Systemic Lupus Erythematosus

What is lupus?

Systemic Lupus Erythematosus, known as lupus or S.L.E. for short is a connective tissue disease, which means it affects tissues throughout the body. Lupus commonly affects the skin, joints, heart, kidneys, lungs and occasionally the brain.

The name of the disease in Latin means wolf, this is because of the red rash that most people develop across the bridge of their nose and cheeks.

There is another form of lupus called Discoid Lupus Erythematosus (D.L.E.), which usually only affects the skin. This type is less serious and causes itchy red patches or lesions on the skin. These rashes usually occur on the face and neck but can appear on the palms of hands, soles of feet, scalp, elbows and fingertips.

Lupus mainly affects women of childbearing age (between 18 and 50), though on rare occasions men and children can also be affected. Lupus is not contagious.

What causes lupus?

Lupus is an autoimmune disease, which means there is a fault in the body's immune system. Normally, the body produces certain chemicals called antibodies, which help the body fight infections, such as viruses. However, if you have an autoimmune disease, your body's immune system attacks its own cells and tissues. In lupus these antibodies, known as auto-antibodies are produced in large amounts causing the inflammation of tissues throughout the body.

Scientists don't know what actually causes lupus, however, the following may play some role in triggering its development or triggering off another attack:

• Viral infections.
• Woman's hormonal changes, such as puberty or the menopause
• Severe stress.
• Excessive sunlight.
• Long term use of certain drugs, for example Hydralazine used to treat high blood pressure.

What are the symptoms of lupus?

The symptoms of lupus vary in each person and they will also depend upon which organs in the body are affected. The symptoms of lupus may come and go and might include any of the following:

• Skin rashes, especially one across the nose and cheeks. This rash is usually painless and might be aggravated by sunlight.
• Ulcers that don't always cause pain, inside the mouth or nose.
• Pain or swelling in the joints. The knees, elbows, wrists, hands and ankles are the joints most commonly affected. Most people with lupus will suffer joint pain.
• Hair loss (alopecia).
• Fever.
• Headaches.
• Sensitivity to sunshine.
• Sjögren's syndrome - which causes dry eyes and a dry mouth.
• Raynaud's phenomenon - which causes poor circulation in the hands and toes making them feel feel numb and change colour (blue) in the cold weather.
• Miscarriage - one specific and important cause of this is 'sticky blood' also known as Hughes Syndrome (click here for more information on Hughes syndrome).
• Anaemia
• Fatigue.
• Depression.
• Loss of appetite.

Lupus can be a serious disease causing inflammation and damage to the joints, skin and major organs, such as the heart, lungs and kidneys. If lupus is severe the kidneys can become inflamed, this rarely causes any pain, though you may experience high blood pressure. If left untreated the inflammation can cause kidney failure. If the lining of internal organs, such as the heart and lungs become inflamed you may experience sharp chest pains, shortness of breath and coughing. On rare occasions the brain tissue can be affected and this can cause personality changes, seizures or even a stroke.

How is lupus diagnosed?

As lupus has many different symptoms and can resemble other illnesses, such as rheumatoid arthritis and multiple sclerosis it can be hard to diagnose. Your doctor will examine your medical history and then you may be required to have a number of tests. As the rash across the face is a common symptom of lupus, you will probably be asked if you have had any rashes.

Tests that you might have include blood tests, chest x-rays and you may have to give a urine sample, to check for any damage to the kidneys. You may also be required to have a kidney biopsy. The blood tests measure the amount of auto-antibodies in your blood and will detect 90% of people suffering with lupus, the antibodies are called:

• Antinuclear antibody (ANA) - this is a simple test but is not specific for lupus.
• DNA antibodies - this blood test is specific for lupus, the presence of these antibodies are the hallmark of lupus and are rarely found in any other condition.
• Antiphospholipid antibodies - this test is associated with Hughes syndrome and patients with high levels will have an increased tendency of clotting in the veins and arteries (thrombosis).

How is lupus treated?

For most people, lupus will be just a mild disease affecting only a few organs but for some it can be quite serious. There is no actual cure for lupus, however, there is a large range of treatments available to reduce inflammation and so helping relieve symptoms.

Drugs used in the treatment of lupus may include, non-steroidal anti-inflammatory drugs (N.S.A.I.D.s) to reduce inflammation around the joints and relieve pain and corticosteroids. Corticosteroids, relieve the inflammation of internal organs and so prevent them from becoming damaged. Corticosteroids may be taken as tablets or in severe cases can be given via injection directly into the veins. If you have skin rashes you may also be prescribed a steroid cream. There are other types of drugs available, such as antimalarial tablets, your doctor will discuss all options with you.

If you have lupus you should avoid excessive sun exposure as ultraviolet light can make the disease worse. Once treated, the majority of people with lupus can lead relatively normal lives.