Lupus is a non-contiguous but chronic autoimmune disease that results to acute and chronic inflammation; and damage of any part of the system including vital organs of the body. This disease mostly attacks the joints, skin, heart, kidney, lungs, nervous system, brain, blood or blood vessels of people of all races and ethnic groups. Lupus which troubles body’s immune system is hardly known but it can last from weeks to years in the affected body part or organ. Hormonal, genetics and environmental are believed to be among other combined stimuli inside and outside the body which contribute to the health challenges posed by this mild but life threatening disease.
Globally, it is reported that about 5 million people aged 15-45 years suffer from some types of this relatively unpopular disease during their lifespan. However, the disease can affect people of all ages. Above 80% of lupus sufferers are mostly coloured women of childbearing age. Generally, about 18,000 new cases of lupus are reported annually among women, men, children and teenagers.
It is heart-warming to emphasize that most people with systemic lupus erythematosus (SLE) enjoy complete, active and rewarding healthy lives. Lupus periodic flare-ups and remissions can be commonly managed by varying medication plans. Presently there is no cure for lupus, but signs and symptoms can be reasonably suppressed if lifestyle modifications and treatment are started early. This basic information hub offers the public the needed facts about lupus disease.
What is lupus?
Lupus, commonly known as systemic lupus erythematosus (SLE), is a chronic systemic autoimmune disease in which the body’s immune system becomes hyperactive and attacks its own normal and healthy tissues and organs mistakenly. Autoimmune diseases occur when the tissues and organs of the body are attacked by its own immune system which is naturally designed to defend the body against infectious pathogens like bacteria, fungi and other foreign microbes. Normally, the immune system produces proteins called antibodies which are essential for protecting the body and fighting antigens or body foreign invaders such as viruses and bacteria. In lupus, the immune system is unable to tell the difference between these foreign invaders and the body’s healthy tissues and organs. This malfunction is characterized by the production of unusual antibodies or autoantibodies that attack and destroy within your own body, healthy tissues and organs thereby causing inflammation, unexplained rashes, ongoing fever, persistent aching or fatigue; and damages in various parts of the body. From birth, some children are prone to lupus disease which may be triggered at some life stages by infections, certain drugs or even sunlight.
Types of lupus
The main types of lupus are described below.
Cutaneous /discoid lupus erythematosus
This lupus concentrates mainly on the skin where it causes many types of rashes and lesions (sores). The rashes and lesions can appear on the cheeks and across the bridge of the nose, known as the butterfly rash. Also rashes or sores may be seen on the face, neck, scalp, mouth or vagina. This type of lupus is responsible for hair loss and changes in the skin pigmentation (colour).
Drug-induced lupus disease is caused by certain prescription drugs. This type of lupus which hardly affects major organs of the body is associated with drugs such as Hydralazine, Procainamide and Isoniazid. The lupus-like signs and symptoms induced by these drugs which are more common in men usually disappear within six months of discontinuing the drugs. The signs and symptoms observed here are related to those of systemic lupus erythematosus (SLE).
This type of false and rare condition affects infants who receive autoantibodies right from the womb of some mothers who have lupus disease. The infant may have skin rash, serious heart defect, liver problems or low blood cells count which may disappear completely after several months of birth.
Systemic lupus erythematosus (SLE)
The manifestations of this type of lupus made it more severe and common because it can affect any organ of the body. SLE may cause inflammation or other health problems in the skin, joints, lungs, kidneys, blood or the heart with periods of flare-ups and remissions. Female are more prone to systemic lupus erythematosus, suggesting that female hormones play important role in the expression of lupus in female.
Causes/triggers of Lupus
The cause(s) of lupus is (are) unknown. However, combinations of genetic and environmental factors are believed to be involved in lupus diseases. It appears that people with hereditary predisposition for lupus may be exposed to the disease when they make direct contact with some environmental triggers of lupus. Some possible triggers include:
- Medications: Lupus can be triggered by some antihypertensive, anti-seizure and antibiotic drugs. The drugs involved in lupus disease are trimethoprim-sulfamethoxazole, sulfisoxazole, tolbutamide, sulfasalazine, diuretics,minocycline, amoxicillin, ampicillin and cloxacillin.
- Sunlight: Direct contact with ultraviolet rays from the sun and/or fluorescent bulbs light or certain chemicals can initiate lupus skin lesions or trigger an internal response in people prone to lupus.
- Extreme stress: Emotional stress and exhaustion from such as divorce, illness, death in the family, surgery, injury, pregnancy or giving birth can trigger lupus in some people.
