When most people hear the term lupus they think “chronic autoimmune disease”, “butterfly rash”, or maybe even “heart disease”, with the presumption that lupus follows a single path of diagnosis and progression. Lupus is different in this way. It can be unique in its symptoms, diagnosis, and progression from person to person. Researchers have at this time been able to identify thirteen autoantibodies associated with lupus and have separated them into subtypes. These subtypes bring about different forms of lupus. There are 4 main types of lupus (3 of which we’ll cover in this blog, look out for a part2!) Let’s break them down to better understand how they differ and what that means for treatment outcomes, innovative research, and the future.
Systemic Lupus Erythematosus
The most commonly known type of lupus is Systemic Lupus Erythematosus or SLE, a chronic autoimmune disease. As with other autoimmune diseases, the body’s immune system mistakenly attacks healthy cells and tissues. This leads to inflammation and tissue damage in the affected organs. It is diagnosed based on symptoms and lab results.
When I hear the word systemic, my mind thinks “full body”. The name is pretty on point because SLE can affect the joints, skin, brain, lungs, kidneys, and blood vessels. Patients with SLE can work with their healthcare providers, mostly rheumatology and dermatology specialists, to manage symptoms of flare ups and then they go into remission. There is no cure for SLE at this time but there is much hopeful research.
The cause of SLE is not clearly known. It may be linked to your genes, environment, hormone profile, and the medications you are using for other conditions. It is more common in women than men and although it can occur at any age, it is most often diagnosed in young women between the ages of 15 and 44.
Rates of Lupus are highest in Native American/Alaskan Native females than any other group. Positive outcomes are affected by socioeconomic status and social support availability. Patients who have social support tend to have the best health and disease outcomes.
SLE treatment is based on severity and can include:
- Both oral (tablets) and topical (creams) corticosteroids for skin and arthritis symptoms.
- Antimalarial medications such as hydroxychloroquine.
- Non-steroidal anti-inflammatory pain medications.
- Immunosuppressive medicines such as mycophenolate, azathioprine and cyclophosphamide.
- Blood thinners, such as warfarin (Coumadin).
Drug-Induced Lupus Erythematosus
Drug-Induced lupus is a reversible condition which causes lupus-like symptoms in people who do not actually have SLE.
Certain drugs can actually cause lupus-like symptoms in people who do not have SLE. Once the drug is discontinued, symptoms will resolve within six months.
The drugs most commonly connected with drug-induced lupus are:
- Hydralazine and methyldopa (used to treat high blood pressure or hypertension)
- procainamide (used to treat irregular heart rhythms)
- isoniazid (used to treat tuberculosis)
- D-penicillamine (used to remove metals from the body)
- minocycline (used to treat acne)
- anti-TNF inhibitors (used to treat rheumatoid arthritis).
Neonatal Lupus Erythematosus
Neonatal lupus erythematosus occurs when autoantibodies (anti-Ro and anti-La) are transported across the placenta to the developing baby. This condition was first discovered in 1954 when a 6-week old baby developed a rash and a few months later it’s mother was diagnosed with lupus. While in that example, the mother’s lupus was connected to the baby that isn’t always the case. A mother who gives birth to a child with neonatal lupus may not have lupus herself. Mother’s without lupus can have children with NLE. They can be carriers of the autoantibodies involved. These autoantibodies can be detected by testing the mother’s blood.
Usually neonatal lupus involves only the baby’s skin and causes lesions similar to those in SLE. All symptoms can subside on their own within a year. In rare cases 1-2% of infants with neonatal lupus experience congenital heart block. This can be diagnosed during pregnancy weeks 18 to 24 and can be treated with a pacemaker. Children with pacemakers can go on to live healthy lives.
By Nadia Bhatti