Actress, singer and makeup mogul Selena Gomez has been candid about her experience of living with lupus. Since 2015, Gomez has documented on social media and in interviews the effect the condition has had on her health.
In 2017, the actress shared that she’d undergone a kidney transplant due to lupus-related organ damage. Then, earlier this month, Gomez said on a podcast that she’s developed arthritis related to her lupus symptoms.
Selena Gomez’s story has raised important awareness of the wide-ranging health impacts associated with lupus. But even still, many people may not know exactly what lupus is – nor how it can have such widespread affects on the body.
What is lupus?
Lupus is an autoimmune condition. This means the immune cells malfunction and attack parts of the body instead of potential pathogens – causing inflammation and damage.
There are two common forms of lupus. Discoid lupus affects the skin, causing painful rashes. Systemic lupus erythematosus (SLE) is more severe and can affect multiple organs. It’s estimated around 3.4 million people worldwide are living with SLE.
In SLE, the immune cells target our DNA, as well as the proteins that help to package our DNA within a cell’s nucleus (information hub). This improper immune response allows the disease to affect nearly every major organ system in the body. This includes the skin (causing a butterfly-shaped rash over the nose and cheeks), kidneys, brain, heart, lungs and the joints.
Up to 95% of people living with systemic lupus will experience arthritis or joint pain. Fatigue and pain can also have a significant affect quality of life for people living with lupus.
Other lesser-known complications from SLE include an increased risk of developing cardiovascular disease and cancers – most commonly lymphoma.
Who is most at risk?
What causes lupus and why the immune system malfunctions remains unknown. However, we do know that women are much more likely to develop systemic lupus. It’s estimated that 90% of those diagnosed with lupus are women. It’s also more common in women of reproductive age.
According to research my colleagues and I have recently published, these gender differences may partly be due to the influence of different sex hormones on immune cell function.
People who are Hispanic, Asian, Black or Indigenous are also more likely to develop SLE than white people. Black people have a five- to nine-fold greater risk of SLE compared to white people.
It has also been shown that Black people living with SLE are more likely to die early compared to white people living with SLE. This is probably due to the complex interplay between socioeconomic factors (such as access to healthcare) and differences in how the immune system functions.
How is lupus treated?
Lupus remains an incurable disease, but can be managed through treatment.
Lupus is characterised by periods where the disease flares up and periods where it’s in remission (where there are few symptoms). The aim with treatment is to keep the disease in remission. However, this can be a complex journey – and may take time to find the right drug that works for a patient.
During flare-ups, symptoms are typically managed with steroids. These quickly dampen immune system function to prevent damage to the body. But long-term steroid use can have multiple side-effects – including changes to bone health and eye health (leading to cataracts and glaucoma). As such, doctors try to limit steroid usage as much as possible.
Alongside steroids, disease-modifying anti-rheumatic drugs are used to stop flare-ups and keep lupus-triggered inflammation at bay. These drugs modulate the immune system and suppress it.
Biologics, which are a type of anti-rheumatic drug, selectively target the parts of the immune system that cause lupus inflammation. But while these drugs are effective at dampening inflammation, many patients report that they do not always help with fatigue and pain.
Crucially, certain lupus treatments (and especially one called cyclophosphamide) can also cause fertility problems, such as menstrual irregularities and a reduced number of eggs in the ovaries. They do this by affecting the health of the ovarian follicles (structures which house eggs in the ovary).
Although new therapies introduced over the last 20 years have drastically reduced mortality associated with systemic lupus, current research estimates that it can still take up to five years to be correctly diagnosed. This can lead to more organ damage – and eventually worse disease outcomes.
It’s clear we still desperately need more research into the causes of the condition so we can improve treatments and quality of life for people living with the condition.
What’s next for lupus treatments?
Despite these challenges, there are some exciting innovations happening in the field of lupus research.
This includes repurposing a form of cancer therapy that uses a patient’s own immune cells (T cells) and engineers them to destroy cancer cells. These cells, called CAR-T cells, are now being engineered to recognise malfunctioning parts of the immune system to help some people living with lupus achieve long-term disease remission.
Researchers are also looking to identify predictive lupus “biomarkers” (signs of the disease that can be detected in a blood sample). This will help identify how different people will respond to certain lupus treatments, which would be an important first step in being able to personalise treatments to each patient.
Our understanding of the biological processes causing lupus continues to grow each year. With continued awareness of the disease and the many ways it can affect daily life, we’re getting closer to identifying treatment targets that may someday help cure the condition.
Elizabeth Rosser receives funding from the Medical Research Foundation, the Lister Institute for Preventive Medicine and the Kennedy Trust for Rheumatology Research.
This article was originally published on The Conversation. Read the original article.
