Systemic Lupus Erythematosus

Overview

Lupus is a multisystem autoimmune condition in which the immune system produces autoantibodies that attack healthy tissue, causing inflammation and damage. It most commonly affects women of childbearing age, with higher prevalence and severity in certain ethnic groups. Clinical presentations vary widely, from mild skin and joint involvement to life-threatening nephritis, cytopenias, or neuropsychiatric disease. Accurate diagnosis requires correlation of clinical features with autoantibody testing (ANA, anti-dsDNA, complement levels). Hydroxychloroquine is a cornerstone of treatment, and immunosuppressive or biologic therapy is used for organ-threatening disease. Dr. Shree Narayan Yadav (NMC 14227) provides comprehensive lupus evaluation and coordination with relevant specialties.

Symptoms

• Joint pain and swelling, often without erosion
• Facial rash across the cheeks and nose (malar rash)
• Photosensitive skin rashes
• Mouth or nose ulcers, often painless
• Fatigue, fever, and weight loss
• Hair loss (alopecia)
• Raynaud's phenomenon (fingers turning white or blue with cold)
• Swelling around the eyes or legs (edema) if kidneys are involved

Causes

• Autoimmune dysregulation with production of anti-nuclear and other autoantibodies
• Genetic predisposition involving multiple immune-related genes
• Environmental triggers including ultraviolet light, infections, and certain medications

Risk factors

• Female sex, especially during reproductive years
• Ethnicity with higher prevalence in South Asian, African, and Hispanic populations
• Family history of lupus or other autoimmune diseases
• Exposure to ultraviolet light, smoking, or silica dust
• Certain medications (drug-induced lupus, e.g., hydralazine, procainamide)

Diagnosis

Diagnosis is based on clinical evidence of multi-system involvement combined with autoantibody testing. A positive ANA is highly sensitive but not specific. Anti-dsDNA and anti-Sm antibodies are more specific. Complement levels (C3, C4) may be low during active disease. Organ-specific evaluation includes urinalysis and renal biopsy for nephritis, complete blood count for cytopenias, and imaging or testing for organ involvement as indicated.

Treatment & management

Hydroxychloroquine is recommended for nearly all lupus patients unless contraindicated. Skin and joint disease may respond to NSAIDs, low-dose corticosteroids, and methotrexate or mycophenolate. Organ-threatening disease (nephritis, severe cytopenias, neuropsychiatric lupus) requires stronger immunosuppression with cyclophosphamide, mycophenolate mofetil, or rituximab. Belimumab, an anti-BLyS biologic, is approved for active lupus. Sun protection and cardiovascular risk management are important adjuncts.

Management is individualized and discussed with benefits, limitations, and follow-up.

Prevention & self-care

There is no proven prevention for lupus. Sun protection, smoking cessation, maintaining a healthy weight, minimizing medication exposure that may trigger drug-induced lupus, and regular monitoring for organ involvement support long-term management.

When to seek medical attention

• New facial rash, mouth ulcers, or photosensitive skin changes
• Joint pain with swelling, especially in multiple joints
• Unexplained fever, fatigue, or weight loss
• Foamy urine, blood in urine, or leg swelling suggesting kidney involvement
• New neurological symptoms such as seizures, confusion, or severe headaches
• Existing lupus treatment not controlling symptoms or new organ involvement

Frequently asked questions