Lupus Treatment in Hyderabad, India

Lupus disease is diagnosed through a combination of clinical assessment, laboratory tests, and, in some cases, tissue biopsies. Since there is no single test that can definitively diagnose the condition, a variety of strategies are used to evaluate symptoms, review medical history, and interpret test results for an accurate diagnosis. The rheumatologist considers the following lupus diagnosis criteria before selecting the appropriate tests.

• Medical history and family history 
• Physical examination 

Medical history and family history

The primary goal during the medical history phase of the lupus diagnostic process is to gather comprehensive information about the patient’s symptoms, including their pattern, duration, and any previous episodes, as well as their family history of autoimmune diseases. A rheumatologist can diagnose the condition by asking the following questions:

• When did your symptoms first begin, and how have they progressed?
• How long have you experienced joint pain?
• Are the affected joints painful on both sides of your body (symmetrical)?
• How many joints are involved?
• Do you experience joint stiffness, swelling, or warmth?
• Have you had any unexplained fevers or unusual fatigue?
• Have your symptoms affected your daily activities or ability to perform tasks?
• What makes your symptoms better or worse?
• Have you noticed any rashes, especially on your face or after-sun exposure?
• Does anyone in your family have lupus or other autoimmune diseases?
• Have you had ulcers in your mouth or nose?

Physical examination

• Systemic lupus erythematosus (SLE) presents with diverse physical findings across multiple systems. General symptoms often include low-grade fever and fatigue, with occasional lymphadenopathy and splenomegaly. 
• Common skin manifestations are malar rash, photosensitivity, discoid lesions, oral or nasal ulcers, and non-scarring alopecia. 
• Musculoskeletal involvement typically presents as non-erosive arthritis or arthralgia, especially in the proximal interphalangeal (PIP), metacarpophalangeal (MCP), and wrist joints. Renal signs such as hypertension (HTN), hematuria (blood in urine), and proteinuria (excess of proteins in urine) may indicate lupus nephritis. 
• Cardiopulmonary findings include pleuritis, pericarditis, myocarditis, and systolic murmurs, which may reflect valvular involvement like Libman-Sacks endocarditis. 
• Abdominal pain may suggest serositis or mesenteric vasculitis.
• Neurological symptoms such as seizures, psychosis, or stroke are possible, with thrombotic events more common in males. Raynaud’s phenomenon is frequent, particularly in women.
• Ophthalmologic assessment is essential for detecting retinal vasculitis from active disease and screening for drug-induced maculopathy.
  

✅Diagnostic Evaluation of Lupus

Based on the above information, a rheumatologist advises the diagnostic tests to detect lupus. The following are the tests that might be recommended to diagnose lupus or systemic lupus erythematosus:

• Laboratory test
• Antinuclear antibodies (ANA) testing 
• Additional antibody testing if ANA is positive, includes 
• Antiphospholipid antibodies
• Anti-smith antibodies
• Anti-double-strand DNA antibodies
• Complement tests (C3 and C4)
• Complete blood counts (CBC)
• Kidney function tests 
• Liver function tests 
• Urinalysis 
• Urine protein-to-creatinine ratio
• C-reactive protein and Erythrocyte sedimentation rate (ESR)
• Imaging tests
• Computed tomography (CT) scan or Magnetic resonance imaging (MRI)
• Chest X-rays 
• Tissue biopsies
• Skin biopsy
• Kidney biopsy

