Lupus is an autoimmune disease, which means the body’s immune system attacks its own tissues and organs. The most common form is systemic lupus erythematosus (SLE), which accounts for approximately 70 percent of lupus cases. SLE is what many people think of when they hear the word “lupus.” The other three main types are cutaneous lupus erythematosus, neonatal lupus, and drug-induced lupus.
The word “systemtic” in “systemic lupus erythematosus” means the condition can affect the entire body, causing inflammation and tissue damage in multiple organs or organ systems. SLE often affects the skin, joints, brain, lungs, heart, nervous system, and blood vessels. The more severe complications of the disease include kidney inflammation or damage, which is called lupus nephritis.
SLE is a complex and chronic disease that affects everyone differently. It can be mild or life-threatening. Although there’s no cure for SLE, treatments are available to help manage the symptoms. This article discusses four things to know about the demographics, symptoms, diagnosis, and treatment of SLE.
Although there’s no definitive cause of lupus, the most significant risk factor for developing SLE is being female. Approximately 90 percent of adults with lupus are women, according to the Lupus Foundation of America. Per the foundation, you have the highest risk of developing SLE if you are:
Having some or all of these characteristics does not mean you will develop SLE. It just means you have a higher risk than the general population. SLE also runs in families. If you have a first-degree relative (parent, sibling, or child) living with SLE, you have a greater risk of developing it than people with no family connection.
Environmental factors such as sun exposure, smoking, and viral infections are also suspected of causing or triggering SLE.
The risk of receiving an SLE diagnosis increases during the childbearing years, according to the Centers for Disease Control and Prevention (CDC). However, people of color are disproportionately affected: Lupus is two to three times more prevalent among African American, Hispanic/Latina, Asian American, Native American, Alaska Native, Native Hawaiian, and other Pacific Islander women compared with white women, according to the Lupus Foundation of America.
SLE affects 1 in 537 Black females, according to a study published in Arthritis & Rheumatology. The researchers also determined that:
The symptoms of SLE vary from person to person, may be worse on some days than others, and can change over time.
Common symptoms include:
Lupus symptoms can also include headaches, depression, chest pain, heart disease, shortness of breath, seizures, swollen glands, blood cell abnormalities, anemia, sensitivity to sun exposure, and more.
Some symptoms of SLE mimic those of other illnesses, like certain types of cancer, rheumatoid arthritis, and cardiovascular disease. These similarities can make diagnosing SLE challenging.
If you notice any changes to your health, you may want to write down a description of what you are feeling, including when and how often it occurs. Detailed notes can help your health care provider determine an accurate diagnosis or refer you to a rheumatologist for further testing.
The first step in accurately diagnosing SLE involves a physical exam. Your doctor should ask about your medical history, family history, and any recent changes to your health. Depending on the signs and symptoms you are experiencing, your primary care doctor may refer you to someone who specializes in rheumatology or dermatology.
No single blood test or imaging test can provide a definitive SLE diagnosis. If your doctor suspects SLE based on the physical exam, they’ll likely order tests to help confirm SLE or rule out other diseases. Your doctor may order:
The blood tests may include autoantibody panels. The results must be interpreted in the context of your symptoms and physical exam, so it’s important that you discuss all results with your provider.
If you are diagnosed with SLE, your care team will likely include your primary care physician and a rheumatologist. Depending on your needs, you may see other doctors who treat SLE, including a nephrologist (a specialist in kidney disease) or a cardiologist — SLE is associated with a higher risk of heart disease.
Although there is no cure for SLE, researchers continue to develop new therapies to help manage symptoms, improve quality of life, and prevent organ damage. The treatment plan you and your doctor decide on together will depend on factors such as your:
Your doctor might recommend SLE treatment options such as antimalarials, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and immunosuppressants.
Medications developed to treat malaria are commonly used to treat SLE, too. Antimalarials reduce the level of antibodies produced by the immune system in people with lupus. Antibodies are proteins in the blood that attack healthy cells and tissues and cause inflammation, pain, and other SLE symptoms.
You may have used aspirin, ibuprofen (Motrin), or naproxen to treat pain, swelling, or a fever. These are nonsteroidal anti-inflammatory drugs, and they can be used to treat those same symptoms in people with SLE. NSAIDs block the production of certain chemicals that cause inflammation.
Corticosteroids can help reduce pain and inflammation. Also called steroids, these drugs suppress the immune system and overactive white blood cells. Depending on the types of symptoms you are experiencing, your doctor may prescribe corticosteroids that are taken orally (by mouth), given intravenously (through a vein), or applied topically (on your skin). Steroids are usually used short term and as a bridge to mainstay therapy.
Your doctor may recommend immunosuppressants, which help stop your immune system from attacking healthy tissues. Doctors may prescribe immunosuppressants to treat SLE if they suspect kidney problems or potential damage to the brain, heart, lungs, or other organs.
A newer class of drugs called biologics is also being used to treat SLE. These drugs suppress specific parts of the immune system rather than the entire system, and they can be effective at slowing or stopping inflammation and joint or organ damage. Biologics are a subclass of disease-modifying antirheumatic drugs (DMARDs), which also include antimalarials.
SLE and the medications used to treat it can cause blood clots, osteoporosis (brittle bones), and other health issues. Your treatment plan may also include drugs such as blood thinners, cholesterol medications, thyroid medications, and antidepressants.
It can take several attempts to find a medication combination that works for you, so try to be patient. You may also need to periodically change medications or adjust dosages to keep up with changing or worsening symptoms, especially during flare-ups, when symptoms are at their worst. Be sure to tell your doctor about any side effects you experience. And, if you have any questions about the drugs you are taking, ask.
A lupus diagnosis can be life-changing, but help is available, and you are not alone. Find a doctor you trust, research the disease, and consider joining a support group or finding other ways to connect with those who are on a similar journey.
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