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June 2016

Handout on Health: Systemic

Lupus Erythematosus

This publication is for people who have

systemic lupus erythematosus, commonly

called SLE or lupus, as well as for their

families and friends and others who want to

better understand the disease. The

publication describes the disease and its

symptoms and contains information about

diagnosis and treatment, as well as current

research efforts supported by the National

Institute of Arthritis and Musculoskeletal and

Skin Diseases (NIAMS) and other

components of the U.S. Department of

Health and Human Services’ National

Institutes of Health (NIH). It also discusses

issues such as health care, pregnancy, and

quality of life for people with lupus. If you

have further questions after reading this

publication, you may wish to discuss them

with your doctor.

What Is Lupus?

Who Gets Lupus?

Understanding What Causes Lupus

Symptoms of Lupus

Diagnosing Lupus

Treating Lupus

What You Can Do: The Importance of

Self-Care

Pregnancy and Contraception for

Women With Lupus

Research Highlights

Hope for the Future

For More Information

Information Boxes

Common Symptoms of Lupus

Diagnostic Tools for Lupus

Warning Signs of a Flare

We want to hear from you

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Preventing a Flare

What Is Lupus?

Lupus is one of many disorders of the

immune system known as autoimmune

diseases. In autoimmune diseases, the

immune system turns against parts of the

body it is designed to protect. This leads to

inflammation and damage to various body

tissues. Lupus can affect many parts of the

body, including the joints, skin, kidneys,

heart, lungs, blood vessels, and brain.

Typically, lupus is characterized by periods of

illness, called flares, and periods of wellness,

or remission. Understanding how to prevent

flares and how to treat them when they do

occur helps people with lupus maintain better

health.

Who Gets Lupus?

We know that many more women than men

have lupus. Lupus is more common in

African American women than in Caucasian

women and is also more common in women

of Hispanic, Asian, and Native American

descent. African American and Hispanic

women are also more likely to have active

disease and serious organ system

involvement. In addition, lupus can run in

families, but the risk that a child or a brother

or sister of a patient will also have lupus is

still quite low.

It is difficult to estimate how many people in

the United States have the disease, because

its symptoms vary widely and its onset is

often hard to pinpoint. Although SLE usually

first affects people between the ages of 15

and 45 years, it can occur in childhood or

later in life as well.

Understanding What Causes

Lupus

Lupus is a complex disease, and its cause is

not fully understood. Research suggests that

genetics plays an important role, but it also

shows that genes alone do not determine

who gets lupus, and that other factors play a

role. Some of the factors scientists are

studying include sunlight, stress, hormones,

cigarette smoke, certain drugs, and infectious

agents such as viruses. Studies have

confirmed that one virus, Epstein-Barr virus

(EBV), which causes mononucleosis, is a

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cause of lupus in genetically susceptible

people.

Scientists believe there is no single gene that

predisposes people to lupus. Rather, studies

suggest that a number of different genes may

be involved in determining a person’s

likelihood of developing the disease, which

tissues and organs are affected, and the

severity of disease.

In lupus, the body’s immune system does not

work as it should. A healthy immune system

produces proteins called antibodies and

specific cells called lymphocytes that help

fight and destroy viruses, bacteria, and other

foreign substances that invade the body. In

lupus, the immune system produces

antibodies against the body’s healthy cells

and tissues. These antibodies, called

autoantibodies, contribute to the inflammation

of various parts of the body and can cause

damage to organs and tissues. The most

common type of autoantibody that develops

in people with lupus is called an antinuclear

antibody (ANA) because it reacts with parts

of the cell’s nucleus (command center).

Doctors and scientists do not yet understand

all of the factors that cause inflammation and

tissue damage in lupus, and researchers are

actively exploring them.

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Common Symptoms of

Lupus

Painful or swollen joints

and muscle pain

Unexplained fever

Red rashes, most

commonly on the face

Chest pain upon deep

breathing

Unusual loss of hair

Pale or purple fingers or

toes from cold or stress

(Raynaud’s phenomenon)

Sensitivity to the sun

Swelling (edema) in legs

or around eyes

Mouth ulcers

Swollen glands

Extreme fatigue.

