Psychosocial Issues

“My symptoms are bizarre—they’re here today and gone tomorrow.”


“I can’t put a handle on my symptoms. I’ll have one today and a totally new one tomorrow.”


“No one seems to believe me. My family thinks it is all in my head and they want me to see a psychiatrist. I am beginning to wonder if it is all in my head.”


A definite diagnosis of lupus may take time. Patients may get upset about the lack of a confirmed diagnosis. They may not understand why the doctor(s) cannot figure out what exactly is going on. The main issue lies in the fact that symptoms change and may be confusing for both the patient and the doctor(s). The patient may become very emotional. The patient knows his/her own symptoms very well, but may begin to doubt what is going on due to the lack of diagnosis. He/she may begin to wonder if everything he/she has been experiencing was imagined because doctors, friends, and family members do not understand what he/she is going through. He/she may feel isolated, angry, or even fearful. This will only add to the amount of stress, which we established earlier, exacerbates the disease process.
It is important for health care providers to understand the disease process of lupus in order to be empathetic during this difficult time in order to reassure the patient and help him/her understand that what he/she is going through is real and it warrants serious attention. The health care providers also need to be educated to treat the patient as a person, not an illness. This can create a wonderful relationship of trust and respect between the patient and the provider.

The Pathophysiology and Etiology of Lupus

As I have stated before, lupus is an autoimmune disease. Let me review again what this means. Autoimmune means that the body’s immune system is functioning abnormally, causing the immune system to produce antibodies against its own tissues. Genetic, environment and hormonal factors might all play roles in the development of lupus. Much research is being done on these factors and how they relate to lupus.
The specific signs and symptoms of lupus are directly related to the effects of autoantibodies on the body. These autoantibodies attack self-cells and cause damage to different organs and tissues. Also leading to some signs and symptoms is the deposition of immune complexes, which is a combination of antigens and autoantibodies, and cell-mediated immune mechanisms. If pathophysiologists can identify the specific immune response steps and how they affect the signs and symptoms of lupus, new and improved treatments may be discovered.
Genetics seem to play a role in lupus. There is an increased prevalence of lupus between first and second degree relatives. According to the National Institute of Health, studies suggest that many genes contribute to susceptibility, not just one specific gene.
Environmental factors are believed to lead to increase lupus signs and symptoms or trigger lupus, such as sunlight, stress, chemical substances, toxic exposures, and infections agents. Exposure to ultraviolet (UV) rays of sunlight can cause skin rash and discoid lesions. The UVB light leads to cellular proteins to accumulate in large amounts near the surface of the skin, causing an inflammatory response. Stress can actually cause a flare, or increase in disease activity. No explanation exists to explain this, but research is being done. Certain medications and drugs can lead to lupus-like illnesses in individuals. The illness goes away once the drug is discontinued. If the relationship is discovered between the medications between the drugs and the illness, then perhaps more will be discovered about lupus in general. Toxic exposures, such as silica and mercury, can be associated with lupus. These substances can be associated with the formation of autoantibodies that lead to lupus formation. Viruses lead to disruption in immune function, which can cause an infection of B cells (cells that produce antibodies) causing them to produce autoantibodies. This can in turn lead to lupus signs and symptoms.
There are many aspects to the etiology of lupus. Hopefully future research will allow a better understanding of the exact cause and treatment of the disease so that those living with lupus will have a better outcome.