Laboratory tests 

• Antinuclear antibodies (ANA)testing: It is a highly sensitive tool for detecting lupus, as nearly all individuals with lupus will have a positive Antinuclear antibodies (ANA) result. However, a positive ANA alone is not specific to lupus, as it can also be found in healthy individuals or in those with other autoimmune conditions. Therefore, ANA results must be considered along with clinical symptoms and other diagnostic findings.
• Antiphospholipid antibodies( aPL): These are commonly found in patients with systemic lupus erythematosus (SLE), with 30–40% testing positive. These antibodies are associated with an elevated risk of blood clots, pregnancy complications, and other clinical issues known as antiphospholipid syndrome (APS). Although not all lupus patients with aPL develop APS, those who do may experience complications such as thrombosis, thrombocytopenia (low platelet count), and recurrent pregnancy loss.
• Anti-smith antibodies: These are autoantibodies found in the blood and are strongly associated with systemic lupus erythematosus (SLE). Although not present in all individuals with the disease, their presence is definite to SLE and is included as part of the diagnostic criteria.
• Anti-double-strand DNA antibodies: These are important autoantibodies found in the blood of individuals with SLE. They play a key role in the diagnosis and monitoring of the disease and are strongly associated with lupus, particularly lupus nephritis. However, while they are highly specific, their absence does not completely rule out the diagnosis.
• Complement tests (C3 and C4): These are helpful in lupus diagnosis and monitoring, especially during flares. Low levels may suggest active disease, especially with kidney involvement like lupus nephritis. However, they are not specific to lupus, as levels can be normal during flares or low in other conditions. Monitoring helps assess disease activity and treatment response.
• Complete blood count: In lupus, complete blood counts (CBC) are essential for detecting common hematologic abnormalities. These include anemia (low red blood cell count), and thrombocytopenia (low platelet count), leukopenia (low white blood cell count), which can result from the disease itself or its treatment. Monitoring CBC helps assess disease activity and guide management.
• Kidney function tests: In lupus, kidney function tests are essential for detecting lupus nephritis, a common and dangerous side effect of the condition. Serum creatinine, estimated glomerular filtration rate (eGFR), and blood urea nitrogen (BUN) are the most commonly used tests to evaluate kidney function. Monitoring is important for early kidney damage detection and therapy guidance.
• Liver function tests: These are used to evaluate liver health and detect any liver involvement or damage in patients with lupus. These tests measure levels of proteins and bilirubin to assess liver function. Monitoring LFTs is essential, especially since some lupus medications can affect the liver.
• Urinalysis: It is performed to detect proteinuria, hematuria, or cellular casts, which can indicate kidney involvement in lupus.
• Urine protein-to-creatinine ratio: When measuring proteinuria in lupus patients, the urine protein-to-creatinine ratio is a crucial test. Through the calculation of urine protein excretion in relation to creatinine, it is possible to evaluate the degree of kidney involvement, especially in lupus nephritis. Monitoring disease activity and directing treatment choices are two benefits of this test.
• CRP(C-reactive protein) and ESR (Erythrocyte sedimentation rate): These levels can be high in SLE and any other inflammatory disease. If both indicators are significantly elevated, suspect the presence of an infectious process. In SLE flares, the ESR elevation level may differ from a normal CRP level. ESR lags behind illness changes, and CRP values fluctuate significantly. 

Imaging tests 

• Computed tomography (CT) or Magnetic resonance imaging (MRI): These are used in lupus to evaluate neurological involvement, such as seizures, psychosis, or stroke-like symptoms. They help detect brain abnormalities, including inflammation, infarcts, or white matter changes associated with neuropsychiatric lupus. CT and MRI are valuable tools for evaluating central nervous system complications and guiding appropriate management. 
• Chest X-rays: These are helpful in diagnosing and monitoring lupus, especially when there is involvement of the lungs, heart, or musculoskeletal system. Although lupus itself is not directly visible on X-rays, related complications such as pleural effusion (fluid around the lungs) can be detected. X-rays can also show bone and joint changes, aiding in the differentiation of lupus from other conditions like rheumatoid arthritis.

Tissue biopsies

• Skin biopsy: It is a crucial diagnostic tool in lupus, particularly when characteristic skin rashes are present. It helps in confirming cutaneous lupus, that can resemble other dermatologic conditions. The procedure involves removing a small skin sample for microscopic examination. In some cases, a direct immunofluorescence (DIF) test also known as the lupus band test is performed on the biopsy to detect antibody deposits at the dermo epidermal junction, supporting the diagnosis of lupus. 
• Kidney biopsy: A kidney biopsy is a crucial lupus diagnostic test, particularly in cases when lupus nephritis is suspected. A tiny sample of kidney tissue is taken for microscopic analysis in order to determine the kind and extent of kidney involvement. Biopsy aids in prognostic estimation, therapeutic guidance, and lupus nephritis stage classification. It is especially helpful when kidney function is compromised or when urine contains blood or protein.

✅Lupus Differential Diagnosis

Lupus differential diagnosis means figuring out whether a person has systemic lupus erythematosus (SLE) or another illness with similar symptoms. This is required since a precise diagnosis of lupus requires a thorough examination of numerous aspects, as the condition can mimic a wide range of other conditions. The following conditions are frequently considered:

