Lupus Erythematosus (cutaneous, systemic): what is it? Is there a cure?

Autoimmune changes can trigger quite different symptoms, depending on each condition. Lupus is one of them. The disease has a low incidence, affecting about 9 people per 100 thousand per year, only in Brazil.

Sometimes it has been present with mild conditions for years, but it can compromise organs and cause several symptoms.

What is lupus?

Lupus Erythematosus, or just Lupus, is a chronic autoimmune disease. This means that, for reasons still unknown, the body produces more antibodies, and they behave abnormally, attacking healthy cells in the body itself.

The disease can trigger manifestations in different regions of the body, causing lesions and inflammations in the skin, kidney, lung, heart, brain and joints, for example.

The course of Lupus is quite variable, and may present mild or asymptomatic conditions for years, or be highly debilitating. In relation to symptoms, in general, it is common to have manifestations such as fever , weight loss, loss of appetite, weakness and discouragement.

But other conditions will depend on the affected organ. For example, joint pain, hypertension, skin blemishes, kidney problems. Remembering that several organs can suffer damage, causing patients to have several secondary problems.

Although there is no cure, it is possible – and indispensable – to treat lupus. For this, anti-inflammatory drugs, topical or injectable medications can be used. This will depend on each frame. But a multidisciplinary medical follow-up can bring significant improvements to the well-being of patients.

According to ICD-10, lupus can be found in the following codes:

  • L93.0 Discoid lupus;
  • L93.1 Subacute cutaneous lupus;
  • M32.1 Disseminated lupus erythematosus (systemic) with involvement of other organs and systems;
  • M32.8 Other forms of disseminated lupus erythematosus (systemic).

What is an autoimmune disease?

Autoimmune disease is when the body’s own defense cells (antibodies) attack healthy cells and tissues. For various reasons, they confuse the proteins in our body as invaders and attack them.

The diagnosis is not always quick. In some cases, it takes years to identify the disease as autoimmune, as soon as the symptoms can be mild and indicate several conditions.

The autoimmune diseases are possibly the result of a number of genetic, hormonal and environmental factors . But it is not known exactly what can trigger an inadequate immune system response.

Lupus is always mentioned when we talk about the main known autoimmune diseases, along with multiple sclerosis, vitiligo , type 1 diabetes , celiac disease, rheumatoid arthritis and others.

What are the types of lupus erythematosus?

Lupus is a disease with a wide range of symptoms and differs in some types. The main two are systemic lupus erythematosus and cutaneous lupus erythematosus. However, there are studies that point to other developments of the disease, also presenting drug-induced lupus as a type.

Systemic lupus erythematosus

When it comes to systemic lupus erythematosus, we are referring to cases in which the disease causes inflammation in various organs of the body, mainly kidneys, lungs and heart. Depending on the affected site, the symptoms will manifest in different ways.

Cutaneous Lupus Erythematosus (Discoid Lupus)

The second type of lupus recognized is cutaneous or discoid. The main symptom, in this case, is the spots on the skin, common in the areas most exposed to the sun, such as face, ears, arms and neck.

Cutaneous lupus, however, has different levels:

  • Acute cutaneous lupus erythematosus (ACLE);
  • Subacute cutaneous lupus erythematosus (LECS);
  • Chronic cutaneous lupus erythematosus (LECC);
  • Deep lupus erythematosus (cutaneous), or lupus panniculitis (LEP).

Acute cutaneous lupus erythematosus

It is at this stage that the lesion commonly known as “butterfly wing” appears. The name is given by the shape of the stain. Also called malar erythema, this reddish lesion is present in the region of the patient’s cheekbones or on the back of the nose, but it can also spread to other areas of the body.

It is not common for it to appear between the joints. When it spreads, it affects the surfaces of the arms and hands. Among the areas susceptible to the appearance of these spots are also the area of ​​the neck and the neck (V-neck).

Excessive and unprotected exposure to the sun is one of the factors that precede this type of lupus. However, their stay is less prolonged. Some people have only a few hours or days of symptoms of this type of lupus, which usually leaves no skin spots or scars.

