Lupus

According to the Centers for Disease Control and Prevention, more than 1.4 million Americans are affected by lupus (systemic lupus erythematosus). Lupus is a disease in which the body's own defenses are turned against themselves. The disease attacks the body by mobilizing antibodies and cells against the body's tissues. It affects the joints, muscles and other parts of the body. Sometimes the kidney, heart and brain are affected.

With medical treatment and good management, people with lupus can lead active, healthy lives, but without treatment, complications from lupus can be life-threatening.

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Symptoms

Symptoms vary from person to person and even with the same person from time to time. The most common signs are:

  • A butterfly-shaped rash across the bridge of the nose and cheeks or a scaly, disk-shaped rash on the face, neck or chest
  • Sensitivity to sunlight. People with lupus often experience severe rashes or sunburns after only a little time in the sun.
  • Skin ulcers, usually painless, on the tongue or inside the mouth or nose
  • Arthritis. Persons with the condition may experience joint pain, stiffness and swelling.
  • Inflammation of the linings of organs such as the heart and lungs (serositis) that makes breathing painful or causes shortness of breath or chest pain.
  • Kidney problems, such as inflammation, either without symptoms or accompanied by swelling of the legs, and high blood pressure.
  • Brain or spinal cord problems, accompanied by headaches, seizures or mental problems.

A person may also experience:

  • Fatigue along with dizziness, headaches or depression
  • Unexplained fever, which may be an early sign of lupus
  • Raynaud's phenomenon, in which fingers, toes, nose and ears turn pale and numb when exposed to cold
  • Chest pain that may be accompanied by coughing
  • Swelling of glands, legs or the area around the eyes
  • Digestive problems, including loss of appetite, nausea, diarrhea and weight loss
  • Unusual hair loss.
  • Depression or trouble concentrating. This is either a result of the disease or a reaction to living with a chronic disease.

If lupus is not treated or controlled, these complications can result:

  • Inflamed kidneys, which may cause no pain but can be detected with urine and blood tests. A blood test is used to check kidney function.
  • Central nervous system problems, such as headaches, dizziness, difficulty concentrating, mood swings or seizures
  • Blood and blood vessel problems. These include anemia, increased risk of bleeding, increased risk of blood clots or inflamed blood vessels.
  • Inflammation of the lungs and the linings of the chest cavity. This can make breathing painful and increase the risk of a form of pneumonia.
  • Chest pain resulting from inflammation of the heart muscle, arteries or heart membrane. The leading cause of death for people with lupus today is cardiovascular disease, which can lead to heart attacks. It is not clear whether this is because people with lupus are living longer or whether it is a complication of treatment. Exercising, not smoking, controlling high blood pressure and reducing cholesterol levels all help reduce the risk of cardiovascular disease.
  • Infection, from having the disease and from treatment
  • Tissue death, caused when the blood supply to certain areas is reduced. The hip joint is commonly affected and may result in pain when walking.

For women who are of the age to bear children, lupus creates special risks, including:

  • Difficulty conceiving. Flare-ups of the disease and medications used to treat it can contribute to infertility.
  • Greater risk for miscarriage. The risk is highest early or late in the pregnancy. The risk can be reduced by careful planning and medical care.
  • More risk of complications during pregnancy. Flare-ups are more likely. The risk for high blood pressure, diabetes and kidney problems during pregnancy is also higher.
  • Limited birth control options. Women may not tolerate birth control pills well, and they should not use intrauterine devices because of the risk of infection.

Causes and Risk Factors for Lupus

The exact cause of lupus is unknown. Many doctors believe that a combination of factors (including genetic heritage, the environment and hormones) leads to its development. While lupus itself is not inherited, it is possible that some combinations of genes make a person more likely to develop the condition. A virus or bacterial infection may then cause the disease to develop.

