Lupus can be difficult to diagnose because it can affect almost
any organ in the body and its symptoms - including joint pain,
fatigue, muscle pain, rash, mouth ulcers, and hair loss - vary
widely from patient to patient. That is one of the greatest
challenges of treating the disease for both doctors and their
patients.
About Lupus
Lupus is a rheumatic (having to do with the muscles, joints, and
connective tissue) condition that affects 1.5 million people in the
United States, including an estimated 10,000 children. Nearly 90%
of those diagnosed with lupus are female.
Lupus is an autoimmune disease in which the immune system
mistakenly works against the body's own tissues. A healthy
immune system produces proteins called antibodies that normally
protect the body against bacteria and viruses that cause
infections.
But when someone has lupus, the immune system can't tell the
difference between the body's healthy cells and bacteria and
viruses, so the antibodies attack the body's healthy cells.
What Causes Lupus?
Although the cause of lupus is unknown, researchers think that
many factors may trigger the disease.
Genetics may play a role. Some people may have a genetic
predisposition to lupus that is then activated by an infection,
certain medications, or extreme physical or emotional stress. The
hormone estrogen may also play a role in lupus and could help
explain why it is more common in females than males. Lupus also
occurs more frequently in African Americans, Asian Americans,
Latinos, and Native Americans than in caucasians.
Types of Lupus
The three main types of lupus are:
- Systemic lupus erythematosus, or SLE
, which can affect multiple organs in the body and is the
most common form of the disease. Although SLE typically develops
in people in their twenties, thirties, or forties, some people
first notice symptoms during childhood or adolescence (after age
10). SLE can be difficult to diagnose because no two patients
will have an identical set of complaints, and the symptoms can
sometimes be mistaken for those of other conditions, like
juvenile rheumatoid arthritis, Crohn's disease, Lyme disease,
and mononucleosis.
- Discoid (or cutaneous) lupus
, which usually affects only the skin and is characterized
by a rash on the scalp, legs, or arms. The rash has sharply
defined patches and can be raised from the skin. Discoid lupus
affects approximately 15% of all lupus patients, but is rare in
children. Occasionally, discoid lupus occurs with systemic
lupus.
- Drug-induced lupus
, which accounts for about 10% of all lupus cases and occurs
as a reaction to specific kinds of medications. In kids,
anti-seizure medications, thyroid medications, and acne
medications can cause lupus. The symptoms are similar to those of
the systemic form, but are usually milder and go away after the
medication is stopped.
Diagnosing Lupus
The two rashes commonly associated with lupus are:
- malar rash - a rash across the cheeks and the bridge of the
nose (also called a "butterfly" rash because it is
shaped like a butterfly)
- discoid rash - circular, red or hyperpigmented raised patches
of skin that often occur on the face, neck, or chest
Other common symptoms:
- sensitivity to ultraviolet light that results in a rash -
either sunlight or, occasionally, certain types of fluorescent
light (also called photosensitivity)
- ulcers in the nose or mouth, which are usually painless
- nonerosive arthritis (arthritis that does not destroy the
bones around the joints)
- inflammation of the lining around the heart, abdomen, or
lungs (called serositis)
- kidney problems, either mild (with no early symptoms) or
severe, such as those that lead to swelling in the legs
- neurological disorders, such as seizures or psychosis
- blood problems, such as a low red blood cell count (anemia),
a low white blood cell count (leukopenia), or a low platelet
count (thrombocytopenia)
- problems with the immune system
- positive blood test for antinuclear antibodies (ANA),
specific proteins that are a hallmark of rheumatic or autoimmune
disease. More than 95% of lupus patients have a positive
ANA.
Someone with
four or more
of these signs or symptoms is likely to have SLE. Most
patients don't develop all of them. Before making a diagnosis,
doctors perform a physical exam and take blood tests to rule out
any other diseases.
In addition to those symptoms, patients with lupus often have
fever, weakness, fatigue, or weight loss. They may experience
muscle aches, loss of appetite, swollen glands, hair loss, or
abdominal pain, which can be accompanied by nausea, diarrhea, and
vomiting.
Sometimes the fingers, toes, nose, or ears will be particularly
sensitive to cold and will turn blue and white in cold
temperatures, a condition known as Raynaud's phenomenon.
Managing Lupus
There is no known cure for lupus, but the symptoms of the
disease can be controlled. Often a patient with lupus has a health
care team that includes specialists who can help treat the
symptoms. That team may include a rheumatologist (a doctor who
specializes in conditions of the joints and connective tissues), a
nephrologist (a doctor who specializes in kidney diseases), an
advanced practice nurse, a social worker, and other consulting
doctors, like a dermatologist, psychologist, or infectious diseases
specialist.
Part of managing lupus is preventing flares, times when the
disease gets worse. During a flare, a person with lupus may feel
much more tired, sick, feverish, and achy than usual.
Almost all lupus patients take medication to control
inflammation and reduce the risk of flares.
Doctors frequently prescribe corticosteroids, which are drugs
that are used to control inflammation. These aren't the same
steroids some athletes take. If a doctor prescribes one of these
medications, the dosage and any side effects will be carefully
monitored.
For day-to-day muscle and joint pain, patients can take
acetaminophen or any of a variety of nonsteroidal anti-inflammatory
drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen. Others
take antimalarial drugs (medicines first developed to prevent and
treat malaria, but that have also been found to help treat lupus).
Antimalarial drugs often help treat skin rashes and joint pain.
Some children with kidney disease may require more aggressive
treatment with immunosuppressive drugs, which lower the body's
immune system responses.
Making Lifestyle Changes
Though the course that lupus takes cannot be predicted, certain
lifestyle changes may help minimize flare-ups. Some doctors advise
patients to avoid too much sun exposure by wearing sunscreen and
protective clothing when outside. Regular
exercise
can help prevent fatigue and joint stiffness. A balanced diet and
sufficient rest also are important for maintaining general health
and well-being.
When to Call the Doctor
Kids with lupus are prone to the usual childhood illnesses, such
as a viral infection or diarrhea. However, a
fever
, rash, or mouth sore may also indicate the beginning of a flare.
As you and your child become more familiar with the disease, you
may learn to recognize signs that a flare-up is around the
corner.
Call the doctor immediately if any of these symptoms appear:
- bloody stools
- easy bruising (with or without nosebleeds)
- chest or abdominal pain
-
seizures
- new or high fever
The Outlook for Lupus
The outlook for lupus patients is continually improving. Over
the past few decades, better tools to diagnose and treat lupus have
remarkably improved the lives of those who live with the
disease.
Reviewed by:
AnneMarie C. Brescia, MD
Date reviewed: June 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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