What Is Lupus? A Rheumatologist Breaks Down Causes, Symptoms, and Lifestyle Strategies That Can Help

Systemic lupus erythematosus, commonly known as lupus, is a chronic autoimmune disease. Lupus can affect any of the body’s organs but most commonly affects the joints, skin, and kidneys. Lupus can range in severity from mild to life-threatening, depending on the organs involved and the degree of the symptoms. An estimated5 million peopleworldwide suffer from the disease.

Types

Symptoms

Diagnosis

Causes

Triggers

Treatment and Management

Success Stories

How Lupus Works

Lupus is an autoimmune disease in which the immune system attacks the DNA and nuclei of its own cells when cells break apart. Thepathophysiologyis complex and involves both the innate and adaptive immune systems, but lupus predominantly has to do with overactive B cells (which belong to the adaptive immune system). Interferons, the part of the immune system that fights viruses, may also be overactive in lupus patients.

This educational video from Osmosis by Elsievir does a great job of showing how SLE works.

https://www.youtube.com/watch?v=0junqD4BLH4&t=10s

Types of Lupus

Lupus can come in many different forms. Lupus in general is called systemic lupus erythematosus (SLE) and can affect many different organs in the body. Other forms include lupus nephritis (lupus of the kidneys); neuropsychiatric lupus (lupus involving the brain); drug-induced lupus (lupus induced from medications); and cutaneous lupus (lupus affecting the skin only).

Symptoms

The manifestation of lupus varies from patient to patient. While some patients can have only one or two symptoms of lupus, others will exhibit many more. Symptoms can present in multiple organs and can range from mild to life-threatening. Some common ones include:

Rashes on the face or body

Fatigue

Arthritis

Brain fog

Hair loss

Photosensitivity

Oral ulcers or nasal ulcers

Chest pain

Shortness of breath

Lupus can also affect the functioning of the kidneys, nerves, and brain, as well as different blood cell types, potentially causing anemia, low platelets, and low white blood cell count.

Diagnosis

Lupus is typically diagnosed by rheumatologists based on a number of different clinical symptoms and laboratory values. The American College of Rheumatology published updatedclassification criteria for SLEin 2019 to help clinicians to determine if a patient has lupus.

What Causes Lupus?

Available researchsuggeststhat a combination of genetic, environmental, and hormonal factors cause lupus.

Research has indicated that there isagenetic component to lupus.Multiple genes have been implicated in SLE development, with a 2010 study published inNature Reviewsfinding more than 30 genetic associations with the disease. A study published in 2018 in theSeminars of Arthritis and Rheumatismfound that twins of lupus patients were more likely to develop lupus or other autoimmune diseases.

Environmental factors,particularly obesity, can also influence lupus risk. In a prospective cohort study among 238,130 women in the Nurses Health Studies, obese participants were85 percent more likelyto have SLE than participants with normal BMIs. One possible explanation for this association is that obesity can contribute to gut dysbiosis. Additionally, an excess of adipocytes (fat cells) can push the immune system toward inflammatory pathways.

Women are much more likely than men to suffer from lupus, representing roughly 90 percent of all lupus cases, and women between the ages of 15 and 44 are the most likely to develop the disease. This may be becauseestrogenstimulates the production of antibodies, making autoimmune responses more likely.

Certain dietary elements are generally inflammatory and thus prone to making lupus worse. These include excess salt, highly processed foods, processed and red meats, and refined sugar—all of which are common in the standard American diet.High-fat dietscan potentially worsen lupus, as well.

In addition to causing inflammation directly,highly processed foodscan promote weight gain and obesity.Obesity, in turn, can contribute to chronic inflammation that heightens the risk of developing autoimmune diseases, including lupus.

Interestingly, a studypublished in 2015found that lupus patients had higher levels of AGEs (advanced glycation end-products),inflammatory compounds found in the highest concentrations in animal products and fried foods.

Triggers

Any factors that put stress on the body can exacerbate lupus and cause symptoms to flare up. Common triggers for SLE flare-ups include:

Stress

Lack of sleep

UV radiation

Smoking cigarettes

Viruses

Bacterial infection

Hormonal fluctuations (particularly estrogen)

How to Treat and Manage Lupus

While there is no cure for lupus, there are ways to manage it. Medications can be an essential part of managing SLE, but lifestyle changes can help reduce and relieve symptoms of autoimmune disease, as well.

Gut dysbiosis—an imbalance in the gut microbiome—has been closely associated with multiple autoimmune diseases,including lupus, rheumatoid arthritis, multiple sclerosis, and inflammatory bowel disease. It is unclear at this time whether gut dysbiosis in lupus occurs as a result of the disease itself or occurs prior to the actual disease onset.In either case, fostering a healthier gut microbiome can be a boon for autoimmune health, since up to70 percentof the immune system is located in the gut. Fruits and vegetables, which are rich in fiber and phytonutrients, are excellent for promoting a healthy gut microbiome.

Chia seedsand flax seeds are high in fiber as well as omega-3 fatty acids, which can potentially decrease lupus disease activity. Polyphenols in fruits and vegetables exert anti-inflammatory activity, as well. Turmeric and ginger have powerful phytonutrients that can help decrease inflammation.

Fiber also seemsprotectiveagainst lupus disease activity. After systematically reviewing 184 studies on diet and SLE, the authors of a2020 reportpublished inFrontiers in Immunologyrecommended that lupus patients consume a low-calorie, low-protein diet that contains plenty of fiber, polyunsaturated fatty acids, vitamins, minerals, and polyphenols.

In astudy published in Lupusin January 2022, researchers surveyed SLE patients about their experiences using dietary changes to manage their symptoms. The greatest reduction in symptoms was reported among those who reduced their intake of dairy and processed foods and those who reported trying a vegan diet.

In addition to the dietary changes mentioned above, SLE is largely managed by medications.Hydroxychloroquineis often the first-line medication. Azathioprine, mycophenolate mofetil, belimumab, and other immunomodulators are also used for management.

Lifestyle modifications that can help with all autoimmune-related issues includeimproving sleep quality, exercising regularly, and decreasing stress levels.

Patients should consult with their rheumatologists to determine an optimal treatment plan.

Success Stories

Read these inspiring stories from patients who reduced their lupus symptoms after adopting a whole-food, plant-based diet.

I Overcame Lupus with a Plant-Based Diet

From Crippling Lupus to Living Pain-Free on a Plant-Based Diet

After a Stroke, This Doctor Reversed Her Lupus With a Plant-Based Diet

Ready to get started? Check outForks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path. To learn more about a whole-food, plant-based diet, visit ourPlant-Based Primer.