Lupus is an autoimmune disease that attacks various parts of the body, causing tissue damage and other illnesses. According to the Lupus Foundation of America, there are approximately 5 million people around the world who have lupus, and there are more than 16,000 new cases of lupus reported annually.  

It is one of the most common autoimmune diseases in the United States. The Lupus Foundation of America estimated that over 1.5 million Americans have some form of lupus, and the disease mainly affects minorities, including those of African, Latin, Asian, and Native American descent. In fact, recent research has shown that lupus affects 1 in 537 young black women in the United States.

While both men and women can have lupus, 90% of those who are diagnosed with the disease are women of childbearing age (14 to 45 years old). A study in 2014 found that minority women commonly develop lupus at a younger age and are at risk of serious complications. These women also have higher mortality rates.

As nurses, it’s important to understand the symptoms, diagnosis process, and treatment procedures for one of the most common autoimmune diseases. Here is our general overview.

Understanding the symptoms of lupus

Like with other autoimmune diseases, symptoms of lupus varies with each patient. While some patients may have a few symptoms, others may present with many. Also, a lot of the symptoms of lupus can affect multiple areas of the body. The most common symptoms are:

• Achy and sore joints
• Swollen joints
• Skin rash, as well as a butterfly-shaped rash across the patient’s face
• Hair loss
• Extreme fatigue for prolonged periods of time
• Sensitivity to the sun and/or other sources of light
• Raynaud’s phenomenon, meaning pale or purple fingers or toes caused by the cold or stress
• Unexplained fever (usually more than 100 F)

Currently, there are four different forms of lupus affecting patients: Systemic lupus erythematosus, cutaneous lupus, drug-induced lupus, and neonatal lupus. Systemic Lupus Erythmatosus (SLE) affects approximately 70 percent of all lupus cases, and can cause major organ or tissue damage to the heart, lungs, kidney, and brain.

Causes of lupus

The cause of lupus isn’t entirely known. However, researchers have linked several factors that can trigger the immune system to attack various parts of the body. This is why one of the main courses of treatment for lupus is by suppressing the immune system with immunosuppressant drugs. Some of the factors that are believed to lead to the development of lupus are viruses, environmental chemicals, and even someone’s genetic markup.

Because so many women are struggling with lupus, researchers also believe that female hormones may play a role in the development of lupus. Especially for those women who are diagnosed with lupus during their childbearing years, since this is the time where hormone levels are at their highest.

Another risk factor that has been observed is with family history. If a patient has a family history of lupus, they are at risk for developing lupus in the future. But, just because you have a family history, doesn’t mean that you’ll develop lupus in your lifetime. Approximately 10 percent of patients with lupus with lupus have a close relative with the disease.

Unlike the other forms of lupus, drug-induced lupus can develop after using prescription medications, like hydralazine and procainamide. However, symptoms usually improve after the patient discontinues using the drug.

Diagnosis of lupus

Diagnosing of lupus can be a challenging and long process. Sometimes, patients won’t be diagnosed for months, maybe even years, after presenting with symptoms. Lupus is commonly misdiagnosed with other autoimmune and rheumatic diseases, and oftentimes it takes a long time for doctors to have all the information before making an official diagnosis.

The American College of Rheumatology created a criteria to help healthcare professionals to make a proper diagnosis of lupus. In order to be diagnosed with lupus, a patient must have at least four of the 11 criteria:

1. Malar rash, otherwise known as the “butterfly” rash
2. Photosensitivity, skin reaction or sensitivity from sunlight
3. Oral ulcers, or open mouth sores
4. Blood disorder, like anemia, leukopenia, lymphopenia, or thrombocytopenia
5. Abnormal blood work, which is a positive antinuclear antibody (ANA) test result
6. Neurological disorder, psychosis, or seizures
7. Kidney disorder, which can include either excess protein or blood cells in the urine
8. Joint pain, swelling, or inflammation
9. Immunologic disorder, with the presence of certain cells or antibodies. This can also include a false positive for syphilis.
10. Discoid rash, or red, scaly patches on the skin, which causes scarring
11. Inflammation of the lungs’ lining (pleuritis) or the heart’s lining (pericarditis)

Treatment of lupus

Because lupus varies for each patient, treatment varies and completely depends on the symptoms and their severity. The goal of treatments are to:

• Ease the patient’s symptoms
• Soothe the patient’s inflammation
• Prevent and relieve lupus flares
• Prevent organ damage and other complications

A mixture of anti-inflammatory, antimalarial, corticosteroids, and immunosuppressant drugs can be used to treat lupus symptoms. Sometimes, physicians may also prescribe anticoagulants monoclonal antibodies when other treatments have not been successful.

Healthy lifestyle changes can also help patients feel better and prevent flare-ups of symptoms. Lifestyle changes can help prevent complications related to lupus, including kidney disease, stroke, and heart attack.

Some lifestyle changes include:

• Changing eating habits to a well-balanced diet
• Stopping the use of tobacco products
• Getting enough rest to ease fatigue
• Exercising to aid with sleep, mood, and heart health
• Using sunscreen
• Receiving routine vaccines for pneumonia and the flu

Treatment and care for lupus is a lifelong commitment. There’s still no cure for lupus, but that doesn’t mean that there aren’t ways for patients to manage their disease and improve their quality of life. As a nurse, educate your patients about the disease and raise awareness where you can.

More awareness leads to better treatments, and more awareness may, one day, lead to a cure.