According to the Lupus Foundation of America, almost 1.5 million Americans are living with some form of lupus. And what makes it so difficult to deal with is the fact that it can actually affect all parts of the body and it’s not always visible to the naked eye either.
Lupus is an autoimmune disease, which means that it causes a person’s immune system to attack the healthy cells and tissues of their body. The Lupus Foundation also shares that almost 70 percent of lupus cases are caused by systemic lupus, which affects tissue and major organs like the kidneys, lungs, heart or brain.
According to George Stojan, MD, a rheumatologist and assistant professor of medicine at the Johns Hopkins University School of Medicine, as well as the co-director of the Hopkins Lupus Center, “The immune system is unable to recognize what is part of the body and what is not.”
According to Dr. Stojan, lupus can present with quite a number of symptoms, and a butterfly-shaped rash across the cheeks and nose is one of the most common. Some of the other symptoms are mouth sores, joint stiffness and swelling, swollen glands, chest pain due to fluid around the lungs or heart, fevers, and low blood count. And while these symptoms can go from benign to life-threatening, what is the most common one is chronic pain, which 65 percent of lupus patients complain about as the hardest symptom to deal with.
But aside from these symptoms, what makes this autoimmune disease even harder is there aren’t any concrete cures or causes. Dr. Stojan explains, “There’s this entire range of things that have been associated with lupus, but association alone doesn’t mean causation.”
Studies have shown that genetics, hormones and environmental changes all have something to do with the development of lupus. But despite the research, they still can’t say which factor is the biggest contributor to the disease. “It’s probably a perfect storm that occurs and leads to the occurrence of the disease,” adds Dr. Stojan.
To further help understand this autoimmune disease, here are 8 possible triggers, as well as possible treatment for those diagnosed with lupus.
1. Genetics
Lupus is one of those autoimmune diseases that tends to occur in more than one family member. When one family member has it, their sibling is 20 times higher risk of developing the disease. According to the U.S. National Library of Medicine, ‘a handful of gene variations have been linked to the development of lupus,’ most of which are linked to immune system function.
Dr. Stojan explains it’s particular gene mutations, such as TREX1, have presented a link, but since they are rare, not all patients have them. He explains, “It’s thought that there is this combination of susceptibility genes and an absence of protective genes that allow the development of the disease in people who have certain environmental exposures or certain infections agent exposures.”
2. Race
While it sounds incredibly unfair, lupus tends to impact specific ethnic groups. The Lupus Foundation of America shares that it’s ‘two to three times more prevalent in women of color.’ The list includes Hispanics and Latinos, Asians, African Americans, Pacific Islanders, Native Americans and many more. While a 2014 study has shown that lupus affects 1 in 537 black women, other reports also show that women of color also develop lupus earlier, have higher mortality rates and end up dealing with more serious complications.
3. Hormones
Unfortunately for women, they are more likely to develop lupus than men, says Dr. Stojan. According to the CDC, nine out of ten people that are diagnosed with the autoimmune disease are women between the ages of 15 and 44 years old. A big factor for this wide range in age is hormones like prolactin and estrogen, which are higher in women. Other research has also shown that “women who were treated with estrogen-containing regimens, like oral contraceptives or hormonal replacement therapy, had a significantly increased risk of developing lupus.” Dr. Strojan adds that estrogen is known to release interleukin-1, which is a group of inflammatory responses linked to lupus flares.
4. Infections
A number of viral infections are linked to lupus flares, like herpes simplex virus, hepatitis A and human parvovirus. But it’s the virus Epstein-Barr that’s responsible for mononucleosis, that is also known to cause an unusual immune system response for those exposed to it. Of course, Dr. Stojan also says that just because you are exposed to it does not mean that you will get lupus for sure.
He also iterates, “After age 20, approximately 90 percent of Americans are exposed to Epstein-Barr, so it’s almost impossible to say whether that exposure in any way affected someone’s risk, simply because everybody gets exposed.” He adds, “It’s certainly possible but having these antibodies alone doesn’t mean somebody will develop lupus in the future.”
5. Stress
It is a well-known fact that stress is a negative factor for many medical conditions, and while there isn’t an actual link between stress and lupus, most patients feel like it plays a large part. Dr. Stojan explains, “I’m not aware of any human epidemiological model that showed how stress affects lupus, but I can tell you that every patient does say that it affects them.” Reports by patients have shared that they think emotional stress, as well as physical stress, can trigger lupus symptoms.
6. Ultraviolet Light
Ultraviolet light can cause damage to any person’s cells, but people that suffer from lupus are even more sensitive to it. Even though ultraviolet light is not necessarily identified as a cause for lupus, the problem with the UV light is that it has the ability to modify one’s skin cells. So for those with lupus, their immune systems will see it as a threat, which can either activate or worsen the symptoms of the disease.
Dr. Stojan reiterates, “The ultraviolet light can both induce mutations in certain genes that then become unrecognized by the immune system and become targets, leading to lupus rashes. But it also can directly stimulate keratin inside the cells of the skin to create more inflammatory mediators.”
7. Toxic Exposures
Toxic exposures like cigarettes and even cleaning powders can trigger lupus. Dr. Stojan says, “We know that silica dust that’s present in some cleaning powders and cigarette smoke can increase the risk of developing lupus.” But what makes it harder is that studies don’t know why that is. What is known is that those exposed to silica at work have two to five times higher risk of developing lupus. Other research also shows that mercury, smoking tobacco and pesticides are also factors.
8. Atmospheric Changes
Dr. Stojan has also shared that preliminary research shows that changes in pollution, barometric pressure, humidity, wind patterns, and temperature are all factors when it comes to specific organ flares for those with lupus. And to make it more complicated, ‘not one variable is associated with all flares,’ says the doctor. “You can technically predict it based on these changes in atmospheric factors 10 days prior to the time the patient shows up for their clinic visit.”
So How is Lupus Treated?
According to Dr. Stojan, if you have been positively diagnosed with lupus, treatment will depend on the severity of the disease. For those that suffer from mild to moderate symptoms, your doctor normally starts you on antimalarial drugs hydroxychloroquine. This will help lessen skin rashes, reduce pain and other symptoms to help protect the affected organs and prevent damage.
Dr. Stojan shares that hydroxychloroquine has helped prevent lupus flares by up to 50 percent, which then helps patients live longer. “It’s something that we keep all lupus patients on as long as they can tolerate it.”
One other option is the use of corticosteroids. These are given to patients when they are going through a flare up, mostly because this type of medication is known to work fast. Unfortunately, they also have negative side effects when taken too long, so doctors generally avoid prescribing them if they are not completely necessary.
What makes lupus hard to treat overall is the fact that there is no actual cure for this autoimmune disease. The best thing to do is to work closely with your doctor in order to figure out the best type of treatment for your personal case in order to reach remission, which according to Dr. Stojan is the ultimate goal.
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