What Problems Can People With Lupus Have? continued...
Sometimes, changes in blood counts (low red cell count, or anemia), may cause fatigue, serious infections (low white cell count), or easy bruising or bleeding (low platelet count). Many patients do not have symptoms from low blood counts, however, so it is important for people with lupus to have periodic blood tests in order to detect any problems.
Blood clots are more common in people with lupus. Clots often occur in the legs (called deep venous thrombosis or DVT) and lungs (called pulmonary embolus or PE) and occasionally in the brain (stroke). Blood clots that develop in lupus patients may be associated with the production of antiphospholipid (APL) antibodies. These antibodies are abnormal proteins that may increase the tendency of the blood to clot. Blood can be tested for these antibodies.
- Brain and Spinal Cord. Brain involvement is, fortunately, a rare problem in people with lupus. When present, it may cause confusion, depression, seizures, and, rarely, strokes. Involvement of the spinal cord (transverse myelitis) can cause numbness and weakness.
- Heart and Lungs. Heart and lung involvement often is caused by inflammation of the covering of the heart (pericardium) and lungs (pleura). When these structures become inflamed, patients may develop chest pain, irregular heartbeat, and accumulation of fluid around the lungs (pleuritis or pleurisy) and heart (pericarditis). The heart valves and the lung itself can also be affected by lupus, resulting in shortness of breath.
What Causes Lupus?
The cause of lupus is unknown. However, there appears to be something that triggers the immune system to attack various areas of the body. That's why suppressing the immune system is one of the main forms of treatment. Finding the cause is the object of major research efforts.
Factors that may contribute to the development of lupus include viruses, environmental chemicals and a person's genetic makeup.
Female hormones are believed to play a role in the development of lupus because women are affected by lupus much more often than men. This is especially true of women during their reproductive years, a time when hormone levels are highest.
The observation that lupus may affect more than one member of the same family has raised the possibility that the tendency to develop lupus may be inherited. Having such a tendency, however, does not predict that a relative will develop lupus. Only about 10% of people with lupus have a close relative with the disease.
Drug-induced lupus can occur after the use of some prescription medications (such as hydralazine and procainamide). These symptoms generally improve after the drug is discontinued.
How Is Lupus Diagnosed?
Lupus is diagnosed when a person has several features of the disease (including symptoms, findings on examination, and blood test abnormalities). The American College of Rheumatology has devised criteria to assist doctors in making the correct diagnosis of lupus. A person should have at least four of the following 11 criteria, either at the same time or one after the other, to be classified as having lupus. These criteria include:
- Malar rash, a "butterfly" rash that appears on the cheeks.
- Discoid rash, red, scaly patches on the skin that cause scarring.
- Photosensitivity, a skin reaction or sensitivity to sunlight.
- Oral ulcers (open mouth sores).
- Arthritis, pain, inflammation, or swelling of the joints.
- Kidney disorder, either excess protein in the urine (proteinuria) or red blood cells in the urine.
- Neurological disorder, seizures, or psychosis.
- Inflammation of the lining around the lungs (pleuritis) or of the lining around the heart (pericarditis)
- Blood disorder, either low red blood cell count (anemia), low white blood cell count (leukopenia), decrease in lymphocytes (lymphopenia), or decrease in blood platelets (thrombocytopenia).
- Immunologic disorder, including the presence of certain cells or autoantibodies, or a false-positive test result for syphilis.
- Abnormal blood work, a positive antinuclear antibody (ANA) test result from blood work.