Definition

Systemic Lupus Erythematosus (SLE), commonly known as lupus, is a chronic autoimmune disease affecting many organs. Essentially, the body's immune system in lupus patients perceives internal organs as foreign objects and attacks them, leading to inflammation and swelling in various organs.

Lupus most commonly occurs in young women, although this disease can affect anyone. Since lupus can target various organs in the body, it can manifest with various symptoms, including:

• Skin: issues such as butterfly-shaped rash on the cheeks and nose
• Blood: decrease in red and white blood cells
• Joint: joint inflammation is widespread in lupus patients, leading to pain and stiffness
• Kidneys: kidney disorders frequently occur in lupus patients and can be life-threatening
• Brain: brain involvement in lupus is relatively rare. However, if the brain is affected, it can result in decreased consciousness, seizures, and strokes
• Heart and lungs: the most common involvement is pericarditis, caused by inflammation of the pericardium, the membrane surrounding the heart. This can lead to shortness of breath, irregular heart rhythm, and fluid accumulation around the lungs and heart

Read more: Pericarditis - Definition, Cause, Symptoms and Management

Causes

The exact causes of lupus are still not precisely known to date. Researchers continue to search for factors influencing the immune system, causing it to perceive the body's cells as foreign objects. Nevertheless, some suspected factors may contribute to lupus, including:

Hormonal changes

Based on research, women tend to suffer from lupus more often than men. This is suspected to be due to hormonal changes, such as estrogen. Lupus often occurs in women aged 15-44 especially when hormonal changes are still active.

Environmental factors

Various environmental factors can increase the risk of developing lupus. Examples include exposure to sunlight, the use of certain medications, exposure to silica dust in specific industries, exposure to certain viruses like Epstein-Barr, physical or psychological stress, and a history of smoking, all of which can contribute as triggers for lupus.

Genetic factors

If there is a family history of lupus, your risk of developing lupus may increase

Although these factors are suspected to play a role in the development of lupus, the complex interplay between genetic and environmental factors remains a focus of research to deeper understand the causes and mechanisms of this disease.

Risk factor

Risk factors for lupus include:

• Female gender: Lupus is more common in women.
• Age 15-44: Lupus often occurs in individuals between the ages of 15 and 44.
• Certain ethnicities: Lupus is more prevalent in certain ethnic groups, including Afro-Americans, Hispanics, and individuals with Asian-American heritage.
• History of specific medications: Some medications may be associated with an increased risk of lupus.
• Smoking: There is a correlation between smoking and an elevated risk of lupus.
• Occupational exposure: Working in industries with high chemical exposure may increase the risk of lupus.

Symptoms

Symptoms of lupus can vary as the disease can affect various organs and systems in the body. The symptoms experienced by each individual may differ depending on the severity of lupus. Therefore, lupus treatment must be tailored intensively and continuously for each patient. Here are some lupus symptoms:

• Joint pain
• Muscle pain
• Red rash on the face and skin
• Fever
• Sensitivity to sunlight exposure
• Hair loss
• Dry mouth
• Dry eyes
• Fatigue
• Chest pain
• Abdominal pain
• Shortness of breath
• Swollen glands
• Headache
• Confusion
• Depression
• Seizure
• Blood clotting
• Anaemia

As mentioned earlier, anyone can be affected by lupus, but it is more common and frequent in women. In women, there is a distinctive lupus symptom known as a butterfly rash, a red rash shaped like a butterfly located on the cheeks and the bridge of the nose. This rash is usually more pronounced when the face is exposed to prolonged sunlight and is sometimes accompanied by itching. Rashes can also appear in other areas of the skin.

Read more: Lupus Erite Skin Economy - Definition, Cause, Symptoms and Management

Diagnosis

If you are suspected of having lupus, the doctor needs to conduct a series of examinations to determine the diagnosis and severity of the disease. This allows the doctor to provide appropriate treatment and management. The process involves a medical interview or anamnesis, a physical examination, and diagnostic tests.

