Lupus: Symptoms & Treatments
Short for systemic lupus erythematosus (SLE), lupus is an autoimmune disease that can affect many parts of the body and cause many symptoms. According to the charity Lupus UK, this means many GPs fail to recognise it, since it produces symptoms similar to a number of other, more common, conditions.
There are three main symptoms: fatigue, joint pain and swelling, and skin rashes that most typically affect the face, wrists and hands. Your symptoms can be anything from mild to severe, and they usually tend to come and go, which means you may have long periods where your symptoms are few or non-existent interspersed with sudden flare-ups (active lupus is another term for a flare-up).
Some people are only affected by the main symptoms, while others will experience others, including one or more of the following:
Flu-like symptoms (including a fever)
Recurring mouth ulcers
Swollen lymph glands
Headaches and migraines
About one in three people who have lupus are also affected by inflammation of the kidneys, which can sometimes lead to kidney damage. And because lupus can cause high blood pressure and high cholesterol, it can affect your heart too (it can also make the tissues around your heart inflamed, which is a condition called pericarditis). Your lungs can also be affected, causing a condition called pleurisy. Arthritis Research UK claims lupus may also cause narrowing of the blood vessels, which can lead to an increased risk of angina, heart attacks and stroke.
Around a third of people with lupus also develop another autoimmune disease, such as hypothyroidism (underactive thyroid) or rheumatoid arthritis. Other related conditions include Raynaud’s phenomenon (poor circulation in the fingers and toes) and Sjögren’s syndrome (severe dryness of the eyes and mouth).
How common is it?
It’s thought that about five in 10,000 people in the UK are affected by lupus. The disease is nine or 10 times more common in women than in men, and most usually develops when you’re between the ages of 20 and 40 (though anyone can be affected, irrespective of age). Lupus is also more common in people from certain ethic backgrounds, including those from Asia, China, Africa and the Caribbean.
Meanwhile, SLE isn’t the only form of lupus:
This generally affects the skin, often causing a more severe rash than SLE and sometimes more severe hair loss. It rarely affects the internal organs, though some people with discoid lupus may go on to develop SLE. The rash is often triggered by exposure to sunlight.
Certain people who take certain medicines for a long time can develop drug-induced lupus as a side effect. The symptoms are similar to those of SLE (though in most cases they are milder), and, like SLE, are caused by an autoimmune response where your immune system attacks your body tissues. Some of the drugs with proven links to drug-induced lupus include hydralazine, procainamide, sulphasalazine and penicillamine.
What causes lupus?
If you have lupus, it means your immune system produces antibodies that attack healthy tissue in one or more parts of your body (these antibodies are called autoantibodies). This can cause inflammation and tissue damage in places such as your skin, joints, muscles, blood cells and vessels, brain, nerves, lungs, heart, kidneys or digestive system, as well as the linings around your internal organs. Nobody knows why this happens. However according to Arthritis Research UK it’s probably caused by a combination of genetic, environmental and hormonal factors.
Lupus isn’t directly passed from parents to children, but a child has a one in 100 chance of developing lupus if one of their parents has it. If you have a close relative who has the disease – a brother or sister, for instance – your risk of developing it is higher than average. According to Lupus UK, people with lupus also often have family members with other autoimmune conditions such as diabetes, multiple sclerosis or rheumatoid arthritis.
The NHS claims a number of environmental factors may be responsible for triggering lupus in susceptible people, though the evidence for many of these factors is limited. Some of the environment factors linked with lupus include exposure to sunlight, smoking and certain viruses such as the Epstein-Barr virus. Discover more on how the sun affects your skin in our helpful guide.
Since women are much more likely to develop lupus than men, it’s also thought the hormonal changes that happen around puberty, after childbirth or during the menopause may trigger it.
If you have lupus, it doesn’t mean you can’t have children, and only a small number of women with severe lupus may be advised not to go through a pregnancy. However health experts say you should try to plan your pregnancy when your lupus isn’t active, and discuss your plans with your GP so your treatment can be adjusted if necessary. According to Arthritis Research UK, if your condition is well controlled at the time your baby is conceived and you don’t have kidney disease, you’re unlikely to have any problems.
How is lupus treated?
