What is Lupus?

S

ystemic lupus erythematosus, commonly referred to as SLE or simply SLE, is a chronic disease which causes inflammation and damage to multiple organs. It is also an autoimmune illness, which means that it occurs because the patient’s immune system attacks its own tissues and organs because it mistakenly thinks they are foreign tissues. It is characterized by the presence of antinuclear antibodies in the patient’s blood.

There are other, less common types of lupus, such as:

Cutaneous Lupus

Can be divided into acute, subacute or chronic. Each type causes different dermal lesions.

Drug-induced Lupus

It resolves after the patient stops taking the medication which caused it.

Neonatal Lupus

This type of lupus is very rare and probably caused by maternal antibodies.

Lupus is much more common in women than in men, and it also affects people of Afro-Caribbean, Chinese and Southeast Asian origin more frequently.

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What Causes Lupus?

The exact cause of lupus is unknown. Genetics might be a contributing factor, since it has been found that lupus can run in families. Other possible triggers are hormonal changes, medications (for example hydralazine, methyldopa, minocycline, d-penicillamine, chlorpromazine, and isoniazid), infections, and environmental factors.

How is Lupus Diagnosed?

Doctors first suspect lupus depending on the patient’s symptoms. The clinical presentation of lupus varies greatly from one person to another and the disease goes through periods of remission and relapse, but symptoms can include:

  • Arthralgia: painful joints.
  • Malar rash: a butterfly-shaped facial rash, which can itch.
  • Fever
  • Weight loss
  • Dry eyes and mouth
  • Myalgia: muscular pain.
  • Fatigue
  • Malaise
  • Raynaud’s phenomenon
  • Chest pain

Systemic lupus erythematosus can affect every system in the body, including the heart, digestive system, kidneys, lungs, and nervous system.

Once your doctors suspect lupus as the cause of your symptoms, they will order laboratory tests to determine the presence of antinuclear antibodies in your blood. Patients with lupus often also have another antibody called anti-double-stranded DNA (anti-dsDNA) present in their blood.

The American College of Rheumatology has compiled a list of criteria to help reach a diagnosis in patients who display certain symptoms.

Lupus Cures & Treatments

Although there isn’t currently a cure for systemic lupus erythematosus, its symptoms can be managed through a variety of treatments. Since lupus produces different symptoms in each patient, the treatment will be individualized to better treat those specific symptoms.Some patients with mild symptoms can use medications intermittently or not at all.

Nonsteroidal anti-inflammatory drugs or NSAIDs such as naproxen, ibuprofen or aspirin are used to treat arthralgia and myalgia. NSAIDs can cause stomach ulcers, so misoprostol is sometimes used in conjunction to prevent this side effect.

Corticosteroids also reduce inflammation, and are often used when the disease causes organ damage. These drugs have multiple and serious side effects, so their use must be closely monitored by the patient’s medical team. These side effects can include weight gain, osteopenia, osteoporosis, and infections.

Antimalarial drugssuch as hydroxychloroquine and chloroquine are used to treat fatigue, joint symptoms, and skin lesions. They also relieve general symptoms and prevent flare-ups. Hydroxychloroquine has shown to be effective in preventing abnormal blood clotting.

Cytotoxic or immunosuppressive drugs, such as cyclophosphamide, cyclosporine, methotrexate, and azathioprine are also used to treat severe cases of systemic lupus erythematosus. Cytotoxic drugs can cause severe side effects such as liver and kidney toxicity.

Rituximab, a chimeric monoclonal antibody which is infused intravenously and destroys B cells, thus decreasing the severity of lupus and even making it go into remission. Belimumab was approved in 2011 and acts as a B-lymphocyte stimulator or BLyS-specific inhibitor which inhibits the production of B cells.

Plasmapheresis is a process during which blood plasma is removed from the body and filtered before being returned to circulation. This procedure is used to remove antibodies from the patient’s blood, and it is performed when there is severe kidney or brain damage. Plasmapheresis also removes cryoglobulins, which are proteins that can cause vasculitis. Patients with severe kidney disease stemming from systemic lupus erythematosus need to receive dialysis or a kidney transplant.

Lupus Clinical Trials

The treatment and prognosis of lupus patients has been greatly improved thanks to clinical trials. Through these trials, new drugs or procedures are tested, helping researchers discover which treatments are most effective, what side effects they can cause, and how to improve patients’ quality of life.

