Systemic Lupus Erythematosus

http://www.lupus.org

What is systemic lupus erythematosus?

Systemic lupus erythematosus (also called SLE or lupus) is an autoimmune disease. This means that your body's defense against infection (your immune system) attacks your own tissue. Areas of your skin or joints get painful, red, and swollen (inflamed). Other parts of the body can also be affected, such as the muscles, kidneys, nervous system (including the brain), blood vessels, lungs, and heart.

Lupus is a serious, chronic disease. It never goes away completely. However, for most people the illness is mild. You may have long periods without symptoms, and when you do have symptoms, they can usually be controlled. When lupus is severe, it can be disabling or even life threatening.

Lupus affects mostly young and middle-aged women. In the US it is more common among African-American, Hispanic, Asian, and Native American women. West Indian women and Chinese women also have higher rates of lupus. Only 1 out of 10 people with lupus are men.

Discoid lupus (also called cutaneous lupus) is a form of lupus that affects the skin only. It is milder and more common than SLE.

You may have times when you do not have symptoms, but lupus is a lifelong disease and it can be hard to predict its course. Early detection and prompt, ongoing treatment can help prevent serious damage to your organs and help you lead a normal life.

How does it occur?

The exact cause of lupus is not known. A tendency to have the disease may be inherited. Like other autoimmune diseases, particular events, like a viral infection or too much sunlight, seem to trigger attacks of lupus. But some people start having symptoms for no apparent reason.

Some medicines can cause a lupuslike syndrome called drug-induced lupus. Examples are hydralazine (used to treat high blood pressure) and procainamide (used to treat abnormal heart rhythms).

What are the symptoms?

Lupus can take many forms. It does not affect everyone in the same way. Some of the more common symptoms are:

• painful and swollen joints
• rash, often on the face
• painful, pale, blue or red fingers or toes when exposed to cold
• unexplained fever
• tiredness and weakness
• hair loss
• sensitivity to sunlight (you sunburn more easily and your other symptoms get worse when you are out in the sun)

There may be times when you don’t have symptoms. These times are called remissions. Times when symptoms become more severe are called flares or flare-ups.

How is it diagnosed?

Lupus can be hard to diagnose. The symptoms of lupus are like the symptoms of several other medical problems. Symptoms may come and go over months or years, so it may be hard to realize that the symptoms are all caused by the same illness.

Your healthcare provider will first ask about your symptoms and medical history and then examine you. You may have blood tests to check for lupus antibody in your blood. The most common antibody tests are:

• ANA (antinuclear antibody) test
• anti-DNA test

The result of the ANA test alone is not very helpful. Over 9 out of 10 people who have lupus have some ANA in their blood (a positive ANA test). However, many other people normally have a small amount of ANA in their blood, and other autoimmune diseases can also cause a positive test.

If your anti-DNA test is positive, the diagnosis is confirmed. But in some cases it can take months to years for this test to become positive.

Depending on which body systems the lupus is affecting, you will have more medical tests. For example, your urine may be tested to check for kidney problems. If you have skin or kidney problems, you may need a skin or kidney biopsy to see if lupus is the cause of your problems. A biopsy is removal of a sample of your skin or kidney for tests in the lab.

How is it treated?

Doctors have not yet found a cure for lupus, but there are treatments for the symptoms. Medicines can ease your discomfort.

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, may be prescribed for joint pain and inflammation. NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take an NSAID for more than 10 days for any reason.
• Steroids, such as prednisone, may be prescribed to reduce inflammation. Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.
• Medicines such as methotrexate, cyclophosphamide, azathioprine, and belimumab may be prescribed for severe symptoms and to decrease flare-ups.
• Medicines used to treat malaria, such as hydroxychloroquine, may be used to treat symptoms affecting the skin or joints.
• Other medicines may be prescribed to treat other problems caused by lupus, such as kidney problems, headaches, or seizures.

Your healthcare provider will tell you which medicine is best for you to manage your symptoms. You will need follow-up tests to check the effect of the medicines and the level of inflammation in your body. Your provider will tell you how often you need to be tested to make sure that the medicines you are taking are having the right effect.

New medicines are being developed and showing promise for treatment of lupus. One or more of these medicines may be available soon. Also, new medicines used for other autoimmune diseases, such as rheumatoid arthritis, are being studied for lupus. Ask your healthcare provider if any of these medicines might help your symptoms.

How can I help take care of myself?

• Work out a plan with your healthcare provider for managing your symptoms. Follow your healthcare provider's plan for treatment, including how to take your medicines and when you should have follow-up visits and tests.
• Avoid things that seem to trigger your symptoms.
• Talk to your provider about all of the medicines you are taking, including birth control pills or other hormone medicines.
• Report any new or worsening of symptoms to your provider. Being aware of changes in your condition and taking action right away can help keep small problems from turning into big problems.
• You may tire easily, but usually you will not have to give up your normal activities. Make sure you get enough rest and try to avoid stress when your disease is active. Don’t let yourself get overly tired or exhausted. Learn ways to cope with stress, especially if stress triggers your symptoms.
• Stay physically active, according to your provider's recommendations. During remissions, try to be more active to keep your muscles strong and your joints flexible.
• Eat a healthy diet and keep a healthy weight.
• Try to avoid outdoor activities during peak sunlight hours (usually 10 AM to 4 PM). Exposure to the sun can worsen skin rashes and other problems of lupus. When you are exposed to sunlight, wear a hat to shield your face. Wear clothing that covers your arms, legs, and chest. Always put sunscreen on your skin.
• Don’t smoke.
• Get quick treatment for new symptoms, infections, or any other illness. Avoid people with illnesses you could catch, like colds or flu, because illnesses can make your lupus flare up.
• Call your healthcare provider right away if you have new or worsening symptoms.
• For more information, you can contact:

  Lupus Foundation of America
  Phone: (800) 558-0121 (English), (800) 558-0231 (Spanish)
  Web site: http://www.lupus.org.

Developed by Ann Carter, MD, for RelayHealth.
Adult Advisor 2012.1 published by RelayHealth.
Last modified: 2012-02-02
Last reviewed: 2011-08-01
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2012 RelayHealth and/or its affiliates. All rights reserved.