Systemic Lupus Erythematosus
(Lupus; SLE; Lupus, Systemic)
by Rick Alan
Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention
Definition
Lupus is an autoimmune disease. It inflames:
- Joints
- Tendons
- Skin
- Other connective tissue and organs
It causes the immune system to make antibodies that attack the body's healthy cells and tissue.
Causes
The cause of lupus is unknown. Researchers believe it may be a combination of:
- Genetic factors
-
Environmental factors, which may include:
- Sunlight (UV rays)
- Stress
- Viral or other type of infection
- Drug-induced ( methyldopa, procainamide, hydralazine, isoniazid, chlorpromazine, TNF-blocking drugs)
Risk Factors
These risk factors increase your chance of developing lupus. Tell your doctor if you have any of these risk factors:
- Sex: female to male ratio: 10:1
- Age: childbearing age (20-45 years)
- Race: African American, Native American, Asian, and Hispanic
Symptoms
Symptoms can be mild or very severe. For some people, only part of the body (eg, skin) is affected. For others, many parts are affected. Though symptoms can be chronic, they can flare up and get better on and off.
Common symptoms:
- Swollen and/or painful joints
- Fever
- Skin rashes over areas exposed to sunlight (especially on the nose and cheeks)
- Extreme fatigue
Common Lupus Rash Sites
Facial butterfly rash is hallmark of Lupus.
© 2009 Nucleus Medical Media, Inc.
Other symptoms may include:
- Hair loss
- Chest pain, coughing up blood, shortness of breath, difficulty breathing
- Kidney inflammation
- High blood pressure
- Anemia or other blood disorders
- Sensitivity to sunlight
- Raynaud's phenomenon
- Ulcers in nose or mouth
- Swollen glands
- Headaches
- Dizziness
- Seizures
- Stroke
- Inflamed heart, heart vessels, or membrane surrounding the heart
- Blood clots
Diagnosis
The doctor will ask about your symptoms and medical and family history, and perform a physical exam. The diagnosis is based on symptoms, especially for young women. No single test can determine if you have lupus. But, a number of blood tests for specific antibodies can confirm diagnosis.
Treatment
Treatment depends on symptoms.
Medication
Medicines for mild symptoms:
- Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs)—to relieve joint pain
- Acetaminophen (eg, Tylenol)—to relieve joint pain
- Hydroxychloroquine
or chloroquine—to relieve joint pain, fatigue, balding, and skin rashes
- Note: Regular eye exams are advised while on these medicines.
- Topical corticosteroids—to treat skin rashes
- Dehydroepiandrosterone (DHEA)—a hormone medicine that has minimal benefit
Medicines for severe symptoms include:
- Oral and intravenous corticosteroids to control and limit inflammation in kidney, brain, lung, and heart, as well as in cases of severe anemia
- Immunosuppressive drugs to suppress the body's autoimmune system
- Mycophenolate, azathioprine, and cyclophosphamide for kidney disease or other life- or organ-threatening conditions
- Rituximab for refractory disease
Transplantation and Dialysis
You may consider transplantation and dialysis if you have end-stage kidney failure.
Prevention
You cannot prevent lupus because the cause is unknown.
To prevent flare-ups of symptoms:
- Schedule regular check-ups.
- Treat any and all infections quickly and vigorously.
- Avoid sun exposure and wear sunscreen and protective clothing when outdoors.
- Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
- Limit emotional stress.
- Get adequate rest.
- Exercise moderately (as much as your condition allows) with your doctor's permission.
- Call your doctor if you think you will have a flare-up.
- Avoid oral contraceptives, especially if you have had a blood clot.
Lupus Foundation of America, Inc.
http://www.lupus.org/
Lupus Research Institute
http://www.lupusresearchinstitute.org/
Lupus Canada
http://www.lupuscanada.org/
Lupus Foundation of Ontario
http://vaxxine.com/lupus/
REFERENCES:
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Contreas G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med . 2004;350;971-980.
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Dorner T, Lipsky PE. Immunoglobulin variable-region gene usage in systemic autoimmune diseases. Arthritis Rheum . 2001;44:2715-2727.
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Lupus. National Institute of Arthritis and Muskuloskeletal and Skin Diseases, National Institutes of Health website. Available at: http://www.niams.nih.gov . Published September 1997. Updated August 2003. Accessed June 26, 2008.
Sherer Y, Gorstein A, Fritzler MJ, Shoenfeld Y. Auto-antibody explosion in systemic lupus erythematosus: more than 100 different antibodies found in SLE patients. Semin Arthritis Rheum . 2004;34:501-537.
Smolen JS. Therapy of systemic lupus erythematosus: a look into the future. Arthritis Res . 2002;4(suppl)3:S25.
Symptoms. Lupus Foundation of America website. Available at: http://www.lupus.org . Accessed June 26, 2008.
12/4/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Hartkamp A, Geenen R, Godaert GL, Bijl M, Bijlsma JW, Derksen RH. Effects of dehydroepiandrosterone on fatigue and well-being in women with quiescent systemic lupus erythematosus. A randomized controlled trial. Ann Rheum Dis. 2009 Oct 22. [Epub ahead of print]
Last reviewed October 2009 by Jill D. Landis
Last Updated: 12/4/2009