Modern conventional treatments for lupus are considered far more effective than they were in the past, and these days most people with lupus can live normal lives. What treatments you may have to take for lupus may vary from time to time and will depend on your symptoms – including how mild or severe they are – and which parts of your body are affected. Some people also find their symptoms stop altogether in time – often when they reach middle age – and can come off their treatments altogether. The main conventional treatments include the following:
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and diclofenac are used to relieve joint and muscle pain in people with lupus. If your pain is mild, versions of these drugs that are available over the counter are helpful. But if you have more severe pain, you’ll need a prescription for stronger NSAIDs from your GP. Some people experience stomach problems – including bleeding – when they take NSAIDs. So if you have to take these medicines for longer periods of time you may also be prescribed other drugs to protect your stomach.
Speak to your GP before taking NSAIDs, as these drugs aren’t suitable for everyone, particularly those with asthma or with stomach, kidney or liver problems.
A drug called hydroxychloroquine, which was originally developed as a treatment for malaria, can be used to help treat joint pain, skin problems and tiredness. Often used in cases of mild to moderate lupus, hydroxychloroquine can help to reduce inflammation and may also help lower cholesterol and control kidney disease. With side effects uncommon hydroxychloroquine is generally well tolerated, but in rare cases can cause eye damage.
Steroid creams may be useful for lupus skin rashes, but steroid tablets are only usually prescribed in severe cases to help treat inflammation quickly. They can sometimes also be used as a long-term treatment for kidney inflammation or severe blood problems, or in the short term to treat lupus complications such as pleurisy or pericarditis. However, if taken for long periods they can cause side effects such as weight gain, high blood pressure, thinning of the skin and thinning of the bones (osteoporosis).
Drugs used to dampen down an overactive immune system are sometimes used alongside corticosteroids and can help reduce the damage your immune system causes when it attacks healthy tissues. They are thought to help control high blood pressure as well as reduce the risk of kidney problems developing. Some of the most commonly prescribed immunosuppressants are methotrexate, azathioprine and cyclophosphamide.
These days newer drugs called rituximab and belimumab are sometimes prescribed for people with severe lupus. These are known as biological therapies, and they work by reducing the activity of particular immune system cells that produce the harmful autoantibodies that cause lupus symptoms. If you’re prescribed either of these therapies you’ll be monitored closely by your GP, as both drugs can cause unwanted side effects.
Lupus: how to help yourself
Besides taking any medication your GP has prescribed for your lupus, there are several ways you can help keep your symptoms under control:
You don’t have to follow any special diet if you have lupus, but you can help boost your general wellbeing by eating healthily. According to the charity St Thomas’ Lupus Trust, it may be a good idea to increase your intake of oily fish slightly – such as mackerel, sardines and salmon – while eating a little less red meat. The charity also advises that the only food you should avoid is alfalfa sprouts, as they may trigger a flare-up. Eating healthily may also help you to manage your weight. This can be important if you have lupus, since being overweight or obese increases your risk of heart attack and stroke – both of which you may be more susceptible to if you have lupus.
Do some gentle exercise
People who have lupus often suffer from bouts of fatigue, so launching into a fully-blown exercise plan if you’re not already that active probably isn’t the best idea. It’s good to be active as often as you can, as this can help with your overall health and wellbeing as well as keep your weight down and your muscles strong. Just take things easy, and build up the intensity and the amount of time you spend being active gradually. If you need help with devising a fitness plan, ask your GP to refer you to a physiotherapist who can advise you about suitable exercises.
Stay out of the sun
If you’re exposed to strong sunlight it can make some of the symptoms of lupus worse, especially skin problems such as rashes (though not everyone with lupus is sensitive to the sun). Whenever you’re out and about on a sunny day, try to protect your skin by keeping as much of it covered as possible. Wear a wide-brimmed hat, and apply high-SPF sunscreen to any parts of your skin that aren’t covered with clothing. Find out more about sun protection, including how you can protect it from getting burned.
If you avoid sun exposure as a result of having lupus, there’s a chance you may not be getting enough vitamin D, since your body makes most of your vitamin D when your skin is exposed to sunlight. People in the UK who avoid the sun are advised to take vitamin D supplements to make sure they don’t become deficient. If you need more information, speak to your GP.
