About 70 percent of people diagnosed with lupus have what is called systemic lupus erythematosus, although several other subtypes exist. (4) Here are some of the most important differences between the types of the disease.
Common SLE Symptoms
Common systemic lupus erythematosus symptoms include a rash, arthritis, fever, and fatigue, says Roberto Caricchio, MD, the chair of rheumatology at the UMass Chan Medical School in Worcester, Massachusetts. Headaches and sun sensitivity are other common symptoms. People with lupus may also have anemia (low red blood cell count) and a condition called edema (swelling of the hands, arms, feet, legs, and around the eyes). (5,6) More serious complications can include:
Kidney inflammation, or lupus nephritis, which can lead to kidney failureHeart disease, including pericarditis and myocarditisCoronary artery diseaseStrokeConfusion, seizures, and psychosisDepressionProblems with short-term memoryA higher risk of miscarriage and preterm labor in pregnant women
How Doctors Test for It
Rheumatologists use various laboratory tests and criteria to diagnose systemic lupus erythematosus and prescribe a personalized medication regimen based on the patient’s symptoms, says Dr. Caricchio.
Systemic Lupus Erythematosus Treatment
Medications can include nonsteroidal anti-inflammatory drugs — such as NSAIDs, corticosteroids, or antimalarial drugs like hydroxychloroquine — which may modulate the immune system, says Dr. Kaplan. Belimumab (Benlysta), a biologic drug — and chemotherapy, which can suppress the immune system — are among other medications used to treat systemic lupus erythematosus, says Caricchio. With proper management, up to 90 percent of patients will have a normal life expectancy, according to the Lupus Foundation of America. (7) It’s important for people living with systemic lupus erythematosus to know that they can maintain a good quality of life. “What I tell patients is that my job is to help them get to the place where they can participate in the activities they like,” says Stacy Ardoin, MD, a rheumatologist at the Ohio State University Wexner Medical Center in Columbus. In addition to recommending that patients regularly visit their rheumatologist to manage the disease, she encourages them to get enough sleep and to exercise regularly — at least 150 minutes of moderate aerobic exercise per week — which can help boost heart health as well as mental health. It’s important to know that some people with this subtype of lupus do go on to develop systemic lupus erythematosus. It happens in about 10 percent of people with cutaneous lupus erythematosus. (1) And experts suspect this is the natural progression of some variants of the disease (meaning there’s not much you can do to stop that from happening). If you do have cutaneous lupus erythematosus it is important to see your doctor regularly and adhere to any treatment instructions, Caricchio notes, so that treatment can be altered as necessary (and as early as possible) to identify and manage symptoms that do progress.
Discoid Lupus
A common type of cutaneous lupus is discoid lupus, which refers to the appearance of a round, raised, red, and scaly rash that does not itch. The rash typically appears on the face and scalp and can cause scarring and hair loss. “A dermatologist typically manages discoid lupus,” says Caricchio. Patients with this type of lupus also need to be carefully monitored for the development of systemic disease, according to a study in Clinical Rheumatology. (8) Treatment for cutaneous lupus erythematosus can include antimalarial drugs, topical steroids, or steroids injected directly into rash lesions. (9) Topical creams such as tacrolimus (Prograf) or pimecrolimus (Elidel) that modulate the skin’s immune response, may also help manage discoid lupus. (10) Oral thalidomide, which affects the immune response, may be an effective treatment in severe cases, says Caricchio. People with discoid lupus have a good life expectancy.
Subacute Cutaneous Lupus Erythematosus
Subacute cutaneous lupus erythematosus is another form of cutaneous erythematosus. The skin rash is red and scaly or can appear with ringed edges. Patients can have organ involvement such as fluid around the heart and lungs, but this is generally milder than with systemic lupus erythematosus, says Caricchio. The same topical remedies used for discoid lupus tend to be used to manage subacute cutaneous lupus erythematosus. People with subacute cutaneous lupus erythematosus usually have a good prognosis, but they need to be monitored for problems with their organs. (11) Because both forms of cutaneous lupus can be aggravated by sunlight, patients also need to avoid sun exposure. “Lab tests can often confirm the diagnosis,” says Caricchio, adding that once medications are discontinued, the symptoms usually go away. Patients usually make a full recovery. (13) The most common medications that cause the condition are isoniazid (an antibiotic used to treat tuberculosis), hydralazine (Apresoline, used for high blood pressure and heart failure), and procainamide (Pronestyl, a drug prescribed for heart rhythm problems). Other drugs that may lead to drug-induced lupus include the acne medication minocycline (Minocin) and some antiseizure medications, Dr. Ardoin adds. If symptoms persist, doctors may prescribe NSAIDs for arthritis, steroid creams to treat skin rashes, and antimalarial drugs to treat skin and arthritis. More rarely, doctors will prescribe high doses of corticosteroids and immunosuppressants if drug-induced lupus erythematosus is causing nephritis or inflammation around the heart or lungs. Physicians may also recommend avoiding sun exposure, which can exacerbate symptoms. The symptoms newborns with neonatal lupus experience, such as decreased platelets and rash, are temporary. However, a rare condition called heart block, or abnormal heart rhythm, can result in heart problems or even death, Dr. Pascual says. Doctors don’t know how to prevent neonatal lupus, but if you do have lupus and get pregnant, Kaplan suggests seeing a high-risk maternal-fetal medicine specialist to help monitor your risk through your pregnancy. Your doctor should order a fetal echocardiogram 18 to 24 weeks into your pregnancy to detect heart block (which can be treated with a pacemaker implanted in utero or at birth), Kaplan explains.
