What is lupus?
Lupus is a chronic (long-lasting) autoimmune disease where the
immune system, for unknown reasons, becomes hyperactive & attacks
normal tissue. This attack results in inflammation & brings
What does autoimmune mean?
'Auto' means 'self', so autoimmune literally means that the immune
system fights the body itself. Instead of fighting & attacking
the bad tissues, such as viruses, it turns on itself & attacks
the good tissues.
What is inflammation?
It is a protective process our body uses when tissues are injured.
Inflammation helps to eliminate a foreign body or organism (virus,
bacteria) & prevent further injury. Signs of inflammation include-
swelling, redness, warmth & pain.
What are antibodies?
Antibodies are proteins produced by white blood cells (B lymphocytes).
Their normal function is to glue up bacteria and make them easy
for the white blood cells to capture and destroy. When the immune
system goes wrong, antibodies can be formed that bind to bits of
the body (an auto-antibody). Sometimes infection can cause auto-antibodies
to be produced and this may be one of the causes of Lupus. The antibodies
circulate in the blood, but some of the body's cells have walls
permeable enough to let some antibodies in. These can then attack
the DNA in the cell's nucleus. That's why some organs can be attacked
during a flare while others aren't.
What are the different kinds of lupus?
Discoid lupus (also known as Cutaneous lupus) affects the skin.
Systemic lupus attacks multiple systems in the body which may
include- the skin, joints, blood, lungs, kidneys, heart, brain &
Drug-induced lupus may develop after taking certain prescription
medications. Symptoms generally disappear after the drug is discontinued.
What are the symptoms of systemic lupus?
The symptoms can include- Arthritis (swelling and pain of the
joints), muscle pain and weakness, fatigue, sun-sensitivity, hair
loss, "Butterfly" or malar rash (a rash across the nose and cheeks),
fever, anaemia, headaches, recurrent miscarriages. For more symptoms
& descriptions of symptoms see the symptoms
page. Some people will have only a few symptoms, others may
have them all.
What are the symptoms of discoid lupus?
They include a variety of different looking skin rashes, photosensitivity,
& sometimes mouth or nose ulcers.
How is discoid lupus different to systemic lupus?
Discoid Lupus is confined to the skin, whereas systemic lupus
may involve any organ system in the body, as well as the skin.
Can discoid lupus turn into systemic lupus?
In approximately 10% of discoid lupus cases, it evolves &
develops into systemic lupus. However, this can't be predicted or
prevented from happening.
What is the difference between drug-induced lupus & systemic
Systemic lupus is irreversible, whereas drug-induced lupus generally
is reversible. The symptoms of drug-induced lupus generally do not
include- kidney involvement or central nervous system involvement.
What drugs are most commonly associated with drug-induced lupus?
The following medications have been definitely proved to be associated
with drug-induced lupus-Procainamide (used for heart rhythm abnormalities),
Hydralazine (used for high blood pressure), Isoniazid (used for
tuberculosis), Quinidine (used for heart rhythm abnormalities),
Phenytoin (used for seizures). There are other drugs which might
possibly be associated with drug-induced lupus, but as yet there
is no definite proof.
Should people diagnosed with SLE or discoid lupus avoid taking
the drugs associated with drug-induced lupus?
Most of the drugs associated with drug-induced lupus can be safely
used in people with SLE or discoid lupus if there are no suitable
How soon after taking the drug do the symptoms appear, &
how long after stopping the drug do they disappear?
Drug-induced lupus requires months to years of frequent use of
a drug before symptoms appear. Usually symptoms disappear after
six months after stopping the drug, but it could be days r weeks,
it varies. The ANA may remain positive for years.
What causes lupus?
The exact cause is unknown, but it is likely to be a combination
of factors. A person's genetic make-up & exposure to certain
trigger factors may provide the right environment in which lupus
Is lupus hereditary?
It is suspected that people inherit something from their parents
that predisposes them to develop lupus. They are not necessarily
pre-destined to develop lupus, but they may be more susceptible.