According to Arthritis Research UK, smoking can make some lupus symptoms and complications worse. If you need help with giving up smoking, you can buy nicotine-replacement therapy products over the counter at pharmacies, including patches, gum and lozenges. These are designed to help you control your cravings for nicotine.
People with lupus can be more likely to pick up infections, particularly those who take steroid or immunosuppressant medicines. That’s why it’s often recommended you avoid contact with people who have infections if you have lupus.
Keep stress at bay
Having a long-term condition such as lupus can put you under extra stress. And according to some experts, emotional stress can make the symptoms of lupus worse too. So if you’re affected it could be a good idea to manage your stress levels by learning relaxation techniques such as deep breathing, yoga or meditation.
Natural relief for lupus
If you have lupus, a healthy balanced diet can support your general health and wellbeing. But you may get some benefit from using certain nutritional supplements too.
The anti-inflammatory effects of curcumin – an active ingredient found in turmeric – could make this well-known culinary spice useful in cases of lupus. There is some evidence it may help with pain (i). In vitro studies also suggest curcumin may improve autoimmune disorders (ii).
Several clinical trials suggest the omega-3 fatty acids found in fish oils may benefit people with lupus. One claims fish oil supplements reduce the activity of lupus (iii), while an animal-based trial suggests taking one of the omega-3 fatty acids in oily fish – namely docosahexaenoic acid (DHA) – may prevent crystalline silica, a known trigger of lupus, from triggering the disease (iv). Other studies suggest taking omega-3 fatty acids may help with the treatment of lupus because of their anti-inflammatory properties (v).
Vitamin B complex
Even if you get plenty of vitamin B12 in your diet, if you also have lupus or another autoimmune disorder your B12 levels may well be lower than they should be, as one study suggests low blood levels of B12 may be frequent in people with lupus, rheumatoid arthritis and psoriatic arthritis (vi). Supplementing your diet with a good vitamin B complex tablet – which includes vitamin B12 – may help counteract the fatigue that’s often associated with both lupus and B12 deficiency. Folic acid – another B vitamin – has been shown to reduce lupus symptoms in animal studies (vii), while one study suggests higher intakes of vitamin B6 may help prevent lupus flare-ups (viii). Meanwhile several members of the B vitamin family are helpful in providing support for the brain and nervous system.
Vitamins C, E and selenium
As antioxidants, these vitamins are widely thought to have anti-inflammatory properties. There’s also evidence that vitamin C may reduce the risk of a lupus flare-up (ix), and a preliminary study suggests vitamin E may suppress the immune system’s production of autoantibodies by a mechanism other than that of its antioxidant activity (x). Also an antioxidant, selenium is often used by natural health practitioners to treat inflammation and some think it could be useful for combating the oxidative stress that leads to lupus-related fatigue.
If you’re deficient in zinc, it’s thought that taking this mineral in supplement form may help maintain normal immune system function. Zinc may also be helpful for those who have a lupus rash as it’s thought to promote healthy skin.
High-strength multivitamin and mineral
As well as providing an overall decent level of nutrition, taking a good-quality multivitamin and mineral supplement can provide several of the nutrients already mentioned, so may help maintain normal skin and the normal function of the immune system.
This flavonoid antioxidant found in richly coloured fruit and vegetables has been shown not only to reduce inflammation but to also regulate the immune system (xi). There is also evidence that quercetin may reduce inflammatory pain, which suggests it may be helpful for those with autoimmune conditions, including inflammatory forms of arthritis (xii). It might help with sun-induced skin rashes too, with one study claiming it helps reduce photosensitivity (an extreme sensitivity to the sun’s UV rays) (xiii). Quercetin is also available in supplement form.
Also found in richly coloured fruit, anthocyanidins are powerful antioxidants that are thought to help protect the skin from harmful UV rays. One study – which used anthocyanidins supplements sourced from pine bark extract – suggests they may reduce skin reddening caused by sun exposure (xiv). It may also be helpful to use a supplement that combines anthocyanidins with another antioxidant called lutein, since there is some evidence it may help protect the skin against some of the damaging effects of the sun, specifically UVB light (xv).
We know that managing lupus on a daily basis can become overwhelming, but this guide should help to make it a little easier. For more information on a number of common health conditions, feel free to visit our health library.
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.