Lupus: Diagnosis, Causes, & Treatment

 

    Do you sometimes wonder how Grammy award-winning singer Seal got his butterfly-shaped rashes on his cheeks? Turns out that what he got isn’t a birthmark or acne scars. His iconic facial rashes were caused by an insidious and hard-to-diagnose disease called lupus.

    Lupus is one of the world's most devastating and unpredictable diseases. It is a chronic autoimmune disease that has a brutal impact on a person who suffers.

    Lupus is a condition that only a few people know about. In 2015, lupus gained even more attention from the public after singer Selena Gomez announced that she had been diagnosed with it in her late teens. She has likewise undergone chemotherapy and a recent kidney transplant to cope with this disease.

 Lupus Facts

❏       Lupus is a chronic autoimmune disorder caused when the immune system becomes hyperactive and attacks healthy organs or areas in the body. It can be mild or life-threatening.

❏       It’s not contagious. You cannot catch or pass lupus to other people, not even through sexual contact.

❏      It's not related to cancer.

❏      Symptoms usually start in early adulthood or anywhere from the teen years into the 30s.

 What is Lupus?

●      Lupus is a chronic autoimmune disease. It means the immune system becomes hyperactive and mistakenly attacks healthy body cells and tissues.

●      Under normal function, our body's immune system makes proteins called antibodies which fight off antigens such as viruses, bacteria, and germs. The antibodies attach themselves to harmful antigens which can cause the disease.

●      Auto-antibodies cause inflammation and swelling that can damage organs and tissues of the body including the joints, skin, kidneys, heart, lungs, blood vessels, and brain.

●      This disorder usually occurs in women. Symptoms typically start in early adulthood, anywhere from the teen years into the 30s.

●      People with lupus generally experience flare-ups and periods of remission. That’s why early signs are easy to dismiss.

●      Doctors believe that lupus results from both genetic and environmental stimuli.

●      There is no cure for lupus and its symptoms, but it can be controlled with medication. Treatments for Lupus include corticosteroids, immunosuppressive drugs, and lifestyle changes.

 There are four known types of lupus:

1.    Systemic Lupus Erythematosus (SLE)

Systemic Lupus Erythematosus (SLE) is the most common form of lupus, and it affects many parts of the body. The most characteristic of the symptoms of SLE is the butterfly rash or malar rash that appears in the bridge of the nose and cheek.

2.    Discoid (Cutaneous)

Discoid is a kind of lupus that causes a rash or lesion on the skin, usually when exposed to sunlight. It does not include the body’s internal organs, but pain may accompany the rash.

3.    Drug-induced Lupus (DIL)

DIL is similar to SLE usually caused by an overreaction to certain medications. Symptoms typically disappear after the patient stops or discontinues taking these medications.

4.    Neonatal  Lupus

In rare cases, it occurs when an infant acquires auto-antibodies from its mother with SLE. This condition can cause skin, anemia, or liver problems. Symptoms resolve within the first six months of the infant's life.

 

Causes of Lupus

The reason for the abnormal auto-immunity that causes the disease is still unknown. However, scientists believe that genetics, epigenetics, and environmental factors are involved. 

 Symptoms and Signs

People with lupus may experience different symptoms from one another because the disease can affect any part of the body. 

The typical symptoms include the following;

●      Extreme fatigue

●      swelling in joint pain

●      facial rash (butterfly rash)

●      unexplained fevers (more than 100 F)

●      hair loss

●       sensitivity to the sunlight

●      seizures

●       nose or mouth sores

●      chest pain

 Diagnosis

Typically, when a person has several features of the disease including signs and symptoms, the doctor will conduct several complete and accurate medical histories, physical examinations, laboratory tests, and other diagnostic studies to determine if you indeed have the disease or to make a diagnosis and to monitor the progress of the disease once diagnosed.

The most useful tests include the following; complete blood count (CBC), urinalysis, blood chemistries, complement levels, erythrocyte sedimentation rate (ESR), ANA, and another autoantibody.

 Treatments

Still, there is no known cure for lupus. However, it can be treated effectively with medications according to the severity of the signs and symptoms.  Factors such as age, type of drugs a patient is taking, and overall health are considered.

 Specific treatments and medications most commonly used to control lupus include the following:

●      Steroids or prednisone and related derivatives of cortisone. Creams can be directly applied to rashes

●      Hydroxychloroquine (Plaquenil). It is used to help keep control of mild lupus-related problems, such as skin and joint disease

●      Cyclophosphamide (Cytoxan). A drug for chemotherapy, it is useful in reducing the activity of the immune system.

●      Azathioprine, a medication originally used to prevent the rejection of transplanted organs.

●      Methotrexate (Rheumatrex). Another chemotherapy medication is used to suppress the immune system. Its use is for skin disease, arthritis, and non-life threatening forms of illness that have not responded to drugs such as low doses of prednisone or hydroxychloroquine.

●      Cyclophosphamide (Cytoxan) and mycophenolate mofetil (CellCept). It is also a  drug for chemotherapy and is useful in reducing the activity of the immune system.  It is usually used t treat severe lupus, especially lupus that affects the kidney.  

●      Belimumab (Benlysta). It is a monoclonal antibody that reduces the activity of white blood cells (lymphocytes) that make autoantibodies.

●      Rituximab (Rituxan) belongs to a class of drugs called monoclonal that reduces the activity of white blood cells (lymphocytes) that produce autoantibodies.

 Alternative or complementary approaches may help cope with or reduce some of the patient's pressure from the situation. Certain activities include:

●      Eat well.  Proper nutrition is an essential treatment plan for the disease

●      Exercise and enough rest

●      Don’t smoke and void alcohol

●      Play it safe in the sun

●      Treat fevers

●      Get to know your condition.

●      Ask for help.

 Lupus continues to present many unanswered questions. However, the outlook for people living with lupus is improving each decade with the development of more accurate monitoring tests and treatments. It is essential to understand the illness.

 If you or your family member has the above symptoms and manifestations, talk to your doctor before you make any assumptions

References

Elish D, Silverberg NB. Neonatal lupus erythematosus. Cutis. 2006;77:82–86

Pons-Estel GJ, Alarcon GS, Scofield L, et al. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum. 2010;39:257–268. Free article (PubMed)

D’Cruz DP. Systemic lupus erythematosus. BMJ. 2006;332:890–894 Free article (PubMed)