Subacute cutaneous lupus erythematosus

Lesions of this type of lupus occur, predominantly, in the frequently exposed regions of the body, such as the face, arms, neck and neck. Like acute cutaneous lupus erythematosus, subacute lupus also leaves no scars.

Lesions are generally more sensitive to light, making patients need to avoid exposure to the sun or too much light. In addition, the duration of symptoms tends to be longer and its evolution can cause white spots on the skin, similar to vitiligo.

Chronic cutaneous lupus erythematosus

The manifestations of this type of lupus are more aggressive than the previous types. In its chronic form, also called discoid lupus, LECC causes, initially, red spots and some lesions similar to pimples and red plaques appear in the affected area.

In addition to the appearance in the face region, these lesions are also frequent on the scalp, ears, on the neck region (“V” neckline) and on the arms.

In 60% of patients with chronic cutaneous lupus erythematosus, lesions that affect the scalp result in areas with permanent hair loss. These rashes, initially red, quickly evolve into a dry lesion, leaving the skin rough and scaly.

A more red pigmentation is common at the edge of the lesion and, in the center, a lighter tone. The worsening of these lesions can leave scars in the affected area. It is also possible for these rashes to appear on the mucous membranes (mouth, nose, genitals and eyelids). There are studies that believe that the evolution of this condition can develop systemic lupus.

Deep lupus erythematosus (cutaneous) or lupus panniculitis

This type of lupus is a more unusual form of chronic cutaneous lupus. The lesions are deeper, reddish, with atrophy and depression in the skin. They can reach the subcutaneous cell tissue (adipose panicle), the deepest layer of the skin, below the dermis.

Drug-induced lupus

The development of drug-induced lupus appears as a temporary inflammation. This type, in particular, disappears when the patient leaves aside the use of the medication that causes inflammation and the imbalance in the behavior of the antibodies.

What are the causes of the disease?

The cause of lupus is still unknown, but some factors may be involved in the processes of immune abnormality, namely:

  • Hormonal;
  • Infectious;
  • Genetics;
  • Environmental.

That is, genetic aspects, added to environmental exposures or infections may be involved in the manifestation of the disease. In addition, external causers can facilitate the disease. Are they:

  • Exposure to excessive sunlight or at inappropriate times;
  • Infections;
  • Use of medicines.

Is lupus a contagious disease?

Lupus is not a contagious disease . A common question among people regarding this disease is about the possibility of contamination, but it does not. The causes of lupus, as discussed, are still unknown and its development is understood by the sum of genetic, hormonal and external factors.

Groups of risk

The group of people who are most susceptible to the development of lupus and care for symptoms are women aged 15 to 45 years. Pregnant women are also part of the risk group. This happens for a few reasons.

Women between 15 and 45 years old

Young women are among the most affected by the disease. This is because it is at this time that hormones are most active and their production is intense.

This production is related to estrogen (female hormone), which unlike testosterone (male hormone), has a high production of antibodies.

For women who suffer from the disease, what happens is an excess of the production of antibodies, which respond to this imbalance by attacking healthy cells. Until the diagnosis of lupus is made by the doctor in charge (the rheumatologist), the body presents the symptoms of autoimmune disease in different ways for each patient.

Pregnancy

There is also a greater concern with lupus women who are pregnant or are looking for a pregnancy. What happens is not a difficulty for women to become pregnant, but a difficult pregnancy that requires a lot of care and prenatal follow-up accompanied by specialists.

For some doctors, there is a consensus that patients in this setting should not, cannot and do not become pregnant due to an immunological issue. The argument raised is related to a specific type of antibodies produced by some women, called phospholipids.

This is a substance with radical phosphorus of the fatty type located in the circulation. The presence of phospholipids for pregnant women is dangerous at this time as this is a substance responsible for the incidence of abortions.

Women with SLE who have antiphospholipid syndrome (antiphospholipid antibodies), that is, when the immune system attacks healthy blood proteins, are at a greater risk of losing pregnancy. Therefore, they may need to use anticoagulants throughout the pregnancy.

