Lupus: A Comprehensive Overview
Lupus is a chronic, inflammatory autoimmune disease that can affect any part of the body. Autoimmune diseases develop when a person’s immune system becomes overactive and is unable to differentiate between foreign invaders and healthy tissue. Instead of targeting only invaders like viruses and bacteria, the immune systems also attacks and destroys healthy tissue and organs. Lupus can affect many different body systems, including skin, joints, blood, kidneys, heart and lungs.
The Lupus Foundation of America estimates that at least 1.5 million people in the U.S. and 5 million people worldwide have lupus. Although lupus is found mostly in women of childbearing age, it can strike men, women and children of all ages.
The cause of lupus is unknown, however, scientists think that some people may have a genetic predisposition to lupus that can be triggered by some type of environmental contact like medication or a virus.
Types of Lupus
There are four types of lupus:
Systemic Lupus Erythematosus - This type of lupus can affect just about any part of the body, although the most common areas are the skin, joints, lungs, kidneys and blood. The effects of systemic lupus can range from mild to severe. Systemic lupus is by far the most common and also the most serious form of the disease. If someone says they have lupus, they are most likely referring to systemic lupus.
Discoid Lupus Erythematosus - This form of lupus is also called cutaneous lupus and only affects the skin. People who have discoid lupus develop a circular rash on the face, neck and scalp. They may also have sores in the mouth, nose, or vagina. Approximately 10% of people with discoid lupus will go on to develop systemic lupus. There is a good chance that these people actually had systemic lupus all along, but early on the skin rash was their main symptom.
Drug-induced Lupus Erythematosus - This type of lupus may be more accurately described as a lupus-like disease that is caused by certain prescription medications. The symptoms of drug-induced lupus are much like those of systemic lupus, although it is rare for major organs to be affected. When the offending medication is stopped, the symptoms will usually disappear within six months.
Neonatal Lupus - This is a rare form of lupus that affects newborn babies. It is caused when antibodies from the mother act upon the infant in the womb. The newborn may have a skin rash, liver problems and/or low blood cell counts. Fortunately, these symptoms usually disappear after several months. In the most serious cases, the baby can have a heart defect.
Symptoms of Lupus
Due to the fact that lupus can affect just about any part of the body, there is a wide range of possible symptoms. According to the Lupus Foundation of America, the most common symptoms of lupus are:
- Extreme fatigue (tiredness)
- Painful or swollen joints
- Anemia (low numbers of red blood cells or hemoglobin, or low total blood volume)
- Swelling (edema) in feet, legs, hands, and/or around eyes
- Pain in chest on deep breathing (pleurisy)
- Butterfly-shaped rash across cheeks and nose
- Sun- or light-sensitivity (photosensitivity)
- Hair loss
- Abnormal blood clotting
- Fingers turning white and/or blue when cold (Raynaud’s phenomenon)
- Mouth or nose ulcers
Lupus symptoms may vary from one person to another; and even in the same person, symptoms can change over time. Most people with lupus experience fluctuations in disease activity - sometimes symptoms may be severe and other times almost unnoticeable.
Diagnosing lupus can be a difficult task. In addition to symptom fluctuations, many lupus symptoms are very similar to other disorders, making it even harder to pin down what is actually causing the symptom. Another factor that can make a lupus diagnosis challenging is the fact that laboratory tests may also vary, giving a positive result one time and a negative result another time.
Ultimately, a lupus diagnosis is usually based on a combination of factors, including:
- Current symptoms
- Laboratory test results
- Personal Medical History
- Family Medical History
There is no single laboratory test that will definitively diagnose lupus. Rather, the results of several different types of tests can reveal the liklihood of lupus. Following are some of the most common laboratory tests used in making a lupus diagnosis:
Complete Blood Count (CBC) - This test measures the levels of red blood cells, white blood cells, platelets, and serum. Low CBC numbers may be indicative of lupus.
Urinalysis - Since lupus can attack the kidneys, urine tests can reveal any problems with kidney functioning.
