Lupus : the symptoms, causes, and treatments

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The purple ribbon is most commonly used to raise awareness for lupus, animal abuse, Alzheimer's disease, domestic violence, epilepsy, sarcoidosis, Crohn's disease, and pancreatic cancer.(Photo: Envato Elements)
An autoimmune disease is a condition in which the body’s immune system classifies healthy and normal parts of the body as foreign and begins to attack them. As a result of the attack, widespread inflammation and tissue damage to the affected area can occur.اضافة اعلان

A common example of this is rheumatoid arthritis (RA), in which the body attacks the joints, but inflammation and tissue damage are relatively contained to areas of the hands, wrists, and knees in RA.

Lupus is an autoimmune disease that is fairly unique due to its ability to affect and cause inflammation in numerous areas of the body.

There are a few different types of lupus, but the most common and well-known form is systemic lupus erythematosus (SLE). Global estimates are difficult to establish, but SLE global prevalence is estimated to be between 13 and 7,713 per 100,000 people.

Unfortunately, the prevalence in Jordan has yet to be thoroughly investigated.
Lupus is an autoimmune disease that is fairly unique due to its ability to affect and cause inflammation in numerous areas of the body.

What is SLE, and what are some of the physical manifestations?

SLE is a chronic, lifelong condition with no cure. By nature, this condition has cyclic phases of symptoms, periods where symptoms worsen, also known as flare-ups, and other periods when symptoms return to a milder state, also known as remission. SLE attacks many different organs and systems in the body, including the kidneys, skin, joints, heart and blood vessels, nervous system, and lungs.

The symptoms of SLE can range from mild to severe depending on how badly and which organs are most affected. Common symptoms and manifestations of SLE include headaches, extreme fatigue, anemia, issues relating to blood-clotting, joint pain and swelling, and hair loss.

One of the more visible symptoms of SLE is when it attacks the skin. The attack can manifest in a rash known as the butterfly rash. This particular rash commonly appears as redness along the length of the nose and across the cheeks.

Another common manifestation is known as Raynaud’s Phenomenon. This occurs due to the body attacking blood vessels, which causes an episode of constriction known as vasospasm. It ultimately results in restricted or interrupted blood flow to certain areas of the body, such as the fingers and toes, ears, or nose.

Raynaud’s Phenomenon will present as tingling in these affected areas and cause the skin to turn white or blue.

What causes SLE?

There is no single cause of SLE, but an intricate relationship between genetic, environmental, and hormonal factors plays a role.

Genetically, there is no certain gene that has been linked to SLE. However, it has been found that those with a family member with the condition are at a higher risk of developing SLE. Many studies also confirmed that SLE disproportionally affects Black, Asian, and Hispanic populations.

Environmental triggers such as ultraviolet rays, certain medications and viruses, physical or emotional stress, and trauma do not necessarily cause SLE but instead exacerbate the condition in those already predisposed.

Sex and hormones also seem to play an interesting role in SLE. Internationally, regardless of race, women are consistently more affected by SLE than men.

According to the Center for Disease Control and Prevention, it is estimated that 4–12 women are afflicted with SLE for every man with the condition. Furthermore, women tend to experience worsening symptoms during pregnancy and menstrual periods. As a result, it has been hypothesized that the female sex hormones known as estrogen may play a role in causing SLE, although more research is needed to confirm.

How is SLE treated?

As of yet, there is no cure for SLE.

The primary focus of treatment for SLE is managing the symptoms brought on by the condition.

For stiffness in the joints and overall pain, it can often be managed by over-the-counter anti-inflammatory medication. There are also medications such as steroids that can help manage overall inflammation but require a prescription.
Sex and hormones ... play an interesting role in SLE. Internationally, regardless of race, women are consistently more affected by SLE than men.
There is also a heavy emphasis on lifestyle changes to help manage symptoms. Since SLE affects the skin, it can cause individuals to become sensitive to ultraviolet (UV) light. Sunscreens that block UV-A and UV-B and have an SPF of 55 or more are recommended to use whenever outdoors.

When it comes to diet, a well-balanced diet is emphasized. Inflammatory diseases such as SLE may require increasing caloric intake and certain medications used to treat symptoms, including glucocorticoids which may increase appetite.

Generally, if a balanced diet is maintained, there is no need for supplemental vitamins with the exception of vitamin D, as vitamin D deficiency in those with SLE is common, likely due to the lack of sunlight exposure.

Additionally, due to the acute flare-ups of SLE, physical activity can be difficult. But, it is important to exercise during milder periods to maintain muscle mass, improve bone strength, and reduce symptoms of fatigue.

Complications of SLE

Unfortunately, SLE is associated with many severe complications, especially in those unable to seek treatment, go undiagnosed, or are poorly managed. Due to the multisystem attack on the body, many events can result in premature death with SLE.

When it comes to the cardiovascular system, many complications can increase mortality. This includes vasculitis (inflammation of the blood vessels), pericarditis (inflammation of the heart), heart attack, and stroke.

SLE can also cause complications in the lungs, particularly inflammation of the lung tissue and lining known as pleuritis.

Another common complication of SLE is decreased kidney function due to inflammation. If kidney function is impaired, it can ultimately result in kidney failure.

The mortality associated with SLE is cause for concern. A 2020 study in Jordan assessed the in-hospital mortality of patients with SLE between 2002–2017 and found that the death rate was 14.1 percent.

The cause of death was primarily due to infection (42.5 percent) and SLE-related complications (40 percent). Of those whose death was attributed to SLE-related complications, the majority were due to critical cases relating to the cardiovascular and respiratory systems.

More disturbing was the length of time between diagnosis and death. The average time between diagnosis and death was 7.5 years in the deceased population. Moreover, those who died during this study were diagnosed with SLE at an early age (27.8 years on average) compared to those who were not (37 years on average).

There is also a notable disparity between men and women exists when it comes to SLE and mortality. At baseline, women with SLE outweigh men by a factor of 8.4:1. However, in those deceased, that disparity shrank to 3.4:1.

While controversy exists on the matter, this difference in disparity has been noticed in other studies, leading to the consideration that SLE is more aggressive in men than in women, despite women making up the majority of those with SLE.

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