Lupus is a chronic (long-lasting) autoimmune disease that can cause inflammation, pain, and tissue damage throughout the body. Autoimmune disease is caused by an immune response against the body’s own tissues. The immune system is designed to fight off foreign invaders by forming antibodies. The immune response is how the body recognizes and defends itself against substances that appear foreign and harmful.
In lupus, the number and variety of antibodies produced are greater than those in any other disease. These antibodies may react against the body’s blood cells, organs, and tissues. Immune cells then attack the affected systems. These antibodies, along with other unknown factors, determine which lupus symptoms will develop.
Lupus is a disease that develops slowly, with symptoms that come and go. The course of lupus may vary from a mild illness that occurs occasionally to a severe fatal disease. At its onset, only one organ system may be involved, with additional organs becoming involved later.
Lupus is characterized by periods of illness (flares) and periods of wellness (remission). Lupus can be difficult to diagnose because of its wide range of symptoms that mimic those of other diseases.
Symptoms of Lupus
According to the American College of Rheumatology, eleven signs and symptoms are used to distinguish lupus from other medical conditions. A lupus diagnostic criterion requires a minimum of four of these symptoms to occur together at the same time.
- “butterfly” rash on the nose and cheeks
- erratic blood cell count – decreased numbers of red, white or platelet cells
- kidney damage
- neurological symptoms
- presence of anti-nuclear antibodies in ANA blood test
- presence of immunological disorders
- sensitivity to light (photosensitivity)
- serositis – inflammation of the serous lining of the heart and lungs
- small, coin-shaped, red, flaky rash anywhere on the body
- swelling and/or pain of the joints
- ulcers inside the mouth (oral)
In addition to the above symptoms, people with lupus may also experience:
- extreme fatigue
- persistent general discomfort, uneasiness or ill feeling (malaise)
- shortness of breath
- loss of appetite
- difficulty swallowing
- swollen glands
- chronic, low-grade fever
- muscle aches or weakness
- increase of headaches
- increasing loss of hair
- nausea
- vomiting
- weight loss
- visual disturbance
Types of Lupus:
Systemic Lupus Erythematosus (SLE) is the most common and serious form of the disease. SLE can affect the heart, lungs, skin, joints, organs that form blood, kidneys, and nervous system. Symptoms of SLE may include:
Musculoskeletal: Nearly all SLE patients have joint pain and develop arthritis. Joints most affected by SLE include fingers, hands, wrists, and knees. Chronic pain in the hips and shoulders is frequently caused by the death of bone tissue.
Skin: Approximately half of SLE patients experience a “butterfly” rash over the cheeks and bridge of the nose. The rash can range from a faint blush to a severe eruption with scaling. It generally worsens when exposed to ultraviolet (sun or tanning bed) light. A more widely scattered rash may appear on other body parts exposed to sunlight. Additional skin problems include lesions (infected or diseased patches of skin) or nodules (small mass of tissue or cells).
Kidney: Kidney problems develop when deposits of protein form within the cells (glomeruli) of the kidney. This can lead to lupus nephritis, a persistent inflammation in the kidney. The two most common symptoms of lupus nephritis are weight gain and high blood pressure.
Nervous System: Approximately 25% of SLE patients experience neurological disorders. The most common disorder is mild mental dysfunction and can include confusion, inability to think with usual speed or clarity (often referred to as “brain fog”), inference with the ability to make decisions, and feeling disoriented. Other neurological disorders can include seizures, psychosis, and headaches.
Blood: Blood disorders can affect up to 85% of SLE patients. Blood clots can form in the veins or arteries and have been associated with strokes, pulmonary embolism (blockage of the blood vessels of the lungs), and miscarriage.
Heart: Inflammation can affect the various parts of the heart and may result in:
Pericarditis – inflammation of the pericardium, the sac-like covering of the heart.
Endocarditis – inflammation of the endocardium, the inside lining of the heart chambers and valves.
Myocarditis – inflammation of the heart muscle.Lungs: Pleurisy is the most common lung disorder that occurs as a result of SLE. It is caused by inflammation of the pleura (lining of the lungs) and pleural effusions (accumulation of fluid between the layers of the membrane that lines the lungs and chest cavity). Pleurisy symptoms include chest pain, shortness of breath, stabbing pain in the back and a feeling of “stickiness” within the lungs.
Discoid/Cutaneous Lupus is a chronic skin condition that causes sores, inflammation, and scarring of the face, ears, scalp and other body areas. Discoid LE generally affects the cheeks and nose. However, it can also affect the upper back, V of neck, and backs of hands. It presents with red scaly patches, which leave the skin discolored with white scars.
