Lupus is a chronic autoimmune disease which can affect people differently. It is predominantly prevalent in females (9 out of every 10 cases) and occurs when the body’s immune system attacks its own tissues or organs, resulting in inflammation. Although there are about four different types of lupus, what we usually simply refer to as ‘lupus’ is actually systemic lupus erythematosus (SLE). This is the most common form of lupus. Other forms include:

• cutaneous lupus – limited to the skin
• neonatal lupus – in infants of women who have lupus; very rare
• drug-induced lupus – lupus-like symptoms caused by certain drugs

Symptoms

Symptoms vary among individuals and are often sometimes when signs related to subsequent complications arise. This makes the diagnosis of lupus a challenging process in some cases. The most common symptoms are:

• muscle and joint aches (arthritis-like)
• fatigue that does not subside with rest
• rashes, particularly over the nose and cheeks (butterfly-shaped pattern)

Additionally, a lupus patient may also experience:

• frequent headaches
• frequent incidence of mouth sores
• sensitivity of skin to light (resulting in rashes or lesions)
• frequent fever
• hair loss
• symptoms related to renal, cardiac or respiratory problems

Symptoms may be constant or may fluctuate between remission (settling down) and relapses (flaring up).

Complications

The intensity with which lupus presents itself may vary from one case to another. As such, the disease may be mild (affecting skin, joints and causing fatigue), moderate (with inflammation in different body parts and organs such as heart, kidneys, lungs) or severe (potentially fatal damage to body organs such as kidneys, heart, lungs, brain). Subsequent outcomes may include:

• renal damage or failure
• anaemia, increased risk of bleeding or clotting
• cardiovascular disease (due to inflammation of heart muscle)
• painful breathing (due to inflammation of chest cavity lining)
• dizziness, vision problems, difficulty expressing oneself, changes in behaviour, strokes or seizures (due to inflammation in brain)
• complications in pregnancy

Causes

It is not clear as to what exactly causes lupus, but there is believed to be a higher risk in:

• women between the ages of 15 – 44
• African American, Hispanic, Asian individuals
• individuals with a family history of lupus or other autoimmune disease

It is also believed that lupus may occur or be triggered in response to certain hormones (such as oestrogen) or environmental factors, as well as exposure to sunlight, infections and certain medications.

Diagnosis

As mentioned earlier, symptoms observed in some cases may, by default, be attributed to other conditions upon examination (e.g. arthritis, renal failure), thereby making lupus hard to diagnose. However, if symptoms consistent with those mentioned above are observed frequently or consistently, blood tests may be carried out to test for certain antibodies. These usually include the following antibodies, but each comes with their own limitations:

• antinuclear antibodies (ANA) – may be present in non-lupus autoimmune disease too
• antiphospholipid antibodies (APL) – may be present in non-lupus autoimmune disease too
• anti-Sm antibodies – present in only up to 30% lupus patients

Hence, the presence of these antibodies alone does not confirm the incidence of lupus, and each individual would have to rely on their own symptoms and diagnostic results to determine if they have lupus or not.

Prevention

There is no real means of preventing lupus, but certain measures can be taken to control or manage symptoms experienced. These include:

• planning and pacing your day to avoid burn out
• remaining active even on days when symptoms are severe
• using high-factor sunscreen (SPF 50+)
• wearing a hat and covering up when in the sun
• not spending too much time in the sun or in rooms with fluorescent (UV) lights
• having a balanced diet with vitamin D and calcium supplements
• not smoking
• engaging in relaxation activities to reduce stress (stress can worsen symptoms)

Treatment

Treatment varies according to symptoms experienced and severity of the disease. Some options used by doctors include:

• non-steroidal anti-inflammatory drugs (NSAIDs), which reduce inflammation
• corticosteroids (injection, tablet or creams), which weaken immune response
• immunosuppressive drugs, which also weaken immune response
• hydroxychloroquine, to alleviate fatigue and joint problems
• treatment with monoclonal antibodies, which reduce antibody production

Cover illustration adapted from Pinnacle Health