Symptoms of Lupus

Each person with lupus has slightly different

symptoms that can range from mild to severe

and may come and go over time. However,

some of the most common symptoms of

lupus include painful or swollen joints

(arthritis), unexplained fever, and extreme

fatigue. A characteristic red skin rash—the

so-called butterfly or malar rash—may

appear across the nose and cheeks. Rashes

may also occur on the face and ears, upper

arms, shoulders, chest, and hands and other

areas exposed to the sun. Because many

people with lupus are sensitive to sunlight

(called photosensitivity), skin rashes often

first develop or worsen after sun exposure.

Other symptoms of lupus include chest pain,

hair loss, anemia (a decrease in red blood

cells), mouth ulcers, and pale or purple

fingers and toes from cold and stress. Some

people also experience headaches,

dizziness, depression, confusion, or seizures.

New symptoms may continue to appear

years after the initial diagnosis, and different

symptoms can occur at different times. In

some people with lupus, only one system of

the body, such as the skin or joints, is

affected. Other people experience symptoms

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in many parts of their body. Just how

seriously a body system is affected varies

from person to person. The following systems

in the body also can be affected by lupus.

Kidneys: Inflammation of the kidneys

(nephritis) can impair their ability to

get rid of waste products and other

toxins from the body effectively. There

is usually no pain associated with

kidney involvement. Most often, the

only indication of kidney disease is an

abnormal urine or blood test;

however, some patients may notice

dark urine and swelling around their

eyes, legs, ankles, or fingers.

Because the kidneys are so important

to overall health, lupus affecting the

kidneys generally requires intensive

drug treatment to prevent permanent

damage.

Lungs: Some people with lupus

develop pleuritis, an inflammation of

the lining of the chest cavity that

causes chest pain, particularly with

breathing. Patients with lupus also

may get pneumonia.

Central nervous system: In some

patients, lupus affects the brain or

central nervous system. This can

cause headaches, dizziness,

depression, memory disturbances,

vision problems, seizures, stroke, or

changes in behavior.

Blood vessels: Blood vessels may

become inflamed (vasculitis),

affecting the way blood circulates

through the body. The inflammation

may be mild and may not require

treatment or may be severe and

require immediate attention. People

with lupus are also at increased risk

for atherosclerosis (hardening of the

arteries).

Blood: People with lupus may

develop anemia, leukopenia (a

decreased number of white blood

cells), or thrombocytopenia (a

decrease in the number of platelets in

the blood, which assist in clotting).

People with lupus who have a type of

autoantibody called antiphospholipid

antibodies have an increased risk of

blood clots.

Heart: In some people with lupus,

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inflammation can occur in the heart

itself (myocarditis and endocarditis) or

the membrane that surrounds it

(pericarditis), causing chest pain or

other symptoms. Endocarditis can

damage the heart valves, causing the

valve surface to thicken and develop

growths, which can cause heart

murmurs. However, this usually

doesn’t affect the valves’ function.

Diagnosing Lupus

Diagnosing lupus can be difficult. It may take

months or even years for doctors to piece

together the symptoms to diagnose this

complex disease accurately. Making a correct

diagnosis of lupus requires knowledge and

awareness on the part of the doctor and good

communication on the part of the patient.

Giving the doctor a complete, accurate

medical history (for example, what health

problems you have had and for how long) is

critical to the process of diagnosis. This

information, along with a physical

examination and the results of laboratory

tests, helps the doctor consider other

diseases that may mimic lupus, or determine

if you truly have the disease. Reaching a

diagnosis may take time as new symptoms

appear.

No single test can determine whether a

person has lupus, but several laboratory tests

may help the doctor to confirm a diagnosis of

lupus or rule out other causes for a person’s

symptoms. The most useful tests identify

certain autoantibodies often present in the

blood of people with lupus. For example, the

antinuclear antibody (ANA) test is commonly

used to look for autoantibodies that react

against components of the nucleus, or

“command center,” of the body’s cells. Most

people with lupus test positive for ANA;

however, there are a number of other causes

of a positive ANA besides lupus, including

infections and other autoimmune diseases.

