Lupus: Natural Approaches, Lupus of America

Epoch Health Article

Lupus, short for lupus erythematosus, is an incurable chronic autoimmune disease capable of damaging any part of the body and manifesting with a wide range of symptoms affecting nearly any organ. The term “lupus” is Latin for “wolf” and was first used by a 13th-century physician to describe the disease’s facial lesions, which he believed resembled a wolf bite.

The Lupus Foundation of America estimates that about 1.5 million Americans and 5 million people globally have some type of lupus. Lupus most often affects women of childbearing age.

What Are the Types of Lupus? Lupus of America....

There are four main types of lupus.

1. Systemic Lupus Erythematosus (SLE)

When people speak of lupus, they’re typically referring to systemic lupus erythematosus, the most common form of lupus, accounting for 70 percent of cases. SLE involves the immune system attacking the body’s own tissues, leading to widespread inflammation and tissue damage in various organs, including the skin, joints, brain, kidneys, lungs, and blood vessels. The severity of the condition can vary from mild to severe.

Pediatric SLE, also known as juvenile lupus or childhood-onset SLE (cSLE), is when the clinical onset of lupus occurs in individuals under 18. It is rare, with a prevalence of 3.3 to 24 per 100,000 children. Approximately 10 percent to 20 percent of all SLE cases are diagnosed in childhood, and pediatric SLE often exhibits more severe symptoms than adult-onset cases.

2. Cutaneous Lupus Erythematosus (Skin Lupus)

In cutaneous lupus, the immune system attacks skin cells, resulting in inflammation that produces red, thick, and typically scaly rashes and sores that can burn or itch. The rashes and sores may appear dark purple or dark brown on dark skin tones.

There are three types of skin lupus

Acute: Acute cases typically develop rapidly, often have a short duration, and usually don’t result in skin scarring. Almost all individuals with acute cutaneous lupus also have SLE. Acute cutaneous lupus can be localized and generalized (i.e., distributed diffusely over the skin). The butterfly rash, a red rash that can be flat or raised and covers the nose bridge and cheeks, is a localized presentation. Generalized acute cutaneous lupus manifests as raised red rashes across the entire body.

Subacute: Subacute cutaneous lupus involves a rash of red, ring-shaped sores or scaly patches with well-defined borders. While it can be associated with SLE, it can also occur independently. Typically, these lesions are neither itchy nor painful and seldom result in scarring once they resolve.

Chronic: There are many types of chronic cutaneous lupus. Chronic cutaneous lupus erythematosus lasts for a long time and may cause permanent scarring and, potentially, hair loss. Among the many kinds of chronic cutaneous lupus, discoid lupus, with its disk-shaped rashes, is the most common. These rashes often appear on the scalp and face and are typically red, scaly, and raised and can lead to scars, hair loss, or skin discoloration over time.

When lupus results in rashes that resemble those seen in other conditions, they are categorized as nonspecific rashes associated with lupus. There are a vast number of these skin conditions, including hives, bruises, and vitiligo.

3. Neonatal

Unlike its name implies, this rare acquired autoimmune disorder is not actually the infant form of lupus, nor is it genuine lupus. Newborns with neonatal lupus may experience temporary skin rashes, liver issues, or low blood cell counts, which generally resolve within six months without lasting consequences.

4. Drug-Induced

This is a lupus-like disease caused by prescription drugs, including hydralazine (for hypertension), procainamide (for heart arrhythmias), valproate (an anti-epileptic), infliximab (for rheumatoid arthritis and Crohn’s disease), and isoniazid (for tuberculosis).

What Are the Symptoms and Early Signs of Lupus?

The earliest signs and symptoms of lupus may include

• Fatigue.

• Joint pain and stiffness.

• Photosensitivity: This is sun or light sensitivity, causing rashes, fever, fatigue, or joint pain upon light (i.e., UV radiation) exposure.

• Muscle pain.

• Gastrointestinal complaints.

• Fever.

• Butterfly-shaped rash on the face (in 30 percent of cases).

• Skin lesions.

• Chest pain.

• Headaches.

• Shortness of breath.

Due to its potential impact on various body parts, lupus manifests with a wide array of symptoms. Not all individuals experience every symptom, which may fluctuate and evolve.

Lupus symptoms typically follow a pattern of flares and remissions, meaning patients don’t experience them continuously. Lupus is characterized by periods of symptom exacerbation— flares—followed by intervals of symptom improvement or remission.

