DEAR MAYO CLINIC: A good friend was diagnosed with lupus. Can you tell me more about it, how it's treated and if there are new options that could make a difference in her quality of life?
ANSWER: Lupus is an autoimmune disease, which means the body’s immune system mistakenly attacks its own tissues. The exact cause isn't fully understood, but it likely involves a combination of genetic, environmental and immune system factors.
What makes lupus especially challenging is that it can affect many different organ systems — including the skin, joints, kidneys, heart and lungs — and may look different from one person to another. Infections, certain medicines or even sunlight can trigger the condition.
Lupus is more common in women — particularly between the ages of 15 and 45 — but it can occur at any age. Symptoms can vary widely and look like other diseases, making it difficult to recognize. Lupus causes swelling and inflammation that can affect joints, skin, kidneys, blood cells, brain, heart and lungs.
Symptoms
The most-common symptoms are:
- Tiredness.
- Fever.
- Joint pain, stiffness and swelling.
- Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose, or rashes on other parts of the body that get worse when in the sun.
- Fingers and toes that turn white or blue when cold or during times of stress.
- Shortness of breath.
- Chest pain.
- Headaches, confusion and memory loss.
For some people, these symptoms come on suddenly; for others, they appear slowly. They may be active for a short time or become long-lasting. People may experience intense flare-ups that fade over time. When symptoms resolve, the person is considered in remission.
Because symptoms can be vague and overlap with other conditions, lupus can take time to diagnose. Sometimes it's detected through abnormal blood tests, such as anemia or changes in kidney function. When making a diagnosis, clinicians consider a person's symptoms, blood tests and, in some cases, biopsy results.
Treatment
Currently, there's no cure for lupus, so care focuses on customized therapies for each patient's symptoms and to prevent organ damage. Most therapies work by suppressing the immune system. Common treatments include medications such as:
- Prednisone, a corticosteroid, to quickly reduce inflammation.
- Hydroxychloroquine, an antimalarial drug, as a long-term therapy.
- Medications tailored to protect the affected organs.
While these treatments control symptoms for many patients, they typically need to remain on medication long term.
For those with moderate to severe or treatment-resistant lupus, these treatments may not be enough, and over time, can increase the risk of infection and other side effects. A key goal is to develop targeted, long-lasting treatments.
One emerging area of lupus treatment research is chimeric antigen receptor-T cell therapy (CAR-T cell therapy). CAR-T cell therapy is used most often to treat cancers that affect blood cells. It's now being studied for autoimmune diseases such as lupus.
In lupus, certain immune cells, called B cells, play a central role. Current therapies that target B cells often provide only temporary or partial benefits.
CAR-T cell therapy for lupus takes a different approach. It involves:
- Collecting a patient's own immune cells.
- Engineering them in a lab to recognize and attack B cells.
- Returning them to the body after a brief course of chemotherapy.
The goal is to more effectively eliminate B cells throughout the body and potentially provide a longer-lasting response.
Early clinical trials of CAR-T cell therapy in patients with severe, treatment-resistant lupus have shown promising results. In small studies, some patients have achieved remission and were able to reduce or stop other lupus medications.
However, these results are still preliminary and limited to a small group of patients. Researchers also are continuing to study the safety of this therapy and how long the benefits may last.
While lupus remains a lifelong condition, treatment options continue to improve. Current therapies can help many people manage symptoms and achieve remission. Emerging treatments like CAR-T cell therapy offer hope for more targeted, long-lasting solutions in the future.
Uma Thanarajasingam, M.D., Ph.D., Rheumatology, Mayo Clinic, Rochester, Minnesota
