Lupus

Systemic Lupus Erythematosus, also known as SLE, or simply lupus, is characterized by periodic episodes of inflammation of and damage to the joints, tendons, other connective tissues, and organs, including the heart, lungs, blood vessels, brain, kidneys, and skin. The heart, lungs, kidneys, and brain are the organs most affected. Lupus affects each individual differently, and the effects of the illness range from mild to severe. Lupus can potentially be fatal.

The majority of people who have lupus are young women in their late teens to mid-40s. This may be due to the fact that the hormone estrogen seems to be associated with lupus. Lupus affects more African-Americans, Asian Americans, Latinos, and Native Americans than Caucasian Americans. In children, lupus occurs most often at the age of 15 and older. About 25,000 children and adolescents have lupus or a related disorder, according to the Arthritis Foundation.

The disease is known to have periods of flare-ups and periods of remission, when patients experience a partial or complete lack of symptoms. The severity of the kidney involvement can alter the survival rate of patients with lupus. In some cases, severe kidney damage leads to kidney failure.

Symptoms of Lupus

Lupus symptoms are usually chronic and relapsing. Each patient experiences symptoms differently, but the following are the most common:

• Anemia
• Discoid rash: A raised rash found on the head, arms, chest, or back
• Fever
• Inflammation of the joints
• Fluid around the lungs, heart, or other organs
• Hair loss
• Kidney problems
• Low white blood cell or low platelet count
• Malar rash: A rash shaped like a butterfly usually found on the bridge of the nose and the cheeks
• Mouth ulcers
• Nerve or brain dysfunction
• Raynaud's phenomenon: A condition in which the blood vessels of the fingers and toes go into spasms when triggered by factors such as cold, stress, or illness
• Sunlight sensitivity
• Weight loss

Evaluation

Lupus is difficult to diagnose because of the vagueness of the symptoms each person might have.

There is no cure for lupus. At UT Southwestern Medical Center, our physicians will evaluate your complete medical history, reported symptoms, and perform a physical examination that may include numerous diagnostic tools including blood and urine tests and X-rays. 

The evaluation may also include:

• Blood test: To detect certain antibodies that are present in most people with lupus
  
• Blood and urine: To assess kidney function
  
• Complement test: To measure the level of complement, a group of proteins in the blood that help destroy foreign substances; low levels of complement in the blood are often associated with lupus
  
• C-reactive protein (CRP): A protein that is elevated when inflammation is found in the body. Although ESR and CRP reflect similar degrees of inflammation, sometimes one will be elevated when the other is not. This test may be repeated to test your response to medication.
  
• Erythrocyte sedimentation rate (ESR): A measurement of how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. Thus, when measured, they fall and settle faster at the bottom of the test tube. Generally, the faster the blood cells fall, the more severe the inflammation.
  
• X-rays: A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film
  

Your physician will then determine your specific treatment based on:

• Your age, overall health, and medical history
• Extent of the condition
• Your tolerance for specific medications, procedures, and therapies
• Expectation for the course of the disease
• Specific organs that are affected
• Your opinion or preference

Treatments

If lupus symptoms are mild, treatment may not be necessary, other than possibly nonsteroidal anti-inflammatory medications (NSAIDs) for joint pain. Other treatment may include:

• Corticosteroids (to control inflammation)
• Hydroxychloroquine, quinacrine, chloroquine, or a combination of these medications
• Immediate treatment of infections
• Immunosuppressive medication (to suppress the body's autoimmune system)
• Liberal use of sunscreen, decreased time outdoors between 10 a.m. and 4 p.m., wearing hats and long sleeves when outdoors
• Rest, including at least eight to 10 hours of sleep at night; naps and breaks during the day
• Stress reduction
• Well-balanced diet