Lupus: Symptoms, Diagnosis and Treatment

Systemic lupus erythematosus (SLE) or commonly known as lupus is an auto immune disease, majorly affecting women. In the United States 20 to 150 women per every 100,000 women are affected by lupus.

Symptoms of Lupus

Lupus presents with a variety of symptoms. One of the most classical forms is a butterfly shaped rash on your face; this may not be found in all individuals affected by lupus.

The symptoms that you may experience depend on the organ affected by lupus. These can be:

• Fever
• Fatigue and pain in the muscles: these are generally present most of the times
• Pain in the joints
• Rash on the skin which worsens with exposure to sunlight
• Chest pain
• Dry eyes
• Oral ulcers
• Loss of hair
• Seizures, confusion, forgetfulness, dizziness

Causes of Lupus

The cause of SLE is not well understood. This disease is related strongly to the presence of particular antibodies in our blood, antibodies against your own cells. Lupus is a disease that slowly affects nearly all the organs in your body. About 90% of individuals affected with lupus are women in their childbearing age. Studies have found that some individuals may be predisposed to lupus because of their genetic makeup. In a few individuals exposed to different stimuli may cause the manifestation of symptoms of lupus; these stimuli can be sunlight, some infections and sometimes a drug too.

Diagnosis of Lupus

Diagnosis lupus is tricky because of the varied forms in which this disease may present. After a thorough examination of skin rashes and taking a history, your doctor might order a few tests to confirm the diagnosis of lupus. These tests are:

Blood test and urine tests:

• Complete blood count: this test measures the number of blood cells in your blood. It can tell your doctor if you have anaemia which is fairly common in lupus. It can also be used to rule out other causes for your fever
• Erythrocyte sedimentation rate (ESR): your blood will be allowed to stand in a tube. The faster the blood settles the higher is the ESR and greater are the chances that there is an inflammatory process going on in your body
• Anti nuclear antibody (ANA) test: to detect the presence of autoantibody in your blood.
• Kidney function test: to assess the functioning of the kidney, the levels of various markers in your blood are measured.

Imaging:

• Chest x ray: shadows in your lung will tell your doctor whether the lupus has affected your lungs or not.

Biopsy:

• Renal biopsy: a small piece of your kidney will be examined by the pathologist to assess the affect of lupus on your kidney. This helps in identifying the best mode of treatment.

Complications of Lupus

Untreated lupus may lead to a variety of complications depending upon the organ involved.

• Kidney: untreated lupus may lead to kidney failure.
• Lungs: inflammation affecting the outer coverings of the ling may lead to painful breathing. The risk of pneumonia also increases.
• Blood vessels: individuals with lupus are more likely to have vasculitis.
• Lupus affects blood vessels, when the blood vessels involved are the ones supplying blood to bones it may lead to avascular necrosis.
• Pregnancy: women with lupus are more likely to undergo still births and abortions compared to women without lupus. They are also at an increased risk of preeclampsia.

Treatment of Lupus

Treatment of lupus aims to reduce the rate of progression of the disease. There is no known cure for lupus.

• NSAIDs: non steroidal anti inflammatory drugs are used to control the joint pain, joint inflammation and fever associated with lupus. Common side effects are stomach ulcers and kidney problems.
• Hydroxychloroquine:  this drug is effective in treating the skin and joint manifestations of lupus. Regular checkups while taking this drug helps monitor its side effects.
• Glucocorticoid therapy: generally started after a life threatening flare of lupus. They counter the inflammation in lupus. The side effects are gain in weight and thinning of bones and increased risk of infections. The side effects increase with the length of therapy and dose used.
• Immunosuppressant: used for serious cases of lupus. Suppressing the immune system reduces the symptoms of lupus but comes with the side effect of increased risk of infections. Drugs like azathioprine and methotrexate may also cause damage to the liver and increase risk of cancer.
• Biologics:  these are monoclonal antibodies which reduce the symptoms of lupus when given intra-venous; eg: belimumab.
• Rituximab has been shown to help some patients who haven’t responded to other forms of treatment.
• All patients of lupus are advised to use sunscreens of sun protection factor (SPF) more than 30 and wear protective clothing. Isolated skin rashes may respond to topical steroids.

Prognosis of Lupus

Approximately 85% of patients have either continuing disease of a flare once every year. Permanent remission is very rare.

Resources:

• Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients, Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR, European Working Party on Systemic Lupus Erythematosus
• B cell depletion therapy in systemic lupus erythematosus: long-term follow-up and predictors of response, Ng KP, Cambridge G, Leandro MJ, Edwards JC, Ehrenstein M, Isenberg DA
• Clinical Practice Guidelines – American College of Rheumatology.