The Truth About Lupus
“The cause of lupus is thought to include both genetic predispositions and environmental triggers such as infections, medications and sunlight. Pregnancy can be seriously affected by lupus.”
Over 17,000 Canadians have systemic lupus erythematosus (SLE), a disease caused by a person’s immune system attacking itself, leading to inflammation and damage. Common areas of the body that can be affected include the joints, skin, blood cells and kidneys. Other areas may include the brain and lungs. Lupus can affect all ages, genders and ethnicities but is most commonly seen in young female adults. The disease can be more severe in certain ethnicities including African Americans, Asians, Hispanics and Canadian Aboriginal people. The cause of lupus is thought to include both genetic predispositions and environmental triggers such as infections, medications and sunlight. Pregnancy can be seriously affected by lupus.
No two cases of lupus are exactly alike
Diagnosing lupus can be challenging because it can look like other diseases just as other diseases can look like lupus. Contrary to some information you might find on the Internet, the disease is not diagnosed by a simple blood test. When a person experiences symptoms such as a rash, joint pain, fever, or fatigue, it makes sense to go and see your primary care physician who can start sorting out the diagnosis. The combination of a person’s symptoms, and supportive blood and urine tests can help point towards or against a diagnosis of lupus.
If lupus is suspected, it is important to be referred and seen quickly by a rheumatologist who specializes in immune diseases and their management. Often, the severity of the signs and symptoms of the disease will determine how quickly a person with suspected lupus will be seen. It is not unusual that your rheumatologists will consult other subspecialties (e.g. nephrologist; kidney doctor, or dermatologist; skin doctor etc.) and get their advice for an optimal treatment and management of lupus.
When lupus is suspected, specific details of a person’s medical history will be explored. Examples of clues suggestive of lupus include rashes caused by sunlight, fingertips turning white in the cold, a rash on the face (butterfly rash or ‘mask of the wolf’), stiffness and pain in little joints of the hands and feet. While fatigue and fevers can be seen in the disease, many other conditions can cause similar symptoms, which can explain why the diagnosis can be delayed for people.
Treatment options available
Once lupus is diagnosed, different treatment options exist. The treatment(s) chosen depend on how active the lupus is, and what organs are affected. Different types of lupus subsets exist explaining why some people only ever have it in their skin, others only in their kidneys and yet others in multiple locations (e.g. brain, lungs, heart and others). The most commonly used medication recommended for most lupus patients, no matter their disease severity, are antimalarial medications that help control the disease and prevent future f lares. With very active lupus, glucocorticoids (cortisone or similar) medications are often used to calm down the immune system and prevent permanent damage of a system. Due to the significant side effects of glucocorticoids, especially in the long-term, other immunosuppressant medications are often overlapped with gluco- corticoids, to make it easier to get off them. These medications can usually be taken long-term under a rheumatologist’s supervision. Currently, no natural products or supplements have been approved for lupus treatment, but a well-balanced diet is recommended especially while on glucocorticoids for a better control of lipids and sugar. Ensuring enough calcium and vitamin D intake to help protect the bones from glucocorticoids side effects (osteoporosis and low bone density; thinning of the bones leading to increased risk of fracture) is also recommended.
The key to lupus treatment is working with your rheumatologist to try control and stop the active disease to prevent long-term irreversible damage. Patients with lupus may suffer early heart disease (atherosclerosis of the coronary arteries which put you at a risk for angina and myocardial infarction), therefore it is important to diagnose and treat lupus quickly. The rates of death from lupus, often caused by lupus activity itself, infections and heart disease, are now trending downwards because of better understanding of lupus, earlier intervention and the availability of new medications for lupus, but it still remains unacceptably high when compared to peers.