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1. Types
2. Causes
3. Risk factors
4. Symptoms
5. Video
6. Classification: 11 symptoms
7. Diagnosis
9. Outlook
The Foundation say that lupus affects women in particular, and it is most likely
to appear between the ages of 15 and 44 years.
Lupus gained public attention in 2015 after the singer Selena Gomez
announced she received a diagnosis in her late teens and underwent
treatment for the condition.
However, in rare cases, women with lupus may give birth to children who
develop a form of lupus. This is called neonatal lupus.
Types
There are different kinds of lupus. This article will focus mainly on systemic
lupus erythematosus (SLE), but other types include discoid, drug-induced,
and neonatal lupus.
It is more severe than other types of lupus, such as discoid lupus, because it
can affect any of the body's organs or organ systems. It can
cause inflammation in the skin, joints, lungs, kidneys, blood, heart, or a
combination of these.
This condition typically goes through cycles. At times of remission, the person
will have no symptoms. During a flare-up, the disease is active, and
symptoms appear.
The raised areas may become thick and scaly, and scarring may result. The
rash may last from a number of days to several years, and it may recur.
DLE does not affect the internal organs, but around 10 percent of people with
DLE will go on to develop SLE, according to the Lupus Foundation of
America. It is not clear, however, if these individuals already had SLE and just
showed clinical signs on the skin or if there is a progression from DLE or SLE.
Drug-induced lupus
In around 10 percent of people with SLE, symptoms occur because of a
reaction to certain prescription drugs. According to Genetics Home Reference,
some 80 drugs may cause the condition.
These include some of the drugs that people use to treat seizures and high
blood pressure. They also include some thyroid medications, antibiotics,
antifungals, and oral contraceptive pills.
Drugs that are commonly associated with this form of lupus are:
Neonatal lupus
Most babies born to mothers with SLE are healthy. However, around 1
percent of women with autoantibodies relating to lupus will have a baby with
neonatal lupus.
At birth, babies with neonatal lupus may have a skin rash, liver problems, and
low blood counts. Around 10 percent of them will have anemia.
The lesions usually go away after a few weeks. However, some infants have a
congenital heart block, in which the heart cannot regulate a normal and
rhythmic pumping action. The infant may need a pacemaker. This can be a
life-threatening condition.
Causes
Lupus is an autoimmune condition, but the exact cause is unclear.
As a result, the immune system directs antibodies against both the healthy
tissue and the antigens. This causes swelling, pain, and tissue damage.
The most common type of autoantibody that develops in people with lupus is
an antinuclear antibody (ANA). The ANA reacts with parts of the cell's
nucleus, the command center of the cell.
These autoantibodies circulate in the blood, but some of the body's cells have
walls permeable enough to let some autoantibodies through.
The autoantibodies can then attack the DNA in the nucleus of these cells. This
is why lupus affects some organs and not others.
Some genes in the body help the immune system to function. In people with
SLE, changes in these genes may stop the immune system from working
properly.
One possible theory relates to cell death, a natural process that occurs as the
body renews its cells, according to Genetics Home Reference.
Some scientists believe that, due to genetic factors, the body does not get rid
of cells that have died.
These dead cells that remain may release substances that cause the immune
system to malfunction.
1) Hormones
Hormones are chemical substances that the body produces. They control and
regulate the activity of certain cells or organs.
Sex: The U.S. National Institutes of Health note that females are nine
times more likely to have lupus than males.
Age: Symptoms and diagnosis often occur between the ages of 15 and 45
years, during the childbearing years. However, 20 percent of cases appear
after the age of 50 years, according to Genetics Home Reference.
There is not enough evidence to confirm that estrogen causes lupus. If there
is a link, estrogen-based treatment could regulate the severity of lupus.
However, more research is necessary before doctors can offer it as a
treatment.
2) Genetic factors
Researchers have not proved that any specific genetic factor causes lupus,
although it is more common in some families.
Genetic factors may be the reason why the following are risk factors for lupus:
Race: People of any background can develop lupus, but it is two to three
times more common in people of color, compared with the white population. It
is also more common in Hispanic, Asian, and Native American women.
If one member of a twin pair has lupus, the other has a 25-percent chance of
developing the disease, according to a study published in Seminars in Arthritis
and Rheumatism in 2017. Identical twins are more likely to both have the
condition.
Lupus can happen in people with no family history of the disease, but there
may be other autoimmune diseases in the family. Examples include thyroiditis,
hemolytic anemia, and idiopathic thrombocytopenia purpura.
Some have proposed that changes in the x-chromosomes might affect the
risk.
3) Environment
Environmental agents — such as chemicals or viruses — may contribute to
triggering lupus in people who are already genetically susceptible.
Viral infections: These may trigger symptoms in people who are prone to
SLE.
Lupus is not contagious, and a person cannot transmit it sexually.
Gut microbiota
Recently, scientists have been looking at gut microbiota as a possible factor in
the development of lupus.
Infants with neonatal lupus may have a higher chance of developing another
autoimmune disease later in life.
Symptoms
The symptoms of lupus occur in times of flare-ups. Between flare-ups, people
usually experience times of remission, when there are few or no symptoms.
fatigue
mouth ulcers
fever
headaches
arthritis
Lupus affects people in different ways. Symptoms can occur in many parts of the body.
Kidneys: Inflammation of the kidneys (nephritis) can make it difficult for the
body to remove waste products and other toxins effectively. Around 1 in 3
people with lupus will have kidney problems.
