Learning About Lupus

Lupus is an acute chronic disease which attacks any organ of the body in unpredictable ways. Diagnosis is difficult because symptoms vary between individuals, and the disease remits and relapses. Delay in diagnosis can lead to organ failure and sometimes death. Lupus belongs in the family of diseases that includes rheumatoid arthritis, multiple sclerosis, juvenile diabetes, and scleroderma.

The most common type of lupus is SLE (systemic lupus erythematosus). It is a complex and baffling condition that can target any tissue or organ of the body, including skin, muscles, joints, blood and blood vessels, lungs, heart, kidneys, and the brain.

There are other types of lupus, which mainly affect the skin; Some develop drug-induced lupus as a response to some medications used to treat other conditions. These symptoms disappear when the person stops taking the medication.

Women of child-bearing age (15 to 45) are most often affected. Indeed, in that particular age group, lupus is 8 to 13 times more common in women than in men. However, the disease does occur in men, in children and in the elderly.

No one knows for sure. What we do know is that, in lupus, the immune system (the body's defense against viruses and bacteria) is unable to tell the difference between intruders and the body's own tissues. Trying to do its job, it attacks parts of the body, causing inflammation and creating the symptoms of lupus. There is some evidence that there is a link between lupus and some hormones, but how this works remains uncertain. It also appears that inherited factors may make certain people more likely to develop lupus, but these also are not clear yet. The risk of a sibling of someone with lupus getting lupus is about 29 times higher than in the “normal” population. Until science fully understands how the immune system works, the specific cause of lupus remains unknown.

Lupus is not contagious. Lupus is not an infection. It cannot be passed from person to person like a cold, the measles or the flu. It is not a form of cancer. There is absolutely no relationship between lupus and AIDS.

Some people will have only a few of the many possible symptoms. Because it can target any of the body's tissues, lupus is often heard to pin down or diagnose. That's why it is called "the disease with 1000 faces". Before symptoms specific to lupus occur, flu-like symptoms may appear, along with severe fatigue, a sudden unexplained loss or gain in weight, headaches, hair loss, hives, high blood pressure, or changes in the colour of fingers in the cold. A person with lupus may experience:

• Muscle and joint pain

• Blood or protein in urine

• Prolonged or extreme fatigue

• Weight gain

• Raynaud’s phenomenon

• Fever

• Anemia

• Sun sensitivity

• Skin rashes

• Hair loss

• Mouth or nose sores

• Chest pain

• Swollen extremities (joints) or face

• Persistent flu-like symptoms with blood abnormalities

• Seizures or severe neurological symptoms

This is far from a complete list of symptoms, and the diagnosis of lupus must be made by a doctor.

What is known is that lupus is an autoimmune disease. The immune system is the part of the body that protects us against germs such as bacteria and viruses. In the normal individual, certain cells of the immune system make proteins called antibodies that react with foreign substances in the body and destroy them. In lupus, something goes wrong with the immune system so that it also makes antibodies that attack the person’s own tissues. The result is an autoimmune reaction which causes the inflammation that affects the specific tissues or organs in SLE.

As yet, there is no cure for lupus. However, researchers studying this disease have made tremendous advances in our knowledge of SLE and this research is continuing. Patients are fully justified in their hopes that a cure will be found.

Heredity may influence whether or not a person develops lupus. It is not unusual for a lupus patient to have in his or her family a relative with an autoimmune disease (including lupus). In fact, SLE studies have shown that between 0.4 to 5% of the relatives of lupus patients may themselves develop lupus. While this may sound frightening, remember that the odds of not having lupus when someone else in the family has it are at least 95% or greater.

1. Systemic lupus erythematosus SLE (or simply “lupus”) is a treatable, chronic, autoimmune, inflammatory disease that can affect any organ in the body and in a pattern that varies greatly from person to person. Lupus is characterized by autoantibodies. SLE is a chronic illness, which means that the disease is lifelong (however, most persons with SLE will not be continuously sick for the rest of their lives). Autoimmune means that there is a disorder of the immune system which cannot tell the difference between the person’s own tissues and foreign tissues. This conflict leads to inflammation (the normal body response to injury or infection) in various organs which causes the symptoms of lupus to appear. If severe or untreated, this inflammation may cause organ damage and loss of function. Autoantibodies, meaning antibodies directed against one’s self, are involved in this process and are typical of SLE.

2. Discoid lupus erythematosus (DLE) and subacute cutaneous lupus (SCLE) are diseases where skin rashes and sun sensitivity are the main problems; involvement of the internal parts of the body does not occur and life is not threatened. However, both DLE and SCLE may, at times, occur along with the systemic form of lupus. Performing appropriate tests to rule out systemic lupus erythematosus is therefore important when DLE or SCLE is newly diagnosed.

3. Neonatal lupus is an uncommon form of lupus that affects the newborn child. This most often occurs in the children of women with SCLE or systemic lupus who also have a particular antibody (molecule that recognizes other molecules that are foreign to the body) in their bloodstream. Skin rashes that come and go and a decrease in some of the blood cells may occur but these problems go away within six months after birth. In rare cases, the tissues that control the normal heartbeat may be affected. However, this serious problem can often be corrected with a pacemaker.

4. Drug-induced lupus is triggered by certain drugs. Only a small number of people taking these drugs develop this form of lupus which has many of the symptoms of systemic lupus. The most important feature of drug-induced lupus is that it goes away when the offending drug is stopped.

Lupus has been known as a disease for over 2000 years. Hippocrates, who lived from 460 to 370 BC, first described lupus lesions (lesions means damage). The name “lupus” comes from a Latin word meaning wolf and was used in reference to the red ulcers on the face. In 1851, Cazenave introduced the name “lupus erythematosus”. Later in the 1800’s, Kaposi described the butterfly rash on the face and Sir William Osler, a Canadian physician, expanded the concept of lupus as a “systemic” disease, a disease which may affect many parts of the body.

In 1948, Hargraves and his colleagues discovered a particular blood cell that appeared in lupus patients and lupus began to be considered as an autoimmune disease. In 1957, Friou described the antinuclear antibodies (antibodies which react with the nucleus of cells) which confirmed that lupus is indeed a disorder of the body’s immune system.

With a clearer understanding of the disease process at work in SLE, researchers have continued their efforts to discover a cause and cure for lupus. In the last 30 years, enormous advances have been made that have improved both the diagnosis and treatment.