Lupus

1 What is lupus?

Lupus is a chronic disease of the immune system that can damage the skin, kidneys, brain, or any other part of the body. A chronic disease is a condition in which the symptoms of the disease last longer than six weeks and often for many years.

Lupus

A healthy immune system attacks foreign substances in the body which can be dangerous. When a person suffers from lupus, the immune system loses its ability to differentiate between the body’s own cells and foreign material, and mistakenly starts attacking healthy cells and tissues.

Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive signs of lupus include a butterfly rash on the face, appetite loss, hair loss, and fever, which occurs in many but not all cases of lupus.

Some people are born with an increased risk of developing lupus, which may be triggered by infections, certain drugs, or even sunlight. While there is no cure for lupus, treatments can help control symptoms.

Lupus is not contagious, so one can neither catch lupus from someone nor can give lupus to someone.

2 What causes lupus?

No one knows exactly what causes lupus. It is an autoimmune disease, which means it occurs due to a misdirected immune response that acts against the tissues of your body.

Normally, the immune cells act against foreign microorganisms that are harmful to your body. However, certain defects in the gene may impair the immune system, making it unable to differentiate between the body’s own tissues and invading microorganisms.

As a result, immune cells produce certain chemicals that destroy healthy tissues in the bodies causing various disorders.

Scientists are working to find the causes of lupus and have come up with several factors that may increase the risk.

These risk factors include:

  • Gender: Being female increases the risk by many folds
  • Race: African-American are more prone to developing lupus than white women
  • Family history: Having a close family member with lupus may boost your risk
  • Medications including hydralazine, procainamide, isoniazid, minocycline and others
  • Age: Lupus is more common in the people of age group 15 to 45

What triggers a lupus attack?

Certain factors may lead to a lupus attack, or flare-up. These include:

  • UV exposure
  • Smoking
  • Viral infections

Scientists are also studying the role of the female hormone, estrogen, as a potential cause or trigger of lupus.

How do you get lupus?

You can get lupus when your immune cells mistakenly attack healthy cells and tissues instead of foreign pathogens.

Rheumatoid arthritis, multiple sclerosis, type I diabetes, and psoriasis are other examples of this category of disease.

This abnormal immune response can cause serious damages to various body parts including the heart, brain, lungs, kidneys, blood vessels, skin, and joints. This is the reason why symptoms of lupus can affect any system of the body.

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3 Types of lupus

The term “lupus” usually refers to systemic lupus erythematosus or SLE, the most common type. However, there are different types of lupus based on the body parts it affects and causes behind it.

  • Systemic lupus erythematosus (SLE): It is the most common and serious type which affects the kidneys, heart, skin, brain, and blood. The symptoms have high interindividual differences in severity and exacerbation.
  • Discoid or cutaneous lupus: This type of lupus is limited to the skin only and causes facial rashes. Unlike in SLE, the internal organs are spared. Nonetheless, about one-tenth of the patients with discoid lupus will eventually develop SLE in their lifetime. 
  • Drug-induced lupus: As the name suggests, this type of lupus develops after a patient takes certain medications to treat other health problems. The symptoms, similar to those of SLE, usually go away after you discontinue the medication. It may take up to six months for symptoms to clear.
  • Neonatal lupus: A woman with lupus may give birth to a baby who has lupus at the time of birth. This type of lupus is uncommon and symptoms usually improve within some months. However, some cases of neonatal lupus have been associated with serious heart defects.

4 How is lupus diagnosed?

Diagnosing lupus is done by performing several tests.

Consult your physician if you feel any symptoms of lupus. He or she may further refer you to a rheumatologist who specializes in the diagnosis and treatment of arthritis and other inflammatory joint conditions.

As symptoms of lupus can mimic other health problems, an accurate diagnosis of lupus may take time.

Always make note of your symptoms and other important information before visiting a doctor, as it helps in finding an accurate diagnosis.

