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Lupus, also known as systemic lupus erythematosus, is a chronic autoimmune illness that causes inflammation and agony throughout the body. Lupus-related inflammation can cause joint pain, skin sensitivity, rashes, and problems with internal organs such as lungs, heart, and kidneys.
The immune system is designed to battle potential threats to the body, such as infections. However, when one has an autoimmune disease like lupus, the immune system attacks healthy tissues in the body. Some people are genetically predisposed to developing lupus, which can be triggered by infections, certain medicines, or even sunshine.
Lupus symptoms might be minimal or non-existent at times. However, instances that severe symptoms may develop which will have a significant influence on one’s everyday life. Many of the symptoms of lupus may come and go in waves, which are referred to as flare-ups. A face rash that mimics butterfly wings unfolding across both cheeks is the most noticeable sign of lupus.
There are several types of lupus, such as systemic lupus erythematosus, which is the most common, cutaneous lupus erythematosus which affects the skin, drug-induced lupus which are caused by specific medications, and neonatal lupus which is a rare type that affects infants at birth. Although there is no cure for lupus, medications can help manage symptoms.
Symptoms
Wide range of symptoms are often associated with lupus. Diagnosing lupus can pose challenges due to its symptoms frequently resembling those of other illnesses. Not everyone with lupus experiences the same symptoms. The lupus signs and symptoms will be determined by which body systems are damaged by the condition.
Signs and symptoms might appear abruptly or gradually, be mild or severe, and be brief or permanent. A flare-up occurs when a symptom becomes abruptly more severe than it was previously.
Symptoms of lupus typically include:
- Fever
- Fatigue
- A butterfly-shaped rash on the face that covers the cheeks and bridge of the nose, as well as rashes on other parts of the body
- Sunlight sensitivity, or skin lesions that form or intensify due to sun exposure
- Headache, confusion, and memory loss
- Hair thinning
- Sores in the mouth
- Joint pain, stiffness, and edema
- White or blue fingers and toes when exposed to cold or during times of stress
- Shortness of breath
- Chest discomfort
- Dry eyes
- Kidney, heart, or lungs problems
- Blood clots
- Seizures
Should you experience the sudden onset of an unexplained rash, , persistent fever, ongoing fatigue, or continuous body aches, it is advisable to seek medical attention promptly. Getting diagnosed is the first step toward managing lupus and improving the quality of life.
Causes
Lupus has no definite cause. However, as an autoimmune disease, lupus is most likely caused by a mix of genetics and environment. It is believed that individuals who have a hereditary tendency for lupus may develop the disease upon exposure to certain environmental triggers.
Researchers are still trying to figure out why people get lupus. Even if the exact cause is unknown, there are some factors that may contribute to the disease, such as:
- Sunlight: Sun exposure can potentially lead to the emergence of skin lesions associated with lupus or elicit an internal response.
- Infections: Exposure to certain infections can trigger lupus or induce a relapse.
- Medications: Individuals who develop drug-induced lupus generally experience improvements upon discontinuing the medication. However, in rare cases, symptoms may persist even after the drug has ceased. Certain categories of blood pressure medications, anti-seizure medications, and antibiotics have the potential to act as triggers for lupus.
- Hormonal changes: Fluctuations in hormones such as estrogen can potentially trigger lupus.
Risk factors
Lupus can affect anyone. It can occur in adults, children, and even infants. However, certain risk factors may contribute to one’s risk of developing lupus, such as:
- Family history: Lupus may have a hereditary component. If a family member has lupus, the risk of developing one also increases.
- Age: It is most diagnosed in people between the ages of 15 and 45.
- Sex: It is far more common in women than in men, with around 90% of identified cases being women of reproductive age.
- Race: Lupus is also more common in specific ethnic groups. African American, Hispanic, and Asian American women are all more prone than Caucasian women to have the illness.
Diagnosis
Lupus cannot be diagnosed with a single test. Its symptoms often take time to emerge, and may overlap with those of other illnesses, such as diabetes and arthritis, adding to the difficulty of detecting the condition. The diagnosis often requires asking about the family history and symptoms. After which, lab tests may be ordered.
- Laboratory tests: such as blood and urine tests may be requested:
- Complete blood count: This test examines for low blood cell counts, anemia, and other abnormalities. The results could indicate that one has anemia, which is frequent in people with lupus. Lupus can also cause a low white blood cell or platelet count.