One of the points that causes great concern by the medical community in cases of pregnancy in women with lupus is the fact of the formation of clots in various parts of the body. This results in the formation of thrombi (coagulation) in the brain. Not all patients have this complication and, in these cases, the possibility of having a normal and risk-free pregnancy is greater.

The idea is that the disease will be completely inactive for at least six months. Some medications for the control of the disease and symptoms will be suspended and for that, medical monitoring is necessary.

With the exception of a few special cases, babies of women with lupus are born healthy. However, there is a risk of miscarriage, premature birth or the child being born below the ideal weight.

Body: which areas are most affected?

Some areas of our body are most affected by lupus according to the types of the disease. Parts that have greater sun exposure  are more likely to manifest symptoms such as blemishes on the face, ears, neck, neck and arms. These parts of the patient’s body usually manifest symptoms of cutaneous lupus.

When related to systemic lupus, the most affected areas tend to be the internal organs, such as the kidneys  and the heart . They are affected by infections in the pleura and pericardium, symptoms of this case.

It is also common, in more than 90% of cases of people who have lupus, at some point, to experience pain and swelling in the joints , such as the feet, hands, knees and wrists.

Symptoms: what are the manifestations of lupus?

There are several symptoms of lupus. They are manifested at different levels and not always the same in all diagnosed patients.

In addition, in some cases, it can take a long time between the appearance of one symptom and another. For other people, the symptoms can arise as major complications and even be lethal.

Some symptoms are referred to as more general symptoms. They are also common symptoms in other diseases and therefore make it difficult to diagnose lupus quickly and accurately.

Most common symptoms

  • Skin spots (usually on the face, neck, neck and arms);
  • Fever;
  • Weight loss;
  • Lack of appetite;
  • Itches;
  • Discouragement;
  • Weakness;
  • Loss of hair;
  • Joint pain;
  • Inflammation in the kidneys;
  • Inflammation of the pleura and pericardium (membrane that lines the lung and heart);
  • Mouth sores;
  • Headaches;
  • Difficulty breathing;
  • Photosensitivity;
  • Poor circulation in the hands and feet.

Less frequent symptoms

  • Convulsions;
  • Anemia;
  • Dizziness;
  • Emergence of lymph nodes or lymph nodes (“lumps”, common in the region of the armpit, neck and groin);
  • Neuro-psychiatric disorders.

Neuro-psychiatric disorders are more rare manifestations in people with lupus. They can be the cause of seizures , one of the symptoms present in more severe cases. In addition, changes in mood, depression and anxiety may be present as aggravating factors.

When the lesions caused by the disease affect the internal organs, problems such as arrhythmia – when the heart has abnormal beats – can arise. In addition, problems in the digestive system, such as vomiting, nausea and discomfort in the abdomen region, can also be symptoms, although not as frequent.

Is lupus cancer?

Lupus is not a type of cancer . Being a chronic autoimmune inflammatory disease, it differs from what cancer causes and manifests in the body.

In cancer, what happens is a disorderly growth of malignant cells that invade organs and tissues of the body, which can spread to other regions, which is called metastasis. In the case of lupus, what happens is a dysfunction in the production of antibodies and their reaction in our body.

How is lupus diagnosed?

The diagnosis of lupus can be difficult due to the amplitude of the symptoms and the various diagnostic possibilities they offer, as it behaves differently in people who suffer from the disease. However, some criteria are taken into account.

In 1971, the American Society of Rheumatology met 11 criteria for diagnosing the disease. As women are among the most affected, after fulfilling four out of eleven criteria, it is safe to say that she has lupus, according to this diagnostic system.

There is still no exclusive exam for the diagnosis of lupus, but the ANA (antinuclear factor or antibody), along with the symptoms, is an exam that allows the diagnosis with more precision.

The eleven criteria

  1. Mouth ulcers;
  2. Mucositis (inflammatory lesion);
  3. Lesions on the skin, known as “butterfly wing”;
  4. Photosensitivity;
  5. Joint pain;
  6. Kidney injuries;
  7. Brain injury (seizures);
  8. Hemolytic anemia (when the immune system identifies red blood cells as foreign bodies);
  9. Immunological criteria;
  10. Inflammation in the pleura and pericardium (membranes that surround the lung and the heart, respectively);
  11. Antinucleus factor – antibodies, in patients with lupus, attack the cell nucleus.