Your doctor may ask:

  1. When did your symptoms begin? Do they come and go?
  2. Does anything seem to trigger your symptoms?
  3. Does lupus run in your family?
  4. What medications and supplements do you take regularly?
  5. Does sun exposure cause you to develop skin rashes?
  6. Do your fingers become pale, numb, or uncomfortable in the cold?
  7. Do your symptoms include any problems with memory or concentration?
  8. How much do your symptoms limit your ability to function at school, at work, or in personal relationships?
  9. Have you been diagnosed with any other medical conditions?
  10. Are you pregnant, or do you plan to become pregnant?

After this session the doctor may recommend you the following diagnostic tests:

  • Blood and urine tests
    • Complete blood count (CBC): This test measures the number of red blood cells, white blood cells, platelets, and the amount of hemoglobin in the blood. Hemoglobin is a protein in red blood cells, which gives the red color to the blood. The results may indicate that you have anemia, which is very common in lupus. A low white blood cell or platelet count may also occur in lupus.
    • Erythrocyte sedimentation rate: This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate is not specific for any one disease but it is elevated when a person has lupus, another inflammatory condition, cancer, or any infection.
    • Kidney and liver assessment: Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs.
    • Urinalysis: An examination of a urine sample may show an increased protein level or red blood cells in the urine, which may occur if lupus has affected your kidneys.
    • Antinuclear antibody (ANA) test: This test is done to check whether a person is suffering from an immune disorder. If you test positive for ANA, your doctor may advise more specific antibody testing.
  • Imaging tests:
    If the doctor suspects that lupus is affecting your lungs or heart, he or she may suggest:
    • Chest X-ray: An X-ray image of the chest may reveal abnormal shadows that suggest fluid or inflammation in the lungs.
    • Echocardiogram: This test uses sound waves to produce real-time images of the heart beats. It can check for problems with heart valves and other portions of the heart.
  • Biopsy
    Lupus can harm various organs including skin, kidneys, brain, and other parts of the body in many different ways. The treatment approach may vary, depending on the type of the damage and the part affected. In some cases, it is necessary to test a small sample of the affected tissue to determine what is the best treatment option. The sample can be obtained with the help of a needle or through a small incision. This process of collecting tissue sample is known as biopsy.

5 What are the signs of lupus?

Lupus symptoms

The signs of lupus are distributed throughout various body parts as the disease affects all the tissues and internal organs in the body.

Lupus signs at the early stages of the disease are not specific, and they may be caused by other conditions. However, you should not overlook any of them and talk to your doctor as soon as they appear.

5 early signs of lupus you shouldn't ignore

  • Fatigue: Extreme or abnormal fatigue could be an early warning sign of lupus. Approximately 90% of the patients diagnosed with lupus report fatigue as an initial symptom. Such is the degree of fatigue that performing usual activities can make you tired and weak. Getting enough sleep and balanced diet does not seem to ease fatigue associated with lupus. It can cause significant distress that may interfere with your social or professional life.
  • Rash: The lupus rash appears most commonly on the face while some patients may develop purplish lace-like spots on the lower limbs. The characteristic feature of the rash is that it resembles the shape of a butterfly. Additionally, the rash is further worsened by exposure to sunlight.
  • Joint pain: Pain particularly affects the joints of your hands and feet. You may experience a more severe pain in the morning. The pain often progresses gradually, causing noticeable swelling and difficulty with movements. You may try to alleviate the pain by taking OTC pain pills. However, if the pain persists or worsens, you should talk to your doctor.
  • Fever without a cause: The fever in lupus is indicative of inflammation or infection. It may occur randomly and your body temperature may get back to the normal range even without any medication. Therefore, if you have a low-grade fever without any obvious cause or it comes and goes often, you should talk to your doctor.
  • Chest pain and breathing problems: Though these are not specific signs of lupus, you should take a close look if they persist or become worse. Lupus causes swelling of the lungs and the blood vessels there. Consequently, you will experience pain in the chest while breathing in. As the disease progresses, it may reduce the size of your lungs and may also affect the diaphragm. This can cause shortness of breath.

