Lupus

What is Lupus?

Lupus, most often systemic lupus erythematosus (SLE), is a chronic autoimmune disease that involves loss of immune tolerance and the production of autoantibodies, with inflammation in multiple organ systems.^{[1, 2]} About 90% of people with SLE are female.^[2] Other forms exist, such as discoid lupus, which mainly affects the skin, drug-induced lupus and neonatal lupus. This page focuses on SLE.

Common symptoms

Fatigue, a lupus-specific rash, mouth ulcers, hair loss, joint pain and muscle pain are among the earliest complaints.^[3] Many people also have fever, sun sensitivity, and color changes in the fingers in the cold. Lupus can involve the kidneys, blood cells, heart, lungs and nervous system, and its course varies, with flares and quieter periods.^[2]

Causes and risk factors

The exact cause is not known. Genetic makeup, hormones, and environmental triggers such as sunlight, infections and some medicines are thought to contribute.^[1] The disease is far more common in women, particularly in the childbearing years.^[2]

How it is diagnosed and treated conventionally

Diagnosis relies on a physician's assessment of symptoms, blood tests for antinuclear and other autoantibodies, urine tests and sometimes biopsy. The 2019 EULAR/ACR classification criteria combine clinical findings with immune markers, and most patients have antinuclear antibodies.^{[1, 2]}

The main treatment goal is remission or low disease activity, with fewer flares and less organ damage. Hydroxychloroquine is first-line therapy and is linked to lower mortality. Immunosuppressants such as azathioprine, mycophenolate or cyclophosphamide, and biologics such as belimumab, anifrolumab and voclosporin, are added for moderate to severe disease.^[2] About 40% of people with SLE develop lupus nephritis (kidney inflammation).^[2] Infections, osteoporosis and cardiovascular disease are important complications of both the disease and its treatment, so ongoing monitoring matters.^[3]

Why Lupus calls for a whole-person approach

Lupus affects many body systems, and treatment itself brings side effects, so care involves more than controlling one set of symptoms. Fatigue is the most prevalent complaint in people with SLE.^[4]

Our role is supportive. We do not diagnose lupus, monitor disease activity or adjust lupus medicines.

Fatigue and quality of life

In a systematic review of nonpharmacologic approaches to fatigue in SLE, all interventions reduced fatigue on at least one measure, with the most consistent results for aerobic exercise, while evidence on acupuncture and diet was thin.^[4]

Pain and mood

A review of 15 randomized trials found that exercise and psychological approaches improved fatigue, depression, pain and quality of life in some studies. No trial showed an improvement in disease activity from these approaches.^[5]

Treatment side effects

The drugs that control lupus carry their own risks, including infections, bone loss and cardiovascular disease.^[3] Some supportive therapies are studied partly for their potential to ease these burdens, for example the possibility of lowering steroid doses, which is discussed below. Any change to a medicine dose must be made by your prescriber.

Diet and supplements

A systematic review of 14 nutrition trials in SLE found that vitamin D or E, omega-3 fatty acids and a low glycemic index diet showed benefits on some markers or symptoms. The authors noted that trials were small and short.^[6]

Acupuncture as supportive care in Lupus

What the research shows

The research on acupuncture in lupus is limited. A meta-analysis of 7 trials with 514 patients found that adding acupuncture to conventional drugs improved the overall response rate and lowered disease activity scores and some blood markers compared with drugs alone. The authors reported that the studies were few and uneven in quality, with bias, and called for better trials.^[7]

A pilot trial randomized 24 people with SLE to 10 sessions of acupuncture, minimal needling or usual care. About 40% of those in the two needling groups had at least a 30% improvement in pain and none of the usual-care group did, but acupuncture was no better than minimal needling. No serious adverse events occurred.^[8] Reviews of nonpharmacologic care for SLE found few acupuncture trials and little data on its effect on fatigue.^{[4, 5]}

How acupuncture may work

No study explains how acupuncture might affect lupus itself. The meta-analysis reported changes in some immune markers in the treated groups, but these results came from small, uneven trials and do not show a mechanism.^[7] For general chronic pain, acupuncture effects are not explained by placebo alone, though that finding is not specific to lupus.^[9]

What treatment involves

Acupuncture uses fine, sterile, single-use needles placed at selected points, typically left in place for about 20 to 40 minutes. A course usually involves several visits, and we reassess how you are doing along the way. Treatment is aimed at pain, fatigue, sleep and stress, not at the immune disease.

Minor reactions such as brief soreness, bleeding or redness at a needle site occur in about 9 in 100 patients, and serious events about 1 in 10,000.^[10] Tell your practitioner first if you have a bleeding disorder or low platelet count, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Because immunosuppressant medicines raise the risk of infection, tell us about them too so that skin care at the needle site is handled carefully.

