Lupus

Lupus is a chronic rheumatic disease (Read about "Arthritis and Rheumatic Diseases") in which inflammation affects joints, muscles and other parts of the body, including the heart, lungs, skin, joints, kidneys, blood and nervous system. (Read about "The Heart and Cardiovascular System" "Respiratory System" "Skin" "Skeletal System" "The Urinary System" "Vascular System" "Nervous System")

There are many kinds of lupus. They include:

• Systemic lupus erythematosus (SLE) - This is the most common and serious type of lupus, it affects many parts of the body.
• Discoid lupus erythematosus - This causes a skin rash that doesn't go away. (Read about "Skin Rash")
• Subacute cutaneous lupus erythematosus - This causes skin sores on parts of the body exposed to sun.
• Drug-induced lupus - This type of lupus can be caused by medications.
• Neonatal lupus - This is a rare type of lupus that affects newborns.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) says a combination of genetic (Read about "Genetics"), environmental, and possibly, hormonal factors may work together to cause the disease. Studies suggest that the risk of developing lupus is higher if someone in your family has it.

In lupus, the immune system (Read about "The Immune System") produces antibodies against the body's own healthy cells and tissues. These antibodies, called autoantibodies ("auto" means self), contribute to the inflammation of various parts of the body, causing swelling, redness, heat and pain. In addition, some autoantibodies join with substances from the body's own cells or tissues to form molecules called immune complexes. A buildup of these immune complexes in the body also contributes to inflammation and tissue injury in people with lupus. Symptoms of lupus can include:

• inflammation
• facial sores and/or a butterfly-shaped rash over the cheeks and nose (malar rash)
• ulcers of the mouth
• sensitivity to sunlight
• pain and joint stiffness
• kidney disorders (Read about "Kidney Disease")
• blood problems such as anemia (Read about "Anemia")
• immune problems (Read about "The Immune System")
• shortness of breath
• neurologic problems, such as psychosis or seizures (Read about "Seizures")
• hair loss (Read about "Alopecia Areata")

According to the Lupus Foundation of America, the heart and lungs are frequently affected in people with systemic lupus erythematosus (SLE). Potential cardiopulmonary complications include:

• coronary heart disease (Read about "Coronary Heart Disease")
• pericarditis, which is inflammation of the sac around the heart
• endocarditis, which is inflammation of the heart valves (Read about "The Heart & Its Valves")
• vasculitis, which is an inflammation of blood vessels (Read about "Vascular System")
• pleurisy, which is inflammation of the lining of the lungs (Read about "Pleurisy")
• pulmonary embolism, which is blood clots in the lung (Read about "Pulmonary Embolism")

Lupus is also considered a risk factor for a condition called osteonecrosis in which a portion of bone loses its blood supply and begins to die. (Read about "Osteonecrosis")

According to the Arthritis Foundation, lupus affects women more than men. It can occur in young children, as well as older people, and it occurs more often in African Americans.

Treatment options

It is important for people with lupus to work closely with their doctor and take an active role in managing the disease. Once lupus has been diagnosed, the doctor will develop a treatment plan based on the patient's age, sex, health, symptoms and lifestyle. Treatment plans are tailored to the individual's needs and may change over time. In developing a treatment plan, the doctor has several goals: to prevent flare-ups, to treat them when they do occur and to minimize organ damage and complications. The doctor and patient should reevaluate the plan regularly to ensure it is as effective as possible.

For people with joint or chest pain or fever, drugs that decrease inflammation, called nonsteroidal anti-inflammatory drugs (NSAIDs), are often used. While some NSAIDs, such as ibuprofen and naproxen, are available over-the-counter, a doctor's prescription is necessary for others. NSAIDs may be used alone or in combination with other types of drugs to control pain, swelling and fever. Even though some NSAIDs may be purchased without a prescription, it is important that they be taken under a doctor's direction. Common side effects of NSAIDs can include stomach upset, heartburn, diarrhea and fluid retention. (Read about "Heartburn" "Diarrhea" "Gastritis") Some people with lupus also develop liver, kidney or even neurological complications, making it especially important to stay in close contact with the doctor while taking these medications. (Read about "The Liver" "Kidney Disease" "Nervous System")

Corticosteroid hormones, often referred to as "steroid" hormones, are also used to treat lupus. Corticosteroids are related to cortisol, which is a natural anti-inflammatory hormone. They work by rapidly suppressing inflammation. Corticosteroids can be given by mouth, in creams applied to the skin or by injection. Because they are potent drugs, the doctor will seek the lowest dose with the greatest benefit. NIAMS says anyone using corticosteroids should talk to their doctors about taking supplemental calcium (Read about "Calcium") and vitamin D to reduce the risk of osteoporosis. (Read about "Vitamins & Minerals" "Osteoporosis") Long-term corticosteroid use has also been linked to a condition called osteonecrosis in which a portion of bone loses its blood supply and begins to die. (Read about "Osteonecrosis") Because of the risks of long-term corticosteroid use, researchers are trying to develop other drug therapies.

For some patients whose kidneys or central nervous systems are affected by lupus, a type of drug called an immunosuppressive may be used. In some patients, methotrexate, a disease-modifying antirheumatic drug, may be used to help control the disease. There is no known connection between lupus and malaria, but anti-malarial drugs can also be used to treat skin or joint symptoms, in some types of lupus. There is also a newer drug that is designed to target B-lymphocyte stimulator (BLyS) protein, which may reduce the number of abnormal B cells thought to be a problem in lupus. It is administered directly into a vein. (Read about "Infusion Therapy")

Treatment for lupus also involves avoidance of potential triggers for flare-ups, including exposure to sun, as well as stress. (Read about "Sunscreen" "Stress") A rehabilitation specialist can provide information on physical therapies that may be helpful. (Read about "Rehabilitation")