Clinical trials are conducted by universities, hospitals, or organizations under the guidance of a medical team. Participants not only get to help to develop new treatments, but also have access to expert healthcare and new medical developments. If you are interested in participating in a clinical trial, ask your doctor about trials open in your area or contact hospitals and universities near you.

ClinicalTrials.gov: Recruiting Studies | lupus | Last update posted in the last 300 days Studies found on ClinicalTrials.gov by a search of: Recruiting Studies | lupus | Last update posted in the last 300 days

  • Exercise and Nutrition Recommendations for Patients Using Glucocorticoids (ENRG)
    on October 22, 2021 at 4:00 pm

    Condition:   Systemic Lupus ErythematosusIntervention:   Other: Exercise TrainingSponsor:   Bruno GualanoRecruiting

  • A Study of CD19/BCMA Chimeric Antigen Receptor T Cells Therapy for Patients With Refractory Immune Nephritis
    on October 20, 2021 at 4:00 pm

    Conditions:   Immune Nephritis;   Autoimmune Diseases;   Lupus NephritisIntervention:   Biological: Assigned Interventions CD19/BCMA CAR T-cellsSponsors:   Zhejiang University;   Yake Biotechnology Ltd.Recruiting

  • Efficacy and Safety of SAR441344 in the Treatment of Systemic Lupus Erythematosus
    on September 10, 2021 at 4:00 pm

    Condition:   Systemic Lupus ErythematosusInterventions:   Drug: SAR441344 IV;   Drug: SAR441344 SC;   Drug: Placebo IV;   Drug: Placebo SCSponsor:   SanofiRecruiting

  • A Study to Evaluate the Efficacy, Safety, and Pharmacokinetics of Obinutuzumab in Adolescents With Active Class III or IV Lupus Nephritis
    on September 9, 2021 at 4:00 pm

    Condition:   Lupus NephritisInterventions:   Drug: Obinutuzumab;   Drug: Placebo;   Drug: Mycophenolate Mofetil;   Drug: Acetaminophen/paracetamol;   Drug: Diphenhydramine hydrochloride (HCl);   Drug: Methylprednisolone;   Drug: PrednisoneSponsors:   Hoffmann-La Roche;   Genentech, Inc.Recruiting

  • A Study of CD19/BCMA Chimeric Antigen Receptor T Cells Therapy for Patients With Refractory Systemic Lupus Erythematosus
    on September 1, 2021 at 4:00 pm

    Conditions:   Systemic Lupus Erythematosus;   Autoimmune DiseasesIntervention:   Biological: Assigned Interventions CD19/BCMA CAR T-cellsSponsors:   Zhejiang University;   Yake Biotechnology Ltd.Recruiting

  • Autologous Stem Cell Transplant (ASCT) for Autoimmune Diseases
    on August 31, 2021 at 4:00 pm

    Conditions:   Systemic Lupus Erythematosus;   Systemic SclerosisIntervention:   Biological: Depletion of CD3/CD19 in an autologous stem cell transplantSponsor:   Stephan Grupp MD PhDRecruiting

  • Safety of Cultured Allogeneic Adult Umbilical Cord Derived Mesenchymal Stem Cell Intravenous Infusion for Lupus
    on August 24, 2021 at 4:00 pm

    Condition:   LupusIntervention:   Biological: AlloRxSponsor:   The Foundation for Orthopaedics and Regenerative MedicineRecruiting

  • Swiss Pediatric Inflammatory Brain Disease Registry (Swiss-Ped-IBrainD)
    on August 23, 2021 at 4:00 pm

    Conditions:   Optic Neuritis;   Transverse Myelitis;   Acute Disseminated Encephalomyelitis;   Multiple Sclerosis;   Neuromyelitis Optica Spectrum Disorder;   Anti-NMDAR Encephalitis;   Anti-GAD65 Associated Autoimmune Encephalitis;   Anti-AMPAR-1/2 Associated Autoimmune Encephalitis;   Anti-Lgi-1 Associated Autoimmune Encephalitis;   Anti-CASPR-2 Associated Autoimmune Encephalitis;   Anti-GABAR-1/2 Associated Autoimmune Encephalitis;   Onconeuronal Antibody (Hu, Ri, Yo, Amphiphysin, CRMP-5, Ma-1, Ma-2, SOX-1) Associated Autoimmune Encephalitis;   Hashimoto Encephalitis;   CNS Vasculitis;   CNS Sarcoidosis;   CNS Lupus;   Rasmussen EncephalitisIntervention:   Sponsors:   University of Bern;   Schweizerische Multiple Sklerose Gesellschaft;   University Hospital Inselspital, Berne;   Roche Pharma (Switzerland) Ltd;   NovartisRecruiting

