What Is Systemic Lupus?
Sometimes, for reasons that are not fully understood, something goes wrong the immune system, and it starts attacking healthy tissues of the body. The term for a condition in which this occurs is an autoimmune disorder.
Lupus is a name given to four different types of autoimmune disorders that cause similar symptoms. The most common of these is systemic lupus erythematosus. This is a condition that can cause inflammation in multiple areas of the body, resulting in a wide range of symptoms. Most people who talk about “lupus” are referring specifically to SLE.
1. Prevalence
Systemic lupus erythematosus is a common condition, but estimates vary as to just how prevalent it is. The Centers for Disease Control and Prevention asserts that there are at least 322,000 people in the United States with definite or probable SLE but acknowledges that this is a conservative figure. The Lupus Foundation of America reports 1.5 million diagnosed cases and speculates that many more may be undiagnosed.
SLE can affect anyone at almost any age. However, most new cases occur in women between the ages of 15 and 45. Approximately 20% of SLE cases are diagnosed when patients are children or teenagers, although it rarely occurs in children younger than 5. It occurs more often in Asians and African Americans than in Caucasians.
2. Causes
While the exact cause of systemic lupus erythematosus is unknown, people with SLE also often have family members with the disease. This suggests a genetic component. However, genetic makeup is only one contributing factor. It appears that some sorts of environmental triggers, such as medications, infections, or ultraviolet radiation, are required for symptoms to manifest.
Because most cases of SLE occur in women of childbearing age, and many are diagnosed during puberty or menopause, it is possible that there is also a link between the hormone estrogen and SLE. However, more research is needed to definitively determine whether estrogen is a causative or contributing factor.
3. Symptoms
Because systemic lupus erythematosus can affect multiple areas of the body, symptoms can vary widely. The most characteristic symptom of SLE is a rash that spreads across the bridge of the nose and the cheeks. The condition was given the name “lupus,” meaning “wolf” in Latin, because the rash resembles the markings on a wolf’s face. The rash is also sometimes referred to as a butterfly rash because it resembles such an insect with its wings outstretched. Only about half of SLE patients have this distinctive rash, although they may have other skin lesions.
Most patients with SLE report joint pain and swelling, mostly in the upper extremities. Other common symptoms include headache, fever, fatigue, and a general feeling of illness or discomfort called malaise.
4. Complications
When systemic lupus erythematosus attacks the vital organs of the body, it can cause serious complications. SLE can affect the cardiovascular system, putting you at greater risk for heart attack and vasculitis, i.e., blood vessel inflammation.
It can affect lungs indirectly by causing blood clots leading to pulmonary embolism or directly by causing a buildup of fluid that makes breathing difficult. Kidney damage due to SLE is a common complication that can lead to death. Complications involving the brain are rare but can cause seizures, memory problems, or behavioral changes.
5. Diagnosis
Diagnosing systemic lupus erythematosus can be difficult. Not only do the symptoms vary widely, but they can also mimic those of other conditions. However, there are 11 common signs of the disease. If your doctor can confirm four of them, he or she may make a diagnosis of SLE.
One of the most important tests used to diagnose systemic lupus erythematosus is the antinuclear antibody blood test. Not everyone with a positive ANA test has SLE, but almost everyone with SLE has a positive ANA test. Other lab tests include urinalysis and complete blood count.
6. Treatment
The goal of treatment for systemic lupus erythematosus is to manage symptoms. This is usually accomplished through medication. Because SLE is an autoimmune disorder, patients sometimes benefit from immunosuppressant therapy. Methotrexate and cyclophosphamide are chemotherapy drugs found to be effective at treating SLE by reducing immune system activity.
To reduce inflammation, doctors sometimes prescribe steroids or corticosteroids to treat SLE. Originally used to treat malaria, hydroxychloroquine can be very effective at treating joint pain and skin lesions. Hydroxychloroquine should not be taken for conditions that it is not approved to treat.
7. Quality of Life
Many symptoms of systemic lupus erythematosus can have a negative effect on your quality of life. However, most patients identify fatigue as the most significantly impactful. SLE can negatively affect not only your physical functioning but your social and mental functioning as well.
Severe SLE can affect your ability to earn your own living by working. Less than half of working-age patients report being employed. You are less likely to be in the workforce the longer you have lived with SLE.
8. Pregnancy Risk
If you are a woman of childbearing age, systemic lupus erythematosus can increase your risk of pregnancy complications such as premature delivery, miscarriage, and pre-eclampsia, which is high blood pressure during pregnancy. Furthermore, the medications used to treat SLE can be harmful to an unborn baby, so you may need to discontinue these during pregnancy.
Doctors consider every pregnancy in a patient with SLE to be high risk. This is especially true if you have serious heart or kidney problems as a result. Nevertheless, many SLE patients have healthy pregnancies and deliver successfully. Your doctor may recommend that you wait until your disease has been under control for at least six months before attempting to get pregnant.
9. Support and Coping
The challenges of living with systemic lupus erythematosus can take a toll on your mental and emotional health. It can help to talk to someone about what you are feeling. You may benefit from counseling or from participating in a support group for people with SLE.
The more you understand about SLE, the better prepared you are to deal with the symptoms you may experience. You should make a list of questions for your doctor and ask him or her for resources where you can find more information. Understanding your condition will also help you explain it to family and friends and let them know how they can help you.
10. Prognosis
Systemic lupus erythematosus is a chronic disease for which there is no cure. However, patients today tend to enjoy a better quality of life than in past generations due to advancements in treating SLE. Research into the causes and management of SLE continues to this day, and the more doctors and scientists understand about the disease, the more effective treatments they may be able to develop.
When you are first diagnosed with SLE, your doctor may refer you to a specialist. Treatment is more effective when it is tailored specifically to you. However, you may require changes to your treatment regimen because the disease does not always progress predictably.
