Lupus is a form of arthritis which can affect joints, muscles and other parts of the body. Symptoms are varied and can include joint pain, fatigue, skin rashes and depression.
Lupus is more common in women and, in New Zealand, in Māori and Pacific Island people. It's one of the autoimmune rheumatic diseases. In people with autoimmune diseases, antibodies are produced which act against certain body tissues and cause inflammation.
There are two main forms of lupus:
- Discoid lupus — which affects only the skin.
- Systemic lupus — which involves the joints and sometimes internal organs as well (systemic lupus is also called SLE - systemic lupus erythematosus).
Lupus (Latin for wolf) takes it name from the fact that it can cause serious rashes across the cheeks and nose (rather fancifully resembling the face of the wolf).
It has been suggested that genetic factors (which people are born with) play an important role in the development of the condition. This does not rule out a role for environmental factors, which may also be shared by people from particular backgrounds.
Genetic factors: There is no single gene which puts people at risk of developing lupus. It seems most likely that between 20 and 80 genes contribute to the risk and while the genes may set the scene, environmental factors contribute to whether or not the disease develops, and when.
Environmental factors: include exposure to UV light (sun exposure), various infections, possibly chemicals in the environment, factors related to stress (not well identified) and female hormonal activity (for example, the oestrogen-containing contraceptive pill or pregnancy). These factors combine to influence the immune system in such a way that immune abnormalities result which cause the disease to develop (or recur).
Who gets lupus?
About 10 times as many women as men develop lupus and it is usually diagnosed in the child-bearing years. In New Zealand, lupus is three to four times more common among Maori and Pacific Island peoples.
Lupus can mimic many different conditions. It usually starts with joint pains, especially in the small joints of the hands and feet, and may ‘flit’ from one set of joints to another quite quickly. Fatigue is one of the most common and certainly one of the most prominent features of lupus. Patients often describe it as an unnatural fatigue. Its causes are not well understood.
Other symptoms may include:
- skin rashes
- recurring mouth ulcers
- hair loss
Usually, the combination of some of the features described above, especially the skin rashes, usually but not always, make the diagnosis clear.
Unfortunately, in many patients, especially those who do not have the classical tell-tale rashes, the diagnosis can be missed. This is particularly true for those with more ‘vague’ symptoms such as fatigue, depression or headaches. Lupus is now almost invariably diagnosed by specific blood tests, which are extremely sensitive.
Although there is no cure for lupus, for the vast majority of people effective treatment can minimise symptoms, reduce inflammation, and maintain normal bodily functions. Medication and lifestyle measures are both aspects of treatment.
Medications are often prescribed, depending on which organ(s) are involved, and the severity of involvement. Commonly prescribed medications include those for pain, inflammation, skin and joint symptoms, and immune system suppressants.
Lifestyle changes can help minimise symptoms and aid an improved sense of well-being. Preventive measures can reduce the risk of flares. For photosensitive patients, avoidance of (excessive) sun exposure and/or the regular application of sunscreens will usually prevent rashes.
Regular exercise can help prevent muscle weakness and fatigue. Immunisation will protect against specific infections and maintaining a healthy lifestyle by getting enough rest, reducing stress, eating a balanced diet, and quitting smoking, all helps.
At times people with lupus may feel angry, depressed and isolated. Support groups offer education, information, meetings and support for people with lupus in New Zealand.