Lupus

UPDATED ON: 2 Apr 2024, 20:13 PM

Medically Reviewed by

Dr Punit Pruthi

What is Lupus?

Causes of Lupus

There is no particular cause of lupus that has been found yet. Yet, as an autoimmune disorder, doctors believe that it may stem from combinations of things that trigger the immune system to mistakenly target the body’s tissues, resulting in inflammation, discomfort, and harm. Here are some causes of lupus:

1. Genes

Genetics plays a significant role in lupus susceptibility. People with a family history of lupus are at a higher risk of developing the condition, suggesting a genetic predisposition.

2. Environment

Environmental factors also play a crucial role in triggering lupus. Exposure to ultraviolet (UV) light from sunlight can exacerbate symptoms in some individuals, leading to skin rashes and flare-ups. Apart from this, cigarette smoke, high temperatures, and stress can also cause it.

3. Hormones

Hormonal fluctuations are another contributing factor, particularly in women. Female hormones, such as estrogen, may contribute to the development and exacerbation of lupus symptoms. The disease often emerges or worsens during periods of hormonal imbalance, such as puberty, pregnancy, and menopause.

4. Medications

Certain medications, such as hydralazine and procainamide, have been linked to drug-induced lupus in susceptible individuals. The symptoms may get better after you stop taking the drug.

5. Infections

Infections, particularly viral infections like the Epstein-Barr virus (EBV), have been associated with triggering lupus in susceptible individuals. Infections can stimulate the immune system and lead to the production of autoantibodies, which target the body’s tissues and contribute to inflammation and organ damage.

Risk factors

1. Gender: Women are more likely to develop lupus than men.
2. Age: Although lupus can affect anyone, it is more common between the ages of 15 and 45.
4. Ethnicity: Lupus is more prevalent in certain ethnic groups, such as African Americans, Hispanics, and Asians.

Complications

Lupus, a complex autoimmune disease, can lead to a myriad of complications affecting various organs and systems in the body. From skin rashes to severe organ damage, the consequences of lupus can be debilitating and even life-threatening.

1. Joint problems

One of the most common complications of lupus is inflammation of the joints, which leads to arthritis. This can result in pain, stiffness, and swelling, significantly impacting mobility and daily activities. In some cases, joints may become permanently damaged, causing long-term disability.

2. Skin issues

Skin problems are also prevalent in lupus patients. The characteristic butterfly rash across the cheeks and nose is a hallmark of the disease. However, lupus can also cause other issues, such as photosensitivity, hair loss, and mouth ulcers. A rare but serious form of lupus rash called bullous lupus rash causes large blisters.

3. Heart disease

Kidney involvement, known as lupus nephritis, is a severe complication that can lead to kidney failure if left untreated. Lupus also increases the risk of cardiovascular complications, including heart inflammation and atherosclerosis, which raise the likelihood of heart attacks and strokes among lupus patients.

4. Brain issues

The nervous system is also vulnerable to lupus. You may experience symptoms such as headaches, cognitive dysfunction, seizures, and mood disorders, which can significantly impact your quality of life. In some cases, lupus can even cause inflammation of the brain or spinal cord, leading to neurological complications.

5. Blood and blood vessels

Lupus increases the risk of developing other autoimmune conditions, such as thyroid disorders, and blood disorders, such as anemia and bleeding or blood clotting.

Key Facts About Lupus

Major Symptoms	Skin rashes Joint pain and swelling Fatigue Fever Chest pain and difficulty breathing Kidney inflammation Hair loss Dry eyes and mouth Neurological symptoms
Necessary Health Tests	Laboratory tests Complete blood count Erythrocyte sedimentation rate Kidney and liver assessment Urinalysis Antinuclear antibody (ANA) test Imaging tests Chest X-ray Echocardiogram Biopsy
Treatment	Nonsteroidal anti-inflammatory drugs (NSAIDs) Hydroxychloroquine Antimalarial drugs Corticosteroids Immunosuppressants Biologics Sunscreen

Symptoms of Lupus

Lupus, a complex autoimmune disease, causes a variety of signs and symptoms. that may emerge slowly or suddenly. Its symptoms usually come and go in waves called flare-ups. During flare-ups, symptoms can range from mild to severe and may be temporary or permanent. Here are some common symptoms:

1. Skin rashes

One of the most recognisable signs of lupus is a butterfly-shaped rash across the cheeks, nose, and elsewhere on the body, known as a malar rash. Skin lesions that appear with sun exposure are also common.

2. Joint pain and swelling

Lupus commonly causes joint inflammation, resulting in pain, stiffness, and swelling. This symptom often mimics arthritis and can affect various joints throughout the body.

