Lupus is an autoimmune disease that can affect multiple parts of the body, causing inflammation and tissue damage. The severity of lupus can range from mild to life-threatening. So yes, it is possible to have a milder case of lupus.
What is lupus?
Lupus is an autoimmune disease, meaning the body’s immune system mistakenly attacks its own healthy cells and tissues. This leads to inflammation and damage that can affect various parts of the body. Some of the most commonly affected areas include:
- Skin – A butterfly-shaped rash may appear across the nose and cheeks
- Joints – Pain, swelling, and stiffness in the joints
- Kidneys – Inflammation can lead to kidney dysfunction or failure
- Brain and nervous system – Headaches, memory issues, seizures
- Blood cells – Anemia, low white blood cell counts
- Lungs – Difficulty breathing, chest pain
- Heart – Irregular heartbeat, chest pain
The exact cause of lupus is not known, but both genetic and environmental factors are thought to play a role. Women between the ages of 15-44 are most commonly affected.
Symptoms and severity can vary
Lupus symptoms can range from mild to severe. The disease may alternate between flare-ups (worsened symptoms) and remission (minimal symptoms).
Some people with lupus experience only occasional mild symptoms like fatigue, rashes, joint pain or fever. For others, lupus can be much more aggressive and lead to life-threatening complications.
Factors that contribute to lupus severity include:
- Which organs or systems of the body are affected
- Frequency and duration of flare-ups
- Severity of symptoms during flare-ups
- Response to treatment
Mild lupus symptoms
Mild lupus is sometimes referred to as “low disease lupus.” People with a milder form of lupus generally have fewer symptoms that are less intense and impact their life less significantly. Mild lupus symptoms may include:
- Fatigue – Feeling very tired even with adequate rest
- Low-grade fever – Having a temperature between 99-100°F
- Joint and muscle aches – Intermittent mild pain in the joints or muscles
- Skin rashes – A butterfly-shaped malar rash across the cheeks, or other localized rashes that come and go
- Hair loss – Mild thinning of the hair or hair falling out
- Sensitivity to sunlight – Development of rashes or feeling ill after sun exposure
- Headaches – Mild, occasional headaches
- Raynaud’s phenomenon – Fingers or toes turning white or blue in the cold
People with a mild form of lupus may experience flares, but they are infrequent and mild. Any symptoms that develop can often be managed with lower doses of medications like anti-inflammatories, antimalarials, or steroids.
Moderate lupus symptoms
Those with a moderate case of lupus have more noticeable symptoms that require more intensive treatment to control. Moderate lupus symptoms may include:
- Fatigue – Feeling extremely exhausted most of the time
- Fever – Having a temperature between 100-102°F
- Joint pain – More persistent pain in multiple joints
- Arthritis – Joint inflammation that may cause deformity
- Butterfly rash – Bright red rash extending over the cheeks and nose that doesn’t go away
- Photosensitivity – Developing rashes frequently after sun exposure
- Oral ulcers – Sores in the mouth or nose
- Chest pain – Temporary pain due to inflammation around the heart or lungs
- Kidney problems – Mild dysfunction shown on tests
- Anemia – Low red blood cell counts
- Hair loss – Noticeable hair falling out in clumps
People with moderate lupus have more frequent flares that disrupt their daily life. Stronger medications like methotrexate, cyclophosphamide or biologics may be needed to control inflammation and prevent organ damage.
Severe lupus symptoms
Severe lupus occurs when the disease is uncontrolled and vital organs are targeted, leading to serious complications. Severe symptoms may include:
- Kidney inflammation (lupus nephritis) – Can lead to permanent kidney damage and failure
- Cardiovascular problems – Inflammation around the heart or atherosclerosis increasing risk of heart attack
- Lung inflammation (pleurisy) – Sharp chest pain and difficulty breathing due to inflammation of lung tissue and fluid buildup
- Blood disorders – Low platelet or white blood cell counts, increasing risk of excessive bleeding or infections
- seizures, psychosis, and cognitive dysfunction
- Sores in mouth or nose – Painful ulcers that won’t heal
People with life-threatening lupus require urgent and aggressive treatment to prevent permanent organ damage. This may include high-dose corticosteroids, cyclophosphamide, rituximab infusions, or plasmapheresis.
Diagnosing lupus
There is no single test that can definitively diagnose lupus. Doctors will look at a combination of factors including symptoms, physical examination findings, and test results.
Diagnostic tests used to help confirm lupus may include:
- Blood tests – To check for anemia, low blood cell counts, autoantibodies, or protein markers of inflammation.
- Urine tests – To check for protein or blood that could indicate kidney problems.
- Skin biopsy – To examine rashes and skin lesions.
