Types of Lupus

The Four Types of Lupus

Lupus Erythematosus is the collection of automimmune diseases where the human immune system becomes hyperactive and starts attacking healthy cells and tissues. Lupus Erthematosus may be Systemic, meaning it can affect many body systems, or Cutaneous, where it’s affects are limited to the skin.

photo from LupusAdventureBetweenTheLines

photo from LupusAdventureBetweenTheLines

There are four different types of lupus:

  1. Systemic Lupus Erythematosus (SLE): organ and non-organ involvement
  2. Cutaneous Lupus (sometimes called discoid lupus): non-systemic discoid lupus
  3. Drug-Induced Lupus (DIL):  caused by certain medications that produce temporary lupus
  4. Neonatal Lupus:  affects some newbors born to mothers who have lupus

Drug-Induced Lupus and Neonatal Lupus can be cured with proper treatment. However since is no cure yet for Systemic Lupus SLE or Cutaneous Lupus, they tend to stay with  patients throughout their life.

Even though there can be some overlap of the symptoms of each type of lupus, each type affects the body differently. Doctors and health care teams must first diagnose the correct type of lupus before determining the best course of treatment and management of the disease.

Systemic Lupus Erythematosus (SLE)

Systemic Lupus Erythematosus, known as SLE for short (or Lupus SLE), is the most common form of lupus. SLE accounts for over 70% of all lupus cases. SLE is  usually considered more serious than the other three forms. The disease can range from mild to severe. SLE can affect nearly every part of a person’s body, including:

  • Kidneys: Kidney problems are common in lupus. Signs of kidney issues include leg swelling, weight gain, generalized itching, nausea and vomiting.
  • Heart: Lupus can inflame the heart muscle, heart membrane, and arteries, increasing the risk of heart disease and stroke.
  • Lungs: Lupus may cause the lining of the chest cavity to become inflamed, making breathing painful. It can cause lupus (such as a noninfectious form of pneumonia) can be monitored through pulmonary tests.
  • Brain: When Lupus affects the brain symptoms can include mild symptoms like headaches, dizziness, and confusion or severe symptoms like migraines, depression, behavior changes, psychosis, memory problems, and seizures.
  • Blood: Lupus can cause anemia and increased risk of bleeding or blood clotting.
  • Skin: Rashes, lesions and ulcers are common among lupus patients and may affect any area of the body but are usually found in areas that are most exposed to sunlight and fluorescent lighting like face, neck, scalp, and hands. Lesions and ulcers are usually found in mouth, nose, and groin/vaginal areas.
    Joints: The Lupus Foundation of America estimates that more than 90 percent of Lupus patients will experience joint and/or muscle pain at some time during the course of their illness. All joints are at risk, but most commonly hands and wrists are the chief complaint.

Another symptom is a rash over the cheeks and across the bridge of the nose, known as the malar rash. It’s commonly known as the butterfly rash as the shape on the face resembles butterfly wings.

It is known as “the great imitator” because the disease often mimics or is mistaken for other illnesses. Also, SLE symptoms vary from patient to patient and can follow an irregular pattern of remissions (symptoms disappear) and flares (active symptoms). Symptoms can also can change often and suddenly. This makes proper diagnosis complicated and many patients have years of symptoms before getting treatment.

Even when SLE is in remission, the disease itself has not left the body. Because of this, SLE patients need to work closely with their doctors, health care team and support system to manage and live with this disease.

Cutaneous Lupus

There are two types of Cutaneous Lupus, both of which are forms of lupus that affects the skin.  Symptoms of both may include rashes/lesions, changes in skin pigmentation, hair loss, vasculitis (swelling of the blood vessels), ulcers, and photosensitivity. Studies have shown that cigarette smoking and exposure to sunlight can worsen the discoid symptoms.

Another symptom is a rash over the cheeks and across the bridge of the nose, known as the malar rash. It’s commonly known as the butterfly rash as the shape on the face resembles butterfly wings.

  • Discoid lupus erythematosus (DLE): Rashes and lesions (sores) are primary symptoms of discoid lupus. They may appear anywhere on the body,  but are usually found on the face, neck and scalp or areas that are exposed to sunlight and fluorescent lighting. The most common rash—called discoid rash—is raised, scaly and red, but not itchy, and appear in areas shaped like a disk or a circle. Many people with DLE have scarring.  Rashes and sores may also appear in the nose, mouth and vagina. This type of lupus does not typically affect any of the internal body organs, however, 10% (1 in 10) of all discoid lupus patients will develop systemic lupus.
  • Subacute cutaneous lupus erythematosus makes up 10 percent of lupus cases. About 50 percent of the time, people with subacute cutaneous lupus also have SLE. Subacute cutaneous lupus causes skin lesions that appear on parts of the body exposed to sun. These lesions do not cause scars.

 

Drug-induced Lupus (DIL)

Drug-induced Lupus occurs after a person takes certain prescription medications. The symptoms can appear similar to Systemic Lupus, but they usually disappear when the person discontinues use of the medicine and rarely affect major organs. Symptoms may continue for six months after medications have stopped. Also, the Antinuclear Antibody (ANA) test, which is used to help diagnose lupus, may stay positive for years, even if the symptoms are no longer active.

Some medications that may cause drug-induced lupus are used to treat other chronic conditions, such as seizures, high blood pressure, or rheumatoid arthritis. Some examples include:

  • Hydralazine ((Apresoline®)—Treatment for high blood pressure or hypertension
  • Procainamide (Pronestyl®, Procanbid®) & Quinidine —Treatment for irregular heart rhythms
  • Isoniazid—Treatment for tuberculosis
  • Phenytoin (Dilantin®) — used to control seizures
  • Etanercept (Enbrel®) & Adalimumab (Humira®) — treats rheumatoid and psoriatic arthritis

Drug-induced lupus is more common in men because they take these drugs more often. Not everyone who takes these drugs will develop drug-induced lupus.

Neonatal Lupus

In rare cases, a mother with lupus may pass antibodies to her unborn baby, causing Neonatal Lupus. This condition can cause skin rashes, anemia or liver problems. Symptoms can last for several months but usually disappear without causing permanent damage. It doesn’t happen often but babies with neonatal lupus can be born with a serious heart defects and rhythm problems.

There is now testing that doctors can now use to help identify most at-risk mothers, and the infant can be treated even before birth.

 

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