LUPUS DAY – Systemic, discoid erythematosis… Lupus is a chronic autoimmune disease which manifests itself by skin and/or joint symptoms which mainly affects women. What are the treatments ? His life expectancy?
There Day of May 10, 2023 is dedicated to Lupus. A disease that would concern metropolitan France about 1 in 2,000 people. The most common form is lupus erythematosus. It is a chronic autoimmune disease which is manifested by skin and/or joint symptoms. It results froma biological anomalycharacterized by the presence of antinuclear antibodies that turn against DNA cells. Among the contributing factors : hormonal factors, genetic predisposition, taking certain medications, environmental factors (sun, tobacco, exposure to the Epstein-Barr virus, cytomegalovirus, etc.). In 90% of caseslupus occurs in women, with a frequency peak around the age of 30. What are the symptoms of lupus? The causes ? The diagnosis ? Treatments ? The disease in detail.
What is lupus disease?
THE lupus is a chronic autoimmune disease relatively rare, the most serious form of which is systemic lupus. The most common form is the systemic lupus erythematosus, also called acute systemic lupus erythematosusbecause it can reach any organ like kidneys, heart, lungs, blood cells… We call “autoimmune disease” a pathology that is characterized by the dysfunction of the immune system, leading it to attack the body’s cells and destroy them. Attention, “lupus is absolutely not a contagious disease“, makes a point of specifying from the start Ginette Volf-Philippot, founder of the Association Lupus France.
Photo: what does lupus look like?
The word “lupus” means wolf in Latin, which refers to the characteristic appearance of the affected face in the shape of a “mask” or butterfly wing.
What are the types of lupus?
There are different types of lupus erythematosus, which do not cause the same symptoms.
Systemic lupus
Formerly called “systemic lupus erythematosus” or “acute systemic lupus erythematosus”, we now speak of “systemic lupus”. Many lupus patients do not present with erythematous cutaneous involvement, the term systemic lupus is therefore now primarily used.
Discoid lupus erythematosus
Among lupus erythematosus is discoid lupus erythematosus. It is most often confined to the skin and does not affect the internal organs of the body. It is manifested by well-defined, often multiple and symmetrical plaques that predominate on the face, sometimes also taking on a butterfly wing or circular shapes. Involvement of the ears, eyebrows and scalp is possible. The lesions of discoid lupus have a different evolution from those of systemic lupus, and leave very unsightly permanent scars, hence the urgency of treatment. There are forms of systemic discoid lupus with lesions that can appear on the trunk and limbs; the lesions then predominate on the elbows and extremities.
Isolated cutaneous lupus
Unlike systemic lupus erythematosus, isolated cutaneous lupus exclusively affects the skin on the face. Certain treatments, such as the use of UV protection, antimalarial therapy, corticosteroids and/or calcineurin inhibitors, can improve the appearance of the skin, limit scarring and prevent new skin lesions .
Induced or drug-induced lupus
Induced lupus appears following the prolonged intake of certain medications such as doxycycline (antibiotics prescribed against acne), Bactrim® (another antibiotic), certain antituberculosis drugs, beta-blockers (antihypertensive drugs), certain antiepileptics (carbamazepine) and anti-epileptics. -TNF. Stopping these medications usually causes the symptoms to disappear rather quickly.
Neonatal lupus
Neonatal lupus is linked to the presence in the mother of anti-SSA (also called anti-Ro) or SSB (or anti-La) antibodies which will affect the fetus or newborn.
At what age does lupus appear?
Anyone can develop lupus. However, lupus affects women more than men : out of 10 lupus patients, 9 are women. In general, this disease appears between the age of 15 and 30 years old. It is therefore a disease of young women. “If a hundred years ago, lupus was a very serious and fatal disease, today, patients who die of lupus are extremely rare, especially if it is stabilized and taken care of early.“, specifies the expert. Are also more at risk the people whose a member of the family is reached of lupus or another autoimmune disease.
What are the symptoms of lupus?
The symptoms of lupus differ from one person to another, On the other hand, the signs which appear at the beginning of the disease are skin problems on the parts generally exposed to the air (such as the face, the neck…) and joint pain. We commonly speak of “cutaneous lupus” or “articular lupus” depending on the clinical manifestations.