Antinuclear antibody (ANA) test - This test is looking for the presence of specific antibodies that indicate a stimulated immune system. The ANA is the test most people think of when someone says they are being tested for lupus, however, the ANA is not a specific test for lupus. A positive ANA result does not necessarily mean you have lupus. In addition to lupus, ANA levels may be elevated if you have another autoimmune diseases, if you have an infection, or even if you’re taking certain medications.
An interesting fact - these antibodies are found in 97% of people with lupus. So although a positive ANA doesn’t necessarily mean you have lupus, a negative ANA makes a lupus diagnosis pretty unlikely - not impossible, but highly improbable.
Erythrocyte sedimentation rate - This is a blood test that can help identify infection or inflammation in the body. An elevated sedimentation rate generally means you have some type of inflammation or infection going on in your body. Since lupus is an inflammatory condition, someone with lupus would most likely have an elevated sedimentation rate.
Other tests - There are a number of other tests your doctor may feel are necessary in order to make an accurate diagnosis, which may include kidney and liver assessments, tests for other types of antibodies, blood clotting time tests, C-reactive protein, chest x-ray, electrocardiogram or tissue biopsies.
Because lupus symptoms and disease progression varies so much from person to person, a treatment plan must be tailored to fit each individual patient’s needs. The primary goals of a lupus treatment plan are to:
- Reduce inflammation
- Suppress the overactive immune system
- Control symptoms
- Prevent flares
- Minimize damage to organs
The most common medications used in the treatment of lupus include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) - These are the most common medications used to treat lupus. Over-the-counter NSAIDs like aspirin, ibuprofen and naproxen sodium or stronger prescription NSAIDs can help reduce inflammation, relieve pain and/or reduce fever. Since NSAIDs can cause stomach irritation and gastrointestinal problems, it is best to take them with food, milk or antacids. Your doctor may also prescribe a medication to help reduce the GI complications.
Corticosteroids - Corticosteroids can be very effective in reducing inflammation, however, they can also have some serious long-term side effects like weight gain, high blood pressure, easy bruising, osteoporosis, diabetes and increased risk of infection. It’s important to try to find the lowest dose of corticosteroids that will control your symptoms and take it for the shortest period of time possible.
Antimalarial drugs - Although there is no relationship between lupus and malaria, antimalarial medications can provide many benefits in the treatment of lupus. They are often prescribed for skin rashes, mouth ulcers and joint pain symptoms. They can also decrease autoantibody production and may help prevent lupus flares. When used with corticosteroids or other medications, antimalarials can reduce the dose needed of the other drugs. Side effects from antimalarial drugs are rare and generally mild, although in high doses (higher than usually used for lupus), they can cause vision problems.
Immunosuppressive drugs - Immunosuppressives, also called immune modulators, can be used to control an overactive immune system as well as help inflammation. However, these drugs can have some very serious side effects. Because they suppress the immune system, they reduce your body’s ability to fight infection, making you much more suseptible to both viral and bacterial infections. For that reason, immunosuppressives are usually only used in more serious cases of lupus.
Other drugs - Depending on which body systems lupus attacks, a wide variety of other medications may be prescribed to control specific symptoms and protect certain organs.
Finding a Doctor
The specialist who treats lupus is a rheumatologist, however, you may find that the best approach to dealing with lupus is with a health care team. Depending on what parts of the body are affected by lupus, different specialists may be called to join your health care team. For example, a dermatologist may consult on skin related issues, a cardiologist for heart problems, or a nephrologist for kidney damage. The important thing is to find a team of doctors you trust, who are willing to work together to develop the best treatment plan for you.
At one time, the prognosis for lupus patients was pretty grim. However, today the prognosis is better than it’s ever been. Although as yet there is no cure for lupus, with current treatment protocols and careful management, people with mild to moderate forms of the disease can have an active lifestyle and live a normal lifespan. Great progress in the diagnosis and treatment of lupus has been made in just the last 10 years and will likely continue. There is every reason for lupus patients to feel positive and hopeful for their future.