by Elizabeth Rosser,The Conversation

Credit: Unsplash/CC0 Public Domain

Actress, singer and makeup mogul Selena Gomez has been candid about her experience of living with lupus. Since 2015, Gomez has documented on social media and in interviews the effect the condition has had on her health.

In 2017, the actress shared that she'd undergone akidney transplantdue to lupus-related organ damage. Then, earlier this month, Gomez said on a podcast that she'sdeveloped arthritisrelated to herlupus symptoms.

Selena Gomez's story has raised important awareness of the wide-ranging health impacts associated with lupus. But even still, many people may not know exactly what lupus is—nor how it can have such widespread effects on the body.

Lupus is an autoimmune condition. This means the immune cells malfunction and attack parts of the body instead of potential pathogens—causing inflammation and damage.

There are two common forms of lupus. Discoid lupus affects the skin, causing painful rashes. Systemic lupus erythematosus (SLE) is more severe and can affect multiple organs. It's estimated around3.4 million peopleworldwide are living with SLE.

In SLE, the immune cells target our DNA, as well as the proteins that help to package our DNA within a cell's nucleus (information hub). This improper immune response allows the disease to affect nearly every major organ system in the body. This includes the skin (causing a butterfly-shaped rash over the nose and cheeks), kidneys, brain, heart, lungs and the joints.

Up to 95% of people living withsystemic lupuswill experiencearthritis or joint pain. Fatigue and pain can also have a significanteffect quality of lifefor people living with lupus.

Other lesser-known complications from SLE include an increased risk of developingcardiovascular diseaseand cancers—most commonly lymphoma.

What causes lupus and why the immune system malfunctions remains unknown. However, we do know that women are much more likely todevelop systemic lupus. It's estimated that 90% of those diagnosed with lupus are women. It's also more common in women of reproductive age.

According to researchmy colleagues and I have recently published, thesegender differencesmay partly be due to the influence of different sex hormones onimmune cell function.

People who are Hispanic, Asian, Black or Indigenous are alsomore likely to develop SLEthanwhite people. Black people have a five- to nine-fold greater risk of SLE compared to white people.

It has also been shown that Black people living with SLE aremore likely to die earlycompared to white people living with SLE. This is probably due to the complex interplay betweensocioeconomic factors(such as access to health care) and differences in howthe immune systemfunctions.

Lupus remains an incurable disease, but can be managed through treatment.

Lupus is characterized by periods where the disease flares up and periods where it's in remission (where there are few symptoms). The aim with treatment is to keep the disease in remission. However, this can be a complex journey—and may take time to find the right drug that works for a patient.

During flare-ups, symptoms are typicallymanaged with steroids. These quickly dampen immune system function to prevent damage to the body. But long-term steroid use can havemultiple side-effects—including changes to bone health and eye health (leading to cataracts and glaucoma). As such, doctors try to limit steroid usage as much as possible.

Alongside steroids,disease-modifying anti-rheumatic drugsare used to stop flare-ups and keep lupus-triggered inflammation at bay. These drugs modulate the immune system and suppress it.

Biologics, which are a type of anti-rheumatic drug, selectively target the parts of the immune system that cause lupus inflammation. But while these drugs are effective at dampening inflammation, many patients report that they do not always help withfatigue and pain.

Crucially, certain lupus treatments (and especially one called cyclophosphamide) can alsocause fertility problems, such as menstrual irregularities and a reduced number of eggs in the ovaries. They do this by affecting the health of the ovarian follicles (structures which house eggs in the ovary).

Although new therapies introduced over the last 20 years have drastically reduced mortality associated with systemic lupus, current research estimates that it can still take up to five years to becorrectly diagnosed. This can lead to more organ damage—and eventually worse disease outcomes.

It's clear we still desperately need more research into the causes of the condition so we can improve treatments and quality of life for people living with the condition.

Despite these challenges, there are some exciting innovations happening in the field of lupus research.

This includes repurposing a form of cancer therapy that uses a patient's ownimmune cells(T cells) and engineering them to destroy cancer cells. These cells, called CAR-T cells, are now being engineered to recognize malfunctioning parts of the immune system to help some people living with lupus achievelong-term disease remission.

Researchers are alsolooking to identifypredictivelupus "biomarkers"(signs of the disease that can be detected in a blood sample). This will help identify how different people will respond to certain lupus treatments, which would be an important first step in being able to personalize treatments to each patient.

Our understanding of the biological processes causing lupus continues to grow each year. With continued awareness of the disease and the many ways it can affect daily life, we're getting closer to identifying treatment targets that may someday help cure the condition.

This article is republished fromThe Conversationunder a Creative Commons license. Read theoriginal article.

Provided by The Conversation