Integrative Approaches to the Treatment of Lupus: A Comprehensive Review

A study by the Lupus Foundation of America on over 3000 adults with Lupus showed that 46.5% reported being misdiagnosed, and over half were told there was nothing wrong with them or their symptoms were psychological. This study is an eye-opener for healthcare practitioners as many patients with Lupus struggle greatly and can experience unpredictable flare-ups for many years without an accurate diagnosis. 

Understanding Lupus is crucial in supporting and finding effective treatment options for those with this complex disease. This discussion will provide some insights into Lupus, including the associated symptoms, possible differentials, and known causes, along with some functional medicine diagnostics and treatment approaches that can offer some much-needed complimentary options for supporting patients with Lupus.

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What is Lupus?

Lupus is an autoimmune disease affecting various body systems and parts. It got its name from the Latin word for "wolf" because its skin rashes resembled wolf bites. Skin involvement is common in 90% of lupus cases, but this is just one aspect of the disease. Lupus can also target the kidneys, joints, brain, heart, and immune system.

The most prevalent type of Lupus is called Systemic Lupus Erythematosus (SLE), accounting for 70% of cases. There are other types as well, such as Drug-Induced Lupus Erythematosus, Cutaneous Lupus Erythematosus, and Neonatal Lupus.

Symptoms of Lupus

Lupus often mimics the symptoms of other conditions, making it challenging to diagnose. Lupus affects individuals differently, with some experiencing severe symptoms while others have milder ones. Patients with lupus experience inconsistent flares and remissions, making it difficult for doctors to identify, manage, and treat this tricky disease. Many adults are often initially misdiagnosed with other conditions, and over half were told their symptoms were psychological or that nothing was wrong. Even though a butterfly-shaped rash, also known as a malar rash, is often associated with Lupus, only around half of the cases display this symptom.

Early warning signs of Lupus are not commonly observed, and symptoms can vary widely between patients and over time. This chronic autoimmune disease affects multiple areas of the body, resulting in diverse symptoms such as chronic fatigue, joint pain, swelling, muscle pain, shortness of breath, chest pain, headaches, unexplained fever, skin rashes (including the distinctive butterfly rash), sensitivity to light, vision disturbances, brain fog, memory loss, anemia, mouth sores, digestive problems, depression, anxiety, insomnia, and Raynaud's disease, an excessive constriction in the small blood vessels leading to a restriction of blood flow to the fingertips or toes.

Lupus's complex and diverse symptoms stress the importance of early detection to improve the quality of life for individuals living with this challenging condition.

What Causes Lupus?

Like many autoimmune diseases, the exact cause of Lupus remains unknown, and there is ongoing research to discover more information on this condition. Currently, scientific studies have identified certain factors contributing to Lupus's development, such as genetics and environmental influences.

Genetics plays a role in Lupus, with around 50 genes associated with the disease. While no single gene is responsible for Lupus, genetics can contribute to an individual's susceptibility to the condition.

Environmental factors also play a part in triggering Lupus in individuals with a genetic predisposition. Although specific triggers have not been definitively identified, research suggests that exposure to certain environmental elements may lead to the development of Lupus. Some potential triggers include sunlight, particularly UVA and UVB waves, infections caused by viruses like EBV, CMV, and HERVs (human endogenous retroviruses), and certain medications.

There are different factors that can increase the risk of developing Lupus. Women are more likely to be affected than men, and most cases are diagnosed between the ages of 15 and 44. Lupus is more common in individuals of African American, Hispanic/Latino, Asian American, Native American, Native Hawaiian, or Pacific Islander descent. African American women have a threefold higher risk compared to Caucasians.

Additionally, a specific type of Lupus called drug-induced lupus erythematosus is triggered by certain medications. This form of lupus shares similarities with SLE but has a distinct classification due to its specific trigger. Stopping the medication causing the lupus symptoms usually resolves the condition. Common drugs known to induce Lupus include hydralazine (used for hypertension), procainamide (used for arrhythmias), isoniazid (used for tuberculosis), minocycline (used for acne), and anti-TNF medications (used for rheumatoid arthritis, psoriatic arthritis, and spondyloarthropathy).