- Infections: Having an existing infection, colds or viral illnesses can promote lupus disease or cause lupus relapse in some people.
Signs and symptoms of lupus
The experience of signs and symptoms of lupus largely depend on individuals, types of lupus and which systems of the body that are affected. Generally the most common signs and symptoms which can get worse, improve or even disappear completely for a while include:
- Extreme or prolonged fatigue.
- Unexplained fever of more than 1000F.
- Dry eyes.
- Joint pain (arthralgia), stiffness and inflammation (arthritis).
- Butterfly-shaped rash that covers the face or malar rashes elsewhere on the body.
- Chest pain when breathing deeply, coughing or at certain body position; due to the inflammation of the lungs (pleuritis) and heart (pericarditis) muscles.
- Skin, mouth or nose sores that worsen with exposure to sun (photosensitivity).
- Raynaud’s phenomenon where fingers and toes turn to pale, white or blue when exposed to cold or stress due to poor circulatory system; thereby causing pain and numbness in the exposed fingers and toes.
- Shortness of breath.
- Headaches, muscle aches, confusion and memory loss.
- Seizures, nausea, hair (alopecia) and appetite loss.
Modifiable and non- modifiable risk factors of lupus
The major risk factors of lupus disease include:
- Smokers suffer more lupus attacks.
- Lupus disease is more common in women.
- Lupus occur more in people within the ages of 15 to 45.
- African-Americans, Hispanics and Asian-Americans experience lupus disease more.
- High blood cholesterol.
- High blood pressure
Complications of lupus
Some of the serious complications of lupus involving major organs of the body are:
- Lupus nephritis: This inflammation of the kidney can affect the ability of the body to filter waste from the blood. Lupus nephritis can also cause leakage of protein into the urine, fluid retention/ swelling (edema) and high blood pressure. This complication can be so damaging that dialysis or kidney transplant may be required. Severe kidney damage and failure are the leading causes of death among people with lupus.
- Central nervous system and brain inflammation: These can result to memory and vision problems, confusion, headaches and/or strokes. Lupus of the nervous system (neurologic) can result to nerve damage which causes numbness, tingling and weakness of the body parts or extremities involved. Complications of lupus in the brain (cerebritis) can cause personality changes, thought disorders (psychosis), seizures or coma.
- Inflammation in the blood vessels: The inflammation of the blood vessels of brain can cause high fevers, seizures and behavioural alterations. The inflammation of other blood vessels (vasculitis) that supply oxygen to tissues can cause peculiar injuries to the nerve, skin or internal organs. Also, there may be diminished blood supply to bones, often leading to tiny breaks in the bones and eventual collapse of the bones.
- Coronary artery disease: This occurs when artery walls hardened with build-up of deposits that can cause heart attack. Lupus can also cause inflammation of the heart muscle, arteries or membrane (pericarditis) leading to increased risk of cardiovascular disease and heart attacks.
- Skin manifestations: Can cause scarring which most times result to permanent hair thinning or loss (alopecia).
- Arthritis: Lupus commonly causes swelling, pain, stiffness and even deformity of the small joints of the hands, feet and wrists.
- Blood: Lupus affects the blood cells. Reduction in white blood cells (leucopenia) can increase the risk of infection. The low blood-clotting factors (thrombocytopenia) can increase the risk of bleeding. And the low red blood cell counts can cause anemia.
- Muscles inflammation (myositis): Can cause serious muscle pain and weakness.
- Pregnancy complications: pregnant women with lupus are more prone to risk of miscarriage. Lupus promotes high blood pressure during pregnancy (preeclampsia) and preterm birth. These complications can be reduced by delaying pregnancy for at least six months within which lupus is expected to be under an appreciable control.
- Altered immune system: Generally lupus causes changes in the functions of immune system which expose the body to cancers, infections and other health problems.
Effects lupus have in the body generally
Lupus causes the immune system to malfunction and unable to distinguish between substances capable of inducing specific immune response (antigens) and healthy tissues. This leads the immune system to produce antibodies against the healthy cells and tissues. Also, this abnormal function removes the ability of the immune system to protect and fight off viruses, bacteria and other pathogens in the body. The effects of the above confusion in the system which clinically manifest in the skin, joints, brain, lungs, kidneys, blood vessels and other internal organs include:
- Feeling of general illness and complain of fever.
- Weight loss and fatigue.
- Skin problems manifesting as different types of rashes, sores and scars.
- Hair loss.
- Mouth sores.
- Arthritis, morning stiffness and pain with or without inflammation.
- Life threatening kidney problems.
- Dangerous reductions in the number of blood cells which may result to clotting problems.
