About 200,000 people in the United States suffer from Systemic Lupus Erythematosus, more commonly known as lupus. Lupus is an autoimmune disease that can impact all body systems including the joints, skin, blood, and organs. While there is no cure for lupus, healthcare providers can help people manage their symptoms and improve their quality of life.
Related: Systemic Lupus Erythematosus
Risk factors for Systemic Lupus Erythematosus
Lupus affects women at a much higher rate than men. In fact, 9 out of 10 people diagnosed with SLE are women. It is most commonly diagnosed between the ages of 15 and 44. Black or African American, Hispanic, Asian, American Indian, and Alaska Native populations have higher rates of SLE than White populations.
In addition, SLE tends to be more severe and more deadly for Black people than White people. Other risk factors for developing lupus include:
- Family history of lupus
- Smoking
- Other autoimmune diseases
- Exposure to pollution
- High estrogen levels
Types of lupus
There are four different types of lupus, each with a unique set of causes and treatment options. However, since they are all inflammatory disorders, they have similar clinical presentations.
Systemic Lupus Erythematosus
Systemic Lupus Erythematosus is the most common type of lupus and is characterized by systemic symptoms. It can affect each body system and symptoms often present as “flare-ups,” where symptoms worsen and improve at different times. This type of lupus is a chronic condition with no cure.
People suffering from SLE can experience a wide variety of symptoms, and each patient will have varying severity and types of symptoms.
Cutaneous Lupus Erythematosus
Cutaneous Lupus Erythematosus is also a chronic condition. However, this type of lupus is isolated to the skin only. The rashes and flare-ups associated with cutaneous lupus erythematosus are often triggered by sunlight.
Drug-induced lupus
Drug-induced lupus is caused by medication and often resolves when the medication is stopped. There are at least 46 known medications that can cause drug-induced lupus. These include medications used for heart disease, thyroid disease, hypertension, neuropsychiatric disorders, antibiotics, and anti-inflammatory medications.
Most drug-induced lupus is caused by procainamide (Pronestyl®), hydralazine (Apresoline®), and quinidine (Quiniglute®).
Neonatal lupus
Neonatal lupus is caused by antibodies that are passed from mother to baby through the placenta. Mothers with autoimmune disorders may produce anti-SSA, anti-SSB, or anti-U1-RNP, antibodies that cause neonatal lupus.
While neonatal lupus is usually mild and resolves at about one year of life, some infants may develop a heart block due to their lupus. These infants need careful monitoring and some may need a permanent pacemaker. Only 2% of babies born with neonatal lupus develop a heart block.
Possible causes of lupus
Experts have not found a definitive answer to the question of what causes some people to develop lupus. However, like other autoimmune diseases, most patients can identify something that triggers their first flare-up.
The following are associated with possible causes of lupus:
- Infections, especially Epstein-Barr virus
- Stressful live events such as divorce or the death of a loved one
- Exposure to silica dust
- Injury or childbirth
Common signs and symptoms of lupus
Because lupus is a disease that impacts every body system, there is a wide range of symptoms that patients can experience. The most common include:
- Joint pain
- Muscle pain
- Chest pain on inhalation
- Headaches
- Rash
- Fever
- Hair thinning or loss
- Mouth sores
- Swollen glands
- Fatigue despite getting enough sleep
- Shortness of breath
- Swelling in extremities
Some symptoms of lupus can be dangerous and even life-threatening. Flare-ups may lead to confusion, decreased level of consciousness, or abnormal blood clotting. These are emergencies and patients experiencing these symptoms should be referred to a higher level of care.
Diagnostic criteria of Lupus
Because patients suffering from a variety of conditions can suffer from symptoms like fatigue, headaches, and muscle pain, there are specific blood tests that are used to diagnose lupus.
A combination of symptoms and blood tests is the best way to get a definitive diagnosis of SLE.
Blood tests that may help confirm a diagnosis of lupus include:
- Anti-Sm and anti-dsDNA antibodies
- Anti-Ro/SSA and anti-La/SSB antibodies
- Antinuclear Antibody (ANA)
- Antiphospholipid antibodies
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP) levels
- Thyroid-stimulating hormone (TSH)
- Anti-thyroglobulin and anti-thyroid peroxidase (TPO) antibodies
Providers can compare symptoms and laboratory results using the SLICC criteria.
Treatment options for lupus erythematosus
While neonates usually outgrow neonatal lupus and stopping the offending medication typically corrects drug-induced lupus, there is no cure for Systemic Lupus Erythematosus or Cutaneous Lupus Erythematosus.
Treatment for these diseases is focused on managing symptoms and decreasing the severity and frequency of flare-ups. As with many chronic diseases, patients should be encouraged to eat well, drink plenty of water, and exercise.
Medications used to treat lupus include hydroxychloroquine, steroids, and biologics. These all reduce inflammation and may decrease the incidence and severity of flare-ups.
Medications that mitigate symptoms and problems associated with lupus include antibiotics, anticonvulsives, statins, vitamin D, and antihypertensive drugs.
Impact of lupus on patients and families
Because lupus is a painful and chronic condition, patients and their families often need extra social and emotional support. Nurses can help by using active listening, referring patients and families to social services or therapy, and helping them find support groups.
The Lupus Foundation of America National Network is an excellent resource for patients and their families seeking extra support and encouragement.
