Lupus Diagnosis and Treatment

Lupus is a chronic disease with no cure. This means that you can manage it with treatment, but it will not go away. Treatment can help improve your symptoms, prevent flares, and prevent other health problems often caused by lupus. Your treatment will depend on your symptoms and needs.

How is lupus diagnosed?

Lupus can be hard to diagnose because it has many symptoms that are often mistaken for symptoms of other diseases. Many people have lupus for a while before they find out they have it. If you have symptoms of Lupus, tell your doctor right away.

Lupus can affect almost any organ in your body. The symptoms of lupus also differ from person to person. For example, one woman with lupus may have swollen knees and fever. Another woman may be tired all the time or have kidney trouble. Someone else may have rashes. Over time, new symptoms can develop or some symptoms may happen less often.

• Medical history. Tell your doctor about your symptoms and other problems. Keep track of your symptoms by writing them down when they happen. Also, track how long they last.

• Family history of lupus or other autoimmune diseases. Tell your doctor if lupus or other autoimmune diseases run in your family.

• Complete physical exam. Your doctor will look for rashes and other signs that something is wrong.

• Blood and urine tests. The antinuclear antibody (ANA) test can show if your immune system is more likely to make the autoantibodies of lupus. Most people with lupus test positive for ANA. But, a positive ANA does not always mean you have lupus. If you test positive for ANA, your doctor will likely order more tests for antibodies that are specific to systemic lupus erythematosus (SLE).

• Skin or kidney biopsy. A biopsy is a minor surgery to remove a sample of tissue. The tissue is then viewed under a microscope. Skin and kidney tissue looked at in this way can show signs of an autoimmune disease.

Lupus Symptoms Include:

• Muscle and joint pain. You may experience pain and stiffness, with or without swelling. This affects most people with lupus. Common areas for muscle pain and swelling include the neck, thighs, shoulders, and upper arms.

• Fever. A fever higher than 100 degrees Fahrenheit affects many people with lupus. The fever is often caused by inflammation or infection. Lupus medicine can help manage and prevent fever.

• Rashes. You may get rashes on any part of your body that is exposed to the sun, such as your face, arms, and hands. One common sign of lupus is a red, butterfly-shaped rash across the nose and cheeks.

• Chest pain. Lupus can trigger inflammation in the lining of the lungs. This causes chest pain when breathing deeply.

• Hair loss. Patchy or bald spots are common. Hair loss could also be caused by some medicines or infection.

• Sun or light sensitivity. Most people with lupus are sensitive to light, a condition called photosensitivity. Exposure to light can cause rashes, fever, fatigue, or joint pain in some people with lupus.

• Kidney problems. Half of people with lupus also have kidney problems, called lupus nephritis.3 Symptoms include weight gain, swollen ankles, high blood pressure, and decreased kidney function.

• Mouth sores. Also called ulcers, these sores usually appear on the roof of the mouth, but can also appear in the gums, inside the cheeks, and on the lips. They may be painless, or you may have soreness or dry mouth.

• Prolonged or extreme fatigue. You may feel tired or exhausted even when you get enough sleep. Fatigue can also be a warning sign of a lupus flare.

• Anemia. Fatigue could be a sign of anemia, a condition that happens when your body does not have red blood cells to carry oxygen throughout your body.

• Memory problems. Some people with lupus report problems with forgetfulness or confusion.

• Blood clotting. You may have a higher risk of blood clotting. This can cause blood clots in the legs or lungs, stroke, heart attack, or repeated miscarriages.

• Eye disease. You may get dry eyes, eye inflammation, and eyelid rashes.

Lupus symptoms also usually come and go, meaning that you don’t have them all of the time. Lupus is a disease of flares (the symptoms worsen and you feel ill) and remissions (the symptoms improve and you feel better).

How is lupus treated?