Occasionally, it is also found in healthy

people. The ANA test simply provides

another clue for the doctor to consider in

making a diagnosis. In addition, there are

blood tests for individual types of

autoantibodies that are more specific to

people with lupus, although not all people

with lupus test positive for these and not all

people with these antibodies have lupus.

These antibodies include anti-DNA, anti-Sm,

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anti-RNP, anti-Ro (SSA), and anti-La (SSB).

The doctor may use these antibody tests to

help make a diagnosis of lupus.

Some tests are used less frequently but may

be helpful if the cause of a person’s

symptoms remains unclear. The doctor may

order a biopsy of the skin or kidneys if those

body systems are affected. Some doctors

may order a test for anticardiolipin (or

antiphospholipid) antibody. The presence of

this antibody may indicate increased risk for

blood clotting and increased risk for

miscarriage in pregnant women with lupus.

Again, all these tests merely serve as tools to

give the doctor clues and information in

making a diagnosis. The doctor will look at

the entire picture—medical history,

symptoms, and test results—to determine if a

person has lupus.

Diagnostic Tools for

Lupus

Medical history

Complete physical

examination

Laboratory tests:

Complete blood

count (CBC)

Erythrocyte

sedimentation rate

(ESR)

Urinalysis

Blood chemistries

Complement

levels

Antinuclear

antibody test

(ANA)

Other

autoantibody tests

(anti-DNA,

anti-Sm, anti-RNP,

anti-Ro [SSA],

anti‐La [SSB])

Anticardiolipin

antibody test

Skin biopsy

Kidney biopsy.

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Other laboratory tests are used to monitor the

progress of the disease once it has been

diagnosed. A complete blood count,

urinalysis, blood chemistries, and the

erythrocyte sedimentation rate test (a test to

measure inflammation) can provide valuable

information. Another common test measures

the blood level of a group of substances

called complement, which help antibodies

fight invaders. A low level of complement

could mean the substance is being used up

because of an immune response in the body,

such as that which occurs during a flare of

lupus.

Treating Lupus

Diagnosing and treating lupus often require a

team effort between the patient and several

types of health care professionals. Most

people will see a rheumatologist for their

lupus treatment. A rheumatologist is a doctor

who specializes in rheumatic diseases

(arthritis and and other inflammatory

disorders, often involving the immune

system). Clinical immunologists (doctors

specializing in immune system disorders)

may also treat people with lupus. As

treatment progresses, other professionals

often help. These may include nurses,

psychologists, social workers, nephrologists

(doctors who treat kidney disease),

cardiologists (doctors specializing in the heart

and blood vessels), hematologists (doctors

specializing in blood disorders),

endocrinologists (doctors specializing in

problems related to the glands and

hormones), dermatologists (doctors who treat

skin disease), and neurologists (doctors

specializing in disorders of the nervous

system). It is also important for people with

lupus to have a primary care doctor—usually

a family physician or internist (internal

medicine specialist)—who can coordinate

care between their different health providers

and treat other problems as they arise.

The range and effectiveness of treatments for

lupus have increased dramatically in recent

decades, giving doctors more choices in how

to manage the disease. Medications used in

the treatment of lupus include the following:1

1All medicines can have side effects. Some

side effects may be more severe than others.

You should review the package insert that

comes with your medicine and ask your

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health care provider or pharmacist if you

have any questions about the possible side

effects.

NSAIDs: For people with joint or chest pain

or fever, drugs that decrease inflammation,

called nonsteroidal anti-inflammatory drugs

(NSAIDs), are often used.2 Although some

NSAIDs, such as ibuprofen and naproxen,

are available over the counter, a doctor’s

prescription is necessary for others. NSAIDs

may be used alone or in combination with

other types of drugs to control pain, swelling,

and fever. Even though some NSAIDs may

be purchased without a prescription, it is

important that they be taken under a doctor’s

direction.

2 Warning: Side effects of NSAIDs include

stomach problems; skin rashes; high blood

pressure; fluid retention; and liver, kidney,

and heart problems. The longer a person

uses NSAIDs, the more likely he or she is to

have side effects, ranging from mild to

serious. Many other drugs cannot be taken

when a patient is being treated with NSAIDs,

because NSAIDs alter the way the body uses

or eliminates these other drugs. Check with

your health care provider or pharmacist

before you take NSAIDs. NSAIDs should only

be used at the lowest dose possible for the

shortest time needed.

