Lupus 101

What is lupus? Lupus is a chronic inflammatory disease that can target your joints, skin, brain, kidneys, blood cells, heart and lungs. Ninety percent of people affected are women. For reasons that aren't clear, lupus develops when the immune system attacks your body's own tissues and organs.

In people with lupus, the immune system loses its ability to distinguish between foreign substances, called antigens, and the body's own cells and tissue. The immune system then makes proteins, called antibodies, that are directed against “self” which causes inflammation.

Three main types of lupus exist — systemic lupus erythematosus (SLE), discoid lupus erythematosus and drug-induced lupus. Of these, SLE is the most common and serious form of the disease, frequently causing swollen, painful joints, skin rash, extreme fatigue and kidney damage. In rare cases, mothers can pass antibodies to their babies during childbirth (neonatal lupus erythematosus), though the mothers themselves usually show no signs of lupus.

What causes lupus? Researchers do not know fully understand the exact causes of lupus. However, lupus is NOT infectious.

While researchers believe there is a genetic predisposition to the disease, it is known that certain environmental factors, such as infections, antibiotics, ultraviolet light, extreme stress, certain drugs, and hormones, also play a role in triggering lupus. Hormonal factors may explain why lupus occurs more frequently in females than in males.

Although lupus is known to occur in families, researchers have not identified a specific gene or genes believed responsible for the disease.

Risk factors: Although anyone can develop lupus at any age, common risk factors include:

• Your sex. Women account for the vast majority of lupus cases and are approximately nine times as likely to develop the disease as men are.
• Age. Although lupus affects people of all ages, including infants and children, it's most often diagnosed between the ages of 15 and 45.
• Race. African Americans are at increased risk of developing lupus. They also tend to develop lupus at a younger age and have more serious complications. Researchers don't know the reason why, but in studies, African Americans were found to have many more recurrent Epstein-Barr virus infections. Hispanics, Asians and Native Americans also are at higher risk of developing lupus.
• Family history. Having a relative who has lupus increases your odds of developing the disease.
• Infection with the Epstein-Barr virus. Almost everyone has been infected with the Epstein-Barr virus, a member of the herpes family and one of the most common human viruses. Once the initial infection, which is usually marked by nonspecific symptoms such as fever and sore throat, subsides, the virus remains dormant in the cells of your immune system unless something reactivates it. For reasons that aren't clear, recurrent Epstein-Barr infections seem to greatly increase the chances of developing lupus.
• Pregnancy. Lupus sometimes shows up for the first time during pregnancy or shortly after giving birth. The disease may also flare after a woman who already has lupus gives birth.

Am I at a higher risk for developing lupus because of race or ethnicity? Lupus affects people of all racial and ethnic groups. However, there are disparities between groups. Lupus is two to three times more prevalent among people of color, including African Americans, Hispanics, Asians, and Native Americans, and this disparity remains unexplained.

When should you seek medical advice? If you develop an unexplained rash, ongoing fever, persistent aching or fatigue, see your doctor. If you've already been diagnosed with lupus, meet with your doctor on a regular basis so that your condition and treatment can be monitored. And because people who have lupus can experience different symptoms at different times, see your doctor immediately if new symptoms arise, especially if they include any of the following:

• Blood in your stool
• Severe abdominal pain
• Chest pain from pleurisy or pericarditis
• Seizures
• New fever or a fever much higher than it usually is
• Unusual bruising or bleeding anywhere on your body
• A severe headache with neck pain and fever

When these or other symptoms occur, they are not always caused by lupus. They can be caused by infections, benign tumors, or other problems. It is important to see a health provider about any of these symptoms or about other physical changes. Only a health provider can make a diagnosis. Waiting to get better is never an option.

How is the screening and diagnosis of lupus? Because many lupus symptoms mimic other illnesses, are sometimes vague and may come and go, lupus can be difficult to diagnose. Diagnosis is usually made by a careful review of a person's entire medical history coupled with an analysis of the results obtained in routine laboratory tests and some specialized tests related to immune status. Currently, there is no single laboratory test that can determine whether a person has lupus or not. To assist the physician in the diagnosis of lupus, the American College of Rheumatology (ACR) in 1982 issued a list of 11 symptoms or signs (http://www.lupus.org/education/diagnosis.html ) that help distinguish lupus from other diseases. A person should have four or more of these symptoms to suspect lupus. The symptoms do not all have to occur at the same time.

How is lupus treated? The treatments for lupus can be as varied and individual as the disease itself and may change over time. But common-sense measures, such as rest, protection from sunlight, exercise, not smoking and a healthy diet (http://www.niams.nih.gov/hi/topics/lupus/lupusguide/chppis9.htm) are important for everyone with lupus.

Beyond this, medications can ease symptoms and reduce complications of lupus, but these drugs carry their own risks. In recent years, more judicious use of drugs has helped reduce some of these risks. The type of medication and length of treatment depend on which parts of the body are affected and the severity of symptoms. Yet because the course of lupus is so unpredictable, doctors may need to try several different drugs or change doses before finding an effective treatment.

For more information on lupus:

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
www.niams.nih.gov

National Institute of Health (NIH): Lupus
http://www.nlm.nih.gov/medlineplus/lupus.html

Lupus Foundation of America
www.lupus.org