Lupus

What is lupus?

Lupus is a serious condition in which the body’s own immune system mistakenly produces molecules, called antibodies, that recognise a person’s own tissue. This ‘autoimmune’ attack can result in damage to a variety of organs.

The most severe form of lupus is systemic lupus erythematosus (SLE), which often affects many organs. Usually, the skin and joints are most affected, but damage can also occur to the kidneys, lungs, heart, brain and blood vessels.

Lupus can be difficult to diagnose. Many of its symptoms can be confused with other conditions. Symptoms can also vary between people, depending on which tissues the disease-causing antibodies attack.

In the long term, and also as a result of treatment, people with lupus are at an increased risk of:

• infection
• cancer
• bone thinning
• complications associated with pregnancy

In Australia, it is estimated that at least 20,000 people have lupus. Lupus places a substantial economic burden on our community. People with lupus have long-term healthcare needs and often have reduced quality of life.

It is not known what triggers the misdirected immune response that causes lupus. Immune cells called B cells normally produce antibodies that protect the body against infection. There are many safeguards to prevent the production of harmful antibodies that target body tissues rather than foreign organisms. In lupus these safeguards seem to be circumvented. Find out how the immune system is normally controlled.

Immunology research has provided many clues to how changes in the immune system contribute to lupus. For example, defects in the machinery that controls cell death can lead to ‘autoimmune’ B cells that can cause lupus.

The immune system also contains cells that stifle unwanted immune responses. If these cells are not functioning properly, autoimmune attacks on body tissues can occur.

The triggers for lupus are poorly understood. Some factors that are associated with developing lupus are:

• being female: 90 per cent of Australians with lupus are women.
• early adulthood: most cases of lupus are detected in people aged between 15 and 45.
• genetic susceptibility: lupus is more prevalent in some families and some racial groups. Lupus is more prevalent and more severe in Aboriginal Australians than in the wider Australian population.
• sunlight exposure can be a trigger in susceptible people.

There is no cure for lupus, but treatment can reduce symptoms and help prevent long-term organ damage.

Treatments are aimed at dampening the immune response, and reducing inflammation. Some of the medicines prescribed to treat lupus are:

• anti-inflammatory drugs: reduce tissue inflammation in the short term.
• certain antimalarial drugs: work gradually to reduce some of the symptoms of lupus.
• immune suppressing drugs and biologic drugs: powerful drugs that dampen the immune system and are used for more severe cases of lupus.

The current treatment options for lupus are limited. They all come with a risk of potentially serious side-effects, such as susceptibility to infection. There is a need for more effective treatments for lupus, and a better understanding of how the disease develops.

Further information for people living with lupus can be found at:

• State lupus organisations such as the Lupus Association of NSW
• Australasian Society of Clinical Immunology and Allergy
• Arthritis Australia