What is Lupus? – Prof Graham Hughes

Posted on: October 12, 2016
Last Updated: December 7, 2023

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 honors 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 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


Learn more

  1. Antiphospholipid Syndrome (APS) Case Files (Stroke and Thrombosis) By Prof Graham Hughes
  2. Antiphospholipid Syndrome (APS) Case Files (Stillbirths and Epilepsy) By Prof Graham Hughes
  3. Antiphospholipid Syndrome (APS) Case Files (Gut, Tinnitus, and Migraine) – Prof Graham Hughes
  4. Antiphospholipid Syndrome (APS): The Clinical Experience – Dr. Graham Hughes
  5. Antiphospholipid Syndrome: 30 Years On – Dr. Graham Hughes
  6. Central Nervous System (CNS) Involvement in Antiphospholipid (Hughes) Syndrome – Prof Graham Hughes
  7. Clues to the Diagnosis of Antiphospholipid Syndrome – Prof Graham Hughes
  8. Neuropsychiatric Lupus and The Curious Case of Molly – What Does This Case Teach Us? – Prof Hughes
  9. Pathogenesis of Neuropsychiatric Systemic Lupus Erythematosus – Prof Graham Hughes
  10. Prof Graham Hughes Introduces You To The World of Lupus and Antiphospholipid Syndrome – Prof Graham Hughes
  11. APS and CNS Lupus: Anticoagulation Treatment By Prof Graham Hughes
  12. Neuropsychiatric Manifestations in APS By Prof Graham Hughes
  13. Q & A session on Lupus, Hughes Syndrome and the Brain – Prof Hughes