Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by abnormal immune system activity, where the immune system mistakenly attacks the body's own tissues. This disease can affect multiple organ systems including the skin, joints, and internal organs, presenting with a wide range of symptoms. The pathogenesis of lupus is complex and involves interactions among genetic, environmental, and hormonal factors. Therefore, diagnosis and treatment require a multidisciplinary medical team working together.
In recent years, medical understanding of lupus has deepened, and new treatment methods and management strategies continue to develop. Early diagnosis and personalized treatment can effectively control the disease and delay organ damage. This article comprehensively analyzes lupus from causes, symptoms, diagnosis to treatment and prevention, helping readers develop an overall understanding of this disease.
The exact cause of lupus remains unclear, but it is known to result from the combined effects of genetics, environment, and immune system abnormalities. Regarding genetic predisposition, certain gene polymorphisms (such as HLA gene groups) increase the risk of developing the disease, but a single gene defect alone does not directly cause lupus; environmental triggers are usually needed. Environmental factors include ultraviolet exposure, infections, certain medications (such as anticonvulsants), or stressful events, which may trigger immune dysregulation.
Hormonal factors play a key role in the development of lupus, with up to 90% of patients being female, correlating with the higher prevalence in women. Additionally, abnormal functions of T cells and B cells in the immune system lead to excessive production of autoantibodies such as antinuclear antibodies (ANA), which in turn cause tissue inflammation. Epigenetic changes (such as DNA methylation) may regulate gene expression and influence immune dysregulation.
Lupus symptoms are diverse and highly variable, often referred to as the "disease of a thousand faces." Typical symptoms include butterfly-shaped facial rash (photosensitive rash), joint pain, and swelling. About 80% of patients exhibit skin manifestations, with the "lupus malar rash" being a common dermatological indicator. Systemic symptoms may include persistent fever, weight loss, and fatigue, the latter often underestimated but severely affecting quality of life.
Organ involvement varies among individuals, potentially affecting the kidneys (proteinuria, renal failure), lungs (pleuritis), cardiovascular system (pericarditis), and central nervous system (headaches, seizures). Some patients may experience "lupus flare," an acute exacerbation involving multiple systems, which is a medical emergency requiring immediate intervention. Symptoms may follow a relapsing-remitting pattern, complicating diagnosis.
The diagnosis of lupus requires a combination of clinical presentation, laboratory tests, and classification criteria. The American College of Rheumatology and the European League Against Rheumatism have jointly established classification standards covering 11 clinical and immunological indicators. The common diagnostic process includes:
Diagnosing lupus can be challenging because symptoms often overlap with other autoimmune diseases such as rheumatoid arthritis or Sjögren's syndrome. Physicians need to exclude other possible diagnoses and monitor disease progression to ensure accurate diagnosis. The 2019 updated classification criteria added quantitative standards for immunological markers, improving diagnostic accuracy.
Initial screening: positive ANA test followed by testing for anti-dsDNA antibodies and complement levels.
The goal of lupus treatment is to control immune system activity, relieve symptoms, and prevent organ damage. Treatment strategies are tailored according to disease severity, divided into basic therapy and management during exacerbations. Common medications include:
Newer treatment strategies include JAK inhibitors and targeted B-cell therapies, which can reduce the side effects associated with traditional immunosuppressants. Patients require regular monitoring of blood counts, liver and kidney functions, and signs of infection, as these treatments may increase immunosuppression risks.
Patients should establish personalized treatment plans combining medication and lifestyle modifications. Regular follow-up items include:
While lupus cannot be completely prevented, the following measures can reduce the frequency and severity of flares:
Nutrition-wise, a high-fiber diet is recommended, limiting processed foods, and supplementing with vitamin D under medical supervision. Avoid known triggers such as certain medications or infectious sources to maintain disease stability.
Women of reproductive age should pay special attention to pregnancy management, as pregnancy may induce disease activity. It is recommended to achieve remission at least six months before conception and to be monitored by rheumatologists and obstetricians jointly.
Seek medical attention immediately if you experience:
Worsening of chronic symptoms (such as increased fatigue, persistent joint swelling for over six weeks) should also prompt early medical consultation. Even during remission, regular specialist follow-up every 3-6 months is recommended to monitor potential organ damage.
If you experience the following urgent symptoms, go to the emergency room immediately:
Early diagnosis and treatment can significantly improve prognosis. Patients should establish a long-term partnership with their healthcare team, regularly evaluating treatment responses and side effect management plans.
Patients should use broad-spectrum sunscreens with SPF 50+ or higher, combined with physical barriers such as long-sleeved clothing and wide-brimmed hats. Avoid going out during peak sunlight hours, and if outdoor exposure is necessary, use UV-protective umbrellas. For skin lesions, follow medical advice on medication use and avoid chemical irritants.
Can patients with lupus receive vaccines during treatment? What precautions should be taken?Most vaccines are safe, but timing depends on disease activity and medication adjustments. Live vaccines (such as measles or varicella) should be administered only when the disease is stable and high-dose steroids are not being used. Consult your specialist before vaccination and inform them of your current medications to reduce infection risk or drug interactions.
How to determine if treatment should be adjusted during symptom relapse?If new symptoms appear (such as unexplained fever, increased joint swelling, or skin lesions spreading) or existing symptoms severely impact daily life, seek medical evaluation promptly. Doctors may perform blood tests (such as anti-dsDNA antibodies, C3/C4 complement levels) or imaging to decide whether to adjust immunosuppressants or biologic agents.
What foods or ingredients should lupus patients avoid to prevent disease exacerbation?There are no specific dietary restrictions, but foods high in iodine (such as kelp), photosensitive foods (such as figs and celery) may trigger photosensitivity in some patients. It is advisable to keep a food-symptom diary. Long-term steroid users should follow a low-sodium, low-calcium diet and supplement calcium and vitamin D as prescribed to prevent osteoporosis.
What stress management strategies are effective for lupus patients?Mindfulness meditation and regular exercise have been proven to reduce stress hormone levels in chronic disease patients. Daily deep breathing exercises for 10-15 minutes and gentle aerobic activities like swimming are recommended. Joining support groups can also help reduce feelings of isolation, but overly strenuous social activities should be avoided.
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