Nuclear Factor or Antibody (FAN)

This test is widely used to detect autoimmune diseases. It is performed in the laboratory from a  patient’s blood sample . To find out if someone has an autoimmune disease, a fluorescent dye is used to mark the types of antibodies. This collected blood is mixed with a cell culture.

Cell culture is the name given to the laboratory process responsible for controlling temperature, humidity and other factors of survival of cells – animals or plants – of living tissues. It is a kind of artificial creation of cells. As the name suggests, it is a cultivation of these cells by laboratory means.

If there are antibodies that attack human cell structures, the test will show the migration towards cell culture. These antibodies become fixed and become fluorescent.

When antibodies attack the cell nucleus, the sample reveals cells with fluorescent nuclei. If cytoplasms are attacked, this change also happens.

It is not an immediate examination. It is only considered positive after approximately 40 dilutions and worrying after 160 dilutions. To give you an idea, there are more than 20 types of immunofluorescence.

In the case of lupus, as the cell nucleus is the most affected during active disease, this factor needs to be taken into account, but it depends a lot on the correct interpretation of the results and the evaluation of the symptoms.

Measuring anti-Sm and anti-DNA

In addition to the ANF, other tests make it possible to diagnose lupus. They are very specific and have the function of detecting some types of antibodies present in the patient. Some of the antibodies are anti-Sm and anti-DNA.

Anti-Sm and anti-DNA antibodies are generally present in between 40% to 50% of people with lupus. The anti-DNA also acts as a thermometer of the disease stage in the patient. Performing these tests, among other precautions, helps to identify whether the disease is active or under control.

Does lupus have a cure?

Lupus is still a disease that has no cure . It goes through periods of activity and remission, that is, the person who has lupus can go years without any of the symptoms, but the medical monitoring and treatment must be continuous.

The absence of symptoms, therefore, does not mean the cure of the disease, but a control or inactivity. Therefore, it is considered a chronic autoimmune disease.

What is the treatment?

The treatment for lupus is continuous and always requires medical follow-up, as there is still no cure for the disease. Its role is to alleviate symptoms and enable a good quality of life for people diagnosed in this setting.

This is a very unique disease, as its symptoms are not a pattern for everyone, not even the periodicity in which they appear. In the face of treatment, it behaves the same way. In people where the disease has manifested itself more severely, treatment will also require greater rigor.

In addition to medications, there are some ways for the patient to relieve symptoms, such as changes in habits and diet. Understand:

Drug treatment

Medication treatment, within other possibilities, will be present in the lives of all diagnosed patients. To alleviate symptoms and leave the disease in a state of remission, rheumatologists should recommend the use of specific medications.

Antimalarial drugs, for example, help prevent the disease, leaving it inactive. For acute inflammatory phases, the use of corticosteroids is recommended. In the initial phase, the use of anti-inflammatory drugs is recurrent and, for skin lesions, the use of corticosteroids in ointment.

It is possible that doctors may also prescribe immunosuppressants. The goal is to reduce the activity of the immune system, decreasing the damage done to the patient’s body. Remembering that only the doctor, after diagnosis and monitoring of the symptoms, will know which will be the appropriate medication and the time of use of each one of them.

Change of habits

Leading a healthier life is always a positive factor in the fight against any disease. Lupus patients are no different.

In addition to the monitoring of doctors and drug treatments, it is possible to lead a more comfortable life with some simple habits. The use of sunscreen, quitting smoking , avoiding exposure to the sun at unspecified times, practicing physical activities when the disease is inactive and maintaining a balanced diet are some of them.

Transplant

Transplants may be necessary in the most severe cases, for example, in kidney injuries that have had complications. A well-known example in this case is that of singer Selena Gomez, who had to undergo the surgical procedure.