• Rheumatoid arthritis: It can be challenging to distinguish rheumatoid arthritis (RA) from SLE since it might exhibit a variety of extra-articular symptoms in addition to the traditional polyarticular inflammatory arthritis. RA patients may also have positive ANA, Anti-Ro, and Anti-La antibodies, while hypocomplementemia and other SLE-specific autoantibodies are uncommon. Rheumatoid factor can be positively correlated with SLE, but anti-CCP is negative in systemic lupus erythematosus (SLE).
• Drug-induced lupus: It may be challenging to distinguish drug-induced lupus from SLE, particularly when the two conditions have many clinical and serological characteristics. The absence of more severe symptoms and the remission of symptoms following drug withdrawal are characteristics of drug-induced lupus, even if autoantibodies may continue to be positive for years.
• Adult-onset Still: The illness is marked by splenomegaly, fever, lymphadenopathy, and arthralgia; however, there is no malar rash or other organ symptoms, and there are no autoantibodies typical of SLE.
• Behcet disease: This condition lacks the typical systemic and serological characteristics of SLE but manifests as arthralgia, uveitis, and aphthous ulcers.
• Sarcoidosis: It manifests as rash, uveitis, fever, cough, dyspnea, exhaustion, and night sweats. It displays bilateral adenopathy and non-caseating granuloma on chest radiography, which are uncommon in SLE.
• Infective endocarditis: It is characterized by symptoms such as fever, arterial emboli, arthralgia, myalgia, and the presence of a heart murmur. It can sometimes be mistaken for cardiac manifestations of systemic lupus erythematosus (SLE). However, it can be differentiated by the absence of SLE-specific autoantibodies and the presence of positive blood cultures.
• Parvovirus B19 infection: It can present with rash, fever, inflammatory arthritis, and cytopenias, which may mimic autoimmune conditions. Antinuclear antibodies (ANA) and rheumatoid factor have also been reported in some cases, potentially leading to diagnostic confusion with diseases like lupus.
• Hepatitis B and C infections: These infections can be associated with arthralgia or inflammatory arthritis and may also show positive antinuclear antibodies (ANA) and rheumatoid factor. These features can resemble autoimmune conditions, making careful evaluation essential for accurate diagnosis.
• Cytomegalovirus (CMV) and Epstein-Barr Virus infections: These infections can resemble lupus flares, presenting with fever, fatigue, cytopenias, and transaminitis. Distinguishing them from active SLE is important, especially in immunosuppressed patients.
• HIV: It can mimic lupus with symptoms like fever, fatigue, oral ulcers, and cytopenias. However, it lacks SLE-specific autoantibodies and systemic features. Positive viral serologies help differentiate it from lupus.
• Non-Hodgkin’s lymphoma: It can mimic lupus with symptoms like fatigue, fever, arthralgia, cytopenias, lymphadenopathy, and positive ANA, but lacks SLE-specific autoantibodies. Cancer screening is important for elderly patients with lupus-like symptoms.
  

The main goals of treatment for lupus or systemic lupus erythematosus (SLE) include:

• To manage symptoms effectively to improve daily comfort and function.
• To maintain the lowest possible level of disease activity, aiming for complete remission when possible.
• To prevent, limit, or stop disease flares to maintain stability.
• To prevent or slow organ damage to preserve long-term health.
• To enhance quality of life through ongoing care and support.
  

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There is currently no cure for lupus or systemic lupus erythematosus (SLE). Treatment primarily focuses on reducing inflammation, protecting organs, and preventing flare-ups. The most effective approach includes a personalized treatment plan based on the people’s specific needs and it depends on the type of lupus, the severity of inflammation, and the extent of organ involvement or damage. The following are the different systemic lupus erythematosus treatment options:

Nonpharmacological Treatment 

• Physical exercise: In lupus patients, regular aerobic and resistance exercise has been demonstrated to increase mood, lessen fatigue, and improve quality of life. Exercise programs need to be tailored to each person's abilities and limitations.
• Psychological interventions: Depression, anxiety, and stress are common in people with lupus and can be managed with cognitive behavioural therapy, mindfulness-based cognitive therapy, group psychotherapy, and psychoeducation.
• Smoking cessation: Smoking raises cardiovascular risk and exacerbates lupus symptoms. Hence, smoking needs to be stopped.
• Photoprotection: Patients need to wear protective clothing, apply sunscreen, and limit their sun exposure, as ultraviolet (UV) light can trigger lupus flares.
• Complementary therapies: Acupuncture, meditation, and massage may be beneficial for specific individuals. However, the evidence supporting their effectiveness is weaker compared to that for psychological and physical therapies.
• Diet and nutrition: Although there is no specific diet for lupus, eating a healthy, balanced diet can improve overall health and help control symptoms.
• Patient education and self-management: Educating patients about lupus, including its management and self-care techniques, empowers them to control their condition better and recognise flare-ups at an early stage.

