In recognition of Lupus Awareness Month and World Lupus Day (May 10th), Human Health Project (HHP) is beginning a new blog series devoted to Lupus which affects millions of people worldwide. For such individuals, it is often difficult to know who to trust and how to navigate through a myriad of online health resources. This blog series will focus on raising awareness and providing helpful information to those living with lupus.
Lupus is a chronic, autoimmune disease that can damage any part of the body such as skin, joints, kidneys, heart, blood vessels & mucous membranes. It is regarded as an autoimmune condition since a person’s immune system creates antibodies that “attack” its own bodily tissues causing inflammation and damage. These signs and symptoms tend to persist longer than six weeks and throughout a person’s lifetime. It is a condition that vacillates in presentation such that it has acute flares causing a person to feel ill while on other times it remits so a person feels well. Lupus is one of America’s least recognized major diseases. While lupus is widespread throughout the world, awareness and accurate knowledge about it is lacking. More than 90% of its sufferers are young women between the ages of 15 to 44. Women of color are two to three times more at risk for lupus than Caucasians.
Lupus is caused by a complex interplay of genes, hormones, and environmental factors. It appears that people with a genetic disposition for lupus may develop the disease when they come into contact with a triggering factor from the environment.
Though the majority of lupus cases are considered to be of unknown origin, some of the well-publicized causes include the following:
- Sunlight (Exposure to the sun may elicit a trigger internal bodily response.)
- Infections (Having an infection can lead to increase in flare-ups or cause a potential relapse of symptoms.)
- Medications (Lupus can be triggered by certain medications such as Hydralazine & Methyldopa (antihypertensive), Isoniazid (antituberculosis) & Phenytoin (antiepileptic). However, symptoms resolve once the offending medication is stopped.)
Lupus affects everyone differently, but certain signs & symptoms are common. Some of the most common ones are the following:
- Painful or swollen joints (arthritis)
- Unexplained fever
- Extreme fatigue
- Malar rash or “butterfly” rash across nose/cheeks
- Photosensitivity ( skin sensitivity to sun)
- Chest pain
- Hair loss
- Anemia ( a decrease in red blood cells)
- Purple/pale fingertips from cold or stress
- Mouth ulcers
- Proteinuria ( protein in the urine)
Because Lupus can produce a variety of symptoms in different individuals, it may take some time for a physician to actually make a diagnosis. Often a doctor will say that Lupus might be present, but that the current symptoms are insufficient to signify a firm diagnosis. They suspect Lupus mainly based on the person’s symptoms & findings during a careful physical examination. The following is a defined set of criteria that has been used by medical practitioners to diagnose Lupus, of which 4 are required:
- Red, butterfly-shaped rash on the face, affecting the cheeks or certain other rashes characteristic of lupus
- Rash characteristic of discoid lupus
- Hair loss without scarring
- Mouth or nose sores
- Joint inflammation (arthritis) or joint tenderness and stiffness in the morning
- Fluid around the lungs (pleural effusion), heart (pericardial effusion), or other organs (serositis)
- Kidney dysfunction
- Nerve or brain dysfunction
- Low red blood cell count caused by destruction of red blood cells (called hemolytic anemia)
- Low white blood cell count (WBC)
- Low platelet count
- Positive results of a blood test for antinuclear antibodies (ANA)
- Positive results of a blood test for antibodies to double-stranded DNA (dsDNA)
- Positive results of a blood test for antibodies to Smith antigen (Anti-Smith Ag)
- Positive results of a blood test for antiphospholipid antibodies
- Low blood levels of complement proteins
- Evidence of antibody against red blood cells by the direct Coombs test
A chest X-ray & CT scan would assist in the evaluation of fluid around the heart or lungs. Kidney biopsy, if needed, would determine treatment for types of damage that might occur. Early detection and treatment is the key to a better health outcome and can usually lessen the progression and severity of the disease.
The treatment of Lupus depends on which organs are affected and how inflamed these organs are. The goal of treatment is to decrease the activity of Lupus—that is, to decrease inflammation, which in turn should prevent damage. While there is no cure for lupus, early diagnosis and treatment can help in managing the symptoms and lessening the chance of permanent damage to organs or tissues.
Because lupus is different for every person, treatments and medications are prescribed based on individual needs.
If Lupus is not very active (mild lupus), treatment may not need to be intensive. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen & naproxen often can relieve joint pain, swelling & fever. Some of the side effects of such drugs, however, are gastrointestinal bleeding, stomach ulcer & heartburn. Antimalarial drugs, such as hydroxychloroquine or chloroquine help relieve skin and joint symptoms and reduce the frequency of flare-ups. These side effects include nausea, vomiting, headache & skin rash. Sunscreen lotions (with a sun protection factor of at least 30) should be used, especially by people who have rashes. Corticosteroids such as prednisone & methylprednisolone have been to shown to demonstrate great efficacy in mitigating Lupus symptoms but with higher doses & longer courses such side effects such as diabetes, high blood pressure, osteoporosis and weight gain. Sometimes an immunosuppressive drug such as cyclophosphamide is given to suppress the body’s autoimmune attacks. Mycophenolate mofetil is an alternative immunosuppressive drug. The combination of a corticosteroid and an immunosuppressive drug is most often used for severe kidney disease or nervous system disease. People who are at risk of blood clots may be given heparin or warfarin. People with severe Lupus often notice their symptoms have lessened after 4 to 12 weeks of treatment.
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