Lupus (Systemic Lupus Erythematosus)

Systemic lupus erythematosus is an autoimmune disease in which the immune system attacks the body's own tissues, producing inflammation in the skin, joints, kidneys, blood cells, lining of the heart and lungs, and sometimes the brain. It mostly affects women, usually starting between 15 and 45, and is more common and often more severe in people of African, Asian and Hispanic ancestry.

Lupus follows a course of flares and quieter periods and differs greatly between people. Some have only rashes and joint pain; others have organ involvement, of which kidney inflammation is the most important. It cannot be cured, but modern treatment allows most people to live a near-normal lifespan, provided monitoring is regular.

Symptome

• Profound fatigue
• Pain and swelling in the small joints of the hands, wrists and knees, without joint destruction
• A butterfly-shaped rash over the cheeks and nose, and rashes after sun exposure
• Mouth or nose ulcers
• Hair thinning
• Fingers turning white then blue in the cold (Raynaud's phenomenon)
• Chest pain on deep breathing from inflammation of the lung or heart lining
• Unexplained fever and swollen glands
• Frothy urine, ankle swelling or raised blood pressure, suggesting kidney involvement

Ursachen und Risikofaktoren

The exact cause is unknown. A genetic predisposition combines with triggers that set off and sustain the immune reaction. Recognised triggers are ultraviolet light, infections including Epstein-Barr virus, smoking, and oestrogen, which helps explain the female predominance and flares around pregnancy. Certain medicines, including hydralazine, procainamide, isoniazid, minocycline and anti-TNF drugs, cause drug-induced lupus that resolves when they are stopped. Lupus is not infectious. The risk for a child of an affected mother is raised but still low.

Wie es diagnostiziert wird

• Clinical assessment: No single test makes the diagnosis. Rheumatologists combine symptoms, examination and laboratory results using classification criteria.
• Antinuclear antibody (ANA): Positive in nearly everyone with lupus, so a negative result makes it unlikely. A positive ANA alone is common in healthy people and does not mean lupus.
• Specific antibodies and complement: Anti-dsDNA and anti-Sm are specific for lupus. Low C3 and C4 with rising anti-dsDNA suggest active disease.
• Blood count, kidney function and urine protein: Look for low blood cells and early kidney involvement at every visit.
• Antiphospholipid antibodies: Identify a raised risk of blood clots and miscarriage.
• Kidney biopsy: Classifies lupus nephritis and determines how intensive treatment must be.

Behandlungsmöglichkeiten

• Hydroxychloroquine: Recommended for almost everyone with lupus. It reduces flares, protects organs and improves survival. Yearly eye checks are advised after 5 years of use.
• Sun protection and lifestyle: High-factor sunscreen, no smoking, exercise, vitamin D, and control of blood pressure and cholesterol, since lupus raises cardiovascular risk.
• Corticosteroids: Bring flares under control quickly. The aim is the lowest dose for the shortest time because of long-term harm.
• Immunosuppressants: Methotrexate, azathioprine or mycophenolate to control disease and spare steroids; cyclophosphamide for the most severe organ involvement.
• Biologic and newer medicines: Belimumab and anifrolumab for active disease despite standard therapy; voclosporin or belimumab added for lupus nephritis; rituximab in selected cases.
• Pregnancy planning: Conceive after at least 6 months of quiet disease, on pregnancy-safe medicines, with joint care from rheumatology and obstetrics.

Wenn es dringend ist

Seek emergency care locally for chest pain or breathlessness, a swollen painful leg, severe headache, seizures, confusion or stroke-like symptoms, very little or dark urine with swelling, high fever while on immunosuppressants, or heavy unexplained bruising or bleeding. Severe flares and infections in lupus can escalate quickly.

Reisen nach Türkiye zur Behandlung

Lupus needs blood and urine monitoring every few months for life and a rheumatologist who can respond to flares, so ongoing care must be local. A visit can reasonably offer a second opinion on an uncertain diagnosis or a treatment plan, with a full antibody panel, imaging and, if indicated, a kidney biopsy review within about a week. Avoid travelling during a flare, protect yourself from strong sun, carry enough medication, and check vaccine advice, as live vaccines are unsuitable on many lupus treatments.

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