It develops when the immune system loses its normal ability to distinguish between foreign invaders and the body's own cells, producing antibodies that target healthy tissue. This leads to widespread inflammation that can affect multiple organ systems, either intermittently or persistently. Lupus is often described as an unpredictable disease because it can flare and settle over time, and its presentation varies considerably from person to person. Without appropriate assessment and management, lupus can lead to organ damage, particularly affecting the kidneys, heart, lungs and nervous system, as well as significant impact on quality of life.
What is lupus?
Systemic lupus erythematosus (SLE) is a chronic autoimmune condition characterised by the production of autoantibodies and immune complexes that cause inflammation in multiple parts of the body. This distinguishes it from more localised autoimmune conditions, as lupus can affect almost any organ system.
The immune system normally works to protect the body. White blood cells and antibodies identify and destroy foreign substances such as bacteria and viruses.
- In lupus, the immune system produces autoantibodies that mistakenly target the body's own cells and tissues.
- These autoantibodies form immune complexes that deposit in tissues such as the skin, joints and kidneys, triggering inflammation and, over time, tissue damage.
- Lupus follows a relapsing and remitting course for most people, with periods of increased disease activity, known as flares, interspersed with periods of relative quiet.
What are the causes of lupus?
The exact cause of lupus is not fully understood, but it is thought to result from a combination of genetic, hormonal and environmental factors that trigger an abnormal immune response. Risk factors for lupus include:
Genetic and demographic factors
- Female sex, particularly during childbearing years, with women affected considerably more often than men
- A family history of lupus or other autoimmune conditions
- Certain ethnic backgrounds, including African, Caribbean, Asian and Hispanic ancestry, associated with higher risk and often more severe disease
Hormonal and environmental triggers
- Hormonal factors, with oestrogen thought to play a role in disease activity
- Ultraviolet light exposure, which can trigger skin flares and, in some cases, systemic flares
- Certain infections, particularly Epstein-Barr virus, which have been implicated as possible triggers
- Some medications, which can cause a drug-induced form of lupus
- Smoking, which is associated with increased disease activity
What are the symptoms of lupus?
Lupus symptoms vary widely between individuals and can affect almost any part of the body. Common signs and symptoms include:
- Persistent fatigue, often disproportionate to activity levels
- Joint pain, stiffness and swelling, frequently affecting the small joints of the hands and wrists
- A characteristic butterfly-shaped rash across the cheeks and nose, often triggered or worsened by sunlight
- Other skin changes, including photosensitivity, mouth ulcers and hair loss, and widespread rashes
- Unexplained fevers and enlarged lymph nodes
- Chest pain related to inflammation of the lining of the lungs or heart
- Symptoms of kidney involvement, such as swelling of the legs, which may occur without other obvious signs
- Raynaud's phenomenon, where fingers turn white or blue in the cold
- Cognitive difficulties, headaches or, less commonly, seizures
Because lupus can affect many organ systems and symptoms often overlap with other conditions, diagnosis can take time and requires a thorough, coordinated assessment.
When to Seek Medical Advice?
You should seek specialist assessment if you have:
- Persistent joint pain or swelling alongside unexplained fatigue
- A rash that worsens with sun exposure, particularly across the face
- Unexplained fevers, chest pain or swelling of the legs
- A family history of lupus or other autoimmune disease
Early assessment allows treatment to begin before significant organ involvement develops, which is particularly important for protecting long-term kidney and cardiovascular health.
How lupus is diagnosed?
Diagnosis is based on a combination of clinical assessment, blood tests and, where relevant, organ-specific investigations. There is no single test that confirms lupus on its own, and results need to be interpreted alongside your symptoms and examination findings. Dr Nuttall will begin with a detailed review of your symptoms, medical history, family history and a physical examination.
Investigations for lupus may include:
- Blood and antibody tests
- Antinuclear antibody (ANA) testing, a sensitive screening test that is positive in the great majority of people with lupus
- Anti-dsDNA and anti-Smith antibodies, more specific markers that support a diagnosis of lupus
- Complement levels (C3 and C4), which are often reduced during active disease
- Full blood count and inflammatory markers, to assess for anaemia, low white cell or platelet counts, and disease activity
- Organ-specific assessment
- Urine testing, to detect protein or blood indicating kidney involvement
- Kidney function blood tests, and kidney biopsy if significant kidney involvement is suspected
- Imaging such as echocardiography or chest X-ray, where heart or lung involvement is suspected
- Further specialist investigations if neurological or other organ-specific symptoms are present
How to treat lupus?
Treatment is aimed at controlling inflammation, preventing flares, protecting organ function and minimising long-term damage. The approach is tailored to which organs are affected and the severity of disease.
Treatment options may include:
Medical management
- Hydroxychloroquine, an antimalarial medication considered a cornerstone of treatment for most people with lupus, used to reduce flares and protect against long-term damage
- Corticosteroids, used to control active inflammation, typically at the lowest effective dose and for the shortest duration possible
- Immunosuppressant medications, such as azathioprine, methotrexate or mycophenolate, used for more significant or organ-threatening disease
- Biologic therapies, including belimumab or rituximab, considered where disease remains active despite standard treatment
Lifestyle and supportive care
- Sun protection, including high-factor sunscreen and protective clothing, to reduce flares triggered by ultraviolet light
- Regular monitoring of blood tests and organ function, to detect flares and treatment side effects early
- Cardiovascular risk management, including blood pressure and cholesterol control, given the increased cardiovascular risk associated with lupus
- Vaccination review and infection prevention, particularly important for those on immunosuppressant treatment
- Psychological support, given the impact of a chronic, unpredictable condition on daily life
Dr Nuttall will tailor treatment to control disease activity, protect organ function, and support your long-term health and wellbeing.
