José Antonio Cetina Manzanilla: World Lupus Erythematosus Day

Since 2004, May 10th has been celebrated as World Lupus Day, a date established during the International Congress on Lupus Erythematosus and Other Related Diseases. The goal is to raise awareness about this chronic, autoimmune, multisystem disease that can affect virtually any organ in the human body.

Lupus can cause irreversible damage. Worldwide, more than five million people suffer from this disease. In autoimmune diseases like lupus, the immune system loses tolerance to the body's own components, generating autoantibodies that cause inflammation and tissue damage.

Women represent the most affected group, at a ratio of 9:1 compared to men, especially during the reproductive years. However, it can also manifest in childhood, adolescence, and old age, with specific clinical characteristics. Diagnosis can be complex due to the wide range of symptoms; in some cases, lupus initially presents as thrombocytopenic purpura or hemolytic anemia.

One of the most well-known skin manifestations is the malar rash, located on the bridge of the nose and cheeks, with the typical shape of butterfly wings.

Renal involvement can be severe, evidenced by proteinuria, changes in urinary sediment, and a decreased glomerular filtration rate. Other common symptoms include arthralgia, pleural pain, severe fatigue, hair loss, cardiovascular changes, and cognitive impairment.

The diagnosis of lupus is essentially clinical, supported by immunological studies such as the detection of antinuclear antibodies, anti-double-stranded DNA, anti-Sm, complement levels, renal function, and hematological tests.

Why talk about the future of lupus in 2025? Because new knowledge about its pathophysiology and the emergence of targeted treatments make it possible to halt disease activity and improve prognosis.

The mainstay of treatment remains hydroxychloroquine, accompanied by glucocorticoids at doses varying according to severity. Immunosuppressive agents such as azathioprine, methotrexate, mycophenolate mofetil, and cyclophosphamide are conventionally used. It is recommended to continue the use of hydroxychloroquine and limit prednisone to maintenance doses of no more than 2.5 mg daily, discontinuing it if possible.

In recent years, new drugs have been introduced, such as belimumab and anifrolumab, for patients with moderate to severe lupus or those with an inadequate response to conventional treatment. Hydroxychloroquine remains essential. Advances in the understanding of lupus and specific therapies have positively changed the outlook for those living with this autoimmune disease. As the rheumatology phrase goes: "Care today... cure tomorrow."

Rheumatologist. Coordinator of the self-help group Family Core of Rheumatic Patients. Mexican College of Rheumatology, National Academy of Medicine of Mexico, and American College of Rheumatology. [email protected]