What is Lupus?
Systemic Lupus Erythematosus: is a disease
where the immune system becomes overactive; a
chronic disease which affects one or many tissues
of the body: skin, joints, muscles, blood vessels,
blood cells, brain and nerves, internal organs such
as lungs, heart, kidneys, gastrointestinal tract
and/or the linings around internal organs.
Inflammatory and immune responses account for
many of the symptoms observed in systemic lupus.
Discoid Lupus (DLE): In general DLE is a benign
disease affecting the skin, which rarely affects the
internal organs, i.e. rarely becomes systemic. Most
studies suggest that approximately 5% of patients
with discoid lupus at some stage may suffer a
generalised flare of the disease, involving joints,
kidneys etc. and may progress to developing
Systemic Lupus Erythematosus.
Drug-induced Lupus (DILE): can occur during the
administration of certain drugs in susceptible
Who gets lupus?
Lupus affects women at least ten times as often as
men, especially women in the childbearing years. It
can, however, occur in children or old age. Afro-
Caribbean, Asian and Eastern races are more likely
to have lupus.
How does Lupus affect the body?
Lupus is a highly variable disease. Potentially, it can
affect every organ and tissue of the body. In any
individual patient, however, only some of these may
ever be affected; the tissues and systems involved
may change and the intensity of involvement may
vary with time. The disease is very much an
individual illness differing from person to person.
What are the features of lupus?
Fatigue, joint and muscle pain, flu-like illness, skin
rashes (including the classical "butterfly" rash on the
cheeks and nose), hair-loss and, more importantly,
internal organ involvement including pleurisy, kidney
disease and brain inflammation. Some patients with
lupus have a clotting tendency and this can present,
for instance, as a thrombosis in the vein or an artery.
How serious is Lupus?
In terms of how disruptive the disease is to life, most
SLE is mild and with appropriate care these patients
can live a virtually normal life with only periodic, brief
interruption during times of flare but no significant
threat to their internal organs. They may, however,
need to make certain adaptations to their home and
lifestyle to make life easier at these times. For
patients with major kidney or central nervous
system or vascular involvement the disease requires
much more intensive medical follow up and
treatment and has a much greater impact on
lifestyle. But even these patients can often have long
periods of remission.
How is Lupus diagnosed?
• Patient awareness of symptoms and accurate
recording of these to the doctor is essential.
• Medical history and physical examination
provide most of the data required for diagnosis.
• Laboratory tests help support the diagnosis
Blood tests: Antibody Test, Blood Count (CB),
Sedimentation Rate, Complement
Studies, Blood Chemistry Tests.
Often 24 hour urine to evaluate
Other: Skin Biopsy, Chest X-ray and
Other Studies: Echocardiogram, Brain Scan, EEG
Functions Tests, Abdominal CT
Scan, EMG (Electromyogram).
Occasional Tests: Kidney Biopsy.
How is it treated?
Medication - type of medication is determined by
the clinical manifestations, and severity of symptoms.
Non-steroidal anti-inflammatory agents are
used for mild disease and painful symptoms – joints,
muscle pain, pleurisy, headaches, etc. Some
experimentation may be needed to find medication
with the least side effect and greatest benefit.
Anti-malarials – Hydroxychloroquine is a useful
drug in mild to moderate disease and can often
control joint symptoms, pleurisy and skin
involvement. Benefit usually occurs gradually over
several months and this type of medication is
frequently used with non-steroidal anti-inflammatory
Steroids - Generally reserved for more serious
manifestations of the disease (vasculitis, central
nervous system, kidney, etc.) and very high doses
may be required. It is sometimes necessary to use
them for non-life threatening manifestations such as
arthritis, pleurisy, but here the dose is kept minimal
and for as short a time as possible.
Cytotoxic drugs - These are reserved for severe
disease either not responsive to high dose steroids
or requiring prolonged use of unacceptably high
doses of steroids. Examples include:
More information regarding medication can be
obtained from the Lupus and Medication fact sheet
available from National Office.
a. Rest, adequate sleep, modifying activity during
time of flare.
b. Minimising stress: Major lifestyle modification and
co-operation with and by family members,
spouse, and employer to achieve this adjustment
may be essential in keeping the disease under
control. Pain clinics, an interested psychologist
or psychiatrist may be helpful.
c. Avoidance of provoking factors - sun, excessive
heat, fatigue, certain medications and infections.
d. Patient awareness of early symptoms, which may
signal a flare and prompt reporting of these to
their physician allowing earlier treatment.
What is the outlook?
In summary, SLE is a potentially serious disease,
which can affect almost any system of the body. We
do not yet know what causes it. The outlook for
survival has improved in recent years and most
patients with SLE will continue to have mild disease.
If diagnosed early and treated appropriately at an
early stage, lupus may settle and ultimately go into
remission – i.e. the patient requires no medication.
With co-operation between the patient, family and
physician the problems associated with the disease
can be significantly modified.