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Lupus - Complications of lupus

NHS Choices Medical Reference

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If your symptoms of systemic lupus erythematosus (SLE) are mild or well-controlled, you may find it barely affects your day-to-day life and you may not have complications.

You may also find your symptoms significantly improve with age. Many people over 50 find their symptoms have eased. In some (but not all) women, SLE may improve after the menopause (when a woman's monthly periods stop, usually at around the age of 50).

However, for some people SLE can be a more serious condition which can cause life-threatening complications. Some of these complications are outlined below.

Cardiovascular disease

Cardiovascular disease (CVD) is a general term for any type of health condition that affects the heart and arteries.

Examples of CVD include:

It is estimated that people with SLE are seven to eight times more likely to develop cardiovascular disease than the general population. This is because SLE can cause inflammation of your heart and arteries.

It helps to take steps to lower your risk of developing CVD, including:

  • quitting smoking (if you smoke)
  • eating a healthy, balanced diet - low in saturated fat, sugar and salt and containing plenty of fruit and vegetables (at least five portions a day)
  • maintaining a healthy weight
  • taking regular exercise - at least 150 minutes a week (the exercise should be strenuous enough to leave you slightly out of breath)
  • if you drink, make sure you stick to recommended guidelines for alcohol consumption (see below)

Maximum recommended daily limits of alcohol consumption are:

  • three to four units of alcohol for men
  • two to three units of alcohol for women

A unit of alcohol is equal to about half a pint of normal strength lager, a small glass of wine or a pub measure (25ml) of spirits.

Read about healthy hearts for more information on how to prevent CVD.

In some people, SLE can cause a number of less serious heart conditions such as:

  • pericarditis - inflammation of the lining of your heart
  • myocarditis - inflammation of the muscles of your heart

Lupus nephritis

Lupus nephritis is a potentially serious kidney disease caused by prolonged inflammation of your kidneys as a result of SLE. Lupus nephritis is a common complication of SLE, estimated to affect around half of people with the condition.

Lupus nephritis tends to develop relatively early in the course of SLE, usually within five years of diagnosis.

Symptoms of lupus nephritis include:

  • swelling of your feet
  • headaches
  • dizziness
  • blood in your urine
  • a frequent need to urinate

In many cases, lupus nephritis does not cause any noticeable symptoms. However, this does not mean the condition is not dangerous as it can damage  kidneys. Lupus nephritis can also cause high blood pressure (hypertension), which if not treated can put you at risk of developing a serious CVD in the long-term, such as a heart attack or stroke.

It is likely you will be referred for regular blood tests so the condition of your kidneys can be carefully monitored.

If you develop lupus nephritis, it can usually be successfully controlled using immunosuppressants such as azathioprine, mycophenolate mofetil or cyclophosphamide.

Other autoimmune conditions

Approximately one in three people with SLE also have another autoimmune condition, such as thyroid disease, Sjogren's syndrome or Hughes syndrome (antiphospholipid syndrome).

Sjogren's syndrome

Sjogren's syndrome is a condition that damages your salivary and tear glands, causing a dry mouth and eyes. It affects one in eight people with SLE.

Hughes syndrome (antiphospholipid syndrome)

Hughes syndrome (antiphospholipid syndrome) can occur as a secondary condition to SLE or on its own.

Hughes syndrome causes an increased risk of clots developing in the arteries (leading to strokes and heart attacks) and the veins (leading to deep vein thrombosis).

Women with SLE and Hughes syndrome also have an increased risk of developing complications during pregnancy (see below).

Diagnosis of Hughes syndrome (antiphospholipid syndrome) in cases of SLE requires the presence of either vascular and/or pregnancy-related complications together with antiphospholipid antibodies in the blood.

Lupus in pregnancy

SLE does not usually affect fertility. Pregnancy problems are more common in people with lupus, especially those who have Hughes syndrome (see above). Complications occurring during pregnancy include:

Treatments such as aspirin and heparin injections are available, which increase the chance of a successful pregnancy in patients with Hughes syndrome.

There is also a risk that women with lupus will experience a flare-up of their symptoms during pregnancy.

Symptoms of SLE that can develop during pregnancy include:

  • hair loss
  • swelling of the feet and hands
  • facial redness
  • anaemia
  • muscle, bone and joint pain

Some symptoms may be difficult to distinguish from those related to pregnancy itself, such as anaemia, facial redness and swelling. The risk of flare-ups can usually be reduced by taking anti-malarial medications and appropriate immunosuppressants, such as azathioprine. If necessary, corticosteroids can also be given.

To reduce the risks of complications developing during pregnancy you may be advised to delay your pregnancy until you have gone for six months without experiencing a flare-up of your symptoms and your kidney function is normal or nearly normal.

While no medication is guaranteed safe to use during pregnancy, medications known to be safest are:

  • hydroxychloroquine - an anti-malarial medication
  • azathioprine - an immunosuppressant
  • prednisolone - a corticosteroid

Read more information about these on our medicines information page for lupus.

Medical Review: June 28, 2012
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