- Erythrocyte sedimentation rate: The sedimentation rate is not disease specific. If one has lupus, an infection, another inflammatory disorder, or cancer, it may increase. This blood test measures how quickly red blood cells drop to the bottom of a tube in an hour. A higher-than-normal rate could suggest a systemic condition like lupus.
- Kidney and liver assessment: The liver and kidneys are organs affected by lupus. Blood testing can determine how effectively these organs are working.
- Urinalysis: If lupus has damaged the kidneys, the analysis of the urine sample may reveal an elevated protein level or red blood cells.
- Antinuclear antibody (ANA) test: ANAs are commonly found in people with systemic lupus erythematosus. If positive, further antibody testing may be recommended. A positive result on the antibody test, which detects the presence of specific antibodies produced by the immune system, suggests immune system activation. However, it is important to note that while the majority of individuals with lupus have a positive ANA (antinuclear antibody) test, most people with a positive ANA do not have lupus.
- Imaging tests: may be recommended if the doctor believes that the lupus damages the lungs or heart.
- Chest X-ray: Fluid or inflammation in the lungs may show as aberrant shadows in a chest imaging.
- Echocardiogram: This test can look for abnormalities with the valves of the heart and other components. An echo employs sound waves to generate real-time photos of the heartbeat.
- Biopsy: A skin biopsy may be conducted to confirm a diagnosis of lupus of the skin. A kidney biopsy, on the other hand, is necessary to establish the appropriate treatment. Lupus can injure the kidneys in a variety of ways, and therapies vary based on the amount of damage. To obtain a sample of kidney tissue, a needle may be used, or a minor incision might be done.
Treatment
Lupus is a chronic condition that must be addressed on a regular basis. The goal of treatment is to keep the symptoms in remission and to limit the harm the disease does to the internal organs. The treatment is usually determined based on the patient’s symptoms and complications, severity of the condition, age, medications, medical history, and overall health.
Lupus, unfortunately, is unpredictable, and the way it affects people might shift and vary over time. The doctor may need to adjust drugs or dosages as the signs and symptoms flare and subside. Medications that can be used to treat lupus include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Lupus-related pain, edema, and fever may be treated using NSAIDs. Potential side effects include gastrointestinal bleeding, kidney difficulties, and an increased risk of cardiac problems. Prescription-only NSAIDs, and over-the-counter NSAIDs, such as naproxen sodium and ibuprofen are available to help manage the symptoms.
- Antimalarial drugs: Hydroxychloroquine is widely used to treat minor lupus symptoms such as skin and joint disorders. It can also be used in the treatment of tiredness and mouth sores as well as help reduce the incidence of lupus flares. Adverse reactions may include stomach upset and, in rare cases, retinal impairment. When taking these drugs, regular eye exams are advised.
- Corticosteroids: Low-dose steroid creams or pills can be beneficial for mild to moderate lupus symptoms. Steroid creams can be used directly on rashes. They are usually safe and effective, especially for minor rashes. Prednisone and other corticosteroids can help to reduce lupus inflammation. High doses of steroids, such as methylprednisolone, are frequently used to treat significant renal and brain disorders. High doses, unfortunately, are also more prone to cause negative effects such as weight gain, easy bruising, thinning bones, high blood pressure, diabetes, and an increased risk of infection.
- Immunosuppressants: Severe cases of lupus can be managed with immunosuppressive drugs. Azathioprine, which was originally designed to avoid organ rejection after transplantation, is now widely used to treat more severe symptoms of lupus. Methotrexate, a chemotherapy medicine intended to suppress the immune system, is increasingly being used to treat skin disease, arthritis, and other non-life-threatening diseases that have not responded to other medications like hydroxychloroquine or low doses of prednisone.
Other immunosuppressants include mycophenolate, cyclosporine and leflunomide. An increased chance of infection, liver damage, lower fertility, and an increased risk of cancer are all possible side effects.
- Biologics: Belimumab is a monoclonal antibody that inhibits the production of autoantibodies by white blood cells or lymphocytes. This medication is given intravenously. Nausea, diarrhea, and infections are some of the side effects. Another similar medication is Rituximab. Infections and allergic reactions to the intravenous infusion are among the side effects. These medications are often used to treat lupus that has not responded to prior medications and does not damage the kidneys.
- Other drugs: Voclosporin, abatacept, anifrolumab, among others are the medications that are currently under clinical trials as potential treatments for lupus. Voclosporin has already been shown to be effective.
