Lupus is an autoimmune disease where the immune system attacks its own tissues. It can affect many body systems like joints, skin, kidneys, lungs and brain. Symptoms vary but may include facial rashes, fatigue, fever and joint pain. There is no cure for lupus but treatments can control symptoms. Treatments include medications like hydroxychloroquine and corticosteroids to reduce inflammation and prevent flares. Managing lupus requires balancing medications, exercise, sleep and avoiding triggers like sunlight.

1. Lupus
Also called: Systemic Lupus
Erythematosus (SLE)
By C Settley

2. What is Lupus?
• Lupus is a systemic autoimmune disease that occurs when the body's
immune system attacks its own tissues and organs.
• Inflammation caused by lupus can affect many different body systems —
including your joints, skin, kidneys, blood cells, brain, heart and lungs.
• Lupus can be difficult to diagnose because its signs and symptoms often
mimic those of other ailments. The most distinctive sign of lupus — a
facial rash that resembles the wings of a butterfly unfolding across both
cheeks — occurs in many but not all cases of lupus.
• Some people are born with a tendency toward developing lupus, which
may be triggered by infections, certain drugs or even sunlight. While
there's no cure for lupus, treatments can help control symptoms.

3. Lupus facial rash

4. Symptoms
• No two cases of lupus are exactly alike.
• Signs and symptoms may come on suddenly or
develop slowly, may be mild or severe, and may
be temporary or permanent.
• Most people with lupus have mild disease
characterized by episodes — called flares —
when signs and symptoms get worse for a while,
then improve or even disappear completely for a
time.

5. Symptoms
• The signs and symptoms of lupus that you experience will depend on which body
systems are affected by the disease. The most common signs and symptoms include:
– Fatigue
– Fever
– Joint pain, stiffness and swelling
– Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere
on the body
– Skin lesions that appear or worsen with sun exposure (photosensitivity)
– Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's
phenomenon)
– Shortness of breath
– Chest pain
– Dry eyes
– Headaches, confusion and memory loss
– Haematological disorders like thrombocytopenia and leukopenia
– MUST AT LEAST HAVE FOUR OF THE SIGNS AND SYMTOMS BEFORE DIAGNOSIS CAN BE MADE

6. Causes
• Lupus occurs when your immune system attacks
healthy tissue in your body (autoimmune disease).
• Some potential triggers include:
– Sunlight. Exposure to the sun may bring on lupus skin
lesions or trigger an internal response in susceptible
people.
– Infections. Having an infection can initiate lupus or cause a
relapse in some people.
– Medications. Lupus can be triggered by certain types of
blood pressure medications, anti-seizure medications and
antibiotics. People who have drug-induced lupus usually
get better when they stop taking the medication. Rarely,
symptoms may persist even after the drug is stopped.

7. Risk factors
• Your sex. Lupus is more common in women.
• Age. Although lupus affects people of all ages,
it's most often diagnosed between the ages of
15 and 45.
• Race. Lupus is more common in African-
Americans, Hispanics and Asian-Americans.

8. Complications
• Kidneys. Lupus can cause serious kidney damage,
and kidney failure is one of the leading causes of
death among people with lupus.
• Brain and central nervous system. If your brain is
affected by lupus, you may experience
headaches, dizziness, behavior changes, vision
problems, and even strokes or seizures. Many
people with lupus experience memory problems
and may have difficulty expressing their thoughts.

9. Complications
• Blood and blood vessels. Lupus may lead to blood
problems, including anemia and increased risk of
bleeding or blood clotting. It can also cause
inflammation of the blood vessels (vasculitis).
• Lungs. Having lupus increases your chances of
developing an inflammation of the chest cavity lining
(pleurisy), which can make breathing painful. Bleeding
into lungs and pneumonia also are possible.
• Heart. Lupus can cause inflammation of your heart
muscle, your arteries or heart membrane (pericarditis).
The risk of cardiovascular disease and heart attacks
increases greatly as well.

10. Complications
• Infection. People with lupus are more
vulnerable to infection because both the
disease and its treatments can weaken the
immune system.
• Cancer. Having lupus appears to increase your
risk of cancer; however the risk is small.

