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Lupus: Causes, Symptoms, Risk factors, Complications, Diagnosis, Treatments and Prevention

Lupus is a serious autoimmune disease that can affect anyone. An autoimmune disease is an abnormal condition of the immune system in which the body attacks its own tissues. One of the most common signs of lupus is rashes in the face that looks like butterfly wings. However this symptom may not be present in all the patients with lupus.

Lupus mostly affects females of childbearing age. It also affects men, children and teenagers and is usually developed between the ages of 15 to 45 years.

Lupus

What is Lupus?

Lupus is a chronic autoimmune condition, which affects and damages any part of the body, due to a hyperactive immune system. Lupus can affect various organ systems of the body including skin, heart, kidneys, brain, lungs, blood cells, and joints etc.

Types of Lupus:

Lupus is usually of the following types:

1. Systemic Lupus Erythematosus (SLE):

SLE is the common form of lupus. About 70% of patients are diagnosed with this type of lupus. A patient with SLE may experience mild to moderate symptoms. SLE mostly affects the individuals between 15 to 45 years.

2. Discoid Lupus Erythematosus (DLE):

DLE is a chronic skin condition. A patient diagnosed with DLE may have red, raised rash on the face, scalp or any other parts of the body.

3. Subacute Cutaneous Lupus Erythematosus:

Subacute cutaneous lupus erythematosus are the lesions on the skin that appear when exposed to the sun.

4. Drug-induced Lupus Erythematosus (DIL):

DIL is caused due to the usage of certain medications, such as hydralazine, isoniazid, and Procainamide. These drugs causes rash, fever and hair loss, the symptoms disappear once if the drug is discontinued.

5. Neonatal Lupus:

Neonatal lupus is a condition that occurs when the auto-antibodies present in a pregnant woman are passed to the baby. It is a temporary condition in newborns and the symptoms disappears within few months.

What Causes Lupus?

The exact cause of lupus remains unknown. However, lupus occurs when the immune system damages its healthy tissues.

With lupus the immune system malfunctions and losses its ability to differentiate between the antigens (foreign substance) and the healthy tissues. This contributes to the formation of excess antibodies that attacks the body’s healthy cells and causes pain, damage and inflammation of different parts of the body.

These antibodies are known as auto-antibodies, and the most common auto-antibody with lupus is an antinuclear antibody (ANA).

Symptoms of Lupus:

The symptoms of lupus can develop anytime between the ages of 15 to 30 years. Patients with lupus may have flare-ups of symptoms along with period of remission. The symptoms of lupus usually depend on the region where it is affected. The most common symptoms of lupus may include:

  • Skin rash on the face or any other parts of the body
  • Intense fatigue
  • Fever
  • Hair loss
  • Severe joint pain, stiffness and joint swelling
  • Weight loss
  • Worsening of skin lesions when exposed to sunlight
  • Shortness of breath
  • Dry eyes
  • Headache
  • Dizziness
  • Anemia
  • Confusion
  • Dry mouth
  • Memory loss
  • Nose, mouth or throat sores
  • Poor circulation in the fingers and toes

Risk Factors for Lupus:

Factors that increase the risk of Lupus include:

Age:

Lupus can develop at any age, but the individuals between 15 to 45 years are at increased risk of developing lupus.

Gender:

Females are at greater risk of lupus than males. Both males and females produce estrogen (the hormone responsible for the development and regulation of reproductive system), but production of this hormone is greater in females.

Estrogen is known as immune-enhancing hormone and its production increase during the menstrual cycle and pregnancy due to this reason women are at higher risk of lupus.

Genetics:

Individuals having a family history of lupus are at increased risk. The genes that help the immune system to recognize and respond to the foreign organisms get changed in the patient with lupus.

Ethnic Group:

Africans, Asians, Hispanics, Native Americans are at increased risk of developing lupus.

Environmental Factors:

Environmental factors act together with genetics and hormonal factor and trigger the risk of lupus. Certain environmental factors that trigger lupus include:

  • Exposure to ultraviolet rays causes the death of the cells present in the skin and triggers lupus.
  • Exposure to certain chemicals, such as silica from the agriculture or industrial settings also increases the risk of lupus.
  • Use of certain medications, such as trimethoprim-sulfamethoxazole, sulfasalazine, and tolbutamide makes the individual more sensitive to the sun and increase the risk of lupus.
  • An injury or infections due to Epstein-Barr virus.
  • Smoking impairs the circulation and triggers the symptoms of lupus.

Complications of Lupus:

Lupus causes inflammation that affects various parts of the body and may lead to certain complications, such as:

  • Kidney damage
  • Stroke
  • Preeclampsia (high blood pressure during pregnancy)
  • Seizures (electrical disturbances in the brain due to altered activity of nerve cell)
  • Blood and blood vessel problems
  • Lung disease, such as pneumonia or pleurisy (inflammation of the chest cavity)
  • Heart diseases, such as heart attacks, pericarditis (inflammation of pericardium)

In rare conditions, lupus may increase the risk of cancer, avascular necrosis (death of bone tissue), and miscarriage.

Diagnosis of Lupus:

Lupus is usually difficult to diagnose with a single laboratory test as it mimics the action of several other medical conditions. The doctor usually initiates the diagnosis by reviewing the medical history, family history and signs and symptoms of the individual.

The doctor recommends certain laboratory tests, such as:

Antinuclear Antibody (ANA) Test:

ANA test is the simple, primary diagnostic test for evaluating lupus. In ANA, a blood sample is collected and is examined. A positive test reveals the presence of high levels of antibodies in the body, which indicates a hyperactive immune system.

Complete Blood Count:

Complete blood count is performed to evaluate the levels of all the blood components, such as red blood cells (RBCs), white blood cells (WBCs), blood platelets, and hemoglobin. If the blood count is reduced, it indicates anemia, which is one of the common symptoms of lupus.

Erythrocyte Sedimentation Rate:

Erythrocyte sedimentation rate is a type of blood test, performed to determine the time at which the red blood cells (RBCs) settle down. If the RBCs settle down faster than the usual time it indicates lupus.

Urinalysis:

Urinalysis is done to determine the levels of proteins or RBCs in the urine. Increased levels of proteins and RBCs occur when lupus has affected the kidneys.

In some conditions kidney function test, liver function test, chest X-ray and echocardiogram are also performed if the doctor suspects that the lupus is affecting the kidneys, liver, lungs or heart. Sometimes a skin biopsy is also performed to confirm lupus affecting the skin.

Treatment for Lupus:

Lupus does not have a complete cure. The treatment mainly focuses on reducing the signs and symptoms of the patient and preventing the flares and organ damage. The doctor changes the drug therapy whenever the signs and symptoms flare and subside. The doctor may recommend:

  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen to reduce the pain and swelling
  • Hydroxychloroquine acts on the immune system and reduces the risk of lupus flares
  • Corticosteroids, such as prednisone are prescribed to reduce the inflammation
  • Immunosuppressants, such as azathioprine is prescribed to suppress the activity of the immune system
  • Rituximabis a monoclonal antibody that is helpful in treating resistant lupus

Prevention of Lupus:

The risk of lupus can be prevented by:

  • Smoking cessation
  • Exercising regularly
  • Eating a healthy and well-balanced diet
  • Avoiding long-term exposure to the sun
  • Applying moisturizer before exposing to sun

 

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