Lupus

Lupus is one of many autoimmune diseases. Autoimmune diseases are chronic disorders of the immune system that occur when the body's defense mechanism, which normally protects it from outsider invaders, attacks the body itself, particularly the body’s connective tissue. What causes the immune system to attack “self” or the body’s own tissues is unknown.

In most cases, lupus involves a malfunction of antibodies, the substances that destroy viruses, bacteria and other foreign invaders. The antibodies lose their ability to tell the difference between attacking microorganisms and the patient's own cells and tissues. When that happens, the flawed antibodies, known as "auto-antibodies," begin to accumulate in affected tissues, triggering inflammation, arthritis and injury to affected skin tissues and organs.

The cause of lupus is unknown, but a combination of genetic, environmental and possibly hormonal factors probably play a part in its development.

Types of Lupus

There are three basic forms of lupus: discoid, systemic and drug-induced.

Discoid lupus, also known as "cutaneous lupus," is restricted to the skin and can be identified by a red rash that usually appears on the face, neck or scalp. This mild form of the disease does not represent a significant health threat. But about 10 percent of those who contract discoid lupus are found to have "systemic" lupus, which is more severe and can involve any organ.

Systemic lupus erythematosus (SLE), the most common form of the disease, can attack one or more organs or systems of the body, including the skin and the joints. Seldom do two people with SLE have the same symptoms. For some people, only the skin and joints will be affected; for others, the joints, lungs, kidneys, blood or other organs and/or tissues may be involved. This version of lupus strikes women 10 to 15 times more often than men, and is usually what people are describing when they use the term "lupus." The disease appears to attack African Americans, American Indians and Asian Americans more frequently than the rest of the U.S. population. Typically, SLE moves through two cycles; periods of "remission" alternate with relapses, or "flares."

Drug-induced lupus, the third type, causes symptoms that are similar to those associated with SLE, but are less severe. In many cases, this form of the illness occurs after frequent use of prescription drugs such as hydralazine, prescribed for high blood pressure, or procainamide, prescribed for irregular heart rhythm. Only a small percentage of people who take these drugs develop drug-induced lupus. Most people who do develop it never develop full-blown SLE, and the disorder usually fades soon after the offending drugs are discontinued.

Symptoms

Most people experience symptoms in only a few organs. Symptoms of lupus include chronic inflammation of the skin; swollen and painful joints; unexplained fever; chronic fatigue; red rashes, including a butterfly rash that covers the nose and cheeks; anemia; hair loss; mouth ulcers; swelling in legs or around eyes; and, less frequently, blood clotting disorders and seizures. Symptoms are caused by the inflammation in the organs. Organs that can be affected include the kidneys, lungs, heart and brain, as well as blood vessels and cells in the blood.

Because its symptoms often mimic other disorders -- and also because they wax and wane in intensity -- lupus can be difficult to diagnose. There is no single test that will diagnose lupus. It may take years for a definite diagnosis. A person and his or her health care provider should consider lupus as a possible diagnosis if several of the signs and symptoms occur together.

Treatment

Lupus cannot be cured. The goals of treatment are to decrease a person’s symptoms and inflammation, and maintain normal functions of affected organs.

Although treatment approaches vary with each patient, most include medications aimed at slowing down the body's inflammatory response to attacking auto-antibodies. These substances include non-steroidal anti-inflammatory drugs, corticosteroids, drugs used to treat malaria, anticoagulants and various drugs designed to reduce immune system reactions.

Research that has shown promise involves using a person’s own bone marrow stem cells, which develop into immune system cells, to fight lupus. This treatment has been tried in people who have stopped responding to standard therapies.  

What to Do

See your doctor if you experience several of the symptoms for lupus, and especially if you begin to develop skin-related symptoms such as rash, photosensitivity and mouth ulcers, along with fever, continuing fatigue, failing appetite and loss of weight. If you have been diagnosed with lupus, follow the medication and testing plan you and your health care provider develop. Blood tests may detect flares before symptoms develop. Early treatment of flares can make it easier to control them, decreases the chance of permanent damage and may reduce the time you must take medication.

A woman with lupus who wants to become pregnant should consider counseling and planning with her health care provider before pregnancy. Women with lupus have a higher rate of complications, miscarriage and premature births. Ideally, a woman should not have signs or symptoms of lupus and not be taking medications for at least six months before she becomes pregnant.

Self-care Steps for Lupus

• If you are photosensitive, avoid the sun.

• Try to get regular exercise, which will improve muscle strength and reduce fatigue.

• Minimize stress.

• Avoid smoking and excessive alcohol consumption.

• Join a lupus support group or seek psychological counseling to help you deal emotionally with this disorder.