Systemic Lupus Erythematosus (SLE)

Common SLE signs and symptoms include

• Fever: Fevers often exceed 100 F (37.8 C), typically due to inflammation or infection. Some individuals may experience recurrent low-grade fevers below 101 F, which may signal impending illness or a forthcoming lupus flare.

• Rashes.

• Muscle and joint pain/stiffness/swelling: These symptoms often appear on the neck, thighs, shoulders, and upper arms.

• Photosensitivity.

• Mouth sores: These ulcers can appear inside the mouth or on the lips.

• Persistent tiredness: Patients may still feel extremely tired even with sufficient sleep.

• Weight fluctuations: This is due to heightened lupus activity or side effects of lupus medications.

• Chest pain: This results from inflammation in the lining of the lungs, leading to discomfort when breathing deeply.

• Abdominal pain.

• Anemia: Anemia is associated with fatigue due to a lack of red blood cells carrying oxygen throughout the body.

• Depression and anxiety: Almost one-third of all lupus patients experience these.

• Blood clotting: Elevated risk of blood clots, potentially leading to issues like leg or lung clots, stroke, heart attack, or recurrent miscarriages.

• Hair loss: Often presenting as patchy or bald spots, potentially triggered by medications or infection.

• Gastrointestinal issues: These may include heartburn from gastroesophageal reflux disease (GERD) and peptic ulcers linked to medications used in lupus treatment, such as NSAIDs and steroids.

• Memory problems: Some individuals may experience forgetfulness or confusion.

• Eye problems: Symptoms may include dry eyes, eye inflammation, and eyelid rashes.

• Sjogren’s syndrome: Up to 10 percent of lupus patients may develop this autoimmune disorder that affects tear and saliva gland function, as the immune system attacks these moisture-producing glands. This leads to dryness in the eyes, mouth, and vagina, often causing a gritty feeling in the eyes.

• Autoimmune thyroid disease.

• Arthritis.

• Discoloration of fingers and toes.

• Swelling in the legs or around the eyes.

• Children with SLE have distinct symptoms, generally more severe disease, and a poorer outlook than adults with SLE. Specifically, more cases of kidney inflammation, blood problems, photosensitivity, brain-related issues, and skin and mouth troubles are observed among patients with childhood-onset SLE. In severe cases, patients may experience psychosis and/or seizures. Pediatric SLE is also linked to more damage than SLE in adults.

Neonatal

Signs and symptoms of neonatal lupus include

• Skin symptoms such as rashes.

• Heart symptoms, including congenital heart block.

• Liver disease.

• In rare cases, macrocephaly, meaning an unusually large head.

• Low platelet count.

• Low white blood cell count.

• Anemia.

Drug-Induced

Drug-induced lupus shares some characteristics with SLE. It may also include serositis, or inflammation around the lungs or heart. Fortunately, drug-induced lupus rarely affects major organs.

What Causes Lupus?

The cause of lupus is unknown, but the disease is believed to result from a complex interplay of genetic, environmental, and hormonal factors. Because most people with lupus are women, researchers have theorized that estrogen may have a role to play in developing the disease, at least in terms of its severity. Individuals with a genetic predisposition to lupus, like those with the gene families MHC classes 1 and 2 (which code for proteins involved in immune response), may develop the condition when exposed to environmental triggers. Typical triggers include:

• UV light exposure.

• Cigarette smoke.

• Infections.

• Certain medications.

• Stress.

• Severe fatigue.

• Vitamin D deficiency, though vitamin D’s relationship to lupus may be bidirectional.

• Exposure to toxins.

• Major surgeries or significant injuries.

Lupus Illustration

The cause of lupus is unknown, but it is believed to be related to a combination of genetic, hormonal, and environmental factors. Illustrations by Shutterstock, The Epoch Times

Systemic Lupus Erythematosus (SLE)

Normal gene variations, often involving multiple genes related to the immune system, can impact the risk of SLE. In rare instances, specific gene mutations can directly cause the condition.

In individuals with SLE, cells that have self-destructed due to damage or obsolescence are not effectively removed. The exact connection between this malfunction and the origins or characteristics of SLE remains uncertain. Some researchers propose that these deceased cells might release substances that trigger an abnormal immune response, leading to the body’s own tissues being mistakenly attacked and causing the manifestations of SLE.