- Worsening symptoms prior to menstrual periods.
Effects of systemic lupus erythematosus (lupus) on pregnancy and the newborn
Lupus can present unique challenges and complications during pregnancy which can equally affect the fetus. Lupus antibodies can be transferred from the mother to the fetus resulting to neonatal lupus which usually clears when the baby is above six months of age. This neonatal lupus can cause the development of low red cell counts (anemia) and/or white blood cell counts (leucopenia) and platelet counts (thrombocytopenia), congenital heart defect and skin rashes. Therefore, the high-risk status of pregnant women living with lupus demands special review and interactive monitoring by skilled/expert rheumatologist and obstetrician. There is need for close observation during the period of pregnancy, delivery and after delivery. Also, the special care and medical attention are very important in reducing the risk of spontaneous abortions (miscarriages) and flare-ups associated with lupus during pregnancy.
Diagnosis and treatment of lupus
Lupus can be difficult to diagnose because of the involvement of a wide variety of signs and symptoms occurring in different organs of the body. To help doctors improve the accuracy of the diagnosis of systemic lupus erythematosus (SLE), some criteria which are closely related to the signs and symptoms of lupus were established by the American Rheumatism Association. Some people suspected of having lupus or SLE may never develop enough criteria for a definite diagnosis. Some people may present enough criteria only after months or years of observation. When a person has four or more of these criteria, the diagnosis of SLE is strongly suggested. Nevertheless, in some settings the diagnosis of SLE may be made in people with only a few of these classical criteria and treatment may sometimes be instituted at this stage. Among the people with minimal criteria, some may later develop other criteria, but many never do. Ultimately, expert medical examination and laboratory tests are essential in clear diagnosis of lupus infection.
Presently there is no cure for lupus, but drugs and lifestyle modification can help check its attack. Your doctor will develop a treatment plan to fit your needs. You and your doctor should review the plan often to be sure it is working. You should report new symptoms to your doctor right away so that your treatment plan can be modified if needed.
The goals of the treatment plan of systemic lupus erythematosus are focused on relieving symptoms and protecting organs by reducing inflammation and/or the level of autoimmune activity with anti-inflammatory drugs for those with mild signs and symptoms. And corticosteroids and/or chemotherapy are prescribed for those with more severe lupus. People with systemic lupus erythematosus can prevent “flare-ups” of the disease by avoiding contact with ultraviolet rays, not suddenly discontinuing drugs and closely monitoring their lupus status with medical experts. An expert treatment plan that is based on individual and severity of lupus is the best option.
In addition to taking drugs for lupus, drugs for problems that are related to lupus such as high cholesterol, high blood pressure, damage to joints, poor immune system and hormone balance or infection are recommended. Since there is no permanent cure for lupus presently, the key to successful management of the disease is regular contact and communication with expert healthcare professionals who will carefully monitor lupus activities, signs and symptoms, and treat side effects of lupus drugs with relevant counseling.
Measures that prevent/ alleviate lupus attacks
People who are under lupus attack need more rest and relaxation through quality sleep especially during periods of active disease so as to check the impact of extreme fatigue. It is important for healthcare professionals to address the issue of possible depression which people with lupus do encounter. Careful and expert plan of active exercise should be prescribed, encouraged and sustained while discouraging all forms of self-care coping strategies by lupus sufferers. Active exercise is very important for maintaining muscle tone and range of motion in the joints.
High-factor (50+) Sunscreens, sun avoidance or sun protection wears are good for checking the bad effects of sun sensitivity. Omega-3 from fish oil diet is appropriate for lupus sufferers because it has potential of reducing the risks of inflammation, heart-disease and other lupus-associated disease activities. Generally patients with lupus are advised to eat balanced diet rich in plant-based foods and lean sources of protein.
Also, dehydroepiandrosterone (DHEA) diet supplementation helps to reduce fatigue and improve thinking, signs/symptoms and quality of life in people with SLE. DHEA is available in standard health-food stores, pharmacies and groceries. For people with lupus, sufficient weight control, low cholesterol diet and most importantly zero smoking habit must be maintained.
Use of corticosteroids or immunosuppressive without proper medical advice, supervision, counseling and evaluation should be avoided. Pregnant women with lupus should seek pregnancy counseling as early as possible and see the doctor often for close monitoring.
People living with lupus or lupus-free can improve their prognosis by learning about many lupus facts as documented here, as well as partnering in monitoring of their own health status with their doctors. It is very important to take an active role in your lupus treatment.
People living with lupus disease can be contact LUPUS UK for support, advice and information that will be of great benefit for coping with this health challenge.