Ruling Out Differential Diagnosis

When considering a diagnosis of Lupus, many of the differentials often involve ruling out diseases similar to SLE, as SLE is the majority of lupus cases. Firstly, it is crucial to rule out drug-induced causes as they can present with similar symptoms. Certain medications, such as procainamide, hydralazine, and isoniazid, have been extensively studied and associated with lupus-like syndrome. Although many patients taking these drugs may show positive antinuclear antibody test results and other serologic findings, only a few will exhibit the clinical manifestations of Lupus.

When differentiating Lupus from other conditions, several factors should be considered. These include the presence of discoid skin lesions, erythematous macules, interstitial lung disease, leukemia, leukopenia, viral infections, photo-distributed rash, pleuritic chest pain, pneumonitis, polyarthritis/polyarthralgia, renal vasculitis, seizures, stroke, thrombocytopenia, and vasculitis.

The differential diagnosis of Lupus also includes conditions such as acute pericarditis, antiphospholipid syndrome, autoimmune hepatobiliary disease, B-cell lymphoma, fibromyalgia, hepatitis C, Epstein-Barr virus (EBV) infectious mononucleosis (mono), infective endocarditis, Lyme disease, mixed connective tissue disease (MCTD), polymyositis, rheumatoid arthritis (RA), scleroderma, Sjogren syndrome, and undifferentiated connective tissue disease.

Careful evaluation and consideration of these differential diagnoses are necessary for accurate diagnosis and appropriate management of patients presenting with lupus-like symptoms.

How is Lupus Diagnosed?

Diagnosing Lupus can be challenging as its symptoms overlap with other autoimmune conditions. To diagnose Lupus, doctors will consider the medical history, including the family history of Lupus, or autoimmune diseases, conduct laboratory tests, and perform a physical exam to rule out other disorders. Diagnostic labs are necessary for identifying Lupus, and the presence of autoantibodies can confirm the diagnosis as well as other concurrent autoimmune conditions. These diagnostic tests will be discussed further in the next section.

In some cases, a biopsy of the affected area, such as a rash or kidney, may be performed as these biopsies can indicate an autoimmune disease. Doctors will take a comprehensive approach to diagnosing this condition by considering multiple factors and assessing diagnostics tests to make an accurate diagnosis.

Functional Medicine Labs That Can Help Individualize Treatment for Lupus

The following functional medicine labs can be helpful for diagnosing Lupus and individualizing treatment plans:

Antinuclear antibody (ANA) test

A standard test is the ANA test, an autoantibody marker positive in most lupus cases. However, a positive ANA does not necessarily indicate Lupus. If ANA is positive, additional tests for antibodies specific to systemic lupus erythematosus may be ordered.

SLE Panel

When a patient tests positive for the ANA test, it is advisable to conduct further testing for more specific antibodies associated with SLE. This panel includes testing antibodies such as Anti-dsDNA and anti-Sm, which are highly specific for SLE.

Inflammatory Markers

Tests like erythrocyte sedimentation rate (ESR) and high sensitivity C-reactive protein (hs-CRP) measure inflammation levels in the body and can screen for autoimmune disorders. By measuring these inflammatory markers, practitioners can gain insights into the presence and extent of inflammation in the body that may be present in Lupus.

CBC and CMP

A complete blood count (CBC) helps assess immune function, while a comprehensive metabolic panel (CMP) tests kidney function. Lupus can affect these body systems making these basic blood panels helpful in managing this condition.

Environmental Toxin Profile

The Toxin Profile is a urine test that can be valuable for individuals with Lupus, especially those who suspect environmental triggers as a potential cause of their symptoms. This comprehensive test is designed to screen for the presence of 173 various toxic chemicals, including pesticides. These chemicals have been identified as possible contributors to the worsening of SLE symptoms or the onset of the disease.

EBV Panel

Physicians may recommend testing for Epstein-Barr Virus (EBV), considering factors such as the patient's risk factors and medical history, as this virus is recognized as a potential contributor to Lupus.

