Systemic Lupus Erythematosus

Systemic lupus erythematosus (lupus) is a chronic autoimmune disease that causes the body’s immune system to malfunction and attack its own healthy cells and tissues, causing a range of diverse symptoms including rashes, fatigue, pain and fever. It affects each person differently, and often develops slowly, over time.

Lupus can affect various parts of the body, including joints, tendons, skin, blood vessels and organs. The heart, lungs, kidneys and brain are the organs most affected.

The effects of the illness range from mild to severe, and symptoms may come and go. A relapse after a period of remission (when symptoms go away) is known as a flare-up.

Lupus occurs most often in young women in their late teens and adult women under age 45. Lupus also affects more African-Americans, Asian-Americans, Hispanics and Native Americans than Caucasians.

In children, lupus occurs most often in those older than 15. In this population, lupus often attacks the kidneys, which can lead to kidney damage and kidney failure. In some cases, lupus can be fatal.

Experts think lupus may be caused by a mix of genetic and other factors, including exposure to the Epstein-Barr virus, ultraviolet (UV) light and stress.

Lupus has no cure, but medicines and healthy lifestyle choices can help manage symptoms.

Lupus is hard to diagnose because it has so many different symptoms that could have other causes. That’s why it’s important to work with specialists who have advanced training and experience in diagnosing and treating lupus—which is exactly what you’ll find at Cooper’s Division of Rheumatology.

Why Choose Cooper to Diagnose and Treat Lupus

Cooper University Health Care’s Division of Rheumatology has a team of expert, board-certified and fellowship-trained rheumatologists with extensive experience in diagnosing and treating lupus. Our capabilities include:

  • Thorough diagnostic testing: Diagnosing lupus begins with a thorough medical history, physical exam and laboratory tests. These tests may include:
    • Antibody blood tests: The main test for lupus is the antinuclear antibodies (ANA) test
    • Complement test: Measures the level of complement, proteins in the blood that help destroy foreign substances; low levels are often linked with lupus
    • Erythrocyte sedimentation rate (ESR or sed rate): A blood test that can reveal inflammatory activity in the body
    • C-reactive protein (CRP): A protein that’s often present when inflammation is found in the body
    • Urine tests to check for blood or protein in the urine and evaluate kidney function
    • Biopsies to assess damage to the skin or kidneys
  • A multidisciplinary team approach to care: Because lupus can affect so many different organs and body systems, you may need a variety of specialists working together on your care team. As an academic medical center, Cooper has physician experts in more than 75 specialties, giving you convenient access to all the expertise you need, all in one place.
  • Personalized treatment based on your symptoms, age, general health, and how severe your condition is. The goals of lupus treatment include easing symptoms, preventing flare-ups, and preventing damage to your organs and skin.
    • Medications are a key part of lupus treatment, and may include anti-inflammatory, immunosuppressive and anti-malarial drugs, as well as a new class of drugs known as biologics  
  • Access to clinical trials: As an academic medical center with extensive clinical expertise in treating lupus, Cooper is involved in research of new pharmaceutical treatments for this disease. When appropriate, you may be offered the opportunity to participate in a clinical trial, giving you access to novel treatments before they are widely available. 

Lupus Causes and Risk Factors

While no single cause of lupus has been identified, most doctors and scientists think that it’s caused by a combination of genetic and environmental factors. These include:

  • Hormones: Because 9 out of every 10 cases of lupus occur in women, estrogen appears to be a factor
  • Genetics: More than 50 genes associated with lupus have been identified; while they don’t cause the disease, they’re believed to contribute to it
  • Environment: Most researchers think an environmental factor, such as a virus or a chemical, can trigger lupus in a genetically susceptible person.

The risk factors for lupus include:

  • Female gender: Women are more likely to develop lupus
  • Age: Lupus is most often diagnosed in patients between age 15 and 44, when symptoms most often first occur
  • Ethnicity: Lupus is more common, develops at an earlier age and is more severe in people of color than in Caucasians
  • Family history: Family members of people with lupus have a 5 to 13 percent chance of developing the disease
  • Exposure to ultraviolet light: UV rays from the sun or fluorescent light bulbs have been cited as a trigger for lupus
  • Infections: Including colds and viral illnesses, particularly the Epstein-Barr virus
  • Certain sun-sensitizing medications: Drugs that make you more sensitive to the sun, including sulfa drugs and tetracylines, have been linked to lupus
  • Certain antibiotics: Penicillin and similar antibiotic medications have been cited as a trigger for lupus
  • Exhaustion: Can trigger lupus and cause flare-ups
  • Emotional and physical stress: Have also been shown to trigger the disease and cause flare-ups
  • Exposure to silica dust: This compound is often found in agricultural or industrial settings
  • Pregnancy: Lupus symptoms can flare up during pregnancy

Lupus Symptoms

Lupus symptoms can appear in many different areas of the body, and vary from person to person. Symptoms may range from mild to severe, and most patients experience periods of remission (when symptoms go away) and relapse (when symptoms come back, or flare up). Some of the common early symptoms of lupus are:

  • Anemia
  • Butterfly-shaped rash on the nose and cheeks (malar rash)
  • Fatigue
  • Fever
  • Hair loss
  • Loss of appetite
  • Pale, blue or red fingers triggered by cold, stress or illness (a condition called Raynaud's phenomenon)
  • Raised rash on the head, arms, chest or back (discoid rash)
  • Rashes caused by sunlight
  • Sores in the mouth or nose
  • Swollen glands
  • Swollen or painful joints (arthritis)
  • Weight loss

Lupus can range from a mild disease to a life-threatening condition that damages organs as it progresses. Possible complications can include:

  • Swelling in legs and ankles (edema)
  • Inflammation of tissue around the lungs that causes chest pain when breathing (pleurisy)
  • Inflammation of the lining of the heart (pericarditis)
  • Fluid around the lungs, heart or other organs
  • Seizures
  • Kidney failure
  • Miscarriage

Managing Lupus

Because lupus symptoms often come and go, it’s important to know the warning signs that a relapse, or flare-up, is going to happen. Each person’s warning signs can be different and may include fatigue, pain, rash or fever. Knowing your warning signs can help you work with your doctor to adjust your medicine, when necessary.

In addition to taking your medications as directed, it’s important to maintain a healthy lifestyle:

  • Get enough sleep; aim for 8 to 10 hours a night, and take naps and breaks during the day
  • Eat a healthy diet
  • Maintain a healthy weight
  • Exercise at least a few times a week
  • Learn ways to reduce or manage stress
  • Stay out of the sun as much as possible; wear clothes that cover your skin and use sunscreen with an SPF of 15 or higher
  • Treat infections right away
  • Don’t smoke
  • Stay current on your immunizations
  • Get regular checkups and tests

If you’re a woman of childbearing age, talk with your doctor about the risks of pregnancy and lupus. Lupus symptoms can flare up during pregnancy. Pregnancy with lupus is high risk, so you’ll need extra care from your healthcare team.

Children with lupus shouldn’t receive vaccines containing live viruses. These include chickenpox, measles-mumps-rubella (MMR) and oral polio vaccines. Talk with your child’s doctor about all vaccines.

Make an Appointment With a Lupus Expert at Cooper

To learn more about the services available for treating lupus in the Division of Rheumatology or to request an appointment, please call 800.8.COOPER (800.826.6737).