Lupus Disease

Lupus (systemic lupus erythematosus) is an autoimmune disease that, depending on the severity, can harm the skin, kidneys, heart, nervous system, blood cells, and more. Lupus symptoms vary widely and can include fatigue, joint pain, swelling, fever, and rashes. Other types of lupus include discoid or cutaneous lupus, drug-induced systemic lupus, neonatal lupus, and subacute cutaneous lupus erythematosus.

Cause

No one knows exactly what causes the body to attack its own tissues. A person may be born with a certain genetic makeup that affects how the immune system functions or makes him or her at risk for lupus. A combination of factors can trigger the autoimmune process, some of which may affect one person but not another.

• Exposure to ultraviolet light, usually from sunlight, is known to trigger the disease process and symptom flares.
• People wonder whether the hormones estrogen and progesterone cause lupus because these hormones are at much higher levels in women and women are much more likely to get lupus. Hormones, including hormones used for hormone replacement therapy or birth control, don't cause lupus. But they may have some effect on it. Birth control pills have low levels of hormones, and to not appear to make lupus worse. In fact, hormone levels are much higher during pregnancy than they are when a woman takes birth control pills. Later in life, the decision about taking hormone replacement therapy is made by each woman and her doctor, based on her lupus and other factors.
• Smoking may increase the risk of getting lupus and may make the disease more severe.
• Some medicines are suspected triggers of lupus and symptom flares.
• Some infections are suspected triggers. Some people who have cytomegalovirus (CMV), parvovirus (such as fifth disease), and hepatitis C infections eventually develop lupus. The Epstein-Barr virus has been linked to lupus in children.

Chemical exposure has been reported to trigger lupus. Suspected chemical toxins include trichloroethylene in well water and silica dust. Hair dyes and straighteners, linked to lupus in the past, are no longer considered to be lupus triggers.

Symptoms

No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus have mild disease characterized by episodes — called flares — when signs and symptoms get worse for a while, then improve or even disappear completely for a time.

The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. The most common signs and symptoms include:

• Fatigue and fever
• Joint pain, stiffness and swelling
• Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose
• Skin lesions that appear or worsen with sun exposure
• Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon)
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches, confusion, memory loss

When to see a doctor

See your doctor if you develop an unexplained rash, ongoing fever, persistent aching or fatigue.

Call a doctor immediately if you:

• Have chest pain.
• Are short of breath.
• Have blood in your urine or are urinating less often and in smaller amounts than usual.
• Have a fever over 100.5°F (38.1°C), with or without headache and body aches, but you haven't recently been exposed to a cold or the flu.
• Experience depression or any changes in behavior or thinking.
• Have numbness or tingling in the hands or feet.
• Are dizzy or have muscle weakness.
• Have swelling of the lower legs or feet.

Call a doctor as soon as possible if you develop any new symptoms, such as fever, aching or swollen joints, increased fatigue, loss of appetite, hair loss, skin rashes, or new sores in your mouth or nose. Also call your doctor if any symptoms that you have had for a period of time get worse.

If you have not been diagnosed with lupus and you have symptoms such as joint pain, fatigue, or skin rashes, see your doctor or tell your doctor about your concerns at your next medical appointment.

Medications

Medicines cannot cure lupus (systemic lupus erythematosus, or SLE), but they can control many symptoms and often can prevent or slow organ damage.

Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), and antimalarial medicines, are often enough to reduce symptoms.

Severe lupus may be treated with more aggressive medicines that suppress the immune system, such as corticosteroids and immunosuppressive medicines. Because these medicines can cause serious side effects of their own, doctors prescribe and monitor them carefully.

Treatment for the skin rash that many people develop with lupus may include sunscreens, protective clothing, and avoiding sun exposure, as well as medicines. Some medicines work for some people but not for others, and some treatments have long-term side effects. More research is needed to determine which treatments are safest and most effective for skin rash.

Some lupus medicines, like acetaminophen and prednisone, are considered safe during pregnancy. Others may not be. You may not be able to stop taking lupus medicines after becoming pregnant, or you may need to start taking medicines for a symptom flare. If possible, talk to your doctor before becoming pregnant about the effect lupus may have on your pregnancy. And for the best medication, you should consult with your doctor.