|This leaflet is devoted mainly to systemic (or disseminated) lupus erythematosus , the most common form of lupus. The term “lupus” will be used in this document to more simply designate this disease. There are other forms of lupus, including discoid lupus erythematosus (which can progress to systemic lupus), drug lupus, and neonatal lupus.|
The Lupus is a chronic autoimmune which occurs when the immune system attacks the body’s cells and destroys them. It can affect many parts of the body, including joints, skin, kidneys, heart, etc. This is the reason why we talk about systemic or “systemic” lupus . Lupus can cause symptoms as different as unexplained outbreaks of fever, joint pain and swelling, blurred vision, and more
The Lupus primarily affects women of childbearing age, 15 to 40 years. The symptoms of the disease and their severity are very variable from person to person.
Cause of Lupus
In lupus , for reasons that are still unknown – perhaps a combination of environmental, hormonal and genetic factors – the body makes antibodies that attack its own healthy tissues. The immune system is a complex network of organs, tissues, cells and circulating factors in the blood. Usually, it protects the individual against diseases. These autoimmune reactions can be very harmful for the body and cause important inflammatory reactions.
Lupus is characterized by alternating periods of relapses (with symptoms) and periods of remission . During outbreaks, the disease is exacerbated: the symptoms worsen and blood tests reveal the presence of abnormal antibodies, which attack the body. Then, the symptoms diminish little by little and disappear totally or partially. Remission periods can last weeks, months, and even years. Although it is a chronic disease, most people with lupus will not be sick continually throughout their lives.
Stress, overwork, sun exposure and getting pregnant or giving birth can trigger lupus through a mechanism that is still unknown (which does not mean that these factors are the cause). In addition, some medications used to treat another disease can trigger lupus symptoms. We then speak of medical lupus. Symptoms usually go away when the person stops taking the medication.Finally, recently, several studies have linked the Epstein-Barr virus to the onset of autoimmune diseases, including lupus . This virus is extremely common since infects 95% of the population, could trigger lupus in some people predisposed.
The prevalence of lupus is difficult to estimate. According to Lupus Canada, nearly 50,000 Canadians suffer from some form of lupus while Statistics Canada estimates that about 15,000 Canadians have systemic lupus erythematosus. In Quebec, researchers estimated that about 4,000 people had systemic lupus erythematosus, but this number may be lower than the reality. In France, an estimated prevalence to 40 cases per 100 000 population.
The symptoms of lupus
The symptoms vary a lot from one person to another, since the disease can affect just about every organ and tissue in the body. Usually, the disease manifests itself in some of the following symptoms, which can appear suddenly or gradually.
- A tiredness extreme.
- Unexplained and continuous weight loss or weight gain due to fluid retention
- Unexplained fever outbreaks
- The nodes swollen.
- Pain (arthralgia), stiffness and swelling of the joints . These are the most common manifestations of lupus.
- A red plaque on the top of the cheeks and at the root of the nose in the form of butterfly wings.
- High sensitivity to the sun , which is manifested by red rashes that occur on sun-exposed skin areas, including the hands, chest, elbows.
- Embossed, “crusted”, disc-shaped plaques can appear on the face, scalp and chest. They are characteristic of cutaneous or discoid lupus, which affects only the skin .
- Painless small sores (ulcers) in the mouth or nostrils.
- Chest pain during deep breaths, and sometimes coughing and difficulty breathing due to lungdamage .
- Swelling of the legs ( edema ).
- If the disease affects the heart , it can cause arrhythmia and more rarely heart failure.
- A depressed state , difficulty in having clear ideas and memory problems.
- Muscular pain .
- A hair loss .
- Disturbances in vision and dry eyes.
- In case of cold or stress: fingers and toes turn blue or pale easily. We are talking about Raynaud’s disease.
- The hives .
- Of headaches , seizures.
- The formation of blood clots in the blood vessels ( thrombosis ).
- Kidney damage , which does not appear at first by any symptoms. It can be detected inter alia by regular urine tests.
- Anemia, that is to say a decrease in the number of red blood cells or hemoglobin in the blood.
