Spotlight on lupus-systemic lupus erythematosus or "SLE"

Lupus is the name given to a group of chronic immune diseases. It affects about 15,000 Canadians-approximately one in 2000.

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. Tissues affected can include the skin, joints, muscles, kidneys, lungs, heart, blood vessels, and brain.

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 45.

While the exact cause or causes of lupus remain unknown, there are a number of factors 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, prolonged and severe stress, viruses, and sun exposure.

Diagnosis of lupus

Because lupus can affect so many different areas of the body, the disease often presents very differently from patient to patient. For this reason, lupus is a disease which is often difficult to diagnose. If you experience three or more warning signs of lupus, you should speak with your doctor about looking into the possibility that you may have lupus.

Warning signs include:
  • Swollen or stiff and painful joints
  • Fever
  • Loss of appetite and weight loss
  • Fatigue and low energy
  • Skin rash, especially if brought on by sun exposure
  • 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

While there is no single test for lupus, several blood tests are available which assist doctors in diagnosing lupus. These, combined with other factors such as physical symptoms and sometimes family history, can assist doctors in diagnosing lupus.

Treatment of lupus

If your doctor believes you may have lupus, you will usually be referred to a rheumatologist-a specialist in the treatment of arthritis. Rheumatologists have many years of extra training on top of their regular medical schooling, and are experts at diagnosing and treating lupus.

Once your rheumatologist has diagnosed lupus, there are effective treatments available. While there is no known cure for lupus, treatments focus on controlling symptoms.

There are five major groups of medications which are used to treat lupus. These are:
  • 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®)
  • Methotrexate
  • 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 are sometimes 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.

Good news for people with lupus and their rheumatologists: new medications are under investigation. 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 may prove to benefit people with lupus, too.

The goal with any medication used to treat lupus is to bring symptoms under control and bring about remission of the disease. Early treatment minimizes tissue damage, and may also lessen the amount of time a patient needs to stay on high doses of medication.

One simple form of lupus "treatment" often overlooked is using sunblock with a skin protection factor (SPF) of 30 or above. Applying appropriate amounts of sunblock on the face and all areas of skin (the sun goes through thin layers of clothing) 30 minutes before exposure to the sun reduces lupus flares as well as skin cancer.

And finally, maintaining a healthy lifestyle is also a critical part of any lupus treatment plan. Poor diet, lack of exercise, and high levels of stress may encourage flare-ups of disease activity, so healthy eating, gentle exercise, and relaxation are highly recommended.

For more information about Lupus, visit the Lupus Canada website at