Introduction:

Systemic lupus erythematosus (SLE) is the most common form of lupus. Lupus is an autoimmune disease, meaning that the body’s immune system mistakenly attacks healthy organs and tissue. Lupus can affect any part of the body, causing inflammation and damage in joints, skin, kidneys, heart, lungs, blood vessels, or the brain. More than 90% of people with lupus experience skin rashes (often triggered by exposure to the sun), and about half have kidney and lung problems. Because lupus affects the joints, it is considered a rheumatic disease.

Signs and Symptoms:

Lupus is often accompanied by the following signs and symptoms:

• Extreme fatigue
• Painful or swollen joints (arthritis)
• Muscle pain and stiffness
• Unexplained fever
• Skin rashes, including a characteristic "butterfly" rash over the nose and cheeks
• Kidney problems
• Hair loss
• Nausea, vomiting, abdominal pain
• Mouth and nose ulcers
• Headaches, migraine, seizures, stroke
• Anemia
• Depression
• Photosensitivity (sensitivity to sunlight)

What Causes It?:

The cause of lupus isn’t known, although genetics and environment probably play a part. Lupus usually first affects people between the ages of 15 - 45 years, but it can also occur in childhood or later in life. Lupus is a chronic disease, and people with lupus may experience periods of remission and flares.

Some researchers believe lupus may develop after a person is infected with an organism that looks similar to particular proteins in the body. In this theory, the body later mistakes the proteins for the organism and attacks them. Lupus also seems to have a genetic component. Some drugs, such as hydralazine, methyldopa, and chlorpromazine, can cause lupus-like symptoms. The symptoms usually go away after the drug is stopped.

Who's Most At Risk?:

The following people are at higher risk for lupus:

• Many more women than men have lupus.
• Lupus is more common in black women and women of Hispanic, Asian, and Native American descent than in white women.
• Lupus can run in families, but the likely that a child or a brother or sister of a patient also will have lupus is quite low.

What to Expect at Your Provider's Office:

Your doctor will refer you to a rheumatologist to diagnose and treat lupus, and a team of specialists usually helpy determine which treatment may work best for you. Lupus can be hard to identify, and it may take time to determine the diagnosis. Its symptoms can mimic other autoimmune rheumatic diseases, such as rheumatoid arthritis.

Your doctor will examine you and may order tests, including:

• Complete blood count
• Erythrocyte sedimentation rate (ESR) -- an elevated ESR indicates inflammation in the body
• Urinalysis
• Blood chemistries
• Complement test (a blood test that measures severity of infection)
• Antinuclear antibody test (ANA) -- positive in most lupus patients
• Other antibody tests
• Syphilis test (may be falsely positive in people with lupus)
• Skin or kidney biopsy
• Imaging techniques may be used to evaluate central nervous system changes or problems and other symptoms associated with lupus.

Treatment Options:

Prevention

While you can’t prevent lupus, you can help prevent flare-ups:

• Avoid sun exposure, high-dose birth control pills, penicillin, and sulfonamides (antibacterial agents)
• Exercise regularly
• Get flu and pneumococcal vaccines

Treatment Plan

There is no known cure for lupus. However, your team of health care providers can develop a treatment plan to prevent flare-ups, to treat them when they do occur, and to minimize complications.

Drug Therapies

Your health care provider may prescribe the following medications:

• Corticosteroids (such as prednisone), to rapidly suppress inflammation. Side effects from long-term use include increased risk of osteoporosis.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), to control pain, swelling, and fever. These drugs include ibuprofen (Advil) and naproxen (Aleve).
• Drugs that suppress the immune system, to help keep the disease under control and prevent flares. These drugs include methotrexate, cyclophosphamide (Cytoxan), and azathioprine (Imuran).
• Antimalarial drugs, to treat fatigue, joint pain, skin rashes, and inflammation of the lungs. One of these drugs, hydroxychloroquine (Plaquenil), also helps prevent flares.

Complementary and Alternative Therapies

A comprehensive treatment plan for lupus may include a range of complementary and alternative therapies.