- Susceptibility to infections due to immune system involvement.
NB Certain forms of lupus (discoid lupus, subcutaneous lupus erythematous skin) are limited to skinrashes and sensitivity to the sun .
People at risk for Lupus
- Women aged 15 to 40 years old. In this age group, lupus affects approximately 9 times more womenthan men. This finding suggests that female hormones play an important role in the development of lupus. Even outside this age group, women are affected more frequently than men.
- People who have a family member with lupus have a slightly increased risk of developing lupus.
- Lupus is more common in some ethnic groups, including African Americans, North American Aboriginals and Asians, probably because of greater genetic susceptibility to the disease.
Some medications taken over long periods can trigger lupus medications, and researchers believe that exposure to certain substances, such as pesticides , mercury or silica , also increases the risk of developing lupus. Furthermore, several studies have shown that current or former smoking was associated with an increased risk of lupus.
Prevention of lupus
|How to prevent|
|Since the exact cause of lupus remains unknown, it is impossible to prevent it.|
|Measures to prevent outbreak and exacerbation of symptoms|
| Protect yourself from the sun . Ultraviolet rays can trigger a flare-up or aggravate the symptoms present. Exposure to the sun causes the death of many skin cells, which “release” their contents, triggering a strong reaction of the immune system. Wear clothing that covers the skin, a hat and sunglasses when you are outdoors. On directly exposed skin, use sunscreen. It goes without saying that it is better to avoid the sun when it is at its zenith, that is to say from 11 am to 16 pm.
Consult your doctor before taking any medicine. Do not take over-the-counter medications without your doctor’s recommendations. Some medicines can increase the sensitivity of the skin to the sun. This is also the case of prescription drugs, especially certain antibiotics. Also avoid products (including natural products) that stimulate the immune system .
For many years, doctors thought that the contraceptive pill increased the number of relapses in women with lupus. However, several recent studies show that most of them can benefit from oral contraceptives without increased risk . Pills that contain low doses of estrogen or progesterone alone are often preferred because estrogens are likely to increase the activity of the disease. As for the hormonal treatment of menopause, it could increase the risk of thrust and should be used very cautiously in people with lupus. Talk to your doctor.
Practice a relaxation technique . If we consider that stress can amplify the symptoms of lupus, we understand the importance of good stress management as a preventive measure. Studies have shown the utility of stress management programs to reduce pain and improve the psychological state of lupus patients. It’s all about choosing a technique that you like. You can consult, among others, the cards Meditation, Relaxation Response, Autogenic Training and Biofeedback.
Be sure to sleep well. The US National Institutes of Health recommends sleeping nights of at least 8 to 10 hours to help minimize lupus pain . Indeed, the first weapon against joint pain would simply be rest. There are several techniques to help relax and promote sleep (breathing exercises, mental relaxation techniques, visualization, meditation, etc.).
Adopt a balanced diet . Some people have noticed that a poor diet contributes to triggering outbreaks. .
Stop smoking . While smoking is bad for your health, people with lupus have extra reasons to quit smoking. First, the activity of the disease is greater in smokers than in non-smokers. Then the smoking increases the risk of developing cardiovascular disease such as heart attack or stroke . However, people with lupus are already particularly susceptible to cardiovascular disease. It is estimated that cardiovascular risk is 50 times higher in young women with lupus than in the rest of the population. We put all the odds on his side by not smoking, the link between smoking and cardiovascular disorders being well demonstrated.
Exercise regularly . In addition to improving well-being, regular exercise prevents symptoms. Apart from painful outbursts, vary the forms of exercise to get the most benefit: stretching to relieve joint stiffness; weights to maintain muscle strength; and an endurance sport (brisk walking, swimming, cycling) to restore energy and improve cardiovascular health. See our Fitness file.
Protect your joints . Read the Arthritis (overview) sheet for preventive pain relief tips that are equally appropriate for people with lupus .
Look for social support . Talk about what you live with your loved ones or people who also live with lupus. This often leads to a better attitude to the disease and keeps abreast of new treatments. The social fabric can be very useful when it comes to restoring energy reserves and improving one’s well-being.
