About Lupus (systemic lupus erythematosus or “SLE”)
What is lupus
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Systemic lupus erythematosus (SLE) occurs when the body’s immune system begins to malfunction and attack healthy tissue in various parts of the body, causing inflammation and damage. Affected areas can include the skin, joints, muscles, kidneys, lungs, heart, blood vessels, and brain.
The main symptoms of lupus
Because lupus can affect various areas of the body, the disease often presents very differently from person to person. For this reason, lupus is a disease which is often difficult to diagnose. If three or more warning signs of lupus are present, it is best to seek medical attention.
Warning signs include1
Who can develop lupus?
- Fatigue or low energy
- Skin rash, especially if brought on by sun exposure
- Swollen, stiff and painful joints
- Loss of appetite or weight loss
- Ulcers in the mouth and/or nose, usually painless
- Pain in the chest while lying down or taking deep breaths
- Low blood counts, including anemia (low iron)
Lupus is the name given to a group of chronic immune diseases. It affects one in 1,000 Canadians2
. Like many other forms of arthritis, lupus occurs more commonly in women than in men – women develop lupus approximately ten times more often than men do. While it can strike at any age, it tends to occur most often between the ages of 15 and 452
. Institutionalize medicine and socioeconomic divides have resulted in health disparities for certain ethnic minority groups3,4
. For example, research has found that Indigenous females over the age of 45 have twice the prevalence of SLE and greater disease activity compared to non-Indigenous females1
. The cause of this discrepancy is likely rooted in centuries of injustice and intergenerational trauma that can only be addressed by restructuring care and ensuring Indigenous peoples voices are heard and at the decision-making table5,6,7
While the exact cause of lupus remains unknown, there are many things which researchers believe may trigger the disease, either alone or in combination with one another. These include genetics, hormones, certain types of antibiotics and other medications, extended and severe stress, viruses, and sun exposure1
Getting a diagnosis of lupus
While there is no single test for diagnosing lupus, several blood tests are available which assist doctors in determining whether a person has lupus, or not. These, combined with other factors such as physical symptoms and sometimes family history, can assist doctors in diagnosing lupus8
If a doctor suspects lupus, the person should be referred to a rheumatologist – a specialist in the treatment of arthritis. Rheumatologists have many years of extra training in addition to their regular medical schooling and are experts at diagnosing and treating lupus.
Treatment for lupus
Upon diagnosis, there are effective and personalized management strategies available. While there is no known cure for lupus, symptom control and maximizing quality of life should be the goal.
There are five major groups of medications which are used to manage symptoms and treat lupus. These are9
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (for example Advil® or Motrin IB®), naproxen (or Naprosyn®), dicloflenac (or Voltaren® and Arthrotec®)
- Hydroxychloroquine (Plaquenil®)
- Corticosteroids, such as prednisone
- Immunosuppressive medications, such as cyclophosphamide (Cytoxan®, Procytox ®) and azathioprine (Imuran®), and mycophenolate mofetil (CellCept®)
Most often, lupus can be controlled using one or a combination of the first four groups of drugs.
- For milder cases, hydroxychloroquine or NSAIDs may be enough alone to control symptoms. Corticosteroids are highly effective in controlling lupus, but hydroxychloroquine, methotrexate and azathioprine may be safer over long periods of time.
- For very severe cases of lupus, corticosteroids and an immunosuppressive agent may be required.
There is good news for people diagnosed with lupus and their rheumatologists; many new medications are being researched. Two biologic response modifiers – abatacept (Orencia®) and rituximab (Rituxan®) – are under active study; both of these medications are currently used to treat rheumatoid arthritis and other forms of inflammatory arthritis and may prove to benefit people with lupus10
Sensitivity to light (called “photosensitivity”) is common. Approximately 40% to 70% of people with lupus will find that their disease is made worse by exposure to UV rays from sunlight or artificial light. One simple way to prevent flares is to apply sunblock with a skin protection factor (SPF) of 30 or above prior to sun exposure. Applying appropriate amounts of sunblock on the face and all areas of skin (the sun goes through thin layers of clothing) has proven to be effective.
Maintaining a healthy lifestyle is a critical part of any lupus treatment plan. Poor diet, inactivity, and high levels of stress may encourage flare-ups of disease activity. Healthy eating, feel good movement, and relaxation techniques such as meditation and mindfulness are highly recommended.
For more information about lupus, visit the Lupus Canada website at www.lupuscanada.org
Key lupus take-aways
- Early diagnosis can be intimidating but incredibly beneficial as it allows people to learn and develop skills to manage their condition.
- It’s important to know that treatment for lupus is not a “one-size-fits-all” approach. It takes good communication with a rheumatologist and patience to find the right balance of medications, nutritious foods and physical activities that work together to best control the disease.
- Getting an early diagnosis and starting on a personalized treatment plan can help to protect joints and lessen the amount of time spent on high doses of medication.
|3||Barnabe et al. (2012). Prevalence of systemic lupus erythematosus and systemic sclerosis in the First Nations population of Alberta, Canada. https://doi.org/10.1002/acr.20656|
|4||Hurd and Barnabe. (2017). Systematic review of rheumatic disease phenotypes and outcomes in the Indigenous populations of Canada, the USA, Australia and New Zealand. https://doi.org/10.1007/s00296-016-3623-z|
|8||Mosca et al. (2019). How do patients with newly diagnosed systemic lupus erythematosus present? A multicenter cohort of early systemic lupus erythematosus to inform the development of new classification criteria. https://doi.org/10.1002/art.40674|