Nutrition and Supplements

Eating a healthy diet with plenty of fruits, vegetables, and whole grains is important for anyone with a chronic disease. People with lupus may also benefit from the following strategies:

• If your health care provider suspects allergies, you may want to eliminate all suspected food allergens, including dairy, wheat (gluten), soy, chocolate, corn, preservatives, and food additives. People who do not eat dairy products and take corticosteroids should make sure to get enough calcium in their diet. Avoid alfalfa sprouts and onions.
• Eat more antioxidant-rich foods (such as green, leafy vegetables) and fruits (such as blueberries, pomegranates, and cherries).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink plenty of fluids.
• Exercise moderately at least 30 minutes daily, 5 days a week.

The following supplements may also help:

• Flaxseed (30 g per day) contains omega-3 fatty acids and alpha-linolenic acid, which may help decrease inflammation. One preliminary study suggested that people with lupus who took flaxseed improved their kidney function -- important because kidney disease (lupus nephritis) is a major complication of lupus.
• Fish oil, which also contains omega-3 fatty acids, may help decrease inflammation. Although evidence is mixed about taking a fish oil supplement, doctors do suggest that people with lupus eat more fish. Cold-water fish, such as salmon or halibut, are good sources. Talk to your doctor before taking a fish oil supplement if you also take anticoagulants (blood-thinners), such as warfarin.
• Dehydroepiandrosterone (DHEA), start at 5 mg three times a day and work up to 100 - 200 mg per day for 7 - 12 months. You should take DHEA only under a doctor’s supervision. DHEA is a precursor to the hormones estrogen and testosterone in the body, and several clinical trials show that it may help improve symptoms of lupus. However, side effects -- including acne, increased facial hair, and excessive perspiration -- were common. DHEA may also lower HDL (good) cholesterol, which could contribute to heart disease. Because of DHEA’s hormone-like effects, people with a history or higher risk of breast, uterine, ovarian, or prostate cancer should not take DHEA.
• Calcium and vitamin D supplement, 1 - 2 tablets daily if taking corticosteroids.
• Methylsulfonylmethane (MSM), 3,000 mg two times per day, to help prevent joint and connective tissue breakdown.

Herbs

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls per cup of water steeped for 10 - 15 minutes (roots need longer).

Green tea (Camelia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.

Astragalus (Astragalus membranaceus) appeared to reduce overactive immune function in people with lupus in one study. However, the study was preliminary; more research is needed to know whether astragalus works. Do not take astragalus without talking to your doctor first, especially if you already take medications to suppress your immune system.

Tripterygium wilfordii, 30 - 45 mg daily, a Chinese herb. You may also prepare teas from the root of this herb. Two preliminary studies suggest that this herb may help suppress the immune system and reduce joint pain and inflammation. However, not much is known about its safety, and one report suggests that using it long-term may reduce bone density in women (a risk factor for osteoporosis). There are other reports of possibly more serious side effects. You should take this herb only under your doctor’s supervision. Do not take tripterygium if you are pregnant.

People with lupus should avoid alfalfa supplements, and should talk to their doctor before taking any herb that is used to strengthen the immune system (such as echinacea or gingko).

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for lupus based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Apis mellifica
• Arsenicum album
• Calcarea carbonica
• Causticum
• Rhus toxicodendron
• Ruta graveolens
• Thuja occidentalis

Acute dose is 3 - 5 pellets of 12X to 30C every 1 - 4 hours until symptoms are relieved.

Prognosis/Possible Complications:

The prognosis for people with lupus is mixed. Half of people who go into remission remain so for decades, but 90% of people with lupus have complications. For women, symptoms tend to decrease after menopause. Ninety percent of people with lupus have a survival rate of 10 years, and 63 - 75% have a survival rate of 20 years. People with certain complications from lupus tend to have a poor prognosis.

Following Up:

Patients need to be closely monitored during flares to determine the appropriate course of treatment and induce remission.

Alternative Names:

Lupus