The many faces of lupus

One person may suffer kidney dysfunction, while another complains of stiff, swollen joints. A third person develops a butterfly-shaped rash across the nose and cheeks. Very different symptoms, yet a medical workup determines that all 3 people have the same disease: systemic lupus erythematosus, commonly called lupus.

Lupus is a chronic inflammatory disease that affects mostly women between the ages of 15 and 45. Its symptoms mimic those of other conditions. It may come on suddenly or unfold over time, and its impact may be mild or severe. Indeed, no 2 people experience lupus in the same way. In each case, however, lupus starts out as a mistake by the body’s immune system.

Mistaken identity

Like rheumatoid arthritis, lupus is an autoimmune disease. The immune system misreads its own molecules as foreign and turns against healthy tissue. Antibodies—proteins that serve as the immune system’s foot soldiers—attack certain parts of a cell, forming complexes that travel to tissues throughout the body, where they set off inflammation. Chronic inflammation damages organs and disrupts their functioning.

Scientists aren’t certain why the immune system goes haywire, but a person’s genes are likely to play a role. The body’s poor disposal of dying cells may set off an immune reaction. Other factors—such as sunlight, infection, and the female hormone estrogen—are believed to act as triggers in susceptible individuals. In addition, long-term use of certain drugs may have an influence.

A diagnostic dilemma

Because there’s no definitive test for lupus, and because its symptoms may suggest other diseases, it’s not unusual for several years to pass before a person with lupus is correctly diagnosed. Among the problems that beset people with lupus are unexplained fever, weight loss, and fatigue; ulcers in the mouth or nose; rashes and skin sensitivity to sunlight; kidney problems; inflammation of the lining of the heart or lungs; seizures; and arthritis in 2 or more joints.

If your doctor suspects that you have lupus, you’ll be referred to a rheumatologist, a physician who specializes in arthritis and autoimmune disorders. Blood and urine tests may detect abnormalities typical of lupus, signs of kidney or liver dysfunction, or antibodies that suggest an immune system gone awry.

Depending on your symptoms, other tests may be needed, including x-rays to look for fluid buildup in the heart or lungs, an electrocardiogram to identify abnormal heart rhythms, and biopsies of tissue from affected organs.

Tailored treatment

Treatment is aimed mainly at relieving an individual’s symptoms. To control pain and inflammation, your doctor may suggest a non-steroidal anti-inflammatory drug such as ibuprofen (e.g., Advil, Motrin) or prescribe a corticosteroid such as prednisone. Hydroxychloroquine (Plaquenil), an anti-malaria drug, is often used to control rashes, fatigue, and joint symptoms, and to prevent flares of the disease. If symptoms are severe, drugs that suppress immune function, such as azathioprine (Imuran) or methotrexate (Rheumatrex), may be needed.

Another goal of treatment is to prevent complications, caused either by lupus or the drugs used to treat it. Complications include high blood pressure, high cholesterol, blood clots, and osteoporosis. A woman who plans to become pregnant should work closely with her doctor to minimize the risks to her fetus and herself.

What you can do

If you learn to recognize what sparks a flare-up of lupus symptoms, you’ll be better able to avoid the triggers. In addition, use SPF-15 or higher sunscreen to protect your skin from ultraviolet light. And find a relaxation technique, such as yoga, that can help you deal with stress. Stop smoking and limit alcohol to prevent further harm to tissues already damaged by the disease.

Take steps to keep yourself generally healthy, with a balanced diet, a good night’s sleep, and naps or relaxation breaks during the day as needed. Although people with lupus are prone to fatigue, regular exercise is important. A study of women with lupus found that those who engaged in cardiovascular training for 12 weeks improved their aerobic capacity and scored better on measures of fatigue, depression, and quality of life than a control group.

From Scientific American and Arthritis & Rheumatism (Arthritis Care & Research)