# Lupus > Lupus (systemic lupus erythematosus, or SLE) is a long-lasting autoimmune condition in which the immune system attacks the body's own tissues, most often the skin, joints, kidneys and blood. It has no cure, but medicines led by hydroxychloroquine, plus sun protection, help manage it. Guide in [Diabetes, arthritis and other conditions](https://footanklelowerlimb.com.au/learn/topics/diabetes-arthritis-and-other-conditions), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/systemic-lupus-erythematosus Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 11 November 2026. Next review by 11 November 2027. - **Lupus is a long-lasting autoimmune condition.** Your immune system attacks your body's own tissues, most often affecting the skin, joints, kidneys and blood. - **It varies a lot from person to person,** from a mild rash or sore joints to serious organ problems. - **There's no single test,** so diagnosis combines your symptoms, an examination and blood tests. - **Medicines and sun protection are the mainstays of care,** and lupus is lifelong. - **Your feet can be affected too,** with foot pain, colour changes in the toes and circulation problems reported. ## What is lupus, and how common is it? Lupus is a long-lasting (chronic) autoimmune condition, which means your immune system attacks your body's own tissues [1]. The main form is systemic lupus erythematosus (SLE), and it is the most common and most serious type [2]. The inflammation it causes can reach almost any part of the body, most often the skin, joints, kidneys and blood [3][4]. Worldwide, an estimated 43.7 in every 100,000 people have SLE, although the true figure is uncertain [5]. It is far more common in women than in men [5]. It can start at any age, and 15–20% of people develop it in childhood [6]. ## What causes lupus, and who gets it? No one knows the exact cause [3]. SLE usually arises when an environmental exposure meets a person whose genes carry enough risk variants [4]. Hormones are also thought to play a part, and you are more likely to have lupus if a blood relative has it [3]. Genes aren't the whole story, because identical twins are not always both affected [4]. The highest risk is among women of reproductive age [4]. Worldwide, SLE is more common in people of South Asian, East Asian and other non-White ancestry than in White people [6]. Recognised triggers include sunlight, hormonal changes such as puberty or pregnancy, and some medicines [7]. Current smoking has been linked with developing SLE, while former smoking has not, and stopping smoking has been suggested as a first step in preventing and treating it [8]. ## What does lupus feel like, how is it diagnosed, and what can make it serious? ### What does it feel like? Lupus varies widely. Features range from mild (a rash or arthritis) to life-threatening organ problems, and it is hard to predict which a person will get [4]. Common features include: - **Joint pain,** usually in several small joints and often without swelling [7]. Some people have painful, swollen joints with morning stiffness [1]. - **Skin rashes,** including a butterfly-shaped rash across the face [3]. Rashes that react to sunlight are more specific to lupus [7]. - **Painless sores** inside the nose and mouth [1]. - **Fingers and toes that change colour** (blue-purple, white or red) with cold or stress, known as Raynaud's phenomenon [1]. - **Heavy tiredness** [2] and **swelling** in the legs or around the eyes [1]. Because the symptoms aren't specific to lupus, early diagnosis can be difficult [2]. Foot problems are common in people with SLE. Many have had foot pain, and Raynaud's phenomenon, chilblains, bunions (hallux valgus), fungal nails and leg pain when walking are all reported [9]. People with SLE are also more likely to have an abnormal ankle brachial index (a comparison of blood pressure at the ankle and the arm), which can point to reduced blood flow in the legs and feet [9]. That is a pattern across groups of people and doesn't show harm in any one person. Foot health research in lupus also highlights circulation problems, nerve problems, deformity, and skin and nail problems [9]. ### How is it diagnosed? No single test diagnoses lupus [10]. Diagnosis combines symptoms, an examination, and blood and immune tests, and it is