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Southern Cross Medical Library


Systemic lupus erythematosus

Systemic lupus erythematosus (SLE or lupus) is a long-term autoimmune disease, where the body’s immune system attacks and damages its own healthy tissue. It can affect any part of the body (most commonly the skin, muscles, joints) causing inflammation and tissue damage.


Anyone can develop lupus but it is around eight times more common in women than men. It can develop at any age but most frequently between the ages of 20 and 45 years.  In New Zealand, lupus is more prevalent in Maori, Pacific Island and Asian races than Europeans. It’s usually a mild disease but can be severe in around 5% of cases. 


Genetic (inherited) factors
Although uncommon, the tendency to develop the condition may run in families giving rise to the theory that genetic factors influence its development.

Infectious agents

Hormonal factors
Because substantially more women than men suffer from lupus, and because some women experience worsening symptoms at the time of their menstural periods, female hormones are thought to play a role in the development of the disease.


Signs and symptoms

There is great individual variation as to the nature and severity of lupus symptoms, from a mild condition that affects only one area of the body to a rapidly progressive disease that can affect many areas of the body at once. Fortunately it is usually a mild  disease that most commonly affects the skin, muscles and joints.   Lupus is characterised by periods of remission (absence of symptoms) and "flares" (when symptoms are problematic). Flares can be triggered by factors such as sunlight, increased stress and some medications.


  • Fatigue
  • Weakness
  • Loss of appetite
  • Weight loss
  • Skin rashes - most commonly a characteristic rash across the nose and cheeks known as the "butterfly rach" or "malar rash"
  • Hair loss
  • Mouth and nose ulcers
  • Red sore dry eyes
Body systems and organs sometimes affected by lupus include:

Heart and lungs


Gastrointestinal tract

Nervous system

Blood and blood vessels
People with lupus may develop anaemia (lack of oxygen carrying haemoglobin in the blood) or leucopaenia (a decreased number of infection fighting white blood cells).  These conditions often compound the feeling of fatigue and ill health. Inflammation of the blood vessels (vasculitis) may also occur and some people with lupus may have an increased risk of blood clots.

Musculoskeletal system
Arthritic pain, stiffness and swelling of the joints can occur - especially in the small joints of the hands and feet. Muscle aches are common and distortion of the hands due to inflammation in the tendons occurs in approximately 20% of cases.  There may also be an increased tendency to develop osteoporosis (loss of bone mass).

Systemic lupus erythematosus should not be confused with discoid lupus erythematosus. This is a similar condition but only affects the skin. It's characterised by a raised, coin-shaped red rash on the skin, which may become thickened and scaly.  A small percentage of people with discoid lupus erythematosus will go on to develop systemic lupus erythematosus.


There is no single test to diagnose lupus. It is a complex disorder and it can be difficult to diagnose. To assist with a diagnosis the doctor will take a full medical history, including any family history of lupus. They will discuss nature and severity of current symptoms experienced and will conduct a thorough physical assessment. A urine sample will also be analysed to check for kidney involvement.  In order to confirm a diagnosis, blood tests will be taken. Blood tests performed may include:

Complete blood count


Erythrocyte sedimentation rate (ESR)
C-reactive protein

Antinuclear antibody test (ANA)
The ANA test detects the presence of autoantibodies. This test is positive in 95% of lupus cases, however there are a number of other causes for a positive ANA result, including other autoimmune diseases and infection. If the test is negative, lupus is unlikely.

Other autoantibody tests
Sometimes tests for other autoantibodies that are specific to lupus are performed to confirm a diagnosis. These may include tests for complement enzymes, antiphosphiloid antibodies, lupus anticoagulant and antibodies to DNA (anti-dsDNA).

Coagulation studies



Anti-inflammatory medications such as aspirin, and non-steroidal anti-inflammatory drugs (NSAID's) such as Brufen and Voltaren, can help to reduce pain and inflammation. To avoid irritating the stomach, it is recommended that these medications be taken with food or with a stomach protectant such as misoprostol (Cytotec).  Other medications that may be used include:
Corticosteroid medications - These are commonly used in the treatment of moderate to severe cases of lupus and work by suppressing inflammation. They can be given as tablets, as a cream applied to the skin, or by injection. Examples of these medications used to treat lupus are prednisone (Apo-Prednisone), hydrocortisone (Locoid) and dexamethasone (Hospira).

Anti-malarial medications - It is not entirely clear how these medications work to treat lupus, however it is thought that they reduce the autoimmune response. An anti-malarial medication commonly used in the treatment of lupus is Hydroxychloroquine.

Immunosupressive medications - These help to dampen down the abnormal response of the immune system and can be given as tablets or as an infusion into a vein. Immunosuppressive medications are used for treating people with more severe disease, such as when there is damage to internal organs.  Examples of these medications include azathiaprine (Imuprine), methotrexate (Methoblastin), cyclophosphamide (Cycloblastin) and mycophenolate mofeti (Cellcept) which is particularly useful for people with kidney disease.

Biological medications - These are synthetic (man-made) antibodies that suppress specific components of immune system function.  They include rituximab (Mabthera) which is also helpful for people with kidney disease, and belimumab (Benyista).

Rest and Exercise
Rest will help reduce fatigue, pain and inflammation.  Exercise is also important to maintain muscle strength, decrease joint deformities and stiffness, and to maintain mobility.  A physiotherapist can recommend an appropriate exercise regime.  When lupus is more problematic, more rest is required.

Avoiding sunlight
Because sunlight can trigger flares and skin rashes in some people with lupus, it is important that lupus sufferers who are sensitive to the sun should avoid sun exposure, particularly between 11.00am and 3.00pm. Protective clothing and sunscreens with a sun protection factor of 15+ should be worn when in the sun.

Alternative therapies


It is important to discuss any alternative therapies with the doctor or specialist before undertaking them to insure that they will not interfere with medical treatments. For advice on dietary factors, consult a dietician.

Further support

Arthritis New Zealand:
Ph: 0800 663 463

Lupus Trust of New Zealand
Ph: 0800 324 634
Lupus Care and Support Inc.
Ph: 021 0286 1056


Arthritis New Zealand (date unknown) Lupus. Pamphlet. Wellington: Arthritis New Zealand
Lupus Trust of New Zealand (2013) What is lupus? Auckland: Lupus Trust of New Zealand -
O’Toole, MT (Ed.). (2013) Systemic lupus erythematous (SLE). Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis: Elsevier Mosby.
Shiel, WC (2012) Systemic lupus erythematosus (SLE or Lupus). New York: WebMD LLC.
Last Reviewed – June 2013