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Article title: The Many Shades of Lupus: NIAMS
Publication Date: August 2001
Updated: February 2002
The Many Shades of Lupus
If you have lupus, you probably have many questions. Lupus isn't a simple disease with an easy answer. You can't take a pill and make it go away. The people you live with and work with may have trouble understanding that you're sick. Lupus doesn't have a clear set of signs that people can see. You may know that something's wrong, even though it may take a while to be diagnosed.
Lupus has many shades. It can affect people of different races, ethnicities, and ages, both men and women. It can look like different diseases. It's different for every person who has it.
The good news is that you can get help and fight lupus. Learning about it is the first step. Ask questions. Talk to your doctor, family, and friends. People who look for answers are more likely to find them. This booklet can help you get started.
- What Is Lupus?
- What Are the Signs and Symptoms of Lupus?
- What Is a Flare?
- What Causes Lupus?
- Who Gets Lupus?
- What Will the Doctor Do?
- Will I Get Medicine?
- How Can I Cope With Lupus?
- Hope Through Research
- Where Can People Find More Information About Lupus?
Lupus is an autoimmune (AW-toe-ih-MYOON) disease. Your body's immune system is like an army with hundreds of soldiers. The immune system's job is to fight foreign substances in the body, like germs and viruses. But in autoimmune diseases, the immune system is out of control. It attacks healthy tissues, not germs.
You can't catch lupus from another person. It isn't cancer, and it isn't related to AIDS.
Lupus is a disease that can affect many parts of the body. Everyone reacts differently. One person with lupus may have swollen knees and fever. Another person may be tired all the time or have kidney trouble. Someone else may have rashes. Lupus can involve the joints, the skin, the kidneys, the lungs, the heart and/or the brain. If you have lupus, it may affect two or three parts of your body. Usually, one person doesn't have all the possible symptoms.
There are three main types of lupus:
- Systemic lupus erythematosus (eh-RITH-eh-muh-TOE-sus) is the most common form. It's sometimes called SLE, or just lupus. The word "systemic" means that the disease can involve many parts of the body such as the heart, lungs, kidneys, and brain. SLE symptoms can be mild or serious.
- Discoid lupus erythematosus mainly affects the skin. A red rash may appear, or the skin on the face, scalp, or elsewhere may change color.
- Drug-induced lupus is triggered by a few medicines. It's like SLE, but symptoms are usually milder. Most of the time, the disease goes away when the medicine is stopped. More men develop drug-induced lupus because the drugs that cause it, hydralazine and procainamide, are used to treat heart conditions that are more common in men.
Lupus may be hard to diagnose. It's often mistaken for other diseases. For this reason, lupus has been called the "great imitator." The signs of lupus differ from person to person. Some people have just a few signs; others have more.
Common signs of lupus are:
- Red rash or color change on the face, often in the shape of a butterfly across the nose and cheeks
- Painful or swollen joints
- Unexplained fever
- Chest pain with deep breathing
- Swollen glands
- Extreme fatigue (feeling tired all the time)
- Unusual hair loss (mainly on the scalp)
- Pale or purple fingers or toes from cold or stress
- Sensitivity to the sun
- Low blood count
- Depression, trouble thinking, and/or memory problems
Other signs are mouth sores, unexplained seizures (convulsions), "seeing things" (hallucinations), repeated miscarriages, and unexplained kidney problems.
When symptoms appear, it's called a "flare." These signs may come and go. You may have swelling and rashes one week and no symptoms at all the next. You may find that your symptoms flare after you've been out in the sun or after a hard day at work.
Even if you take medicine for lupus, you may find that there are times when the symptoms become worse. Learning to recognize that a flare is coming can help you take steps to cope with it. Many people feel very tired or have pain, a rash, a fever, stomach discomfort, headache, or dizziness just before a flare. Steps to prevent flares, such as limiting the time you spend in the sun and getting enough rest and quiet, can also be helpful.
Preventing a Flare
- Learn to recognize that a flare is coming.
- Talk with your doctor.
- Try to set realistic goals and priorities.
- Limit the time you spend in the sun.
- Maintain a healthy diet.
- Develop coping skills to help limit stress.
- Get enough rest and quiet.
