Is lupus always serious?

Quick answers

Lupus is an autoimmune disease that can range from mild to life-threatening. While some people with lupus have mild symptoms, others suffer from serious organ damage and other complications. There is no cure for lupus, but early diagnosis and proper treatment can help control symptoms and prevent serious problems. Lupus requires lifelong monitoring and care.

What is lupus?

Lupus is a chronic autoimmune disease where the immune system attacks healthy tissue and organs in the body. This leads to inflammation, pain, and damage throughout the body. Some of the most commonly affected parts of the body include the skin, joints, kidneys, brain, heart, and lungs. There are several types of lupus:

• Systemic lupus erythematosus (SLE) – This is the most common type of lupus and can be mild or severe. It affects the whole body.
• Cutaneous lupus – This type only affects the skin and is usually milder.
• Drug-induced lupus – This type is caused by certain medications and goes away when the medication is stopped.
• Neonatal lupus – A rare type that temporarily affects infants born to women with certain autoantibodies.

In SLE, the immune system produces autoantibodies that target healthy cells and tissues in the body. This leads to widespread inflammation and a wide variety of symptoms. The most distinctive sign of SLE is a butterfly-shaped rash across the cheeks and nose. However, lupus can affect any part of the body and cause serious complications if not treated.

What causes lupus?

The exact causes of lupus are unknown, but research points to a combination of genetic, environmental, and hormonal factors. Some potential causes and risk factors for lupus include:

• Genetics – Lupus tends to run in families. Individual genes may make a person more susceptible to SLE.
• Hormones – Because lupus is far more common in women, hormones like estrogen likely play a role.
• Environmental triggers – Factors like viruses, UV light, smoking, and certain medications may trigger lupus in those already at risk.
• Race – Lupus disproportionately affects women of color, especially those of African, Hispanic, Asian, and Native American descent.
• Age – Symptoms typically first emerge between ages 15-44.

What are common symptoms of lupus?

Lupus has a wide range of symptoms that can flare up and disappear over time. Common symptoms include:

• Fatigue
• Joint pain, swelling, and stiffness
• Butterfly rash on cheeks and nose
• Skin rashes and lesions
• Fever, chills, and flulike symptoms
• Chest pain when breathing deeply
• Sunlight sensitivity
• Hair loss
• Pale or purple fingers/toes from cold or stress (Raynaud’s phenomenon)
• Headaches and memory issues
• Mouth or nose ulcers
• Swollen lymph nodes

Symptoms range from mild to severe. Flare-ups may come and go over time. Early diagnosis and treatment helps prevent serious damage.

What are potential complications of lupus?

When left untreated, lupus can cause damage to major organs with life-threatening complications:

• Kidneys (lupus nephritis) – Inflammation of the kidneys occurs in 40-70% of lupus cases. This can lead to leakage of protein in the urine, fluid retention, and potentially kidney failure.
• Brain (neuropsychiatric lupus) – Some people with SLE experience memory problems, seizures, mood disorders, headaches, and strokes. These neurological complications impact about 40% of lupus patients.
• Blood disorders – Anemia, leukopenia (low white blood cell count), and thrombocytopenia (low platelet count) are common. This raises risk for infections and excessive bleeding.
• Lungs (pleurisy) – Chest pain, coughing, and breathing issues can signal inflammation of the lung lining and fluid buildup.
• Heart (pericarditis) – Inflammation of the sac around the heart (pericardium) causes chest pain and potential heart damage.

Catching and controlling lupus early on reduces the likelihood of severe organ involvement and other complications.

Who gets lupus?

About 1.5 million Americans have lupus, with 16,000 new cases diagnosed each year. Women make up 90% of cases, typically diagnosed between ages 15-44. African American, Hispanic, Asian, and Native American women are 2-3 times more likely to develop lupus. Hormones likely contribute to higher rates among females. Men, children, and postmenopausal women can also develop lupus, but it’s less common. There also appears to be a genetic component, since lupus runs in families.

How is lupus diagnosed?

There is no single test to definitively diagnose lupus. Doctors will look at a combination of factors:

• Physical exam and medical history – Looking for typical signs of SLE like rashes and joint pain.
• Blood tests – Antinuclear antibody (ANA) test is positive in 98% of lupus cases. Complete blood count may show anemia and low white blood cells.
• Urine test – Presence of excess protein or red blood cells points to lupus nephritis.
• Imaging tests – X-rays, CT scans, echocardiograms check for organ damage.
• Skin biopsy – Examining skin rashes and lesions under a microscope.

