What Is Lupus?

Lupus is a chronic autoimmune disease in which the immune system malfunctions and mistakes the body's tissues for foreign substances (e.g. bacteria, toxins or viruses). Autoantibodies are produced by the immune system in people with lupus and they can attack the body's cells and tissues. Autoantibodies combine to form immune complexes that cause inflammation and damage, potentially affecting organs or joints (rheumatoid arthritis) in some lupus patients. Lupus affects people assigned female at birth (PAFAB) and people of Black African, Caribbean, and Asian ancestry disproportionately. 

It is important to mention that there are four major types of lupus:

• Systemic Lupus Erythematosus
• Cutaneous Lupus (Lupus of the skin)
• Drug Induced Lupus 
• Neonatal Lupus 

The most common type of lupus is Systemic Lupus Erythematosus (SLE), which causes the immune system to attack healthy cells and tissues. 

In the following sections, we will dive deeper into the symptoms, causes, and treatments of lupus, its impact on daily life and available support resources.¹

Overview

Lupus is a complicated autoimmune disease that can make it difficult for your body to distinguish between healthy tissue and harmful invaders such as viruses or bacteria. When this happens, your immune system attacks your healthy cells and tissues, resulting in inflammation and damage.

Diagnosing lupus can be challenging as its symptoms often mimic those seen in other illnesses, making it difficult to accurately identify. One of the most notable characteristics of lupus is a facial rash that often resembles the wings of a butterfly spreading across both cheeks. However, it's important to note that this rash is not present in every instance of lupus.

Individuals who have a genetic disposition are more likely to develop lupus. The onset of the disease can be brought on by various factors such as infections, certain medications, and even exposure to sunlight. While there is no cure for lupus, treatments can help keep it under control.¹

Causes of lupus

The development of lupus is believed to be a result of a combination of genetic and environmental factors. An individual's genetic predisposition towards lupus may lead to the onset of the disease when they are exposed to triggering elements in their surroundings. In many cases, however, the exact cause of lupus remains uncertain.

The potential triggers are:

• Sunlight - sun exposure may cause lupus skin lesions or cause an internal response in susceptible people
• Infections - infections can trigger lupus or cause a relapse in some people
• Medications - certain blood pressure medications, anti-seizure medications, and antibiotics can all cause lupus 

People with drug induced lupus usually improve once they stop taking the medication. Symptoms may persist even after the drug is stopped in rare cases.

Risk factors

The following factors may increase your risk of lupus:

• Gender - lupus is more prevalent among PAFAB than among people assigned male at birth (PAMAB)
• Age - lupus affects people of all ages, but it is most commonly diagnosed between the ages of 15 and 45
• Race - lupus affects African Americans, Hispanics, and Asian Americans more frequently²

Types of lupus

Systemic lupus erythematosus

SLE (systemic lupus erythematosus) is the most common form of lupus. SLE is an autoimmune disease that can cause problems with the joints, skin, brain, lungs, kidneys, and blood vessels. 

SLE can range in severity from mild to life-threatening. A doctor who specialises in the care of SLE patients should treat the disease. People with lupus who receive proper medical care, preventive care, and education can improve their function and quality of life significantly.

SLE can have both immediate and long-term consequences in a person's life. Early detection and treatment can help reduce the harmful effects of SLE and improve the chances of having a better function and quality of life. Poor access to care, delayed diagnosis, ineffective treatments, and poor adherence to therapeutic regimens may exacerbate the damaging effects of SLE, resulting in more complications and a higher risk of death. 

Systemic lupus erythematosus has the potential to impair a person's physical, mental, and social functioning. It can cause symptoms like rheumatoid arthritis which affects a person's joints and physical health. Such limitations can have an impact on the quality of life, especially if they are fatigued (another common symptom of SLE).

Cutaneous lupus (Lupus of the skin)

Cutaneous lupus (skin lupus) is a type of lupus that causes a rash or lesions on the skin. This type of lupus can appear anywhere on the body, but it is most common where the skin is exposed to sunlight.

Drug induced lupus

Drug induced lupus is similar to SLE but occurs as the result of an overreaction to certain medications. The onset of symptoms in drug-induced lupus typically takes place between 3 to 6 months after the start of medication, and the symptoms will typically subside once the medication is discontinued.

