According to the Lupus Foundation of America, lupus affects approximately 1.5 million Americans and at least 5 million people worldwide. However, the foundation also states that 73% of Americans between the ages of 18 and 34 are either unaware of the condition or know little or nothing about it. Because lupus can have wide-ranging effects on the body, yet be a challenge to diagnose, we want to help you understand lupus symptoms, how a diagnosis is made, and the types of treatment options available to manage this widespread but little understood condition.
What Is Lupus?
Lupus is an autoimmune disease that occurs when the body’s immune system becomes overactive and begins to attack healthy cells, tissues, and organs. As a result, the condition can affect an array of bodily systems, including the joints, kidneys, lungs, and skin. Lupus also impacts each person differently and can result in symptoms that overlap with other conditions, making diagnosis difficult.
What Causes Lupus?
Unfortunately, the exact cause of lupus is unknown. However, experts suspect the disease is the result of an interplay between genetic and environmental factors. Many genetic variants have already been linked to the condition, and the disease tends to run in families with a history of either lupus or another autoimmune condition. Specific environmental factors have also been implicated in triggering the development of lupus. These include:
- Ultraviolet light
- Chemicals and toxins
Risk Factors for Lupus
Lupus is most often seen in people aged 15 to 44, but women actually develop the condition 9 times more often than men. Although researchers believe differences in hormones and sex chromosomes may play a role in a person’s susceptibility to lupus, the extent to which these differences contribute to the development of the disease is largely unknown.
However, estrogen is known to be an immunoenhancing hormone, which means that women have stronger immune systems than men. And while this contributes to women’s longer life spans, it’s a double-edged sword that helps explain why the incidence of autoimmune diseases is generally higher in women.
Interestingly, lupus is also 2 to 3 times more prevalent in women of color, including Hispanics and African Americans, who are more likely to develop the disease at a younger age and have more severe symptoms.
Types of Lupus
There are actually four different types of lupus, each of which comes with its own set of symptoms.
- Systemic lupus erythematosus (SLE): Approximately 70% of people diagnosed with lupus have SLE. Unfortunately, this is also the most serious type of lupus and affects the tissues and organs of about half those diagnosed with the condition.
- Discoid lupus erythematosus (DLE): Also known as cutaneous lupus erythematosus, DLE is a type of lupus that affects only the skin.
- Drug-induced lupus: This form of lupus occurs in people using certain types of medications, including antibiotics and heart-related drugs. Symptoms seen with drug-induced lupus are similar to those experienced with systemic lupus. However, symptoms generally disappear after the offending medication is stopped. Interestingly, this form is more commonly seen in men.
- Neonatal lupus: This type of lupus, which affects newborns, is the most rarely seen. Babies born with the condition may have a skin rash and liver or heart problems. Neonatal lupus appears to be associated with a reaction to the mother’s antibodies, and symptoms tend to disappear over the course of several months.
Lupus Symptoms and Signs
As mentioned earlier, the symptoms and signs of lupus often mimic those of other conditions, and they differ from person to person, making diagnosis difficult. Symptoms may also appear suddenly or develop slowly over time and vary in severity, with long periods of mild (or even nonexistent) symptoms punctuated by episodes, or flares, of increased manifestations.
However, the signs and symptoms experienced will reflect the parts of the body involved with the disease. Some of the more common symptoms of lupus include:
|Butterfly rash across the cheeks and bridge of the nose||Headaches|
|Extreme fatigue||Hair loss|
|Fever||Weight loss or gain|
|Joint pain or swelling||Raynaud’s phenomenon|
|Shortness of breath||Abnormal blood clotting|
|Chest pain with deep breathing||Nose or mouth sores|
|Sun or light sensitivity||Low blood counts|
|Confusion or memory problems||Blood clots|
Getting a Lupus Diagnosis
Since the symptoms of lupus are so diverse, getting an accurate diagnosis can be a long process. Moreover, there’s no single test that’s used to diagnose the condition.
Because of the complexity of both the condition and its diagnosis, the American College of Rheumatology has put together a list of signs and symptoms to help guide health care providers in determining whether a diagnosis of lupus is warranted. Factors your health care provider should keep an eye out for are:
- Skin rashes
- Nose or mouth sores
- Lung or heart inflammation
- Kidney problems
- Central nervous system issues
- Abnormal blood tests
If after speaking with you regarding your personal and family medical history and performing a physical exam your doctor suspects lupus, a series of blood tests will be conducted to confirm the diagnosis. These tests include:
- Complete blood count (CBC): A CBC is a test that measures the number of red blood cells, white blood cells, and platelets in the blood. Low values can be associated with lupus.
- Erythrocyte sedimentation rate (ESR): This is a blood test that’s used to determine the rate at which red blood cells settle to the bottom of a test tube over the course of an hour. A faster than normal rate can be associated with lupus.
- Urinalysis: This test is used to check a sample of urine for red blood cells or increased levels of protein. The presence of either can indicate the kidneys have been affected by lupus.
- Antinuclear antibody (ANA): The ANA test evaluates for the presence of an autoimmune disorder by looking for autoantibodies—antibodies the body produces when it begins attacking itself. If the test comes back with positive results, it indicates an overstimulated immune system. Because most people with lupus have a positive ANA, but most people with a positive ANA don’t have lupus, additional testing of specific antibodies may be recommended to confirm the diagnosis.
- Imaging: An echocardiogram or chest X-ray may be recommended if heart or lung problems are suspected.
- Biopsy: Tissue sampling can be used to check specific organs for damage, especially the kidneys and skin.
Lupus Treatment Options
Treatment of lupus depends on the specific type as well as a person’s symptoms and their severity. Because most people tend to experience a waxing and waning of symptoms, with periodic lupus flares, you and your health care provider may find that both medications and their dosages need to be changed on occasion. However, the medications most commonly used to control lupus are:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin) may be prescribed for fever, pain, and swelling.
- Antimalarials: Medications commonly used to treat malaria can help decrease lupus flares.
- Corticosteroids: Steroids can be effective against inflammation and serious conditions involving the kidneys and brain.
- Immunosuppressants: Medications designed to suppress the immune system may be used in people with severe lupus symptoms.
- Biologics: Medications made from living organisms—as opposed to chemically synthesized drugs—may be helpful in some people, especially those with resistant forms of lupus.
Additionally, certain lifestyle changes may be beneficial in reducing lupus symptoms and flares. These include:
- Eating a healthy diet with plenty of antioxidants and omega-3 fatty acids
- Getting plenty of rest
- Getting regular exercise
- Reducing sun exposure
- Maintaining a support network
While there’s still no known cure for lupus, both diagnosis and treatment have improved, and most people with the disease are now able to live out a normal life span. However, regular communication with your health care team is vital for maintaining quality of life and ensuring the condition stays under control, so be sure to keep track of your symptoms and report any significant changes.