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Lupus, also called systemic or disseminated lupus erythematosus, is an autoimmune disease. The gastrointestinal microbiota may be involved in this disorder.

The number of people affected by lupus is hard to determine. Its worldwide prevalence is estimated to vary between 10 and 150 cases for every 100,000 inhabitants, of whom the majority are women (85%).

When the immune system attacks its own cells

For reasons that remain unknown, the immune system in people afflicted with lupus produces autoantibodies, which cause inflammatory reactions and lesions that can affect all tissues. A whole range of symptoms results from lupus: fatigue, cutaneous eruptions, joint pain, dry eyes, hair loss, thrombosis, fever, pleurisy, and pericarditis. The disease progresses in flares of variable duration and intensity, which alternate with phases of remission. A diagnosis of lupus is confirmed by blood test, and the extent of the damage is measured with imaging examinations.

Predisposing factors but an unknown cause

Although the causes of lupus remain a mystery, several predisposing factors have been identified: estrogen, a genetic disposition, certain medications, UV rays, stress, and certain viruses (Epstein-Barr virus). Research work has also examined the role of the intestinal microbiota. Indeed, an imbalance (dysbiosis) was observed in lupus patients during the remission phase. The microbiota may even be involved in the production of autoantibodies.

Reduce and space out flares

No medication cures lupus. However, combining several molecules (nonsteroidal anti-inflammatories, antimalarials, corticosteroids, immunosuppressants, and monoclonal antibodies, depending on the severity of the disease) eases flares, limits complications, and lengthens the periods of remission. At the same time, less harsh long-term treatments prevent relapses.

If the role of the microbiota is confirmed, modulating it via diet or probiotics could become a promising therapeutic option.

Le lupus systémiques, Orphanet
Lupus systémique, Société Nationale Française de Médecine Interne (SNFMI)
Hevia A, Milani C, López P, et al. Intestinal dysbiosis associated with systemic lupus erythematosus. MBio 2014 ; 5 : e01548-14.
Zhang H, Liao X, Sparks JB, et al. Dynamics of Gut Microbiota in Autoimmune Lupus. Applied and Environmental Microbiology, 2014 ; 80(24), 7551–7560.
Ruff W, Viera S, Kriegel M. The role of the gut microbiota in the pathogenesis of antiphospholipid syndrome. Curr Rheumatol Rep 2015 ; 17 : 472.