Most Common Lupus Symptoms
- Redness (skin rash)
- Canker sores,
- Photosensitivity
- Alopecia
- Dander or peeling skin
- Arthritis
Other symptoms of lupus:
Since lupus is a surprising disease, other symptoms can appear very quickly:
- Kidney damage (often silent),
- Fever,
- Intense fatigue or asthenia (not necessarily only with effort),
- Weightloss,
- Headaches,
- Memory loss (cerebral lupus)…
Other organs can be affected, such as the heart, kidney, lung, liver, but inconstantly. “Note that the appearance of one or two symptoms listed above are not enough to establish the diagnosis of lupus, so the patient must present a bundle of symptoms, in other words at least 4 or 5 well marked and characteristic symptoms of lupus“, specifies Ginette Volf-Philippot.
What are the causes of lupus?
Sun exposure could be one of the aggravating factors for the onset of lupus
“We understand better and better the origin of lupus, even if its exact causes are clearly not demonstrated. However, the genetic background and the influence of the environment seem to play a role“, explains the founder of Lupus France. Particularly, sun exposure could be one of the aggravating factors for the onset of lupus, hence the need to protect your skin. Moreover, the stress would probably be one of the causes associated with lupus: stressed people see their immune defenses drop and would thus be more vulnerable to the onset of lupus. To know that lupus can reveal itself during pregnancyfollowing a series of miscarriages For example. “Until a few years ago, when a woman had lupus, even if it was under control, she was strictly advised not to get pregnant. Today, this is absolutely no longer the case: there are a lot of young women with lupus who still have children”, rejoices the specialist.
“As it is a rare disease, doctors do not always think of lupus first when the patient presents with different symptoms that are inherent to lupus during the clinical examination. So, the diagnosis of lupus is often made late“, laments Ginette Volf-Philippot. Other examinations such as a blood test or a dosage of antinuclear antibodies are necessary to establish the diagnosis or on the contrary to eliminate it.
What are the treatments for lupus?
Lupus cannot be cured, but it can be controlled. And if the disease is stabilized and treated early, it is possible to have almost a normal life with lupus, in particular thanks to treatments that are certainly heavy, but effective. These treatments make it possible to reduce inflammation and symptoms related to lupus.
Corticosteroids
A treatment based corticosteroids (cortisone) in particular prednisone and methylprednisone is usually the most effective in treating systemic lupus. These drugs are administered in very high doses. “Nevertheless, today, doctors try as much as possible gradually reduce cortisone doses until trying to remove it, especially if the disease is under control. Indeed, prolonged cortisone intake increases the risk of osteoporosis and diabetes. And above all, patients on cortisone are much more vulnerable to viral and microbial attacks”, says the specialist.
Anti-inflammatories and immunosuppressants
“A real climate of trust must be established between the patient and the caregiver”
Doctors can also prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve symptoms of mild lupus. Other drugs like immunosuppressants can treat severe and rebellious lupus. Regular biological monitoring must be carried out throughout the duration of treatment. “Find the right treatment and the right dosage takes a long time because it’s all about the dose. The doctors will then base themselves on the patient’s feelings, his tolerance to the treatment and the appearance or not of side effects.“, she concludes. The follow-up of lupus is, as for all rare diseases, fundamental : thus, the patient must feel confident with her doctor and listened to.
Plaquenil® (chloroquine)
Based onhydroxychloroquine, Plaquenil® is a drug that can be given to patients with discoid lupus erythematosus and acute systemic lupus erythematosus. Its effectiveness focuses on the symptoms associated with this disease in the skin and joints. It sometimes requires a delay of several months. Plaquenil® can also be prescribed to prevent relapses. Among its contraindications: if the patient is hypersensitive to the active substances of the drug, in the event of retinopathy, breastfeeding, in children under 6 years of age, and in the event of combination with citalopram, escitalopram, l hydroxyzine, domperidone and piperaquine (increased risk of heart rhythm disorders).
What is the life expectancy with lupus?
The survival prognosis for people with lupus has improved dramatically in recent decades. Life expectancy exceeds 95% at 10 years with appropriate care.
For more than 30 years, reference and competence centers (19 and 66 respectively in France) for rare diseases have been set up thanks to the 1st National Plan for Rare Diseases. These centers are located throughout France. The Lupus France Association makes it possible to direct patients to the center closest to them, to answer their questions and to be followed up as best as possible.
Thanks to Ginette Volf-Philippot, founder of the Association Lupus France.