Lupus Overview

Lupus — also known as systemic lupus erythematosus — is a disease of the immune system. Normally, the immune system protects the body from infection. In lupus, however, the immune system inappropriately attacks tissues in various parts of the body. This abnormal activity leads to tissue damage and illness.

According to the Lupus Foundation of America, approximately 1.5 million people in the U.S. have lupus. People of African, Asian, and Native American descent are more likely to develop lupus than are Caucasians. Although it can occur in both men and women, 90% of people diagnosed with the disease are women. Women of childbearing age (14 to 45 years old) are most often affected and as many as 1 in 250 people may develop lupus.

The symptoms of lupus differ from one person to another. Some people have just a few symptoms, while others have many. In addition, there are many different symptoms of lupus because the disease can affect any part of the body. Some of the more common symptoms include:

Many people with active lupus feel ill in general and complain of fever, weight loss, and fatigue. People with lupus also develop specific problems when the immune system attacks a particular organ or area in the body. The following areas of the body can be affected by lupus:

Sometimes, changes in blood counts (low red cell count, or anemia), may cause fatigue, serious infections (low white cell count), or easy bruising or bleeding (low platelet count). Many patients do not have symptoms from low blood counts, however, so it is important for people with lupus to have periodic blood tests in order to detect any problems.

Blood clots are more common in people with lupus. Clots often occur in the legs (called deep venous thrombosis or DVT) and lungs (called pulmonary embolus or PE) and occasionally in the brain (stroke). Blood clots that develop in lupus patients may be associated with the production of antiphospholipid (APL) antibodies. These antibodies are abnormal proteins that may increase the tendency of the blood to clot. Blood can be tested for these antibodies.

The cause of lupus is unknown. However, there appears to be something that triggers the immune system to attack various areas of the body. That’s why suppressing the immune system is one of the main forms of treatment. Finding the cause is the object of major research efforts.

Factors that may contribute to the development of lupus include viruses, environmental chemicals and a person’s genetic makeup.

Female hormones are believed to play a role in the development of lupus because women are affected by lupus much more often than men. This is especially true of women during their reproductive years, a time when hormone levels are highest.

The observation that lupus may affect more than one member of the same family has raised the possibility that the tendency to develop lupus may be inherited. Having such a tendency, however, does not predict that a relative will develop lupus. Only about 10% of people with lupus have a close relative with the disease.

Drug-induced lupus can occur after the use of some prescription medications (such as hydralazine and procainamide). These symptoms generally improve after the drug is discontinued.

Lupus is diagnosed when a person has several features of the disease (including symptoms, findings on examination, and blood test abnormalities). The American College of Rheumatology has devised criteria to assist doctors in making the correct diagnosis of lupus. A person should have at least four of the following 11 criteria, either at the same time or one after the other, to be classified as having lupus. These criteria include:

An antinuclear antibody (ANA) test is a sensitive screening tool used to detect autoimmune diseases, including lupus. Antinuclear antibodies (ANAs) are antibodies that are directed against certain structures within a cell’s nucleus (thus, antinuclear antibody). ANAs are found in particular patterns in people with autoimmune diseases (those in which a person’s immune system works against his or her own body).

An ANA test is done on a sample of a person’s blood. The test determines the strength of the antibodies by measuring how many times the person’s blood must be diluted to get a sample that is free of antibodies.

Not necessarily. The antinuclear antibody (ANA) test is positive in most people who have lupus, but it also may be positive in many people who are healthy or have another autoimmune disease. Therefore, a positive ANA test alone is not adequate for the diagnosis of lupus. There must be at least three additional clinical features from the list of 11 features for the diagnosis to be made.

The type of lupus treatment prescribed will depend on several factors, including the person’s age, type of drugs he or she is taking, overall health, medical history, and location and severity of disease.

Because lupus is a condition that can change over time and is not always predictable, a critical part of good care includes periodic visits with a knowledgeable, accessible doctor, such as a rheumatologist.

Some people with mild features of the disease do not require treatment, while people with serious involvement (such as kidney complications) may require powerful medications. Drugs used to treat lupus include:

The outlook for lupus varies, depending on the organs involved and the severity of symptoms. The disease often includes periods of symptoms followed by periods of remission or lack of symptoms. Most people with lupus can expect to have a normal lifespan, especially if they follow their doctor’s instructions and their treatment plans.

There is no cure for lupus, but there are steps you can take to improve your sense of well-being and your quality of life, including:

If someone close to you has lupus, your life will likely be affected, as well. It is important to understand your loved one’s illness and what he or she may be expecting from you. The following are some tips for living with someone who has lupus:

SOURCES:

The Lupus Foundation of America.

American College of Rheumatology.

FDA.

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Lupus Overview

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