Relatives of lupus patients have an approximate 5-12% greater tendency
to get the disease if family members have it.
How common is lupus?
It is not known why, but lupus occurs more often in certain ethnic
groups. The incidence in Caucasians is approx. 1:1000. In African-Americans,
the incidence is approx. 1:250. In Latinos the incidence is approx.
What can trigger lupus?
It is believed that certain things may trigger the onset of lupus
or cause lupus to flare, these include- Ultraviolet light, certain
prescription drugs & antibiotics, infections or viruses, hormones
Are there any medications people with lupus should avoid?
There are no absolute contraindications to medications for people
with lupus. But, as people with lupus are usually 'allergic' people,
your doctor should watch for any connection between flares &
medications, especially oral contraceptives, sulfa antibiotics &
Is there a test for systemic lupus?
No, there is not a single diagnostic test for SLE.
Why is SLE so difficult to diagnose?
For a number of reasons-
SLE is a multi-system disease, & before a multi-system disease
can be diagnosed, there have to be symptoms in many parts of the
body & lab work (blood tests) that supports the presence of
a multi-system disease.
SLE is also difficult to diagnose because it is a disease that
does not typically develop rapidly, but develops slowly & evolves
over time. Symptoms come & go, it can take time for the disease
to show up in blood tests, which one time can be positive &
the next be negative again. It can take months or even years for
enough symptoms to show up for the doctor to be able to make an
SLE is known as a great imitator, because it mimics so many other
diseases & conditions, which often have to be ruled out.
SLE is difficult to diagnose because there is no one diagnostic
test for lupus, the doctor has to do a full examination of the patient
& do various tests, before looking at all the evidence &
coming to a conclusion.
How is SLE diagnosed?
Physicians have to gather information from a variety of sources-
past medical history, lab tests & current symptoms. They use
a list of 11 criteria to help diagnose SLE. Generally, a person
needs to satisfy at least 4 out of the 11 criteria before a diagnosis
can be made. (see the diagnosis page
for more info.)
What is the ANA test?
The anti-nuclear antibody (ANA) test is a blood test that measures
the antibodies that are directed against various components of the
nucleus, so-called anti-nuclear antibodies. The nucleus of living
cells contains many chemicals, including the well known DNA &
RNA. For reasons which are unclear, patients produce antibodies
which are directed against a number of these molecules.Throughout
the world, the ANA test has become the screening test for lupus.
Patients with active lupus generally have high levels of anti-nuclear
antibodies. About 95% of people with SLE will have a positive ANA
test at some point during their disease. It is rare to have lupus
& have a negative ANA test, however it does happen, it can also
take a while for the ANA test to become positive. It is also
possible for the ANA to convert from positive to negative following
administration of steroids, cytotoxic drugs or kidney failure. Unfortunately,
the ANA test, although a very useful screening test, is not specific
to lupus. It can be positive in other connective tissue disorders,
& also in healthy people. Therefore, a positive ANA test is
not diagnostic of lupus, & is only an indicator. A positive
ANA test only satisfies one criterion, a person would need to satisfy
at least three additional criteria before a doctor would consider
My ANA test came back 'Borderline Positive', what does this mean?
All lab tests have normal values. If a test comes back & the
value is at the upper limit of normal, this is often referred to
as being borderline. It is likely that a borderline positive ANA
assumes more importance if other criteria are also present.
What doctor should a lupus patient see?
There are no rules here. Lupus patients can be diagnosed &
treated by a number of different specialists, or indeed a combination
which could include- rheumatologist, dermatologist, nephrologist,
immunologist, or they can just be treated by their GP.
Do all lupus patients have the same symptoms?
No, symptoms vary from patient to patient. They even vary within
one patient from time to time. Lupus is a disease that can attack
different organ systems of the body, & it therefore affects
Can an individual with lupus continue to develop new symptoms?
A patient's symptoms can vary from week to week, even from day
to day. However it is uncommon for the affected organ system to
change, e.g. it is rare for a patient with kidney disease to develop
central nervous system lupus.
