A. My 43-year-old sister-in-law was recently diagnosed with lupus. What is lupus? Is it contagious? —[email protected] Q. Lupus is one of the more common autoimmune diseases, a protean group of disorders that affect women more often than men. There are more than 80 different autoimmune diseases. Most occur rarely, but taken together, they afflict millions all over the world. An autoimmune disease arises when the body’s immune system, which consists of trillions of cells that fight off disease-causing microorganisms and other harmful foreign substances that attack the body, goes awry, mistakes the body’s own cells as invaders, and attacks them. There are two kinds of lupus, discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE). Discoid lupus usually affects only the skin. It is characterized by circular (discoid) skin lesions that often leave scars after healing. SLE, on the other hand, which is what is generally referred to when we say lupus, is a more serious disorder because it inflames and damages various tissues and organs, including joints, muscles, and skin, along with the lungs, heart, kidneys, and brain. Although it can occur in both sexes, 90 percent of people diagnosed with SLE are women. It generally strikes between ages 15 and 44, although it can occur in older individuals. ENDING LUPUS Celebrities who suffered from lupus are (Clockwise from top left) Cindy Frey; Toni-Braxton; Selena Gomez; Nick Cannon; Lady Gaga; and Seal What gives rise to lupus? No single factor is known to cause lupus, and a combination of genetic, hormonal, environmental, and immune system factors may be behind it. Lupus, and this answers your second question, is not contagious. The disease is sometimes triggered or exacerbated by viral and bacterial infections, aging, hormonal imbalance, severe emotional stress, overexposure to sunlight, and intake of certain drugs such as hydralazine and procainamide. What are the symptoms of lupus? SLE is characterized by alternating periods of active attacks during which symptoms are present, and remissions or symptomless periods. The length of active and symptomless periods is highly variable. The symptoms of lupus differ from one person to another. They depend on the part of the body that is affected. Likewise, some people have only a few symptoms, while others have many. Most people with active lupus feel ill in general and complain of fever, weight loss, and fatigue. Other common symptoms include achy and swollen joints, skin lesions that typically include a butterfly–shaped rash across the cheeks and nose, hair loss, and sores in the mouth, photosensitivity, and pale or purple fingers or toes from cold or stress (Raynaud’s phenomenon).   Complications of SLE SLE gives rise to serious problems if it attacks or affects vital tissues and organs such as the kidneys, blood, heart, lungs, and brain. Kidney involvement in people with lupus can be life threatening and may occur in up to half of those with lupus. Blood involvement gives rise to anemia, reduction in the number of white blood cells, which makes the person susceptible to infections, and reduction of platelets, which can cause bleeding. Heart and lung involvement often is caused by inflammation of the covering of the heart (pericardium) and lungs (pleura). When these structures become inflamed, patients may develop chest pain, irregular heartbeat, and accumulation of fluid around the lungs and heart. The heart valves and the lung itself can also be affected by lupus, resulting in shortness of breath. Brain involvement is, fortunately, a rare problem in lupus. When present, it may manifest as confusion, depression, seizures, and, rarely, strokes.   How is lupus diagnosed and treated? A set of criteria is used by doctors in making the correct diagnosis of lupus. The criteria take into account the patient’s signs and symptoms and the results of blood tests, including antinuclear antibody (ANA) test. Some people with mild features of SLE do not even require treatment. In contrast, those with serious involvement (such as kidney and heart complications) require powerful medications that have dangerous adverse effects. Medical treatment of lupus generally focuses on reducing the activity of the immune system activity. Drugs used include steroids, imuran, hydroxychloroquine, and chemotherapeutic agents such as cytoxan and methotrexate. The outlook for lupus varies depending on the organs involved and the severity of symptoms. Most people with lupus can expect to have a normal lifespan, especially if they religiously follow their doctor’s instructions and their treatment plans.   Email inquiries on health matters to: [email protected]