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Every day in the world of 5 million people, they struggle with the consequences of having lupus. A life-threatening autoimmune disease, capable of damaging virtually any part of the body including the skin, heart, lungs, kidneys and brain.   Out of 10 patients with this disease, 9 are women, and although the highest prevalence occurs in the third and fourth decade of life, children and older adults

What is it?
Lupus is a chronic and systemic rheumatic autoimmune disease, which in addition to affecting joints and muscles, can damage the skin and almost all organs. As an autoimmune disease, it is caused by the formation of antibodies and cells directed against their own components. The evolution of the disease is characterized by stages of outbreak and others in which the effects of the disease refer. Lupus is so heterogeneous or variable that it occurs in forms not as serious as some manifestations in the skin and sometimes in very severe forms with organ / s lesion. This disease mainly affects women and at a time of life in which it is fertile (between 20 and 40 years). Cases have also been reported in children and older adults.
The cause is unknown. However, as it is an autoimmune disease there are several factors that can influence the immune system and provoke lupus. Several hypotheses have been discussed, including genetics and the environment. One of the environmental factors involved has been exposure to sunlight. In fact, many individuals with lupus have photosensitivity which is manifested as an increased skin response when exposed to ultraviolet rays from sunlight. Likewise, hormones, specifically female estrogens, appear to be involved in the development of the disease.
Symptoms of Lupus
As it is a multi-systemic disease it affects several organs. On the one hand it presents general symptoms: easy fatigue, unexplained weight loss, prolonged fever not due to an infectious process and alterations of temperature. In addition, the most common clinical manifestations, seen in 90% of patients, are joint and muscle symptoms, joint pain and inflammation (arthritis) in hands, wrists, elbows, knees and feet with more frequency. Joint stiffness may appear in the morning and damage to the skin. The most known, but not the most recurrent, lesion is called "butterfly wing erythema," which consists of a reddening and rashing of the skin on the cheeks and back of the nose. When it affects the heart and lungs: The lining layers of the heart (pericardium) and the lungs (pleura) become inflamed due to disease. This causes pericarditis and pleuritis. Both have similar symptoms: chest pain and fever. At other times, lupus affects the lungs or heart valves causing cardiorespiratory failure.
  • When it affects the kidney (a good number of patients have renal compromise), the most frequent lesion is inflammation (nephritis), which sometimes prevents the kidney from properly disposing of body waste and accumulating it in the blood. Because of this inflammation, many times the kidney is unable to assimilate and retain protein. With what they are eliminated by the urine, causing swelling of face and legs.
  • When it affects the nervous system the manifestations can range from headaches, depressions to inflammation of the brain, spinal cord, cerebral infarctions which may be due to cerebral inflammation by lupus or may be secondary to other circumstances, such as infections and antiphospholipid antibodies . Hence, a very careful evaluation is required. It is possible that depression is not triggered by the disease, but because the patient is facing the fact of suffering from a disease, of unknown origin and that can affect so many organs.
Types of Lupus
There are three types of lupus:
  1. The cutaneous: only compromises the skin and is the most frequent. It does not cause organ damage.
  2. The systemic or SLE that compromises several organs.
  3. Drug induced, which is rare and with very mild manifestations.
Diagnosis is mainly based on symptoms. Blood tests can detect anti-nuclear antibodies, which are positive in up to 98% of patients with lupus. However, these antibodies also manifest themselves in other diseases, and therefore it is indicated to look for more disease-specific markers such as anti-double-stranded DNA and anti-ENA antibodies. A high value of some of these antibodies is specific for lupus.
Kidney damage caused by lupus can be detected by blood and urine tests, although kidney biopsy is sometimes indicated to better determine treatment.
The treatment of the disease is very different depending on the organ to which it affects. Steroids, although still considered part of the basic treatment, therefore, all affected at one time or another take them, the current criterion is to indicate them in the lowest dose and for the shortest possible time. All patients with lupus, both mild (fatigue, cutaneous or joint manifestations) and severe forms (involvement of a major organ), and with the exception of a formal contraindication, should receive antimalarials (immunomodulator) for a prolonged period . If the damaged organs are the lung, heart, central nervous system or kidney, treatment should be much more aggressive and based on very high doses of corticosteroids and immunosuppressive drugs. The rheumatologist is the best qualified specialist to treat patients with lupus.
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