Lupus: What It Is, Its Causes, Symptoms, and Treatment

Systemic Lupus Erythematosus (SLE), or simply lupus, is a condition in which the immune system mistakenly perceives some substances in the body as foreign, leading to the initiation of a chronic inflammatory response that can affect almost every system in the body.

The immune system plays a crucial role in maintaining and improving the health of our body. The immune elements in our body are specialized to fight against harmful factors such as microorganisms or tumor cells that can negatively affect health and to remove these harmful agents from the body. However, research has shown that certain diseases observed in the clinic are caused by the immune system mistakenly attacking the body's own cells, perceiving them as threats. This is the case with autoimmune diseases, one of which is lupus.

What is Lupus?

Systemic lupus erythematosus (SLE), or simply lupus, is a condition where the immune system perceives some of the body’s own substances as foreign, leading to the initiation of a chronic inflammatory response that can affect nearly every system in the body. Lupus, which is classified as a rheumatologic and autoimmune disorder, can cause clinical symptoms and health problems in almost every part of the body, including the hematologic system, joints, kidneys, heart, lungs, nervous system, and digestive system. However, the most common form of lupus seen in clinics is localized inflammation in a specific part of the body.

Lupus is a chronic disease that progresses with intermittent flare-ups. If not treated properly, it can lead to permanent damage to organs and serious complications. Therefore, it is extremely important for patients to have accurate and sufficient information about their condition and to comply with the prescribed treatment.

What Causes Lupus?

Although the exact cause of the immune system perceiving the body's tissues as a threat is not fully understood, it is known that certain factors make it easier for lupus to develop. The following conditions are considered risk factors for lupus:

• Genetics: Research has shown that individuals with certain genetic traits are more likely to develop lupus symptoms. In this context, more than 50 risk genes have been identified.
• Environmental Factors: Environmental factors such as smoking, stressful lifestyles, exposure to toxic substances like silica, and others are known to trigger the development of lupus.
• Hormones: Studies suggest that imbalances in certain hormone levels, such as estrogen, may affect the development of lupus.
• Infections: Viral infections, such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV), can lead to lupus development due to the immune system perceiving the body as a threat.
• Drug Side Effects: Lupus-like symptoms may occur due to certain medications, such as hydralazine, quinidine, or biological agents used for rheumatologic disorders.

Additionally, people between the ages of 15 and 44, women, those of African descent, and individuals with a family history of lupus are at a significantly higher risk of developing lupus compared to the general population.

What Are the Symptoms of Lupus?

Since lupus can affect almost every tissue in the body, the clinical presentation can vary widely from patient to patient. Symptoms may also fluctuate, disappearing or worsening due to the progression of the disease. The following symptoms may be observed in the course of lupus:

• High fever
• Weakness – fatigue
• Muscle weakness and widespread muscle pain
• Joint pain, especially in small joints like those in the fingers, in a migratory pattern
• Typical butterfly-shaped rash on the face
• Redness, rashes, or swelling on the skin
• Sensitivity to sunlight; skin symptoms worsen with exposure to sunlight
• Hair loss and baldness
• Recurrent mouth ulcers or sores, nausea, vomiting, diarrhea, or constipation
• Finger tips turning purple or pale, especially in stressful situations or exposure to cold
• Shortness of breath
• Dryness in the eyes or mouth
• Chest pain
• Headaches
• Psychological symptoms such as confusion, depression, and psychosis
• Memory loss

In addition to these, if lupus is not effectively treated in its early stages, it can lead to permanent organ damage over time and result in serious complications. These may include kidney failure due to kidney damage, anemia due to bone marrow damage, immune system deficiency, persistent shortness of breath and coughing due to lung damage, and other related problems.

How is Lupus Diagnosed?

Since lupus can affect almost every tissue in the body and shares symptoms with many other diseases, a detailed evaluation by a specialist is required for its diagnosis. In this regard, based on the patient's medical history and a thorough physical examination, further imaging and laboratory tests may be performed if deemed necessary. The disease diagnosis can be made based on the results obtained from all these evaluations.

Certain laboratory tests play a significant role in the diagnosis of lupus. In this context, a complete blood count, sedimentation rate, liver and kidney function tests, urinalysis, and antinuclear antibody (ANA) test are commonly applied. Additionally, imaging tests like chest X-rays and echocardiography may be used to assess whether lupus affects internal organs. A kidney biopsy may be necessary to determine the extent of kidney damage caused by lupus.

According to research, lupus can be diagnosed when at least four of the following 11 criteria are present:

1. Butterfly-shaped rash on the face (malar rash)
2. Disk-shaped rash on the skin or scalp (discoid rash)
3. Sensitivity to sunlight
4. Recurrent ulcers inside the mouth
5. Recurrent joint inflammation without joint damage
6. Inflammation and fluid accumulation in the outer membranes of the lungs or heart (pleuritis or pericarditis)
7. Signs of kidney damage such as protein loss in urine
8. Evidence of nervous system involvement, such as seizures or psychological symptoms
9. Hematological findings indicating involvement of the blood system, such as anemia or a decrease in white blood cells
10. The presence of certain antibodies in immune tests indicating lupus (anti-dsDNA, anti-Sm, etc.)
11. Positive ANA (antinuclear antibody) test

How is Lupus Treated?

Currently, there is no definitive cure for lupus. However, the main goal of treatment is to control the disease, prevent flare-ups of symptoms, and prevent the development of complications. Therefore, treatment must be lifelong, and patient adherence to the treatment plan can directly impact its success.

Since lupus is a chronic condition that can fluctuate, the treatment approach follows a dynamic course. As such, the treatment method or frequency may change according to the doctor's decisions, and new medications may need to be added. Additionally, periodic examinations and tests may be necessary to monitor the development of complications during the course of the disease.

Common treatment approaches for lupus include:

Lifestyle Changes: Alongside clinical treatments, it is crucial for patients to make specific lifestyle changes for successful treatment. In this regard, patients are advised to adhere to the following recommendations:

• Avoid direct sunlight exposure; use sunscreen and sunglasses when outdoors.
• Maintain a balanced and adequate diet.
• Reduce the amount of salt in the daily diet.
• Supplement specific vitamins and minerals, such as vitamin D, calcium, and phosphorus.
• Engage in regular exercise.
• Quit habits such as smoking.

Medication Treatment: The medications used in lupus are directly related to the severity of the disease. The primary goal of these medications is to alleviate disease symptoms, suppress the immune system to prevent flare-ups, and prevent the development of complications. In this context, non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen), steroids (such as prednisone), anti-malarial drugs (such as hydroxychloroquine), immunosuppressants (such as methotrexate), and biological agents (such as anti-TNF blockers) may be prescribed.