Ayurvedic medicine as supportive care in Lupus

The Ayurvedic view

Ayurveda does not describe lupus as such. A practitioner might consider a pattern such as aggravated Pitta (heat and inflammation) with weakened digestion (agni) and accumulated metabolic residue (ama), or Vata imbalance in the case of joint pain and fatigue. These are traditional frameworks for choosing supportive care, not biomedical diagnoses.

Therapies that may be used

Traditional supportive care is individualized and may include:

• Dietary changes and regular daily routines, with stress-reducing and breath-based practices
• Gentle warm oil massage, avoiding inflamed or rash-affected skin
• Herbs, including turmeric, chosen individually by a qualified practitioner after review of your medicines

Panchakarma, the traditional cleansing series, is not appropriate during pregnancy, acute illness or frailty. It is also not appropriate during a lupus flare or for people on immunosuppressant medication or with kidney involvement, and we would not use it without your physician's knowledge.

What the research shows

The research on Ayurvedic medicine for lupus is very limited. No randomized trials of Ayurvedic treatment programs in lupus were found. The nearest evidence concerns turmeric, an herb used in Ayurveda. In a placebo-controlled trial of 70 people with SLE (62 completing), curcumin for 10 weeks lowered anti-double-stranded DNA antibody and interleukin-6 levels compared with placebo, with no change in most other markers.^[11] A systematic review of curcumin trials in autoimmune diseases found only two trials in SLE and too little clinical data to pool.^[12] Trials on diet and supplements in SLE have been small and short.^[6]

Herbal medicine as supportive care in Lupus

Herbs and formulas that have been studied

Most research is on Chinese herbal formulas, including modified Zhibai Dihuang pill, and on single herbs such as Tripterygium wilfordii (thunder god vine), which is used in China for autoimmune disease.^{[13, 14]} Turmeric and its component curcumin have also been tested.^[11]

What the research shows

The evidence is limited. A meta-analysis of 13 placebo-controlled trials (856 participants) found that Chinese herbal medicine lowered SLE disease activity scores and glucocorticoid dose compared with placebo, with no significant difference in adverse events. The authors called for better-designed, longer, multicenter trials.^[15]

A meta-analysis of 20 trials (1,470 patients) found that modified Zhibai Dihuang pill added to standard care was linked to a larger reduction in steroid dose, and the authors called the evidence preliminary.^[13] Another meta-analysis of 15 trials found higher white cell, hemoglobin and platelet counts with herbal medicine plus conventional therapy than with conventional therapy alone.^[16] Any steroid reduction must be directed by your physician. These results do not mean herbs can replace or lower your lupus medicines.

Safety and herb-drug interactions

Herbs can cause harm in lupus, particularly with kidney, liver or blood involvement. Tripterygium wilfordii is a reminder that herbs with real immune effects also have real toxicity, and its toxicity and side effects limit its clinical use.^[14] Herbal and dietary supplements are a recognized cause of liver injury.^[17]

Herb-drug interactions can have serious consequences, including altered levels of immunosuppressant drugs such as cyclosporine and bleeding with warfarin.^[18] Ayurvedic products also carry a quality risk, since about one fifth of those bought online contained detectable lead, mercury or arsenic.^[19] Tell us if you take hydroxychloroquine, steroids, immunosuppressants or blood thinners, have kidney disease, are pregnant or breastfeeding, or are planning pregnancy. Herbs should come from tested sources and be prescribed individually. We do not recommend any herb that is promoted to stimulate the immune system, because lupus involves an overactive immune response, and we would check any herb with your rheumatologist.

Translating traditional medicine into modern biological language

This section is interpretation, not equivalence. Chinese medicine often describes lupus in terms of yin deficiency with heat, or blood stasis. Researchers studying Chinese herbal formulas for lupus measure disease activity scores, complement levels, inflammatory markers and steroid dose.^{[13, 15]}

Ayurveda's idea of aggravated Pitta, with heat and inflammation, loosely parallels the immune-driven inflammation of lupus, and turmeric's curcumin has been studied for effects on T cells, dendritic cells and inflammatory cytokines.^[20] No study has shown that a traditional pattern corresponds to a specific immune process.

How this care fits with your medical care

This care is complementary and supportive. Keep your rheumatologist and other physicians, and do not stop or change hydroxychloroquine, steroids or any other prescribed medicine without your prescriber. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Please bring your diagnosis, recent blood and urine test results, a full list of medicines and supplements, and any kidney or blood count concerns. We do not monitor disease activity, so keep your regular appointments and lab checks.

When to seek urgent medical care

Lupus can affect vital organs, and some changes need prompt medical assessment.^[2]

• Chest pain, shortness of breath or coughing up blood
• New swelling in the legs, face or around the eyes, foamy or dark urine, or much less urine
• Seizures, confusion, sudden severe headache or new weakness on one side
• Fever, particularly while taking immunosuppressant medicines, which can signal serious infection
• Unexplained bruising or bleeding, or a painful, swollen leg that could be a blood clot
• A rapidly worsening rash, joint swelling or fatigue

If any of these occur, call your physician right away, and for an emergency call 911 or go to the nearest emergency department.