Systemic Lupus Erythematosus: Symptoms, Diagnosis, and Treatment

In a healthy person, our immune system works to protect the body by producing proteins called antibodies, which work to fight off invaders and foreign substances within the body. However, in people with autoimmune disorders, the immune system malfunctions—it cannot tell the difference between an invader and the body’s own tissue, and it starts to attack itself.

Lupus is a non-contagious autoimmune disorder that causes the immune system to attack the body’s healthy tissues. This may eventually cause widespread inflammation, swelling, and a host of other problems within the body. Lupus usually happens in cycles—when a patient is going through symptoms, they’re experiencing a “flare” and when they are not, they’re in “remission.”

Lupus almost never looks the same across two patients and can be hard to diagnose. In fact, sometimes lupus is referred to as “the disease of 1,000 faces.”

Typically, patients with lupus see their first symptoms sometime between the ages of 15-45. According to the Lupus Foundation of America, up to 1.5 million people may be living with lupus. Lupus affects mostly women, including a disproportionately high number of women of color.

What Is Lupus?

Systemic lupus erythematosus, or “SLE” is the most common form of lupus. For the purposes of this article, I’ll refer to SLE broadly as lupus, unless otherwise noted.

As the name suggests, systemic lupus affects the whole body. SLE typically acts in a cyclical nature, meaning patients can feel healthy for a while before being affected with another round of symptoms.

Other types of lupus include:

• Cutaneous lupus: There are a few different types of cutaneous lupus, all of which affect the skin, causing rashes, lesions, and scarring. Cutaneous lupus types include acute cutaneous lupus, or ACLE; discoid lupus, or DLE; chronic cutaneous lupus, or CCLE; and subacute cutaneous lupus, or SCLE.
• Temporary drug-induced lupus: This occurs when a patient experiences lupus symptoms after taking certain drugs. Generally, when the medication is stopped, lupus symptoms resolve on their own. Medications known to cause this include methyldopa and procainamide, minocycline, and anti-TNF.
• Childhood lupus: Childhood lupus presents in children similar to how SLE presents in adults. It typically affects the kidneys more aggressively than SLE.
• Neonatal lupus: This is a rare condition that affects the babies of mothers who have certain autoantibodies. Neonatal lupus typically resolves itself without treatment.

Symptoms and Signs of Lupus

Lupus can have a variable presentation of symptoms. Some commonalities include:

• High fever
• Butterfly rash across the face
• Joint pain and stiffness
• Weight loss or gain, or changes in appetite
• Fatigue
• Skin rashes
• Raynaud’s disease
• Mood changes, including depression and anxiety
• Sjogren’s syndrome
• Gastrointestinal complications
• Pulmonary complications
• Headaches

Causes of Lupus

Genetics can play a significant role in lupus development. For example, if you have a sibling with lupus, your risk of developing lupus is 20 times higher than another person without a family history of the disease. While over 50 genes have been associated with lupus development, more research is needed in this area.

Lupus is more common in women. Women are nine times more likely than men to develop lupus. Certain environmental factors contribute to lupus, including exposure to mercury and cigarette smoke, and a history of infections like herpes zoster.

How Is Lupus Diagnosed?

Lupus can be difficult to diagnose. Often laboratory testing, along with a patient’s signs and symptoms will be used to make the diagnosis. Many conditions can be confused with lupus, such as fibromyalgia (which can occur alongside lupus) and rheumatoid arthritis.

The American College of Rheumatology has a number of classification criteria, and the presence of four or more of those criteria translates to a lupus diagnosis. The current ACR criteria include:

• Malar rash
• Discoid rash
• Photosensitivity
• Oral or nasal ulcers
• Arthritis affecting multiple areas
• Serositis
• Kidney disease
• Neurological issues
• Blood disorders

Your doctor may also order laboratory studies to test for antibodies, order imaging tests, or perform a tissue biopsy to diagnose lupus.

Lupus Treatment Options

Lupus has a variable presentation, so a person’s treatment plan is individualized and can change over time.

