As of Tuesday, October 15, 2013
DEAR DOCTOR K: I saw my doctor for a rash on my face. After further tests, she diagnosed me with lupus. What is this? What is the treatment?
DEAR READER: Lupus is an autoimmune disease. Your body's immune system mistakenly attacks your body's own tissues rather than protecting them from outside invaders.
Immune proteins called autoantibodies attack many different parts of the body. This can lead to inflammation and tissue damage in the joints, skin, kidney, nervous system (brain, spinal cord and nerves), blood, heart, lungs, digestive system and eyes.
The cause of lupus remains a mystery. Some researchers think it may be triggered by an infection in people who are susceptible to the disease, but no particular type of infection has been discovered to be the cause.
In some people, lupus causes only mild illness. But in others it leads to potentially deadly complications.
Lupus can cause a wide range of symptoms throughout the body including:
-- malaise (a general sick feeling);
-- loss of appetite;
-- weight loss;
-- muscle and joint pain and swelling;
-- a butterfly-shaped rash on the cheeks and bridge of the nose;
-- a more widespread rash and flu-like symptoms after exposure to sunlight;
-- hair loss;
-- a rash that appears as firm, round red plaques with raised borders;
-- painful ulcers in the mouth, nose and genital areas.
Other possible symptoms include:
-- Neurological symptoms, such as difficulty with memory and concentration, seizures and confusion;
-- Psychiatric symptoms, including the most dramatic psychiatric illness -- psychosis -- or a loss of contact with reality;
-- Heart problems: chest pain caused by increased rates of atherosclerosis and inflammation of the outer lining of the heart;
-- Lung symptoms: pain on taking in a deep breath, shortness of breath;
-- Loss of vision.
Symptoms tend to come and go. Periods of intensified symptoms are called flare-ups. Periods when symptoms disappear are called remissions. You can help prevent flare-ups by limiting sun exposure and using sunscreen when you are in the sun.
Many different types of medications may be used to treat lupus. Doctors usually try antimalarial drugs first. Recent studies suggest that lupus patients treated with antimalarial medications have less active disease and less organ damage over time.
Other drug treatment options include:
-- nonsteroidal anti-inflammatory drugs (NSAIDS)
-- immunosuppressive drugs
Lupus is a long-lasting condition. Life expectancy and quality of life can vary widely depending on the severity of your illness. Fortunately, new treatments in recent years have helped to control the disease in many people.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.