- Moderately exercise when possible.
- Develop a support system by surrounding yourself with people you trust and feel comfortable with (family, friends, etc.).
We don't know what causes lupus. There is no cure, but in most cases lupus can be managed. Lupus sometimes seems to run in families, which suggests the disease may be hereditary. Having the genes isn't the whole story, though. The environment, sunlight, stress, and certain medicines may trigger symptoms in some people. Other people who have similar genetic backgrounds may not get signs or symptoms of the disease. Researchers are trying to find out why.
Anyone can get lupus. But 9 out of 10 people who have it are women. African American women are three times more likely to get lupus than white women. It's also more common in Hispanic/Latino, Asian, and American Indian women.
Both African Americans and Hispanics/Latinos tend to develop lupus at a younger age and have more symptoms at diagnosis (including kidney problems).
They also tend to have more severe disease than whites. For example, African American patients have more seizures and strokes, while Hispanic/Latino patients have more heart problems. We don't understand why some people seem to have more problems with lupus than others.
Lupus is most common in women between the ages of 15 and 44. These are roughly the years when most women are able to have babies. Scientists think a woman's hormones may have something to do with getting lupus. But it's important to remember that men and older people can get it, too.
It's less common for children under age 15 to have lupus. One exception is babies born to women with lupus. These children may have heart, liver, or skin problems caused by lupus. With good care, most women with lupus can have a normal pregnancy and a healthy baby.
Diagnosis: How Do You Find Out If You Have Lupus?
- Medical history--Telling a doctor about your symptoms and other problems you have had can help him or her understand your situation. Your history can provide clues to your disease. Use the checklist at the end of this booklet to keep track of your symptoms. Share this checklist with your doctor. Ask your family or friends to help you with the checklist or come up with questions for your doctor.
- Complete physical exam--The doctor will look for rashes and other signs that something is wrong.
- Laboratory testing of blood and urine samples--Blood and urine samples often show if your immune system is overactive.
- Skin or kidney biopsy--In a biopsy, tissue that is removed by a minor surgical procedure is examined under a microscope. Skin or kidney tissue examined in this way can show signs of an autoimmune disease.
Go see a doctor. He or she will talk to you and take a history of your health problems. Many people have lupus for a long time before they find out they have it. It's important that you tell the doctor or nurse about your symptoms. This information, along with a physical examination and the results of laboratory tests, helps the doctor decide whether you have lupus or something else.
A rheumatologist (ROOM-uh-TALL-uh-jist) is a doctor who specializes in treating diseases that affect the joints and muscles, like lupus. You may want to ask your regular doctor for a referral to a rheumatologist.
In some cases, a dermatologist, a doctor who specializes in treating diseases that affect the skin, may be involved in diagnosis and treatment. No single test can show that you have lupus. Your doctor may have to run several tests and study your medical history. It may take time for the doctor to diagnose lupus.
Remember that each person has different symptoms. Treatment depends on the symptoms. The doctor may give you aspirin or a similar medicine to treat swollen joints and fever. Creams may be prescribed for a rash. For more serious problems, stronger medicines such as antimalaria drugs, corticosteroids, and chemotherapy drugs are used. Your doctor will choose a treatment based on your symptoms and needs.
Always tell your doctor if you have problems with your medicines. Let your doctor know if you take herbal or vitamin supplements. Your medicines may not mix well with these supplements. You and your doctor can work together to find the best way to treat all of your symptoms.
You need to find out what works best for you. You may find that a rheumatologist has the best treatment plan for you. Other health professionals who can help you deal with different aspects of lupus include psychologists, occupational therapists, dermatologists, and dietitians. You might find that doing exercises with a physical therapist makes you feel better. The important thing is to follow up with your health care team on a regular basis, even when your lupus is quiet and all seems well.
Dealing with a long-lasting disease like lupus can be hard on the emotions. You might think that your friends, family, and coworkers do not understand how you feel. Sadness and anger are common reactions.
People with lupus have limited energy and must manage it wisely. Ask your health care team about ways to cope with fatigue. Most people feel better if they manage their rest and work and take their medicine. If you're depressed, medicine and counseling can help.
- Pay attention to your body. Slow down or stop before you're too tired.
