Lupus

What is lupus?

Lupus is a disease that affects your immune system. A normal immune system has antibodies that fight off viruses, bacteria, and other foreign substances. In people who have lupus, their immune system becomes overactive and attacks healthy cells and tissue.

There are several kinds of lupus. Each type has its own symptoms and affects your body in different ways.

  • Systemic lupus erythematosus (SLE) is the most common and serious type of lupus. It affects all body systems, including blood vessels, joints, kidneys, skin, heart, lungs, and the brain and nerves. Symptoms of SLE can be mild or severe.
  • Discoid lupus erythematosus (DLE) is sometimes called cutaneous lupus erythematosus. This kind of lupus only affects the skin, not the organs. Some people who have DLE may have SLE, too. The first symptom of DLE is often a red rash or scaly patch on the face or scalp. It is typically in the shape of a circle or disk. The rash may last a few days or several years. It can go away for a while and then come back. Sometimes DLE can cause sores in the mouth or nose.
  • Drug-induced lupus is caused by a reaction to certain long-term prescription medicines. Symptoms are similar to those of SLE, including muscle and joint pain, a rash, and fever. Drug-induced lupus does not cause problems with the kidneys, heart, brain, or blood vessels. Symptoms are often mild, and usually go away after you stop taking the medicine. This kind of lupus is more common in men who take medicine for heart conditions.
  • Neonatal lupus is a rare form of lupus that affects newborn babies. Babies who have neonatal lupus are born with a skin rash, and sometimes liver and heart problems. For most babies, the symptoms gradually go away over several months. In rare cases, neonatal lupus can cause a serious heart problem. Doctors think that neonatal lupus might be caused in part by certain proteins in the mother’s blood that are passed on to the baby at birth. If you are pregnant and have SLE, your doctor will want to monitor you and your baby for certain complications. Most babies born to mothers who have SLE are healthy.

Symptoms of lupus

Lupus can affect many parts of the body, including your joints, skin, and organs. It depends on the kind of lupus you have. Symptoms can develop quickly or slowly. They also can come and go, and be mild or severe.

Not everyone who has lupus has the same symptoms. Common symptoms of lupus may include:

  • red rashes, often on the face and in the shape of a butterfly (called a malar rash)
  • fever
  • joint pain or swelling
  • muscle pain
  • mouth ulcers
  • chest pain with deep breathing
  • sensitivity to the sun or light
  • low blood count
  • trouble thinking, and/or memory problems
  • hair loss (alopecia)
  • constant fatigue
  • kidney problems

Less common symptoms include:

  • swollen glands
  • blood clots
  • pale or blue fingers or toes from cold or stress (Raynaud’s Disease)
  • seizures
  • weight loss or weight gain
  • dry eyes
  • severe headaches
  • dizziness
  • stroke
  • depression
  • hallucinations
  • repeated miscarriages or other infertility problems

Children can have the same symptoms of lupus as adults. The most common symptoms in children are:

  • A red, butterfly-shaped rash (malar rash) over the bridge of the nose and the cheeks.
  • Low red blood cell count (anemia).
  • Low white blood cell count (leukocytopenia).
  • Severe brain or kidney problems.

It is common for lupus symptoms to come and go. Often, they may disappear for a period of time called remission. You may get new symptoms all of a sudden. When symptoms appear or get worse, it’s called a “flare.” You may have swollen joints and muscle pain one week and then no symptoms at all the next week.

What causes lupus?

The cause of lupus is unknown. Lupus can affect anyone, but it is most common in women between the ages of 15 and 44. African American, Hispanic, Asian, and Native American women are more likely to have lupus than people of other races.

How is lupus diagnosed?

Lupus is a hard disease to diagnose. There is not a specific test to find lupus. Many times, lupus goes undiagnosed or is diagnosed as a different problem. It may take a long time to determine a diagnosis.

