Varied early symptoms make diagnosis difficult; early detection key to preventing organ damage
Immunosuppressants and biologics used in tailored treatment to control disease activity
The number of lupus patients in South Korea has risen nearly 20% over the past five years, according to national health insurance data. Patients treated for systemic lupus erythematosus rose from 26,856 in 2020 to 31,994 in 2025. Lupus is a chronic autoimmune disease in which the immune system attacks the body's own healthy cells and tissues, potentially affecting not only the skin and joints but also major organs including the kidneys, lungs and heart. Treatment strategies have also advanced in recent years, with a growing emphasis on reducing steroid-related side effects while achieving long-term disease stability. Kim Se-hee, a professor in the Division of Rheumatology at Gangdong Kyung Hee University Hospital, spoke about the key symptoms, diagnosis and evolving treatments for lupus.
The body's immune system normally defends against invading bacteria and viruses. When the system malfunctions, however, it can mistakenly identify the body's own healthy cells and tissues as foreign threats and attack them.
This process produces "autoantibodies" that target the body's own cells and tissues, causing inflammation and damage across multiple organs — the hallmark of systemic lupus erythematosus, commonly known as lupus. According to national health insurance statistics, the number of patients treated for lupus rose from 26,856 in 2020 to 31,994 in 2025, a 19.1% increase. Women accounted for 86.9% of all patients, confirming lupus as a condition that disproportionately affects women — at a rate 6.7 times higher than men.
Lupus can cause inflammation in multiple organs, including the skin, joints and kidneys. Because symptoms vary widely from patient to patient, the disease is sometimes called "the disease of a thousand faces." In its early stages, persistent fatigue, low-grade fever, muscle pain, joint pain, weight loss and hair loss can be mistaken for ordinary tiredness or other conditions, often delaying diagnosis.
The most distinctive symptom is a butterfly-shaped red rash across both cheeks and the bridge of the nose; skin symptoms can also worsen after sun exposure. Some patients experience swelling and pain in the joints of the fingers or wrists. Anyone with persistent or multiple concurrent symptoms should seek medical evaluation for an accurate diagnosis.
Complications from major organ involvement are among the most serious concerns in lupus. Inflammation can develop not only in the skin and joints but also in the kidneys, lungs, heart and brain. Lupus nephritis — inflammation of the kidneys — can cause proteinuria, edema and declining kidney function, and may progress to renal failure in severe cases.
Involvement of the lungs or pleura can produce chest pain and shortness of breath, while inflammation of the heart and blood vessels can lead to cardiovascular complications. A particular concern is that some organ involvement may progress without obvious symptoms in the early stages. Regular blood and urine tests are therefore important to monitor for organ involvement, even when symptoms appear mild.
Lupus cannot be confirmed by a single test alone; diagnosis requires a comprehensive assessment of the patient's symptoms, physical findings and laboratory results. Blood tests check for autoantibodies such as antinuclear antibodies and anti-double-stranded DNA antibodies, along with complement levels and blood cell counts. Urine tests and kidney function tests are performed to assess renal involvement, and imaging or biopsy may be added as needed. Regular testing is especially important for lupus nephritis, which often produces no clear early symptoms. Early diagnosis and prompt treatment help control inflammation and prevent organ damage.
The goal of lupus treatment is to relieve symptoms and maintain remission or low disease activity in order to prevent organ damage. Treatment is determined by the patient's symptoms, the extent of organ involvement and disease severity. Mild symptoms — such as muscle pain, joint pain, fatigue and skin redness — are managed with nonsteroidal anti-inflammatory drugs, antimalarials and supportive care. When major organs such as the kidneys, lungs, heart or brain are involved, more aggressive treatment with steroids or immunosuppressants is required. Depending on disease severity, biologics or plasmapheresis may also be considered.
Recent treatment approaches increasingly emphasize controlling the disease stably while minimizing the long-term side effects of steroid use. The 2025 guidelines issued by the American College of Rheumatology for systemic lupus erythematosus recommend broad use of hydroxychloroquine, minimizing steroid exposure, and early introduction of immunosuppressants and biologics. The aim is not merely to relieve symptoms but to keep disease activity low while reducing both organ damage and treatment-related side effects.
Lupus can follow a relapsing and remitting course, making long-term management essential. Even when symptoms stabilize, stopping medication without medical guidance can reactivate the disease, so any changes to treatment must be made in consultation with a specialist. Ultraviolet light can worsen symptoms in some patients, so limiting sun exposure through sunscreen, hats and parasols is advisable. Adequate sleep, regular exercise and stress management are also important, as is taking precautions against infection. Above all, consistent follow-up visits and regular testing to monitor disease activity and organ function — with treatment adjusted to the patient's condition — remain the cornerstone of care.
kty@heraldcorp.com