Lupus can also cause one or more of the following symptoms:

  • Convulsions
  • Elevated blood pressure
  • Headache and stomach pain
  • Impaired thinking and memory problems
  • Loss of hair
  • Memory problems
  • Mental depression
  • Swelling in the ankle due to fluid accumulation

6 Lupus symptoms in women

Women are naturally at a greater risk of developing lupus. Therefore, lupus symptoms in women need special attention.

Though lupus is not a gender-specific disorder, women aged 15 to 45 are more likely to have it compared to men of the same age group. In addition, the risk in African-American women is three times that in Caucasian women. Lupus symptoms in women may co-occur with other health conditions that may be very detrimental to health.

Why are lupus symptoms in women a major concern?

While the set of symptoms are similar in both men and women, certain lupus symptoms in women need extra attention. This is because women are inherently predisposed to certain health conditions that may be worsened by lupus.

Eventually, such predisposition may lead to an increased mortality and impaired quality of life in women.

Lupus is a more serious concern for women because of the following:

  • Heart diseases: Heart diseases are more common in women than in men. Additionally, lupus multiplies the risk of heart diseases. Therefore lupus is considered a greater health threat for women.
  • Bone loss: Women lose their bone mass to a greater extent than men as they age. Lupus or its medications can further enhance bone loss.

If you are a woman and show any lupus symptoms, you should talk to your doctor right away.

7 What is a lupus rash?

Lupus, at the very early stages, can cause a facial rash known as slupus rash.

In most cases, the rash affects your face, particularly the cheeks and the nose.

Exposure to sunlight or even artificial light can worsen the rash. It is seen in almost half of the patients who have lupus. It is easily recognizable, as it appears like a butterfly. Therefore, it is also known as a butterfly rash.

Your doctor can diagnose lupus through examination of the rash. The presence of lupus rash is one of the essential characteristic features that is used by clinicians to confirm the diagnosis. In addition to the rash, some patients may also develop discolored skin on the toes and fingers.

Though lupus is a systemic disorder, meaning it affects the internal organs of the body, some patients initially develop lupus that is restricted to the skin only. This condition is known as discoid lupus. According to some studies, discoid lupus in up to one-tenth of patients ultimately progresses to systemic lupus.

Some patients may also have spotty marks on their legs, which is known as Livedo reticularis. The spots appear like a purplish lace.

However, Livedo reticularis is not exclusive to lupus only. Various others conditions such as arthritis, tuberculosis, certain medications, or disorders of blood cells or blood vessels can also cause such skin discolorations.

When to see a doctor

Consult your doctor immediately if:

  • A butterfly-shaped rash appears suddenly or after exposure to sunlight or artificial light.
  • You suffer from hair loss, fever without a reason, extreme tiredness, chest pain while inhaling, and swollen joints in addition to the lupus rash.

In some patients, the lupus rash may also cause itching and pain.

8 Which lupus treatments can help you?

Since there is no cure, lupus treatment aims to reduce the symptoms' severity and preserve quality of life. 

It is possible to ease the symptoms and prevent occurrence of flare-ups by adopting a healthy lifestyle and taking certain medications. Lupus treatment is a collaborative effort undertaken by a team of healthcare professionals. The treatment plan involves regular monitoring of the symptoms and your response to particular medications.

The medications that constitute lupus treatment plan include:

  • Pain medications: You can take OTC pain medications to relieve pain and reduce swelling. Additionally, your doctor may prescribe some stronger pain medications if the OTC pain medications fail to provide the expected relief. Before you take these medications, you should ask your doctor or pharmacist about potential side effects and their proper use.
  • Immune-suppressing medications: These agents lower your immune function and may help to treat severe cases. However, they make your more susceptible to infections and may also damage your liver. Therefore, you should take precautions while taking any of them and follow your doctor’s instructions.
  • Malaria medications: Antimalarial agents are particularly effective to reduce joint pain, rashes, fatigue, and inflammation of the lungs. They alter your immune system, therefore making symptoms more manageable. Unlike immune-suppressing medications, they do not boost the risk of infection. Your doctor may prescribe them once you have a confirmed diagnosis.
  • Steroid medications: Steroids help to reduce inflammation and also affect your immune system. Long-term steroid therapy has its own share of harmful side effects. You should ask your doctor if you really need them and also learn about their proper use.

