Lupus
Also known as SLE, Systemic lupus erythematosus
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is lupus?
Systemic lupus erythematosus is an autoimmune disease in which the immune system attacks multiple tissues, most often skin, joints, blood cells and kidneys. It follows a relapsing and remitting course and varies enormously between people. Kidney involvement is often silent, so regular urine testing is a routine and important part of monitoring.
Causes
- Loss of immune tolerance with autoantibody production
- Genetic susceptibility
- Hormonal influences, given the strong female predominance
- Environmental triggers including ultraviolet light
- Some medicines causing drug induced lupus
- Epstein Barr virus association
Symptoms
- Fatigue that is often profound
- Joint pain and swelling
- Butterfly shaped rash across the cheeks and nose
- Photosensitivity with rashes after sun exposure
- Mouth or nose ulcers
- Hair loss
- Fever without infection
- Raynaud phenomenon with colour change in the fingers
Risk factors
- Female sex, particularly of childbearing age
- African, Caribbean, Hispanic or Asian ancestry
- Family history of lupus or other autoimmune disease
- Sun exposure
- Certain medicines such as hydralazine
Diagnosis
- Antinuclear antibody testing as a sensitive screen
- Anti double stranded DNA and anti Smith antibodies for specificity
- Complement levels C3 and C4
- Full blood count for cytopenias
- Urinalysis and protein creatinine ratio for kidney involvement
- Kidney biopsy if lupus nephritis is suspected
Treatment
- Hydroxychloroquine for nearly all patients as background therapy
- Corticosteroids for flares at the lowest effective dose
- Immunosuppressants such as mycophenolate or azathioprine
- Biologic therapy including belimumab in selected cases
- Rigorous sun protection
- Cardiovascular risk management
- Pre pregnancy planning with specialist input
Self care
- Use high factor sunscreen daily and cover up outdoors
- Take hydroxychloroquine consistently, even in remission
- Pace activity and rest before exhaustion
- Attend regular blood and urine monitoring
- Keep vaccinations current, avoiding live vaccines on immunosuppression
- Do not smoke, which reduces hydroxychloroquine effectiveness
- Plan pregnancy during a stable period
When to see a doctor
Book an appointment if:
- New or worsening joint pain and swelling
- Rash after sun exposure
- Unexplained fever without infection
- Increasing fatigue or hair loss
- Frothy urine or ankle swelling
- Chest pain on deep breathing
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Lupus cannot be prevented, but flares can be reduced
- Rigorous sun protection year round
- Continuous hydroxychloroquine therapy
- Avoid smoking
- Manage infections promptly
- Attend monitoring so kidney involvement is caught early
Outlook
Outlook has improved dramatically, and most people with lupus now have a normal or near normal life expectancy. The course is relapsing and remitting. Kidney involvement is the main determinant of long term outcome, which is why urine testing at every review matters. Hydroxychloroquine improves survival and is continued indefinitely.
Common questions
Does a positive antinuclear antibody test mean lupus?
No. A positive result occurs in many healthy people, particularly at low titre, and in other autoimmune conditions. Diagnosis requires characteristic clinical features alongside more specific antibodies.
Why is hydroxychloroquine given to almost everyone?
It reduces flares, protects the kidneys, lowers clotting and cardiovascular risk and improves survival. It is continued long term, including through pregnancy, with periodic eye monitoring.
Can people with lupus have children?
Yes, though pregnancy is best planned during a period of stable disease with specialist input, because active disease and certain antibodies increase risks for both mother and baby.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.