Symptoms and Complications
With lupus, symptoms may flare up every once in a while and then go away for a period of time. This symptom-free period is called remission.
Lupus may be mild or severe, and may result in a range of symptoms, such as:
- joint pain, swelling, and redness that comes and goes (the fingers and wrists are commonly affected)
- rashes, especially across the nose and cheeks, known as a "butterfly rash"
- weight loss
- chest pains due to inflammation of the coverings of the heart and lungs (serositis)
- coughing and breathing problems
- sensitivity to sunlight, which can sometimes occur even with the use of sunblock
- unexplained fatigue
- Raynaud's phenomenon (fingers or toes turn blue on exposure to cold, then white, then red and warm as the blood flow returns to normal)
- hair loss
- disordered thinking or confusion
- labile emotions (unsteady and uncontrolled emotions or mood changes)
Complications of lupus may involve inflammation that can affect other areas of the body (such as the kidneys, central nervous system, and heart). If complications occur, they usually appear during the first few years after the initial diagnosis.
Kidney inflammation as a result of lupus is usually without symptoms at first, and unfortunately many people may not even notice it until the problem is advanced. Once it progresses, there may be other signs such as bloating, ankle swelling, and abnormal blood and urine tests. Ultimately, kidney failure may develop.
It is very important that people with lupus be monitored closely for signs of early kidney disease, such as protein and other abnormalities in the urine.
Lupus also commonly accelerates and worsens atherosclerosis (hardening of the arteries), so your doctor may also monitor for risk factors like high blood pressure, cholesterol, and diabetes. Your doctor may also advise you to not smoke. Treatment for atherosclerosis is very important.
Making the Diagnosis
An antinuclear antibody (ANA) test is the most important test for lupus, as almost all people with lupus will have elevated blood levels of antinuclear antibodies. But a diagnosis will not be based on ANA results alone, because many people have positive ANA tests without lupus, and it can also occur in other autoimmune diseases. A person with a positive ANA test but who does not have clinical signs or other lab abnormalities has about a 5% chance of developing full-blown lupus over a lifetime.
Your medical history and a physical examination done by your doctor will play an important role in making the diagnosis. Other laboratory studies such as tests of kidney function, as well as joint X-rays and MRI (magnetic resonance imaging) scans, will help determine the extent of the disease.
People may need heart tests and an electroencephalogram (test to measure electrical activity of the brain) to detect neurolupus (lupus that affects the brain).
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Treatment and Prevention
The use of medication to treat lupus depends on the severity of the disease. In some cases, medication may not even be necessary.
Commonly prescribed medications include:
- painkillers such as nonsteroidal anti-inflammatory drugs (NSAIDs) - some of these medications are available over-the-counter, but check with your doctor or pharmacist before starting one
- hydroxychloroquine* is used, although it is often used with other medications to help control the disease
- oral corticosteroids are the main treatment for most cases - this type of medication will help to reduce inflammation and its symptoms
- immunosuppressive agents (e.g., cyclophosphamide, mycophenolate, azathioprine, and belimumab) suppress the immune system from attacking the body's organs and tissues - these are used when there is kidney, brain, or other major organ involvement
Note that all of these medications, while they can be helpful and sometimes even lifesaving, have potentially very serious side effects. You should discuss the benefits and risks carefully with your doctor. You may also want to discuss with health care professionals who are experienced in the use of these medications, such as rheumatologists (doctors who specialize in the diagnosis and treatment of arthritis and other diseases that affect the joints, muscles, and bones).
For those who have lupus, the following tips may be helpful:
- Consult a rheumatologist. Rheumatologists have the greatest experience and expertise in diagnosing and managing lupus in all its many forms.
- Pregnancy can sometimes trigger the onset of lupus or it may worsen it in people who already have lupus, but in other cases the disease may not be affected by pregnancy. If you have lupus and are planning to become pregnant, or if you develop lupus while pregnant, you should be under the care of an obstetrician/gynecologist experienced in high-risk pregnancy as well as a rheumatologist.
- Get plenty of rest and relaxation.
- Learn stress management methods.
- Receive regular medical and dental care.
- Participate in regular moderate exercise.
- Maintain a healthy, balanced diet.
- Do not smoke.
- Maintain vitamin D levels well within the recommended guidelines.
- Don't take over-the-counter medications without the advice of a health care professional.
- If you're taking corticosteroids and other immune-suppressing medications, report any signs of infection to your doctor.
- Avoid excessive exposure to the sunlight's ultraviolet rays – wear a hat, sunglasses and long-sleeved clothing, and use a sunscreen with a sun protection factor (SPF) of at least 15 that protects against both ultraviolet A and B (UVA and UVB) light.
- If you're pregnant or planning to have a baby, consult your doctor. You will need to be carefully monitored to prevent complications.
- Consider joining a support group to help cope with various aspects of the condition.
- Inform yourself as much as possible about lupus.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Michael E. Makover, MD, is a professor of medicine at NYU School of Medicine and an Adjunct Professor at NYU College of Arts and Sciences. He is in the private practice of Rheumatology, Internal Medicine and Preventive Medicine in New York, NY. Review provided by VeriMed Healthcare Network.