According to the Lupus Foundation of America, up to 1.5 million people in the United States live with lupus. This number grows by more than 16,000 new cases each year. Like other rheumatic conditions, lupus is difficult to diagnose because it presents a wide range of symptoms that are often mistaken for symptoms of different diseases and vary widely from person to person. Though there is still much to learn about the condition, medical science is developing new approaches to lupus diagnosis, treatment options, and care, quickly revolutionizing therapies to control symptoms better and foster disease remission.
Lupus Disease Profile
Lupus is a disease of immune system overactivation and dysregulation. The immune system attacks the body’s tissues, and that attack can lead to damage in many different parts of the body. There is no known cause for lupus, but lupus likely results from several factors interacting. Researchers have found that several hormonal, environmental, and genetic factors that predispose people to the disease.
Though no single gene or group of genes has been proven to cause lupus, it does appear in certain families. According to the Lupus Foundation, studies suggest that there is an increased risk of developing lupus if a family member has been diagnosed. Most lupus cases are sporadic, meaning no known relative has the disease. Although lupus can develop in people with no family history of lupus, there are often other autoimmune diseases in other family members.
Types of Lupus
There are several types of lupus, but the most common type is systemic lupus erythematosus (SLE). SLE accounts for 70% of lupus cases. At its most severe, SLE can affect multiple organs and systems throughout the body, causing inflammation of the:
- Skin
- Joints
- Lungs
- Kidneys
- Blood
- Heart
- Other organs
Other types of lupus are specific to the part of the body most affected by the disease. For example, cutaneous lupus (such as discoid lupus erythematosus [DLE]) is a skin disease affecting people with or without SLE. Lupus nephritis is when Systemic Lupus Erythematosus affects the kidneys.
Lupus in Women and Racial & Ethnic Minority Communities
Anyone can get lupus. Still, according to the U.S. Centers for Disease Control and Prevention, ten times more women than men have the condition. The CDC reports about nine out of 10 diagnoses of lupus are in women ages 15 to 44 or during their childbearing years when estrogen is highest.
Although people of all races and ethnicities can have the disease, some racial and ethnic minority groups are more genetically susceptible than others. African American women are three times more likely than white, non-Hispanic women to have lupus. Lupus is also more common in Hispanic, Asian, Native American and Alaska Native women.
African-American and Hispanic women usually get lupus at a younger age and have more severe symptoms, such as kidney issues, than women of other groups. African-American women with lupus tend to have more problems with seizures, strokes, and dangerous swelling in the lining of the heart called pericarditis.
Targeted Therapies for Treating Lupus
Historically, lupus has been treated with medications that suppress the entire immune system, such as steroids like prednisone. These therapies are effective, but with long-term use, patients risk serious side effects, like:
- Weight gain
- Poor bone health
- Increased risks for infections
Over the last 50 years, research has focused on developing new lupus therapies that act more narrowly, affecting only a minor element of the immune system’s operation. These “targeted therapies” have changed the treatment plan landscape and paved a new way for lupus research.
Newer Medications Used to Treat Lupus
- The FDA approved Benlysta (belimumab)—the first targeted therapy for lupus— in 2011 to treat systemic lupus in adults. Belimumab blocks or kills the B cells that cause tissue damage in people with lupus. In healthy people, B cells produce antibodies - proteins that float in the blood and fight infection. In patients with lupus, the B cells are abnormally regulated, making antibodies that bind to the body’s healthy cells. Belimumab is now FDA-approved for lupus patients with or without kidney involvement.
- Voclosporin (lupkynis), a calcineurin inhibitor developed in the 1990s as a transplant medication, was approved in 2021 for use in the treatment of lupus nephritis cases. Calcineurin inhibitors interfere with the action of the protein calcineurin, which contributes to certain types of immune system overactivity.
- In 2021, the FDA approved Saphnelo (anifrolumab-fnia), a targeted therapy for treating adults with systemic lupus. Saphnelo, a human monoclonal antibody, dampens many lupus patients' excessive type I interferon signature. Interferons signal the immune system to be activated when an infection is detected. In patients with lupus, the balance has been destabilized so that too many unnecessary interferon signals are getting through, leading to inflammation in different body parts, which can cause a person to become ill. Saphnelo has been shown to dampen these signals and improve lupus symptoms.
New Therapies Approved for Treatment Show Promise in Clinical Trials.
As several new lupus medications have received U.S. Food and Drug Administration (FDA) approval, others have demonstrated benefits in early clinical trials, and there’s hope that more approvals will follow soon. From new monoclonal antibody therapies to advancements in how the disease’s activity is monitored in patients’ urine, scientists are rapidly innovating lupus treatment and care. Many drugs—either novel medicines or treatments that have proven effective against other conditions—are now under investigation in clinical trials or awaiting approval.
Antibody Treatments
Obinutuzumab is a monoclonal antibody treatment that works by depleting the blood’s B cells. Some research has found that it can help people with systemic lupus who have not responded well to other medications. Other monoclonal antibody treatments, such as obexelimab, have been found to help extend symptom remission among many people with lupus. Another new medication, daratumumab, targets long-lived white blood cells that are thought to contribute to lupus-related immune overactivity.
The Road Ahead for Lupus Research
Part of what makes lupus research challenging is that the precise problem with the immune system is so different among patients and is often caused by more than one underlying issue.
Because no two patients are alike, personalized approaches to care and treatment are necessary. For some people—perhaps even a majority with systemic lupus—a single drug may not be sufficient to address the heterogeneous nature of the condition, and much work is now looking at how combinations of existing drugs may help patients with specific subtypes of SLE.
Big Data Effective in the Treatment Pursuit
In the past 20 years, new technology, collectively called ‘Big Data,’ has allowed thousands of data points to be assessed in individual lupus patients and compared to healthy control groups. Scientists hope these new analytical methods will help inform new treatment models in ways that reduce side effects and improve responses.
Research Into Treatment Outcomes for Women & Minorities
There is also promising newly funded research focused on women and people of color. Because of lupus’ disproportionate impact on racial and ethnic minority communities, it is critical to advance research into treatments for lupus and increase diversity in clinical research to help ensure that the medical products being developed work for the people they are intended to help. The U.S. Food and Drug Administration’s Office of Women’s Health has funded several studies on lupus and other autoimmune diseases. The FDA’s Office of Minority Health and Health Equity also funded a lupus survey.
The Future of Lupus Treatment Advances
Lupus is a chronic disease; treatment may be controlled, but there is no cure at this time. Advances in the understanding and treatment of lupus over the last several decades have resulted in better treatment options and people with the disease living longer and better lives. Though there is still much to learn, the medical community agrees that the right treatment approach and proper care improves quality of life. Patients with the best health outcomes work collaboratively and regularly with an interdisciplinary team of care providers led by a rheumatologist.