- Learn to pace yourself. Spread out your work and other activities.
- Don't blame yourself for your fatigue. It's part of the disease.
- Consider support groups and counseling. They can help you realize that you're not alone. Group members teach one another how to cope.
- Consider other support from your family as well as faith-based and other community groups.
It's true that staying healthy is harder when you have lupus. You need to pay close attention to your body, mind, and spirit. Having a chronic disease is stressful. People cope with stress differently. Some approaches that may help are:
- Staying involved in social activities
- Practicing techniques such as meditation and yoga
- Setting priorities for spending time and energy
Exercising is another approach that can help you cope with lupus. Types of exercise that you can practice include the following:
- Range-of-motion (for example, stretching) exercise helps maintain normal joint movement and relieve stiffness. This type of exercise helps maintain or increase flexibility.
- Strengthening (for example, weight-lifting) exercises help keep or increase muscle strength. Strong muscles help support and protect joints affected by lupus.
- Aerobic or endurance (for example, brisk walking or jogging) exercises improve cardiovascular fitness, help control weight, and improve overall function.
People with chronic diseases like lupus should check with their health care professional before starting an exercise program.
Learning about lupus may also help. People who are well-informed and take part in planning their own care report less pain. They also may make fewer visits to the doctor, have more self-confidence, and remain more active.
Women who want to start a family should work closely with their health care team; for example, doctors, physical therapists, and nurses. Your obstetrician and your lupus doctor should work together to find the best treatment plan for you.
Scientists are working to find out what causes lupus and how it can best be treated. Here are some of the questions they are trying to answer:
- Who gets lupus and why?
- Why are women more likely to get lupus than men?
- Why are there more cases of lupus among certain racial and ethnic groups?
- What goes wrong in the immune system and why?
- What genes play a role in lupus?
- How can we fix an immune system that isn't working well?
- How can lupus symptoms best be treated?
The National Institutes of Health (NIH) supports research on health and disease. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) supports research on the bones, joints, muscles, connective tissue, and skin. These are the parts of the body that can be affected by lupus. Research supported by NIAMS is looking at these issues:
- Certain genes make some people more likely to have serious complications, such as kidney disease. NIAMS researchers have found a gene linked to a higher risk of lupus kidney disease in African Americans. Changes in this gene keep the immune system from removing harmful germ-fighters from the body after they've done their job. Other genes may also play a role.
- Lupus is more common in women than in men. Researchers are looking into the role of hormones and other male-female differences.
- One NIAMS project is testing a new drug that scientists hope will have milder side effects than standard treatments. Another study is testing a combination of two medicines. One is a standard drug and the other is a new drug. Scientists hope that the combination will be more effective and cause fewer side effects.
NIH Information Sources
National Institute of Arthritis and Musculoskeletal and Skin Diseases
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or
877-22-NIAMS (226-4267) (free of charge)
The NIAMS, a part of the NIH, leads the Federal Government research effort in arthritis and other diseases that affect the muscles, bones, joints, and skin. The NIAMS supports research and research training throughout the United States, as well as on the NIH campus in Bethesda, Maryland. The NIAMS Office of Communications and Public Liaison provides health and research information for the public through the NIAMS Information Clearinghouse.
Clinical Trials at NIH
Phone: 800-411-1222 (free of charge)
Clinical trials are medical research studies to see whether new treatments are safe and effective. These studies help doctors learn how people respond to medicines or other new or improved treatments. This Web site provides patients, families, and the public with an easy way to get information about clinical trials. Links to the people who are recruiting participants for each study are also provided.
The National Library of Medicine's Web site for consumer health information
Department of Health and Human Services (DHHS) On-line Resources
The following Web sites can help you find additional sources of information about lupus:
The DHHS site for consumer health information
Combined Health Information Database
The NIH and the Centers for Disease Control and Prevention database of sources for consumer health information
American Academy of Dermatology
930 North Meacham Road
Schaumburg, IL 60168-4014
Phone: 847-330-0230 or
888-462-3376 (free of charge)
This national organization for dermatologists publishes brochures on skin problems such as acne, as well as those related to lupus. These brochures can be obtained by calling or writing the academy; they are also available on the organization's Web site. The academy can also provide referrals to dermatologists.
