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Created: February 25, 1999
by: Diane Manhattan
Revised: August 2001
Diane Manhattan
An Introduction to Lupus
Defining Lupus
Lupus is a type of immune system disorder known as an autoimmune disease. In autoimmune diseases, the body harms its own healthy cells and tissues. This leads to inflammation and damage of various body tissues. Lupus can affect many parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain. Although people with the disease may have many different symptoms, some of the most common ones include extreme fatigue, painful or swollen joints (arthritis), unexplained fever, skin rashes, and kidney problems. Lupus is also known as a rheumatic disease. The rheumatic diseases are a group of disorders that cause aches, pain, and stiffness in the joints, muscles, and bones.At present, there is no cure for lupus. However, the symptoms of lupus can be controlled with appropriate treatment, and most people with the disease can lead active, healthy lives. Lupus is characterized by periods of illness, called flares, and periods of wellness, or remission. Understanding how to prevent flares and how to treat them when they do occur helps people with lupus maintain better health. Intense research is underway and scientists funded by the NIH are continuing to make great strides in understanding the disease, which ultimately may lead to a cure.
Two of the questions researchers are studying are who gets lupus and why. We know that many more women than men have lupus. Lupus is three times more common in black women than in white women and is also more common in women of Hispanic, Asian, and Native American descent. In addition, lupus can run in families, but the risk that a child or a brother or sister of a patient also will have lupus is still quite low. It is difficult to estimate how many people in the United States have the disease because its symptoms vary widely and its onset is often hard to pinpoint.
Although "lupus" is used as a broad term, there actually are several kinds of lupus:
Systemic lupus erythematosus (SLE), which is the form of the disease that most people are referring to when they say "lupus." The word "systemic" means the disease can affect many parts of the body. The symptoms of SLE may be mild or serious. Although SLE usually first affects people between the ages of 15 and 45 years, it can occur in childhood or later in life as well. This booklet focuses on SLE.
Discoid lupus erythematosus primarily affects the skin. A red, raised rash may appear on the face, scalp, or elsewhere. The raised areas may become thick and scaly. The rash may last for days or years and may recur. A small percentage of people with discoid lupus later develop SLE.
Drug-induced lupus refers to a form of lupus caused by medication. It causes some symptoms similar to those of SLE (arthritis, rash, fever, and chest pain, but not kidney disease) that go away when the drug is stopped. Common medications that may cause drug-induced lupus include hydralazine (Apresoline), procainamide (Procan, Pronestyl), methyldopa (Aldomet), quinidine (Quinaglute), isoniazid (INH), and some anti-seizure medications such as phenytoin (Dilantin) or carbamazepine (Tegretol).
Neonatal lupus can affect some newborn babies of women with SLE or certain other immune system disorders. Babies with neonatal lupus may have a serious heart defect. Other affected babies may have a skin rash, liver abnormalities, or low blood counts. Physicians can now identify most at-risk SLE patients, allowing for prompt treatment of the infant at birth. Neonatal lupus is very rare, and most infants of mothers with SLE are entirely healthy.
In lupus, the body's immune system doesn't work, as it should. A healthy immune system produces antibodies, which are special proteins that help fight and destroy viruses, bacteria, and other foreign substances that invade the body. In lupus, the immune system produces antibodies against the body's healthy cells and tissues. These antibodies, called autoantibodies ("auto" means self), contribute to the inflammation of various parts of the body, causing swelling, redness, heat, and pain. In addition, some autoantibodies join with substances from the body's own cells or tissues to form molecules called immune complexes. A buildup of these immune complexes in the body also contributes to inflammation and tissue injury in people with lupus. Researchers do not yet understand all of the factors that cause inflammation and tissue damage in lupus, and this is an active area of research.
Symptoms of Lupus
Each person's experience with lupus is different. Symptoms can range from mild too severe and may come and go over time. Common symptoms of lupus include extreme fatigue, painful or swollen joints, unexplained fever, and skin rashes. A characteristic skin rash may appear across the nose and cheeks - the so-called butterfly or malar rash. Other rashes occur elsewhere on the face and ears, upper arms, shoulders, chest, and hands.Other symptoms of lupus include chest pain, hair loss, sensitivity to the sun, anemia (a decrease in red blood cells), and pale or purple fingers and toes from cold and stress. Some people also experience headaches, dizziness, depression, or seizures. New symptoms may continue to appear years after the initial diagnosis, and different symptoms can occur at different times.
Common Symptoms Of Lupus
- Painful or swollen joints and muscle pain
- Unexplained fever oExtreme fatigue
- Red rash or color change on the face
- Chest pain upon deep breathing
- Unusual loss of hair
- Pale or purple fingers or toes from cold or stress (Raynaud's phenomenon)
- Sensitivity to the sun
- Swelling (edema) in legs or around eyes
- Swollen glands
Kidneys: Inflammation of the kidneys (nephritis) can impair their ability to effectively get rid of waste products and other toxins from the body. Because the kidneys are so important to overall health, lupus in the kidneys generally requires intensive drug treatment to prevent permanent damage. There is usually no pain associated with kidney involvement, although some patients may notice that their ankles swell. Most often the only indication of kidney disease is an abnormal urine test.
Central nervous system: In some patients, lupus affects the brain or central nervous system. This can cause headaches, dizziness, memory disturbances, vision problems, stroke, or changes in behavior. Some of these symptoms, however, also can be caused by some treatments of lupus or by the emotional stress of dealing with the disease.
Blood vessels: Blood vessels may become inflamed (vasculitis), affecting the way blood circulates through the body. The inflammation may be mild, and may not require treatment.
Blood: People with lupus may develop anemia or leukopenia (a decreased number of white blood cells). Lupus also may cause thrombocytopenia, a decreased number of platelets in the blood that contributes to an increased chance of bleeding. Some people with lupus may have an increased risk for blood clots.
Lungs: Some people with lupus develop pleuritis, an inflammation of the lining of the chest cavity that causes chest pain, particularly with breathing. Patients with lupus also may get pneumonia.
Heart: In some people with lupus, inflammation can occur in the arteries that supply blood to the heart (coronary vasculitis), the heart itself (myocarditis and endocarditis), or the membrane that surrounds it (pericarditis), causing chest pains or other symptoms.
This is a brief adaptation of the publication of the National Institutes of Health - National Institute of Arthritis and Musculoskeletal and Skin Diseases. This publication is not copyrighted. Readers are encouraged to duplicate and distribute as many copies as needed.
Additional Information
National Arthritis and Musculoskeletal and Skin Diseases Information ClearinghouseNational Institutes of Health (NAMSIC/NIH)
1 AMS Circle, Bethesda, Maryland 20892-3675
Phone: (301) 495-4484
Fax: (301) 587-4352
Related Websites
Handout on Health: Systemic Lupus Erythematosus - National Institutes of Health National Institute of Arthritis and Musculoskeletal and Skin DiseasesCurrent Research (on lupus) - National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases
Lupus Erythematosus - National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIAMS RESEARCH NEWS, January 15, 1996
Books Worth Reading
The Lupus Book : A Guide for Patients and Their Families
Authors: Daniel Wallace In the only book for non-specialists endorsed by The Lupus Foundation of America, a world-renowned expert on lupus explains what the disease is, why it is so difficult to diagnose, and how patients can ease their suffering.