How Does A Person Get Lupus?

The cause of lupus is unknown, though it is believed to have genetic, hormonal, immunologic, and/or environmental triggers.

Lupus (systemic lupus erythematosus, or SLE) is a chronic autoimmune disease in which the body’s immune system mistakenly attacks its own organs and tissues, causing inflammation and pain, commonly in the skin, joints, and internal organs such as the heart and kidneys, though it can affect any part of the body.

Common symptoms of lupus include:

• Extreme fatigue 
• Fever
• Weight loss
• Muscle pain
• Joint pain or swelling 
• Swelling in the hands, feet, or around the eyes
• Butterfly-shaped rash on the cheeks and nose 
• Headache
• Sensitivity to light 
• Chest pain when inhaling deeply
• Skin lesions
• Hair loss
• Sores in the mouth or nose
• Fingers and toes turning white or blue and feeling numb when exposed to cold or stress (Raynaud’s disease)
• Blood clots, which can lead to stroke or seizures
• Gastrointestinal problems
• Respiratory symptoms including pleuritis, pneumonitis, interstitial lung disease, pulmonary hypertension, shrinking lung syndrome, and alveolar hemorrhage
• Neurologic and psychiatric problems, including cognitive dysfunction, organic brain syndromes, delirium, psychosis, seizures, headache, and numbness or tingling of extremities 
• Blood abnormalities such as anemia, decreased white blood cells (leukopenia and neutropenia), decreased platelets (thrombocytopenia)
• Swollen lymph nodes
• Eye problems

The cause of lupus is unknown, though it is believed to have genetic, hormonal, immunologic, and/or environmental triggers. 

• Genetic
  • There is a high proportion of SLE in identical twins
  • One large study found that first-degree relatives have a 17-fold increased risk of SLE compared with the general population 
  • Siblings have a 29-fold higher risk of developing SLE than the general population 
• Hormonal
  • The Nurse's Health study showed that women with early onset of menstrual periods, or who were treated with estrogen such as oral contraceptives or postmenopausal hormone replacement therapies, have a significantly increased risk for SLE
  • Progesterone and prolactin also affect immune activity 
  • Thyroid hormone may influence SLE, or vice versa
  • Abnormalities of the hypothalamus-pituitary-adrenal axis may exist among patients with SLE
• Immunologic
  • There are numerous immune defects in patients with SLE
• Environmental exposures 
  • May stimulate the immune response and lead to SLE
• Viruses
• Ultraviolet (UV) light 
• Silica dust, found in cleaning powders, soil, pottery materials, cement, and cigarette smoke, may increase the risk of developing SLE, especially in African American women
• Allergies to medications, particularly to antibiotics, occur frequently in patients with newly diagnosed SLE 

There is no single test to diagnose lupus. Tests that may help diagnose the condition include:

• Blood tests 
  • Complete blood count (CBC) 
  • Antibody tests 
  • Blood clotting time tests 
  • Complement tests 
  • Creatinine
  • Protein electrophoresis
  • ANA 
  • Anti-double-stranded DNA (anti-dsDNA)
  • Antiphospholipid antibodies (lupus anticoagulant [LA], immunoglobulin [Ig] G and IgM anticardiolipin [aCL] antibodies, and IgG and IgM anti-beta2-glycoprotein [GP] 1)
  • C3 and C4 or CH50 complement levels
  • Erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) levels
  • Urine protein-to-creatinine ratio
  • Serologic studies for infection
  • Rheumatoid factor and anti-cyclic citrullinated peptide antibodies
  • Creatine kinase (CK)
• Urine tests
  • Urinalysis
  • 24-hour urine collection
• Tissue or organ biopsies
• Electrocardiography for chest pain
• Tests to check for pulmonary embolism in patients with chest pain and shortness of breath
• Diffusing capacity for carbon monoxide if there is suspected lung disease
• X-rays of swollen joints
• Chest X-rays
• Ultrasound of painful joints
• Ultrasound of kidneys to rule out urinary tract obstruction 
• Echocardiography 
• Computed tomography (CT) scan for abdominal pain, suspected pancreatitis, interstitial lung disease
• Magnetic resonance imaging (MRI) for neurologic deficits or cognitive dysfunction

Lupus is generally treated with medications to help manage symptoms, such as:

• Anticoagulants to help prevent blood clots
• Anti-inflammatories and steroids to help with inflammation
  • Prednisone
  • Methylprednisolone
• Antimalarials to protect skin from rashes and UV light
  • Hydroxychloroquine or chloroquine
• Biologics that can help boost the immune system 
• Immunosuppressives to help keep the immune system from attacking the body
  • Azathioprine 
  • Methotrexate
  • Mycophenolate
  • Azathioprine
  • Cyclophosphamide
  • Rituximab

Other measures that can help patients manage lupus include:

• Sun protection 
• Dietary modifications
  • Patients with active inflammatory disease and fever may need increased calories
  • Daily multivitamin for patients who cannot maintain an adequate diet
  • Vitamin D supplementation
  • Salt restriction in patients with high blood pressure (hypertension) and/or kidney inflammation (nephritis)
• Regular exercise
• Don’t smoke
• Get vaccinated as recommended by your doctor
  • Influenza vaccine
  • Pneumococcal vaccines 
  • Quadrivalent human papilloma virus (HPV) vaccine 
  • Hepatitis B vaccine 
• Manage any other medical conditions such as high blood pressure or osteoporosis