3. Fatigue

Extreme fatigue is prevalent in lupus patients and can be debilitating. It is often persistent and not relieved by rest, significantly impacting daily activities and quality of life.

4. Fever

Low-grade fevers are common in lupus and can be an indication of inflammation or infection within the body.

5. Kidney inflammation

Lupus can cause kidney inflammation, which is called lupus nephritis. It may lead to symptoms such as blood or protein in the urine, swelling in the legs or ankles, and high blood pressure.

6. Chest pain and difficulty breathing

Inflammation of the lining surrounding the lungs (pleuritis) and heart (pericarditis) can cause chest pain, which worsens with deep breathing. This may also lead to shortness of breath.

7. Neurological symptoms

Lupus can affect the nervous system, causing headaches, confusion, memory loss, and even seizures or strokes in severe cases.

8. Hair loss

Lupus can lead to hair thinning or loss, often occurring in patches or diffusely throughout the scalp.

9. Dry eyes and mouth

Some people with lupus can also have secondary Sjögren’s disease, which causes dry eyes and mouth. These are the early signs of lupus.

Types

These are 5 most common types of lupus:

1. Cutaneous lupus erythematosus: Primarily affects the skin, leading to rashes, lesions, and discoloration.

2. Systemic lupus erythematosus (SLE): This is the most common form, impacting multiple organs and systems, causing joint pain, fatigue, and inflammation.

3. Lupus nephritis: It involves inflammation of the kidneys, potentially leading to kidney failure if untreated.

4. Neonatal lupus: A rare condition affecting infants born to mothers with specific antibodies, resulting in skin rashes, liver problems, and heart defects.

5. Drug-induced lupus: Occurs as a reaction to certain medications, with symptoms typically subsiding once the medication is discontinued.

Diagnosis of Lupus

Diagnosing lupus involves a comprehensive approach that involves laboratory tests, imaging studies, and sometimes biopsies to confirm the presence of the disease and its potential impact on various organs and systems.

1. Laboratory tests

Blood and urine analyses are fundamental in lupus diagnosis, typically comprising:

• Complete blood count (CBC): It identifies abnormalities such as low red blood cell count (anemia), low white blood cell count (leukopenia), or low platelet count (thrombocytopenia), which are common in lupus patients due to immune system dysfunction.
• Erythrocyte sedimentation rate (ESR): This test measures the rate at which red blood cells settle in a tube of blood and can indicate inflammation in the body, which is often elevated in lupus patients.
• Kidney and liver assessment: Assessing kidney and liver function through blood tests is crucial, as lupus can affect these organs, leading to complications such as lupus nephritis or liver inflammation.
• Urinalysis detects abnormalities in urine, including protein or blood, which may indicate kidney involvement.
• Antinuclear antibody (ANA) test: ANA antibodies are frequently present in lupus patients and are indicative of autoimmune activity, though a positive result does not necessarily confirm lupus.

2. Imaging tests

Imaging studies help evaluate the extent of organ involvement and monitor disease progression. These may include:

• Chest X-ray: Used to detect any abnormalities in the lungs or chest cavity, such as inflammation or fluid accumulation, which can occur in lupus-related conditions like pleuritis or pleural effusion.
• Echocardiogram: This ultrasound imaging test assesses the structure and function of the heart, important for identifying cardiac complications like pericarditis or valve abnormalities associated with lupus.

3. Biopsy

In some cases, a tissue biopsy may be necessary to confirm lupus-related organ damage or inflammation. Common biopsies include skin, kidneys, or even less frequently affected organs like the lungs or brain, aiding in accurate diagnosis and treatment planning.

Treatment of Lupus

1. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Initially, mild lupus symptoms like joint pain and fever can be managed with NSAIDs, such as ibuprofen or naproxen, to alleviate inflammation and pain.

2. Hydroxychloroquine and antimalarial drugs

Commonly prescribed for mild to moderate lupus, hydroxychloroquine, and other antimalarial drugs not only reduce symptoms but also help prevent lupus flares and organ damage.

3. Corticosteroids

For more severe symptoms, corticosteroids like prednisone are used to suppress the immune system’s activity, effectively reducing inflammation and minimizing damage to organs.

4. Immunosuppressants

When lupus doesn’t respond well to other medications or affects major organs, immunosuppressants like azathioprine or methotrexate may be prescribed to further suppress the immune system’s activity and reduce inflammation.

5. Biologics

In cases where traditional medications fail to control lupus symptoms, biologic therapies like belimumab may be recommended. These drugs target specific immune system proteins involved in lupus inflammation.

Since sun exposure can trigger lupus flares and worsen symptoms, regular use of broad-spectrum sunscreen with a high SPF is advisable for lupus patients to protect their skin and minimise flare-ups.

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