Lupus: Causes, symptoms, treatment

Lupus, a chronic inflammatory disease, occurs when an individual’s immune system attacks its tissues and organs. Inflammation caused by lupus can affect the joints, skin, kidneys, blood cells, brain, heart and lungs. The inflammatory disease may be difficult to diagnose as symptoms sometimes mimic signs of other ailments and diseases.

According to the Mayo Clinic, many individuals who have lupus present with a facial rash that tends to resemble the wings of a butterfly unfolding across both cheeks. However, not every person with the disease develops this characteristic.

Risk factors

According to the National Resource Center on Lupus, risk factors for lupus include:

• sex;
• age;
• race/ethnicity; and
• family history.

Lupus occurs in men, women, children and teenagers, but women of childbearing age are more likely to develop the disease. Most people affected will experience symptoms and diagnosis between 15 and 44 years of age.

African Americans, Hispanics/Latinos, Asian Americans, Native Americans, Native Hawaiians and Pacific Islanders are at greater risk for developing a more severe form of lupus at an earlier age than Caucasians.

Additionally, the risk for developing lupus among those with a family history of the autoimmune disease is 5% to 13%. 

Causes of lupus

Some individuals are born with an inherited predisposition to developing lupus, according to the Mayo Clinic. The disease may develop when a person experiences something in the environment that could trigger lupus. But, the exact cause for lupus in most cases is unknown.

Because lupus occurs 10 times more often in women than in men, researchers have begun studying the possible relationship between estrogen and lupus, according to the Lupus Foundation of America.

Although men and women produce estrogen, women produce significantly more of the hormone than men. Many women tend to present with lupus symptoms prior to menstrual periods and/or during pregnancy when the production of estrogen is high. According to the Lupus Foundation of America, this could be an indicator that estrogen plays a role in regulating the severity of lupus. However, there is no evidence that proves estrogen, or any other hormone, has a direct relationship to the cause of lupus.

Recent research is focused on differences between men and women – not involving hormones – that might explain why women are more prone to developing lupus and other autoimmune diseases, according to the Lupus Foundation of America.

According to the Mayo Clinic, some possible triggers of lupus include:

• exposure to sunlight;

• infections; and

• anti-seizure, blood pressure medications and antibiotics.

Types of lupus

There are four different types of lupus. The most common type of lupus is systemic lupus erythematosus, the type most people mean when referring to lupus, according to the Lupus Foundation of America. Systemic lupus can range from mild to severe cases. According to the Lupus Foundation of America, some of the more serious complications include:

• lupus nephritis, also known as inflammation of the kidneys;

• inflammation of the brain and nervous system;

• inflammation that can cause seizures, high fevers and behavioral changes; and

• the hardening of arteries or coronary artery disease, which can lead to myocardial infarction.

Some individuals may develop cutaneous lupus erythematosus, which is limited to the skin. The most common occurrence of cutaneous lupus, according to the Lupus Foundation of America, is called discoid rash, a raised, scaly and red, but not itchy rash. Additionally, the butterfly rash is another common example of cutaneous lupus – a rash over the cheeks and across the bridge of the nose. Individuals also might have rashes appear on areas of the skin that are exposed to sunlight or fluorescent light, as well as in the mouth, nose or vagina. Other symptoms include hair loss and changes in pigment, or color, of the skin.

About 10% of those with cutaneous lupus will develop systemic lupus, according to the Lupus Foundation of America.

Drug-induced lupus is the third type of the autoimmune disease and is caused by certain prescription drugs. Symptoms of drug-induced lupus are like those of systemic lupus, but it rarely affects major organs.

According to the Lupus Foundation of America, drugs most commonly connected with drug-induced lupus include:

• hydralazine, which treats high blood pressure and hypertension;

• procainamide, which treats irregular heart rhythms; and

• isoniazid, which treats tuberculosis.

