Lupus

Prognosis of Lupus

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The improvements in diagnosis and treatment have meant that the life expectancy of patients with lupus has notably improved. Nowadays it is considered that it is practically normal.

Acute and chronic complications of lupus

The complications, both acute and chronic, may be due to the activity of the disease and the side-effects of the treatment.

Acute complications. Some side-effects of the therapy used are responsible for complications such as, infections, drowsiness, nervousness, or changes in laboratory results (changes in the liver or a decrease in defence cells).

Chronic complications. They are probably the most important, since they cause the damage to organs and furthermore, are irreversible and are associated with a worsening of the lupus prognosis. Unfortunately, among the most common are osteoporosis, avascular necrosis (death of the bone tissue due to lack of blood irrigation), accelerated arteriosclerosis with its cardiovascular manifestations, and other that, although not so serious, can significantly affect the quality of life of the patients, with the Cushinoid appearance (moon face), a significant increase in weight or skin stretchmarks. Other types of chronic complications are directly related with the activity of the disease, such as the chronic kidney failure that, in some cases, may require a renal transplant, or a deforming arthritis, that can lead to significant functional disability.

Pregnancy and lupus

Young women that have lupus may become pregnant. However, it is very important that the pregnancy is planned by the patient, her partner and the doctor responsible in a pre-conception visit.

The planning is necessary because the pregnancy should take place in situations of little or no activity of the lupus, some treatments may not be given during the pregnancy, and the presence of some antibodies are associated with complications during the pregnancy. All these aspects must be taken into account in the wish to become pregnant.

A slight increase in the risk of flare-up during pregnancy requires frequent monitoring by a team specialised in medical care. Furthermore, there is an increased risk of delayed intra-uterine growth, pre-eclampsia, miscarriages, and prematurity. The frequency of the visits, laboratory tests, and ultrasounds are adapted to the clinical progression of the disease.

In principle, lupus is not a contradiction for vaginal delivery or for breastfeeding. Puerperium or the period after the delivery is a risk situation for triggering a flare-up of the disease.

As has been mentioned, there are some antibodies that require a more exhaustive monitoring, such as the anti-Ro, due to the risk of foetal heart block, or the anti-phospholipid antibodies, due to their association with miscarriages and foetal death.

Women with lupus that do not want to become pregnant, or in those where it is not advised (due to taking drugs that could be harmful to the foetus or presenting severe lupus activity), need a reliable birth control method that must be indicated by the specialist.

How to alleviate the secondary effects of lupus

  • Reduce fatigue, through rest and reducing the level of daily activity.
  • Reduce stress.
  • Avoid direct exposure to the sun, and also fluorescent lights. Use sunglasses, sun creams, caps and hats.
  • Discuss them with those around you (family and friends).
  • Surround yourself with friends who understand that, for example, you cannot go out at night, that you don’t have the energy to carry out activities, or that they accompany you outside, walking in the shade.
  • Ask for help from relatives, friends, and health professionals when you need it.

Substantiated information by:

Ricard Cervera
Gerard Espinosa
Neus Guasch
José-Manuel Mascaró
Luis Quintana
Irene Teixidó

Published: 20 February 2018
Updated: 20 February 2018

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