Understanding Lupus: Symptoms, Diagnosis, Treatment and Care

What is Systemic Lupus Erythematosus?

Systemic lupus erythematosus (SLE), commonly known as lupus, is a chronic autoimmune disease in which the immune system mistakenly attacks healthy tissues throughout the body. Unlike some autoimmune conditions that target a single organ, lupus can affect multiple body systems, including the skin, joints, kidneys, heart, lungs, brain, and blood cells.

Lupus is known for being difficult to diagnose because its symptoms often mimic those of other conditions. One distinctive sign is the malar rash, a butterfly-shaped rash that spreads across the cheeks and bridge of the nose, though not everyone with lupus develops this symptom. The disease typically follows a pattern of flares, when symptoms worsen, and remission, when symptoms improve or disappear.

While there is no cure for lupus, early diagnosis and proper treatment can help manage symptoms, reduce inflammation, and prevent serious complications.

What Causes Systemic Lupus Erythematosus?

The exact cause of lupus is not fully understood, but researchers believe it results from a combination of genetic, environmental, and hormonal factors. Some people have an inherited predisposition to the disease, which may be triggered by external factors.

Potential triggers include:

Sunlight: Ultraviolet (UV) exposure can cause lupus skin lesions or trigger a systemic flare in people who are susceptible
Infections: Certain infections may initiate lupus or cause a relapse in those who already have the disease
Medications: Some drugs, including certain blood pressure medications, anti-seizure medications, and antibiotics, can trigger drug-induced lupus in predisposed individuals. Symptoms often improve when the medication is stopped.
Hormonal changes: Lupus is far more common in women, and flares sometimes occur during pregnancy or around menstrual cycles, suggesting hormones may play a role

Risk factors for developing lupus:

Sex: Women are affected by lupus approximately nine times more often than men
Age: Lupus can occur at any age but is most commonly diagnosed between ages 15 and 45
Race & ethnicity: Lupus is more common and often more severe in African Americans, Hispanics, and Asian Americans

Symptoms of Systemic Lupus Erythematosus

Lupus symptoms vary widely from person to person, and no two cases are exactly alike. Symptoms depend on which body systems are affected and may range from mild to severe. Many people experience periods of flares followed by times when symptoms improve.

Common symptoms of lupus include:

Fatigue, often severe and persistent
Low-grade fever with no known cause
Joint pain, stiffness, and swelling, particularly in the hands, wrists, and knees
Butterfly-shaped (malar) rash across the cheeks and nose
Skin rashes or lesions that appear or worsen with sun exposure
Fingers and toes that turn white or blue in cold temperatures or during stress (Raynaud’s phenomenon)
Shortness of breath and chest pain
Dry eyes and mouth
Headaches, confusion, and memory problems

Lupus can also cause symptoms related to specific organ involvement

How is Systemic Lupus Erythematosus Diagnosed?

Diagnosing lupus can be challenging because its symptoms vary widely and often resemble those of other conditions. There is no single test that confirms lupus, so your rheumatologist will use a combination of clinical evaluation, lab work, and imaging to reach an accurate diagnosis.

During your visit, your provider will review your symptoms, medical history, and family history of autoimmune disease. A physical exam will assess for visible signs such as skin rashes, joint swelling, or mouth sores.

Laboratory Tests

Blood and urine tests play an important role in diagnosing lupus and monitoring disease activity:

Complete Blood Count (CBC): Measures red blood cells, white blood cells, platelets, and hemoglobin. Abnormalities such as anemia, low white blood cell count, or low platelet count are common in lupus.
Erythrocyte Sedimentation Rate (ESR): Measures how quickly red blood cells settle to the bottom of a tube. A faster rate can indicate inflammation, though this test is not specific to lupus.
Kidney and Liver Function Tests: Lupus can affect these organs, so blood tests are used to evaluate how well they are functioning.
Urinalysis: A urine test may reveal increased protein or red blood cells, which can indicate kidney involvement (lupus nephritis).
Antinuclear Antibody (ANA) Test: Most people with lupus test positive for ANA, which indicates an activated immune system. However, a positive ANA alone does not confirm lupus, as it can be elevated in other conditions as well.
Additional Antibody Tests: If ANA is positive, your provider may order more specific tests such as anti-dsDNA, anti-Smith, and antiphospholipid antibodies to help confirm the diagnosis.

Imaging

Imaging studies may be used to evaluate organ involvement:

Chest X-Ray: Can reveal fluid or inflammation in the lungs, which may occur in some lupus patients.
Echocardiogram: Uses sound waves to create real-time images of the heart, allowing your provider to check for valve problems or inflammation affecting the heart.

In some cases, a kidney biopsy may be recommended if there are signs of lupus nephritis. This helps determine the type and severity of kidney involvement and guides treatment decisions.

How is Systemic Lupus Erythematosus Treated?

While there is no cure for lupus, effective treatments can help manage symptoms, prevent flares, reduce organ damage, and improve overall quality of life. Treatment plans are highly individualized because lupus affects each person differently. Your rheumatologist will consider your specific symptoms, disease severity, and which organs are involved when recommending a treatment approach.

NSAIDs (Nonsteroidal Anti-inflammatory Drugs)

Corticosteroids

Antimalarial drugs

Immunosuppressants

Biologic Therapies

Lifestyle and Supportive Care

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