Systemic lupus erythematosus (SLE) is an autoimmune disease that can cause damage to the heart, lungs, kidneys, joints, skin, brain, and blood vessels. It is characterized by flare-ups, and symptoms, ranging from mild to severe, including extreme fatigue, chest pain, anemia, swelling in legs and near the eyes, painful joints, fever, skin rashes, hair loss, and kidney problems.
At least 1.5 million Americans suffer from lupus. The ratio of female to male is 9:1 according to the Lupus Foundation of America. African-American women are far more likely to be affected than are Caucasian women. Recent research points to a strong genetic role, but environmental and hormonal factors seem to be involved in lupus as well.
Diagnosis can be difficult and may be delayed because the onset of symptoms is hard for patients to pinpoint and because the wide variety of symptoms overlap with many other conditions. To diagnose lupus, the clinician takes a careful history, performs a physical exam, and orders anti-nuclear antibodies and other laboratory tests.
Although lupus can be life-threatening, some 80 to 90 percent of sufferers can expect to live a normal lifespan if they are carefully monitored and treated.
Management of lupus is directed at preventing flare-ups, treating symptoms, and preventing or slowing damage to organs. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the principal medications include:
- NSAIDs to reduce inflammation.
- Anti-malarials such as hydroxychloroquine (Plaquenil®) to prevent flare-ups.
- Corticosteroids such as prednisone (Deltasone®), hydrocortisone, methylprednisolone (Medrol®), and dexamethasone (Decadron®, Hexadrol®) to reduce inflammation.
- Immunosuppressive agents such as cyclophosphamide (Cytoxan®) and mycophenolate mofetil (CellCept®) to inhibit an overactive immune system. Belimumab (Benlysta®) is a B-lymphocyte stimulator protein inhibitor that was approved by FDA 2011 for patients with lupus who are receiving other standard therapies. It may reduce the number of abnormal B cells thought to be a problem in lupus.
- Methotrexate (Folex®, Mexate®, Rheumatrex®), a disease-modifying antirheumatic drug, may be used to help control the disease in some patients.
Other treatments may include hormonal therapies such as dehydroepiandrosterone (DHEA) and intravenous immunoglobulin, which may be useful for controlling lupus when other treatments haven’t worked.
A variety of self-care and complementary approaches can be useful, including exercise, diet, the avoidance of sun exposure, and skin protection. Patients are advised to recognize early signs of a flare-up and get immediate medical attention.
Findings from prospective human studies have strengthened the evidence of a connection between lupus and vitamin D status. There is evidence that increased vitamin D levels (via supplementation) may help reduce inflammation. A reasonable dose would be 2000 IU of vitamin D3 on a daily basis. Vitamin D levels are easily checked.