Neonatal

Neonatal lupus is not actually lupus. It gets its name from the similarity of the rash to lupus, but the baby does not have lupus. Most often, the mother does not have lupus either. It arises in a newborn due to antibodies received from the baby’s mother rather than from inherited genes. These antibodies, produced by the mother’s immune system, typically protect against harmful substances. A mother naturally passes antibodies to her child during pregnancy, as babies cannot make their own. Even if she has lupus herself, it is very uncommon for a mother to transmit the antibodies that can cause neonatal lupus to her baby, which is why the condition is rare.

Who Is at Risk of Lupus?

The people with a higher risk of developing lupus include

• Women: Although lupus can affect anyone, it predominantly impacts women, with approximately 90 percent of adults diagnosed with the disease being female. Female hormonal factors play a substantial role in the risk of developing SLE. Estrogen, for example, triggers the activation of various immune cells, such as B cells, macrophages, and thymocytes, and the release of certain cytokines. Also, the use of contraceptives containing estrogen and hormone replacement therapy after menopause has been linked to an increased occurrence of SLE.

• Younger people: Although lupus can develop at any age, it is most commonly diagnosed in people between 15 and 44. About 20 percent of SLE cases are in patients over 50.

• Nonwhite racial groups: In the United States, blacks, Hispanics, Asians, and Native Indians are more likely to develop lupus than whites.

• Residents of industrialized Western countries: The incidence of SLE has inexplicably increased by 10 percent in Western nations over the past five decades, while Africa and Asia exhibit notably lower SLE prevalence. Researchers propose that factors like ethnic diversity, tobacco use in industrialized countries, and regional variations in infectious diseases may contribute to these distinctions.

• People with specific genes: Researchers have identified over 100 gene variants linked to lupus; these variants may impact the body’s immune system. When one of two twins has lupus, there is an elevated likelihood that the other twin will also develop the disease (approximately 30 percent for identical twins and 5 percent to 10 percent for fraternal twins).

• People taking certain drugs: Over 100 medications have been linked to lupus due to their capacity to induce DNA demethylation and modify self-antigens, with procainamide and hydralazine being those with the highest incidence of drug-induced lupus.

• People with particular infections: Epstein-Barr virus (EBV) has been shown to increase the risk of lupus.

• People living with high stress: People going through a divorce, illness, or losing a loved one have a higher risk of developing lupus.

• People with vitamin D deficiency: Evidence indicates that vitamin D plays a significant role in SLE development and progression.

• People exposed to toxins: Researchers have identified links between lupus and various toxins, including silica, mercury, and cigarette smoke.

How Is Lupus Diagnosed?

Diagnosing lupus can be challenging, as its symptoms may resemble those of many other conditions.

Your doctor/rheumatologist will first examine your medical history and conduct a physical checkup. Then, you may need to undergo multiple tests, as lupus cannot be definitively diagnosed with one single test and may require several months or even years to confirm a diagnosis.

Blood Tests

Although a blood test alone cannot diagnose lupus, specific proteins in the blood provide valuable information to your doctor so he or she can make an accurate diagnosis. The following tests may be performed:

• Complete blood count (CBC): This test measures the levels of white blood cells, red blood cells, and platelets in the blood. The results are then compared to reference ranges.

• Antinuclear antibody (ANA) test: The ANA test is commonly used to detect autoantibodies that can trigger autoimmune disorders by attacking components within the cell nucleus. While around 95 percent of people with lupus test positive for ANA, those with drug-induced lupus linked to quinidine often test negative for ANAs. However, a positive ANA test doesn’t conclusively indicate lupus. Conversely, a negative ANA test significantly lowers suspicion. Therefore, additional tests are typically conducted for those with a positive ANA to confirm the diagnosis. Known as an ANA panel, this assesses various antibodies. The antibodies tested may vary among laboratories.

• Complement test: This test measures the concentration of complement, a group of proteins in the bloodstream responsible for eliminating foreign substances. Reduced levels of complement in the blood are frequently linked to lupus.

• Erythrocyte sedimentation rate (ESR or sed rate): This test measures the rate at which red blood cells settle at the bottom of a test tube. In the presence of swelling and inflammation, blood proteins aggregate and become denser, causing them to settle more rapidly. Typically, the faster the descent of blood cells, the more pronounced the inflammation.

