Systemic Lupus Erythematosus (+ Infographic)

General description

Lupus is a chronic illness that manifests when the body’s immune system attacks its own tissues and organs (autoimmune disease). The inflammation caused by this disease can affect different organs and organ systems of the body, including joints, skin, kidneys, blood cells, brain, heart, and lungs.

Lupus can be difficult to diagnose because its signs and symptoms are generally similar to other diseases. The most distinctive sign of lupus is a skin rash on the face that resembles open butterfly wings on each cheek and is seen in many cases of lupus, but not always.

Some people are born with a tendency to have lupus, which can be triggered by infections, certain medication, or even sunlight. While there is no cure for lupus, there are treatments that help control the symptoms.

Causes

As an autoimmune disease, lupus appears when the immune system attacks the healthy tissues of the body. It is likely that lupus results from a combination of genetic and environmental causes.

Apparently, people who have a hereditary disposition to catch lupus can develop this illness by coming in contact with an environmental factor capable of producing lupus. However, in most cases the cause of lupus is unknown.

Some of the possible triggers include:

• Sunlight. Exposure to sunlight can trigger lupus-related skin damage or trigger an internal response in predisposed people. 

• Infections. The presence of an infection can cause lupus or produce a relapse in some people. 

• Medication. Lupus can be triggered by certain types of blood pressure medication, seizure medication, and antibiotics. People with medication-induced lupus usually recover after suspending the medication. In rare cases, symptoms persist even after suspending the medication.

Risk factors

The factors that can increase the risk of suffering from lupus are the following:

Sex. Lupus is more common in women.

Age. Although lupus affects people of all ages, it is more commonly diagnosed in people between 15 and 45 years of age.

Race. Lupus is more common in African Americans and Asians.

Symptoms

No case of lupus is exactly the same as another one. The signs and symptoms can appear suddenly or develop slowly, they can be mild or intense; temporary or permanent. Most people have a mild disease characterized by episodes (called "flares") during which the symptoms worsen for a while, and then improve or even disappear completely for some time.

The signs and symptoms of lupus depend on which organ systems are affected by the disease. The most common one is skin damage, which affects 90% of the patients.

The most common signs and symptoms are:

• Fatigue 

• Fever 

• Joint pain, stiffness, and swelling. 

• A rash on the face in the form of butterfly wings which can cover the cheeks and the bridge of the nose or an eruption on the rest of the body. This is a pathognomonic sign, that is, a sign which presence confirms the existence of a certain disease with no room for doubt. The absence of this sign doesn’t deny the possibility of the presence of the disease, but the presence of the pathognomonic sign makes it certain. 

• Injuries that appear on the skin and worsen after exposure to sunlight. 

• Fingers and toes that turn white or blue when the person is exposed to cold or stressful situations. 

• Shortness of breath. 

• Chest pain. 

• Dry eyes. 

• Headache, disorientation, and memory loss.

Complications 

Lupus is a disease that affects various organs:

1. General symptoms: tiredness, weight loss, and prolonged fever, not associated with any infectious process.

2. Joint and muscle symptoms: 90% of the patients with lupus present pain and swelling of the joints (arthritis.) The most affected are usually the joints of the fingers, wrists, elbows, knees, and feet. It is frequent for the patient to notice joint stiffness in the morning. 

3. Skin: The best-known symptom, although not the most frequent, is the “butterfly pattern erythema”, which consists in a reddening and a rash on the skin of the cheeks and nose. Lupus-related skin damage can appear on any part of the body and doesn’t generally cause discomfort.

4. Heart and lungs: Lupus causes inflammation of the membranes surrounding the heart (pericardium) and the lungs (pleura), which causes pericarditis y pleuritis. Both processes have similar symptoms: thorax pain and sometimes fever.

5. Kidney: The most common type of damage is inflammation (nephritis.) Blood urea levels increase, and proteins appear in blood and urine. Kidney damage is asymptomatic manifesting sometimes as tiredness or an elevated blood pressure.

6. Brain: It is practically impossible to know how often lupus affects the brain.

7. Infections: Patients with lupus are sensible to infections.

8. Antiphospholipid syndrome: It is characterized by the appearance of thrombosis, repeated abortions, and homological disturbances (thrombopenia or hemolytic anemia), associated with the presence of antiphospholipid antibodies (aPL.) The best known aPL are anticardiolipin antibodies and lupus anticoagulant.

9. Bone tissue death: This is produced when the blood supply to a certain bone decreases, which, in general, causes small bone fractures and, sooner or later, its collapse.

10. Pregnancy complications: Women who suffer from lupus have a higher risk of miscarriage. Lupus increases the risk of having high blood pressure during pregnancy and of preterm labor. To reduce the risk of these complications, doctors generally suggest delaying pregnancy until the illness has been controlled for at least six months.

How is lupus diagnosed?

Lupus erythematosus is difficult to diagnose. The diagnosis is based on the symptoms displayed by the patient, physical exploration, and analyses.

Blood tests commonly show a diminished count of leukocytes, lymphocytes, and platelets. 

Practically 100% of the patients have antinuclear antibodies; when there are none, the presence of this disease can be denied.

There are other, lupus-specific antibodies, such as the so-called anti-DNA antibodies or anti-Sm antibodies, which presence helps confirm the diagnosis. The presence of antiphospholipid antibodies also helps diagnose lupus.

How is SLE treated?

General advice

The patient with lupus can lead a normal life in all aspects of family, work and social life.

It is recommended to carry out such activities as walking, swimming, or biking, to prevent muscle weakening.

Daily activities must alternate with periods of rest, to control fatigue.

Reduce exposure to sunlight using clothes that cover the body, as well as sunscreen to prevent future damage to the skin.

Medical treatment

Painkillers and anti-inflammatories.

Relief pain from arthritis and can suppress other mild symptoms, such as muscle pain and sometimes pleuritis or pericarditis.

Steroids.

Modify the effects of hormones, to reduce the inflammation or to induce the growth and repair of tissues.

Immunosuppressants.

This is a medication used to control inflammation when the immune system is hyperactive. They are especially used when steroids don’t manage to control lupus symptoms, or when the person can’t take high doses of steroids. However, this medication can cause serious side effects.

Patients who take immunosuppressants must be closely monitored by their physicians, since this medication reduces the body’s ability to fight against infections.

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