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What is Lupus? Understanding SLE

    • Lupus (also known as systemic lupus erythematosus, or SLE for short), is a complicated disease that can manifest in many different ways in the body. It can present as a simple skin rash; can show up as fatigue and fever; or can manifest as an abnormality in the kidneys, heart, lungs and joints.

      The common factor in lupus is its origin: Lupus is considered an “autoimmune disease” and may appear when the body’s own immune system becomes hyperactive and attacks the healthy cells of the body, instead of targeting only foreign invaders.

      Sacramento rheumatologist JaNahn Scalapino, M.D., of Sutter Medical GroupOpens new window, sees many patients with lupus, as well as other autoimmune diseases.

      “With lupus, the immune system has ‘gone haywire’ and begins to make antibodies that may attack the body’s own organs,” says Dr. Scalapino. “However, it does not present the same way in everyone, as many different symptoms are possible.”

    • What are the symptoms of lupus?

    • A patient’s experience of lupus can vary widely, but the most common features are:

      • Achiness in the body and joints
      • Fatigue
      • Fever
      • Skin rash, particularly on the face – in a butterfly pattern across the nose and cheeks
      • Inflammation and swelling in the joints, similar to rheumatoid arthritis

      Beyond these common symptoms of the disease, lupus can impact the lungs and heart, resulting in pleurisy or pericarditis – forms of inflammation of the tissues lining the lungs and heart. Lupus can also affect the kidneys, resulting in different types of kidney damage.

      Some patients experience neurological disorders from lupus, including seizures, while others can have blood disorders with the white or red blood cells, or platelets being damaged.

    • Who gets lupus?

    • More women than men get lupus – in a ratio of almost 10 to 1. It also impacts younger people, especially young women under 40.

      Ethnicity plays a role, with lupus more common in African Americans, Hispanics and Asians than in Caucasians.

      People over 40 can still get lupus, often drug-induced lupus, where the immune system overreaction is triggered by a medication. The female to male incidence in older individuals, however, is closer to 2:1.

    • How dangerous is lupus?

    • While some patients can have problems that actually threaten key organs like the kidneys, most patients will experience lupus as a mild, annoying and uncomfortable disease. Dr. Scalapino notes that way back in time, patients frequently died of lupus, but we now have good diagnostic methods and treatments that can keep the disease in check. About 90 percent of lupus patients are living active lives 10 years after their diagnosis. Late deaths in lupus may be due to excess cardiovascular disease, which we now know correlates with chronic inflammation. (See a video on how chronic inflammation affects the body.) Young women with lupus can go on to have successful pregnancies, but it is best to bring the lupus under control before trying for conception.

      This good news does not diminish the discomfort that lupus brings, or the need for continued treatment to keep the disease in check, notes Dr. Scalapino. Lupus is a chronic disease that can appear to be in remission, but always has the chance to flare up.

    • What causes lupus?

    • Dr. Scalapino admits that scientists and physicians are still struggling to answer this question. Scientists and doctors don’t have a clear picture into what kicks the immune system into overdrive, resulting in the damage to healthy cells in the body.

      Lupus is not caused by a single gene, but probably by multiple genes interacting with environmental triggers. Like other autoimmune diseases, lupus is believed to be influenced by hereditary factors, with the general category of autoimmune diseases running in families. However, most cases of lupus are sporadic; meaning no one in the immediate family has the disease. (See What is an Autoimmune Disease? for more information on the entire range of diseases caused by an overactive immune system.)

      Dr. Scalapino notes that recent studies have shown that some people have antibodies within their system similar to lupus patients but have not developed the actual symptoms of the disease. These patients are likely at higher risk for developing an autoimmune disease.

      Unfortunately, Dr. Scalapino notes that nothing specific can be done to prevent lupus. While there is no scientific evidence to support particular recommendations to avoid lupus, Dr. Scalapino says that maintaining a healthy lifestyle – diet, exercise, and adequate rest – cannot hurt. Smokers have a higher risk of developing autoimmune disease.

    • How is lupus diagnosed?

    • Diagnosis usually starts by seeing a primary care doctor for the generalized symptoms of lupus – fatigue, aches and pains, rash. These can, of course, be symptoms of many conditions. An ANA blood test can help guide the diagnosis. Dr. Scalapino notes that a positive ANA test does not, in itself, mean the patient has lupus, but can lead to other more definitive tests, depending on the particular symptoms. There are 11 indicators of lupus, and a patient must have 5 or 6 of them before being given the diagnosis of lupus. The 11 indicators (which rarely occur all at once) include:

      • A malar rash (the typical butterfly pattern)
      • A discoid rash (scarring lesions on the face, head, chest or upper extremities)
      • A photosensitive rash (appearing after sun exposure)
      • Oral ulcers
      • Arthritis (inflammation and swelling of the joints)
      • Serositis (inflammation of the tissues lining the lungs, heart and abdomen)
      • Kidney disease
      • Neurologic disorders
      • Hematologic (blood) disorders
      • A positive ANA blood test
      • A positive blood test for antibodies

    • How is lupus treated?

    • A number of drugs are available to treat lupus. These range from over-the-counter NSAID medications all the way to strong chemotherapy drugs. Corticosteroids are also useful in reducing the inflammation that lupus can cause. Treatment for lupus depends on the particular appearance of the disease in each patient.

      Dr. Scalapino notes that some promising treatments are under development, including monoclonal antibodies, and research is underway into treatments that target specific arms of the immune system response.

      In additional to medical treatment, Dr. Scalapino recommends these common-sense activities to boost overall health in patients with lupus:

      • Maintain a healthy weight
      • Exercise, even though fatigue is present
      • Don’t smoke
      • Get adequate rest and sleep
      • Manage stress and seek balance in life

      Scalapino also emphasizes staying with treatment and maintaining regular checkups, even if the symptoms lessen. Lupus can come back from an apparent remission and cause serious damage to organs before being detected.

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