What is Lupus? (video/podcast)

Lupus is an autoimmune disease, which means your body’s own immune system starts to attack your healthy tissues and organs. Lupus can affect many parts of the body, including your brain, lungs, heart, kidneys, joints, skin and even blood cells. While there is not yet a cure for lupus, there are ways to manage it and improve quality of life.

In this video, San Diego Health host Susan Taylor talks with Usman Ajaz, MD, a rheumatologist at Scripps Coastal Medical Center Vista, about diagnosing and treating lupus. 

The most common type of lupus, systemic lupus erythematosus (SLE), affects multiple organs. Most cases of SLE begin in adulthood, between the ages of 15-44, while 10-20 percent develop in childhood. Systemic lupus can range from mild to severe.

Like other autoimmune diseases, the exact cause of lupus is not known, but multiple factors may increase the risk of developing it. Women of childbearing age are most at risk. The risk is also higher among people from certain racial or ethnic groups, including Black or African American, Hispanic/Latino, American Indian/Alaska Native and Asian Americans and Pacific Islanders.

Genetics is a leading risk factor for lupus; if a relative has lupus, your risk of developing it during your lifetime is 16 times greater than average. Hormones and environmental factors also can play a role.

“You need to have the genes that can predispose you to getting lupus, and then you have to come across this environmental factor that can trigger your lupus, meaning drugs, medications, even sunlight or infections,” says Dr. Ajaz.

Lupus symptoms can vary depending on which areas of the body are affected. It can cause rashes that are sensitive to sunlight; the most common is a butterfly-shaped rash that spreads across the nose and cheeks. Sores or ulcers also may develop in the nose or mouth.

Underlying inflammation can cause flu-like symptoms, such as feeling rundown or having fatigue, low-grade fever and body aches. Depending on which organs are inflamed, symptoms may include brain fog, memory loss, chest pain or shortness of breath and joint pain that is often worse in the morning or during the night.

However, having any of these symptoms doesn’t necessarily mean you have lupus. Other conditions, such as arthritis, can have similar symptoms.

“That’s one of the challenging features of lupus. It’s like solving a puzzle because you have so many diverse symptoms in this condition, and these symptoms mimic those of other conditions, so you have to rule out a lot of other things before you get to the diagnosis of lupus,” explains Dr. Ajaz.

“Also, lupus symptoms come and go. There will be periods of time when the patients are having all those symptoms, and then there are times when the symptoms will mellow down or even disappear. That makes it very challenging for the patient and provider,” he says.

There is no single diagnostic test for lupus. Doctors consider the symptoms, conduct a physical exam and may run various blood tests. They may check liver and kidney function and order chest X-rays, echocardiograms or other tests to check the heart and lungs.

If lupus is not well-controlled, ongoing inflammation can lead to permanent organ damage, potentially increasing the risk of issues including stroke, cardiovascular disease or kidney failure.

“All of these things can really shorten your lifespan, so it’s extremely important to get it under control as quickly as possible,” says Dr. Ajaz.

Lupus treatments include medication and lifestyle changes. The most common medication is hydroxychloroquine (HCQ), an anti-malarial medication that helps prevent flare-ups of symptoms and further organ damage. Immunosuppressant drugs can calm the immune system so that it stops attacking the body. Steroids can help reduce inflammation, especially if lupus affects the brain or kidneys.

Lifestyle changes are also important, especially in terms of reducing factors that trigger flare-ups. If sunshine is a trigger, Dr. Ajaz recommends wearing sunscreen with SPF 50 or higher and sun-protective clothing.

“Stress, anxiety, depression, these things can trigger your lupus as well, so it’s very important that you have a good support system, you’re asking for help,” he says. “I advise my patients to do an anti-inflammatory diet, like a Mediterranean diet. Avoid nitrates. Avoid smoking. Exercise and do meditation.”

He encourages people who have symptoms of lupus, especially if they come and go, to get them checked out sooner rather than later.

“You definitely need to seek some help promptly, because that’s going to increase your quality of life and help better manage the condition.”

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