Symptoms of Discoid/Cutaneous Lupus may include:
- red, raised rash on the face, scalp, or other parts of the body
- internal ear rash
- rash on mouth lining
- hair loss
Subacute Cutaneous lupus includes two forms of skin lesions. One looks like psoriasis and has red scaly patches that form on the arms, shoulder, neck and trunk. The other has red ring-shaped lesions with a slight scale around the edges.
Symptoms of Subacute Cutaneous Lupus may include:
- slightly raised lesions on the upper trunk and arms
- hair loss
- extreme photosensitivity (sensitivity to light)
Lupus Nephritis is a kidney disorder that arises from complications connected to systemic lupus erythematosus. It can cause weight gain, high blood pressure, dark-colored urine and swelling around the eyes, legs, ankles, or fingers.
Lupus nephritis is a glomerular disease which damages the glomeruli. The glomeruli are a group of capillaries within the kidney that filter waste products from the blood. The disease interferes with the clearance of the waste products, so they begin to build up in the blood.
Symptoms of glomerular disease include:
- large amounts of protein in the urine (foamy urine)
- blood in the urine (pink or cola-colored)
- inability to efficiently filter wastes from the blood
- low blood protein
- swelling of the body
Drug-induced lupus is a rare form of lupus, caused by a reaction to certain drugs. Generally, symptoms take three to six months to develop and disappear once the drugs are discontinued. The drugs that can trigger drug-induced lupus are more frequently prescribed for men than for women. Therefore, this type of lupus is more prevalent among men.
Drugs known to potentially trigger drug-induced lupus include:
- Hydralazine – used to treat high blood pressure or hypertension
- Procainamide – used to treat irregular heart rhythms
- Carbamazepine – used to reduce abnormal excitement in the brain
- Lithium – used to treat and prevent episodes of mania
- Phenytoin – used to control convulsions or seizures
- Minocycline – used to treat many different bacterial infections
Neonatal lupus is a rare type of lupus that affects newborns. Women with lupus and autoimmune disorders produce specific antibodies in their blood. Some women have these antibodies even if they have not yet developed symptoms. When these women become pregnant, they may pass the antibodies to their infants. These antibodies may cause the infant to develop neonatal lupus. The two main symptoms of neonatal lupus include an abnormally slow heart beat and a skin rash.
Common features in lupus patients:
- The majority of people affected by lupus are women.
- In some women, the signs and symptoms develop during pregnancy. In others, they appear soon after delivery.
- Exposure to the sun can cause a sudden rash.
- Infections or colds do not getter better and complications arise. These complications may be the first signs of lupus.
- Drugs taken for another illness produce lupus symptoms.
Who Gets Lupus?
Approximately 1.4 million Americans have been diagnosed with lupus. While this disease can affect anyone, it mainly affects women. In fact, about 90% of people diagnosed with lupus are women. Lupus may occur at any age, but appears most often in people between the ages of 10 and 50 years.
African American women are three times more affected by lupus than Caucasian women. It is also more common in women of Hispanic/Latino, Asian and American Indian descent. Symptoms tend to develop earlier in Hispanic/Latino and African American women. African Americans with lupus tend to have more seizures and strokes, while Hispanic/Latino patients have more heart problems.
The Cause of Lupus
Lupus is on the rise, and scientists don’t know why. Researchers suspect it occurs following an infection. The theory is the infectious organism appears similar to particular proteins in the body. These proteins are later mistaken for the organism and wrongly targeted for attack.
Occasionally, the use of certain drugs can cause lupus. Drug-induced lupus usually disappears after the drug is discontinued.
Genetics
People with lupus share some type of common genetic link. First-degree relatives (mother, father, brother, sister) of people with lupus, have an 8 to 9-fold increased risk of developing lupus. An identical twin has a 3 to 10-fold greater risk of developing lupus than a non-identical twin.
Environmental Factors
Lupus is considered to be a multi-factorial condition – meaning that “many factors” are involved in causing the health problem. These factors are generally a combination of both genetic and environmental. Multi-factorial traits do recur in families because there are partly covered by genetics.
Certain drugs, toxins and diets have been linked to the development of lupus. Exposure to ultraviolet light is a known environmental factor that can trigger a lupus flare or worsen skin rashes.
Lupus and Quality of Life
Although lupus presents with a wide variety of symptoms and there are potential side effects to treatment, people with lupus can still maintain a high quality of life. The key to managing lupus is to understand the disease and its impact. Many people experience an increase in symptoms (fatigue, pain, rash, headache or dizziness) prior to a flare. Patients who learn to recognize the warning signs can take steps to ward off or reduce the intensity of a flare.
Earlier diagnosis and advanced treatment of lupus has significantly improved the outlook for people with lupus. With proper care and balanced nutrition, most people with lupus can lead normal, active lives.
Reference:
- Healthy Divas Autoimmune Disease SeminarLupus Foundation of America
