Lupus

Sonia Nagda, M.D., M.P.H.

Like other autoimmune diseases, lupus develops when the body’s immune system begins to work incorrectly. Instead of attacking bugs like bacteria or viruses that make you sick, it begins to attack different parts of your body, causing damage to the skin, kidneys, blood, muscles and joints, and brain.[1] The formal name for lupus is systemic lupus erythematosus (SLE). Experts believe that lupus is caused by a perfect storm of a combination of genetics, age, hormones, and the environment.[2]

Women are more likely to develop lupus than men; in fact, some estimate that 90% of people with lupus are women.[3] African American women may also be at greater risk of developing the disease, though African women living in Africa are not as likely.[2] There is also a higher risk of lupus in people of Hispanic and Asian backgrounds.[1] The risk of developing lupus is highest during the childbearing years, peaking in women around age 30.[2]

How is Lupus Diagnosed?

There are 11 different criteria that the American College of Rheumatology uses to diagnose lupus. To be diagnosed with lupus, a patient must have at least four of the following signs and symptoms:[4]

  1. Malar rash: a red, butterfly-shaped red rash on the cheeks and nose.
  2. Discoid rash: a red, raised, scaly rash
  3. Photosensitivity: a rash from exposure to the sun
  4. Oral ulcers: painless sores in the mouth
  5. Arthritis: tender, swollen joints in the arms, legs, hands, or feet
  6. Serositis: inflammation of the lining of the lungs or heart (can be heard using a stethoscope)
  7. Renal disorder: kidney problems causing protein in the urine
  8. Neurologic disorder: brain malfunction resulting in seizures or psychosis
  9. Hematologic disorder: blood disease with too few of needed blood cells
  10. Immunologic disorder: blood tests positive for anti-double-stranded DNA antigen, anti-Sm nuclear antigen, or antiphospholipid antibody
  11. Antinuclear antibodies (ANA): blood tests positive for immunity against the nuclei of the body’s own cells

Someone with lupus typically has several  of these symptoms-as well as more common health complaints such as fever, weight loss, and fatigue-that are sometimes  particularly bad (known as “flares”).[1]

Risk Factors

Lupus affects less than 1% of the U.S. population,3 but if you have any of the symptoms described above and you have some of the risk factors below, you may have lupus.

You are at a higher risk for being diagnosed with lupus if you are:

  • Female
  • Age 15-49
  • African American, Asian, or Hispanic heritage
  • Have a blood relative who has been diagnosed with lupus or another autoimmune disease

Treating Lupus

Lupus is a chronic disease, which means that it never really goes away completely. It is a lifelong ailment that can be partially controlled with medication, but not cured. Treatments for lupus focus on reducing the symptoms that come with the disease. For example, treatment for arthritis symptoms can include common anti-inflammatory medications such as ibuprofen and naproxen (NSAIDs), malaria medications, steroids, and drugs that suppress the immune system.[5] Sensitivity to the sun can be reduced by using sunblock, retinoid medications, or sulfa drugs. Flares and other symptoms can be lessened with steroids, chemotherapy drugs, blood thinners (for patients who are at increased risk of blood clots).  Seizure medications or anti-psychotic drugs may also be prescribed. Researchers have been trying to determine whether biologic medications, which are made from the protein in cells and are used to treat a wide variety of autoimmune diseases, can help ease the symptoms in lupus patients..[6] In 2011, a biologic called Benlysta was the first new drug approved for the treatment of lupus in 55 years, but only for the minority of lupus patients whose disease has not spread to their kidneys or brain.[7]  Benlysta was approved as safe and effective based on a one-year study; the long-term risks and benefits are not known.

Lupus and Pregnancy

Pregnant women with lupus have to take special precautions to have a healthy pregnancy and healthy newborn. Lupus can cause the blood to become thick, which can cause a miscarriage, high blood pressure during pregnancy, premature birth, or low birth weight.[8]  Aspirin, heparin, and other blood thinners can help reduce these risks. All pregnant women, and especially those with lupus, must check with their doctors to find out how the medications they are taking might affect their babies. Steroids, oral blood thinners, and chemotherapy drugs can be especially harmful, causing birth defects.[9]

Living with Lupus

If you have any of the signs and symptoms noted above, see your healthcare provider to discuss them and get a physical exam. Remember: lupus is a disease people can live with, but only if you get tested and start getting treated.  People with lupus are more likely to develop infections and certain types of cancers.[2] Blood and urine tests, x-rays, and biopsies may be necessary to find out if you have lupus, and if you do, you will want to start treating and managing it right away to minimize permanent damage to your health.

 


[1] Gill JM, Quisel AM, Rocca PV, Walters DT. “Diagnosis of Systemic Lupus Erythematosus.” American Family Physician 2003; 68(11): 2179-2186.

[2] O’Neill SO. Cervera R. “Systemic lupus erythematosus.” Best Practice & Research Clinical Rheumatology 2010; 24: 841-855.

[3] Pons-Estel GJ, Alarcon GS, Scofield L, Reinlib L, Cooper GS. “Understanding the Epidemiology and Progression of Systemic Lupus Erythematosus.” Seminars in Arthritis and Rheumatism 2010; 39(4): 257-268.

[4] Hochberg MC. “Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.” Arthritis &Rheumatism 1997; 40(9): 1725.

[5] Petri M. “Treatment of Systemic Lupus Erythematosus: An Update.” American Family Physician 1998; 57(11): 2753-2760.

[6] Schroder JO, Zeuner RA. “Biologics as Treatment for Systemic Lupus: Great Efforts, Sobering Results, New Challenges.” Current Drug Discovery Technologies 2009; 6: 252-255.

[7] Boyce EG, Fusco BE. “Belimumab: Review of Use in Systemic Lupus Erythematosus.” Clinical Therapeutics 2012. Web. Accessed 9 May 2012.

[8] Derksen R, DeGroot PG, Nieuwenhuis H, Christiaens G. “How to treat women with antiphospholipid antibodies in pregnancy?” Annals of the Rheumatic Diseases 2001; 60(1): 1-3.

[9] Andreoli L, Fredi M, Nalli C, Reggia R, Lojacono A, Motta M, Tincani A. “Pregnancy implications for systemic lupus erythamatosus and the antiphospholipid syndrome.” Journal of Autoimmunity 2012; 38(2-3):J197-208.