What is Lupus?
There are 4 types of Lupus: Systemic Lupus Erythematosus (what I will refer to as just Lupus), Cutaneous Lupus (only affects the skin), Drug-induced Lupus (caused by high doses of certain meds and usually clears up when the meds are stopped), and Neonatal Lupus (a rare condition caused by the mothers’ antibodies, usually clears up by 6 months).
Systemic Lupus Erythematosus
Lupus is a complex and chronic inflammatory disease in which the body’s immune system (the part of the body that normally fights off the bad stuff like germs, viruses & bacteria) becomes hyperactive and begins attacking the body’s healthy cells and tissues by making antibodies. Antibodies are proteins that are supposed to protect the body from the germs. With lupus the immune system can’t tell the difference between healthy cells and the bad ones like from a cold or a stomach bug. The antibodies cause inflammation, pain and damage can be done to many areas of the body including, but not limited to: joints, skin, kidneys, heart, lungs, blood vessels and brain.
What Causes Lupus?
Researchers still don’t know the exact cause of lupus. Though it is believed that it may be a combination of several factors including:
- Physical or mental stress
- Certain medications
- Other environmental triggers such as ultraviolet (UV) rays from the sun and certain lights
Lupus is most common in women in their childbearing years (15-40 years old), though men and children can develop lupus too. All races can have lupus but people of color (African-American, Hispanic, Asian & Native American) are 3x more likely to develop it than Caucasians.
The symptoms of lupus can vary greatly. They can come on suddenly or slowly over months or even years. Symptoms can come & go and often change in the course of the disease. The symptoms can range from mild like during times of remission (periods of little to no disease activity) to severe like during flares (an increase in disease activity). Lupus is known as “the great imitator” because many of the symptoms are seen in other illnesses such as: Rheumatoid Arthritis, Fibromyalgia, Lyme disease as well as many heart, blood, lung, bone & muscle diseases.
Some of the most common signs & symptoms are:
- Pain & swelling in joints
- Muscle pain
- Unexplained fever
- Extreme fatigue
- Mouth and/or nose sores
- Rashes – especially butterfly shaped rash on the face that covers the cheeks and nose
- Sun or light sensitivity (photosensitivity) that can result in skin lesions
- Shortness of breath
- Chest pain
- Dry eyes
- Hair loss
- Pale or purple fingers when stressed or cold
- Swelling in feet, legs or hands
- Low white blood count
- Anemia – low red blood count
- Positive ANA – Antinuclear Antibodies test
- Blood or protein in urine
- Poor kidney function
Diagnosing lupus can be tricky because of the way symptoms vary and come & go. If your primary care provider suspects you may have lupus he or she may refer you to a specialist called a rheumatologist. A rheumatologist specializes in diagnosing and treating arthritis and other inflammatory joint conditions.
There is no one test to diagnose lupus. The doctor will use a combination of blood & urine tests, review of your medical history & symptoms, a physical exam and possibly imaging studies (xray, MRI, etc…) or other tests as he or she deems necessary. The information gathered from all of the above will help rule out other conditions and hopefully receive a quick diagnosis.
During this time patience may be required. Lupus is such a complex condition it could take months to receive the final diagnosis while your doctor monitors your labs and tracks symptoms.
There is no cure for lupus at this time but there are several treatment options. You and your doctor will come up with a treatment plan suited to your disease activity and which organs are being affected.
Goals of the Treatment Plan
Prevent and treat flares
Suppress the overactive immune system
Manage symptoms like pain and fatigue
Minimize organ damage
The most common medications used to treat lupus include:
- Nonsteroidal AntiInflammatory Drugs (NSAIDs) – Ex. Ibuprofen & Aleve decreases pain and inflammation
- Antimalarial drugs – Plaquenil (hydroxychloroquine) is used to help with arthritis, fatigue, rashes & mouth sores seen in lupus.
- Corticosteroids – Ex. Prednisone decreases inflammation
- Immunosuppresants – Ex. Imuran, CellCept, methotrexate used when serious or life-threatening problems such as inflammation around the heart and/or lungs or kidney involvement occurs. This is considered an aggressive treatment.
- Biologics – Benlysta lessens lupus symptoms
Treatment is often made up of a combination of the above medications. For example my current treatment plan includes: NSAIDs (prescription & over-the-counter), Plaquenil, Imuran, and corticosteroids added in burst packs as needed. It is common to have to adjust doses or change medications until you and your doctor find what works for you. None of these medications are without risk. It is important to discuss the potential benefits and risks with your doctor.
Treatment of lupus has improved tremendously in the last 20 years and continues to do so. People with this disease are living longer than ever. Lupies are experiencing a better quality of life and are more able to be active and involved in their lives, family and work. With a good support system and treatment plan, 80-90% of Lupies can live a normal life span
For more resources about lupus click here.
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