Drug-induced lupus is more common in men as they are more likely to take these drugs, but not everyone who takes these drugs will develop drug-induced lupus. Typically, according to the Lupus Foundation of America, lupus-like symptoms disappear less than a year after medications are stopped.

Neonatal lupus is the last type of the autoimmune disease and is not a true form of lupus, according to the Lupus Foundation of America. The disease is a rare condition that impacts infants of women who have lupus and is caused by antibodies from the mother acting upon the infant. When the child is born, the infant may present with a skin rash, have liver problems or low blood cell counts. However, these symptoms disappear after several months with no lasting effects.

Lupus symptoms

Signs and symptoms of lupus may appear suddenly or develop slowly, may be mild or severe and symptoms may be temporary or permanent. Most individuals have mild disease characterized by moderate episodes – referred to as flares – when symptoms become worse for a short time, and either improve or disappear.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, some of the most common symptoms of lupus include:

• swollen joints;

• muscle pain;

• fever with unknown cause;

• red rashes, most occurring on a person’s face;

• chest pain when taking a deep breath;

• hair loss;

• pale or purple fingers or toes;

• swelling in the legs or around the eyes;

• sensitivity to the sun; and

• fatigue.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, some of the less common symptoms include:

• anemia;

• sadness;

• confusion; and

• seizures.

Diagnosis

Lupus cannot be diagnosed with one single test. Instead, physicians may use a detailed medical history, physical exam and laboratory tests of blood, skin or kidney samples to diagnose lupus. Diagnosis may take anywhere from a few months to a few years.

Lupus treatment

The objective in treating lupus is to induce remission, according to the American College of Rheumatology. Treating lupus depends on the signs and symptoms of the patient, according to the Mayo Clinic. Patients should consult with a doctor to determine the benefits and risks associated with using certain medications to treat lupus, according to the Mayo Clinic.

According to the American College of Rheumatology, some of the most common treatment options include:

• NSAIDs;

• antimalarial drugs;

• biologics; and

• combination treatment.

Because lupus can affect multiple organs and systems within the body, individuals should consider visiting various specialists to help with treatment. According to National Institute of Arthritis and Musculoskeletal and Skin Diseases, patients should consider visiting:

• a family doctor;

• rheumatologists;

• clinical immunologists;

• nephrologists;

• hematologists;

• dermatologists;

• neurologists;

• cardiologists; and

• endocrinologists.

Occasionally, patients might need prescribed prescription for other medications to help treat lupus-related problems including high cholesterol, high blood pressure or infection.

Patients can also take simple measures to help prevent lupus flares and, should they occur, better cope with the signs and symptoms they experience. According to the Mayo Clinic, patients should:

• have regular checkups with a physician;

• get adequate rest;

• wear protective clothing and use strong sunscreens;

• get regular exercise;

• not smoke; and

• eat a healthy diet.

Lupus prognosis

Although there is not yet a cure, lupus prognosis is relatively good with low mortality rates, according to the National Resource Center on Lupus.

Because lupus severity varies depending on the individual, prognosis outcomes may be different. However, as long as there is not an organ threatening complication, 80% to 90% of individuals diagnosed with lupus can experience a normal life span.

According to the National Resource Center on Lupus, patients should:

• follow physician’s instructions;
• take medication(s) as prescribed;
• seek help for unexpected medical side effects; and
• consult their doctor if a new manifestation of lupus occurs.

Severe flare-ups may result in a more severe, life-threatening prognosis. Hospitalization, though, is rarely required for individuals with lupus unless severe and recurrent flare-ups occur. Maintaining a healthy lifestyle and controlling the symptoms and flare-ups is key, according to the National Resource Center on Lupus.

Additional information can be found on these websites:

http://www.mayoclinic.org/diseases-conditions/lupus/basics/definition/con-20019676

https://www.niams.nih.gov/health_info/lupus/lupus_ff.asp

http://resources.lupus.org

https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Lupus