Lupus

Symptoms

Lupus symptoms vary widely, and there are no similar cases of the disease. The signs can appear abruptly or develop gradually, range from mild to severe, and might be temporary or permanent. Many people experience mild illness accompanied by flares where symptoms worsen for some time and then improve or disappear for a while.

The signs and symptoms of lupus vary based on the affected body systems. However, the most common ones are:

• Fever
• Tiredness
• Joint pain, swelling and stiffness
• Butterfly-like rash on the face, covering the cheeks and the nose bridge, or rashes in another part of the body
• Skin lesions which emerge or get worse with sun exposure
• Fingers and toes turning white or blue due to exposure to cold or when under stress
• Shortness of breath
• Dry eyes
• Chest discomfort
• Headaches, confusion, and memory loss

Causes

Lupus is an autoimmune disease that arises when the body’s immune system mistakenly attacks the healthy tissue. There is a possibility of lupus occurrence due to a combination of genetic predisposition and environmental factors.

Persons with a hereditary tendency for lupus are likely to get the disease if they encounter environmental triggers. In most cases, the actual cause is unidentified. However, the possible contributing factors of lupus are:

• Sunlight: Being exposed to the sun can cause lupus skin lesions or prompt an internal reaction in individuals who are vulnerable.
• Infections: Infections are likely to provoke lupus or sometimes lead to relapses.
• Medications: Certain kinds of blood pressure medicines, anti-seizure drugs and antibiotics can trigger lupus. Drug-induced lupus tends to improve once a person stops taking medication. However, in rare cases, the symptoms can persist despite discontinuing the medicines.

Risk factors

Several factors can increase the likelihood of developing lupus:

• Sex or gender: Lupus is reported to be more prevalent among women.
• Age: While lupus can strike at any age it is mostly detected in people between 15 and 45 years.
• Race: The disease is more prevalent among African Americans, Asian Americans, and Hispanics.

Complications

Inflammation resulting from lupus can impact various body parts, such as:

• Kidneys: Lupus can lead to severe damage to the kidney. Kidney failure is among the major causes of fatality in individuals with lupus.
• Brain and central nervous system: If lupus affects the brain, it can cause symptoms like dizziness, headaches, vision problems, behavioural changes and sometimes seizures or strokes. Most individuals with lupus have memory issues and might find it difficult to express their thoughts.
• Blood and blood vessels: Blood disorders, such as the reduced amount of healthy red blood cells (anaemia) and high risk of blood clots or bleeding can occur due to lupus. It can as well lead to blood vessel inflammation.
• Lungs: People with lupus have an increased risk of chest cavity lining inflammation that could cause painful breathing. Other possible problems are pneumonia and bleeding into the lungs.
• Heart: Lupus can trigger inflammation of the arteries, heart muscle, or heart membrane. The possibility of heart attacks and cardiovascular disease also significantly increases.

Additional complications

Individuals with lupus are also at a high risk of:

• Infection: Both lupus and the treatments are likely to compromise the immune system, making individuals with the disease more susceptible to infections.
• Cancer: People with lupus are vulnerable to cancer, although the risk is small.
• Bone tissue death: Bone tissue death arises due to a decline of blood flow to the tissues. This causes tiny bone fractures and eventual collapse of the bone.
• Pregnancy complications: Women who have lupus are at a higher risk of experiencing a miscarriage. The disease also increases the likelihood of preterm birth and high blood pressure during pregnancy. Doctors often advise waiting until lupus has been controlled for at least 6 months before attempting to conceive.

Diagnosis

Lupus diagnosis is challenging due to the considerable variability in signs and symptoms among individuals. These symptoms can change with time and usually intersect with those of other conditions.

There is no single test to detect lupus. However, a combination of physical exams, blood and urine tests, and evaluation of signs and symptoms results helps with diagnosis.

Laboratory tests

Medical providers can conduct blood and urine tests including:

• Complete blood count: Doctors can perform this test to measure white blood cells, red blood cells and platelets, along with haemoglobin (protein present in the red blood cells) levels. The outcomes can point to anaemia that is common with lupus. The disease can also cause reduced white blood cells or platelets.
• Erythrocyte sedimentation rate: This test measures how fast red blood cells settle down at the bottom of a tube within an hour. A quicker rate can mean a systemic disease like lupus. Although the sedimentation speed is not specific for a single disorder, it could be raised for lupus, infection, cancer or a different inflammatory condition.
• Kidney and liver assessment: Medical providers can order blood tests to evaluate the function of the kidneys and liver, which can be affected by lupus.
• Urinalysis: This examines a urine sample to show if there is an elevated protein level or red blood cells. This can happen if the kidneys have been affected by lupus.
• Antinuclear antibody (ANA) test: A positive ANA test for antibodies (released by the immune system) signifies an activated immune system. Although most individuals with lupus test positive for ANA, this does not always mean that they have the condition. However, the doctor can recommend additional specific antibody tests if ANA is positive.

Imaging tests

If lupus is suspected to impact the heart or lungs the medical provider can recommend imaging tests including:

• Chest X-ray: This imaging test can show abnormal shadows indicating fluid or inflammation within the lungs.
• Echocardiogram: Using sound waves, this test creates real-time pictures of the heart beating. Doctors can order an echocardiogram to look for issues with the heart valves or other portions.

