A running gag on the television drama House is that patients with hard-to-diagnose symptoms are thought to have lupus -- underscoring the difficulty doctors have diagnosing the disease. As the fictional Dr. Gregory House says, "it's rarely ever lupus."
But what if it is? What is this mysterious disease? Who does it affect? And could you be at risk?
General definition of lupus:
Lupus (sometimes generically referred to as SLE, systemic lupus erythematosus) is an autoimmune disease, one that takes on several forms and can affect any part of the body, but is most commonly attacks the skin, joints, the heart, lungs, blood, kidneys and brain.
Autoimmune diseases are characterized by a malfunction of the immune system one in which the immune system cannot distinguish between the body's own cells and tissues and that of foreign matter, like viruses. Rather than simply producing antibodies to attack antigens (viruses, bacteria and similar foreign matter), the immune system creates auto-antibodies that attack the immune system itself.
When this happens, victims can suffer inflammation (the primary feature of lupus), pain, and tissue damage. Inflammation in and of itself can cause pain, heat, redness, swelling and loss of function, either internally (certain organs) or externally (primarily the skin) or both.
For some patients who are mildly afflicted, symptoms lupus can be managed as a chronic illness, however, the disease can be quite serious and even life threatening for others. There is no cure for lupus, though symptoms can be treated with drugs such as corticosteroids and immunosuppressants. Also, the disease does not follow a common path. Lupus patients often suffer unpredictable bouts of the disease (called flares) followed by periods of remission.
The prognosis for those with lupus often depends on the amount of organ involvement. In other words, is the disease targeting organs rather than skin and joints?
Survival for lupus patients with central nervous system, major organ involvement and/or kidney disease is likely to be shorter than those with only skin and/or joint disease related to lupus. The most common cause of death associated with lupus is infection due to immunosuppression, caused by medications used to manage the disease.
Who gets lupus:
Nearly 2 million Americans have lupus, according to the Lupus Foundation of America, with about 16,000 newly diagnosed each year. Anyone at any age can acquire the disease, though 90 percent of lupus patients are women between the ages of 15 and 45.
Although used as a joke on House, confusion surrounding the disease diagnosis is actually quite true. Initial and chronic lupus symptoms mimic the symptoms of several diseases, leading to misdiagnosis. Initial symptoms often include:
- Malaise, or general discomfort
- Joint paint
- Muscle pain
Usually, it isn't until those symptoms are coupled with other, more suggestive signs, do doctors tend to walk down the lupus path. Those signs include, but are not limited to:
- Skin ulcers, lesions and rashes, most significantly malar rash, commonly called butterfly rash.
- Iron deficiency
- Cardiac issues, such as pericarditis, myocarditis, and endocarditis.
- Pleuritis and other lung inflammation
- Renal issues, including painless hematuria or proteinuria
Causes and risk factors:
Lupus is still a relative mystery to medical researchers. An exact cause of the disease remains unknown, and many still debate whether lupus is one disease or the combination of several similar diseases.
But the consensus on the most likely ways in which lupus develops include: genetics (your family's history of having the disease), environmental triggers (from medications to stress and exposure to sunlight), and reaction to drugs (this is usually a disease that mimics lupus and is reversible, caused by long-term medication use).
Currently, there is no cure for lupus, but patients can lead a normal life through medical treatment. Treatment focuses on the symptoms of lupus, rather than the disease itself.
- Drug therapy, such as anti-inflammatory drugs and immune system modulators.
- Acupuncture (an alternative, but not recommended treatment)
- Phototherapy, or light therapy
- Lifestyle moderation, including weight loss and protection from the sun
- Getting Treated for Lupus
- Complementary and Alternative Medicine Techniques
- Clinical Trials
“What is Lupus? Fast Facts: An Easy Read Series of Publications for the Public". National Institute of Arthritis and Musculoskeletal and Skin Diseases. September 2005
“Systemic Lupus Erythematosus (SLE or Lupus)" Shiel Jr., William C, MD, FACP, FACR. MedicineNet.com. Collected June 2007.
"Lupus" Petri, Michelle, MD, MPH. The Johns Hopkins Arthritis Center. November 2002.