Lupus and Inflammation
Similar to “friendly fire,” with lupus, the body is constantly attacked by its own immune system, resulting in a series of reactionary, inflammatory responses. Understanding what can trigger these responses may help individuals with SLEplay a greater role in the management of their own health.
- What is inflammation, and how does it relate to lupus?
- Treatment and Prevention of Inflammation
- In Conclusion
Lupus is an inflammatory disease as much as it is an autoimmune disease. From the discomfort of joint pain and swelling, to the potential life-threatening complications of lupus nephritis, inflammation can occur virtually anywhere in the body. Inflammation itself is not the cause of lupus, but it is very often the body’s response to lupus, and it contributes to some of the most serious symptoms of the disease.
As there is no cure for lupus, healthcare practitioners spend much of their time addressing the inflammatory symptoms that it causes. By treating inflammation, they try to prevent tissue damage, thereby giving the individual with lupus the best possible quality of life.
There are two main types of inflammation:
- Acute inflammation: Acute inflammation occurs after injury or illnesses such as a broken bone or a lung infection. It is often visible, and easy to locate with a specific cause. Once the broken bone heals or antibiotics start to work, the inflammation subsides.
- Chronic inflammation: Like the inflammation of SLE and other autoimmune diseases, chronic inflammation can continue for a long time. It is often diffuse or “invisible,” making it much harder to diagnose and treat.
Everyone will probably experience inflammation at some time in life due to injury or illness; simple sunburn is an example of inflammation of the skin. While most inflammation is uncomfortable or even painful, it is often relatively easy to treat and generally goes away in an otherwise healthy individual. For individuals with lupus, however, the inflammation does not always go away, and it seems to occur (and re-occur) almost spontaneously with little rhyme, reason or warning. This chronic form of inflammation requires constant attention, and that is why it is so important to have a good understanding of lupus as an inflammatory disease. The more you know about what is happening, the better you can develop a sense of empowerment over this chaotic condition.
What is inflammation, and how does it relate to lupus?
Basically, inflammation is a defensive response by the immune system to an infection or injury. It is a complex biological and chemical “red alert” that is meant to warn you about possible damage, prevent further injury and begin the healing process. Conditions or diseases that cause inflammation often have names ending in “-itis.” For example, bronchitis is the inflammation of the bronchi of the lungs; hepatitis is inflammation of the liver; nephritis is inflammation of the kidneys, and vasculitis is inflammation of blood vessels.
The five classic signs of the acute inflammation response are pain, swelling, redness and heat:
- Pain: Chemicals are released that trigger pain receptors so that you are aware that there is a problem and hopefully are able to locate where the problem is located.
- Swelling: Other chemicals (vasodilators) “open up” the capillaries so blood plasma and white blood cells (leukocytes) can get to the area of damage or infection and stop either from spreading.
- Redness: The increase in blood flow to the site of damage or infection means that the area also fills with red blood cells and that area this distinctive color.
- Heat: The increased blood flow also brings warmth to the area.
- Loss of Function: When an organ or area of the body becomes inflamed, it can lose its ability to function properly. This happens in joints with arthritis.
It is important to note that inflammation is not the same as the allergic response, which is another, related, defensive reaction. An allergic reaction occurs when the body comes in contact with certain foreign substances (food, medications, bee stings, etc.) through eating, inhalation or contact with the skin. The body over-reacts to this perceived threat with a series of responses, like watery eyes, running nose, itchy skin, shortness of breath and in extreme cases, life-threatening anaphylactic shock. An allergy is an unhealthy over-reaction of the immune system to a foreign substance, but it will not create an inflammatory response unless tissue damage takes place.
So, how does lupus cause inflammation?
There are several ways this may happen, but one of the most common ways occurs when the body attacks itself with autoantibodies. The autoantibodies associated with lupus either attack organs directly or they attack the blood vessels that feed those organs creating serious damage. Once the body notices this damage, the inflammatory response is triggered, creating the pain, and other symptoms of inflammation. If the inflammation is not treated, even more damage can occur and perhaps even organ failure.
The inflammation of acute cutaneous lupus, for example, occurs when the immune system attacks skin cells, causing the butterfly rash. The inflammation of lupus nephritis, on the other hand, can become life-threatening as autoantibodies attack the structures of the kidneys causing inflammation, preventing the kidney’s filtering system from functioning properly. If conditions such as these are not managed well, the effects may be irreversible and devastating. The body cannot perform its vital processes, severely impacting an individual’s quality of life, possibly even causing death.
Scientists also believe that cell death may play a vital role in the inflammatory response in individuals with autoimmune conditions. Normally, cells go through a process called apoptosis where cells die and are removed before cell membranes burst and toxins are released to the surrounding healthy tissue. However, when cells become damaged (necrosis), as possibly with inflammatory conditions, the membranes burst before the cells are removed, and the toxins are released into the body, which can trigger a generalized inflammatory response.