Central nervous system: Lupus can sometimes affect the brain or central
nervous system. Symptoms include headaches, dizziness, depression,
memory disturbances, vision problems, seizures, stroke, or changes in
behavior.
Other complications
Having lupus increases the risk of a number of health problems.:
Infection: Infection becomes more likely because both lupus and its
treatments weaken the immune system. Common infections include urinary
tract infections, respiratory infections, yeast infections, salmonella, herpes,
and shingles.
Bone tissue death: This occurs when there is low blood supply to a bone.
Tiny breaks can develop in the bone. Eventually, the bone may collapse. It
most commonly affects the hip joint.
Video
The following video explains how lupus causes symptoms.
Classification: 11 symptoms
The American College of Rheumatology use a standard classification scheme
to confirm a diagnosis.
If a person meets 4 out of 11 criteria, a doctor will consider that they may have
lupus.
Non-erosive arthritis: This does not destroy the bones around the joints,
but there is tenderness, swelling, or effusion in 2 or more peripheral joints.
Kidney disorder: Tests show high levels of protein or cellular casts in the
urine if a person has a kidney problem.
Neurologic disorder: The person has seizures, psychosis, or problems
with thinking and reasoning.
Positive ANA: The test for ANA is positive, and the person has not used
any drugs that might induce it.
However, even this system sometimes misses early and mild cases.
Underdiagnosis can occur because the signs and symptoms of lupus are not
specific.
On the other hand, some blood tests can lead to overdiagnosis, because
people without lupus can have the same antibodies as those with the
condition.
Diagnosis
A blood test can help to diagnose lupus.
Diagnosis can be difficult because of the varied symptoms that may resemble
symptoms of other illnesses.
The doctor will ask about symptoms, carry out a physical examination, and
take a personal and family medical history. They will also consider the 11
criteria mentioned above.
The doctor may request some blood tests and other laboratory investigations.
Biomarkers
Biomarkers are antibodies, proteins, genetic, and other factors that can show
a doctor what is happening in the body or how the body is responding to
treatment.
They are useful because they can indicate if a person has a condition even
when there are no symptoms.
Blood tests
Blood tests can show whether certain biomarkers are present, and biomarkers
can give information about which autoimmune disease, if any, a person has.
1) Antinuclear antibody
Around 95 percent of people with lupus will have a positive result in the ANA
test. However, some people test positive for ANA, but they do not have lupus.
Other tests must confirm the diagnosis.
2) Antiphospholipid antibodies
Antiphospholipid antibodies (APLs) are a type of antibody directed against
phospholipids. APLs are present in up to 50 percent of people with lupus.
People without lupus can also have APLs.
A person with APLs may have a higher risk of blood clots, stroke, and
pulmonary hypertension. There is also a higher risk of pregnancy
complications, including a loss of pregnancy.
Around 70 percent of people with lupus have an antibody known as the anti-
DNA antibody. The result is more likely to be positive during a flare-up.
4) Anti-dsDNA antibody
If the test is positive, it may mean that a person has a more serious form of
lupus, such as lupus nephritis, or kidney lupus.
5) Anti-Smith antibody
6) Anti-U1RNP antibody
Around 25 percent of people with lupus have anti-U1RNP antibodies, and
fewer than 1 percent of people without lupus have them.
Between 30 and 40 percent of people with lupus have anti-Ro/SSA and anti-
La/SSB antibodies. These also occur with primary Sjögren's syndrome and in
people with lupus who test negative for ANA.
They are present in small amount in about 15 percent of people without lupus,
and they can occur with other rheumatic conditions, such as rheumatoid
arthritis.
If a mother has anti-Ro and anti-La antibodies, there is a higher chance that a
baby born to her will have neonatal lupus.
A person with lupus who wishes to become pregnant have tests for these
antibodies.
8) Anti-histone antibodies
Antibodies to histones are proteins that play a role in the structure of DNA.
People with drug-induced lupus usually have them, and people with SLE may
have them. However, they do not necessarily confirm a diagnosis of lupus.
A serum complement test measures the levels of proteins that the body
consumes when inflammation takes place.
If a person has low complement levels, this suggests that inflammation is
present in the body and that SLE is active.
Urine tests
Urine tests can help to diagnose and monitor the effects of lupus on the
kidneys.
The presence of protein, red blood cells, white blood cells, and cellular casts
can all help to show how well the kidneys are working.
For some tests, only one sample is necessary. For others, the person may
need to collect samples over 24 hours.
Tissue biopsies
The doctor may also request biopsies, usually of the skin or kidneys, to check
for any damage or inflammation.
Imaging tests
X-rays and other imaging tests can help doctors see the organs affected by
lupus.
Monitoring tests
Ongoing tests can show how lupus continues to affect a person or how well
their body is responding to treatment.
balance hormones
control cholesterol
The exact treatment will depend on how lupus affects the individual. Without
treatment, flares can occur that may have life-threatening consequences.
Apart from medication, the following may helpto relieve pain or reduce the risk
of a flare:
applying heat and cold
Outlook
In the past, people who had a diagnosis of lupus would not usually survive for
more than 5 years.
As scientists learn more about genetics, doctors hope that one day they will
be able to identify lupus at an earlier stage. This will make it easier to prevent
complications before they occur.
Sometimes people choose to join a clinical trial, as this can give access to
new medications. To find out more about clinical trials click here.