessen symptom flare-ups but can also have mild side effects like acne or hair growth.
• Acupuncture. Small studies show that acupuncture can lessen pain and fatigue.
• Mind-body therapy. Meditation and cognitive behavioral therapy could ease pain as well as mental health issues like depression and anxiety.

Lifestyle Changes

Some daily changes can ease symptoms and improve your quality of life:

• Exercise. Low-impact exercises such as walking, swimming, and biking can help you keep muscle and lower your chances of osteoporosis (thinning of the bones). It might also boost your mood.
• Get enough rest. Pace yourself. Follow periods of activity with periods of rest.
• Eat well. Get a healthy, well-balanced diet.
• Avoid alcohol. Alcohol can interact with your medications to cause stomach or intestinal problems, including ulcers.
• Don't smoke. Smoking can hurt blood flow and make lupus symptoms worse. Tobacco smoke also harms your heart, lungs, and stomach.
• Play it safe in the sun. Limit your time in sunlight, especially between 10 a.m. and 2 p.m. Wear sunglasses, a hat, and sunscreen when you’re outdoors.
• Treat fevers. Take care of high temperatures right away. A fever may be a sign of an infection or a lupus flare-up.
• Be a partner in your care. Work toward an honest and open relationship with your doctor. Be patient. It often takes time to find the medication and dosage that works best for you. Follow your doctor's treatment plan, and don't be afraid to ask questions.
• Get to know your disease. Keep track of your lupus symptoms, which parts of your body are affected, and any situations or activities that seem to trigger your symptoms.
• Ask for help. Don’t be afraid to ask for help. Consider joining a support group. It often helps to talk to other people who have been through similar experiences.

Lupus Outlook

The outlook for lupus varies, depending on which organs are involved and how bad your symptoms are. The disease often includes periods of symptoms followed by times of remission, when you don’t have symptoms.

A healthy lifestyle can help prevent attacks that send you to the hospital.

Lupus doesn’t affect how long you’ll live in most cases, especially if you follow your doctor's instructions and their treatment plans.

Final Thought 

While lupus can affect your health, it doesn’t have to affect your quality of life. By focusing on your medications and wellness, you can live as healthy a life as possible.

In addition to sticking to your treatment plan, some things that you can do at home to help focus on your wellness include:

• staying active and getting plenty of exercise
• eating a healthy, balanced diet
• finding ways to manage stress
• being sure to get enough rest and not overwork yourself

Additionally, reading about other people’s lupus journeys may help you to learn more about living with lupus. There are many lupus blogs available that you can dive into.

Sometimes, coping with a diagnosis of lupus may be challenging. It may help to share your experience with others through in-person or online support groups.