Systemic Lupus Erythematosus (SLE), or lupus in Icelandic, is an autoimmune disease that causes the immune system to become overactive and start producing antibodies against its own cells. When the disease is active, the immune response can cause inflammation in the body's cells, which can affect one or more of its tissues: skin, joints, muscles, blood vessels, blood cells, brain and nerves, as well as other organs such as the lungs, heart, kidneys, digestive system and/or the membranes surrounding internal organs. The presentation of the disease varies between individuals but is characterised by periods where the disease is either active or in remission.

Discoid Lupus (DLE): DLE is usually a disease that only affects the skin and rarely affects internal organs, i.e. it rarely progresses to SLE. If left untreated, DLE can cause scarring. Research suggests that 5–12% of those with DLE may develop SLE, which affects more organs.

Lupus is six to nine times more common in women than in men, and usually presents in women of childbearing age. However, it can also present in children and postmenopausal women. People of African and Asian descent are more likely to develop the disease.

Environmental factors such as infections, stress and sunlight can have an effect and even trigger the disease.

Lupus is not caused by lifestyle or injuries, but is an autoimmune disease.

Symptoms vary greatly between individuals, but common ones include:

• Fatigue.
• Body aches and muscle aches.
• Flu-like symptoms.
• Skin rash (including the classic 'butterfly' rash on the cheeks and nose).
• Hair loss.
• Sores in the mouth.

Symptoms from internal organs:

• Chest pain or pleurisy (pleuritis).
• Kidney disease.
• Inflammation of the nervous system or brain.

In addition, some patients with lupus are prone to blood clots (thrombosis).

If you find:

•  for persistent fatigue, joint pain or a rash.
• swollen joints that last for several weeks.
• for unexplained flu-like symptoms.
• changes in skin or hair.
• symptoms from the eyes (e.g. red eyes or visual disturbances).
• or has symptoms of kidney problems (e.g. changes in urine).

If red wolves are suspected, it is important to get a medical assessment, and you will often be referred to a rheumatologist.

Analysis is based on:

1. Medical history and symptoms
2. Physical examination
3. Blood tests and urine tests
4. Exclusion of other diseases

Research may include:

• Blood tests (blood count, inflammatory markers, kidney, liver, hormones, vitamins)
• Autoantibodies (e.g. ANA and anti-dsDNA)
• Urinalysis (to assess kidney function)
• Imaging (X-ray, ultrasound, MRI)
• Electrocardiogram and lung tests

Diagnosis can be complicated as the disease presents in different ways.

The aim of treatment is to:

• to reduce symptoms
• reduce inflammation
• to prevent organ damage

Drug therapy:

• Hydroxychloroquine (Plaquenil) – first-line treatment for mild to moderate disease
• Corticosteroids – used temporarily for increased activity
• Immunosuppressant drugs – e.g. methotrexate and azathioprine
• Biologics – e.g. rituximab and belimumab
• Anti-inflammatory drugs – for mild pain

Regular monitoring is important, especially for potential side effects of medication.

• Schedule breaks during the day, manage your workload by spreading tasks out throughout the day, take regular meal breaks and ensure you get enough sleep, and you may need to consider making further changes when flare-ups occur.
• Minimise stress by considering lifestyle changes that make life more manageable. Maintaining good communication with and receiving support from doctors, family members and employers is beneficial. Regular exercise also helps to reduce fatigue and lower stress.
• Avoid environmental factors that affect the disease. It is important to avoid sunlight and excessive heat, and to treat infections early. Vaccinations with non-live virus vaccines are safe and effective, as the benefits outweigh the risks. However, it may be necessary to avoid vaccination when the disease is active.
• It is important to monitor your symptoms closely and contact a doctor if they suggest the disease is becoming more active, in order to prevent severe flare-ups.
• Smoking has adverse effects and can reduce the effectiveness of the medicines used to treat the disease.
• It is important to look after your general health, take vitamin D, have your cholesterol checked annually, and maintain a healthy blood pressure.
• Be under regular review by a rheumatologist.

In short, SLE is a potentially serious disease that can affect almost any system in the body. We do not yet know what causes it. The outlook for living a good quality of life has improved in recent years, and most patients with SLE will continue to have a relatively mild disease. If the disease is diagnosed early and treated appropriately at its initial stage, the symptoms of lupus can be kept under control. With good cooperation, support and collaboration between the patient, family and doctor, the problems associated with the disease can be significantly reduced.