• C-reactive protein (CRP) test: This blood test identifies inflammation in the body. While both ESR and CRP indicate comparable levels of inflammation, there are instances where one may be elevated while the other is not.

Tissue Biopsies

• Skin: A small sample of skin tissue is removed for examination under a microscope. Skin biopsies can help determine the cause of skin abnormalities, such as symptoms caused by lupus, assess the extent of a skin condition, and guide treatment decisions.

• Kidney: A small tissue sample is removed from the kidneys for examination.

• Other Tests

• Urinalysis: Urine samples may reveal elevated levels of blood or protein in the urine, suggesting potential kidney involvement in lupus.

• X-rays and scans: If your doctor suspects some of your organs might have been affected by lupus, X-rays and scans will be employed.

• Echocardiogram: This noninvasive procedure evaluates the heart’s function and structures, aiding in the diagnosis of various heart issues in adults with SLE, including congenital heart blocks due to neonatal lupus.

What Are the Complications of Lupus?

Lupus has various complications, including the following major ones, sorted by type of lupus:

Systemic Lupus Erythematosus (SLE)

Complications in SLE patients can arise from either disease-related organ damage or medication side effects. Specifically, disease-related complications include:

• Lupus nephritis: This is a severe complication of SLE. In lupus nephritis, the immune system mistakenly attacks the kidneys, leading to inflammation and damage to the kidney tissue, potentially causing kidney dysfunction and, in severe cases, kidney failure.

• Accelerated atherosclerosis and coronary heart disease.

• Neurological deficits.

• Lupus vasculitis (LV): Vasculitis is the inflammation of blood vessels, which develops in about 50 percent of SLE patients. It primarily affects small, sometimes medium-sized, and rarely large vessels. It can manifest across various organ systems, displaying symptoms based on the size and location of the affected blood vessels. Unfortunately, it is often associated with an unfavorable prognosis.

• Abnormal blood clotting: This is a common complication, leading to either excessive clotting or insufficient clotting, as the body produces too many antibodies. This condition can persist even when a person’s lupus is well-managed.

• Anxiety and depression.

• Lung issues: Approximately half of SLE patients will eventually encounter lung complications in their disease course. There are five primary lung issues associated with lupus: pleuritis, acute lupus pneumonitis, chronic (fibrotic) lupus pneumonitis, pulmonary hypertension, and “shrinking lung” syndrome (where a patient experiences breathing difficulties, chest pain, and a gradual reduction in lung capacity).

• Pregnancy-related complications: A high-risk pregnancy is not a direct complication of lupus itself, but active lupus during pregnancy can lead to complications such as miscarriage, stillbirth, or serious health issues for both mother and baby. In fact, all pregnancies in women with lupus are classified as high-risk. To maximize safety, it’s essential for the mother to have her disease well-controlled or in remission for at least six months before conceiving.

• Infections: SLE patients are often immunocompromised due to the disease itself and the use of immunosuppressive treatments. Secondary infections are a common and significant source of health issues, with bacterial infections accounting for 60 percent to 80 percent of total cases. Cytomegalovirus is an opportunistic pathogen that can affect SLE patients. Urinary tract infections are also common, affecting nearly 40 percent of lupus patients.

• Macrophage activation syndrome (MAS): Although its causes are unknown, in MAS, the immune system becomes overactive, leading to the buildup of specific immune cells in organs. This can cause symptoms similar to a sudden disease flare, including fever and fatigue, with some variations in blood test results and physical findings. MAS is potentially fatal and less often detected in adult SLE cases.

• Fibromyalgia.

• Complications due to long-term corticosteroid use in SLE patients include:

• Osteoporosis.

• Avascular necrosis.

• Glaucoma.

• Cataracts.

• Weight gain.

• Worsened diabetes.

• Acute psychosis.

• Cyclophosphamide use is linked with a high risk of interstitial cystitis, also known as painful bladder syndrome, and bladder cancer.

• Cutaneous Lupus Erythematosus

Common complications of CLE include:

• Advancement to SLE.

• Skin discoloration.

• Scarring, permanent hair loss, and the development of cutaneous squamous cell carcinoma in discoid lupus erythematosus (DLE) cases.

Neonatal

Complications of neonatal lupus include:

• Congenital heart block, which results in a slow heartbeat and is potentially life-threatening.

