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Dec 2

Systemic Lupus Erythematosus- What is it?

 

What is lupus?

Our immune system is designed to fight foreign “things”- like bacteria and viruses. To do this, the immune system produces antibodies that attack these foreign things. When our immune system mistakenly produces antibodies that attack and fight our own tissues, it causes an autoimmune disease. Systemic lupus erythematosus (commonly referred to as lupus, for short) is an autoimmune disease where the immune system produces antibodies that can attack many different organs in our body. This can cause pain, swelling, fatigue, and damage to organs like kidneys, heart, brain, etc.

 

Who is at risk for lupus?

The exact cause of lupus is not known. Some component of the disease may be genetic. Environmental factors like infection, exposure to sunlight, stress and hormones can also play a role. Women are 9 times more likely to get lupus than men. Lupus is a chronic condition, and can have periods of flares (disease exacerbation) and remission (when the disease is quiet). There is no cure for lupus, but very effective treatments can be tailored to your type of lupus.

 

What are the signs and symptoms of lupus?

Signs and symptoms of lupus can vary greatly in each individual. While some people with lupus may have just a rash or joint pain, others may have involvement of more crucial organs like the brain or the kidneys. The following are the most common signs and symptoms of lupus.

  • Fatigue

Fatigue is the most common symptom of lupus. It can be caused by ongoing inflammation from the disease, or from anemia, depression, sleeping disturbances, or a side effect of medications. In addition, some people with lupus may also have thyroid disease, which can cause fatigue.

 

  • Fever

Fever is thought to be the result of the inflammation caused by the immune system.

 

  • Weight changes

Weight loss can be caused from decreased appetite. Weight gain may be seen when the kidneys are involved, or in people who are treated with long term steroids.

 

  • Hair loss

There may be hair thinning or hair loss around the hairline, or patches of hair loss anywhere on the scalp.

 

  • Rashes

Many types of rash can be seen in lupus:

Malar rash (ie. acute cutaneous rash)- this is a butterfly-shaped rash over the cheeks and nose. It usually occurs or worsens after sun exposure.

Discoid rash– is usually round, raised, and scaly patches of skin that most commonly occurs on the face but can be seen anywhere. These have a tendency to scar.

Photosensitivity rash (subacute cutaneous rash, tumid lupus)- areas of redness in sites of sun exposure like arms, neck, chest.

Bullous rash– blister-like rash that can happen all over the body

Panniculitis (ie. Lupus profundus)- painful nodules under the skin

 

  • Mouth sores (oral ulcers)

Painful ulcers in the mouth or nose can accompany flares of lupus.

 

  • Joint pain

Pain and stiffness in the joints is a common symptom of lupus. There also may be inflammation of the joints. Typical joints include fingers, wrists, and knees.

 

  • Lung disease

Can lead to shortness of breath or lung failure. Some of the lung manifestations of lupus include:

Pleurisy/Pleuritis– refers to inflammation in the lining of the lungs. It can cause shortness of breath and a sharp pain when taking a deep breath.

Interstitial lung disease- is inflammation and scarring in the lung tissue that can significantly affect breathing.

Pleural effusion– is the fluid that can collect in the lining of the lungs.

 

  • Heart disease

Pericarditis– is inflammation of the lining of the heart. It can cause a sharp pain when taking a deep breath.

Myocarditis– refers to inflammation of the heart muscle.

Endocarditis– is inflammation of the heart valves.

Coronary artery disease and myocardial infarction (ie. Heart attack).

 

  • Kidney disease

Unlike normal kidneys, kidneys affected by lupus can leak protein and/or blood into the urine (termed proteinuria or hematuria). In more advance stages, there may be severe kidney failure requiring dialysis.

  • Gastrointestinal problems

Lupus can impact the pancreas (pancreatitis) which can cause abdominal pain, nausea, and vomiting. It can cause inflammation of the colon (colitis) leading to abdominal pain and cramping, and blood in the stools.

  • Neurologic problems

A variety of neurologic problems can be seen in people with lupus. Symptoms like headaches, trouble with memory and concentration (commonly called “lupus fog”) are more common. Weakness and numbness in the hands and feet (peripheral neuropathy) is less common. In severe cases, lupus can cause seizures or strokes.

  • Vasculitis

Refers to inflammation of the blood vessels. This can lead to ulcers in the skin or dysfunction of the organ supplied by the blood vessel.

  • Blood clots

About 10% of people with lupus also have certain antibodies (anti-phospholipid antibodies) that can cause blood clots. Some of the manifestations of this include clots in the legs (deep vein thrombosis or DVT), clots in the lungs (pulmonary embolism or PE), clots in the brain causing strokes or seizures, or clots in the uterus causing miscarriages.

Next section:

Systemic Lupus Erythematosus- How is it diagnosed?

Systemic Lupus Erythematosus- Treatment

Firooz, Dr. Nazanin

Dr. Firooz is board-certified in Rheumatology and Internal Medicine. She is an active member of the American College of Rheumatology, and is affiliated with the Department of Rheumatology at Cedars Sinai Medical Center.

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