Why does lupus particularly favor women? How serious is it?

On the evening of December 12, 2023, Zhou Haimei's studio issued a statement saying that actress Zhou Haimei passed away on December 11 due to illness.

Previously, there were rumors that Zhou Haimei "has been suffering from lupus erythematosus for a long time". Therefore, terms related to "lupus erythematosus" immediately became hot searches, triggering widespread discussion.

So, what exactly is lupus? Why does it prefer women? Let’s talk about it in detail today.

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Lupus erythematosus is not a skin disease but an autoimmune disease

Although we don’t hear much about it, lupus is actually a global health problem. According to the Lupus Foundation of America, more than 1.5 million people in the United States are affected by the disease, and the number of patients worldwide is at least 5 million. In China, there are more than 1 million lupus patients, and the prevalence rate is the second highest in the world. Its actual prevalence is much higher than people think.

Lupus is a systemic autoimmune disease. As we all know, under normal circumstances, the immune system protects us from being harmed by pathogens, but the immune system of lupus patients becomes confused, misidentifies the target, and turns to attack our own body, causing various injuries, and the first to bear the brunt are the skin, joints, blood, kidneys and brain.

These organs and tissues, under the attack of the immune system, will develop various inflammations and tissue damage, which is why the symptoms of lupus erythematosus are complex and varied.

Nephrologists are one of the doctors who most often see lupus patients, because the kidneys are one of the most commonly affected organs. According to statistics, about 40% to 60% of lupus patients will experience kidney damage in the early stages of the disease, and 17% to 25% of lupus nephritis patients may develop end-stage renal disease, also known as uremia.

In addition, childhood lupus erythematosus, i.e. lupus erythematosus that develops before the age of 18, accounts for about 20% of all cases. The incidence of childhood lupus erythematosus has been on the rise in recent years.

What causes lupus?

Why is it more common in women?

So what causes this disease? Unfortunately, so far, the scientific community still has no conclusive single conclusion on the cause of lupus erythematosus - just like we cannot accurately answer how most cancers occur.

But like cancer, we have found some factors that make people more likely to develop lupus. In a sense, it is a combination of genetics, hormones and environment.

Scientists have discovered more than 50 genes related to lupus, which are like some special codes in the body that may make people more susceptible to the disease. In other words, if someone in the family has had lupus, it means that members of the family may be more likely to get lupus. However, having these genes does not necessarily mean that you will get sick. For example, if a pair of twins have these genes, one may get lupus, but the other may not.

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In addition, lupus is more common in women, and scientists have found that estrogen may be responsible. Although there is no evidence to prove a direct cause-and-effect relationship between estrogen or any other hormone and lupus, many women experience more severe lupus symptoms before their menstrual period or during pregnancy, when estrogen levels are higher, suggesting that hormones may play a role in regulating lupus activity.

In addition to genes and hormones, environmental factors may also be one of the causes of lupus erythematosus. For example, ultraviolet rays from the sun, certain infections, or taking certain medications may all be external causes of the disease.

If you have multiple symptoms, you may need to consider lupus erythematosus

Since we don’t know which organ will be attacked first or which organ is most likely to show symptoms when the immune system has problems, we need to pay attention to the following common symptoms of lupus:

Fatigue and fever: Patients may experience persistent fatigue and a low-grade fever. These symptoms are caused by systemic inflammation due to an overactive immune system.

Joint pain, stiffness and swelling: These symptoms usually occur in joints such as the wrists, fingers and knees, affecting daily activities and quality of life.

Facial butterfly-shaped rash: This is one of the most typical signs of lupus erythematosus, usually appearing on the cheeks and bridge of the nose, and is shaped like butterfly wings.

Sun sensitivity: The skin of people with lupus may be allergic to sunlight, and sun exposure may trigger or worsen skin lesions.

Fingers and toes change color in response to cold or stress: This is called "Raynaud's phenomenon," where a person's fingers or toes may change color to white or blue in response to cold or stress.

Shortness of breath and chest pain: These symptoms may indicate that lupus is affecting the lungs or heart.

Dry eyes and vision problems: Lupus may cause dry eyes and vision problems.

Headaches, confusion, and memory loss: These neurological symptoms may occur when lupus affects the brain.