Treatment and Prevention of Inflammation
Inflammation is typically treated using medications called, predictably … anti-inflammatories. These can be common, over-the-counter drugs or prescribed medications. Again, since there is no cure for the disease itself – lupus is treated symptom-by-symptom, and usually inflammation is one of the first to be treated.
Anti-inflammatories work by blocking the chemicals in the body that create inflammation. There are two types of anti-inflammatory medications that may prescribe:
- Corticosteroids: Available only by prescription, these powerful drugs include hydrocortisone, dexamethasone, prednisone, prednisolone, methylprednisolone and triamcinolone. These medications contain steroids that act similarly to cortisone, the naturally occurring hormone produced by the body.
Cortisone or cortisol is produced by the adrenal glands when triggered by the pituitary gland. Cortisol works to control blood pressure in response to stress or danger and reduces overall inflammation. When the body is not producing enough cortisol, inflammation may occur. A corticosteroid is prescribed to bring levels of cortisol back to normal and alleviate inflammation.
While corticosteroids can provide serious relief for individuals with lupus, they come with a host of side effects including high blood pressure, swelling, mood swings and weight gain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications are typically available over-the-counter and include ibuprofen, naproxen and aspirin and are typically given to ease minor aches, pains and fevers. They are often used in tandem with other medications. Some NSAIDs such as celecoxib, diclofenac, fenoprofen and ketorolac tromethamine are available by prescription only.
Though NSAIDs work like corticosteroids, they do not contain steroids and therefore have fewer side-effects. Side effects include gas, heartburn, nausea and stomach pain.
Other medications that may be prescribed in order to treat inflammation in individuals with lupus may include:
- Disease-modifying antirheumatic drugs (DMARDs): This class of drugs includes hydroxychloroquine (Plaquenil) and is often prescribed in tandem with NSAIDs. Scientists believe that hydroxychloroquine can disrupt the communication of the cells of the immune system and therefore can decrease inflammation, pain and swelling.
- BLyS-specific inhibitors (Benlysta): Benlysta is a very targeted medication and biologic that works by interfering with B-cell production, which in turn reduces inflammation and related pain and swelling.
- Adrenocorticotropic hormone (Acthar – ACTH): ACTH is secreted by the pituitary gland, which stimulates the production of glucocorticoids (cortisol) and may in turn inhibit inflammatory functions of the immune cells.
While it may not be possible to entirely prevent inflammation, individuals with lupus can practice good habits on their own, in conjunction with drug therapy, that may help significantly reduce inflammation and alleviate pain and discomfort.
- Nutrition: A well-balanced diet full of antioxidants, vitamins (A, C, D, E) and dietary fiber can help reduce inflammation as well as the risk for other diseases such as cardiovascular disease and atherosclerosis. Sugar should also be consumed in moderation as it not only increases the risk for diabetes, but may also potentially trigger the production of proinflammatory cytokines and C-reactive protein causing systemic inflammation. Alcohol consumption can also disrupt the gut microbiome, which may cause inflammation and eventually organ damage.
Omega-3s have also been shown to be beneficial in managing inflammation by inhibiting the production of proinflammatory cytokines. Individuals with rheumatoid arthritis who take omega-3s report “…improvements in several clinical outcomes including reduced duration of morning stiffness, reduced number of tender or swollen joints, reduced joint pain, [and] reduced time to fatigue.”
- Maintaining a healthy weight: Obesity can lead to an increase in the production of proinflammatory cytokines. Achieving and maintaining a healthy weight reduces the occurrence of inflammation as well as lowers the risk for diabetes and heart disease. Working towards a healthy weight may also make an individual feel as though they have more control over their own health.
- Exercise: Regular exercise, no matter what one’s ability, not only helps with weight management, fatigue and stress, but it also may help to reduce the production of proinflammatory cytokines as well.
- Avoiding smoking: Smoking may exacerbate inflammatory processes within the body by changing how T-cells work, the body’s response to pathogens and the suppression of anti-tumor cell function.
- Sun protection: UV light exposure may cause photosensitivity, which in turn can spike inflammation and cause a lupus flare. Using sunscreen, wearing protective clothing and seeking shade can help stave off symptoms.
- Managing fatigue: The body’s constant battle with inflammation can cause a great deal of fatigue. Scientists believe that proinflammatory cytokines may impact the central nervous system, signaling the brain and changing the way it responds and functions. Conversely, working to better manage fatigue through adherence to treatment plans may reverse this physically and emotionally debilitating process.
- Reducing stress: Researchers have found that there is a large body of evidence that supports that emotional stress may cause inflammation. Seeking mental health therapy as necessary, as well as using other tools to help prevent stress may also work to alleviate inflammation.