Antimalarials: Antimalarials are another type

of drug commonly used to treat lupus. These

drugs prevent and treat malaria, but doctors

have found that they also are useful for

lupus. A common antimalarial used to treat

lupus is hydroxychloroquine. It may be used

alone or in combination with other drugs and

generally is used to treat fatigue, joint pain,

skin rashes, and inflammation of the lungs.

Clinical studies have found that continuous

treatment with antimalarials may prevent

flares from recurring.

Corticosteroids: Corticosteroids, such as

prednisone, hydrocortisone,

methylprednisolone, and dexamethasone,

are related to cortisol, which is a natural

anti-inflammatory hormone. They work by

rapidly suppressing inflammation.

Corticosteroids can be given by mouth, in

creams applied to the skin, by injection, or by

intravenous (IV) infusion (dripping the drug

into the vein through a small tube). Because

they are potent drugs, the doctor will seek the

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lowest dose required to achieve the desired

benefit.

In an effort to minimize side effects

associated with corticosteroids, researchers

are working to develop ways to limit or offset

the use of corticosteroids. For example,

corticosteroids may be used in combination

with other, less potent drugs, or the doctor

may try to slowly decrease the dose once the

disease is under control.

Immunosuppressives: For some patients

whose kidneys or central nervous systems

are affected by lupus, a type of drug called

an immunosuppressive may be used.

Immunosuppressives, such as

cyclophosphamide and mycophenolate

mofetil, restrain the overactive immune

system by blocking the production of immune

cells. These drugs may be given by mouth or

by IV infusion. The risk for side effects

increases with the length of treatment.

BLyS-specific inhibitors: Belimumab, a

type of agent referred to as a B-lymphocyte

stimulator (BLyS) protein inhibitor, was

approved by the U.S. Food and Drug

Administration (FDA) in March 2011 for

patients with lupus who are receiving other

standard therapies, including those listed

above. Given by IV infusion, belimumab may

reduce the number of abnormal B cells

thought to be a problem in lupus.

In studies conducted so far, African American

patients and patients of African heritage did

not appear to respond significantly to

belimumab. An additional study of this patient

population is planned to evaluate belimumab

further in this subgroup of lupus patients.

However, this difference in response to a

treatment may be another indicator of the

various ways that the disease affects

different patients.

Because some treatments may cause

harmful side effects, it is important to report

any new symptoms to the doctor promptly. It

is also important not to stop or change

treatments without talking to the doctor first.

In addition to medications for lupus itself, in

many cases it may be necessary to take

additional medications to treat problems

related to lupus such as high cholesterol,

high blood pressure, or infection.

Alternative and complementary therapies:

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Because of the nature and cost of the

medications used to treat lupus and the

potential for serious side effects, many

patients seek other ways of treating the

disease. Some alternative approaches

people have tried include special diets,

nutritional supplements, fish oils, ointments

and creams, chiropractic treatment, and

homeopathy. Although these methods may

not be harmful in and of themselves and may

be associated with symptomatic or

psychosocial benefit, no research to date

shows that they affect the disease process or

prevent organ damage.

What You Can Do: The Importance

of Self-Care

Despite the symptoms of lupus and the

potential side effects of treatment, people

with lupus can maintain a high quality of life

overall. One key to managing lupus is to

understand the disease and its impact.

Learning to recognize the warning signs of a

flare can help the patient take steps to ward it

off or reduce its intensity. Many people with

lupus experience increased fatigue, pain, a

rash, fever, abdominal discomfort, headache,

or dizziness just before a flare. Developing

strategies to prevent flares can also be

helpful, such as learning to recognize your

warning signals and maintaining good

communication with your doctor.

It is also important for people with lupus to

receive regular health care, instead of

seeking help only when symptoms worsen.

Results from a medical exam and laboratory

work on a regular basis allow the doctor to

note any changes and to identify and treat

flares early. The treatment plan, which is

tailored to the individual’s specific needs and

circumstances, can be adjusted accordingly.