Contact your doctor if you have symptoms that might be caused by lupus. There are several things they will do to help diagnose it. The doctor will start with a full medical exam. They may order blood and urine tests, such as:

  • Antinuclear antibody (ANA) test.This test checks for antibodies to the nucleus of your cells. A positive result means that your immune system may be attacking healthy cells. This does not always mean that you have lupus. Your doctor may recommend you see a specialist for more testing.
  • Complete blood count. Lupus often affects a person’s red blood cell, white blood cell, and platelet count. This test checks for anemia or the presence of certain proteins in your blood.
  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tests. Results from these tests will show if there is inflammation (swelling) in your body.
  • Urinalysis. Extra protein in the urine may show up in a lab test if lupus affects your kidneys.

Blood tests can also show how well your kidneys and liver are working, and if these organs have been affected by lupus. Your doctor may recommend a chest x-ray because lupus can sometimes cause swelling in the lungs and heart. An electrocardiogram test (ECG) checks for an abnormal heartbeat or damage to the heart that may be caused by lupus.

Depending on your symptoms and test results, your doctor also may order a skin or kidney biopsy.

Can lupus be prevented or avoided?

You cannot avoid lupus since the cause of it is unknown. However, you may be able to help prevent flares. Common triggers include:

  • lack of rest
  • stress
  • sun exposure
  • exposure to fluorescent or halogen light
  • certain medicines
  • infections
  • injuries

If you take medicines to help manage lupus, do not stop taking them without your doctor’s approval. This can cause flares as well.

Knowing the things that cause flares can help you better cope with your symptoms.

Lupus treatment

There is no cure for lupus, but treatments have improved in recent years. Treatment options vary depending on the kind of lupus you have, as well as your symptoms and the severity. Your treatment approach may change depending on if your symptoms are active or in remission.

If you have joint pain, sore muscles, or skin problems, such as a rash, your doctor may recommend that you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. Medicine that is used to treat malaria, such as hydroxychloroquine, can be helpful in treating lupus symptoms and preventing flares. Some people have side effects from this kind of medicine, including problems with vision and muscle strength. Corticosteroids are another type of medicine that your doctor may prescribe. They can help reduce swelling, but often have worse side effects.

You will likely need stronger medicines if lupus has caused problems in your vital organs or the central nervous system (heart, brain, and blood vessels). Stronger drugs have the potential for more severe side effects, and your doctor will want to closely monitor you. High-dose corticosteroids, such as prednisone, can be given by mouth or through a vein in your arm. Another option is medicine that suppresses the immune system, such as cyclophosphamide or azathioprine. Both types of medicine can help control dangerous symptoms quickly and prevent permanent damage. Sometimes, these medicines are used together at a lower dosage to lessen the risk of side effects.

Your doctor may want you to stop taking certain drugs if your lupus symptoms go away for a time (in remission). This is because medicines used to treat lupus carry a high risk of side effects. However, even if you don’t have active symptoms, your lupus can return and cause future problems. These may include kidney disease and kidney failure, or atherosclerosis (build-up in the arteries), which can lead to a heart attack or stroke. It is important to see your doctor regularly for check-ups and maintain good health.

The following lifestyle changes may help relieve symptoms and/or prevent flares.

