What is lupus and how is it treated?

Definition and Symptoms

Our body produces antibodies to protect us against infections. When bacteria or a virus are present, antibodies identify and neutralize them. However, in the case of SLE, the immune system is no longer able to distinguish between pathogens and healthy cells. Thus, in an attempt to defend itself, it mistakenly releases autoantibodies that attack the body’s own cells and tissues. This abnormal reaction causes inflammation and can lead to lesions that may affect one or more organs. Certain factors predisposing to SLE have been identified, although many remain unknown, such as sun exposure or infection. Women with SLE who are of childbearing age benefit from preconception counseling as well as close monitoring during pregnancy. 

Cutaneous lupus: lupus can affect only the skin and manifest in several forms (discoid, subacute, acute, lupus pernio, etc.).
 

SLE and its various manifestations: SLE can affect all organs and present with a wide range of symptoms:  joint, cutaneous-mucosal, respiratory, digestive, neurological, renal, and even cardiac symptoms. It is very often associated with a decline in general health: fatigue, weight loss, loss of appetite, and night sweats.

Its main cutaneous feature is a butterfly-shaped rash on the cheeks and bridge of the nose. Ulceration of the mucous membranes (palate, gums, nose) is also a typical symptom.

Joint problems affect the majority of patients. These may include intermittent pain or inflammation affecting multiple joints (acute polyarthritis). The progression of joint problems can span several years, sometimes long before other signs of the disease appear.

What are the other possible symptoms of lupus?

Lung problems: Serous effusions (pleurisy) associated with lupus are relatively common. Patients experience chest pain when they take a deep breath. This is generally associated with pleurisy[1], that is, inflammation of the membrane surrounding the lungs, sometimes accompanied by fluid buildup. More rarely, lupus can cause serious complications such as parenchymal lung damage or pulmonary artery thrombosis due to blood clots.

Heart problems: Lupus can cause chest pain, most often linked to pericarditis, an inflammation of the heart’s lining. More serious complications are possible but rare, such as coronary vasculitis (inflammation of the heart’s arteries) which can cause angina, or myocarditis, with a risk of heart failure. In the rare case of heart valve damage, surgery is necessary.

Nervous system: When the brain is affected, lupus can cause headaches, mental disorders, thought and personality disturbances, seizures, or strokes. The nerves of the spinal cord, in particular, can also be affected.

Kidney disorders: Symptoms of kidney involvement may be mild or even asymptomatic, or, conversely, may progress to severe kidney failure requiring dialysis. Kidney failure is frequently accompanied by high blood pressure and protein loss in the urine, with a risk of edema, particularly in the legs.

Hematological disorders: Lupus can lead to a decrease in the number of red blood cells, white blood cells, and platelets, which play an essential role in blood clotting.

Lupus: Treatment and Diagnosis

The diagnosis of lupus is based on a thorough medical history and clinical examination conducted by an immunologist-rheumatologist. Additional tests are necessary to confirm the diagnosis and rule out other conditions.

Treatment for lupus is tailored to the affected organs or organ systems as well as the disease’s activity level. It aims to control inflammation to prevent the development of new lesions and limit the progression of existing ones. Hydroxychloroquine (an oral antimalarial drug) is the standard first-line treatment. In cases of active disease, corticosteroids or other immunosuppressants may be prescribed.

FAQ about lupus

What causes lupus? 

The causes of lupus are unknown, but it is thought to be linked to a combination of genetic and environmental factors. This autoimmune disease primarily affects women of childbearing age, although it can also affect men, children, and the elderly. Sometimes, certain medications can trigger lupus, which generally resolves once treatment is stopped.

What are the risks during pregnancy? 

Women with SLE are closely monitored during their pregnancy and receive preconception counseling to help them plan their pregnancy as effectively as possible.

Can a child develop lupus if one of the parents has it? 

Lupus is not a hereditary disease in the strict sense. It is a multifactorial autoimmune disease: a genetic predisposition may be inherited, but other factors (hormonal, environmental, immunological) play a role in its onset.

What is the life expectancy for someone with lupus? 

In most cases, a patient with lupus has a life expectancy similar to that of the general population. However, the prognosis depends on the severity of symptoms, particularly in cases of kidney, cardiovascular, or neurological complications. 

Key Points

Lupus is a chronic autoimmune disease that primarily affects the skin and joints but, in some cases, can also affect all other organs, making it a systemic disease. It progresses in inflammatory flare-ups interspersed with periods of remission. This condition is generally well-managed today, but it requires careful medical monitoring to ensure the patient leads a long and active life.