If new symptoms are identified early,

treatments may be more effective. Other

concerns also can be addressed at regular

checkups.

People with lupus should also be aware of

their increased risk of premature

cardiovascular disease. This makes healthy

lifestyle choices such as eating well,

exercising regularly, and not smoking

particularly important for people with lupus.

Warning Signs of a Flare

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Increased fatigue

Pain

Rash

Fever

Abdominal discomfort

Headache

Dizziness.

Preventing a Flare

Learn to recognize your

warning signals.

Maintain good

communication with your

doctor.

Staying healthy requires extra effort and care

for people with lupus, so it becomes

especially important to develop strategies for

maintaining wellness. One of the primary

goals of wellness for people with lupus is

coping with the stress of having a chronic

disorder. Some approaches that may help

include exercise, relaxation techniques such

as meditation, and setting priorities for

spending time and energy.

Developing and maintaining a good support

system is also important. A support system

may include family, friends, medical

professionals, community organizations, and

support groups.

Learning more about lupus may also help.

Studies have shown that patients who are

well-informed and participate actively in their

own care experience less pain, make fewer

visits to the doctor, build self-confidence, and

remain more active.

Pregnancy and Contraception for

Women With Lupus

Although pregnancy in women with lupus is

considered high risk, NIAMS-supported

research suggests that most women with

mild to moderate lupus can expect to have

healthy pregnancies. Pregnancy counseling

and planning before pregnancy are

important. Ideally, a woman should have no

signs or symptoms of lupus and be taking no

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medications for several months before she

becomes pregnant.

Some women may experience a mild to

moderate flare during or after their

pregnancy; others do not. Pregnant women

with lupus, especially those taking

corticosteroids, also are more likely to

develop high blood pressure, diabetes,

hyperglycemia (high blood sugar), and kidney

complications, so regular care and good

nutrition during pregnancy are essential.

For women with lupus who do not wish to

become pregnant or who are taking drugs

that could be harmful to an unborn baby,

reliable birth control is important. Oral

contraceptives (birth control pills) were once

not an option for women with lupus because

doctors feared the hormones in the pill would

cause a flare of the disease. However, a

large National Institutes of Health (NIH)-

supported study called Safety of Estrogens in

Lupus Erythematosus National Assessment

(SELENA) found that severe flares were no

more common among women with lupus

taking oral contraceptives than those taking a

placebo (inactive pill). As a result of this

study, doctors are increasingly prescribing

oral contraceptives to women with inactive or

stable disease.

Research Highlights

Lupus is the focus of intense research as

scientists try to determine what causes the

disease and how it can best be treated.

Some of the questions they are working to

answer include: Why are women more likely

than men to have the disease? Why are

there more cases of lupus in some racial and

ethnic groups, and why are cases in these

groups often more severe? What goes wrong

in the immune system and why? How can we

correct the way the immune system functions

once something goes wrong? What treatment

approaches will work best to lessen lupus

symptoms? How do we cure lupus?

To help answer these questions, scientists

are developing new and better ways to study

the disease. They are doing laboratory

studies that compare various aspects of the

immune systems of people with lupus with

those of other people both with and without

lupus. They also use mice with disorders

resembling lupus to better understand the

abnormalities of the immune system that

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occur in lupus and to identify possible new

therapies.

The National Institute of Arthritis and

Musculoskeletal and Skin Diseases (NIAMS)

has a major focus on lupus research in its

on-campus program in Bethesda, Maryland.

By evaluating patients with lupus and their

relatives, researchers at the National

Institutes of Health (NIH) are learning more

about how lupus develops and changes over

time.

The NIAMS also funds many lupus

researchers across the United States. To

help scientists gain new knowledge, the

NIAMS sponsored the development of a

Lupus Registry and Repository that gathers

medical information, as well as blood and

tissue samples from patients and their

relatives. This gives researchers across the

country access to information and materials

they can use to help identify genes that

determine susceptibility to the disease.

