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Last updated: Mar 02, 2022
5 min read

What is lupus? Symptoms, causes, and treatment

raagini yedidikaitlin sullivan

Medically Reviewed by Raagini Yedidi, MD

Written by Kaitlin Sullivan

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Lupus is an autoimmune condition where your immune system attacks different systems in the body including your joints, brain, heart, skin, kidneys, lungs, blood vessels, and more.

Lupus can’t be cured, but there are treatments and lifestyle changes you can try to help manage the condition.

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What causes lupus?

Lupus, also called systemic lupus erythematosus (or SLE), is a complicated disease. Doctors aren’t sure exactly what the cause of lupus is, but genetics can play a role. A family history of lupus is a risk factor for the disease, especially if you’re a female between ages 15–44. 

It’s more common in certain demographics, most commonly affecting young and middle-aged females as well as people who are American Indian and Alaska Native (AI/AN), Black, Asian, and Hispanic.  

Lupus signs and symptoms

The symptoms of lupus, as well as the frequency and severity of flare-ups, vary a lot from person to person. 

Lupus symptoms take many forms, ranging from occasional flare-ups with mild symptoms to fatigue, arthritis, myocarditis (inflammation of the heart), and life-threatening organ failure (Jung, 2017; Nosal, 2021). 

The most common lupus symptoms are (Wallace, 2022):

  • Alopecia: Hair loss (alopecia) is common in people with SLE (Fava, 2019).
  • Arthritis: Lupus is a rheumatic disease, meaning it impacts joints. Arthritis is one of the earliest symptoms. Around 90% of people with lupus have arthritis, joint pain and swelling, or joint stiffness. For most people, inflammation-induced arthritis is considered mild. It’s also typically symmetrical, meaning it affects both sides of the body––for example, both wrists. 
  • Blood abnormalities: Blood issues are common among people with lupus. These commonly include anemia, which is when your blood doesn’t have enough red blood cells to carry oxygen to the rest of the body. Another blood issue is leukopenia, a lack of white blood cells critical for fighting infection. As many as half of people with lupus also have leukopenia. 
  • Photosensitivity: One telltale sign of lupus is photosensitivity, which is sensitivity to sunlight that causes skin lesions. The most iconic is a red, butterfly-shaped rash on the cheeks, nose, and chin, which commonly creeps in after spending time in the sun (or a tanning bed). Lupus can also cause a red, scaly rash on other parts of the body that are exposed to sunlight, such as the forearms (Eastham, 2014). 
  • Mouth or nose ulcers: People may also develop ulcers in their mouths or noses, which are usually not painful. These ulcers are different from the typically painful sores caused by herpes.
  • Fatigue: Between 80–100% of people with lupus report feeling fatigued. 
  • Fever: As many as half of those with lupus experience a fever during flare-ups.
  • Kidney disease: About 50% of individuals living with lupus develop kidney problems. If you’re diagnosed, your kidney function may be routinely monitored to catch any issues early.
  • Myalgia: Muscle aches and pains are another sign of lupus. 
  • Unintentional weight loss: Most of the time, weight loss occurs prior to lupus being diagnosed. Weight loss could be related to decreased appetite, acid reflux, abdominal pain, or ulcers. 

How is lupus diagnosed?

Lupus can present itself in many ways. Your healthcare provider may start by listening to your symptoms and also perform a physical exam and additional tests (Wallace, 2022). 

These are some of the common elements that fall into a lupus diagnosis. You may have lupus if you have at least four of the following (Hochberg, 1997):

  • Malar rash: A red, butterfly rash on the cheeks, nose, and chin.
  • Discoid rash: A particular rash on the face, arms, neck, and torso.
  • Photosensitivity: Skin rashes that come after exposure to the sun or ultraviolet light (UV).
  • Ulcers: Mouth or nasal sores.
  • Arthritis: Joint swelling or stiffness, usually involving two or more joints.
  • Heart and lung issues: Inflammation of the layers surrounding the lung (pleuritis) or the heart (pericarditis).
  • Cell casts: Abnormalities in urine, such as clumps of cells (cell casts) or increased protein levels.
  • Brain-related problems: These can include seizures or psychosis with an unknown cause.
  • Blood issues: Problems with the blood, like reduced numbers of red blood cells (anemia), platelets, or white blood cells.
  • Immune system activity: Laboratory tests that show autoimmune activity (antibodies fighting against your own tissues).
  • Antibody test: A positive ANA (antinuclear antibody) test.

