Lupus is a systemic autoimmune disease that occurs when the immune system mistakenly attacks your tissues and organs. Inflammation from lupus can affect many different body systems — including the joints, skin, kidneys, blood cells, the brain, and the lungs.
Lupus can be difficult to diagnose because its signs and symptoms are similar to those of other diseases. The most characteristic sign of lupus is a facial rash that looks like butterfly wings over the cheeks. This sign appears in many cases of lupus but not all of them.
Some people have a genetic predisposition to develop lupus, and it may be triggered by infections, some medications, or sun exposure. While there is no treatment for lupus, some treatments can help to control the symptoms.
What are the symptoms of lupus?
Signs and symptoms of lupus never appear in the same way. They can appear suddenly or develop slowly, and they may be mild or severe, or temporary or permanent. Most people with lupus have episodes of mild illness, such as face redness. Signs and symptoms worsen for a short time, then improve or even disappear completely for a period.
Signs and symptoms of lupus will depend on the types of body systems affected by the disease. The most common symptoms and signs include:
- Chest pain
- shortness of breath
- Dry eyes
- A butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body
- Skin lesions that appear or worsen with exposure to the sun (photosensitivity)
- Joint pain, swelling, and stiffness
- Hair loss
- Fingers or feet turn white or blue when exposed to cold or during periods of stress (Raynaud’s phenomenon)
- Headache, confusion, and memory loss
What are the causes of lupus?
Lupus occurs when the immune system attacks healthy tissues in the body (an autoimmune disease). It is likely that lupus results from a combination of genetics and environment.
It appears that people with a genetic predisposition to lupus may develop the disease when contact occurs with something in the environment that can lead to lupus. In most cases, however, the cause of lupus is unknown. Some potential triggers include:
- Infections. The presence of an infection may trigger lupus or cause a relapse in some people.
- Medication. Lupus can be caused by certain types of blood pressure medications, antiepileptic drugs, and antibiotics. People who have drug-induced lupus usually improve when they stop taking the drug. In rare cases, symptoms may persist even after stopping the drug.
- Sun exposure. Exposure to sunlight may trigger lupus skin lesions or trigger an internal response in susceptible individuals.
What are the complications of lupus?
Inflammation from lupus can affect many areas of your body, including:
- The brain and central nervous system. When lupus affects the brain, it can cause headaches, dizziness, behavior changes, vision problems, and even strokes or seizures. Many people with lupus have memory problems and may have difficulty expressing their thoughts.
- The heart. Lupus can cause the inflammation of your heart muscle, arteries, or heart membrane (pericarditis). The risk of cardiovascular disease and heart attacks also increases greatly.
- The lungs. Lupus increases the chances of developing an infection in the lining of the chest cavity (pleuritis), which can make breathing painful. There is a possibility of bleeding inside the lungs and pneumonia.
- Blood and blood vessels. Lupus can lead to blood problems, including anemia and an increased risk of bleeding or clotting. It can also cause inflammation of the blood vessels (vasculitis).
- The kidneys. Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus.
How is lupus diagnosed?
Lupus is difficult to diagnose because signs and symptoms can vary greatly from person to person. Signs and symptoms of lupus may vary over time and overlap with signs and symptoms of many other disorders.
There is no single test that can diagnose lupus. A combination of blood and urine tests, signs and symptoms, and results of a physical examination can help reach the diagnosis.
- Complete blood count (CBC). This test measures the number of red and white blood cells and platelets as well as the amount of hemoglobin, which is a protein found in red blood cells. The results may indicate anemia, which occurs more commonly in people with lupus. Moreover, the number of white blood cells or platelets may decrease as well in people with lupus.
- Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells are deposited at the bottom of the tube within an hour. A faster than normal rate could indicate an immune system disease such as lupus. The rate of sedimentation is not characteristic of any of the diseases. The sedimentation rate may increase if you have lupus or other inflammatory conditions, cancer, or certain infections.
- kidneys and liver evaluation. Blood tests are useful in evaluating how well the kidneys and liver are working. Lupus can affect these organs.
- Urinalysis. A urine sample can show an elevated level of protein or red blood cells in the urine, which may occur if lupus affects the kidneys.
- Antinuclear antibody (ANA) test. A test with a positive result for these antibiotics – produced by the immune system – indicates the strength of the immune system. While most people with lupus get a positive result on an antinuclear test, most people who get a positive result on this test do not have lupus. If you get a positive result on an antinuclear test, your doctor may recommend more tests related to the antibodies.
- Chest X-ray. An image of your chest can reveal abnormal shadows that suggest fluid or inflammation in your lungs.
- Echocardiogram. This test uses sound waves to produce real-time images of your beating heart. It can be checked for problems with your valves and other parts of your heart.
How is lupus treated?
Treatment for lupus depends on your signs and symptoms. Determining whether your signs and symptoms should be treated and the medications you should use requires a careful discussion of the benefits and risks with your doctor.
As your signs and symptoms increase and decrease, you and your doctor may find that you will need to change your medications or doses. Medicines most used to control lupus include:
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Over-the-counter non-steroidal anti-inflammatory drugs such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others) can be used to treat pain, swelling, and fever associated with lupus. More powerful NSAIDs can be obtained by prescription. Side effects of NSAIDs include stomach bleeding, kidney problems, and a higher risk of heart problems.
- Antimalarial drugs. Medicines commonly used to treat malaria, affect the immune system, and can help lower the risk of lupus infections. Side effects can include stomach-ache and, rarely, retinal damage. Regular eye exams are recommended when taking these medications.
- Corticosteroids. Prednisone and other types of corticosteroids can be used to treat the inflammation associated with lupus. High doses of methylprednisolone are often used to treat serious disease of the kidneys and brain. Side effects include weight gain, easy bruising, osteoporosis, high blood pressure, diabetes, and an increased risk of infection. The risk of side effects increases with higher doses and with longer-term treatment.
- Immunosuppressive drugs. Drugs that suppress the immune system may be helpful in severe cases of lupus. Possible side effects may include an increased risk of infection, cirrhosis, decreased fertility, and an increased risk of cancer.