made by clinicians experienced in managing lupus [6]. It shouldn't be made without at least one autoantibody (an antibody against the body's own tissues) or low complement (a measure of immune activity in the blood) [6]. Each feature is also worked out: is it from lupus activity, organ damage, a medicine's side effects, infection, clots or another condition [6]? ### What can make it serious? Kidney inflammation and blood clots can be life-threatening, and it is hard to predict who will get them [4]. Lupus can also damage the heart and lungs [2] and inflame blood vessels (vasculitis) [1]. About a third of people with lupus have antiphospholipid antibodies, which make the blood "sticky" and can cause strokes, clots in the leg or lungs, and pregnancy complications [2]. Corticosteroids and immunosuppressants raise the risk of serious infection, and guidance advises vaccination for people taking immunosuppressants [7][11]. ### What else could it be? Lupus symptoms can mimic other disorders [2]. One example is undifferentiated connective tissue disease (autoimmune symptoms that don't yet fit a single diagnosis). In some people it later turns into SLE or rheumatoid arthritis, usually within 5–6 years [12]. ## What can I do myself, and what treatments come first? Lupus is managed with medicines, alongside everyday steps. Hydroxychloroquine is the foundation of treatment. Guidelines recommend it for everyone with lupus unless it can't be used, with the dose kept within a weight-based limit [11][6]. It can cause an eye problem (retinopathy) that isn't reversible and has no treatment. The risk rises with higher doses and longer use, and kidney disease is another major risk factor. Guidance sets a weight-based maximum, a baseline eye exam, and yearly screening starting after 5 years of use, or earlier if there are major risk factors [13]. Glucocorticoids (steroid medicines) are used short term, or as "bridging" treatment, during active disease. Long-term oral steroids aren't routinely recommended because of their harms, so guidelines advise using the lowest amount possible and stopping them when possible [6][11][14]. Sun protection is the main everyday step. Guidelines advise a high-SPF, broad-spectrum sunscreen that blocks both UV-A and UV-B [6]. Vitamin D supplements are often used when sunlight is being avoided [7]. Guidelines give hydroxychloroquine and careful steroid use the strongest backing, so these are the steps most agreed on. > [!tip] Try this > Before heading outdoors, put on a high-factor sunscreen (at least factor 50) and a hat. Where you can, avoid direct sunlight and long stretches in rooms lit by fluorescent lights. ## What helps if the first treatments aren't enough? Hydroxychloroquine stays the base of treatment, and steroid exposure is still kept as low as possible [6]. A newer cell-based treatment, CAR T-cell therapy, has been tried in SLE. It caused cytokine release syndrome (an inflammatory reaction) in over half of the people treated, almost all of it mild or moderate. Some people had nervous-system side effects, and some had serious infections, including one death from meningitis [15]. ## How long does lupus last, and can flares be prevented? Lupus is lifelong and has no cure [10]. Its course differs from person to person. Memory and thinking problems affect about 38% of people with SLE. They can be subtle and easy to miss [6]. Low mood and depression are also part of caring for lupus, and screening and treatment are advised [7]. Whether sun protection prevents flares that affect the whole body isn't clear, because the studies are of low quality, but guidelines still advise it [6]. ## Common questions ### Why does lupus affect women more than men? The reason isn't fully understood. Hormones are believed to play a part, and lupus is most often diagnosed in women of childbearing age. The gap between the sexes is smaller before puberty, and lupus can start at any age, including in childhood and in men. ### Is it safe to have a baby if you have lupus? Lupus can cause complications in pregnancy, and antiphospholipid antibodies can add to that risk. Hormonal changes such as pregnancy are also a recognised trigger. Health services advise reviewing the risks and checking whether medicines need changing before a pregnancy. ### Is there