The NIAMS also helped establish a registry

to collect information and blood samples from

children affected by neonatal lupus and their

mothers. Information from the registry forms

the basis of family counseling and tracks

important data such as recurrence rates in

subsequent pregnancies. The hope is that

the registry will facilitate improved methods of

diagnosis, as well as prevention and

treatment for this rare condition.

In 2003, the NIH established the Lupus

Federal Working Group (LFWG), a

collaboration among the NIH Institutes, other

Federal agencies, voluntary and professional

organizations, and industries with an interest

in lupus. The Working Group is led by the

NIAMS and includes representatives from all

relevant U.S. Department of Health and

Human Services (HHS) agencies and other

Federal departments having an interest in

lupus.

Following are some recent areas of

NIAMS/NIH lupus research:

Genetics

Identifying genes that play a role in the

development of lupus or lupus severity is an

important area of research.

Genome-wide association studies have

identified a number of genetic variations

associated with lupus, although the functions

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of identified variants and the contribution to

the disease remain largely unknown. In most

cases, lupus is thought to be caused by a

combination of many genetic variations, each

with modest effects. Recent studies,

however, have pointed to the existence of

rare variations with more substantial effects

in certain subsets of lupus patients.

A number of genes associated with lupus risk

and severity have been discovered. Some

are linked to patient populations at high risk

for lupus, including African American and

Hispanic individuals.

Biomarkers

Biomarkers are another significant area of

lupus research. Biomarkers are defined as

molecules that reflect a specific biological or

pathological process, consequence of a

process, or a response to a therapeutic

intervention. Simply put, they can let the

doctor know what is happening in the

body—or predict what is going to happen

—based on something reliably measurable in

tissues, cells, or fluids. NIAMS-supported

researchers are seeking to identify

biomarkers that could be predictors of a flare

in people with lupus.

The Disease Process

NIAMS-sponsored researchers are exploring

possible triggers for lupus. One study found

that biofilms, protective coatings that some

bacteria develop, may be involved in the

immune response leading to lupus. Another

study revealed that TREML4, a protein found

on certain immune cells, can cause the

immune system to activate an inflammatory

response. These findings may lead to new

targets for treatments.

Investigators continue to uncover the role of

viruses, hormones, systemic inflammation,

and other factors in the initiation of lupus and

disease flares. They are also attempting to

understand the biological basis for sex

differences in immune and inflammatory

systems that contribute to the sex differences

in the disease.

Treatment

Understandably, identifying and developing

better treatments for lupus—and ensuring

that patients receive the best

treatments—are among the primary goals of

lupus research.

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Earlier studies from the NIH Intramural

Research Program determined that treatment

with immunosuppressive drugs

(cyclophosphamide and prednisone) can

prevent or delay kidney failure caused by

nephritis, one of the most serious and

life-threatening complications of lupus. Other

NIH-supported research has shown that

lupus patients treated with

hydroxychloroquine were less likely to

develop severe kidney disease, had lower

disease activity, and used less steroid

medication.

Today, NIAMS intramural investigators are

exploring how lupus develops and how

therapies impact the course of the disease.

Investigators are also conducting therapeutic

trials to test the safety and efficacy of novel

lupus treatments.

In 2014, the NIH, pharmaceutical companies,

and nonprofit organizations together created

the NIH Accelerating Medicines Partnership

(AMP). The goal of the AMP is to increase

the number of new diagnostics and therapies

for select diseases, including lupus, and to

reduce the time and cost of developing them.

More information on research is available

from the following resources:

NIH Clinical Research Trials and

You was designed to help people

learn more about clinical trials, why

they matter, and how to participate.

Visitors to the website will find

information about the basics of

participating in a clinical trial,

first-hand stories from clinical trial

volunteers, explanations from

researchers, and links on how to

search for a trial or enroll in a

research-matching program.

ClinicalTrials.gov offers up-to-date

information for locating federally and

privately supported clinical trials for a

wide range of diseases and

conditions.

NIH RePORTER is an electronic tool

that allows users to search a

repository of both intramural and

extramural NIH-funded research

projects from the past 25 years and

access publications (since 1985) and

patents resulting from NIH funding.

PubMed is a free service of the U.S.