American Academy of Orthopaedic Surgeons
6300 North River Road
Rosemont, IL 60018-4262
Phone: 800-346-AAOS (2267) (free of charge)
This academy publishes brochures on arthritis and other subjects. Single copies of a brochure are available free of charge by sending a self-addressed, stamped (business-size) envelope to (name of brochure) at the address above.
American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345
This association provides referrals to doctors and health professionals who treat arthritis and other rheumatic diseases like lupus. The association also provides educational materials and guidelines.
American Autoimmune Related Diseases Association
22100 Gratiot Avenue E.
Detroit, MI 48021-2227
Phone: 800-598-4668 (free of charge)
The AARDA is dedicated to the eradication of autoimmune diseases and the alleviation of suffering and the socioeconomic impact of autoimmunity through fostering and facilitating collaboration in the areas of education, research, and patient services in an effective, ethical, and efficient manner. The organization provides patient information on lupus and other diseases on its Web site. Additional information can be ordered; a voluntary donation is requested for patient information.
1330 West Peachtree Street
Atlanta, GA 30309
Phone: 404-872-7100 or
800-283-7800 (free of charge)
or your local chapter listed in the telephone book
The Arthritis Foundation is the major voluntary organization devoted to supporting research into arthritis and other rheumatic diseases, like lupus, and providing education and other services to people with rheumatic diseases. This foundation publishes free pamphlets on lupus and many other topics. Local chapters provide many services in the community, such as exercise classes, self-help courses, and support groups.
Lupus Foundation of America
1300 Piccard Drive, Suite 200
Rockville, MD 20850
Phone: 301-670-9292 or
800-558-0121 (free of charge)
or your local chapter listed in the telephone book
The LFA is the main voluntary organization devoted to lupus. The LFA assists local chapters in providing services to people with lupus, works to educate the public about lupus, and supports lupus research. Through a network of more than 500 branches and support groups, the chapters provide education through information and referral services, health fairs, newsletters, publications, and seminars. Chapters provide support to people with lupus, their families, and friends through support group meetings, hospital visits, and telephone help lines.
149 Madison Avenue, Suite 205
New York, NY 10016
Phone: 212-685-4118 or 800-74-LUPUS (745-8787) (free of charge)
The SLE Foundation supplies literature on a variety of lupus-related issues to anyone who requests it. In addition, the foundation offers a referral service to knowledgeable lupus specialists. The foundation produces and distributes a newsletter several times a year and offers a variety of events and lectures by medical experts.
Print out this page and use it to make notes to take to your doctor. Put a check mark beside the symptoms you have. Note when you experienced them. Symptom Where? When did you first notice? How
rash face and chest 2 years ago Once or twice a month 9/17, 10/8, 10/23, 11/15 Red rash or color change Painful or swollen joints Unexplained fever Chest pain with deep breathing Unusual hair loss Pale or purple fingers or toes Sensitivity to sun Other
Do You Have Lupus or a Related Condition?
You may be able to help scientists learn more about these conditions.
For information about research projects near your home, call the
You could make a difference!
The NIAMS thanks the following people and organizations for their contribution to this project:
Arthritis Foundation Metropolitan Washington Chapter, Lupus Foundation of Greater Washington, Lupus Foundation of America, Barbara Mittleman, M.D., Clifton A. Poodry, Ph.D., Laura Robbins, D.S.W., Cheryl Contreras, M.P.I.A., Patricia Fraser, M.D., M.P.H., M.S., Lori Harrison Port, M.P.H., and Bobbie Drake-Saucer.
Special thanks go to our focus group participants and patients with lupus who reviewed this publication and provided valuable input.
This booklet is provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases in cooperation with the Arthritis Foundation Metropolitan Washington Chapter.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. The NIAMS Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. Additional information and research updates can be found on the NIAMS Web site at http://www.niams.nih.gov/hi/index.htm.
This booklet is not copyrighted. You can make copies of it and give out as many as you want.
For more copies, contact
National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) Information Clearinghouse
National Institutes of Health (NIH)
1 AMS Circle
Bethesda, MD 20892-3675
NIH Publication No. 01-4958
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