Plan your pregnancy well . Women with lupus must choose the time of pregnancy (after a period of 6 months remission ideally) and get close medical supervision during it. Lupus increases the risk of miscarriage and premature birth. It is also known that symptoms tend to reappear in pregnant women.
|Measures to prevent complications|
|Measure your blood pressure every 3 months. Kidney problems sometimes manifest as increased blood pressure. Regular blood and urine tests will also help to ensure that the kidneys are functioning properly or to detect kidney damage early.
In addition, consult your doctor quickly in case of fever . The drugs used to treat lupus may indeed increase the risk of infection.
Medical treatment of lupus
The research has made great progress in treating the symptoms of lupus . However, there is no definitive cure for this disease. Medications improve the quality of life by decreasing the intensity of symptoms, reducing the risk of complications and prolonging life expectancy.
Ideally, lupus should be treated with as little medication as possible and for the shortest time to relieve relapses. Some people do not need any medicine, others use it only for the sake of it or for short periods of time, but many need treatment for a long time.
Drugs against pain (nonsteroidal anti-inflammatory drugs). Acetaminophen (Tylenol, Atosol) and anti-inflammatory counter (ibuprofen, Advil or Motrin) can be used to soothe aching joints when lupus is not too serious or outbreaks are not too intense. However, doctors advise against people with more severe lupus to take over-the-counter pain medications on their own. These medications may actually increase the risk of lupus complications, especially kidney damage. It may take some time to find the right anti-inflammatory and adjust the dose with the doctor.
Corticosteroids. Corticosteroids, especially prednisone and methylprednisone, are the most effective anti-inflammatory drugs for treating lupus when the disease affects several organs . Used since the early 1960s against lupus, prednisone (Deltasone, Orasone) has quickly become an essential drug to improve the quality of life of patients. It helps to reduce inflammation and control symptoms, especially in case of an outbreak. However, corticosteroids taken in high doses or over a long period can cause a range of side effects including bruising, mood swings, diabetes , vision problems (cataracts), increased blood pressure and bone fragility (osteoporosis). The dose is finely adjusted with the doctor so as to obtain the least possible side effects. In the short term, the main side effects of corticosteroids are weight gain and swelling of the face and body (edema). The use of calcium and vitamin D supplements helps reduce the risk of osteoporosis.
Creams and local treatments. The rashes are sometimes treated with creams, most often with corticosteroids.
Anti-malarial drugs . Hydroxychloroquine (Plaquenil) and chloroquine (Aralen) – medicines also used to treat malaria – are effective in treating lupus when nonsteroidal anti-inflammatory drugs are not enough. They reduce pain and swelling of the joints and help treat rashes. Either of these medications can be taken from spring to fall to prevent the onset of sun damage . Hydroxychloroquine is also used as a DMARD to prevent relapse. The main side effects of these medications are stomach pain and nausea.
Immunosuppressants . Immunosuppressive agents reduce the activity of the immune system against its own organs and tissues. These powerful drugs are used in a small proportion of people, when prednisone does not help to reduce symptoms or when it causes too many side effects. They are needed when lupus affects the functioning of the kidneys or the nervous system. The most commonly used are cyclophosphamide (Cytoxan), azathioprine (Imuran) and mycophenolate mofetil (Cellcept). In some patients, methotrexate (Folex, Rheumatrex) can also be used at a low dose as a background treatment. These medications also have their share of adverse effects, the most important of which are greater susceptibility to infections and a higher risk of developing cancer. A new drug, Belimumab (Benlysta) may be effective in some cases of lupus; its possible side effects are nausea, diarrhea and fever .
Immunoglobulin infusions . Immunoglobulin preparations (antibodies) are obtained from donor blood. Administered intravenously, they have an anti-inflammatory action since they partially neutralize the autoantibodies, that is to say the abnormal antibodies that turn against the body and are involved in lupus . Immunoglobulin infusions are reserved for lupus cases that are resistant to other treatments, such as corticosteroids.