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Ameer MA, Chaudhry H, Mushtaq J, Khan OS, Babar M, Hashim T, Zeb S, Tariq MA, Patlolla SR, Ali J, Hashim SN, Hashim S An Overview of Systemic Lupus Erythematosus (SLE) Pathogenesis, Classification, and Management. Cureus. 2022; 14:(10) https://doi.org/10.7759/cureus.30330

Katarzyna PB, Wiktor S, Ewa D, Piotr L Current treatment of systemic lupus erythematosus: a clinician's perspective. Rheumatol Int. 2023; 43:(8)1395-1407 https://doi.org/10.1007/s00296-023-05306-5

McCarty DJ, Manzi S, Medsger TA, Ramsey-Goldman R, LaPorte RE, Kwoh CK Incidence of systemic lupus erythematosus. Race and gender differences. Arthritis Rheum. 1995; 38:(9)1260-70 https://doi.org/10.1002/art.1780380914

Morgan C, Bland AR, Maker C, Dunnage J, Bruce IN Individuals living with lupus: findings from the LUPUS UK Members Survey 2014. Lupus. 2018; 27:(4)681-687 https://doi.org/10.1177/0961203317749746

NHS. Lupus. 2023. https://www.nhs.uk/conditions/lupus/ (accessed 7 May 2024)

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Yusof MY, Smith EMD, Ainsworth S, Armon K, Beresford MW, Brown M, Cherry L, Edwards CJ, Flora K, Gilman R, Griffiths B, Gordon C, Howard P, Isenberg D, Jordan N, Kaul A, Lanyon P, Laws PM, Lightsone L, Lythgoe H, Mallen CD, Marks SD, Maxwell N, Moraitis E, Nash C, Pepper RJ, Pilkington C, Psarras A, Rostron H, Skeates J, Skeoch S, Tremarias D, Wincup C, Zoma A, Vital EM Management and treatment of children, young people and adults with systemic lupus erythematosus: British Society for Rheumatology guideline scope. Rheumatol Adv Pract. 2023; 7:(3) https://doi.org/10.1093/rap/rkad093

A guide to lupus

02 May 2024
In Practice
02 May 2024
Volume 12 | Journal of Family Health · Issue 4

Abstract

In this article, Amy Noakes looks at lupus – an autoimmune condition that affects around 50 000 people in the UK and is more common in women of childbearing age

Lupus is a chronic condition with a wide range of clinical presentations (NHS, 2023). An autoimmune disease of unknown origin, the exact aetiology of the disease is not understood, but environmental and genetic factors interact to trigger an immune response resulting in excessive production of pathogenic autoantibodies by B cells and cytokine dysregulation (Ameer et al, 2022).

The four main types of lupus are neonatal and paediatric lupus erythematosus (NLE); discoid lupus erythematosus (DLE); drug-induced lupus (DIL); and systemic lupus erythematosus (SLE).

Approximately 50 000 people in the UK currently have lupus. It commonly affects women of childbearing age with a ratio of 9 women to 1 man diagnosed (LUPUS UK, 2024). Lupus is more prevalent in people with African, south Asian and Chinese heritage (McCarty et al, 1995).

Lupus can be difficult to diagnosis due to its multi-organ effect, with no single measure that can confirm diagnosis (Morgan et al, 2018). The condition is diagnosed based on clinical assessment and laboratory findings.

Ordinarily, rheumatology specialist support is required where the assessment of disease activity is measured using a validated tool such as the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and the British Isles Lupus Assessment Group (BILAG) 2004 (Yusof et al, 2023).

» Severe lupus may be treated with immunosuppressants or other drugs used more rarely, such as immunoglobulin and cyclosporin A «

Lupus is cyclical in nature and the symptoms vary in intensity. It can range from mild to severe and can even be fatal. There are lots of possible symptoms but the main ones include (NHS, 2023):

  • Joint and muscle pain
  • Extreme and persistent tiredness
  • Rashes that come on after being in the sun, particularly over the nose and cheeks.

    • Other symptoms include:

  • Headaches
  • Mouth ulcers
  • Fevers
  • Hair loss
  • Weight loss
  • Swollen glands in the neck, armpit or groin
  • Depression
  • Anxiety
  • Chest or stomach pains
  • Raynaud's symptoms (changes to the colour of the fingers when cold or anxious).

    • Treatment for lupus is based on trying to reduce symptoms and achieve a state of remission rather than curative (Katarzyna et al, 2023). Treatment may include:

  • Non-steroidal anti-inflammatory drugs, such as ibuprofen and aspirin
  • Anti-malarial medication, such as hydroxychloroquine for fatigue, skin and joint problems
  • Steroids, such as prednisolone for kidney disease and rashes.

    • Severe lupus may be treated with immunosuppressants such as azathioprine, methotrexate and cyclophosphamide or other drugs used more rarely, such as immunoglobulin and cyclosporin A. For severe skin disease in which pregnancy is not considered, thalidomide may also be used (LUPUS UK, 2023).

    Some self-help strategies aim to reduce the risk of lupus symptoms getting worse, and include (NHS, 2023):

  • Using high-factor (at least 50) sunscreen and sun protection methods such as wearing a hat in the sun
  • Pacing activities to reduce the risk of becoming overly tired
  • Undertaking daily activity
  • Relaxation techniques to reduce any feelings of stress
  • Consuming a balanced diet
  • Engaging with health professionals.

    • Lupus is a global health concern that affects people of all nationalities, races, ethnicities, genders and ages (World Lupus Federation, 2017). It can affect any part of the body, often occurs unpredictably and can have life-changing impact. Health visitors need to have good understanding of lupus so they can help to recognise the signs and symptoms to enable diagnosis and treatment as quickly as possible.