- Joint fluid tests – To look for inflammation.
- Chest X-ray or echocardiogram – To assess for heart or lung involvement.
Based on a person’s constellation of signs and symptoms, a doctor will determine whether lupus is likely and how severe the disease appears to be. Milder cases of lupus may take longer to diagnose because symptoms are vague and come and go.
Treatment for mild lupus
Treatment for lupus focuses on controlling symptoms and preventing flares. Milder cases of lupus can often be managed with the following medications:
- Anti-inflammatories – Such as ibuprofen to relieve pain and reduce swelling
- Antimalarials – Such as Plaquenil (hydroxychloroquine) to treat fatigue, rashes, and joint pain
- Low-dose corticosteroids – To help suppress overactive immune system activity
- Immunosuppressants – Medications that dampen the immune system may be added if antimalarials and steroids aren’t sufficient
In addition to medications, lifestyle measures can help minimize symptoms. These include:
- Use sunscreen and protective clothing to prevent rashes from sun exposure
- Get enough rest to combat fatigue
- Adopt a healthy diet and stay active to support overall health
- Avoid tobacco smoking which can worsen lupus symptoms
- Learn techniques to manage stress which can exacerbate lupus
Treatment for severe lupus
Treatment for severe, life-threatening lupus generally includes:
- High-dose corticosteroids – Powerful anti-inflammatory doses of steroids to quickly control symptoms
- Immunosuppressants – Medications like cyclophosphamide or methotrexate to suppress the overactive immune system
- Biologic drugs – Newer injections like Benlysta (belimumab) to reduce immune activity
- Plasmapheresis – Filtering the blood to remove autoantibodies
People with severe lupus need to be closely monitored by their doctor for any signs of worsening disease activity so that treatment can be adjusted as needed. Maintaining compliance with medications and doctor visits is crucial.
Complications from severe lupus
When severe lupus goes uncontrolled, it can lead to serious, even life-threatening complications such as:
- Kidney failure – If kidney inflammation goes untreated, permanent damage can occur. Kidney transplant may be required.
- Cardiovascular disease – Inflammation around the heart can cause scarring, arrhythmias, heart attacks, or heart failure.
- Seizures and psychosis – If the brain is affected, neurological symptoms like memory loss, confusion and seizures can develop.
- Serious infections – Due to a weakened immune system and use of immunosuppressants, severe infections can occur.
- Pregnancy complications – Lupus increases the risk of miscarriage, preeclampsia, and preterm birth.
To reduce the likelihood of end-organ damage and other problems, close monitoring and early intervention for severe flares is essential.
Monitoring and outlook for mild lupus
People with mild lupus need to have regular doctor visits to monitor for any changes in disease activity and potential organ involvement. This generally includes:
- Physical exams to check for rashes, joint swelling, enlarged lymph nodes, etc.
- Blood work to look for changes in inflammatory markers, cell counts, or autoantibody levels
- Urine tests to screen for early kidney problems
- Imaging such as x-rays or echocardiograms to check for inflammation around the heart or lungs
It’s important for individuals with lupus to take medications as prescribed and promptly report any new or worsening symptoms to their doctor. With close monitoring and compliance with treatment, most people with mild lupus can live a relatively normal life span.
However, some people with mild lupus may progress to more severe disease over time. The likelihood of this depends on multiple factors including which organs are impacted, responsiveness to treatment, and socioeconomic factors.
Studies suggest that after five years of living with lupus:
- 60-70% of patients will have no organ damage
- 20-30% of patients will have reversible organ damage
- 10-15% of patients may develop irreversible, life-threatening damage to vital organs
But with proactive medical care and healthy lifestyle choices, many patients learn to successfully manage even mild lupus and prevent severe flares.
Key points about mild lupus
- Lupus symptoms can range from very mild to severe and life-threatening.
- Mild lupus may cause fatigue, rashes, joint pain, and sensitivity to sunlight that comes and goes.
- People with mild lupus have infrequent flares and are generally able to control symptoms with anti-inflammatories, antimalarials, and lifestyle changes.
- Severe lupus causes vital organ damage and requires urgent intensive treatment with immunosuppressants or biologics.
- With regular monitoring and compliance with treatment, the majority of people with mild lupus have a good prognosis.
The bottom line
Lupus is a chronic autoimmune condition characterized by flare-ups and remissions. The severity can range from mild symptoms like rashes and joint pain that come and go, to severe life-threatening complications such as kidney failure or heart disease.
Many people are able to maintain a milder form of lupus with treatment and lifestyle changes to control symptoms and prevent flares. While lupus should never be taken lightly, with proper medical care and vigilance, it is possible to have a mild case of lupus and live an active, relatively healthy life.
