Lupus
Overview of Lupus
Lupus is an auto-immune disease in which the body's own immune system starts acting against the normal and healthy tissues of the body. The hyperactive immune system in turn affects the other organs of the body such as inflammation (swelling) of joints, heart, lungs, kidney, and brain.
The word Lupus is a Latin word, literally meaning ‘wolf’. This word is derived from the fact that in this auto-immune disorder, rashes appear on the cheeks skin below both eyes, and covering the nose that seems like a wolf’s facial markings.
Occurrence
Lupus affects both genders but is particularly common in women of age 15 to 44 years.
Signs and Symptoms of Lupus
Lupus symptoms vary from case to case based on the severity of the condition. Signs and symptoms of lupus include;
- Fever
- Fatigue (exhaustion)
- Butterfly-shaped rashes on the nose and cheeks
- Kidney problems
- Arthritis (joints swelling)
- Hair loss
- Gastrointestinal problems
- Pulmonary (lungs) problems
- Dry mouth
- Dry eyes
- Thyroid problems
- Mouth sores
- Psychosis (illusive thoughts)
- Anemia (blood cells disorder)
- Eye diseases
- Memory loss
- Photosensitivity
Types of Lupus
There are four types of lupus, as follows
1. Systemic lupus Erythematosus (SLE)
SLE is the commonest type of lupus. It is so named because it affects multiple organs of the body i.e. joints, kidneys, heart, skin, lungs, and nervous system. SLE symptoms vary with the severity i.e. early to late stage.
SLE goes through a cycle of two periods; flares and remissions. When the disease is active and symptoms get worse, they are called ‘flares’ and when the disease becomes inactive and symptoms improve, they are called ‘remissions.
- Lupus cerebritis occurs in SLE. It is the inflammation of the nervous system and has neuropsychiatric symptoms i.e. coma, headache, stroke, seizures, psychosis, and mood swings.
- Lupus nephritis is another complication of SLE in which the immune system attacks the kidneys. Lupus nephritis treatment include; the use of steroids, and immune-suppressive drugs, and stopping the use of salt and protein.
SLE can be life-threatening if left untreated!
Therefore, a timely diagnosis and treatment are required to address its symptoms. SLE treatment includes the use of immuno-suppressive drugs i.e. hydroxyquinoline and corticosteroids.
SLE can affect both males and females but is more common in females of child-bearing age (15-45 years old).
Can an SLE-affected female have a normal pregnancy?
Yes! SLE women can give birth to a normal baby. However, they are considered at high risk of pregnancy.
2. Cutaneous lupus
Lupus affects your skin and causes lesions and rashes. Cutaneous lupus is further categorized into three types based on severity.
- Acute cutaneous lupus: a butterfly-shaped red-colored rash on cheeks and nose. It is also associated with SLE.
- Subacute cutaneous lupus: The red, raised, and scaly rashes all over the body. Those areas that have been exposed to sunlight are more prone to develop rashes.
- Chronic cutaneous lupus: The purple or red rashes on the skin that turns into skin scarring (marks), hair loss, and discoloration. This condition is also known as “discoid lupus erythematosus”.
3. Neonatal lupus
Neonatal lupus is an extremely rare condition. This occurs in those infants whose mothers have some autoimmune antibodies that pass across the placenta from mother to fetus.
According to research, mothers with lupus antibodies do not always show symptoms of lupus. However, an asymptomatic lupus mother can give birth to a baby with visible lupus symptoms (neonatal lupus).
Symptoms of neonatal lupus include; low blood count, liver issues after birth, heart defects, and skin rashes.
Pregnant females with auto-antibodies should be very cautious. They should consult an Obstetrician (maternal-fetal specialist) and rheumatologist during pregnancy.
4. Drug-Induced Lupus (DIL)
Drug-induced lupus or drug-induced lupus erythematosus is caused by the use of certain medicines that trigger lupus. Long-term usage of certain drugs leads to DIL e.g. antimicrobials (terbinafine, pyrazinamide), anticonvulsant drugs (Dilantin), HBP drugs (Timoptic, hydroxyzine) and anti-TNF agents (infliximab, Enbrel).
DIL produces symptoms similar to SLE but does not affect major organs. DIL can be cured after stopping the use of causative medicines.
Causes of Lupus
The exact single cause of lupus is not known yet. It may cause by the combination of some factors including;
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Environmental pollutants- environmental factors that can trigger lupus are; silica dust (toxins) and smoking.
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Sunlight- sunlight may trigger lupus skin lesions.
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Hormonal Imbalance- usually by increased estrogen level.
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Inheritance- some genes are associated with lupus. If someone in your family has a lupus history then you might have a chance of getting lupus.
