What is Lupus? – Prof Graham Hughes

Posted on October 12, 2016

Graham Hughes trained at The London Hospital. In 1969-70, he spent two years with Professor Charles Christian in New York working on the introduction of anti-DNA assays in lupus. He set up Europe’s first dedicated lupus clinic in 1971 and described the antiphospholipid syndrome (Hughes Syndrome) in 1983. Professor Hughes has published widely on lupus and connective tissue diseases and has published twelve books. He is Founder and Editor of the international journal ‘LUPUS’, now in its 20th year. His honours include the ILAR International Prize for Rheumatology Research, and Docteur Honoris Causa in the Universities of Marseille and Barcelona. Professor Hughes is currently Head of The London Lupus Centre.

Key Messages

The traditional view of Lupus is the butterfly rash in young women, but actually we see 400 Lupus and Antiphospholipid patients in our clinic per month and it is unusual to have a butterfly rash.

  1. Prof. Hughes presents us with images of the myriad manifestations of Lupus.  Joint pains, neurological involvement, another patient with Idiopathic Thrombocytopenic Purpura (ITP) and another patient suffering psychiatric illness. In terms of a diagnosis for Lupus, there are many symptoms to look out for, in which Prof.Hughes terms
  2. Regarding a diagnosis for Lupus there are many symptoms to look out for, in which Prof.Hughes terms the ‘alternative’ criteria:
  • Childhood migraine
  • Childhood ‘growing pains’ –

This is a major feature, many of our patients dragged to the doctor at 10 or 12.

  • Teenage prolonged ‘glandular fever.’

This comes up time and time again. EB virus is a big suspect in some of the autoimmune diseases but not proved satisfactorily yet.

  • Agoraphobia

Phobia is very common in the presentation of Lupus.

  • Septrin allergy
  • Chronic fatigue + ‘fibromyalgia.’
  • Intermittent alopecia
  • Lupus patients don’t catch colds

You see patient after patient, they’ve gone down the whole family with colds, or influenza: “No, I’m immune, I’m ok”. One wonders whether this has something to do with the overactive immune system that is lupus.

Causes of Lupus

What is the cause of lupus? The usual story: genetics vs. environment.

  1. Genetics:
  • At least 38 lupus susceptibility loci
  • Strong familial aggregation
  • Parental history of lupus à 14-fold increased risk of lupus among offspring

If you have a parental history of Lupus, there is a 14-fold increase of Lupus amongst the offspring… There is a genetic tendency.

2. Environmental:

      Agents causing oxidative stress:

  • UV light
  • Silica –

Did you know that silicone breast implants give an atypical Lupus, an atypical scleroderma?

  • Infections
  • Smoking
  • Heavy metals, e.g. mercury
  • Pesticides