Support groups

Some symptoms of lupus affect people psychologically, such as in cases where patients experience depression and anxiety. Some doctors recommend the patient’s participation in support groups, as a form of treatment accompanied by medication and rest.

Lupus Medications

There are some remedies used to treat lupus with the function of inhibiting the disease and treating symptoms, such as skin blemishes and other inflammations caused. It is common among doctors to indicate anti-inflammatory, antimalarial, corticosteroids and immunosuppressants.

Some examples are:

  • Naproxen ;
  • Ibuprofen ;
  • Prednisone ;
  • Betamethasone;
  • Azathioprine ;
  • Hydroxychloroquine ;
  • Methotrexate ;
  • Chloroquine diphosphate .

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living together

As it is a chronic disease, the person who is diagnosed with lupus will have to live with some care and adopt a different routine.

However, with the disease inactive, the lupus person must lead a normal life, just like any other person. It is important to understand that some special care will be necessary, but that life should go on normally when everything is under control.

Sun care

For sun care, the use of some accessories is a good tip to enhance the task already performed by sunscreen, such as hats and parasols. Taking special care in the most exposed areas (face, neck, neck and arms) and avoiding inappropriate sun exposure times are essential.

Periodic visits to the doctor

Consultations are usually scheduled every 3 to 6 months, varying according to the severity of the cases. It is important not to leave the doctor’s office with doubts. This will make a difference when searching for remission of lupus.

Healthier habits

It is important to stay healthy, physically and mentally. Seek pleasurable activities, enjoy the company of people who do well and adopt the aforementioned care.

Food is also an extremely important factor. Try healthy dishes with fresh ingredients. Maybe even venture into the kitchen?

food

Some foods are more suitable for those who suffer from this autoimmune disease due to its anti-inflammatory properties. Among the foods that the patient should add to the diet are:

  • Fish (rich in omega 3): salmon, tuna, cod, herring, sardines, trout;
  • Antioxidant foods: green tea, garlic, oats, onions, broccoli, cauliflower, cabbage, flaxseed;
  • Alkalizing foods (regulate blood acidity): avocado, lemon, lettuce, cucumber, turnip, tomato, onion.

Can lupus cause complications?

Lupus can have many complications, depending on the stage of the disease and the lack of treatment. The symptoms themselves can be aggressive and change the routine of those affected.

Because it causes inflammation in various parts of the body, complications such as:

Lung damage

Lupus can cause lung damage, causing shortness of breath and weakening the muscles of the diaphragm.

Kidney damage or nephritis

Nephritis is an inflammation that prevents the filter of toxins and waste in the blood. Swelling, high blood pressure and blood in the urine are some of the consequences that can occur within this complication.

Other autoimmune diseases

Lupus can increase the chances of other autoimmune diseases, such as Hashimoto ‘s thyroiditis, which affects metabolism, changes hormone levels, weight, menstrual cycle, skin, among other symptoms.

Heart diseases

This type of complication is more rare and long-term. The heart, blood vessels and tissues that protect the organ can be damaged.

Brain and spinal cord

In some cases, connective and nervous tissue can be compromised. It is at this stage that problems such as mood swings and seizures can occur.

How to prevent lupus?

Lupus does not have an exact form of prevention , but adopting some habits can help to alleviate symptoms and prevent attacks. It works like a balance: the balance of a healthier life can counter the “imbalance” caused by antibodies. Some tips are:

  • Avoid exposing yourself to the sun without protection, especially at inappropriate times. This minimum care assists in the control of symptoms and prevents other skin diseases;
  • Look for some physical exercise that gives you pleasure. For many people, physical exercise is an unpleasant obligation, so find out what activity will keep you motivated. Walking, weight training, swimming or any sport, the important thing is to stay active and happy;
  • Fruits, vegetables and grains are essential in the diet of those seeking control or prevention of lupus. Follow the doctor’s recommendations and explore new dishes. Being healthy is also tasty;
  • For patients with or without lupus, smoking should be avoided. Respiratory complications and other ills arising from this habit can arise;
  • Maintain a routine of examinations and visits to the doctor. As busy as our day to day is, stopping to know if everything is fine with our organism is extremely necessary.
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