Is lupus infectious or contagious?
No, it is neither.
Is there a cure for lupus?
At present there is no cure for lupus, but research is being carried
out the world over, to find new treatments for lupus & to find
out what causes lupus to develop, so there is hope for the future.
However, lupus can be controlled using medications.
How is lupus treated?
The majority of lupus symptoms are due to inflammation & so
the treatment is aimed at reducing that inflammation. There are
four families of medications used in the treatment of lupus- Nonsteroidal
anti-inflammatory drugs (NSAIDs), corticosteroids, antimalarials,
& cytotoxic drugs (chemotherapy). For more information see the medications page.
What is a flare?
A flare is a sudden change of disease activity, for example, the
development of new symptoms. A patient may suddenly feel weak &
have joint & muscle aches. Flares can take on many different
forms, indicating that the disease is quite active.
What is an exacerbation?
An exacerbation is a 'worsening' & is a term that is generally
synonymous with a flare.
What is remission?
A remission is a period of disease-free activity. Certain cases
of lupus have become permanently inactive, or in total remission.
Although total remission is rare, partial remission - a definite,
but limited, period of inactive disease - is more common.
How long will a flare last? How long will remission last?
There is no way of predicting how long a flare will last when
it comes, nor is there any way of predicting how long remission
will last when it comes.
What is the connection between lupus & allergies?
An allergic state produces a very specific antibody to substances
such as drugs, pollen & grass. People with lupus are often very
sensitive to such substances.
Is lupus a fatal disease?
The majority of people living with lupus today can expect to live
a normal life span. About 20 or so years ago it was a different
matter, many more people died from lupus. This was due to the fact
that it was only diagnosed when it was very severe, & treatments
weren't as effective. Now, with better diagnostic facilities, increased
awareness & effective treatments, at least 90% of people with
lupus will lead a normal lifespan. Lupus does vary in intensity
& degree, & there are people who have a mild case, there
are those who have a moderate case & there are some who have
a severe case (severe organ involvement), which tends to be more
difficult to treat & bring under control. Recent studies in
longterm survival rates: Patients diagnosed with Lupus in 1990/95
have 92% chance of living more than the next 5 years (88% if initial
diagnosis was lupus nephritis). This compares with 49% in 1960s.
The figure has been steadily rising over the decades. Also remember
that the chance of living more than the next 5 years for everybody,
lupus patient or not, is less than 100%.
When people die of lupus, what do they usually die of?
Overwhelming infection & kidney failure are the two most common
causes of death in people with lupus.
Are people with lupus more likely to develop cancer?
People with lupus are no more likely to develop cancer than people
in the general population. However, people who have received certain
chemotherapy drugs do carry the added risk of developing cancer
sometime in later life.
Is there a connection between lupus & multiple sclerosis?
MS & lupus are both autoimmune diseases, & you can have
both together, but they are diagnosed & treated in different
ways. Lupus can sometimes mimic the symptoms of MS.
Is lupus like AIDS?
No. In AIDS, the immune system is underactive, but in lupus it
is overactive. HIV (which can lead to AIDS) is transmissible, lupus
Can a lupus patient get another autoimmune disease?
Yes, & it is quite common. Antibodies can develop against
a variety of organs, tissues or glands, resulting in many different
diseases. Among the most frequently experienced autoimmune diseases
for a lupus patient to have are Sjogren's Syndrome, multiple sclerosis,
& Hashimoto's thyroiditis.
How can I find out more about lupus?
To start with, read all of the information on this site, &
follow the links to other sites. Secondly, read some of the many
books available on lupus, start by visiting the lupus bookstores
on this site, the books are available at a discount! US
customers - UK customers.
Join the national lupus charity in your country, e.g. Lupus
UK, The Lupus Foundation of America, they can provide information
& support, & run regional groups in your area where you
can meet fellow lupus sufferers.
If you still have any questions that want answering, please visit