GI-MAP

The GI-MAP test detects microbial DNA in stool, including bacteria, parasites, fungi, and viruses, linked to SLE symptoms. It assesses inflammation, digestion, and immune function, which is crucial for SLE management. Gut microbiome imbalances can cause chronic inflammation and immune dysregulation, worsening SLE symptoms and influencing disease onset.

Vitamin D

Testing for levels of this vitamin is beneficial for Lupus patients. These patients are often deficient in Vitamin D, and monitoring these levels can be helpful in managing their Lupus-related symptoms. Vitamin D plays a vital role in Lupus disease activity. 

Conventional Treatment for Lupus

Presently, Lupus does not have a cure. Therefore, the aim of treatment is to manage the symptoms. Conventional therapies focus on reducing pain and swelling, calming the immune system to prevent further damage to healthy tissues, and minimizing organ and joint complications. Treatment may involve multiple specialists depending on the areas of the body affected by Lupus. Additionally, individuals with Systemic Lupus Erythematosus (SLE) often have other autoimmune conditions, necessitating additional treatments. Common approaches include the use of anti-malarial medications like hydroxychloroquine to address joint pain and fatigue, nonsteroidal anti-inflammatory drugs (NSAIDs) for mild pain and swelling, corticosteroids such as prednisone to reduce pain and regulate the immune system, BLyS-specific inhibitors to target abnormal B cells, and anti-coagulants as people with Lupus are prone to blood clots. 

Functional Medicine Treatment Protocol for Lupus

Functional medicine treatment protocols for Lupus take a holistic approach, focusing on nutrition, lifestyle modifications, acupuncture, and clinically relevant supplements. A personalized nutrition plan helps reduce inflammation and supports immune system function. Lifestyle modifications such as regular exercise, stress management, and quality sleep promote overall well-being. Acupuncture may help alleviate pain and improve symptoms. Targeted supplements, like omega-3 fatty acids and vitamin D, may be recommended to support immune health. These integrative approaches aim to enhance overall health and reduce lupus symptoms, complementing conventional medical treatments.

Therapeutic Diet and Nutrition Considerations for Lupus

As most people who utilize functional medicine approaches know, personalized nutrition is one of the core therapies for addressing chronic conditions. Regarding managing symptoms associated with Lupus, a nutritious diet can be very beneficial for these patients. Although there is no specific diet to treat this condition, functional medicine practitioners will often recommend a balanced diet that includes various vegetables, fruits, and fatty fish while limiting processed foods to help lower inflammation and improve overall health in this condition. 

The Mediterranean diet, which emphasizes fruits, vegetables, whole grains, legumes, nuts, and olive oil, with moderate fish and dairy intake and limited red meat and sweets, may benefit those with Lupus because this diet is rich in anti-inflammatory fats and antioxidants. Research indicates that following a Mediterranean diet can lead to reduced cardiovascular risk factors and lower disease activity in people with Lupus. It is important to note that if you have Lupus-related organ damage, you may need a specific dietary restriction, such as avoiding salt or protein intake, and your healthcare provider should be consulted.

Supplements Protocol for Lupus

Here are some commonly used functional medicine supplements to support Lupus: 

Omega 3

Fish oil, high in omega-3 fatty acids, may benefit individuals with Lupus. A study showed that taking 3 grams of fish oil daily for 24 weeks can lead to improvements in disease activity, blood vessel function, and reduced oxidative stress. In another study, 20 grams daily of marine oil containing eicosapentaenoic acid (EPA) showed positive effects in reducing SLE disease activity. These findings suggest that fish oil supplementation can be beneficial for individuals with Lupus.

Curcumin

Curcumin, a compound found in turmeric, may benefit individuals with Lupus, particularly those with lupus nephritis. In a study, participants taking 500 mg of turmeric containing curcumin three times a day for three months experienced significant improvements, including decreased proteinuria, hematuria, and systolic blood pressure compared to the placebo group. No adverse effects were observed. Curcumin's anti-inflammatory and antioxidant properties make it a potential natural supplement for managing lupus symptoms.

Vitamin D

This vitamin is crucial for immune function and bone health. SLE patients often have low vitamin D levels due to sun avoidance. A recent study indicated that vitamin D supplementation improves disease activity, reduces fatigue, and correlates with better outcomes in SLE patients. A regimen of 8000 IU daily for eight weeks (if deficient) or four weeks (if insufficient), followed by 2000 IU daily for maintenance, may be beneficial.

