What is lupus? A Baylor rheumatologist explains the chronic disease

Lupus is a chronic autoimmune disease that causes issues within different organs in a person’s body, skin, joints and blood. The Lupus Foundation of America estimates that 1.5 million Americans, and at least five million people worldwide, have a form of lupus. Rheumatologist Dr. Kalpana Bhairavarasu details symptoms, treatment and more.

Is lupus hereditary?

Lupus can be caused by a combination of factors. Bhairavarasu says that one of the reasons the number of people getting diagnosed with lupus is increasing is because there are more changes in our environment, which is concerning to her and other rheumatologists.

“For those who get lupus, there is a combination of genetics and environmental factors, and then there is the theory about a tipping point in immune tolerance,” Bhairavarasu said. “You can have family members with autoimmune issues, have increased sun exposure, have environmental toxin exposure or take antihypertensives, anti-seizure or retinoid medications. It’s very complex, and there is not a uniform answer for everybody.”

There are also hormonal factors. Lupus is more prevalent in women than men, mainly because of the changes in their hormones.

“At times of major hormonal shifts in the female body, be it at puberty, pregnancy or perimenopause, these are times when incidences of lupus can rise,” she said.

What are the symptoms?

“Symptoms of lupus are non-specific, leading to a lot of confusion when patients are not seeking care from rheumatologists. It is a multisystem disease and can affect everything from head to toe,” Bhairavarasu said.

Symptoms can range from:

• Fatigue from low blood counts
• Severe or systemic inflammation
• Swollen joints
• Bald patches
• Oral and nasal ulcers
• Purple-colored scarred lesions
• Fluid build-up around the heart and lungs

“The most common feature that 80% of patients with lupus will have is joint swelling and a skin rash, also called a butterfly rash. It goes across the face, over the bridge of the nose and spans to the nasolabial folds,” she said.

There are increasing cases of lupus in Latin American, African American and East Asian communities, and the disease can show up differently in different ethnicities or subgroups.

“Clinical manifestations can vary, and the presentation of a skin rash can be different. Also, how these groups respond to medications can differ,” Bhairavarasu said.

How is lupus diagnosed?

When a patient sees a rheumatologist, they would likely have already addressed some of their non-specific symptoms with their referring provider. Most will have completed simple tests of their blood counts and specific antibody panels.

“Lupus is a clinical diagnosis. We’re not just treating blood test results. We treat the patient and their symptoms in light of those abnormal tests,” Bhairavarasu said.

The usual screening test for lupus is the antinuclear antibody. Lupus criteria are also developed by the American College of Rheumatology and the European League Against Rheumatism. Bhairavarasu says that applying these criteria, lupus can be diagnosed based on a person’s blood test, skin rash or kidney biopsy.

Treatment for lupus

The treatment of lupus is highly individualized and depends on the management of the patient, what they have agreed on with their physician and what is safe for them to take.

There are simpler drugs like Plaquenil, or hydroxychloroquine, which has been around since lupus was discovered. Patients also take “steroids” like Prednisone to help alleviate their acute presentation of the disease. Bhairavarasu says that she likes educate her patients and also to refer them to rheumatology.org or thelupusguide.com

“In some cases, we’ll use low-dose chemotherapy medications, and if we see organ involvement or life-threatening involvement, we’ll recommend full-dose chemotherapy medications, but once again, this depends on the symptoms of the patient.”

By Taylor Barnes