Lupus

Inflammatory and Immune System

Lupus is an autoimmune disorder characterized by chronic inflammation of the organs (brain, kidneys, heart, lungs, and skin), joints, and/or blood. There are four main types of lupus, but the most common form is systemic lupus erythematosus (SLE). Lupus affects many different parts of the body causing a variety of symptoms, including fatigue, joint pain, headaches, and swelling in the joints, hands, and feet. Lupus can be difficult to diagnose because it presents in flares during which the symptoms are more noticeable and pronounced followed by a remission of symptoms. Women of childbearing age (15 -44 years of age) are at the greatest risk for developing lupus. However, this inflammatory disease can affect people of all ages, including newborns. The Lupus Foundation of America states that over 1.5 million people in the United States and over 5 million people across the globe have been diagnosed with lupus. While lupus is a chronic disorder, most sufferers can live normal lives with proper medication and self-management.

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Symptoms

Symptoms can be widespread all over the body. Most of them tend to occur during flares, but some may be present all the time. These include:

  • Disabling fatigue
  • Joint pain
  • Joint swelling
  • Headaches
  • Low-grade fever
  • Puffiness in the hands, feet, and legs
  • Chest pain
  • Rash on cheeks and nose
  • Sensitivity to sunlight
  • Mouth ulcers
  • Blue fingers with temperature changes (Reynaud’s)
  • Hair loss
  • Blood clots

When lupus flares, many people complain of “feeling like they have the flu” because their body is attacking itself as if its cells were foreign. The disorder is often mistaken for chronic fatigue syndrome, fibromyalgia, Lyme disease, or arthritis.

Types

Generally, people use the term “lupus” to refer to systemic lupus erythematosus (SLE) – the most common form of lupus. However, other, more specific forms of lupus also exist. The main types of lupus include:

  • Systemic lupus erythematosus (SLE)
  • Discoid lupus erythematosus (DLE)
  • Subacute cutaneous lupus erythematosus (SCLE)
  • Neonatal and pediatric lupus erythematosus (NLE)
  • Tumid lupus
  • Drug-induced lupus

Risk Factors

You may be at higher risk for lupus if you have any of the following:

  • Family history of autoimmune disease (mother, father, sibling)
  • Female gender
  • Age between 15 and 40 years
  • Darker-skinned ethnicity
  • History of viral infection
  • Chronic exposure to chemicals

Diagnosis

Diagnosing lupus can be tricky for three reasons: First, lupus symptoms present differently across individuals. Secondly, symptoms can mimic other commonly occurring disorders. Lastly, blood testing only comes back positive during flares which may occur intermittently with long periods of no symptoms.

Doctors consider eleven major criteria to be classic signs of lupus. If you have four or more of the criteria, the doctor can officially diagnose lupus, sometimes without blood testing.

These include:

Malar rash. A rash shaped like a butterfly over the nose and cheek area.

Discoid rash. Raised red rash that appears in patches on the skin.

Sensitivity to sunlight.

Mouth or nose ulcers.

Arthritis. Must be in two or more joints and have swelling, pain, and tenderness.

Cardio-pulmonary signs. Inflammation of the heart and lungs.

Neurological. Psychosis, seizures, anxiety, or depression.

Kidneys. Protein in the urine, or cellular casts in urine.

Blood. Clotting, anemia, low white blood cells, or low platelets.

Immunity. Cardiolipin antibodies or antibodies to double-stranded DNA.

Positive ANA. This may or may not be positive and there is also a high possibility of false positives. It isn’t always a confirmation of lupus.

Treatments

You will most likely be referred to a Rheumatologist for treatment of lupus. Together, you will come up with a treatment plan that best fits your symptoms. The treatments include:

Non-steroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatories help lower the inflammation in the body and reduce the activity of the autoimmune disorder if taken every day on a regular basis. They also treat local symptoms like fever, joint swelling, and pain. They have to be closely monitored due to long-term side effects on the kidneys, heart, and/or possible stomach bleeding.

Anti-malaria drugs. Malaria medications help to reduce the severity of lupus symptoms and control the disorder. Side effects include upset stomach and retinal damage.

Immunosuppressant medications. In severe cases of lupus, the doctor may opt to give you drugs that lower your immune system reaction. Using these will raise your risk of getting a serious infection. Other side effects include liver damage, nausea, fever, diarrhea, and an increased risk of cancer.

Corticosteroids. These are reserved for severe flares because they can stop an immune system reaction quickly. However, corticosteroids can cause severe side-effects if they are used too often. Side effects include diabetes, osteoporosis, risk of infection, bruising, and weight gain.

Alternative Treatments and Home Remedies

It is very important to discuss alternative medicine for lupus with your physician. Please note that any herbal remedies (e.g., echinacea) that “boost” the immune system are contraindicated in autoimmune disorders. They can make a flare worse. Still, there are a few things you can add to your regimen to help relieve symptoms:

Vitamin D. Make sure you are getting enough vitamin D other than sunlight since lupus requires you to avoid the sun. Your doctor can recommend the best supplements.

Fish oil capsules. Omega-3 fatty acids may help. Use with caution if you are on blood thinners.

Dehydroepiandrosterone (DHEA). DHEA is a mild male hormone recommended by the John Hopkins Lupus Center in treating some symptoms of lupus. There are some indications that DHEA may help lessen fatigue, joint pain, alopecia, and inflammation. People on high doses of steroids have been able to lower their dosage when using this supplement.

References

Centers for Disease Control and Prevention. (2018, October 17). Systemic lupus erythematosus (SLE). Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/lupus/facts/detailed.html#sle

Lupus Foundation of America Staff. (2016, October 6). Lupus facts and statistics. Retrieved from Lupus Foundation of America: https://www.lupus.org/resources/lupus-facts-and-statistics

Lupus Foundation of America Staff. (2020, October 21). What is lupus? Retrieved from Lupus Foundation of America: https://www.lupus.org/resources/what-is-lupus

Maidhof, W. & Hilas O. (2012, April). Lupus: An overview of the disease and management options. Pharmacy and Therapeutics, 37(4), 240-246. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351863/

Sawalha, A. H. & Kovats S. (2009, June 24). Dehydroepiandrosterone in systemic lupus erythematosus. Current Rheumatology Reports, 10(4), 286-291. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701249/

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