Women and Lupus

Lisa Sharp
OSF Saint Francis Medical Center Women's Resource Center
Systemic lupus erythematosos (SLE), also known as lupus, is a disorder in which the body’s own immune system attacks healthy tissues and organs, leading to inflammation and damage. Lupus affects approximately 1.4 million Americans—9 out of 10 of those are women.

African American women are three times more likely to develop the disease than Caucasian women, and it appears to be more prevalent in women of Hispanic/Latina, Asian, and Native American descent.

Lupus symptoms can range from mild to life-threatening and can be very vague, often resembling other disorders, making diagnosis difficult. Symptoms may come on suddenly or develop slowly.

The following are types of lupus:
• SLE is the most common type and often the most serious. SLE can affect many parts of the body, such as joints, skin, kidneys, lungs, heart, blood vessels, nervous system, and brain. Approximately 70 percent of lupus cases are systemic, and in about 50 percent of these cases, a major organ will be affected.
• Discoid lupus is always limited to the skin and is identified by a rash that appears on the face, neck, and scalp. The classic “butterfly rash” that can appear across the bridge of the nose and spread across the cheeks can be present in both SLE and discoid lupus.
• Drug-induced lupus results from the long-term use of certain prescription medications. Medications used to treat high blood pressure, tuberculosis, arthritis, ulcers, and certain antibiotics have been known to trigger symptoms of the disease; however, these symptoms usually disappear after stopping the medication.
• Neonatal lupus is rare, but some newborns of women with SLE or other immune disorders are born with lupus.

The cause of lupus is unknown, but it’s believed to be viral or bacterial. Environmental, genetic, and possibly hormonal factors may play a role. Because so many more women than men develop lupus, researchers wonder if there’s a link between estrogen and lupus. Some women with lupus report their symptoms become worse during menstruation and pregnancy and with the use of birth control pills or hormone therapy.

Symptoms of lupus usually develop over time and can mimic other, less serious illnesses. Symptoms include, but aren’t limited to, butterfly rash, sensitivity to sunlight, sores on the mouth or lips, and painful or swollen joints. Vague complaints such as frequent fevers, prolonged or extreme fatigue, hair loss, abdominal pain, and discoloration of fingers or toes from cold temperatures or stress also can occur. According to the Lupus Foundation of America, 95 percent of persons affected with lupus report achy joints, while 90 percent experience fevers and swollen joints. Because symptoms can vary considerably from person to person, lupus can be challenging to diagnose.

There’s no specific lab test to diagnose lupus. In addition to a thorough health history and physical exam, some lab tests may help piece together an accurate diagnosis. Although having a close relative with lupus is thought to increase the odds of developing lupus, there currently are no genetic tests available to predict who will be affected.

Women in their childbearing years are those most likely to develop lupus, and pregnancy can be stressful for those affected. Although studies haven’t shown an increased rate of infertility in women with lupus, the risk of miscarriage, premature birth, and stillbirth is significantly high— especially if symptoms become worse during pregnancy. While flares aren’t caused by pregnancy, they often occur during the crucial first and second trimesters of pregnancy, as well as the first few months post-partum.

High blood pressure and the risk of developing blood clots during pregnancy are other factors that put mother and baby at risk. The majority of women with lupus who get pregnant are followed closely by on obstetrician who specializes in high-risk pregnancy, as well as a rheumatologist. It’s been suggested that delaying becoming pregnant until a woman is free of lupus symptoms for at least six months may better the outcome of the pregnancy. The good news: it’s estimated that 85 percent of pregnancies in women with lupus result in a healthy infant.

While there’s no known cure for lupus, there are many effective treatments. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce joint and muscle pain and inflammation, common to those with systemic lupus. Medications to treat malaria, powerful steroid medications like Prednisone, and even chemotherapy are being used to treat the symptoms of the disease until a cure can be found.

To help prevent flare-ups, getting adequate rest, applying sunscreen before going outside, exercising moderately, and eating a healthy diet can mean the difference between being functional and being disabled.

Promising areas of research are on the horizon. With the link between estrogen and lupus being investigated, some research is being done using androgen or “male hormones” to treat symptoms of systemic lupus. A supplement called DHEA, presently available in most health food stores, is being shown in some studies to reduce flare up of the disease in some women—and even improve or stabilize active SLE.

As with many disorders, especially autoimmune diseases such as lupus, the course of disease, symptoms, and prognosis is very individualized. When a woman develops the disease, self-esteem, the ability to care for herself, and fear of an uncertain outcome with pregnancy are only a few of the difficult issues she must face. Knowing the facts, taking care of herself, and seeking out the support of family and others facing lupus may make living with this disease a little less stressful. For more information, call (800) 558-0121 or visit www.lupus.org.  TPW