Based on these factors, doctors can determine if a person meets the diagnostic criteria for SLE.

How is lupus treated?

While there is no cure for lupus, treatments can help control symptoms and minimize organ damage. Common medications used include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) – For relieving joint pain, swelling, and fever.
• Antimalarials – Hydroxychloroquine helps treat fatigue, rashes, and inflammation.
• Corticosteroids – Prescription steroids like prednisone reduce swelling and pain.
• Immunosuppressants – Drugs like methotrexate and cyclophosphamide calm the overactive immune system.
• Belimumab (Benlysta) – A biologic drug used for severe SLE cases.

Doctors also recommend:

• Staying out of the sun
• Getting plenty of rest
• Eating a healthy diet
• Avoiding smoking and alcohol
• Reducing stress

Some people experience mild lupus that can be managed with NSAIDs or antimalarials alone. Those with organ damage or severe symptoms may need stronger immunosuppressants.

What is the prognosis for lupus patients?

Advancements in diagnosing and treating SLE have improved the outlook for lupus patients. The 5-year survival rate for SLE is over 90%, and the 10-year rate is around 80%. Many people with lupus can live a normal lifespan with proper medical care. However, minorities and low-income patients have higher mortality rates, underscoring socioeconomic disparities.

Several factors affect lupus life expectancy:

• Age at diagnosis – Developing SLE earlier in life raises risks.
• Severity – Mild forms can be managed more easily than severe SLE.
• Organ involvement – Kidney, heart, lung, and brain damage reduce life expectancy.
• Medication compliance – Taking prescribed treatments consistently gives the best results.
• Lifestyle – Staying active and avoiding smoking/drinking improves outlook.

While some only experience occasional flare-ups, up to 60% have a persistent moderate form requiring ongoing care. About 20% battle severe SLE with organ damage. With comprehensive treatment, most can live relatively normal lives.

Can lupus ever go away?

There is currently no cure for lupus. Most patients deal with some level of symptoms throughout their lifetime. During inactive periods, symptoms may go away completely. However, flare-ups are common as the disease waxes and wanes. About 10-20% of lupus cases do go into long-term remission, sometimes lasting decades. But the potential for recurrence always exists, so continued follow-up is essential. Some factors associated with lupus remission include:

• Early treatment of mild symptoms
• Fewer flare-ups in the first year
• No major organ involvement
• age
• Race (Caucasian and Asian individuals more likely to experience remission)

Even if all symptoms disappear, people with lupus still have higher cardiovascular risks and susceptibility to infections. Staying on medications that control inflammation and the overactive immune system can keep the disease in remission. With careful monitoring and medical compliance, it is possible to keep lupus symptoms at bay for prolonged periods.

Can lupus be fatal?

In rare cases, lupus can cause fatal complications. However, most deaths attributed to SLE are due to cardiovascular disease rather than complications directly from lupus. The most life-threatening lupus complications include:

• Severe kidney inflammation – Can lead to permanent kidney damage, requiring dialysis or transplant.
• Heart problems – Inflammation around the heart or atherosclerosis increases risk of heart attack.
• Lupus cerebritis – Serious brain inflammation can cause seizures, mental impairment, stroke, and death.
• Lung disease – Complications like pleurisy or pulmonary hypertension raise the risk of respiratory failure.
• Sepsis – Infections can overwhelm the weakened immune system, turning into life-threatening sepsis.
• Pregnancy complications – Lupus increases risks of preeclampsia, miscarriage, and stillbirth.

While concerning, most patients can reduce risks by carefully managing lupus with medications and lifestyle changes. Routine screening and treatment for cardiovascular disease is especially important.

Conclusion

Lupus is a complex autoimmune condition that can vary immensely in symptoms and severity. Mild forms may cause occasional flare-ups without serious organ damage. On the other end of the spectrum, aggressive SLE leads to debilitating symptoms and permanent organ injury. Most people fall somewhere in the middle, needing medications to control inflammation and prevent complications. While lupus can sometimes be fatal, the prognosis continues to improve. Ongoing medical care and diligent treatment keeps the disease in check for the majority of patients. Lupus requires a lifelong commitment to treatment, but most people with SLE can maintain a good quality of life.