Biopsy

Lupus can damage the kidneys in various waysand the treatments may vary, based on the nature of the harm caused. A small kidney tissue sample might be needed to determine the best course of treatment. This sample can be removed using a needle or via a tiny incision.

In some cases, a skin biopsy may be conducted to confirm lupus that affects the skin.

Treatment

Lupus treatment is often determined by a person’s signs and symptoms. Careful consideration of the advantages and risks is necessary when deciding if you need treatments and the medications to take.

As the symptoms flare and subside, your medicine or dosages may need adjusting. The medications that doctors mostly prescribe to help manage lupus are:

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs, including ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve), can help relieve pain, swelling, as well as fever caused by lupus. Prescription NSAIDs that are much stronger are also available. Possible side effects are kidney problems, stomach bleeding, and a high possibility of heart disorders.
• Antimalarial drugs: Medicines like hydroxychloroquine (Plaquenil) that are mostly recommended for treating malaria influence the immune system, and may reduce lupus flare-up risks. Potential side effects are stomach upset and, in rare cases, eye retina damage. Frequent eye examinations are advisable while using these drugs.
• Corticosteroids: Prednisone along with other corticosteroid types can help reduce inflammation associated with lupus. Higher steroid dosages, including methylprednisolone (Medrol), are usually prescribed for severe cases involving the kidneys and brain. Possible side effects are weight gain, bone thinning, easy bruising, diabetes, high blood pressure and elevated infection risk. The likelihood of side effects rises with high doses and prolonged use.
• Immunosuppressants: These medications help suppress the immune system and are useful in severe lupus cases. The side effects may include liver damage, an increased infection risk, liver damage, reduced fertility and a higher cancer risk.
• Biologics: Belimumab is another form of medication given intravenously to help relieve symptoms of lupus for some people. Potential side effects are diarrhea, nausea, and infections, which, in rare cases, worsen depression.

Rituximab can benefit those who are not responding to other treatments. Side effects that can occur include infections and allergic reactions triggered by intravenous infusions.

Self-care

Caring for your body is important if you have lupus. Various simple approaches can prevent flares if they happen and help one cope well with symptoms:

• Regularly visiting your doctor: Frequent check-ups, rather than only visiting your doctor whenever symptoms aggravate, can help prevent flare-ups and address routine health problems like stress, exercise, and diet, which can be vital in avoiding lupus complications.
• Being sun smart: Since ultraviolet light is likely to provoke a flare, you should consider wearing a protective outfit like a long-sleeved shirt, hat, and long pants as well as applying sunscreen that contains SPF (sun protection factor) of 55 whenever you are outdoors.
• Getting regular exercise: Exercising regularly can strengthen your bones, lower the risk of heart attack, and enhance overall well-being.
• Avoid smoking: Smoking raises the possibility of developing cardiovascular disease. It could also exacerbate lupus effects on the blood vessels, and heart.
• Eating a healthy diet: Always consume a healthy diet rich in vegetables, fruits, and whole grains. However, try to be careful of any dietary restrictions particularly for people with kidney damage, high blood pressure, and gastrointestinal disorders.
• Inquiring if you require vitamin D and calcium supplements: Some research states that individuals with lupus are likely to benefit from vitamin D supplements. Supplemental calcium can also aid in meeting your everyday recommended dietary allowance of 1,000 to 1,200 milligrams, based on your age, to maintain bone health.

Coping and Support

People with lupus are likely to experience a range of emotions, from fear to intense frustration. The difficulties of living with such a condition increase the likelihood of depression and associated mental health issues like stress, anxiety, and low self-esteem.

To cope better, consider the following strategies:

• Learn everything about lupus: Note down questions as they happen to you and discuss them with your doctor during your next visit. Also, inquire about reliable sources where you can get more information from your caregivers. This is because the more informed you are, the more confident you will be in your treatment options.
• Get support from friends and family: Talk to your friends and family about lupus, and inform them how they can help during flare-ups. Living with lupus can be infuriating to your loved ones, as they often don’t notice it, and you might seem okay to them. This means that unless you explain it to them, they won’t know if you are going through a good or bad day. It’s thus important to be open regarding your feelings so others are aware of what to expect.
• Take time for yourself: Manage stress by taking time for self-care and instead use this moment to meditate, read, write a journal, or listen to music. You can also engage in activities that help calm and rejuvenate you.
• Connect with people diagnosed with lupus: Reach out to others who have lupus by connecting through support groups within your community or via online forums. Talking to individuals facing similar challenges can provide unique support and understanding.

What to Expect from Your Doctor

During your visit, the doctor can ask you several questions about your condition. Therefore, being prepared to answer them might provide you extra time to discuss any other concerns you may have. The questions may include:

• Do you develop skin rashes from sun exposure?
• Does the cold cause your fingers to turn pale, become numb or uncomfortable?
• Does your symptoms involve any issues with memory or attentiveness?
• To what extent do your symptoms restrict your ability to perform at school, work, or in individual relationships?
• Have you had a diagnosis for any other health conditions?
• Are you currently pregnant, or do you plan to conceive?