Pharmacological Treatment

• Antimalarial drugs: These are recommended for nearly all lupus patients unless contraindicated. They help reduce disease activity, prevent flares, and are effective in managing skin and joint symptoms. Regular eye exams are advised due to the rare risk of retinal toxicity.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications are used to relieve pain, swelling, and fever in mild cases, particularly for joint and muscle symptoms. Prescription-strength NSAIDs may be used if necessary; however, long-term use can pose risks to the gastrointestinal system, kidneys, and cardiovascular health.
• Corticosteroids: These medications are used to rapidly control inflammation, especially during flares or in cases involving major organs such as the brain or kidneys. High doses may be required for severe disease; however, long-term use is minimized due to potential risks including weight gain, osteoporosis, hypertension, and increased susceptibility to infections.
• Immunosuppressants: These medications suppress the immune system and are used in cases of moderate to severe lupus or when corticosteroids alone are not sufficient. They help prevent organ damage but carry an increased risk of infection and need regular monitoring to manage potential side effects.
• Biologics: These targeted therapies are used in patients with refractory or severe lupus. They specifically target components of the immune system involved in lupus activity, helping to reduce disease severity and manage symptoms more effectively.
  

Systemic lupus erythematosus (SLE) continues to be linked to substantial morbidity and elevated mortality despite improvements in treatment. The main causes of death are cardiovascular disease, infections and renal problems, with ten-year survival rates ranging from 85% to 90%. Improved patient outcomes can be achieved through early diagnosis, suitable treatment, and regular monitoring for problems. Male sex, renal involvement (especially diffuse proliferative glomerulonephritis), very young or old age at onset, hypertension, low socioeconomic status, high disease activity, African American ethnicity, and the presence of antiphospholipid antibodies or antiphospholipid antibody syndrome are all considered poor prognostic indicators.

What is lupus?

Lupus, also termed as systemic lupus erythematosus (SLE), is a chronic (long lasting) autoimmune disease that can affect various internal organs and systems. In individuals with lupus, the immune system, designed to protect the body from illness and infection, mistakenly attacks healthy tissues. This abnormal immune response results in inflammation and, in some cases, permanent tissue damage. Lupus can impact multiple parts of the body, including the skin, joints, heart, lungs, kidneys, blood cells, and brain.

What is the meaning of lupus?

The word "lupus" originates from the Latin term lupus, meaning "wolf." It was first used in the late 14th century to describe skin diseases that caused severe sores or ulcers. The name was likely chosen due to the damage to the skin, which appeared as if it had been eaten away, same as a wolf's bite. In early medical texts, it was sometimes referred to simply as "wolf." Over time, the term became specifically associated with systemic lupus erythematosus (SLE), the autoimmune disease known today.

Is lupus deadly?

Yes, lupus can be life-threatening if it causes serious damage to important organs such as the kidneys, heart, or brain. However, with early diagnosis and proper treatment, most people can manage the disease effectively and live long, healthy lives. Medical advancements have significantly improved the prognosis for individuals with lupus.

What are the 4 types of lupus?

Lupus is an autoimmune disease with 4 different types. The most common is Systemic Lupus Erythematosus (SLE), which affects multiple organs. Cutaneous Lupus (CLE) involves only the skin, while Drug-Induced Lupus is triggered by certain medications and usually resolves when the drug is stopped. Neonatal Lupus is a rare form seen in newborns of mothers with lupus or related autoimmune diseases.

Is lupus genetic?

No, lupus does not follow a simple genetic pattern; genetic factors play an important role in its development. The condition is believed to result from an interaction between genetic predisposition and environmental triggers. While not everyone with genetic markers will develop lupus, people with a family history of the disease have a higher likelihood of being affected.

What is lupus nephritis?

It is a severe form of systemic lupus erythematosus (SLE), a chronic autoimmune illness that primarily affects the kidneys but also causes inflammation and damage to other organ systems. This illness considerably raises the risk of end-stage renal disease (ESRD) and frequently appears three to five years after the onset of SLE.

Does lupus cause weight gain?

Yes, lupus can be associated with both weight gain and weight loss, although weight gain is more commonly observed. It can cause fatigue and decreased physical activity, that may result in weight gain. In addition, medications such as corticosteroids, commonly prescribed to manage lupus, can also result in increased weight.

Is lupus a chronic illness?

Indeed, lupus is a chronic condition. It is a chronic autoimmune condition that alternates between flare-ups, when symptoms worsen, and remissions, when symptoms improve or subside. Numerous bodily parts may be impacted by lupus, which can lead to inflammation and possible organ and tissue damage.

How is lupus transmitted?

Lupus cannot be transferred from one person to another and is not communicable. Because it is an autoimmune illness, the body's defenses unintentionally target its own healthy tissues. Environmental factors combined with genetic susceptibility result in the development of lupus.

How to prevent lupus?

Although lupus cannot be completely avoided, there are things one may do to lower their chance of getting it or to control its symptoms if they already have it. These include altering one's lifestyle to avoid too much sun exposure, managing stress, and keeping up a regular exercise and nutrition regimen.