11. Complications
• Bone tissue death (avascular necrosis). This occurs
when the blood supply to a bone diminishes, often
leading to tiny breaks in the bone and eventually to the
bone's collapse.
• Pregnancy complications. Women with lupus have an
increased risk of miscarriage. Lupus increases the risk
of high blood pressure during pregnancy
(preeclampsia) and preterm birth. To reduce the risk of
these complications, doctors often recommend
delaying pregnancy until your disease has been under
control for at least six months.

12. Management of Lupus
• There is no permanent cure for SLE.
• The goal of treatment is to relieve symptoms and
protect organs by decreasing inflammation and/or the
level of autoimmune activity in the body.
• The precise treatment is decided on an individual basis.
• Many people with mild symptoms may need no
treatment or only intermittent courses of anti-
inflammatory medications.
• Those with more serious illness involving damage to
internal organ(s) may require high doses of
corticosteroids in combination with other medications
that suppress the body's immune system.

13. Management of Lupus
• People with SLE need more rest during periods of
active disease.
• Researchers have reported that poor sleep quality was
a significant factor in developing fatigue in people with
SLE.
• These reports emphasize the importance for people
and physicians to address sleep quality and the effect
of underlying depression, lack of exercise, and self-care
coping strategies on overall health.
• During these periods, carefully prescribed exercise is
still important to maintain muscle tone and range of
motion in the joints.

14. Management of Lupus
• Corticosteroids are more potent than NSAIDs in reducing
inflammation and restoring function when the disease is
active. Corticosteroids are particularly helpful when
internal organs are affected. Corticosteroids can be given
by mouth, injected directly into the joints and other tissues,
or administered intravenously.
• Unfortunately, corticosteroids have serious side effects
when given in high doses over prolonged periods, and the
doctor will try to monitor the activity of the disease in
order to use the lowest doses that are safe. Side effects of
corticosteroids include weight gain, thinning of the bones
and skin, infection, diabetes, facial puffiness, cataracts, and
death (necrosis) of the tissues in large joints.

15. Management of Lupus
• To protect from sun sensitivity, sunscreens, sun avoidance, and sun
protection clothing are used.
• Certain types of lupus rash can respond to topical cortisone medications.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful in reducing
inflammation and pain in muscles, joints, and other tissues. Examples of
NSAIDs include aspirin, ibuprofen (Motrin), naproxen (Naprosyn), and
sulindac (Clinoril).
• Since the individual response to NSAIDs varies, it is common for a doctor
to try different NSAIDs to find the most effective one with the fewest side
effects.
• The most common side effects are stomach upset, abdominal pain, ulcers,
and even ulcer bleeding. NSAIDs are usually taken with food to reduce side
effects. Sometimes, medications that prevent ulcers while taking NSAIDs,
such as misoprostol (Cytotec), are given simultaneously.

16. Management of Lupus
• Hydroxychloroquine (Plaquenil) is an antimalarial
medication found to be particularly effective for
SLE people with fatigue, skin involvement, and
joint disease.
• Consistently taking Plaquenil can prevent flare-
ups of lupus.
• Side effects are uncommon but include diarrhea,
upset stomach, and eye-pigment changes.
• Eye-pigment changes are rare but require
monitoring by an ophthalmologist (eye specialist)
during treatment with Plaquenil.

17. Management of Lupus
• Hydroxychloroquine (Plaquenil) is an antimalarial
medication found to be particularly effective for SLE people
with fatigue, skin involvement, and joint disease.
• Consistently taking Plaquenil can prevent flare-ups of lupus.
• Side effects are uncommon but include diarrhea, upset
stomach, and eye-pigment changes.
• Eye-pigment changes are rare but require monitoring by an
ophthalmologist (eye specialist) during treatment with
Plaquenil.
• For resistant skin disease, other antimalarial drugs, such as
chloroquine (Aralen) or quinacrine, are considered and can
be used in combination with hydroxychloroquine.

18. Reference list
• https://www.mayoclinic.org/diseases-
conditions/lupus/symptoms-causes/syc-
20365789
• https://www.medicinenet.com/systemic_lupu
s/article.htm#what_is_the_prognosis_of_lupu
s_what_does_the_future_hold_for_people_w
ith_systemiclupus