When I met a lupus patient I’d ask what other autoimmune conditions they had. They’d always ask how I knew they had more than one condition and I used to say it was like lupus having a party and invited all its friends to come along. In other words its sadly not unusual for us to have two or more autoimmune conditions, often referred to as overlap syndrome.
About 25 - 30 percent of people with lupus often develop a second or third autoimmune disease. Most patients are diagnosed with their second soon after the first diagnosis of lupus, but for some, overlapping conditions can appear as many as ten years apart. People whose lupus began earlier, age 16 to 28, seem to be more likely to develop additional autoimmune diseases.
A study showed that in 78 percent of patients, lupus develops first and in 22 percent another autoimmune develops first.
Doctors simply do not understand why so many people with lupus also develop other autoimmune conditions. Scientists believe that it takes a combination of genetics, environmental exposures, hormones and lifestyle factors to cause the body’s immune system to misfire in a new way. The co-existence of more than five autoimmune diseases is extremely rare.
Autoimmune disorders that sometimes overlap lupus
Antiphospholipid syndrome (APS)
Antiphospholipid Syndrome is a type of blood disorder that makes it more likely to develop blood clots. The most common association with SLE which can increase the risks of complications and premature death from thrombosis.
People with lupus have roughly double the risk of developing atopic dermatitis compared to the rest of the population.
Autoimmune hepatitis is a liver disease that results from elevated liver enzymes causing jaundice and other gastrointestinal complications.
Autoimmune thrombocytopenia is a blood disorder where the body attacks healthy platelets (one of the parts of blood) causing easy bruising, bleeding, and tiny reddish, purple spots on the lower legs.
Between 3 percent and 24 percent of people with lupus also have a thyroid issue. Hypothyroidism is the name of an underactive thyroid. Hyperthyroidism is the name for overactive thyroid. Autoimmune thyroid disease a well-recognised association, as is a positive family history of thyroid disorders.
Coeliac disease is a type of immune disorder in which eating gluten damages the small intestine causing diarrhoea, fatigue, anaemia, osteoporosis and malnutrition. It’s uncommon but can be associated with SLE and especially with Sjogren’s.
An uncommon inflammatory disease marked by muscle weakness and a distinctive skin rash.
Very rare to see Type 1 diabetes and SLE, but very common to see steroid related diabetes.
Studies suggest that about 25% of people who have lupus also have fibromyalgia. FM and lupus are both hard to diagnose and because their primary symptoms can be very similar, people with FMS are sometimes misdiagnosed as having lupus and vice versa.
Professor D’Cruz comments: Very controversial! A common complication of SLE and other autoimmune rheumatic diseases. I do not consider FM to be an autoimmune disease, other experts disagree though.
An autoimmune condition where your immune system produces antibodies that cause the thyroid to produce too much thyroid hormone. Autoimmune thyroid disease is a well-recognised association, as is a positive family history of thyroid disorders.
Normally, your autoimmune system protects your body by attacking bacteria and viruses. But with this disease, your immune system attacks your thyroid gland by mistake. Your thyroid then can't make enough thyroid hormone, so your body can't work as well. As with Graves, autoimmune thyroid disease is a well-recognised association, as is a positive family history of thyroid disorders
Idiopathic pulmonary fibrosis (IPF)
Idiopathic pulmonary fibrosis (IPF), also known as Fibrosing alveolitis is a lung disease that makes it hard for the air sacs (alveoli) in the lungs to take up enough oxygen and causes scarring of the lungs.
Mixed Connective Tissue Disease (MCTD)
Mixed connective tissue disease (MCTD) has signs and symptoms of a combination of disorders — primarily lupus, scleroderma, and polymyositis. It is important to note that there is a lack of general consensus as to whether or not mixed connective tissue disease (MCTD) is truly an overlap of lupus. It is even often hard to determine which of these two are manifested in an individual first.
Polymyositis is a muscle disease in which the muscles and nearby blood vessels become inflamed. Symptoms are pain and weakness in the muscles, most often in the neck, shoulder, upper arms and thighs.
Raynaud's phenomenon is where your blood stops flowing properly to your fingers and toes. It's common and does not usually cause severe problems. Almost universal in scleroderma patients and very common as part of SLE.
Rheumatoid arthritis is an immune disorder in which the body attacks the tissue in the joints causing swelling, pain, bone erosion and deformity. A well recognised but uncommon association so-called ‘Rhupus’
Scleroderma makes the connective tissue harden, which causes tightening of the skin, joint pain and Raynaud’s Phenomenon. A well recognised association – usually considered as an Overlap syndrome.
Sjögren's syndrome causes the body to attack the healthy cells that create tears and saliva. This leads to dry eyes mouth and vagina, difficulty swallowing and irritated red eyes. 15-18% of people with lupus also have Sjögren's. Very common association with SLE. About 50% of patients with SLE have dry eyes and dry mouth. We used to call this secondary Sjogrens but this term is very confusing and has been dropped.
Inflammation is your immune system's natural response to injury or infection. It causes swelling and can help the body deal with invading germs, but in vasculitis, for some reason the immune system attacks healthy blood vessels, causing them to become swollen and narrow. Vasculitis is a common complication of active SLE. ANCA vasculitis is a separate autoimmune disease that is only very rarely seen with SLE.
Other illnesses commonly experienced
Other illnesses experienced by lupus patients include: GERD acid reflux, high cholesterol, dental issues, high blood pressure and osteoporosis. With osteoporosis it appears that simply having lupus increases your risk of bone loss, but also long-term use of steroids to control lupus is known to trigger bone loss. The joint pain and fatigue felt by many people with lupus can make it hard to engage in the type of exercise and activities that prevent osteoporosis.
Managing multiple illnesses in addition to lupus can seem overwhelming. Keeping track of all the symptoms you may experience will help doctors diagnose, treat and manage any additional conditions that may arise. Understanding when symptoms seem outside the norm of what an individual may typically experience can help in the early detection of overlap diseases, which in turn can help maintain optimal health.
Since having multiple autoimmune conditions at once is so common in people with lupus, it is important to tell your doctor if you begin to experience any new symptoms or if older symptoms change or become more severe.
Angie Davidson
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