There is no cure for lupus but treatments can help you feel better and improve your symptoms. Your treatment will depend on your symptoms and needs. The goals of treatment are to:

• Prevent flares

• Treat symptoms when they happen

• Reduce organ damage and other problems

Your treatment might include medicines to:

• Reduce swelling and pain

• Calm your immune system to prevent it from attacking the organs and tissues in your body

• Reduce or prevent damage to the joints

• Reduce or prevent organ damage

Can I treat my lupus with alternative medicine?

Some people with lupus try creams, ointments, fish oil, or supplements they can buy without a prescription. Some people try homeopathy or see a chiropractor to care for their lupus. Some people with lupus who try these types of treatments say that they help.

Research studies have not shown any benefits to these types of treatments. And research studies have not been done to see if these treatments hurt people with lupus.

Talk to your doctor or nurse before trying any alternative medicine. Also, don’t stop or change your prescribed treatment without first talking to your doctor or nurse.

What types of medicines treat lupus?

Several different types of medicines treat lupus. Your doctors and nurses may change the medicine they prescribe for your lupus as your symptoms and needs change.

Types of medicines commonly used to treat lupus include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as ibuprofen and naproxen, help reduce mild pain and swelling in joints and muscles.

• Corticosteroids. Corticosteroids (prednisone) may help reduce swelling, tenderness, and pain. In high doses, they can calm the immune system. Corticosteroids, sometimes just called “steroids,” come in different forms: pills, a shot, or a cream to apply to the skin. Lupus symptoms usually respond very quickly to these powerful drugs. Once this has happened, your doctor will lower your dose slowly until you no longer need it. The longer a person uses these drugs, the harder it becomes to lower the dose. Stopping this medicine suddenly can harm your body.

• Antimalarial drugs. Medicines that prevent or treat malaria also treat joint pain, skin rashes, fatigue, and lung inflammation. Two common antimalarial medicines are hydroxychloroquine (Plaquenil) and chloroquine phosphate (Aralen). Studies found that taking antimalarial medicine can stop lupus flares and may help people with lupus live longer.

• BLyS-specific inhibitors. These drugs limit the amount of abnormal B cells (cells in the immune system that create antibodies) found in people with lupus. A common type of BLyS-specific inhibitor that treats lupus symptoms, belimumab, blocks the action of a specific protein in the body that is important in immune response.

• Immunosuppressive agents/chemotherapy. These medicines may be used in severe cases of lupus, when lupus affects major organs and other treatments do not work. These medicines can cause serious side effects because they lower the body’s ability to fight off infections.

• Other medicines. You may need other medicines to treat illnesses or diseases that are linked to your lupus — such as high blood pressure or osteoporosis. Many people with lupus are also at risk for blood clots, which can cause a stroke or heart attack. Your doctor may prescribe anticoagulants (“blood thinners”), such as warfarin or heparin, to prevent your blood from clotting too easily. You cannot take warfarin during pregnancy.

Talk to your doctor:

• About any side effects you may have

• If your medicines no longer help your symptoms

• If you have new symptoms

• If you want to become pregnant

• About any vitamins or herbal supplements you take — they might not mix well with medicines you use to treat lupus

Can I die from lupus?

Yes, lupus can cause death. But, thanks to new and better treatments, most people with lupus can expect to live long, healthy lives. The leading causes of death in people with lupus are health problems that are related to lupus, such as kidney disease, infections, and heart disease.1,2

Work with your doctor to manage lupus. Take your medicine as your doctor tells you to and make healthy choices, such as not smoking, eating healthy foods, getting regular physical activity, and managing your weight. Learn more about eating healthy in our

LIVING WITH LUPUS section.

Lupus is a lifelong disease that can affect many parts of your life. But, many women with lupus live long, healthy lives. You can take steps to control your symptoms, prevent lupus flares, and cope with the challenges of lupus.

Will I need to see a special doctor for my lupus?

Maybe. Start by seeing your family doctor and a rheumatologist, a doctor who specializes in the diseases of joints and muscles such as lupus. Depending on your symptoms or whether your organs have been hurt by your lupus, you may need to see other types of doctors. These may include nephrologists, who treat kidney problems, and clinical immunologists, who treat immune system disorders.

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