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National Library of Medicine that lets

you search millions of journal citations

and abstracts in the fields of

medicine, nursing, dentistry,

veterinary medicine, the health care

system, and preclinical sciences.

Hope for the Future

With research advances and a better

understanding of lupus, the prognosis for

people with lupus today is far brighter than it

was in the past. It is possible to have lupus

and remain active and involved with life,

family, and work. As current research efforts

unfold, there is continued hope for new

treatments, improvements in quality of life,

and, ultimately, a way to prevent or cure the

disease. The research efforts of today may

yield the answers of tomorrow, as scientists

continue to unravel the mysteries of lupus.

For More Information

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS (877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

If you need more information about available

resources in your language or another

language, please visit our website or contact

the NIAMS Information Clearinghouse at

NIAMSinfo@mail.nih.gov.

Other Resources

American College of Rheumatology

Website: http://www.rheumatology.org

Alliance for Lupus Research, Inc.

Website: http://www.lupusresearch.org

American Autoimmune Related Diseases

Association, Inc.

Website: http://www.aarda.org (con

información en español)

Handout on Health: Systemic Lupus Erythematosus https://www.niams.nih.gov/health_info/lupus/

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Arthritis Foundation

Website: http://www.arthritis.org

Lupus Clinical Trials Consortium, Inc.

Website: http://www.lupusclinicaltrials.org

Lupus Foundation of America

Website: http://www.lupus.org

Lupus Research Institute

Website: www.lupusresearchinstitute.org

(con información en español)

SLE Lupus Foundation

Website: http://www.lupusny.org

Acknowledgments

The NIAMS gratefully acknowledges the

assistance of the following individuals in the

preparation and review of the original version

of this publication: Jill P. Buyon, M.D.,

Hospital for Joint Diseases, New York, NY;

Patricia A. Fraser, M.D., Brigham and

Women’s Hospital, Boston, MA; John H.

Klippel, M.D., The Arthritis Foundation,

Atlanta, GA; Michael D. Lockshin, M.D.,

Barbara Volcker Center for Women and

Rheumatic Disease, Hospital for Special

Surgery, New York, NY; Rosalind RamseyGoldman, M.D., Dr.P.H., Northwestern

University Medical School, Chicago, IL;

George Tsokos, M.D., Uniformed Services

University of the Health Sciences, Bethesda,

MD; and Elizabeth Gretz, Ph.D., Barbara

Mittleman, M.D., Susana Serrate-Sztein,

M.D., and Peter E. Lipsky, M.D., NIAMS,

NIH. Special thanks also go to the many

patients who reviewed this publication and

provided valuable input. An earlier version of

this publication was written by Debbie Novak

of Johnson, Bassin, and Shaw, Inc.

The mission of the National Institute of

Arthritis and Musculoskeletal and Skin

Diseases (NIAMS), a part of the U.S.

Department of Health and Human Services’

National Institutes of Health (NIH), is to

support research into the causes, treatment,

and prevention of arthritis and

musculoskeletal and skin diseases; the

training of basic and clinical scientists to

carry out this research; and the dissemination

of information on research progress in these

diseases. The NIAMS Information

Clearinghouse is a public service sponsored

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by the NIAMS that provides health

information and information sources.

Additional information can be found on the

NIAMS website at www.niams.nih.gov.

For Your Information

This publication may contain information

about medications used to treat the health

condition discussed here. When this

publication was produced, we included the

most up-to-date (accurate) information

available. Occasionally, new information on

medication is released.

For updates and for any questions about any

medications you are taking, please contact:

U.S. Food and Drug Administration

Website: http://www.fda.gov

Toll free: 888-INFO-FDA (888-463-6332)

For updates and questions about statistics,

please contact:

Centers for Disease Control and

Prevention, National Center for Health

Statistics

Website: http://www.cdc.gov/nchs

Toll free: 800-232-4636

This booklet is not copyrighted. Readers are

encouraged to duplicate and distribute as

many copies as needed.

Additional copies of this booklet are available

from

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS (877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

NIH Publication No. 16–4178

Many of our publications are

available in print. Would you like

to order publications on lupus to

be mailed to you? Visit our online

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order form.

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