Lupus and Other Associated Diseases

Systemic lupus erythematosus (SLE) is the most common and serious form of lupus, as discussed in our previous article. It is a chronic autoimmune disorder that has a wide array of complications, as vital organs and systems are affected by the increased levels of inflammatory molecules and autoantibodies, as well as medications used in treatment.

In this article, we will explore some diseases that patients with SLE are commonly at risk for developing. 

Other Autoimmune Diseases 

In 80% of patients, lupus presents first before other autoimmune diseases such as rheumatoid arthritis start to manifest. About one in three patients diagnosed with lupus are prone to developing a second or third autoimmune disease, some of which include

Atopic Dermatitis (Eczema)

Patients with lupus are twice as likely to suffer from atopic dermatitis as compared to the healthy population. 

Autoimmune hepatitis  

Blood disorder that can cause jaundice and other digestive and gastrointestinal diseases.

Autoimmune thrombocytopaenia

Platelets (cell fragments involved in blood-clotting) are being attacked, making one more susceptible to bruising and bleeding. 

Autoimmune thyroid disease

Including Hashimoto’s disease, Hyperthyroidism and Hypothyroidism  

Myasthenia gravis 

Weakness in the arm and leg muscles, including problems with day to day activities such as impediments to speech, walking and swallowing. 

Rheumatoid arthritis 

Tissues in the joints are attacked by autoantibodies, resulting in swelling and pain. 

Scleroderma 

A group of rare diseases that causes the hardening of skin and connective tissues and is more apparent in women, occurring between the ages of 20 to 50.  

Sjogren’s syndrome

10% of lupus patients also suffer from this disorder of the immune system that causes drying out of parts of orifice mucosal tissue, mainly dry eyes and dry mouth. 

Heart Diseases

Coronary Heart Disease

Atherosclerosis is accelerated in SLE patients due to inflammatory mechanisms, steroid therapy and renal disease which cause increased plaque volume/build-up in arteries. . Coronary heart disease (CAD) is due to the resultant decreased blood flow to heart and when the blood flow is completely blocked, a heart attack occurs.

Research has shown that women with lupus (SLE) aged 35-44 are >50 times more likely to suffer from a heart attack than healthy women of a similar age, and for everyone with lupus the risk is increased 7 to 9-fold. 

Pericarditis 

The most common heart problem associated with active lupus and present in 25% of those who suffer from SLE is pericarditis. Pericarditis is the inflammation of the sac around the heart. Patients usually suffer from chest pain and shortness of breath, which are worse when lying down. Often, NSAIDs or steroids are effective in reducing the inflammation associated with this condition.

Further complications that could arise include pericardial effusion, which is the filling of the pericardium with inflammatory fluid. The fluid may compress the heart, causing cardiac tamponade, where the heart is unable to fill completely or contract properly; resultant poor blood flow and a lack of oxygen to the body is life-threatening and requires emergency treatment. In addition, the pericardial fluid can also become infected by bacteria, causing infectious pericarditis.

Myocarditis 

Myocarditis is a rare and fatal SLE complication and can be found in about 10% of patients. It is the inflammation of the myocardium or heart muscle tissue. This may also cause impairment in the contractile function of the heart and unable to pump blood efficiently. This can lead to heart failure or sudden cardiac death. The time between the onset of SLE and clinical presentation is about 8 to 9 years. To treat lupus myocarditis, high doses of corticosteroid treatments are administered. 

Endocarditis

Libman-Sacks Endocarditis (LSE) is an asymptomatic, rare and fatal inflammation of the heart walls and valves that affects 15% of lupus patients, especially those with anti-phospholipid antibodies. This condition causes the developments of growths (vegetations) on the surface of the heart valves. This can lead to infections, as vegetations are prime sites for bacterial growth, usually necessitating surgical replacement of infected valve. In addition, pieces of a vegetation can break off and travel through the blood stream, potentially blocking blood flow to the brain and causing a stroke. If you have a heart vegetation, your doctor will prescribe an anticoagulant to reduce this risk.

Kidney Disease

Lupus Nephritis is a very common kidney disease amongst SLE patients, with up to 60% of them developing kidney problems within the first five years of lupus onset. Lupus nephritis occurs due to lupus autoantibodies destroying kidney structures e.g. glomeruli and consequent loss of waste-filtering function.

This in turn causes kidney inflammation which can lead to blood in the urine (haematuria), protein in the urine (proteinuria), high blood pressure in the kidneys from overworking (renal hypertension) and eventual impaired kidney function. Since kidney inflammation rarely manifests symptoms or pain in the early stages, it is essential to evaluate renal function through urine and blood tests in SLE patients regularly as early detection can significantly improve renal health. 

Osteoporosis 

Patients with SLE are at high risk of osteoporosis due to the inflammatory activity of the disease, as well as chronic use of corticosteroids, which can lead to bone mass loss (Osteopenia) and develop into osteoporosis over time, resulting in weakened bones and a higher risk of fractures. 

Conclusion

Many autoimmune conditions and other related diseases can occur in patients with lupus. Early diagnosis and effective treatments can help reduce the damaging effects of SLE and improve the chance to have better function and quality of life.