• Endocardial fibroelastosis: This rare heart condition involves the thickening of the muscular lining of the heart chambers resulting from an increase in the amount of supportive connective tissues. This can affect the heart’s ability to pump blood effectively, leading to various heart problems.

• Dilated cardiomyopathy: This heart condition is characterized by the initial enlargement (dilation) of the heart’s left ventricle, the main pumping chamber responsible for pumping blood throughout the body. In this condition, the heart muscle becomes weakened and cannot contract effectively, decreasing the ability to pump blood.

• Congestive heart failure, typically due to the factors above.

Drug-Induced

Most individuals with drug-induced lupus do not face severe complications. There are rare cases of pericarditis, neuropsychiatric disorders, and glomerulonephritis (inflammation and damage to the filtering part of the kidneys). The occurrence of lasting kidney damage in glomerulonephritis is uncommon.

What Are the Treatments for Lupus?

While there is currently no cure for lupus, treatments can alleviate symptoms and improve a patient’s well-being. The treatment plan will be tailored to address the specific symptoms and requirements, thus preventing flares and minimizing adverse outcomes.

Systemic Lupus Erythematosus (SLE)

Common lupus medications include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Non-prescription NSAIDs, such as ibuprofen and naproxen, can ease mild joint and muscle pain and reduce swelling.

• Corticosteroids: Also called steroids for short, these drugs reduce swelling, tenderness, and pain, and in higher doses, they can control the immune system. Lupus symptoms typically respond rapidly to these potent medications. However, doctors aim for the lowest effective dose due to their side effects.

• Antimalarial drugs: Drugs used to treat malaria, including hydroxychloroquine and chloroquine phosphate, effectively treat joint pain, skin rashes, fatigue, and lung inflammation in lupus. Hydroxychloroquine is a first-line treatment for childhood-onset SLE. Research has shown that these medications can prevent lupus flares and potentially extend the lifespan of individuals with lupus.

• BLyS-specific inhibitors: These inhibitors, such as belimumab, reduce the number of abnormal B cells, which are immune system cells that produce antibodies and are considered an issue in lupus.

• Immunosuppressive agents: In severe and treatment-resistant cases of lupus affecting major organs, immunosuppressive agents may be prescribed. However, they can also lead to severe side effects, as they weaken the body’s immune system. Systemic glucocorticoids are an important treatment for pediatric SLE.

• Anifrolumab-fnia: This is a first-of-its-kind type 1 interferon receptor antagonist used for adults with moderate to severe SLE.

• Voclosporin: This is the only oral medication approved by the U.S. Food and Drug Administration (FDA) for treating lupus nephritis.

• Biologic agents: The monoclonal antibody rituximab may benefit some lupus patients, but more studies are needed to determine its long-term effects and efficacy.

• Disease-modifying anti-rheumatic drugs (DMARDs): These reduce joint pain, swelling, and long-term joint damage by calming the immune system.

Cutaneous Lupus Erythematosus

When treating CLE, dermatologists aim to clear skin rashes, sores, and other issues, relieve itching and pain, prevent scarring, and address hair loss in discoid lupus. Typically, patients visit their dermatologist every three to six months. Treatment options include:

• Sun protection: This prevents new flare-ups and worsening of lupus.

• Medications used for treating SLE.

• Tacrolimus ointment: This is used when corticosteroids are unsuitable for the affected skin. It may also promote hair regrowth.

• Laser therapy: Laser therapy can treat persistent thick discoid lupus patches, dark patches, and scarring.

How Does Mindset Affect Lupus?

A positive attitude and overall mental well-being can positively impact an individual living with lupus. Although a positive attitude may not directly improve the underlying condition, it can help individuals cope with the challenges and stress associated with lupus. According to one study, almost 23 percent of the participants used a positive attitude as their coping strategy for lupus.

In another small study, 56 people with SLE participated in six weekly psychosocial program sessions to enhance their self-confidence and develop a positive attitude toward the condition. The study revealed that in addition to increased self-esteem, participants in the program exhibited positive changes in anxiety, depression, coping, social functioning, and sleep disturbance.

What Are the Natural Approaches to Lupus?

Various natural treatments may help with symptom management.

Dietary

Although there is no special “lupus diet,” maintaining a healthy, unprocessed diet is crucial for managing lupus because it regulates inflammation and improves a patient’s overall health. According to the Lupus Foundation of America, people living with lupus should consume:

• Fruits and vegetables, including leafy greens.