Neonatal lupus

Neonatal lupus is a condition that affects infants and is caused by transplacental transmission of maternal autoantibodies.  The skin, liver, and blood problems associated with neonatal lupus typically resolve within 6 months, but the most serious problem which can occur is congenital heart block, a condition which requires a pacemaker and has a mortality rate of about 20%.

Signs and symptoms of lupus

Lupus can affect nearly every organ in your body. Lupus symptoms also vary from person to person. One person with lupus, for example, may have swollen knees and a fever. Another person may be constantly tired or have kidney problems. Someone else may be experiencing rashes. New symptoms may emerge over time, or some symptoms may become less frequent.

Lupus symptoms typically come and go, which means you do not have them all of the time. Lupus is a disease that has flares (when your symptoms worsen and you become ill) and remissions (the symptoms improve and you feel better).  

Lupus symptoms include the following.

Muscle and joint discomfort 

You may experience pain and stiffness, as well as swelling. These symptoms are similar to those of rheumatoid arthritis, but they are not the same. Muscle pain and swelling are most common in the neck, thighs, shoulders, and upper arms.

Fever

Many people with lupus experience a fever (more than 37⁰C). Fever is frequently caused by inflammation or infection. Lupus medication can help control and prevent fevers associated with the condition.

Rashes 

Rashes can appear on any part of your body that is exposed to the sun, including your face, arms, and hands. A red, butterfly-shaped rash across the nose and cheeks is a common symptom of lupus.

Aching chest 

Lupus can cause inflammation of the lining of the lungs . Chest pain can be experienced when taking deep breaths.

Hair loss 

Patchy or bald patches are quite common. Some medications or infections can also cause hair loss.

Sensitivity to the sun or light

The majority of people with lupus are light-sensitive, a condition known as photosensitivity. Some people with lupus experience rashes, fever, fatigue, or joint pain when exposed to light.

Kidney issues

Lupus nephritis affects half of all people who have the disease. Weight gain, swollen ankles, high blood pressure, and decreased kidney function are three symptoms.

Sores in the mouth 

These sores, also known as ulcers, typically appear on the roof of the mouth but can also appear in the gums, inside the cheeks, and on the lips. They could be painless, or they could cause soreness or dry mouth.

Extensive or extreme fatigue

Even if you get enough sleep, you may feel exhausted. Fatigue can also be an indicator of a lupus flare.

Anaemia

Fatigue could be a sign of anaemia, a condition in which your body lacks red blood cells to transport oxygen throughout your body.

Memory issues

Some people with lupus experience forgetfulness or confusion.

Clotting of the blood

Blood clots may be more likely to affect you. This can result in blood clots in the legs or lungs, a stroke, a heart attack, or a miscarriage.

Dry eyes

Dry eyes, eye inflammation, and eyelid rashes are all reported symptoms.

Any of these symptoms warrant an immediate visit to the doctor. A doctor can run tests to see if you have lupus or another condition that causes similar symptoms. Early detection and treatment can help prevent or reduce organ damage and improve your quality of life.

Management and treatment for lupus

Treatment for lupus can be difficult and often requires a combination of approaches, such as antimalarials, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids to manage symptoms and reduce inflammation. Immunosuppressive drugs may be used in some cases to control the overactive immune response.

It is important to note that lupus can be confused with rheumatoid arthritis, but the two conditions are not the same. While both conditions cause joint pain and inflammation, rheumatoid arthritis is caused by an immune response that is misdirected and attacks the joints, whereas lupus is a more systemic disease that can harm various tissues and organs.

To treat cutaneous lupus, a combination of topical and oral medications, as well as strategies to protect the skin from further damage, such as wearing protective clothing and avoiding sun exposure, may be used. Hair loss can be an unwanted symptom of lupus, but there are treatments available, such as hair restoration procedures and wigs.

To summarise, managing lupus and its associated symptoms, such as hair loss, necessitates a comprehensive and individualised approach that may include medications, lifestyle changes, and therapeutic interventions. Working closely with a rheumatologist or other medical professional to determine the best treatment plan for you is critical.

Summary

Lupus is a complex disease that can manifest in many different ways and one that disproportionately affects people of African, Asian or Hispanic heritage. Living with lupus can be difficult, but with proper treatment, a healthy diet and active lifestyle, many people can lead active and fulfilling lives. It's important to work closely with a healthcare provider and seek support from family and friends to manage the physical and emotional effects of the disease.