Lupus is a disease that belongs to the group of autoimmune diseases, in which, for unknown reasons, part of the human being’s defenses attack the organism itself.
The best known types of lupus are:
- Systemic lupus erythematosus: this is the most important form of lupus, as it can affect practically any organ of the human being. As in chronic cutaneous lupus, its causes are unknown, although it is known that there is a familial genetic predisposition, on which an external agent acts, still to be discovered, producing an immunological alteration, by which part of the defenses, in the form of autoantibodies, are directed against cells and tissues of the human being itself.
- Chronic cutaneous lupus: exclusively affects the skin and exceptionally evolves into systemic lupus erythematosus. It is of unknown cause and is usually diagnosed and treated by dermatologists, sometimes with the collaboration of internists, and sometimes a skin biopsy is required to confirm the process.
- Drug-induced lupus: among the drugs that cause it are some antiarrhythmic drugs, antibiotics and antiepileptics, which can cause a picture similar to systemic lupus erythematosus, but more benign; these symptoms disappear after discontinuation of the causative drug.
- Neonatal lupus: a transient form of lupus that affects some newborns of mothers affected by systemic lupus erythematosus and carriers of the SSA/Ro or SSB/La antibody; these antibodies pass through the placenta and can produce an urticarial skin reaction in the newborn for a few weeks, which disappears without leaving any sequelae.
Systemic lupus erythematosus, more common in young women
Systemic lupus erythematosus is a disease that mainly affects women of childbearing age and is suffered by approximately one in every 1500 – 2000 people. It is a chronic disease that progresses in flares, alternating with periods of inactivity.
The most frequent triggers of lupus flares are exposure to unprotected sunlight, infections, failure to correctly follow treatment and stress.
Symptoms of systemic lupus erythematosus
The most frequent symptoms are fever, fatigue, a wide variety of skin eruptions, the best known being butterfly wing erythema on the face, and musculoskeletal pain.
Inflammation of the pleura or pericardium, mouth sores and anemia or decrease of leukocytes or platelets in the blood are also frequent. Renal, cardiopulmonary or nervous system complications are less frequent, but are more important and require more aggressive treatment.
It should also be taken into account that lupus patients more frequently suffer from infectious processes and cardiovascular complications.
Diagnosis of systemic lupus erythematosus
The diagnosis of systemic lupus erythematosus is based on the clinical history and physical examination of the patient, as well as the determination of a general blood and urine analysis, complement levels C3 and C4, and autoantibodies in the blood, mainly antinuclear antibodies, anti native DNA antibodies and anti-SM antibodies. With these tests the differential diagnosis with other autoimmune diseases such as rheumatoid arthritis, Sjogren’s syndrome or mixed connective tissue disease, infectious or neoplastic diseases, with which lupus can be confused, is generally well done.
Once the diagnosis of lupus has been correctly made, it should be followed up by a specialist with knowledge and experience in this disease, generally an internist or a rheumatologist, although sometimes the help of other specialists, such as dermatologists, nephrologists, etc., is necessary. depending on the severity of the affected organ.
Treatment of systemic lupus erythematosus
The treatment of systemic lupus erythematosus is mainly based on general measures to promote healthy lifestyles and an ideal weight, the use of UV protection creams, avoidance of stress, avoidance of smoking and alcohol abuse, as well as adequate rest and drugs.
The most important drugs are antimalarials/hydroxychloroquine and corticosteroids, although the latter should be avoided as far as possible or their use should be very moderate. For discomfort such as fever or musculoskeletal pain, anti-inflammatory drugs can be taken, although it is important not to overuse them. For more important organ complications, medications known as immunosuppressants are available.
There is currently a high level of research on new drugs for lupus, which interfere with more specific molecules of immunity, so it is foreseeable that in the future we will have powerful and less aggressive drugs.
The life of the lupus patient
The prognosis of patients with lupus has improved extraordinarily in recent years, to which better knowledge of the disease, better management of infections and drugs, and the help and collaboration of lupus patients’ associations, which are very important, have contributed.