Ashwagandha

Ashwagandha, an adaptogenic herb, can help manage stress levels in individuals with SLE. In a double-blind study, participants taking 300 mg of Ashwagandha root extract twice daily for 60 days experienced reduced stress and lower cortisol levels. As stress can worsen SLE symptoms, incorporating Ashwagandha may enhance stress resilience and overall well-being.

Vitamin C

Vitamin C is a crucial nutrient for a healthy immune system. It acts as an antioxidant, protects against germs, supports skin defense, and boosts immune cell function. Inadequate levels of vitamin C can weaken the immune system, while supplementation helps prevent and treat infections. For individuals with SLE, maintaining a strong immune system is vital. The recommended dose is 100-200 mg daily.

Green Tea Extract

A study on SLE patients found that green tea extract supplementation at 1000 mg daily for 12 weeks significantly reduced disease activity and improved vitality and general health. The study suggests that daily consumption of green tea extracts may benefit SLE patients by improving disease activity and quality of life.

Acupuncture for Lupus Symptoms

Acupuncture may be a safe, complementary therapy for patients with Lupus. A study on individuals with SLE found that ten sessions of acupuncture reduced their pain. In fact, the participants reported a >30% reduction in pain. This study also found that there were no side effects reported with acupuncture, making this therapy a very safe option for managing pain symptoms associated with SLE. Although further research is needed to determine the exact benefits of acupuncture for Lupus symptoms, this finding holds promise for acupuncture as a beneficial treatment option.

Lifestyle Modifications That Can Help With Lupus Symptoms

Lifestyle modifications can aid in managing Lupus symptoms and is an important consideration as part of a comprehensive treatment approach for this complex condition.

Physical activity can strengthen the body and reduce inflammation. While low-impact exercises can improve the range of motion, reduce stiffness, and decrease the risk of heart disease. These activities also have positive effects on mental well-being. 

Other lifestyle changes that can help prevent symptoms include practicing good hygiene and maintaining a strong immune system which can lower the risk of viral infections that may trigger Lupus. This process involves regular handwashing, vaccination, and consuming a balanced diet. Protecting yourself from UV light exposure is also important, as sunlight can activate Lupus in susceptible individuals. Wearing sunscreen and protective clothing and avoiding peak sun hours can help minimize this risk.

Managing stress is another modification that can benefit individuals with Lupus, as stress can exacerbate symptoms. Recognizing stress triggers and developing coping strategies can be helpful. Some techniques include planning for stressful situations, setting boundaries, and engaging in activities that you find relaxing. Getting enough sleep should also be prioritized to minimize stress levels.

Yoga has shown promising results in managing SLE. Studies concluded that regular yoga can decrease inflammatory markers, maintain immune function, and improve overall well-being in individuals with SLE.

Taking a proactive role in managing symptoms of Lupus with these lifestyle interventions can improve the overall quality of life in individuals with this condition. A qualified functional health provider should be consulted to develop a personalized approach.

When to Retest Labs

Functional healthcare providers may recommend regular retesting for Lupus to monitor progress. The frequency of retesting may vary depending on various factors. Typically, retesting is done every 3 to 6 months or as needed, based on the patient's response to treatment and any changes in symptoms. Functional medicine providers generally have a comprehensive approach to managing conditions such as Lupus, and retesting allows these practitioners to assess the effectiveness of these protocols so they can make necessary adjustments.

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Summary

Lupus affects many Americans, particularly women. For instance, SLE can affect over 1.5 million Americans. This condition can be difficult to manage as it is often misdiagnosed due to its symptoms that overlap with other conditions. While there is no cure for Lupus, a comprehensive functional medicine approach can offer some promising options for those struggling with Lupus. This approach utilizes evidence-based supplements, individualized nutrition plans, lifestyle modifications such as stress management, exercise, and complementary therapies like acupuncture as part of its well-rounded protocols. It is important to take into consideration that functional medicine practitioners will retest with functional labs regularly to assess, monitor progress, and manage underlying health factors associated with Lupus.

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