• Whole grains, beans, and nuts.

• A combination of lean meats, poultry, tofu, seafood, and eggs.

• Foods with healthy fats, including olive oil, avocados, nuts, and fatty fish.

Supplements

• Vitamin D: Vitamin D supplementation is essential, as people with lupus should avoid exposure to sunlight, which is needed for the body to produce vitamin D. In a study involving 177 SLE patients, about 82 percent of participants had low levels of vitamin D, which was linked to more severe disease activity and unfavorable blood test results. In another study, taking vitamin D supplements for five years, either alone or combined with omega-3 fatty acids, led to a 22 percent reduction in autoimmune diseases such as lupus. Vitamin D supplementation appears to positively impact inflammatory and hemostatic markers, potentially leading to improved clinical outcomes.

• Omega-3 fatty acids: Omega-3 polyunsaturated fatty acids have anti-inflammatory properties. In one study, participants taking omega-3 fish oil experienced a significant decline in lupus disease severity compared to placebo.

• N-acetylcysteine (NAC): NAC, a supplement containing a modified form of the amino acid cysteine, has antioxidant and anti-inflammatory properties. People with SLE have T-cell dysfunction. One pilot study indicates that NAC can safely reduce lupus disease activity by inhibiting a protein in T cells crucial in regulating various cellular processes.

Herbs

Several herbs can reduce lupus symptom severity, including

• Curcumin: Curcumin, a polyphenol found in turmeric, exhibits antioxidant, anti-cancer, and anti-inflammatory properties, and it may be an effective immunomodulator. Research found that lupus involves the immune system’s complement system going into overdrive, and curcumin can slow down this immune reaction. Additionally, curcumin prevented specific immune cells called B cells from becoming too active by reducing antibody production in mice models.

• Green tea: Green tea contains powerful antioxidants called catechins, especially epigallocatechin gallate (EGCG), which have potent anti-inflammatory and anti-cancer properties. In one study, drinking green tea extracts daily for 12 weeks reduced disease activity in SLE and enhanced patients’ quality of life.

• Ginger: Ginger, well-known for its anti-inflammatory and antioxidant properties, contains a key compound called 6-gingerol. One animal study revealed that 6-gingerol can reduce the release of neutrophil extracellular traps (NETs), which are relevant to lupus. This research highlights the protective potential of ginger-derived compounds in the context of lupus.

• Some herbs and supplements may interfere with other medicines, so consult your doctor before beginning any new therapies.

Mind and Body Practices

• Exercise: Physical activity can help manage lupus symptoms, as it reduces inflammation by regulating key chemicals involved in the inflammatory process, helps reduce weight gain due to lupus medication side effects, enhances muscle flexibility, and improves mental well-being.

• Meditation: Stress is one of the triggers for lupus flares, so stress-reducing techniques such as meditation and yoga can help improve lupus patients’ overall health. In one study, 26 SLE patients received a mindfulness-based stress reduction (MBSR) group therapy. Compared to a waitlist group, the group practicing MBSR exhibited more significant enhancements in quality of life, reduced psychological rigidity concerning pain, and decreased lupus-related negative feelings.

• Acupuncture: Acupuncture is a traditional practice of using fine needles inserted into the skin for health treatment, dating back over 2,500 years. A meta-analysis of seven studies involving 514 SLE patients found that additional acupuncture treatment, when combined with conventional drug therapy, improved the overall response rate, regulated immunological indicators, lowered SLE disease activity, and decreased the incidence of adverse events during treatment.

How Can I Prevent Lupus?

Since the cause of lupus is unknown, there’s no way to prevent the disease. However, you can minimize your exposure to environmental triggers to reduce the risk of a lupus flare by practicing the following behaviors:

• Using UV radiation protection: Wearing protective clothing and sunscreen when necessary, avoiding excessive sun exposure, and avoiding tanning equipment can minimize the UV radiation that can trigger lupus flares.

• Minimizing exposure to toxins: These include silica, mercury, and cigarette smoke.

• Avoiding smoking.

• Leading a healthy lifestyle: Maintaining a balanced diet, staying physically active, and managing stress effectively can support one’s immune system and overall health.

• Managing medications: Learn about the risk of developing drug-induced lupus from the intake of your medications and monitor your health condition.