Lupus

What is lupus?

From: MedlinePlus, National Library of Medicine

Lupus is a chronic (long-lasting) type of autoimmune disease. Autoimmune diseases happen when your immune system attacks healthy cells and tissues by mistake. This attack causes inflammation. It can also damage many parts of the body, including the joints, skin, kidneys, heart, lungs, and brain.

There are several types of lupus:

• Systemic lupus erythematosus (SLE) is the most common type. It can be mild or severe and can affect many parts of the body.
• Cutaneous lupus affects the skin. It causes a rash or sores, usually after your skin is exposed to sunlight. The two major types of cutaneous lupus are discoid lupus and subacute cutaneous lupus.
• Drug-induced lupus is caused by a reaction to some medicines. The symptoms may start 3 to 6 months after starting the medicine. The symptoms usually go away when you stop taking the medicine.
• Neonatal lupus, which is rare, affects newborns. It is caused by certain antibodies that are passed from the pregnant mother to the fetus.

What causes lupus?

From: MedlinePlus, National Library of Medicine

The cause of lupus is unknown. Researchers are studying what might cause or trigger the disease, such as:

• Genetics
• Environmental factors, such as viral infections, sunlight, certain medicines, and smoking
• Problems with the immune system

Who is more likely to get lupus?

From: MedlinePlus, National Library of Medicine

Anyone can get lupus, but women get it much more often than men.

Lupus is more common in African Americans than in White people. It is also more common in people of American Indian and Asian descent. African American and Hispanic women are more likely to have severe forms of lupus.

What are the symptoms of lupus?

From: MedlinePlus, National Library of Medicine

Lupus can have many symptoms, and they differ from person to person. Some of the more common ones are:

• Arthritis, causing painful and swollen joints and morning stiffness
• Fever
• Fatigue or feeling tired often
• Red rash, most often on the face (also called the "butterfly rash")
• Chest pain when taking a deep breath
• Hair loss
• Pale or purple fingers or toes, from cold and stress (Raynaud phenomenon)
• Sensitivity to the sun
• Swelling in legs or around eyes
• Mouth ulcers
• Swollen glands
• Headache and dizziness
• Confusion and memory problems

Symptoms may come and go. When you are having symptoms, it is called a flare. Flares can range from mild to severe. New symptoms may appear at any time.

What other problems can lupus cause?

From: MedlinePlus, National Library of Medicine

Lupus causes inflammation throughout your body. This can cause problems in your organs, including:

• Kidney damage (lupus nephritis).
• Heart problems, including inflammation in the heart (myocarditis), heart valves, or lining of the heart muscle (pericarditis).
• Inflammation of blood vessels (vasculitis).
• Blood clots
• Inflammation of the tissue that surrounds the lungs (pleurisy). This can make it painful to breathe.

Some people with lupus may be more likely to develop other conditions, such as coronary artery disease (CAD) and atherosclerosis.

How is lupus diagnosed?

From: MedlinePlus, National Library of Medicine

There is no specific test for lupus, and it's often mistaken for other diseases that cause similar symptoms. So it may take a while to get a diagnosis. To find out if you have lupus, your health care provider:

• Will ask about your symptoms, medical history, and family health history
• Will do a complete physical exam
• May order blood tests, such as ANA (antinuclear antibody), antibodies, complete blood count, and complement tests
• May order other tests, such as urine tests
• May do biopsies: Skin biopsy (looking at skin samples under a microscope) Kidney biopsy (looking at tissue from your kidney under a microscope)

What are the treatments for lupus?

From: MedlinePlus, National Library of Medicine

There is no cure for lupus, but medicines and lifestyle changes can help control it.

People with lupus often need to see different providers. You will most likely have a primary care provider and a rheumatologist (a doctor who specializes in autoimmune and other diseases of the bones, joints, and muscles). Which other specialists you may need depend on how lupus affects your body. For example, if lupus is damaging your heart or blood vessels, you would see a cardiologist (a doctor who specializes in heart diseases).

Your primary care provider should coordinate care between all of your other providers and treat other problems as they come up. You and your primary care provider will develop a treatment plan to fit your needs. You will both review the plan often to make sure that it is working. You should report new symptoms to your provider right away so that your treatment plan can be changed, if needed.

The goals of a treatment plan are to:

Treatments may include drugs to:

Newer medicines are now available for some types of lupus, including lupus that affects the kidneys. These medicines work by targeting specific parts of the immune system. Besides taking medicines for lupus, you may need to take medicines for problems that are related to lupus such as high cholesterol, high blood pressure, or infections.

Alternative and complementary therapies are therapies that are not part of standard treatments. Some people try alternative and complementary therapies to improve their lupus symptoms. But research has not clearly shown whether these treatments may help or treat lupus. Talk to your provider before trying any new treatments.

Researchers are also studying treatments, such as CAR-T cell therapy, for lupus that hasn't improved with other medicines. New treatments like this are usually only available by joining a research study, until they're approved for general use.

• Prevent flares
• Treat flares when they occur
• Reduce organ damage and other problems
• Improve your quality of life
• Reduce fever, swelling, and pain
• Reduce inflammation in your body
• Prevent or reduce flares
• Reduce or prevent damage to joints
• Suppress (lower) the activity of your immune system

How can I cope with lupus?

From: MedlinePlus, National Library of Medicine

It is important to take an active role in your treatment. It helps to learn more about lupus - being able to spot the warning signs of a flare can help you prevent the flare or make the symptoms less severe.

It is also important to find ways to cope with the stress of having lupus. Exercising and finding ways to relax may make it easier for you to cope. A good support system can also help.

Which doctor should you see?

The suggested department for discussing Lupus is Rheumatology, with a rheumatologist as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• Are the findings inflammatory, structural or due to another mechanism?
• Is there evidence that other organs need assessment?
• How will function and any treatment-related risks be monitored?

Treatment discussions and follow-up

Where the source describes treatments, these are an overview of possible care, not a prescription for an individual. Ask which option applies to the confirmed diagnosis, what benefit is expected, what adverse effects to watch for and how progress will be assessed. Availability, approvals and local practice can differ from the country described in the source.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.