Lupus overview

Systemic lupus erythematosus (lupus) is a disease of the immune system. Normally the immune system protects the body from infection. In lupus, however, the immune system inappropriately attacks tissues in various parts of the body. This abnormal activity leads to tissue damage and illness.

Who gets lupus?

In the UK approximately 50,000 people are thought to have lupus, according to Lupus UK. People of African-Caribbean, Chinese and Asian descent are more likely to develop lupus than white people. Although it can occur in both men and women, 90% of people diagnosed with the disease are women. Women of child-bearing age (15 to 50 years old) are most often affected.

What are the symptoms of lupus?

The symptoms of lupus differ from one person to another. Some people have just a few symptoms, while others have many. In addition there are many different symptoms of lupus because the disease can affect any part of the body. Some of the more common symptoms include:

• Joint pain (arthralgia)
• Unexplained fever (more than 38C or 100F)
• Swollen joints (arthritis)
• Prolonged or extreme fatigue
• Skin rash
• Ankle swelling and fluid accumulation
• Swollen lymph glands
• A butterfly-shaped rash across the cheeks and nose
• Hair loss
• Depression and anxiety
• Anaemia
• Mouth and nose ulcers
• Pale or painful fingers or toes from cold or stress (Raynaud's phenomenon)

What problems can people with lupus have?

Many people with active lupus feel ill in general and complain of fever, weight loss and fatigue. People with lupus also develop specific problems when the immune system attacks a particular organ or area in the body. The following areas of the body can be affected by lupus:

• Skin. Skin problems are a common feature of lupus. Some people with lupus have a red rash over their cheeks and the bridge of their nose - called a ‘butterfly’ or malar rash. Hair loss and mouth ulcers are also common. One particular type of lupus that generally affects only the skin is called ‘discoid lupus’. With this type of lupus, the skin problems consist of large red circular rashes that may scar. Skin rashes are usually aggravated by sunlight. A common lupus rash called subacute cutaneous lupus erythematosus is often worse after exposure to the sun. This type of rash can affect the arms, legs and torso. An uncommon but serious form of lupus rash results in the development of large blisters and is called a ‘bullous’ lupus rash.
• Joints. Arthritis is very common in people with lupus. There may be pain, with or without swelling. Stiffness and pain may be particularly evident in the morning. Arthritis may be a problem for only a few days or weeks, or may be a permanent feature of the disease. Fortunately arthritis usually is not crippling.
• Kidneys. Kidney involvement in people with lupus can be life threatening and may occur in up to half of those with lupus. Kidney problems are more common when someone also has other lupus symptoms such as fatigue, arthritis, rash, fever and weight loss. Less often kidney disease may occur when there are no other symptoms of lupus.
• Blood. Blood involvement can occur with or without other symptoms. People with lupus may have dangerous reductions in the number of red blood cells, white blood cells or platelets (particles that help clot the blood).
  • Sometimes changes in blood counts may cause fatigue (low red cell count, or anaemia), serious infections (low white cell count) or easy bruising or bleeding (low platelet count). However many patients do not have symptoms from low blood counts, so it is important for people with lupus to have periodic blood tests in order to detect any problems.
  • Blood clots are more common in people with lupus. Clots often occur in the legs (called deep vein thrombosis) and lungs (called pulmonary embolism) and occasionally in the brain (stroke). Blood clots that develop in patients with lupus may be associated with the production of antiphospholipid antibodies. These antibodies are abnormal proteins that may increase the tendency of the blood to clot. Blood can be tested for these antibodies.
• Brain and spinal cord. Fortunately brain involvement is a rare problem in people with lupus. When present it may cause confusion, depression, seizures and, rarely, strokes. Involvement of the spinal cord (transverse myelitis) can cause numbness and weakness.
• Heart and lungs. Heart and lung involvement is often caused by inflammation of the covering of the heart (pericardium) and lungs (pleura). When these structures become inflamed, patients may develop chest pain, irregular heartbeat and accumulation of fluid around the lungs (pleuritis or pleurisy) and heart (pericarditis). The heart valves and the lung itself can also be affected by lupus, resulting in shortness of breath.