  • AS-OCT Study of Cornea and Tear Film Parameters in Juvenile SLE Patients
    on August 20, 2021 at 4:00 pm

    Condition:   Juvenile Systemic Lupus ErythematosusIntervention:   Diagnostic Test: Anterior Segment OCTSponsor:   Minia UniversityRecruiting

  • ILD-SARDs Registry and Biorepository
    on August 16, 2021 at 4:00 pm

    Conditions:   Interstitial Lung Disease;   Systemic Autoimmune Disease;   Rheumatic Diseases;   Rheumatic Arthritis;   Systemic Sclerosis;   Autoimmune Myositis;   Systemic Lupus Erythematosus;   Usual Interstitial Pneumonia;   Nonspecific Interstitial PneumoniaInterventions:   Other: Blood draws;   Other: Other biological samples to biobank (skin, lung and muscle biopsies; bronchoalveolar lavage (BAL fluid);   Other: Clinical data collection;   Other: Genetic data/DNA/RNASponsors:   McGill University Health Centre/Research Institute of the McGill University Health Centre;   McGill UniversityRecruiting

  • Anifrolumab PK Study for Systemic Lupus Erythematosus (SLE)
    on August 12, 2021 at 4:00 pm

    Condition:   Systemic Lupus ErythematosusIntervention:   Biological: AnifrolumabSponsor:   AstraZenecaRecruiting

  • COVID-19 Booster Vaccine in Autoimmune Disease Non-Responders
    on August 11, 2021 at 4:00 pm

    Conditions:   Rheumatoid Arthritis;   Systemic Lupus Erythematosus (SLE);   Pemphigus Vulgaris;   Multiple Sclerosis;   Systemic Sclerosis (SSc)Interventions:   Biological: Moderna mRNA-1273;   Biological: BNT162b2;   Biological: Ad26.COV2.S;   Drug: IS (MMF or MPA);   Drug: IS (MTX);   Biological: IS (B cell depletion therapy)Sponsors:   National Institute of Allergy and Infectious Diseases (NIAID);   Autoimmunity Centers of Excellence;   Rho Federal Systems Division, Inc.Recruiting

Lifestyle Changes

Patients with systemic lupus erythematosus need to rest more when they are going through a flare-up; however, exercise is still necessary to prevent muscle atrophy.

Although there isn’t a specific diet for lupus patients, they should follow a healthy and balanced diet. A patient could require more calories during an active phase of lupus. Decreasing salt intake can help with swelling and edema. Also, patients who take corticosteroids should take calcium and vitamin D supplements to avoid osteopenia and osteoporosis. Although alcohol isn’t contraindicated in lupus, it may interact with the medications a patient is taking; therefore, patients should be made aware of any possible interactions.

In order to prevent dermal lesions, sun exposure should be avoided and sunscreen must be worn to protect the skin. Wearing long sleeve tops and hats is recommended on sunny days.

Tips For Friends and Family
  • Research the disease, its symptoms, complications, and consequences in order to be able to understand what your loved one is going through.
  • Make sure there are healthy and balanced meals available to suit the needs of a lupus patient.
  • Be understanding when your loved one is going through a flare-up, since they will likely need more rest than usual; offer help, and ask what the other person needs.
  • Offer encouragement and support to your loved one.
Lupus Infographic Image and Quick Facts

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Sources
  1. Tidy, C. (2015, Feb. 3rd). Systemic Lupus Erythematosus. Retrieved from https://patient.info/health/systemic-lupus-erythematosus-leaflet#nav-8
  2. Wallace, D. (2017, Jan. 10th) Patient education: Systemic lupus erythematosus (SLE) (Beyond the Basics). Retrieved from https://www.uptodate.com/contents/systemic-lupus-erythematosus-sle-beyond-the-basics