a cure for lupus? No. Lupus is a lifelong condition without a cure, and its course varies from person to person. Treatment depends on individual circumstances and preferences, and decisions are shared between you and your clinician. Research continues into its genetic and environmental causes. ## Further reading - [Lupus on Clindice](https://clindice.com/systemic-lupus-erythematosus-podiatry) - [Systemic lupus erythematosus: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000435.htm), MedlinePlus - [Lupus](https://www.nhs.uk/conditions/lupus/), NHS - [Lupus Nephritis: What Is It, Causes, Symptoms and Treatment](https://my.clevelandclinic.org/health/diseases/21809-lupus-nephritis), Cleveland Clinic - [Hydroxychloroquine therapy](https://www.enherts-tr.nhs.uk/wp-content/uploads/2024/08/Hydroxychloroquine-Therapy-V1-08.2024.pdf), NHS - [Belimumab for the treatment of active autoantibody-positive systemic lupus erythematosus: updated NICE draft guidance](https://www.medicinesresources.nhs.uk/belimumab-for-the-treatment-of-active-autoantibody-positive-systemic-lupus-erythematosus.html), NHS ## Sources 1. Systemic Lupus Erythematosus (Lupus) · National Institute of Arthritis and Musculoskeletal and Skin Diseases · 2017. https://www.niams.nih.gov/health-topics/lupus 2. Spotlight on Lupus – the ‘disease of a 1,000 faces’ — Research & Innovation · Research & Innovation · 2019. https://research.cmft.nhs.uk/news-events/spotlight-on-lupus-the-disease-of-a-1000-faces 3. Lupus - diagnosis, treatment, symptoms and causes · Healthdirect Australia · 2026. https://www.healthdirect.gov.au/lupus 4. Genetic Basis of Lupus · library.wmuh.nhs.uk. https://www.library.wmuh.nhs.uk/wp/library/wp-content/uploads/sites/2/2023/03/Genetic-Basis-of-Lupus.pdf 5. Global epidemiology of systemic lupus erythematosus: a comprehensive systematic analysis and modelling study · Tian J, Zhang D, Yao X et al. · Annals of the Rheumatic Diseases · 2023. https://doi.org/10.1136/ard-2022-223035 6. The 2026 British Society for Rheumatology guideline for the management of children, young people and adults with systemic lupus erythematosus · Md Yusof MY, Smith EMD, Lythgoe H et al. · Rheumatology (Oxford, England) · 2026. https://doi.org/10.1093/rheumatology/keag223 7. City and Hackney Systemic Lupus Erythematosus guidelines · gps.cityandhackneyccg.nhs.uk. https://gps.cityandhackneyccg.nhs.uk/cdn/serve/pathway-downloads/1523535635-940f7fc620ac4f709f567e00bdc6b4c7.pdf 8. Risk factors of systemic lupus erythematosus: an overview of systematic reviews and Mendelian randomization studies · Xiao X-Y, Chen Q, Shi Y-Z et al. · Advances in Rheumatology (London, England) · 2023. https://doi.org/10.1186/s42358-023-00323-1 9. Foot and ankle characteristics in systemic lupus erythematosus: A systematic review and meta-analysis · Stewart S, Brenton-Rule A, Dalbeth N et al. · Seminars in Arthritis and Rheumatism · 2019. https://doi.org/10.1016/j.semarthrit.2018.07.002 10. Lupus arises from complex interplay of genetic and environmental factors · National Institute of Environmental Health Sciences. https://www.niehs.nih.gov/news/factor/2024/7/science-highlights/lupus 11. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus · Fanouriakis A, Kostopoulou M, Alunno A et al. · Annals of the Rheumatic Diseases · 2019. https://doi.org/10.1136/annrheumdis-2019-215089 12. Undifferentiated Connective Tissue Disease: Comprehensive Review · Rubio J, Kyttaris VC · Current Rheumatology Reports · 2023. https://doi.org/10.1007/s11926-023-01099-5 13. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision) · Marmor MF, Kellner U, Lai TYY et al. · Ophthalmology · 2016. https://doi.org/10.1016/j.ophtha.2016.01.058 14. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update · Fanouriakis A, Kostopoulou M, Andersen J et al. · University of East Anglia · 2023. https://research-portal.uea.ac.uk/en/publications/eular-recommendations-for-the-management-of-systemic-lupus-erythe/ 15. CAR T-cell therapy in SLE: A systematic review · Nordmann-Gomes A, Khalili L, Tang W et al. · Seminars in Arthritis and Rheumatism · 2025. https://doi.org/10.1016/j.semarthrit.2025.152786 --- This is general information, not advice about your own situation. To discuss your issues, book with one of our podiatrists. In an emergency, call 000.