Some common medications currently used to treat lupus and its associated symptoms include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These can relieve discomfort and inflammation.
• Anti-malarials: Plaquenil is perhaps the most well-known of the anti-malaria drugs. Many lupus patients will take Plaquenil long-term in order to control their disease.
• Steroids: These can help reduce symptoms that occur because of inflammation, but steroid use must be balanced with an understanding of potential risks of long-term use.
• Immuno-suppressives: These drugs help quiet the immune system’s disordered activity. For example, DHEA is a male hormone that has been shown to treat some symptoms of lupus.
• Biologics: These are relatively new medications that can be used to block proteins in the body and limit the immune system’s response.

The Lupus Foundation of America estimates that between 80-90% of people with lupus will live a normal lifespan. If you are diagnosed with lupus, the best thing you can do is follow your doctor’s advice and treatment plan.

What You Can Do at Home

If you have lupus, you should protect yourself from the sun. Many people who have lupus are photosensitive, and sun exposure can cause uncomfortable flares. When outside, you should always wear sunscreen with an SPF of at least 30 and sun protective clothing. Additionally, be sure to tell your doctor that you have lupus, so you are not prescribed medications that can increase sun sensitivity.

Dietary changes can also help lupus symptoms. A healthy diet comprised mainly of whole foods and healthy fats will help manage any co-existing conditions and reduce your risk of complications. Others recommend reducing or eliminating garlic and alfalfa sprouts from your diet and staying away from echinacea supplements. You may want to experiment with these recommendations and see how they affect you.

Women with lupus between the ages of 35-44 have a higher risk of heart attack compared to women of the same age who do not have lupus. This means it’s critical to take care of your body and your health by staying as active as feels manageable for your body.

To improve your comfort and reduce lupus symptoms, apply heat and/or cold packs as needed. You may find that stress reduction techniques, like yoga and meditation, are also beneficial.

Who Is at Risk for Lupus?

Known risk factors for lupus include:

• Sex: Females are nine times more likely to have lupus
• Age: Symptoms usually show up in women between the childbearing years
• Family history: If you have a first or second degree relative with lupus, you are at a higher risk
• Race: People of color are 2-3 times more likely to have lupus than the white population
• Smoking
• Taking certain medications, as in the case of drug-induced lupus
• History of viral infections

Related Conditions and Complications

Lupus and the associated inflammation can have a widespread effect on the body, including but not limited to these body systems:

• Kidneys: By some estimates, up to 60% of patients will experience kidney problems, or lupus nephritis, which can affect your ability to process and remove waste from the body.
• Nervous system: Lupus’s effect on the central nervous system can lead to mood changes and headaches, among other symptoms.
• Lungs: About half of lupus patients experience lung problems like pleurisy, when the membrane surrounding the lungs becomes inflamed.
• Blood and blood vessels: Blood circulation issues, or complications like anemia, may occur.
• Heart: Half of lupus patients have high blood pressure; lupus can also cause heart-related conditions like pericarditis.
• Eye health: Lupus is known to cause changes to the skin around the eyes and eyelids; it can also affect the eye itself in the form of uncontrolled eye movement, dryness, inflammation, and damage to overall vision.
• Gastrointestinal system: Problems in your liver, gallbladder, pancreas, and stomach can sometimes occur in people with lupus—sometimes due to medications you’re on rather than lupus itself.
• Behavioral health: Living with lupus can take an emotional toll on you. It is common for people with lupus to also experience depression, anxiety, or difficulty sleeping.

In general, lupus—or medications for treatment—weakens the immune system, which can leave you susceptible to infection. In some cases, medications prescribed for lupus may lead to increased risk of other conditions, like osteoporosis.

For pregnant women, lupus can increase the likelihood of micarriage. Pregnant women with lupus should be closely monitored by a doctor.

When to See a Doctor

If you are experiencing symptoms you think might be lupus, see your doctor as soon as possible to be evaluated. If you already have lupus, continue your treatment plan and visit your doctor if you notice any new or concerning symptoms, or if you have questions about your care plan.

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