Among them, the "China Systemic Lupus Erythematosus Development Report 2020" recommends: When women of childbearing age have repeated fevers, they need to pay attention to whether they often have oral ulcers and joint swelling and pain. Combined with the symptoms, they should consider whether it may be a problem with immunity. In addition to seeing a doctor for the symptoms, you can also consider seeking help from an immunologist and additional blood tests, which may be able to detect lupus erythematosus early.

In addition, lupus may cause a variety of complications, such as kidney disease, brain and central nervous system problems, blood and vascular diseases, lung inflammation and heart problems, etc. Among them, thrombocytopenia is one of the typical symptoms of lupus patients.

This is because the immune system indiscriminately attacks and destroys healthy platelets, and may also cause the spleen to swell, which in turn hinders the circulation of platelets. And certain drugs used by lupus patients, such as cyclosporine, mycophenolate mofetil, and azathioprine, may also inhibit the production of platelets in the bone marrow, leading to thrombocytopenia.

Platelets are a type of cell in the blood that helps the blood clot and prevent bleeding. Therefore, when platelets are severely reduced, the most likely symptom is bleeding that does not stop. In addition, there may be bruises, prolonged bleeding from small wounds, small red spots on the skin, heavy menstrual periods or fatigue, and severe bleeding after severe impact or trauma, which can also lead to death.

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4 common lupus myths

1. Does lupus erythematosus always cause facial erythema?

Not necessarily. The immune system of lupus patients will indiscriminately attack organs throughout the body, so the symptoms of lupus are diverse. However, the skin, especially the facial skin, attracts more attention, so facial rashes are the most common and often the first to be noticed.

2. Lupus erythematosus has a genetic tendency, so patients cannot have children?

Not necessarily. Lupus itself does not affect the patient's fertility. However, in order to avoid the risks to the mother and fetus, birth control needs to be planned in advance, because many lupus treatment drugs are contraindicated during pregnancy.

Generally speaking, it is best to try to conceive after the disease has been stagnant for 6 months using medications suitable for pregnancy, and a pre-pregnancy evaluation is required. Patients who want to conceive should ideally continue to use medications suitable for pregnancy and continue taking them during pregnancy.

However, if lupus patients become pregnant when their disease activity is high (especially nephritis) or they have severe associated injuries (such as pulmonary hypertension, cardiovascular disease), the morbidity and mortality rates are high, and the fetal outcome is poor.

In addition, lupus itself is not a hereditary disease, but there is a certain genetic tendency, which is a problem that lupus patients need to consider. In other words, if someone in the family has had lupus, then the child may be more likely to get it.

3. Do lupus patients need to use hormones for life?

Not necessarily. Hormone therapy is a way to control lupus erythematosus, but not all patients need to use it for life. The treatment plan should be determined according to the severity of the disease and individual differences.

4. Can I stop taking the medicine on my own after lupus erythematosus is cured?

No. Lupus is a chronic disease with a risk of relapse. Patients can stop taking medication, but they must not stop taking medication on their own. Please trust your doctor and follow the doctor's advice on treatment and medication use.

References

[1]Lupusfactsandstatistics: https://www.lupus.org/resources/lupus-facts-and-statistics

[2]SystemicLupusErythematosus(SLE)|CDC：SystemicLupusErythematosus(SLE)|CDC

[3]https://www.uptodate.com/contents/zh-Hans/epidemiology-and-pathogenesis-of-systemic-lupus-erythematosus?topicRef=4668&source=see_link

[4]https://www.niams.nih.gov/zh-hans/health-topics/langchuang

[5]https://www.mayoclinic.org/zh-hans/diseases-conditions/lupus/symptoms-causes/syc-20365789

[6] Li YZ, Wu XC. Research progress in systemic lupus erythematosus from 2021 to 2022. Zhongguo Dang Dai Er Ke Za Zhi. 2023 Aug 15; 25(8): 785-790. Chinese. doi: 10.7499/j.issn.1008-8830.2302150. PMID: 37668024; PMCID: PMC10484082.

This article is a work of Science Popularization China-Starry Sky Project

Produced by: Science Popularization Department of China Association for Science and Technology

Producer｜China Science and Technology Press Co., Ltd., Beijing Zhongke Xinghe Culture Media Co., Ltd.

Author: Chen Mo'ao, Master of Epidemiology and Health Statistics

Reviewer: Tang Qin, Director and Researcher of the Science Popularization Department of the Chinese Medical Association