Definition

Systemic lupus erythematosus (or lupus) is an autoimmune disease that causes inflammation of joints, tendons, skin, and other connective tissue and organs. It causes the immune system to produce antibodies that attack the body's healthy cells and tissue.

Causes

The cause of lupus is unknown. Researchers believe it is caused by a combination of:

• Genetic factors
• Environmental factors, which may include:
  • Sunlight (UV rays)
  • Stress
• Viral or other type of infection
• Drug-induced (methyldopa, procainamide, hydralazine, isoniazid, chlorpromazine, TNF blocking drugs)

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for lupus include:

• Sex: female to male ratio: 10:1
• Age: childbearing age (20-45 years)
• Race: African American, Native American, Asian, and Hispanic

Symptoms

The symptoms of lupus vary from mild to extremely severe and debilitating. In some patients, only part of the body (for example, the skin) is affected. In others, many parts of the body are affected. Though symptoms of lupus can be chronic, they usually flare up and subside intermittently.

Common symptoms include:

• Swollen and/or painful joints
• Fever
• Skin rashes over areas exposed to sunlight (especially on the nose and cheeks)
• Extreme fatigue

	Butterfly Rash on the Face
	© 2008 Nucleus Medical Art, Inc.

Other symptoms of lupus may include:

• Hair loss
• Chest pain, coughing up blood, shortness of breath, difficulty breathing
• Kidney inflammation
• High blood pressure
• Anemia or other blood disorders
• Sensitivity to sunlight
• Raynaud's phenomenon
• Ulcers in nose or mouth
• Swollen glands
• Headaches
• Dizziness
• Seizures
• Stroke
• Inflammation of the heart, heart vessels, or membrane surrounding the heart
• Blood clots

Diagnosis

The doctor will ask about your symptoms and medical and family history, and perform a physical exam. The diagnosis of lupus is usually made on the basis of symptoms, especially if they appear in young women. No single test can determine if you have lupus, but a number of blood tests for specific antibodies can help confirm a diagnosis of lupus.

Treatment

Treatment of lupus depends on your specific symptoms.

Medication

Medications for mild symptoms of lupus include:

• Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve joint pain
• Acetaminophen (Tylenol) to relieve joint pain
• Hydroxychloroquine or chloroquine to relieve joint pain, fatigue, balding, and skin rashes (Note: regular eye exams are advised while on these medications.)
• Topical corticosteroids for skin rashes

Medications for severe symptoms of lupus include:

• Oral and intravenous corticosteroids to control and limit inflammation in kidney, brain, lung, and heart, as well as in cases of severe anemia
• Immunosuppressive drugs to suppress the body's autoimmune system
• Mycophenolate, azathioprine, and cyclophosphamide for kidney disease or other life- or organ-threatening manifestations
• Rituximab for refractory disease

Transplantation and Dialysis

If you have end stage kidney failure , transplantation and dialysis are options to consider.

Prevention

There are no guidelines for preventing lupus because the cause is unknown.

To prevent flare-ups of symptoms:

• Develop a long-term relationship with your doctor and schedule regular check-ups.
• Treat any and all infections quickly and vigorously.
• Avoid sun exposure and wear sunscreen and protective clothing when outdoors.
• Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
• Limit emotional stress.
• Get adequate rest.
• Exercise moderately (as much as your condition allows) with your doctor's permission.
• Contact your doctor if you think a flare-up is imminent.
• Avoid oral contraceptives especially if you have ever had a blood clot.

RESOURCES:

Lupus Foundation of America, Inc.
http://www.lupus.org

Lupus Research Institute
http://www.lupusresearchinstitute.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov

CANADIAN RESOURCES:

Lupus Canada
http://www.lupuscanada.org/

Lupus Foundation of Ontario
http://vaxxine.com/lupus/

References:

Contreas G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med . 2004;350;971-80.

Dorner T, Lipsky PE. Immunoglobulin variable-region gene usage in systemic autoimmune diseases. Arthritis Rheum . 2001;44:2715-2727.

Gescuk, BD, Davis, JC Jr. Novel therapeutic agents for systemic lupus erythematosus. Curr Opin Rheumatol. 2002;14:515.

Hejaili Ff, Moist LM, Clark WF. Treatment of lupus nephritis. Drugs . 2003;63:257-74.

Lupus Foundation of America website. Available at: http://www.lupus.org .

The Merck Manual of Medical Information . Simon and Schuster, Inc.; 1999.

National Institute of Arthritis and Muskuloskeletal and Skin Diseases, National Institutes of Health (NIH) website. Available at: http://www.niams.nih.gov .

Sherer Y, Gorstein A, Fritzler MJ, Shoenfeld Y. Auto-antibody explosion in systemic lupus erythematosus: more than 100 different antibodies found in SLE patients. Semin Arthritis Rheum . 2004; 34:501-537.

Smolen JS. Therapy of systemic lupus erythematosus: a look into the future. Arthritis Res. 2002;4(suppl)3:S25.

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