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Infectious Diseases- some viral infections have been shown linked with lupus i.e. Epstein barr virus and Cytomegalovirus.
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Certain Medications- long-term use of certain medicines increase the risk of lupus. The medicines include; tetracyclines, minocycline, quinidine, hydralazine, procainamide, and TNF blockers used for inflammatory bowel disease and rheumatoid arthritis.
It can be possible that lupus is caused by some unknown factor other than the causes mentioned here.
Risk Factors of Lupus
Is lupus disease contagious?
No! Lupus is not contagious (transfer from one person to another). It is caused by the combined effects of some factors.
How much does the lifespan of a lupus patient?
Nowadays, lupus patients can survive longer than ever due to the advancement in diagnostic tests and treatment. Most people (~80%) live a normal lifespan.
Is lupus disease contagious?
No! Lupus is not contagious (transfer from one person to another). It is caused by the combined effects of some factors.
How much does the lifespan of a lupus patient?
Nowadays, lupus patients can survive longer than ever due to the advancement in diagnostic tests and treatment. Most people (~80%) live a normal lifespan.
Prevention
Preventing lupus might not be avoidable, completely, however some measures can be taken to prevent lupus. One major prevention can be to always wear sunscreen, indoors and outdoors. In case of a rash development directly, consult with a doctor immediately.
Diagnosis
Lupus is complex to diagnose due to its vast range of symptoms therefore, no single test is used to diagnose lupus. A series of tests are performed to rule out the cause of lupus considering the signs and symptoms.
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Medical History:
A doctor will ask you about your medical history, family history of lupus or other autoimmune disorder, and how long you have been facing the symptoms.
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Blood Tests:
The blood tests include; CBC (complete blood count), ESR (erythrocyte sedimentation rate, CRP (C-reactive protein test), and an antinuclear antibody test (detect activity extent of the immune system).
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Urine Test:
A complete urine analysis is done to detect increased levels of protein or blood in the urine that will give an indication of affected kidneys.
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Imaging Tests:
Echocardiograms and chest X-rays indicate fluid buildup and swelling in or around your heart and lungs.
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Tissue Biopsy:
A tissue sample is cut from an area of lupus rash to find the cells with lupus e.g. kidney biopsy if kidney damage is detected previously.
Treatment of Lupus | When to Consult a Doctor
Currently, there is no complete treatment available for lupus. At times some lifestyle changes are recommended. Only medicines are prescribed by the doctor to treat underlying symptoms and prevent lupus flares.
1. Medications
As lupus changes its symptoms with time, over-the-counter medication is recommended to manage symptoms. Better to visit your doctor whenever you feel some reaction by using the medicine so that the doctor will change or adjust the dosage of your current medicines.
The medicines aid in reducing symptoms by;
- Lessening inflammation
- Protect joints from damaging
- Relax the immune system from its hyperactive state
Lupus medicines are categorized as:
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Nonsteroidal anti-inflammatory drugs (NSAIDs): reduce inflammation and pain e.g. naproxen and ibuprofen.
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Corticosteroids: Calm your immune system and reduce pain. Corticosteroids can be given in three forms; injections, tablets, and topical creams. They do produce some side effects, therefore very small dosage for a limited time is prescribed.
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Anti-malarial: Although anti-malarial drugs were used for treating malaria, they can be used to address some symptoms of lupus such as joint pain, rashes, lupus flares, and malaise (fatigue). Anti-malarial drugs are especially recommended in pregnancy to reduce the risk of severe lupus.
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Immuno-suppressive drugs: Recommended in severe forms of lupus. They can lower your immune system's response to infections and relax the hyperactive immune system. They include; azathioprine, methotrexate, mycophenolate, and mycophenolic acid.
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Biologics: medicines of biological origin e.g. benlysta. It is an antibody that neutralizes the active protein of the immune system in the body to lower the hyperactive auto-immune response against the body.
Disclaimer! Please do not use any of these medicines on your own, as they are mentioned here just for your information. Always consult your doctor for the treatment of a disease.
2. Lifestyle changes
Some lifestyle changes help to reduce lupus symptoms: -
- Eat healthy food
- Avoid sunlight exposure
- Supplements include vitamin D, fish oil, and calcium.
- Exercise
- Avoid smoking
- Lupus cure from medicines
Is there any special diet plan designed for Lupus?
Well, there is no special diet plan provided by the doctors. However, a healthy and balanced diet that makes your immune system neutral and vigorous will definitely help you in dealing with lupus. You should include the following food items in your diet:
- Fish with high omega-3 fatty acids i.e. tuna, salmon, or mackerel
- Dairy products for calcium intake
- Whole grains
- Plenty of fresh fruits and vegetables
In case of any concerning signs and symptoms, consult the medical professional as soon as possible.