  • Get plenty of rest. Fatigue is a common symptom of lupus, so try to maintain good sleep habits. Get enough hours of sleep at night and nap during the day, if needed.
  • Get regular exercise. You might not always feel like it, but exercise is good for you. It will help you sleep better, as well as improve your mood and heart health. Try to avoid outside activities when you have a flare. Exposure to the sun can make your symptoms worse.
  • Protect yourself from the sun. Wear clothing that covers as much of your skin as possible. Always use sunscreen, even if you are only outside for a short time. Don’t use tanning beds, and avoid fluorescent and halogen lighting. All of these are sources of ultraviolet light, which is known to trigger lupus symptoms.
  • Quit or avoid smoking. Lupus can affect your heart and blood vessels. If you smoke, you are at a much higher risk for cardiovascular disease.
  • Eat a healthy diet. Avoid any food that seems to make your symptoms worse. You may need to make changes to your diet if lupus causes high blood pressure or stomach or kidney problems. Try to eat a balanced and nutritious diet, including fruits, vegetables, and whole grains.
  • Take your medicine according to your doctor’s orders. Ask your doctor to explain the benefits and risks of your medicines. Depending on your symptoms and flares, you may need to make adjustments to the type of medicine you take, when you take it, and the dosage. Be sure to follow your doctor’s instructions.
  • Pay attention to your mental health. Tuning into your emotional well-being will help you cope with your condition and give you a sense of control. Living with lupus can mean learning to manage a number of physical, mental, and social problems.
  • Develop a support network. Get help from your family, friends, doctor, community, counselors, and support groups. This network can help you manage your condition.
  • Be mindful of your symptoms, especially pain and fatigue. You should try to keep realistic expectations about what you can and cannot do. Make sure you communicate these needs to those around you.

Living with lupus

When you are first diagnosed with lupus, you may have conflicting feelings. You may be relieved to finally know what is causing your symptoms. You may also have feelings of sadness, fear, confusion, and anger. Some people who have lupus have bouts of depression because of the challenges of living with this disease. Learning all you can about your illness can help you better cope with your symptoms, prevent flares, and deal with side effects and complications.

Lupus can affect and damage different parts of your body.

Kidneys

Your kidneys get rid of waste and other toxins from the body. Lupus can affect the kidneys and cause the structures that filter the blood to swell. Without treatment, lupus can lead to permanent kidney damage. If lupus affects your kidneys, you will probably need medicine to prevent serious damage. The most common symptom of kidney problems is swelling in your feet, legs, hands, or eyelids.

Heart

Lupus can inflame the sac around your heart and cause chest pain. Though less common, but more serious, it can harden the walls of your coronary arteries. This can lead to angina (chest pain) and an increased risk of coronary artery disease. Lupus can also cause inflammation of the heart itself, which can lead to scarring and possible heart failure.

Lungs

Inflammation can also occur in the lining of your lungs. This can cause chest pain, which is often felt with deep breathing. People who have lupus are at risk of getting pneumonia.

Joints

Most people who have lupus have swollen and painful joints. These symptoms can come and go, and may affect several joints at once. Usually, there is no long-term damage.

Skin

People who have lupus often get a butterfly-shaped, red rash across their nose and cheeks. This is called a malar rash. Other parts of the skin may be affected. You could have raised bumps or dry patches, often on areas that are exposed to the sun. You could get sores inside your mouth or nose. Hair loss (alopecia) is common during flares. You may notice a blotchy purple color on your hands, fingers, or toes. This happens when blood does not flow well to the skin’s surface. It is called Raynaud’s Disease.

Central Nervous System

Lupus can affect your brain and the nerves in your spinal cord. Symptoms include headaches, dizziness, mild confusion or memory problems, vision problems, and changes in your mood. It can lead to more serious health issues, such as seizures or a stroke.

Blood

Lupus can cause the number of red blood cells, white blood cells, and platelets to decrease. Fewer red blood cells can lead to anemia, which is common in people who have lupus. White blood cells help the body fight infection. Rarely, do white blood cells get low enough to cause infection. Platelets help your blood to clot. A low platelet count can lead to easy bruising, nosebleeds, and other bleeding. It can also cause your blood to clot too easily or in unneeded places. If the blood clot breaks away and travels through the bloodstream, it can block blood vessels and cause serious problems, such as a stroke, blood clots in the lungs (thrombosis), or repeated miscarriages.

Questions to ask your doctor

  • How do I know if I have lupus?
  • How can I figure out possible triggers of lupus flares?
  • What are the best treatment options for me?
  • If I have lupus, what is the chance my children will have it?