Although anyone can develop lupus at any age, it mostly affects women in the childbearing years. Common risk factors include:

  • Gender. Women are about nine times more likely than men to develop lupus.
  • Race. African Americans are three to four times more likely than Caucasians to develop the disease.
  • Family history. Having a relative who has lupus increases the odds.
  • Pregnancy. Lupus sometimes shows up for the first time during pregnancy or shortly after giving birth.
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Diagnosis

Lupus is often hard to diagnose because symptoms vary from person to person. Symptoms in an individual can vary over time. The doctor may not suspect the disease until symptoms become more obvious. Nearly all people with lupus have flare-ups and times when the disease goes away.

Diagnosis and treatment have improved a great deal in the past fifty years. 

Although the disease is not curable, there are many options for managing it. Certain criteria are helpful in diagnosing lupus, including:

  • Rash
  • Sensitivity to sunlight
  • Ulcers
  • Arthritis
  • Inflamed membranes
  • Kidney problems
  • Neurological problems, such as seizures or psychosis
  • Blood problems, such as anemia
  • Signs of immune problems

Physicians can use a variety of tests to diagnose lupus, including:

  • Medical history and physical exam
  • Blood test to get a complete blood count, to measure hemoglobin, red blood cells, white blood cells and platelets. Results may indicate anemia, which often occurs in lupus. Low white blood cell counts may occur as well.
  • A blood test to see how fast red blood cells settle to the bottom of a test tube. If the blood sinks fast, this can indicate lupus or other inflammatory conditions or infection.
  • A blood test to see how well the kidneys and liver are working
  • Urinanalysis. This may show abnormal levels of protein or blood cells.
  • Antibody testing. When antibodies are present, they can indicate an immune system problem.
  • Chest X-rays can show lung problems that may be a sign of lupus
  • ECG test, to test the heart's electrical system
  • Syphilis test. This has nothing to do with checking for venereal disease.
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Treatments

There is currently no cure for lupus, but treatment can ease symptoms and reduce complications. How lupus is treated depends on how seriously organs are affected. Because lupus may take many forms, finding the best treatment may take time and should be customized to the patient's needs.

The doctor may recommend a variety of medications, including:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, may reduce joint and other tissue inflammation
  • Antimalaria drugs. No one knows why these drugs help improve lupus. They may be useful for treating skin and joint problems and the inflamed surface of organs like the heart and lungs. These drugs may also prevent flare-ups of the disease.
  • Immunosuppressive medications, which reduce normal immune responses. These may be prescribed if lupus is widely affecting organs, especially the kidneys. Immunosuppressive medications may cause anemia and a low white blood cell count. They may also increase risk of infection and cancer. The doctor may prescribe them if corticosteroids are not effective or to allow for a lower dose of corticosteroids to reduce side effects. Sometimes, even with drugs, the kidneys may fail, and a kidney dialysis or kidney transplant may be needed.

Lupus may not be a major illness, or it can be a serious, life-threatening one. The following precautions should be followed:

  • Know the symptoms - Recognize when they are worse, and treat them. This can reduce the chance of permanent tissue or organ damage. Early treatment can cut the time spent taking higher doses of medications that cause side effects.
  • Work with the doctor - and take medications only as directed
  • Avoid exposure to the sun - Wear hats, long-sleeved shirts and long pants to avoid being in ultraviolet light and avoid a flare-up. Use sunscreens with a sun protection factor (SPF) of at least 15. Stay out of the sun during its strongest hours - 10 a.m. to 3 p.m.

Because lupus is a systemic problem, patients can best manage the disease by generally taking care of themselves. 

To improve the function of the immune system, patients need to:

  • Get enough rest
  • Exercise regularly
  • Not smoke. Smoking increases the risk of cardiovascular disease and makes the effects of lupus worse on the heart and blood vessels.
  • Limit alcohol use, which can affect the liver, kidneys, heart and muscles. Alcohol may also interact with medications.
  • Eat a healthy, balanced diet
  • Seek medical counseling when considering getting pregnant to find out steps that can be taken to ensure a safe pregnancy. This can reduce risks for the mother and the baby.
  • Reduce stress and use relaxation methods, such as meditation or yoga
  • Build a support network through family, friends or an organized support group
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