Lupus Type 1 and Type 2: Symptoms and Treatment Distinctions

When considering treatment options for Lupus Warriors, clinicians should focus on key symptoms. These symptom groups, coined Type 1 and Type 2, manifest from different biological activity.

Systemic lupus erythematosus, or SLE, is the most common type of lupus. SLE is usually what people mean when they just say “lupus”. It is an autoimmune disease that has a broad spectrum of intensity, ranging from mild symptoms, to serious organ issues. SLE has acute (short-term and intense) and chronic (long term and constant) symptoms.

Chances are, if you have SLE, you experience a variety of symptoms that fall under both categories. You can read more about SLE and its symptoms here.

A Strategic Approach to Lupus Management

The goal of clinical care is to identify the most appropriate treatment for a given patient. Researchers have developed a model which "posits that manifestations of SLE can be divided into 2 broad categories," termed Type 1 and Type 2.

Lupus Type 1 SLE and lupus Type 2 are different subsets – types – of SLE  symptoms. It is possible for a person to experience both types. They are classified according to their symptom profiles, but also have biological differences. Your clinician can refine their treatment approach as particular medications lead to better results depending on type.

Type 1 causes the most tissue damage. It involves more immune system activity that actively attacks the internal organs. While Type 1 can quiet down and resemble remission, it can also flare up into painful, debilitating events.

Type 2 presents with less immune system activity and less organ damage. However, people with Type 2 SLE experience high levels of pain, fatigue, and more constant symptoms. Type 2 can come and go, and also have flares, but it usually ‘simmers’ at a lower intensity, but more constant state. These Type 2 concerns should be prioritized and treated by clinicians. Though, studies have shown that managing organ damage is often a rheumatologist's primary concern.

Type 1 Lupus and Lupus Nephritis

Type 1 SLE is heavily associated with organ damage, and that includes the kidneys. The inflammation happens in the nephrons, the part of the kidney that is in contact with the bloodstream. The kidneys filter out waste products and keeping a good balance of salts and water in the blood. In SLE and lupus nephritis, the immune system misidentifies and attacks healthy tissues of the kidneys.

Lupus nephritis is distinct from SLE. However, the inflammation and subsequent organ damage caused by SLE leads to lupus nephritis. Although Type 2 SLE can lead to a lot of generalized inflammation in the body that could trigger lupus nephritis, this direct damage to the kidneys by Type 1 SLE appears to be a more frequent trigger.

Different Antibodies, Different Symptoms

One of the primary differences between the two types of lupus is the presence of a specific type of antinuclear antibody. Antinuclear antibodies ("ANA”)mark proteins found inside a cell’s nucleus (the "control center" of the cell). This sends the immune system to attack otherwise healthy cells. Normally, antibodies tag harmful pathogens, such as bacteria and viruses. But in autoimmune conditions such as lupus, ANAs set the body against itself. These types of antibodies are detected by a series of tests called ANA tests, which you can read more about here.

The special ANA that differentiates Type 1 and Type 2 lupus is Anti-dsDNA. Anti-dsDNA tags and attacks DNA strands. It is found in about 30% of people with SLE.

When it attaches to DNA, it may begin or contribute to chronic inflammation, and increased levels of anti-dsDNA may herald a return of disease. Several tests, including the enzyme-linked immunosorbent assay (ELISA), the Crithidia luciliae immunofluorescence test, and radioimmunoassay tests, can detect it.

Anti-dsDNA Antibodies

These anti-dsDNA antibodies are a major factor in organ damage (particularly of the kidneys) and  serositis. Researchers often find them in structures associated with (and inside) the kidney. This makes it very likely that they are the antibodies responsible for causing the damage. Add this to the fact that 2-30% of patients with SLE test negative for these antibodies, and there is a very compelling case for anti-dsDNA antibodies being involved in Type 1 SLE, but not necessarily Type 2.

Anti-RNP Antibodies

In comparison, anti-RNP antibodies are ANAs that react to RNA. RNA acts as a messenger, carrying the instructions for protein synthesis. Anti-RNP antibodies are generally associated with skin manifestations, as in cutaneous lupus, though whether they are associated with chronic disease is less known. However, the fact that there appear to be two different antibody profiles – the antibodies that are in play in each case – make it very likely that anti-RNPs may be a part of Type 2 SLE.

However, Anti-dsDNA antibodies frequently respond to immunosuppressant drugs, which shut down the immune system to prevent severe symptoms.

Strategically Treating Symptoms

Lupus Type 1

The etiology of lupus Type 1 is autoimmunity (inflammations-based which can lead to organ damage). Immunosuppressants and corticosteroids treat the biological factors related to Type 1.These biological factors result in symptoms like:

• nephritis

• malar rash

• inflammatory arthritis

• mouth sores

• pleuritic chest pain

• cutaneous rashes

• serositis

• alopecia

• ILD (shrinking lung)

• vasculitis

Lupus Type 2

The etiology for Type 2 is noninflammatory. As such, these symptoms will not respond to standard immunosuppression.Type 2 lupus patients are more likely to be prescribed analgesics (for pain), antidepressants, and lifestyle strategies (including sleep hygiene and exercise) to battle symptoms. Common Type 2 symptoms include:

• depression

• fatigue

• memory loss

• anxiety

• sleep disturbances

• brain fog

• cognitive disfunction

• pain 

A Lupus Warrior's Takeaway

Aside from differences in treatment options, what does it matter what type you have? Understanding the type of SLE you have can help predict what issues you are more likely to face in the future:

• People with Type 1 SLE will have to be on the lookout for signs of organ failure. Proactive monitoring helps protect the kidneys. Catching organ damage early is essential for limiting overall damage. It also underscores the importance of certain medication options.

• People with Type 2 SLE benefit from knowing that the symptoms are going to be more continuous. These symptoms, especially fatigue and pain, are both difficult to explain and severely impact day-to-day life. Many people write these symptoms off or try to "power through". But, a lupus diagnosis can be a helpful step towards active strategies to reduce symptoms and chronic inflammation. You will also be more aware of new symptoms manifesting for different periods of time. And, will be better able to track them, figure out flare triggers, and report them to your lupus treatment team.