April 1, 2024

Understanding Lupus: Senior Pathologist Answers Your Questions

Written by our expert

Drneha

Dr. Neha Singh

Master's in Pathology (DNB) & MBBS

Understanding Lupus: Senior Pathologist Answers Your Questions
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Lupus, technically known as systemic lupus erythematosus (SLE), is a chronic autoimmune disease where the immune system attacks healthy tissues. This can affect various organs and systems, including the skin, joints, kidneys, heart, lungs, brain, and blood cells.

Lupus symptoms can vary widely and may include fatigue, joint pain and swelling, skin rashes (especially a butterfly-shaped rash across the cheeks and nose), fever, chest pain, hair loss, sensitivity to sunlight, mouth sores, and organ dysfunction.

A detailed diagram demonstrating the basics of lupus erythematosus.
What is lupus? Source

What Are the Main Triggers for Lupus?

The exact cause of systemic lupus erythematosus (SLE) is not fully understood, but it is believed to result from a combination of genetic, environmental, and hormonal factors.

Here are some key factors thought to contribute to the development of SLE:

  • Genetic Factors: People with a family history of lupus or other autoimmune diseases are at higher risk of developing SLE. Certain genetic variations, particularly in genes related to the immune system, can increase susceptibility to autoimmune diseases like lupus.
  • Environmental Triggers: Environmental factors, such as infections, exposure to ultraviolet (UV) light from sunlight or artificial sources, certain medications, and chemicals, may trigger the onset or exacerbation of lupus in genetically susceptible individuals. Some infections, including Epstein-Barr virus (EBV) and cytomegalovirus (CMV), have been associated with an increased risk of developing lupus.
  • Hormonal Influences: Hormonal factors, particularly estrogen, may play a role in the development and course of SLE. Fluctuations in hormone levels, such as those occurring during puberty, pregnancy, and menopause, can affect disease activity and symptoms in individuals with SLE.
  • Immune System Dysfunction:  In lupus, the immune system produces autoantibodies that target various organs, leading to inflammation and tissue damage. 
  • Epigenetic Factors: Epigenetic modifications, which regulate gene expression without altering the underlying DNA sequence, may also influence the development of lupus.

How do Doctors Diagnose Lupus?

Diagnosing systemic lupus erythematosus (SLE) can be challenging because its symptoms can mimic those of other conditions, and can vary widely among individuals.

Infographic showing a detailed explanation of criteria that doctors use to classify the types of lupus

However, there are several key steps and criteria commonly used in the diagnosis:

  • Medical History and Physical Examination: A thorough physical examination to look for signs and symptoms of lupus, such as skin rashes, joint pain, and organ involvement.
  • Diagnostic Criteria: The American College of Rheumatology (ACR) has established criteria for the classification of SLE. These include symptoms such as skin rashes, oral ulcers, arthritis, photosensitivity, blood disorders, kidney involvement, and abnormalities in laboratory tests.
  • Laboratory Tests: Blood tests are often conducted to check for specific markers associated with lupus, including:
  • Antinuclear Antibodies (ANA)
  • Anti-double-stranded DNA (anti-dsDNA) antibodies: Signify  active disease
  • Anti-Smith antibodies: highly specific to lupus.
  • Complete blood count (CBC) and blood chemistry
  • Imaging Tests: In some cases, imaging tests such as X-rays, ultrasounds, or CT scans may be used to assess organ damage or abnormalities caused by lupus.
  • Biopsy: If organ involvement is suspected, such as in the kidneys or skin, a biopsy may be performed to examine the tissue under a microscope for signs of inflammation or damage characteristic of lupus.

Diagnosing lupus often requires a combination of clinical judgment, symptom assessment, and laboratory testing. A

rheumatologist, who specializes in autoimmune diseases like lupus, typically leads the diagnosis and management process.

Can Lupus Be Cured?

Treatment aims to control symptoms, minimize flare-ups, prevent organ damage, and improve overall quality of life.

The specific treatment plan may vary depending on the severity of symptoms, which organs are affected, and individual patient factors. Here are some common components of SLE treatment:

Medications

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are often used to alleviate mild to moderate joint pain, muscle aches, and fever.
  • Corticosteroids reduce inflammation and suppress the immune system during flare-ups. 
  • Antimalarial Drugs: Hydroxychloroquine (Plaquenil) is often prescribed to help control skin rashes, joint pain, and fatigue.
  • Immunosuppressants may be used to suppress the overactive immune response and reduce inflammation in severe cases or when organs are affected.
  • Biologics: They work by targeting certain components of the immune system involved in the inflammatory process.

Can Lupus Kill You?

While lupus itself is not typically fatal, complications from the disease can be serious and sometimes life-threatening.

These complications may include kidney failure, cardiovascular problems, infections, and complications during pregnancy.

With proper medical care and management, many people with lupus are able to live relatively normal lives, but it's essential for those with lupus to work closely with their healthcare providers to monitor and manage their condition effectively.

Can Lupus Patients Get Pregnant?

Pregnancy with lupus is possible, but it can pose certain risks and complications which need to be carefully managed.

These may include:

  • an increased risk of miscarriage
  • preterm birth
  • preeclampsia
  • flare-ups of lupus symptoms during pregnancy

Women with lupus who are considering pregnancy should work closely with their healthcare providers, including rheumatologists and obstetricians, to develop a comprehensive treatment plan and to monitor their health closely throughout pregnancy.

This may involve adjusting medications, ensuring proper prenatal care, and managing lupus symptoms to optimize the chances of a healthy pregnancy and delivery.

What Lifestyle Modifications Can You Do to Manage Lupus?

  • Sun Protection: Sunlight can trigger lupus flares in some individuals, so it's essential to use sunscreen, wear protective clothing, and avoid prolonged sun exposure.
  • Regular Exercise: Gentle exercise can help improve joint mobility, reduce fatigue, and maintain overall physical and emotional well-being.
  • Healthy Diet: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help support overall health and may reduce inflammation.
  • Smoking Cessation: Smoking can worsen lupus symptoms and increase the risk of cardiovascular disease, so quitting smoking is strongly recommended.
  • Monitoring and Management of Complications:
    • Regular monitoring of organ function, including kidney function, cardiovascular health, and bone density, is essential to detect and manage any complications early.
    • Vaccinations: The flu and pneumococcal vaccines are important for preventing infections, especially for individuals with compromised immune systems.
  • Supportive Therapies:
    • Physical therapy may help improve joint mobility and strength.
    • Counseling or support groups can provide emotional support and coping strategies for managing the challenges of living with a chronic illness.

Do you have more questions for Dr. Neha Singh? Send them to [email protected].

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