Medical interview

The doctor will engage in a question-and-answer session with the patient to identify risk factors and symptoms of the disease. Questions may include:

• Main complaints of the patient
• Associated complaints
• When these complaints first appeared
• History of specific treatments
• Previous medical history
• Family medical history

Physical examination

The doctor will perform a physical examination to look for clinical symptoms such as:

• Impaired consciousness
• Hair loss
• Skin rash
• Joint pain
• Dry mouth or eyes
• Swollen glands

Diagnostic Tests

a.  Laboratory Tests:

• Complete blood count: Evaluates red blood cell count, markers of inflammation in the blood, and erythrocyte sedimentation rate
• Urinalysis: Assesses protein, blood, and bacterial content to check for kidney involvement.
• Blood chemistry: Examines liver and kidney function

b. Specialized Tests:

     Autoantibody tests, such as:

• Antinuclear antibodies (ANA)
• Anti-double stranded DNA antibodies (anti-dsDNA)

All these tests will be recommended by the doctor, so be sure to consult before undergoing any diagnostic tests.

Management

Doctors will provide treatment for lupus patients depending on the symptoms experienced, severity, age, overall health condition, and medical history. Lupus is a chronic condition requiring ongoing care to control symptoms throughout life. Regular check-ups with a doctor are essential to improve the quality of life.

Some management strategies can be applied to lupus patients:

• Anti-inflammatory drugs: To halt the continuous inflammatory process
• Immunosuppressive drugs: To suppress the immune system and prevent it from attacking the body's cells
• Antimalarial drugs: Proven to help alleviate symptoms and prevent relapses, however not necessarily prescribed to all lupus patients
• Biologic agent: To reduce proteins in the circulation that can trigger lupus

Additionally, lifestyle changes such as stress management, consuming nutritious foods, increasing fruit and vegetable intake, ensuring adequate sleep, reducing exposure to sunlight and chemicals, and engaging in regular exercise can be beneficial. Regular follow-up appointments with the doctor are crucial for ongoing symptom control and to enhance the patient's overall well-being.

Complications

Complications that often occur in lupus include:

• Kidney disorders: most common complication and a leading cause of death in lupus patients
• Brain and Central Nervous system disorders: If lupus involves the brain and central nervous system, patients may experience symptoms such as dizziness, confusion, and decreased consciousness
• Blood and circulation: Involvement of the blood and blood vessels can lead to inflammation in blood vessels and disruptions in blood clotting
• Lungs: Lupus can cause inflammation in the membrane around the lungs, resulting in pain during breathing
• Heart: Inflammation in the heart increases the risk of heart attacks in lupus patients
• Infections: Individuals with lupus are generally more susceptible to any infections due to their weakened immune system
• Cancer: Increased risk of cancer
• Bone tissue death: This occurs when blood flow to the bones decreases
• Pregnancy complications: In pregnant women with lupus, the risk of complications such as miscarriage, pre-eclampsia, and premature birth is elevated

Read more: Preeclampsia - Definition, Cause, Symptoms  and Management

Prevention

There is no specific way to prevent lupus because its exact cause remains unknown. However, if you have risk factors for lupus, you can adopt a healthy lifestyle, such as:

• Consuming a balanced and nutritious diet
• Avoiding highly processed foods that contain preservatives
• Maintaining regular physical activities
• Managing stress effectively
• Avoiding excessive sun exposure
• Avoiding exposure to chemicals and tobacco

Although these steps cannot guarantee the prevention of lupus, they can contribute to overall health maintenance and reduce potential risk factors that may influence the development of the disease.

When to see a doctor?

Seek medical attention promptly if you experience the above symptoms and have risk factors for lupus. You can visit a general practitioner or an internist. If there is suspicion of lupus, the general practitioner may refer you to a specialist, particularly a rheumatology consultant, for examinations and proper treatment.

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