A hallmark of lupus––and many autoimmune diseases––is the presence of antinuclear antibodies (ANA). Instead of attacking invaders like viruses or bacteria, ANAs mistakenly attack healthy tissues and cause a lot of inflammation in the process. 

If your healthcare provider suspects lupus or another autoimmune disease is causing your symptoms, they may use a blood test to check your ANA levels, platelets, or white and red blood cell counts (Nosal, 2021).

An ultrasound of your kidneys may be ordered to rule out a urinary tract obstruction. A physical exam will be performed to check for skin lesions, rashes, swollen joints, or other external signs of lupus (Wallace, 2022).

Treatments for lupus

Treating lupus often involves a combination of managing symptoms and keeping flare-ups at bay. 

Because there is no cure for lupus, most treatments involve the use of medications that lower the immune system’s activity. Drugs can also prevent organ damage, reduce fatigue and pain, and treat other medical conditions made worse by lupus (Fava, 2019). 

Your healthcare provider will determine which therapies are best depending on your symptoms and how advanced the condition is. It’s common for people with lupus to be on medications that affect the way the immune system works like immunomodulators or immunosuppressants.

Common drugs used to treat lupus include hydroxychloroquine and chloroquine. When taken regularly, hydroxychloroquine helps reduce lupus symptoms, the frequency of flare-ups, and organ damage (Ruiz-Irastorza, 2010). 

Other medications sometimes needed to get symptoms under control include corticosteroids (like prednisone) or immunosuppressants like azathioprine and methotrexate. There’s no one-size-fits-all for lupus therapy, and the combination of drugs people need often changes over time. 

Individuals with lupus may also need to take vitamin D supplements as deficiencies are common. Vitamin D has the added benefit of boosting the immune system. Outside of medication and supplements, one of the most helpful things you can do is avoid triggers. Triggers are things that can cause a lupus flare-up and may vary on an individual basis (Fava, 2019). 

Common triggers include smoking, stress, and exposure to substances like mercury, silica, and echinacea. Sun exposure is another trigger. You can avoid sun exposure by wearing protective clothing and sunscreen when spending time outside (Fava, 2019; Wallace, 2022). 

References

  1. Eastham, A. B. & Vleugels, R. A. (2014). Cutaneous Lupus Erythematosus. Journal of the American Medical Association Dermatology, 150(3), 344. Retrieved from https://jamanetwork.com/journals/jamadermatology/fullarticle/1843885
  2. Fava, A. & Petri, M. (2019). Systemic Lupus Erythematosus: Diagnosis and Clinical Management. Journal of Autoimmunity, 96, 1–13. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310637/
  3. Hochberg, M. C. (1997). Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus (letter). Arthritis & Rheumatology, 40, 1725. Retrieved from https://www.rheumatology.org/portals/0/files/1997%20update%20of%201982%20revised.pdf
  4. Jung, J. & Suh, C. (2017). Infection in systemic lupus erythematosus, similarities, and differences with lupus flare. The Korean Journal of Internal Medicine, 32(3), 429-438. doi:10.3904/kjim.2016.234. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5432804/
  5. Nosal, R. S., Superville, S. S. & Varacallo, M. (2021). Biochemistry, Antinuclear Antibodies (ANA). StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537071/
  6. Ruiz-Irastorza, G., Ramos-Casals, M., Brito-Zeron, P., & Khamashta, M. A. (2010). Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review. Annals of the Rheumatic Diseases, 69(1), 20-28. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19103632/ 
  7. Wallace, D. J. & Gladman, D. D. (2022). Clinical manifestations and diagnosis of systemic lupus erythematosus in adults. UpToDate. Retrieved from https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-systemic-lupus-erythematosus-in-adults