Cannabis may be an alternative treatment for inflammation, though more research needs to be conducted. Studies have shown that cannabidiol – a phytocannabinoid otherwise known as CBD – may suppress the inflammatory response in individuals with conditions such as arthritis with relatively few side effects. Again, the studies are few and far between and it is always strongly encouraged to speak with a healthcare practitioner before embarking on any new treatment options.
Chronic inflammation is a complex and often misunderstood process. While an individual may seem perfectly healthy on the outside, a storm of chemical reactions could be brewing inside. Having a basic understanding of these processes, learning one’s own, unique triggers for symptoms and flares and sticking to prescribed treatment plans while communicating any changes in health can help an individual achieve better health and a robust quality of life.
Bishehasari, F., Magno, E., Swanson, G., Desai, V., Voigt, R., Forsyth, C., & Keshavarzian, A. (n.d.). Alcohol and gut-derived inflammation. Alcohol Research: Current Reviews, 38(2), 163-171. Retrieved August 25, 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513683/pdf/arcr-38-2-163.pdf
Diet. (2020). Johns Hopkins Lupus Center. Retrieved August 25, 2020 from https://www.hopkinslupus.org/lupus-info/lifestyle-additional-information/lupus-diet/
Everett, S. & Yu, S. (25, June 2019). Nutrition and lupus: How to maintain a healthy diet. Hospital for Specialty Surgery. Retrieved August 25, 2020 from https://www.hss.edu/conditions_nutrition-and-lupus-healthy-diet.asp
Gottschalk, T., Tsantikos, E., & Hibbs, M. (2015). Pathogenic inflammation and its therapeutic targeting in systemic lupus erythematosus. Frontiers in Immunology, 6(550). doi: 10.3389/fimmu.2015.00550. Retrieved August 25, 2020 from: https://www.frontiersin.org/articles/10.3389/fimmu.2015.00550/full
Lahita, R. & Phillips, R. (2004). Lupus Q & A (2nd ed.). Penguin Group (USA) Inc.
Lee, J., Taneja, V., & Vassalo, R. (2012). Cigarette smoking and inflammation. Journal of Dental Research, 91(2), 142-149. doi: 10.1177/0022034511421200. Retrieved August 25, 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3261116/
Lupus. (2017). Mayo Clinic. Retrieved August 25, 2020 from https://www.mayoclinic.org/diseases-conditions/lupus/diagnosis-treatment/drc-20365790
Lupus medications and treatment options. (2020). Johns Hopkins Lupus Center. Retrieved August 25, 2020 from https://www.hopkinslupus.org/lupus-treatment/lupus-medications/
Medications for systemic lupus erythematosus. (2020). NYU Langone Health. Retrieved August 25, 2020 from https://nyulangone.org/conditions/systemic-lupus-erythematosus-in-adults/treatments/medications-for-systemic-lupus-erythematosus
Mee-inta, O., Zhao, Z., & Kuo, Y. (2019). Physical exercise inhibits inflammation and microglial activation. Cells, 8(691). doi: 10.3390/cells8070691. Retrieved August 25, 2020 from https://www.mdpi.com/2073-4409/8/7/691
Munoz, L., Janko, C., Grossmayer G., Frey, B., Voll, R., Kern, P., Kalden, J., Schett, G., Fietkau, R., Herrmann, M., & Gaipl, U. (2009). Remnants of secondarily necrotic cells fuel inflammation in systemic lupus erythematosus. Arthritis & Rheumatism, 60(6). doi: 10.1002/art.24535. Retrieved August 25, 2020 from https://onlinelibrary.wiley.com/doi/full/10.1002/art.24535
Oeser, A., Chung, C., Asanuma, Y., Avalos, I., & Stein, C. (2005). Obesity is an independent contributor to functional capacity and inflammation in systemic lupus erythematosus. Arthritis & Rheumatology, 52(11), 3651-3659. doi: 10.1002/art.21400. Retrieved August 25, 2020 from https://onlinelibrary.wiley.com/doi/full/10.1002/art.21400
Podolska, M., Biermann, M., Naueroder, J., & Herrmann, M. (2015). Inflammatory etiopathogenesis of systemic lupus erythematosus: An update. Journal of Inflammation Research, 161-171. doi: 10.2147/JIR.S70325. Retrieved August 25, 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548750/
The role of cortisol in the body. (2020). HealthDirect. Retrieved August 25, 2020 from https://www.healthdirect.gov.au/the-role-of-cortisol-in-the-body#:~:text=Cortisol%20is%20a%20steroid%20hormone,the%20body’s%20metabolism%20of%20glucose
Thomas, D. (2014). The Lupus Encyclopedia. Johns Hopkins University Press.
Author: KFL Team
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