Lupus is a long-lasting illness with periods of flare-ups. Understandably, treatment can last for a long time. You may also need to take more than one medications to control symptoms and prevent flare-ups.

Therefore, you should take extra care to reduce the incidence of adverse drug effects and possible interactions between medications.

If you have any questions regarding medications used in lupus treatment, you should always talk to your doctor and pharmacist.

9 Alternative and homeopathic remedies

Alternative or complementary remedies may also prove beneficial in the treatment of lupus. However, these therapies are usually used alongside conventional medications. It is highly recommended to discuss these treatments with your doctor before starting.

The most common complementary and alternative treatments for lupus include:

  • Dehydroepiandrosterone (DHEA): Supplements containing the DHEA hormone have been shown to reduce the dose of steroids needed to stabilize symptoms in some people who have lupus.
  • Fish oil: Fish oil supplements contain omega-3 fatty acids that may prove beneficial for people with lupus. Preliminary studies have found some promise, though more study is needed. Side effects of fish oil supplements can include nausea, belching, and a fishy taste in the mouth.
  • Vitamin D: There is some evidence that people with lupus may benefit from supplemental vitamin D.

10 Lifestyle and coping

Lifestyle modifications are necessary in order to cope with lupus.

People with lupus experience persistent fatigue so get plenty of sleep at night, and rest during the day as needed. Ultraviolet rays in the sunlight can trigger flares, so protect your skin by wearing protective clothing. You can protect your exposed skin by using sunscreen lotions with high sun protection factor (SPF).

Exercise can help ease flare-ups, and also help avoid heart attack. Smoking can increase the risk of cardiovascular disease and worsens the effect of lupus on your heart.

Speak with your doctor to discuss how you can alter your diet to find the most relief. In some cases, you may have some dietary restrictions, especially if you have kidney damage, high blood pressure, and gastrointestinal problems, so ask your doctor about any restrictions. 

Don’t miss regular visits to your doctor. Regular examination helps in finding and avoiding lupus-associated complications.

11 Lupus FAQs

Is lupus contagious?

No. Lupus is a disease that is caused by an abnormal immune function that works against the body’s healthy cells and tissues. You cannot get lupus by external means, as it is not caused by a microorganism.

Is lupus fatal?

Usually, lupus is not fatal and symptoms come under control with proper use of medications in combination with healthy lifestyle measures.

However, in a small fraction of patients who have very severe symptoms, it can be fatal. Deaths of lupus patients occur due to complications.

Is lupus hereditary?

Scientists have not yet been able to establish a gene or a group of genes as a cause of lupus. However, family history is a known risk factor.

Is there a cure for lupus?

No, there is no known cure for lupus. However, a combination of medications and lifestyle changes can control symptoms and prevent flare-ups and complications.

Can alternative treatments help if I have lupus?

No alternative treatments have shown measurable benefits in treating lupus. However, certain forms of alternative treatments may be helpful to cope with the stress caused by it. You should always consult your doctor if you are considering giving any of them a try.

12 How can you help someone with lupus?

If anyone in your family has lupus, it can be very distressing not only to the patient but also to the whole family.

Fighting with a chronic disease is always a challenge and lupus is no different. Certain things may work to ease symptoms and enhance productivity.

Consider the following:

  • Participating actively in the treatment plan and its implementation
  • Learning and updating your own knowledge about lupus
  • Managing stress with a suitable technique
  • Living an active life as much as possible
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